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Background: Acute respiratory infections (ARIs) contribute significantly to inappropriate antimicrobial prescription. The rate of such prescriptions in US emergency departments (EDs) has remained stable over time. The use of procalcitonin (PCT) testing has been shown to lower risk of mortality and to reduce antibiotic consumption. It also has the potential to aid ED physicians in stratifying ARI patients who may require antibiotics but do not require hospital admission. In this study, we described the characteristics and proportion of antibiotic prescription in patients evaluated in and discharged from the ED with ARI. Methods: We performed a retrospective chart review of patients diagnosed with ARI and discharged from a single academic ED between January 2018 and January 2020. We compared those for whom a PCT test was ordered to those without a PCT test ordered at ARI diagnosis. Charts were reviewed until there were 110 subjects in each of the 2 study groups. The main outcome variable was receipt of an antibiotic prescription. The χ2 test was used to compare the proportion of patients who received an antibiotic prescription, demographics, and clinical characteristics between the 2 groups. The Mann-Whitney U test was used to compare the distribution of ages between the 2 groups. Results: Among patients in the PCT group, 87 (79.0%) received antibiotics versus 69 (62.7%) in the non-PCT group (P ± 18.8 vs 52.7 years ± 17.6; P = .0002); more likely to have preexisting heart and lung disease (28.2% vs 15.5%; P = .02); more often male (58.2% vs 40%; p < 0.01); had more subjective fevers (47.3% vs 33.6%, p=0.04), sputum production (49.1% vs 28.2%, p < 0.01), and nausea (17.3% vs 8.2%, p=0.04). PCT results were low (≤0.25) in 82.7% (91) of patients, of whom 70.3% (64) received antibiotics. Conclusions: Patients for whom PCT testing was ordered were older, had more underlying conditions and increased severity of illness. This finding may reflect that PCT testing was more likely to be ordered in patients at risk of severe infection but not requiring admission. The proportion of antibiotics prescriptions was higher for patients who had a PCT test. For patients with a low PCT result, the proportion of patients prescribed antibiotics was high. This finding may suggest that clinical characteristics were more influential than PCT result in the decision to prescribe antibiotics. More research is needed on the role of PCT testing in antibiotic prescription decisions for patients presenting to the ED with ARI.
Cross-cultural research is burgeoning. Behavioral and social sciences such as psychology, sociology, management, marketing, and political science witness a steady increase in cross-cultural studies. For example, during the last decades, there has been a consistently increasing number of psychological studies on cross-cultural similarities and differences (Boer, Hanke, & He, 2018; Smith, Harb, Lonner, & Van de Vijver, 2001; Van de Vijver & Lonner, 1995). The increased interest is undoubtedly inspired by various factors, such as the opening of previously sealed international borders, large migration streams, globalization of the economic market, international tourism, increased cross-cultural communications, and technological innovations such as new means of telecommunication.
In the previous chapters, typical problems and pitfalls of cross-cultural research were discussed and solutions proposed. The current chapter briefly integrates the major methodological issues into eight statements. Each statement is followed by an explanation. The last section is devoted to our view on the future of cross-cultural research.
This chapter contains a description of the sampling of cultures, design, data analysis, and major strengths and weaknesses of the eight types of cross-cultural studies described in Chapter 2: structure- and level-oriented psychological differences studies; structure- and level-oriented generalizability studies; structure- and level-oriented contextual linkage exploration studies; and structure- and level-oriented contextual linkage validation studies. The structure- and level-oriented studies differ primarily in the analyses employed, so their presentation is integrated. A schematic overview is given in Table 5.1.
This book addresses the methodological features of cross-cultural research. The common characteristic of such studies is their comparative nature, which involves the comparison of at least two cultural populations. Many studies involve different nation states, in sociology (e.g., Inglehart & Welzel, 2010; Van Deth, Montero, & Westholm, 2007), education (e.g., Arnove, Torres, & Franz, 2012; Van de Werfhorst & Mijs, 2010), political sciences (e.g., Coffé & Bolzendahl, 2010; Poguntke & Webb, 2007), management (e.g., House et al., 2004), and psychology (e.g., Schmitt, Allik, McCrae, & Benet-Martínez, 2007). However, comparative studies can also involve different ethnic groups from a single country such as the comparison of ethnic groups in the United States (e.g., Trinidad, Pérez-Stable, White, Emery, & Messer, 2011) and in Europe (Phalet & Kosic, 2006).
Two closely related concepts play an essential role in cross-cultural comparisons, namely equivalence and bias (Poortinga, 1989; Van de Vijver, 2015). There is no consensual definition of either concept in the cross-cultural literature. Johnson (1998) identified more than fifty types of definitions of equivalence, addressing dissimilar features, such as constructs, methodology, language, and context. All definitions refer to some aspect that is shared across cultures or to a qualitative or quantitative procedure to establish the shared features. A review of bias approaches would probably show a comparable variety.
Four procedures for sampling cultures can be discerned (cf. Boehnke, Lietz, Schreier, & Wilhelm, 2011). In convenience sampling, researchers select a culture simply because of considerations of convenience. These considerations can derive from various sources; researchers may be from that culture, are acquainted with collaborators from that culture, or happen to stay there for a period of time. The choice of culture is not related to the theoretical questions raised and is often haphazard. Studies adopting this sampling scheme often fall into the category of psychological differences studies.
Data analysis in cross-cultural research involves more than the preparation of the correct instructions to run a computer program of a statistical package. It is a link in the long chain of empirical research that starts with the specification of a theoretical framework and ends with drawing conclusions. Strategic decisions in the data analysis such as the choice of statistical techniques can only be made on the basis of a combination of substantive considerations such as the research questions or hypotheses involved and statistical considerations such as measurement level and sample size.
This book gives an up-to-date overview of methodological and data-analytical issues of cross-cultural studies. Written by leading experts in the field, it presents the most important tools for doing cross-cultural research and outlines design considerations, methods, and analytical techniques that can improve ecological validity and help researchers to avoid pitfalls in cross-cultural psychology. By focusing on the relevant research questions that can be tackled with particular methods, it provides practical guidance on how to translate conceptual questions into decisions on study design and statistical techniques. Featuring examples from cognitive and educational assessment, personality, health, and intercultural communication and management, and illustrating key techniques in feature boxes, this concise and accessible guide is essential reading for researchers, graduate students, and professionals who work with culture-comparative data.
Seniors are a population of concern due to exposure to both increasing gambling venues and powerful age-specific risk factors. There has been only limited research on this population so far, but studies conducted among younger adults suggest that the illusion of control is a key factor, leading players to develop strategies that increase their risk-taking in gambling. Time perspective (TP) is a good indicator of risky behaviours in a number of different areas, including health and the environment. In the present study, we sought to identify the age-specific cognitive mechanisms underlying gambling behaviour in normal ageing. We asked 115 emerging adults (mean age = 20.86 years), 86 young adults (mean age = 30.59), 82 middle-aged adults (mean age = 44.57) and 108 seniors (mean age = 65.19) to play an online game. We rated their illusion of control, risk-taking and TP. Analysis revealed that seniors took more risks and had less illusion of control than younger adults. The fatalistic-present TP positively influenced the illusion of control, such that perceiving the present as being determined by uncontrollable forces increased the perceived level of control. Finally, we found an influence of age on TP. These results suggest that seniors constitute a specific population in terms of gambling-related cognitions and behaviours. Including TP in risky behaviour assessments would allow the development of tailor-made preventive measures.
The objective was to establish new diagnostic criteria for undernutrition for the French population, concordant for children aged <18 years and adults aged <70 years, easy to use by health professionals and applicable whatever the situation (in and outpatients). A multi-disciplinary working and a reading group were involved. The procedure was divided into four phases: (1) systematic review and synthesis of the literature; (2) writing of the initial version of the guidelines; (3) reading and (4) finalisation. The literature search included international guidelines, meta-analyses, systematic reviews and randomised control trials from January 2007 to 31 July 2018. A two-step approach was selected: diagnosing undernutrition and then grading its severity. For diagnosis at least one phenotypic criterion associated with at least one aetiologic criterion were required for both children and adults. Phenotypic criteria for children were weight loss, Body Mass Index (BMI) < International Obesity Task Force curve 18·5, weight stagnation, reduction of muscle mass/function; for adults: weight loss, BMI < 18·5 and reduction of muscle mass/function. Aetiological criteria for children and adults were reduction in dietary intake, reduced absorption and hypercatabolism. Phenotypic metrics were used in both children and adults for grading severity (moderate or severe). These new French recommendations integrate the proposals of recent international recommendations combining aetiologic with phenotypic criteria, but for the first time, they are concordant for children and adults. The WHO threshold of 18·5 for BMI was kept as phenotypic criteria because epidemiological data show an increased mortality for that threshold.