Associated Factors with Prolonged Stay in Pediatric Observation Ward of Urban University Hospital in Thailand

Background: Pediatric observation ward (OW) is the area where the patient can be monitored or have early investigation/management and observe part of emergency department (ED);patients are admitted to this area with an expectation of discharge within 24 hours. Observation ward was beneficial in preventing avoidable hospitalizations, due to the high volume of patients in ED, OW increasing demands, overcrowding, and prolonged stay. Objective: This study aimed to examine the characteristics and factors associated with prolonged length of stay (LOS) more than 24 hours in the pediatric observation ward. General demographic data were recorded including age, sex, LOS, diagnosis and disposition. Results: This is a retrospective study of children 15 years old or younger who admit to Pediatric OW at urban university hospital and prolonged stay more than 24 hours during January 2014 to June 2015. There were 670 patients admitted at OW during the study period (median age of 5 years;53% were male). Mean length of stay in OW was 61 hours. The most common top 5 diagnoses were respiratory problem (32%), gastrointestinal problem (29%), infectious disease (11%), neurological (7%), and dental problem (6%). The majority of patients were discharge home 602/670 cases (90%), and 10% (68/670 cases) were admitted to inpatient ward. There were 552 patients (82%) who had prolonged OW more than 24 hours. Compared with the factors in both group, we found that the associated factor for prolonged OW stay was the age of patient, which seems to be younger in the prolonged stay group (median age of 4 years 3 months vs 3 years 5 months, p = 0.04). Younger children had significant factors for prolonged stay in OW (p < 0.001) compared to all age categorized less than 1 year, 1 - 5 years, 5 - 10 years, 10 - 15 years and more than 15 years respectively. Conclusion: This was the study for report of pediatric observation ward utilization. The younger patient was the associated factor for prolonged stay in OW. Understanding this related issue will be the starting points for assessing patients carefully before admitting to OW for improving efficiency and quality of care in pediatric OW.

Disruption of sleep patterns among secondary school adolescents

Objectives:This study aims to assess sleep disorders among secondary school adolescents and explore the relationship between sociodemographic factors(age,gender,household income,and sleep duration)and the occurrence of these disorders.Methods:A quantitative,descriptive,cross-sectional study,was conducted from November 20th,2022,to May 25th,2023,involving 200 secondary school students selected through convenience sampling.Data collection utilized a structured questionnaire divided into sociodemographic and sleep disorder sections.Validity was ensured by a panel of ten experts,and reliability was confirmed using Cronbach’s Alpha(0.77).Statistical analysis employed SPSS version 26.Results:Findings revealed that a majority of participants(70.5%)had low-level sleep disorders,followed by moderate disorders represented(29%).Significant associations were found between sleep disorders and gender(P=0.000),economic status for family(P=0.020),and nightly sleep duration(P=0.016).However,no significant relationship was observed between sleep disorders and family structure or age(P>0.05).Conclusions:The study highlights that most secondary school students experience mild sleep disorders,followed by moderate disorders.Notably,gender,income,and sleep duration showed significant correlations with sleep disorders.

The Improving Effects of Diabetes Education on Diabetes Awareness and Management in Children and Adolescents with T1DM

Background: Diabetes education is crucial in empowering persons with Type 1 diabetes (T1DM) and their families to properly manage the condition by providing comprehensive knowledge, tools, and support. It boosts one’s belief in their ability to succeed, encourages following medical advice, and adds to the general enhancement of health. Objective: This study is to investigate the effectiveness of diabetes education in empowering individuals with Type 1 Diabetes Mellitus (T1DM) and their families to effectively manage the condition. Furthermore, it strives to improve nursing care for families whose children have been diagnosed with Type 1 Diabetes Mellitus (T1DM). Design: This research study investigates the efficacy of diabetes education in empowering individuals with Type 1 Diabetes Mellitus (T1DM) and their families to effectively handle the condition. Materials and Methods: A systematic search was conducted between the years 2000 and 2022, utilizing the Medline and Google Scholar databases. The purpose of the search was to uncover relevant papers pertaining to diabetes education, management of Type 1 Diabetes Mellitus (T1DM), nurse care, and empowerment. The search focused on peer-reviewed research, clinical trials, and scholarly articles that evaluated the efficacy of diabetes education in empowering individuals and families. Results: Diabetes education is crucial for understanding and controlling T1DM. It includes personalized sessions, webinars, group classes, and clinics that provide customized therapies. Comprehensive education enhances glycemic control and family dynamics. Nevertheless, the implementation of diabetes education for families requires specific standards, especially in the field of nursing. Conclusion: Diabetes education is essential for effectively managing Type 1 Diabetes Mellitus (T1DM), providing patients and families with crucial knowledge, resources, and confidence. It encourages independence in-home care and provides explicit guidelines for diabetic nurses to improve nursing care.

Relationship of sociodemographic factors and low birth weight in toddlers

Objective:This study analyzes the relationship between sociodemographic factors and low birth weight(LBW)in toddlers.Methods:The research design uses a correlational method.The population is 303 mothers with toddlers aged 12-60 months in Lojejer Wuluhan Jember Village,East Java,Indonesia.The cluster sampling took 172 samples in total.The sociodemographic variables measured included the father’s and the mother’s age,the father’s and mother’s education,family income,the father’s occupation,the mother’s occupation,and the child’s gender.Data collection techniques used questionnaires and document studies in the Maternal Child Health(MCH)handbook.Data were analyzed using logistic regression.Results:The results showed that the variable age of the father and mother≥20 years was a protective factor for the incidence of LBW.Family income<IDR 3,000,000 per month,fathers with farm workers and fishermen as occupation,male sex,and low father’s education were predictor factors for LBW.Conclusions:This study concluded that the variable sociodemographic factors related to LBW in toddlers in Lojejer Wuluhan Village,Jember district,East Java Province,Indonesia.Therefore,the government needs to establish stricter policies in terms of maturing the age of marriage to reduce the incidence of LBW.

Phagocytic and oxidative burst activity of neutrophils in the end stage of liver cirrhosis

AIM：To evaluate the phagocytic activity and neutrophil oxidative burst in liver cirrhosis.METHODS： In 45 patients with advanced postalcoholic liver cirrhosis （aged 45±14 years） and in 25 healthy volunteers （aged 38±5 years）, the percentage of phagocytizing cells after in vitro incubation with E. coli （Phagotest Kit）, phagocytic activity （mean intensity of fluorescence, MIF） and the percentage of neutrophil oxidative burst （Bursttest Kit）, and the level of free oxygen radical production （MIF of Rodamine 123） were analyzed by flow cytometry. The levels of soluble sICAM-1, sVCAM-1, sP-selectin, sE-selectin, sL-selectin, and TNF-α were determined in blood serum.RESISTS： The percentage of E. coli phagocytizing neutrophils in liver cirrhosis patients was comparable to that in healthy subjects. MIF of neutrophil - ingested E. coli was higher in patients with liver cirrhosis. The oxidative burst in E. coli phagocytizing neutrophils generated less amount of active oxygen compounds in liver cirrhosis pa- tients （MIF of R123：24.7±7.1 and 29.7±6.6 in healthy, P〈0.01）. Phorbol myristate acetate （PMA） - stimulated neutrophilsproduced less reactive oxidants in liver cirrhosis patients than in healthy subjects （MIF of R123： 42.7±14.6 vs 50.2±13.3, P〈0.01）. A negative correlation was observed between oxidative burst MIF of PMA-stimulated neutrophils and ALT and AST levels （r -0.35, P〈0.05; r-0.4, P〈0.03）. sVCAM-1, sICAM-1, sE-selectin concentrations correlated negatively with the oxygen free radical production （MIF of R123） in neutrophils after PMA stimulation in liver cirrhosis patients （r-0.45, P〈0.05, r-0.41, P〈0.05; r-0.39, P〈0.05, respectively）.CONCLUSION： Neutrophil metabolic activity diminishes together with the intensification of liver failure. The metabolic potential of phagocytizing neutrophils is significantly lower in liver cirrhosis patients, which can be one of the causes of immune mechanism damage. The evaluation of oxygen metabolism of E. coli-stimulated neutrophils reveals that the amount of released oxygen metabolites is smaller in liver cirrhosis patients than in healthy subjects.

Soluble adhesion molecules ICAM-1,VCAM-1,P-selectin in children with Helicobacter pylori infection

AIM: To assess the sICAM-1, sVCAM-1, and sP-selectin levels in children withHelicobacter pylori(H pylori)infection and to evaluate their significance for the morphological changes found in gastric mucosa.METHODS: The study included 106 children: 59children (55.7%) with chronic gastritis and positive IgG against H pylori, 29 children (27.3%) after previous H pylori infection without the bacterium colonization but with positive IgG against H pylori, and 18 children (17%) with functional disorders of the gastrointestinal system but with normal IgG against H pylori. Endoscopic and histopathological evaluation of gastric mucosa was performed based on the Sydney System classification.The evaluation of sP-selectin, sIC AM-1, sVCAM-1 levels in the sera of children was carried out using ELISA test.RESULTS: The assessment of gastritis activity degrees indicated statistically significant values in the antrum and corpus (P＜0.001) of children examined. Serum sVCAM-1 levels were higher in group with gastritis due to H pylori infection than in group without infection and differed statistically (P＜0.05). Serum sVCAM-1 levels proved to be the highest among other adhesive molecules in infected children and decreased after eradication of H pylori. Serum sICAM-1 levels were similar in all examined groups. Serum sP-selectin levels were similar in children with and without H pylori infection.CONCLUSION: Assessment of adhesive molecules (sPselectin, sICAM-1, sVCAM-1) in the sera of children with active H pylori infection can show the participation of sVCAM-1 in the pathogenesis of gastric mucosal inflammation, sP-selectin and sICAM-1 concentrations in the sera of children with H pylori infection after eradication cannot reveal any significant differences as compared to healthy children.

Mental health of parents of children with autism spectrum disorder during COVID-19 pandemic: A systematic review

BACKGROUND Children diagnosed with autism spectrum disorder(ASD)may have great difficulties when their routines change,and this may affect the psychological wellbeing of their parents.For this reason,it is important to examine studies that address the mental health of parents in order to adapt to the coronavirus disease 2019(COVID-19)pandemic.AIM To determine the mental health status of parents with children diagnosed with ASD in the COVID-19 pandemic.METHODS The study,which is a systematic review,was conducted between December 15,2020 and December 30,2020 by scanning articles in English.The Scopus,Science Direct,PubMed,Cochrane,Web of Science,and Google Scholar databases were used for scanning.The keywords COVID-19 AND(“autism”OR“autistic”OR“autism spectrum disorder”)AND parent AND(“mental health”OR“anxiety”OR“stress”)were used in the search process.The inclusion criteria in the study were findings regarding the mental health of parents with children diagnosed with ASD in the COVID-19 pandemic,addressing their anxiety and stress situations,being a research article,and accessing the full text of the article.RESULTS In the study,a total of 6389 articles were reached,and the full texts of 173 articles were evaluated for eligibility.After the articles excluded by the full-text search were eliminated,12 studies involving 7105 parents were included in the analysis.The findings obtained from the articles containing data on mental health in the COVID-19 pandemic of parents with children with autism spectrum disorder were discussed in three groups.These were findings on the experiences of parents with children with ASD in the COVID-19 pandemic regarding the areas where parents with children with ASD need support in the COVID-19 pandemic and methods of coping with the COVID-19 pandemic for parents with children with ASD.In the systematic review,it was determined that the anxiety and stress of the parents increased,they needed more support compared to the pre-pandemic period,and they had difficulty coping.CONCLUSION In this systematic review,it was concluded that the COVID-19 pandemic negatively affected the mental health of the parents of children with ASD.

Expression of β2-integrin on leukocytes in liver cirrhosis

AIM： To analyze β2-integrin expression on blood leukocytes in liver drrhosis.METHODS： In 40 patients with liver cirrhosis and 20 healthy individuals, the evaluation of expression of CD11a （LFA-1α）, CD11b （Mac-1α）, CD11c （αX） and CD49d （VLA-4α） on peripheral blood leukocytes was performed using flow cytometry. The analysis was carried out in groups of patients divided into B and C according to Child-Pugh＇s classification. RESULTS： An increased CDlla, CD11b, CD11c and CD49d integrin expression was observed on peripheral blood leukocytes in liver cirrhosis. The integrin levels were elevated as the advancement of liver failure progressed. The highest expression of integrins occurred predominantly on monocytes. A slight expression of VLA-4 was found on lymphocytes and granulocytes and it increased together with liver failure. A positive correlation was noted between median intensity of fluorescence （MIF） expression on polymorphonuclear cells of CD11a and CD11c and CD49d （r = 0.42, P 〈 0.01; r = 053, P 〈 0.01, respectively） in liver cirrhosis stage C. However, no correlation was observed between integrin expression on leukocytes. The concentrations of sICAM-1, sVCAM-1, and TNFα, were significantly elevated in liver cirrhosis. CONCLUSION： β2-integrin expression on leukocytes increases in liver cirrhosis decornpensated as the stage of liver failure increases, which is a result of permanent activation of leukooytes circulating through the inflamed liver environment.β2-integrin expression on circulating leukocytes can intensify liver cirrhosis,

A determination of the quality of life of children and adolescents with type 1 diabetes and their parents

Objective: Type 1 diabetes is a chronic illness which can have a negative effect on the health care and development of children and can put their lives in danger. This descriptive study aimed to determine the quality of life and the factors affecting it of children and adolescents with type 1 diabetes using the Pediatric Quality of Life Inventory (PedsQL).Methods: The study was conducted in the Child Endocrinology Unit of a University Hospital in Bursa, Turkey. Totally 64 children eight-12 years and 85 adolescents aged 13-18 with type 1 diabetes and their parents were recruited. HbA1c measurements were obtained from the records of the endocrinology clinicare, which were made once every three months, and the average of the last three measurements was taken in the study. The PedsQL was used to measure quality of life of the children and adolescents. The data was analyzed using SPSS version 20.0 and P<0.05 was considered significant. The demographic data of the children and parents were analyzed using means and percentiles. Pearson's correlation analysis was used to assess the relationship between two averages. Results: Of the sub-groups on the scale, affective and school function scores were somewhat low, and social function scores were high. The quality of life scores of the children and adolescents were found to correlate with those of their parents. A negative correlation was found between HbA1c levels and adolescent quality of life, a positive correlation was found between the child's age and the quality of life of the child and parents, and a negative correlation was found between the number of children in the family and the quality of life of the child and parents. Conclusions: An evaluation of the quality of life after a diagnosis of diabetes can be used to assess the problems which may be faced by children and adolescents and to combat these problems.

School health promotion:A cross-sectional study on Clean and Healthy Living Program Behavior(CHLB)among Islamic Boarding Schools in Indonesia

Objective:This study aims to identify the knowledge,attitude,and behavior of students using eight indicators of Clean and Healthy Living Behavior(CHLB)in relation to the health education and grade levels in Islamic Boarding Schools(IBS)in Jember regency,East Java Province,Indonesia.Methods:A cross-sectional school-based survey design was used.About 114 students(mean age of 13.17 years old)selected through a multi-stage random sampling completed a selfadministered questionnaire to measure the eight indicators of CHLB,such as washing hands with running water and soap,eating healthy snacks,using clean and healthy latrines,exercising regularly and measurably,eradicating mosquito larvae,not smoking at school,weighing and height measurement every 6 months,and disposing garbage properly.The data analyses included descriptive and comparative analyses of the difference in knowledge,attitude,and behavior toward CHLB by health education and grade level.Results:About 66.7% students received health education.Significant knowledge in CHLB in relation to health education and grade was observed(P<.05),including in-depth knowledge of exercises,measurable weight and height,smoking,and healthy latrines.Meanwhile,no significant difference was observed between the attitude toward CHLB and health education in different grade levels.Furthermore,CHLB was associated with health education,including habitual exercise and using of clean and healthy latrines.

Coping mechanism against high levels of daily stress by working breastfeeding mothers in Iran

Objectives:Breastfeeding mothers returning to work undertake multiple conflicting roles at home and work that can result in high levels of stress.Exploring coping skills amongst these mothers can help in planning useful programmes to promote family wellbeing.This study aims to explore the experiences of working breastfeeding mothers and their coping mechanism against high levels of daily stress.Methods:In this qualitative study,we described the experiences of 20 Iranian breastfeeding mothers through in-depth and semi-structured interviews.All interviews were recorded,transcribed and analysed using thematic analysis.Results:Two main themes emerged as follows:1) self-management with subthemes of a) attitude reconstruction,b) order and planning,c) creating a boundary between work and family and d) reprioritising life affairs;and 2) seeking help with subthemes of a) family member support,b) childcare facilities and c) spirituality.Conclusions:Findings suggest that women need support from family members and family-friendly policies at the workplace.Breastfeeding mothers may benefit from educational programmes that focus on effective coping strategies.

Risk Factors of Otitis Media with Effusion in Children

The aim of this study is to detect the risk factors associated with otitis media with effusion (OME) among children with age ranged from 6 months to 2 years. Materials and Methods: it is a cross-sectional study 500 children were selected from Assiut University Hospital clinics through multi-staged randomized sampling. Parents of these children were interviewed with a structured questionnaire. Clinical examination, including otoscopic examination and tympanometry was performed for each child. Results: There was no statistical significant relationship between OME and gender, age, mother job. There is statistical significant relationship between OME and breast feeding, using pacifier, mother education, sibling of children and exposure to passive smoking. Conclusion: There are multiple risk factors associated with OME in children between 6 months to 2 years of age.

The Indonesian version of the Premature Infant Pain Profile-Revised:Translation and adaptation of a neonatal pain assessment

Purpose: Pain assessment is a key component of good pain management in hospitalized infants.This study aimed to translate and adapt a version of pain measurement in infants,the Premature Infant Pain Profile Revised (PIPP-R) into Indonesian.Method: The adaptation process of the measuring instrument used a modified Brislin method which included forward translation,back translation 1,group discussion 1,back translation 2,group discussion 2,and pilot testing on neonatal nurses: feasibility test,inter-rater reliability using intraclass correlation (ICC),and internal consistency using Cronbach's α coefficient.Results: The PIPP-R version in English has been translated into Indonesian.In general,nurses assessed this measuring instrument as feasible.The inter-rater reliability showed a high agreement (ICC =0.968,P=0.001) and this measuring instrument had good internal consistency (Cronbach's α=0.856).Conclusion: The Indonesian version of PIPP-R is easy to use and shows good psychometric properties.The use of this measuring instrument will help nurses and researchers obtain accurate infant pain intensity measurement values.

Concentrations of gastric mucosal cytokines in children with food allergy and Helicobacterpylori infection

AIM： To measure the concentrations of chosen cytokines in the antrum mucosa depending on the kind of harmful pathogenic factors and to compare the concentrations with the values of controls without allergy and coexisting Helicobacter pylori （H pylori） infection. METHODS： The patients （97 children） were divided into three groups according to the data obtained from the case history, to the main cause of the disease and to the dominant clinical symptoms. Group Ⅰ： children with food allergy （Fa）; group Ⅱ： children infected with H pylori; group Ⅲ （control group）： children with functional disorders of the alimentary tract （without Fa and Hp infection）. H pylori infection was determined by the presence of anti-Hp antibodies in serum （ELISA method） and urease test performed during endoscopic examination. Cytokine concentration in homogenates of gastric mucosa was detected by ELISA method. RESULTS： The IL-2 concentration in gastric mucosa bioptates was the highest in children with Hp infection （116.5±179.5 pg/mg of the protein） and Fa and Hp infection （98.1±101.0 pg/mg）, while decreased in children with Fa （44.8±50.3 pg/mg） and controls （45.7±23.5 pg/mg）. The lowest mean concentration of IFN-y was observed in children with Hp infection （18.9±16.4 pg/mg）, with Fa and Hp infection （25.5±27.7 pg/mg）, with Fa （40.6±39.7 pg/mg） and controls （49.9±33.4 pg/mg）. The highest IL-4 concentrations were observed in children with Hp infection （35.3±52.8 pg/mg） and in children with Fa and Hp infection （37.2±51.7 pg/mg）, while lower IL-4 concentration （23.64-35.8 pg/mg） was found in children with Fa compared to the controls （22.7±13.8 pg/mg）. The analysis of IL-4 concentrations in children with Hp infection regarding the intensity of gastritis showed the highest value （62.2±61.2 pg/mg） in mild and moderate gastritis. The concentrations of IL-5 in the gastric mucosa of children with or without Fa did not differ significantly and were comparable to the control group. The highest mean IL-8 value was observed in Hp-infected children with or without Fa. The highest concentration of mucosal IL-10 was detected in children with Hp infection （79.3±41.2 pg/mg） and decreased in children with Fa and Hp infection （50.1±18.8 pg/mg） and in children with Fa （39.9±35.5 pg/mg）. The intensity and activity of the inflammation did not affect IL-10 concentrations in the gastric mucosa. In children with Hp infection, TNF-α concentration was the highest （45.9±49.3 pg/mg） and in children with Fa and Hp infection was low （45.3±32.6 pg/mg）, whereas decreased in children with Fa （21.7±34.2 pg/mg） and in controls （31.6±14.5 pg/mg）. CONCLUSION： The morphological changes of the gastric mucosa in children with Hp infection are comparable to those in children with Fa and coexisting Hp infection. Cytokine concentration in children with Fa and Hp infection is significantly different in IFN-7, IL-2, IL-8, and TNF-α.

Moving from fear to realization: Family engagement in tuberculosis prevention in children living in tuberculosis Sundanese households in Indonesia

Objective: Children living in tuberculosis households need protection.However,families need to be engaged to prevent tuberculosis transmission to children.This study aimed to analyze the details of "moving from fear to realization," which is one category of a substantive theory of family engagement in tuberculosis prevention in children.Methods: Fourteen family caregivers participated as key informants after their families met the criteria.The participants were recruited at a lung clinic in West Java,Indonesia and followed up at their homes.The data were gathered using in-depth interviews and analyzed following the coding procedures of the Straussian grounded theory.Findings: "Moving from fear to realization" was the main category that emerged from the experiences of the Sundanese families to begin engaging in tuberculosis prevention in children living in tuberculosis households.It was composed of four sub-categories,namely,fear of tuberculosis,seeking information,following God's will,and awareness of tuberculosis transmission risks.Conclusions: This study showed how a family moves from fear to the realization of tuberculosis transmission risks.Its findings are useful for nurses to provide optimum care in order to prevent tuberculosis transmission to children with household contact by providing both education and counseling for families.

Intensive care outcomes of refugee patients in Turkey between 2013 and 2019: A retrospective descriptive study

Objectives:To assess the outcomes of the intensive care of Syrian refugees under temporary protection (SRUTP). Methods: The sample of the study was composed of 110 SRUTP patients who were treated at a tertiary intensive care unit (ICU) between 2013 and 2019 in Istanbul, Turkey. Baseline information and clinical data of the patients were collected by scanning the hospital's electronic database and clinical decision support system. Results:The mean length of ICU stay was 97.6 (36.3-187.8) h. Among the patients, 71 (64.5%) had comorbid diseases, and ICU mortality was 40%. The median cost of health care for each patient was 2144 (1060-4471) USD, and the total health care cost of all patients was 534012USD. Conclusions: Use of vasoactive drug, hemodialysis application, and low Glasgow Coma Scale scores are independent risk factors of the mortality. More researches are needed to clearly reveal the health and cost consequences of war.

Code blue applications as an indicator of clinical quality

Objective:To investigate the code blue application at a training and research hospital in Turkey.Methods:The code blue declaration forms and the hospital database with 238 complete records between January 2016 and July 2017 were collected.The form involved individual characteristics,the reason for issuing the code blue call,the unit and block where the code was given,time and location related properties such as working time and arrival duration,properties regarding the intervention process such as its type,duration or result.The 24-hour and 30-day long survival data of the patients to whom cardiopulmonary resuscitation was implemented were obtained from the hospital database,or from their relatives.The influencing factors of arrival duration were analyzed.Results:The median duration of arrival was 2.14(2.00-3.02)min.Code blue applications were performed more frequently in Departments of General Surgery,Internal Medicine,Orthopaedics,and Cardiology Clinics.Half of the code blue calls were due to cardiac arrest;the other half was due to shortness of breath or respiratory distress,syncope,and respiratory arrest.Three-out-of four code blue calls were treated with orotracheal intubation and cardiopulmonary resuscitation,or only orotracheal intubation or only medical treatment;one-fourth of the calls were not intervened.Altogether,72.36%of the code blue calls patients were intervened;69.35%of them were made both orotracheal intubation and cardiopulmonary resuscitation,and 20.5%of them were made only orotracheal intubation and 10.55%of them made only medical treatment.It was found that giving the code blue day or night had no effect on the time to reach the area where the code was given.Similarly,it was found that giving the code blue within daytime or night shift had no effect on the time to reach the area where the code was given.(P>0.05).The survival rates were 39.1%within the first 24 h and 18.1%within the first 30 d.Conclusions:Applications of code blue should be analyzed at regular intervals as clinical quality indicators.Reasons for wrong calls should be determined.The duration of reaching locations where calls are made should also be decreased.

Effects of physical activity by the teach-back educational method on the physical ability and quality of life in hemodialysis patients:a clinical trial

Objective:To determine the effect of physical activity by using the teach-back educational method on hemodialysis patients’quality of life(QOL)and physical ability.Methods:This is a single-blind clinical trial study involving a control group.A total of 90 patients who admitted to the dialysis centers of Beheshti and Besat hospitals in Hamadan were selected using a convenience sampling method and were randomly assigned to intervention(n=45)and control(n=45)groups.Data were collected using a demographic information checklist,a kidney disease QOL questionnaire,and a 6-minute-walk distance(6MWD)checklist.The patients’QOL questionnaire was completed,and the 6MWD was recorded before and at the end of the 2nd,4th,6th,8th,and 12th weeks of the intervention.In the intervention group,the patients were taught to perform physical activities with Pilates stretches in different resistances using the teach-back educational method during dialysis sessions for 12 weeks.Data were analyzed by using the independent t-test and chi-square test using SPSS-22 software.Results:Before the intervention,no differences were observed between the experimental and control groups in terms of demographic characteristics,QOL,and physical ability(P>0.05).The physical ability and QOL levels of patients exercising in the test group were higher than those in the control group after the intervention(P<0.05).Based on the results,the 2 groups significantly differed with regard to the scores of various dimensions of QOL and physical ability after the intervention(P<0.05).Conclusions:Physical activity by using the teach-back method can effectively increase physical ability and improve QOL of hemodialysis patients.Therefore,the recommendations and inclusion of exercise in the dialysis care plan can effectively promote patients’health.

Prevalence of underweight and overweight among school-aged children and it's association with children's sociodemographic and lifestyle in Indonesia

Objectives:Underweight remains a health problem among Indonesian children,and the incidence of overweight continuously increases.This study aims to determine factors associated with underweight and overweight in school-aged children in Indonesia.Methods:This study is a cross-sectional investigation on parents and children aged 6e13 years in elementary schools in Makassar,Indonesia.The participants included 877 children and their parents.Anthropometric data were obtained using standardized equipment,and sociodemographic and lifestyle data were determined using a questionnaire.The nutritional status of the children was assessed based on the child growth standard prescribed by the WHO.Results:The prevalence rates of underweight and overweight among the children were 14.5%and 20.4%,respectively.Underweight was more prevalent in boys.Factors such as mother's level of education,having an underweight father,and playing outdoors on weekends for more than 2 h were significantly associated with underweight children.By contrast,mothers with high levels of education,overweight parents,sleeping for less than 9 h,and playing outdoors on weekends for less than 1 h were significantly associated with overweight children.

Energy efficiency training's effect on fatigue scores of children with a cancer diagnosis

Objective:Fatigue is the most common complication of cancer treatment procedure during chemotherapy,leading to limited daily activities,mood swings,and ultimately impaired functional status.This study aimed to determine the effect of energy efficiency training on the fatigue scores of children with a cancer diagnosis.Methods:In the present clinical trial study,30 children with a cancer diagnosis were randomly assigned variously to the control and testing groups.The cancer-related fatigue questionnaire for children with cancer was employed as the data collection tool.The intervention of the testing group was conducted in 4 sessions of 45-60 min of face-to-face interaction,group sessions,and questionand-answer sessions.Meanwhile,routine interventions were employed in the control group.Quantitative variables were repor ted as mean and standard deviation,and qualitative variables as frequency and percentage.Stata 11 statistical software and a change score approach were used to analyze the data.Results:The mean fatigue score of the testing group increased from 72.12 to 77.53.There was a statistically significant difference between the mean fatigue scores of the testing group before and after the intervention(P=0.013),and the children’s fatigue score decreased.There was a statistically significant difference between the mean fatigue scores of the testing and control groups before and after the intervention(P=0.001),and the fatigue score of the children in the testing group had decreased compared to the control group.Conclusions:Energy efficiency techniques can be employed to increase energy and reduce fatigue during pediatric chemotherapy.