Gender effects on student performances on the NBOME Part I, Part II, and Part III.
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Educational Measurement↗
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Results for “Effect Modifier, Epidemiologic”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Power analysis: Part II.
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Data Interpretation, Statistical↗
The role of lavender oil in relieving perineal discomfort following childbirth: a blind randomized clinical trial.
Aromatherapy is a movement growth in popularity, but lacking scientific justification in the field of practice, although laboratory experiments are in evidence. Lavender oil is frequently selected for aromatherapy as having antiseptic and healing properties. More specifically, it has been used as a bath additive postnatally to reduce perineal discomfort. A blind randomized clinical trial is described, involving three groups of mothers, one using pure lavender oil, one a synthetic lavender oil and one an inert substance as a bath additive for 10 days following normal childbirth. Analysis of daily discomfort scores revealed no statistically significant difference between groups. It cannot be concluded that current practice results in a reduction of postnatal perineal discomfort at the dilution levels used. However, there is some consistency in results between the 3rd and 5th days, with those women using lavender oil as a bath additive recording lower mean discomfort scores. This is a time when the mother usually finds herself discharged home and perineal discomfort is high. A total of 635 women participated and no side-effects were found.
Baths↗
Just another day in a woman's life? Part II: Nature and consistency of women's long-term memories of their first birth experiences.
Twenty women who attended the author's natural childbirth classes between 1968 and 1974 were the informants in this study of long-term memories of their first childbirths. The data from each informant consisted of 1) a labor and birth questionnaire, including an open-ended account of her labor, written shortly after her baby was born; 2) a similar questionnaire and account written in 1988 and 1989; and 3) a transcribed interview during which her memories and perceptions were discussed and any discrepancies between the questionnaires were explored. The questionnaires were compared for consistency of recall, and the interviews consulted for further clarification. Specific memories were excerpted, compared, classified, tabulated, and summarized. Findings were that, years later, women's memories are generally accurate, and many are strikingly vivid, especially of onset of labor; rupture of the membranes; arrival at the hospital; actions of doctors, nurses, and partners; particular interventions; the birth; and first contact with the baby. Most memory lapses or confusion were minor. Evidence of a halo effect was observed as well.
Adaptation, Psychological↗
Nursing homes and tranquilizer use among the institutionalized elderly.
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Effect Modifier, Epidemiologic↗
Measuring physical function in community-dwelling older persons: a comparison of self-administered, interviewer-administered, and performance-based measures.
PURPOSE: To compare two self-administered, one interviewer-administered, and one performance-based measure of physical function in community-based older persons. METHODS: Eighty-three subjects were recruited from meal sites, senior recreation centers, and senior housing units for a comprehensive geriatric assessment program. At the time of screening, study participants self-administered the Functional Status Questionnaire (FSQ) and were administered the Katz Activities of Daily Living (ADL) and the Older Americans Resources and Services Instrumental Activities of Daily Living (OARS-IADL) instruments by interview. Participants also completed the Physical Performance Test (PPT) and were given the Medical Outcomes Study SF-36 to self-administer on site or at home and return by mail. RESULTS: All 83 subjects completed FSQ, Katz ADL, OARS-IADL, and PPT; 72 returned SF-36 forms. Correlations between the two self-administered physical function measures (FSQ and SF-36) were higher than between self-administered and interviewer-assessed (ADL and OARS-IADL) or performance-based (PPT) measures. When assessed for construct validity, the self-administered, OARS, and PPT measures had comparable correlations with role limitations as a result of physical health problems, but relationships between physical functional status measures and other SF-36 measures of health were inconsistent. CONCLUSION: The relationships between commonly used self-administered, interviewer-administered, and performance-based measures of physical function were inconsistent and weak, suggesting that these instruments are not measuring the same construct.
Activities of Daily Living↗
Meta-analysis: overview and application to clinical nursing practice.
If nursing practice is to benefit from the abundance of nursing research being conducted, a technique is needed to synthesize and integrate the results of individual studies. Meta-analysis, a quantitative approach to literature review, is such a technique. This article provides an overview of meta-analysis. Examples of published meta-analysis studies in obstetric and neonatal nursing are discussed to illustrate the clinical significance of this technique.
Clinical Nursing Research↗
Single-blind studies of the effects of improved periodontal health on metabolic control in type 1 diabetes mellitus.
Uncontrolled studies have suggested a beneficial effect of periodontal treatment on metabolic control of insulin-dependent diabetes mellitus (IDDM). We therefore conducted controlled single-blind studies, using current metabolic status indicators in IDDM subjects free of significant complications other than periodontal diseases. In the 1st study, 41 IDDM subjects with gingivitis and early periodontitis were randomly assigned to treatment (oral hygiene and scaling) or control groups. The study was completed by 16 experimental and 15 control subjects. Reassessment after 2 months showed a Hawthorne effect in the control group, and no difference between groups. However, further analysis showed a relationship between individual metabolic control variation and gingival inflammation. A 2nd study enrolled 23 IDDM subjects with advanced periodontitis, who were randomised to treatment (full initial therapy including root planning) or control groups. Only 1 subject failed to complete the study, owing to illness. In this study, a significant response to periodontal treatment was not accompanied by any improvement in metabolic control. These results support the concept that the effect of metabolic control may be predominant in the relationship between IDDM and periodontal health.
Adolescent↗
Breast feeding and acute lower respiratory infection.
The association between breast feeding and acute lower respiratory infection (ALRI) was studied in a case-control study in southern Italy. Two groups of children were studied: the first group comprised 73 infants, aged 0-6 months, whose diagnosis was pneumonia or bronchiolitis; the second group included 88 infants less than 12 months of age with a diagnosis of pertussis-like illness. Control infants were two groups of infants admitted to the same ward. Compared with controls, infants in the first group were less likely to have been breast fed (odds ratio 0.42, 95% CI 0.19-0.90). The protection conferred by breast feeding was stronger among infants who were receiving human milk at the time of admission (odds ratio 0.22, 95% CI 0.09-0.55) and was absent among those infants who had stopped breast feeding for two or more weeks before admission. Among infants who were severely ill, breast feeding was less likely than among those with milder illnesses. There was evidence in the stratified analysis of effect modification by the presence of other children in the family. Among the infants with pertussis-like illness, the incidence and duration of breast feeding were not different compared with controls. The results suggest that breast feeding has a strong protective effect against ALRI in industrialized countries also. No protection seems to be conferred by human milk against pertussis-like illness.
Acute Disease↗
Can we learn anything from small trials?
In summary, then, we can learn three useful things from small clinical trials. First, we can learn when to challenge conventional but untested therapeutic wisdom. Second, because the patient number in any trial is the number of events, rather than the number of study patients, some small trials are so definitively positive that they are sufficient to identify the best therapy. And third, small trials, even when individually inconclusive, can serve as the basis for convincingly conclusive overviews and meta-analyses that carry, and deserve, greater credibility than a single large trial of similar size to their sum.
Bias↗
Collaborative worldwide overviews of randomized trials.
Formal overviews (or meta-analyses) are now widely accepted as the most reliable way to evaluate the evidence from several randomized controlled trials that have all assessed a particular form of therapy. If a limited amount of trial data has accumulated, overviews can be undertaken at a relatively simple level, assembling just summary data extracted from published reports. Such overviews are likely to be incomplete and biased and may (because of the restricted number of analyses that are possible) not answer all the clinically important questions that might be addressed. Where a particularly large body of data from randomized trials has accumulated, more thorough and detailed overview analyses are needed. Such detailed reviews are greatly facilitated if a collaborative group of all the trialists is formed. Such groups have sought to collate individual patient data (a very few key items for every patient randomized). A central statistical secretariat then coordinates the process of data collection, checking, and analysis. Analyses are presented to the whole group for discussion and final reports are published in the name of the whole group. Experience from two very large groups that have followed this model, the Antiplatelet Trialists' Collaboration and the Early Breast Cancer Trialists' Collaborative Group, has shown that detailed collaborative overviews have many benefits: the results are particularly clear and therefore have substantial public health impact; the areas of statistical and medical agreement on the evidence can be defined; the areas of uncertainty (and hence future research priorities) are clarified; and the group can disseminate the results particularly widely and rapidly.
Bias↗
Large-scale randomized evidence: large, simple trials and overviews of trials.
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Aspirin↗
The effect of a five-month delay on children's and adults' eyewitness memory.
Child witnesses must endure a delay of around six months between observing or being the victim of an alleged offence and being required to give evidence in a criminal court. While the legal profession seem to believe that young children's memories are particularly sensitive to the passage of time, developmental psychology can offer little relevant data to support or refute this presumption. In the present study, children aged six and nine years and adults witnessed a staged event and were subsequently interviewed in the days following the event and/or five months later. Results indicate that while all witnesses forgot information over this period, the younger children (six years) recalled slightly less information than the older children and the adults. The total amount of incorrect information recalled did not increase over the same period. Two different interviewing techniques were used--cued recall vs. 'enhanced' recall--the latter incorporating some aspects of the cognitive interview procedure. No differences were found relating to the interview techniques employed. The results underline the importance of recording initial interviews with child witnesses wherever possible.
Adult↗
Postal survey on airborne occupational exposure and respiratory disorders in Norway: causes and consequences of non-response.
STUDY OBJECTIVE: The aim was to examine causes for non-response in a community survey, and how non-response influences prevalence estimates of some exposure and disease variables, and associations between the variables. DESIGN: This was a cross sectional questionnaire study with two reminder letters. The questionnaire asked for information on smoking habits, occupational airborne exposure and respiratory disorders. SETTING: A random sample of 4992 subjects from the general population aged 15-70 years of Hordaland County, Norway. MAIN RESULTS: The overall response rate was 90%, with a 63% response to the initial letter. The response rates to the first and second reminder letters were 56% and 36% respectively. In 20% of the non-respondents an uncompleted questionnaire was returned with cause for non-response; in two thirds of these the cause for non-response was that the subject was not resident at the mailing address. A home visit to a random sample of 50 urban non-respondents provided further information on 29 subjects. A wrong address at the Central Population Registry and the subject's feeling of lack of personal benefit from a postal survey were the major reasons for non-response. Smokers were late respondents and subjects with respiratory disorders tended to be early respondents. CONCLUSION: The main reasons for non-response were a wrong mailing address and a feeling of lack of personal benefit from responding. Using only the initial letter would have changed the estimated prevalence of smokers from 39% to 35%. Otherwise, the estimated prevalence of the exposure and disease variables as well as the associations between them were only slightly changed after including the respondents to the first and second reminder letters.
Adolescent↗
Investigating the proxy effect and the saliency principle in household based postal questionnaires.
STUDY OBJECTIVE: The aim was to investigate two possible sources of bias inherent in using a household based postal questionnaire, the "proxy effect", inaccurate reporting about characteristics of others, and the "saliency principle", reporting of only the most salient features. This is of importance in surveys concerned with screening the population to identify individuals with certain characteristics, and so possibly relying on one member of the household to reply on behalf of all others. DESIGN AND SETTING: A two stage survey of disablement in the population was undertaken. A first phase postal questionnaire was sent to 25,168 households in Calderdale, West Yorkshire, England, to ascertain the prevalence of physical disability and of troubles with the joints. The second phase comprised in depth interviews with a sample of individuals identified in the first phase as being disabled. RESPONDENTS: A total of 21,889 postal questionnaires were returned (87%) representing households containing 42,826 people aged 16 years and over. A disproportionately stratified random sample of 950 respondents reporting disability was taken in the second phase. Of these 891 were still available, and 838 (94%) were interviewed. MEASUREMENTS AND MAIN RESULTS: The postal questionnaire found that almost 29% of those who lived "alone" (without another adult) reported some level of disability, compared to only 10% of those who lived with others. The difference remained significant after standardisation. This apparent underreporting or "proxy effect" was present for reporting about disability overall, but not for severe disability (dependence on help of others), which suggests the operation of the "saliency principle". Reporting on joint troubles appeared to be affected by the proxy effect both for any joint problems, and when more than five joints were affected. Analysis of a small set of postal questionnaires from respondents who reported joint problems only at interview and where we could identify who had completed the postal questionnaire supports the hypothesis of a proxy effect; two thirds of the original postal questionnaires had been completed by a proxy. The results were further complicated by an interaction between reporting of disability and joint troubles: the greater the level of disability, the less likely the reporting of joint troubles. CONCLUSIONS: The findings have general implications for studies involving postal household screening questionnaires, and raises additional concerns about those that are multitopic in content. In surveys of symptoms and minor disability, a proxy effect is likely to be operative. This effect is not apparent for obvious and long standing problems such as dependence on others for help. However the interaction between the reporting of disability and joint symptoms carries important implications for the development of multitopic postal screening questionnaires.
Adolescent↗
The person-trade-off approach to valuing health care programs.
The person-trade-off technique is a way of estimating the social values of different health care interventions. Basically it consists in asking people how many outcomes of one kind they consider equivalent in social value to X outcomes of another kind. The paper outlines a number of the author's previous studies using the technique. The studies suggest that while the technique is theoretically appealing for resource-allocation purposes, it is in practice quite demanding. It needs to be applied in fairly large groups of subjects to keep random measurement error at an acceptable level. Possible framing effects include the effects of argument presentation and the choice of start points in numerical exercises. To control for these effects, it seems important to take subjects through a multistep procedure, in which they are induced to carefully consider the various arguments that might be relevant in each exercise and to reconsider initial responses in the light of their implications. The investigator must also think through which decision context he or she wishes to study and make his or her choice of context very clear when reporting the results. In spite of these problems, the person-trade-off technique deserves greater attention in the field of cost-utility analysis.
Bias↗
Assessing preferences about the DNR order: does it depend on how you ask?
Despite increasing emphasis on advance directives, there has been little methodologic work to assess preferences about the "do not resuscitate" (DNR) order. This developmental work assessed, in a non-patient group, the performance of a probability-trade-off task designed to assess DNR attitudes, in terms of framing effects and stability of preferences. 105 female nursing students each completed one of two versions of the task. In version I (n = 58), the trade-off moved to increasingly negative descriptions of the outcomes of resuscitation (decreasing chance of survival and increasing risk of brain death), whereas in version II (n = 47), the trade-off moved to increasingly positive descriptions. One week later, repeat assessments were obtained for versions I (n = 35) and II (n = 28). The DNR preference scores were lower and more stable when the task moved to increasingly positive descriptions; perhaps this version of the task tends to weaken risk aversion. These results imply that care should be used in applying a probability trade-off task to the assessment of DNR preferences, since artefactual effects could be induced.
Attitude to Health↗