Hierarchical regression for analyses of multiple outcomes

The Relationships among communication competence, professional autonomy and clinical reasoning competence in oncology nurses

AIMS

To investigate the relationships among communication competence, professional autonomy and clinical reasoning and to identify the factors that influence clinical reasoning competence in oncology nurses.

DESIGN

Cross-sectional descriptive design.

METHODS

Participants included 147 oncology nurses with more than a year of clinical experience in cancer wards. The Global Interpersonal Communication Competence Scale, Schutzenhofer Professional Autonomy Scale and Nurses Clinical Reasoning Scale (NCRS) were used to collect data. Data were analysed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation analysis and hierarchical multiple regression analysis.

RESULTS

Communication competence (r = 0.59) and professional autonomy (r = 0.46) showed significant positive relationships with clinical reasoning competence. Clinical experience, communication competence, age and professional autonomy were statistically significant predictors and explained 48.6% of clinical reasoning competence.

CONCLUSIONS

The clinical reasoning competence of oncology nurses increases proportionally with their communication competence and professional autonomy. Therefore, oncology nurses must reinforce their communication competence and professional autonomy to enhance their clinical reasoning competence.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The reinforcement of communication competence and professional autonomy is necessary for oncology nurses to enhance their clinical reasoning competence. In order to improve nurses' communication competence, practical-focused communication education programmes must be designed and deployed systematically and periodically. In addition, to increase nurses' professional autonomy, it is necessary to expand their clinical experiences through the regular rotation of working units and to make institutional efforts to retain experienced nurses.

REPORTING METHOD

We have adhered to STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION

Participants in the study were recruited online. They were informed of the study's purpose, method and usability and the survey could only be conducted if they consented to participate voluntarily.

Importance of parental anxiety in management of developmental breast conditions in children: A study with a prospective hierarchical regression model

The parent is the most critical link and decision-maker between the patient and the healthcare provider in treating many pediatric diseases. This entity is essential for the management of pediatric breast diseases for which the rate of surgical intervention is known to be very low. Although previous publications have emphasized that pediatric breast diseases may cause alarming anxiety in parents, the demographic factors that influence this anxiety have not been investigated. Even if practitioners complete patient management with appropriate procedures, treatment is incomplete if the questions remain unanswered. In this observational prospective study, we investigated the demographic factors that affect parental anxiety, which should be prioritized to prevent incomplete management. The Beck Anxiety Inventory score (BAS) created by the parents of 409 boys and girls aged 0 to 17 with breast conditions was recorded at the diagnosis, termination of treatment, and final control stages. A 2-stage hierarchical logistic regression model was applied to show how strongly the demographic characteristics of parents and their children predicted the parental BAS. Of the demographic characteristics, there was a significant correlation (P < .05) between the patient's sex, age, developmental period, Tanner stage, referral status, management method, family's place of residence, economic distress, and BAS. However, according to the 2-stage hierarchical regression model, only 3 demographic characteristics, the patient's gender, place of residence, and method used in patient management, significantly predicted BAS (P < .05, ΔR2 = .35). Among the many factors that affect anxiety experienced by parents whose son or daughter has breast problems, the gender of the child, place of residence of the family, and management methods used by the practitioner are demographic characteristics that should be taken into consideration.

The effect of social media environmental information exposure on the intention to participate in pro-environmental behavior

With the threat of global warming, countries worldwide have enhanced their environmental campaigns on social media to increase users' willingness to take pro-environmental actions. In this study, we examined the direct and indirect effects of exposure to environmental information on Chinese young adults' (18-25 years old) intention to participate in environmental protection actions (e.g., recycling, using public transportation, involvement in an environmental group, and participation in eco-friendly events). Data were collected from a sample of 291 Chinese young adults using a web-based survey and a thoroughly designed questionnaire. The accumulated data were analyzed using SPSS version 20. Hierarchical regression and mediation analysis were performed for testing hypotheses. The results indicated that exposure to environmental information on Chinese social media platforms (WeChat and Xiaohongshu) positively affected individuals' intention to participate in pro-environmental behavior, perceived pro-environmental behavior control, pro-environmental attitude, and fear of victimization. The indirect effect demonstrated that pro-environmental behavior control and attitude mediated the relationship between exposure to environmental information on both WeChat and Xiaohongshu and the intention to participate in pro-environmental behavior. Extending the existing literature, this study provides empirical evidence on the influence of environmental information exposure on the intention to participate in environmental protection among Chinese adults. In addition, it provides valuable insights into the mediating mechanisms involving cognitive, psychological, and emotional factors in this relationship. Policy makers should implement effective pro-environmental promotions on social media to inspire individuals to engage in environmentally friendly actions. In addition, social media managers should strictly authenticate and remove misleading environmental content.

The Impact of Union Membership on Nursing Turnover and Job Satisfaction

OBJECTIVE

The present study examines the scope of nursing unions and the relationship with turnover and job satisfaction among RNs.

BACKGROUND

There is no recent empirical literature documenting evidence on workplace performance measures (turnover and job satisfaction) among unionized nurses at the national level.

METHODS

This cross-sectional study analyzed secondary data (n = 43 960), the 2018 National Sample Survey of Registered Nurses.

RESULTS

Approximately 16% of the sample reported being represented by labor unions. The overall nursing turnover rate for the sample was 12.8%. Unionized nurses were less likely than their counterparts to report turnover (mean, 10.9% vs 13.16%; P = 0.02) and less job satisfaction (mean, 3.20 vs 3.28). Union nurses were more likely than nonunion nurses to be male (12.72% vs 9.46%; P = 0.0004), minorities (37.65% vs 25.67%, P < 0.001), be employed in hospital settings (70.1% vs 57.9%, P = 0.001), but report fewer hours of work per week (mean, 36.73 vs 37.66; P = 0.003). Regression results revealed a positive association between union status and nursing turnover (odds ratio, 0.83; P < 0.05), whereas union status was inversely associated with job satisfaction (B = -0.13, P < 0.001) after adjusting for age, gender, race/ethnicity, care coordination time per week, weekly hours of work, and employment settings.

CONCLUSION

Overall, job satisfaction was high among all nurses, regardless of union membership. However, when comparing specifically union and nonunion members, unionized nurses were less likely to report turnover, but were more likely to experience job dissatisfaction.

Risk factors for SARS-CoV-2 transmission in close contacts of adults at high risk of infection due to occupation: results from the contact tracing strategy of the CoVIDA epidemiological surveillance study in Bogotá, Colombia, in 2020-2021

OBJECTIVES

To estimate the risk factors for SARS-CoV-2 transmission in close contacts of adults at high risk of infection due to occupation, participants of the CoVIDA study, in Bogotá D.C., Colombia.

SETTING

The CoVIDA study was the largest COVID-19 intensified sentinel epidemiological surveillance study in Colombia thus far, performing over 60 000 RT-PCR tests for SARS-CoV-2 infection. The study implemented a contact tracing strategy (via telephone call) to support traditional surveillance actions performed by the local health authority.

PARTICIPANTS

Close contacts of participants from the CoVIDA study.

PRIMARY AND SECONDARY OUTCOME MEASURES

SARS-CoV-2 testing results were obtained (RT-PCR with CoVIDA or self-reported results). The secondary attack rate (SAR) was calculated using contacts and primary cases features.

RESULTS

The CoVIDA study performed 1257 contact tracing procedures on primary cases. A total of 5551 close contacts were identified and 1050 secondary cases (21.1%) were found. The highest SAR was found in close contacts: (1) who were spouses (SAR=32.7%; 95% CI 29.1% to 36.4%), (2) of informally employed or unemployed primary cases (SAR=29.1%; 95% CI 25.5% to 32.8%), (3) of symptomatic primary cases (SAR of 25.9%; 95% CI 24.0% to 27.9%) and (4) living in households with more than three people (SAR=22.2%; 95% CI 20.7% to 23.8%). The spouses (OR 3.85; 95% CI 2.60 to 5.70), relatives (OR 1.89; 95% CI 1.33 to 2.70) and close contacts of a symptomatic primary case (OR 1.48; 95% CI 1.24 to 1.77) had an increased risk of being secondary cases compared with non-relatives and close contacts of an asymptomatic index case, respectively.

CONCLUSIONS

Contact tracing strategies must focus on households with socioeconomic vulnerabilities to guarantee isolation and testing to stop the spread of the disease.

Associations between Cues of Sexual Desire and Sexual Attitudes in Portuguese Women

Sexuality is defined as a multidimensional experience that involves genital, mental, and bodily components. It is also assumed as a basic condition inherent to the human existence that encourages the search for love, intimacy, sex, and proximity to others. The main objective of this study is to assess the relationship between cues of sexual desire and sexual attitudes in Portuguese women. This is a cross-sectional study with 804 Portuguese women to whom the protocol was applied. It included an informed consent, a sociodemographic questionnaire, a questionnaire related to intimacy, a scale of sexual attitudes, and the scale of cues of sexual desire. The protocol was applied via Google Forms due to the current pandemic situation (COVID-19). Differences were found in sexual attitudes and the cues of sexual desire in terms of sociodemographic characteristics, as well as in terms of women's intimacy. Significant correlations were found between the brief sexual attitudes scale (BSAS) and the cues of sexual desire scale (CSDS). Age, sexual orientation, relation nature, sexual practices, visual proximity cues, erotic explicit cues, and sensory explicit cues explain, altogether, 25% of the total sexual attitudes. Additionally, age, sexual orientation, the relation's nature, sexual practices, visual proximity cues, emotional bonding cues, romantic implicit cues, erotic explicit cues, and sensory explicit cues explain, altogether, 30% of the permissiveness. Sexual attitudes are developed under the influence of sociodemographic variables, variables related to women's intimacy, and cues of sexual desire, which are new data in the study of sexual attitudes and have implications at the level of gender issues.

Is It All a Conspiracy? Conspiracy Theories and People's Attitude to COVID-19 Vaccination

A large body of research has found that people's beliefs in conspiracy theories about infectious diseases negatively impacts their health behaviors concerning vaccination. Conspiracy belief-based vaccination hesitancy has become more rampant after the global outbreak of COVID-19. However, some important questions remain unanswered. For instance, do different versions of conspiracy theories-particularly conspiracy theories about the origin of the epidemic (e.g., that the SARS-CoV-2 leaked from a Wuhan virology laboratory or that the virus was of foreign origin) and the general theories about vaccine conspiracies (e.g., pharmaceutical companies covered up the danger of vaccines or people are being deceived about the effectiveness of vaccines)-have the same effect on vaccination intentions? Through a national survey adopting quota sampling in China, the current study tested the relationship between people's conspiracy beliefs and their intention to receive the COVID-19 vaccination. The findings show that people's embrace of conspiracy theories did indeed affect their intention to take COVID-19 shots. However, only conspiracy theories related to vaccines had a significant impact, while belief in more general theories about COVID-19 did not significantly affect vaccination intentions. People's knowledge of vaccines (vaccine literacy) played an important role in this relationship. People with lower beliefs in vaccines conspiracy theories and higher levels of vaccine literacy were more likely to receive the COVID-19 vaccination.

Issues in Interpreting Epidemiologic Studies of Populations Exposed to Low-Dose, High-Energy Photon Radiation

This article addresses issues relevant to interpreting findings from 26 epidemiologic studies of persons exposed to low-dose radiation. We review the extensive data from both epidemiologic studies of persons exposed at moderate or high doses and from radiobiology that together have firmly established radiation as carcinogenic. We then discuss the use of the linear relative risk model that has been used to describe data from both low- and moderate- or high-dose studies. We consider the effects of dose measurement errors; these can reduce statistical power and lead to underestimation of risks but are very unlikely to bring about a spurious dose response. We estimate statistical power for the low-dose studies under the assumption that true risks of radiation-related cancers are those expected from studies of Japanese atomic bomb survivors. Finally, we discuss the interpretation of confidence intervals and statistical tests and the applicability of the Bradford Hill principles for a causal relationship.

Effect of Heterogeneity in Background Incidence on Inference about the Solid-Cancer Radiation Dose Response in Atomic Bomb Survivors

A recent analysis of solid cancer incidence in the Life Span Study of atomic bomb survivors (Hiroshima and Nagasaki, Japan) found evidence of a nonlinear, upwardly curving radiation dose response among males but not among females. Further analysis of this new and unexpected finding was necessary. We used two approaches to investigate this finding. In one approach, we excluded individual cancer sites or groups of sites from all solid cancers. In the other approach, we used joint analysis to allow for heterogeneity in background-rate parameters across groups of cancers with dissimilar trends in background rates. Exclusion of a few sites led to the disappearance of curvature among males in the remaining collection of solid cancers; some of these influential sites have unique features in their background age-specific incidence that are not captured by a background-rate model fit to all solid cancers combined. Exclusion of a few sites also led to an appearance of curvature among females. Misspecification of background rates can cause bias in inference about the shape of the dose response, so heterogeneity of background rates might explain at least part of the all solid cancer dose-response difference in curvature between males and females. We conclude that analysis based on all solid cancers as a single outcome is not the optimal method to assess radiation risk for solid cancer in the Life Span Study; joint analysis with suitable choices of cancer groups might be preferable by allowing for background-rate heterogeneity across sites while providing greater power to assess radiation risk than analyses of individual sites.

Is Granulocyte colony-stimulating factor associated with development of aortitis?

The aim of this study was to mention some methodological issues in a study which investigate the effect of Granulocyte colony-stimulating factor on developing of aortitis.

WITHDRAWN: Clinical correlates of cerebral white matter abnormalities in patients with Parkinson's disease: Methodological issues

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Site-specific Solid Cancer Mortality After Exposure to Ionizing Radiation: A Cohort Study of Workers (INWORKS)

BACKGROUND

There is considerable scientific interest in associations between protracted low-dose exposure to ionizing radiation and the occurrence of specific types of cancer.

METHODS

Associations between ionizing radiation and site-specific solid cancer mortality were examined among 308,297 nuclear workers employed in France, the United Kingdom, and the United States. Workers were monitored for external radiation exposure and follow-up encompassed 8.2 million person-years. Radiation-mortality associations were estimated using a maximum-likelihood method and using a Markov chain Monte Carlo method, the latter used to fit a hierarchical regression model to stabilize estimates of association.

RESULTS

The analysis included 17,957 deaths attributable to solid cancer, the most common being lung, prostate, and colon cancer. Using a maximum-likelihood method to quantify associations between radiation dose- and site-specific cancer, we obtained positive point estimates for oral, esophagus, stomach, colon, rectum, pancreas, peritoneum, larynx, lung, pleura, bone and connective tissue, skin, ovary, testis, and thyroid cancer; in addition, we obtained negative point estimates for cancer of the liver and gallbladder, prostate, bladder, kidney, and brain. Most of these estimated coefficients exhibited substantial imprecision. Employing a hierarchical model for stabilization had little impact on the estimated associations for the most commonly observed outcomes, but for less frequent cancer types, the stabilized estimates tended to take less extreme values and have greater precision than estimates obtained without such stabilization.

CONCLUSIONS

The results provide further evidence regarding associations between low-dose radiation exposure and cancer.