Congruence between perceived and theoretical knowledge before and after an internet-based continuing education program about VLU nursing care

Background: Previous research has revealed nurses' knowledge gaps in venous leg ulcer (VLU) nursing care, and continuing education is needed. The closer nurses' perceived knowledge is to their evidence-based theoretical knowledge, the better possibilities they have to conduct evidence-based VLU nursing care.Objectives: To assess the congruence between nurses' perceived and theoretical knowledge about VLU nursing care before and after an internet-based education about VLU nursing care (eVLU).Design: Quasi-experimental study with intervention and comparison groups and pre- and post-measurements.Setting: Home health care in two Finnish municipalities.Participants: Nurses (n = 946) working in home health care were invited to participate. In the intervention group, 239 nurses and 229 nurses in the comparison group met the inclusion criteria, and they were all recruited to the study.Method: Nurses were divided into intervention and comparison groups with lottery between the municipalities. Nurses in both groups took care of patients with VLU according to their organizations' instructions. In addition to this, nurses in the intervention group received a 6-week eVLU while those in the comparison group did not. Data were collected with a questionnaire about perceived and theoretical knowledge before education, at six weeks, and at 10 weeks. The percentages of congruence were calculated at every measurement point, and the McNemar test was used to detect statistical significance of changes between measurements.Results: The increase of congruence was more often statistically significant in the intervention group than in the comparison group.Conclusion: The results support the hypothesis that the congruence between perceived and theoretical knowledge will be higher among nurses receiving eVLU. Because of the low participation and drop-outs, the results should be interpreted with caution.</p

Topic Modeling and Text Analysis for Qualitative Policy Research

This paper contributes to a critical methodological discussion that has direct ramifications for policy studies: how computational methods can be concretely incorporated into existing processes of textual analysis and interpretation without compromising scientific integrity. We focus on the computational method of topic modeling and investigate how it interacts with two larger families of qualitative methods: content and classification methods characterized by interest in words as communication units and discourse and representation methods characterized by interest in the meaning of communicative acts. Based on analysis of recent academic publications that have used topic modeling for textual analysis, our findings show that different mixed‐method research designs are appropriate when combining topic modeling with the two groups of methods. Our main concluding argument is that topic modeling enables scholars to apply policy theories and concepts to much larger sets of data. That said, the use of computational methods requires genuine understanding of these techniques to obtain substantially meaningful results. We encourage policy scholars to reflect carefully on methodological issues, and offer a simple heuristic to help identify and address critical points when designing a study using topic modeling.Peer reviewe

Effects of risk-based multifactorial fall prevention on health-related quality of life among the community-dwelling aged: a randomized controlled trial

BACKGROUND: This study aimed to assess the effects of a risk-based, multifactorial fall prevention programme on health-related quality of life among the community-dwelling aged who had fallen at least once during the previous 12 months. METHODS: The study is a part of a single-centre, risk-based, multifactorial randomised controlled trial. The intervention lasted for 12 months and consisted of a geriatric assessment, guidance and treatment, individual instruction in fall prevention, group exercise, lectures on themes related to falling, psychosocial group activities and home exercise. Of the total study population (n = 591, 97% of eligible subjects), 513(251 in the intervention group and 262 in the control group) participated in this study. The effect of the intervention on quality of life was measured using the 15D health-related quality of life instrument consisting of 15 dimensions. The data were analysed using the chi-square test or Fisher's exact test, the Mann-Whitney U-test and logistic regression. RESULTS: In men, the results showed significant differences in the changes between the intervention and control groups in depression (p = 0.017) and distress (p = 0.029) and marginally significant differences in usual activities (p = 0.058) and sexual activity (p = 0.051). In women, significant differences in the changes between the groups were found in usual activities (p = 0.005) and discomfort/symptoms (p = 0.047). For the subjects aged 65 to 74 years, significant differences in the changes between the groups were seen in distress (p = 0.037) among men and in usual activities (p = 0.011) among women. All improvements were in favour of the intervention group. CONCLUSION: Fall prevention produced positive effects on some dimensions of health-related quality of life in the community-dwelling aged. Men benefited more than women

Discriminative and predictive properties of disease-specific and generic health status indexes in elderly COPD patients

<p>Abstract</p> <p>Background</p> <p>The association between bronchial obstruction severity and mortality in Chronic Obstructive Pulmonary Disease (COPD) is well established, but it is unknown whether disease-specific health status measures and multidimensional assessment (MDA) have comparable prognostic value.</p> <p>Methods</p> <p>We analyzed data coming from the Salute Respiratoria nell'Anziano (Respiratory Health in the Elderly – SaRA) study, enrolling elderly people attending outpatient clinics for respiratory and non-respiratory problems. From this population we selected 449 patients with bronchial obstruction (77.3% men, mean age 73.1). We classified patients' health status using tertiles of the Saint George Respiratory Questionnaire (SGRQ) and a MDA including functional (the 6' walking test, WT), cognitive (Mini-Mental State Examination, MMSE) and affective status (Geriatric Depression Scale, GDS). The agreement of the classification methods was calculated using the kappa statistic, and survival associated with group membership was evaluated using survival analysis.</p> <p>Results</p> <p>Pulmonary function, expressed by the FEV1, worsened with increasing SGRQ or MDA scores. Cognitive function was not associated with the SGRQ, while physical performance and mood status were impaired only in the highest tertile of SGRQ. A poor agreement was found between the two classification systems tested (k = 0.194). Compared to people in the first tertile of SGRQ score, those in the second tertile had a sex-adjusted HR of 1.22 (0.75 – 1.98) and those in the third tertile of 2.90 (1.92 – 4.40). The corresponding figures of the MDA were 1.49 (95% CI 1.02 – 2.18) and 2.01 (95% CI: 1.31 – 3.08). After adjustment for severity of obstruction, only a SGRQ in the upper tertile was associated with mortality (HR: 1.86; 95% CI: 1.14 – 3.02).</p> <p>Conclusion</p> <p>In elderly outpatients with mild-moderate COPD, a disease-specific health status index seems to be a better predictor of death compared to a MDA.</p

Asthma caused by occupational exposures is common – A systematic analysis of estimates of the population-attributable fraction

<p>Abstract</p> <p>Background</p> <p>The aim of this paper is to highlight emerging data on occupational attributable risk in asthma. Despite well documented outbreaks of disease and the recognition of numerous specific causal agents, occupational exposures previously had been relegated a fairly minor role relative to other causes of adult onset asthma. In recent years there has been a growing recognition of the potential importance of asthma induced by work-related exposures</p> <p>Methods</p> <p>We searched Pub Med from June 1999 through December 2007. We identified six longitudinal general population-based studies; three case-control studies and eight cross-sectional analyses from seven general population-based samples. For an integrated analysis we added ten estimates prior to 1999 included in a previous review.</p> <p>Results</p> <p>The longitudinal studies indicate that 16.3% of all adult-onset asthma is caused by occupational exposures. In an overall synthesis of all included studies the overall median PAR value was 17.6%.</p> <p>Conclusion</p> <p>Clinicians should consider the occupational history when evaluating patients in working age who have asthma. At a societal level, these findings underscore the need for further preventive action to reduce the occupational exposures to asthma-causing agents.</p

A population-based study of asthma, quality of life, and occupation among elderly Hispanic and non-Hispanic whites: a cross-sectional investigation

BACKGROUND: The U.S. population is aging and is expected to double by the year 2030. The current study evaluated the prevalence of asthma and its correlates in the elderly Hispanic and non-Hispanic white population. METHODS: Data from a sample of 3021 Hispanics and non-Hispanic White subjects, 65 years and older, interviewed as part of an ongoing cross-sectional study of the elderly in west Texas, were analyzed. The outcome variable was categorized into: no asthma (reference category), current asthma, and probable asthma. Polytomous logistic regression analysis was used to assess the relationship between the outcome variable and various socio-demographic measures, self-rated health, asthma symptoms, quality of life measures (SF-12), and various occupations. RESULTS: The estimated prevalence of current asthma and probable asthma were 6.3% (95%CI: 5.3–7.2) and 9.0% (95%CI: 7.8–10.1) respectively. The majority of subjects with current asthma (Mean SF-12 score 35.8, 95%CI: 34.2–37.4) or probable asthma (35.3, 34.0–36.6) had significantly worse physical health-related quality of life as compared to subjects without asthma (42.6, 42.1–43.1). In multiple logistic regression analyses, women had a 1.64 times greater odds of current asthma (95%CI: 1.12–2.38) as compared to men. Hay fever was a strong predictor of both current and probable asthma. The odds of current asthma were 1.78 times (95%CI: 1.24–2.55) greater among past smokers; whereas the odds of probable asthma were 2.73 times (95%CI: 1.77–4.21) greater among current smokers as compared to non-smokers. Similarly fair/poor self rated health and complaints of severe pain were independently associated with current and probable asthma. The odds of current and probable asthma were almost two fold greater for obesity. When stratified by gender, the odds were significantly greater among females (p-value for interaction term = 0.038). The odds of current asthma were significantly greater for farm-related occupations (adjusted OR = 2.09, 95%CI: 1.00–4.39); whereas the odds were significantly lower among those who reported teaching as their longest held occupation (adjusted OR = 0.36, 95%CI = 0.18–0.74). CONCLUSION: This study found that asthma is a common medical condition in the elderly and it significantly impacts quality of life and general health status. Results support adopting an integrated approach in identifying and controlling asthma in this population

Digitalization of a manufacturing firm and understanding the change through familiar and unfamiliar managerial problems

This study focuses on digitalization of manufacturing industry, commonly known as Industry 4.0. In this study, digitalization is viewed as a radical change from the perspective of current processes and organizational structures. In general, transformation and radical change create a threat for the existence of the organization. Simplified definitions of Industry 4.0 solution in manufacturing environment would be embedded sensor in product components communicating with interlinked manufacturing equipment. At the same time production system analyzes available data from various sources, and represent the information to human operator(s) who oversees ultimate decision making. This study aims at supporting the strategic decision making of the managers working towards Industry 4.0 and digitalization. Secondly, this study makes an attempt to understand if ad hoc process model can be used to describe organizational success. Study combines two models, dynamics capabilities and ad hoc process in order to explain why some firms manage to go through successfully such a big change and some of them not, and which part of the successful digitization might be explained through dynamic capabilities and when the success can be derived from reacting to spontaneously appearing, unfamiliar problems. Study uses qualitative research method, and it has both theoretical and empirical part. Theoretically formulated problems are categorized in the familiar and unfamiliar sub-problems with applicable solutions based on empirical part. Empirical has been collected through theme-centered interviews of four Finnish digitalization experts. Results show that digitization-related problems can be divided in the unfamiliar and familiar problems. Thus, organization might be able to prepare itself for incoming change with dynamic capabilities. Findings to not represent or generate a single I4.0 framework nor organizational change theory, but provide tools for managerial implementation. Results of this study can be used as a vehicle to understand what kind of problems utilization of I4.0 technologies might generate before the actual benefits are reached

Changing forest stakeholders' perception of ecosystem services with linguistic nudging

This paper explores whether the perceptions of forest owners and professionals could be nudged towards more sustainable management practices by adjusting a policy text's metaphorical content. Recent research has demonstrated a link between information interventions and preference change, but there is a need to further explore individuals' reactions to information on forest-based ecosystem services and to link these to the design of policy instruments. We contribute to narrowing this gap by nudging the content of a policy text comparing rotation forest management (RFM) and continuous cover forestry (CCF), and exposing it to forest stakeholders. The research is carried out in Finland, the so-called 'forest nation' of Europe, whose economy and culture is closely tied to forests. The results highlight a deep-rooted opinion divide between Finnish forest owners and professionals: the professionals reacted significantly more negatively towards policy text emphasising continuous cover practice than forest owners. Our results support the use of linguistic nudging as a complement to other policy instruments, but they also highlight the challenges of using one-fits-all approaches to make policies more palatable. In our study, the stakeholders' different reaction to nudge was also explained by their age, and type and degree of prior knowledge on forest management.Peer reviewe