Category: Nevin Manimala

Zhonghua Nei Ke Za Zhi. 2023 May 1;62(5):513-519. doi: 10.3760/cma.j.cn112138-20220516-00377.

ABSTRACT

Objective: To investigate dose-response associations between fluid overload (FO) and hospital mortality in patients with sepsis. Methods: The current cohort study was prospective and multicenter. Data were derived from the China Critical Care Sepsis Trial, which was conducted from January 2013 to August 2014. Patients aged≥18 years who were admitted to intensive care units (ICUs) for at least 3 days were included. Fluid input/output, fluid balance, fluid overload (FO), and maximum FO (MFO) were calculated during the first 3 days of ICU admission. The patients were divided into three groups based on MFO values: MFO<5%L/kg, MFO 5%-10%L/kg, and MFO≥10% L/kg. Kaplan-Meier analysis was used to predict time to death in hospital in the three groups. Associations between MFO and in-hospital mortality were evaluated via multivariable Cox regression models with restricted cubic splines. Results: A total of 2 070 patients were included in the study, of which 1 339 were male and 731 were female, and the mean age was (62.6±17.9) years. Of 696 (33.6%) who died in hospital, 968 (46.8%) were in the MFO<5%L/kg group, 530 (25.6%) were in the MFO 5%-10%L/kg group, and 572 (27.6%) were in the MFO≥10%L/kg group. Deceased patients had significantly higher fluid input than surviving patients during the first 3 days [7 642.0 (2 874.3, 13 639.5) ml vs. 5 738.0 (1 489.0, 7 153.5)ml], and lower fluid output [4 086.0 (1 367.0, 6 354.5) ml vs. 6 130.0 (2 046.0, 11 762.0) ml]. The cumulative survival rates in the three groups gradually decreased with length of ICU stay, and they were 74.9% (725/968) in the MFO<5% L/kg group, 67.7% (359/530) in the MFO 5%-10%L/kg group, and 51.6% (295/572) in the MFO≥10%L/kg group. Compared with the MFO<5%L/kg group, the MFO≥10%L/kg group had a 49% increased risk of inhospital mortality (HR=1.49, 95%CI 1.28-1.73). For each 1% L/kg increase in MFO, the risk of in-hospital mortality increased by 7% (HR=1.07, 95% CI 1.05-1.09). There was a”J-shaped”non-linear association between MFO and in-hospital mortality with a nadir of 4.1% L/kg. Conclusion: Higher and lower optimum fluid balance levels were associated with an increased risk of in-hospital mortality, as reflected by the observed J-shaped non-linear association between fluid overload and inhospital mortality.

PMID:37096277 | DOI:10.3760/cma.j.cn112138-20220516-00377

EClinicalMedicine. 2023 May;59:101959. doi: 10.1016/j.eclinm.2023.101959. Epub 2023 Apr 19.

ABSTRACT

[This corrects the article DOI: 10.1016/j.eclinm.2022.101762.].

PMID:37096187 | PMC:PMC10115131 | DOI:10.1016/j.eclinm.2023.101959

J Transp Health. 2023 May;30:101615. doi: 10.1016/j.jth.2023.101615. Epub 2023 Apr 13.

ABSTRACT

INTRODUCTION: COVID-19 has impacted millions of commuters by decreasing their mobility and transport patterns. While these changes in travel have been studied, less is known about how commute changes may have impacted individuals’ body mass index (BMI). The present longitudinal study explores the relationship between commute mode and BMI of employed individuals in Montréal, Canada.

METHODS: This study uses panel data drawn from two waves of the Montréal Mobility Survey (MMS) conducted before and during the COVID-19 pandemic (n = 458). BMI was modeled separately for women and men as a function of commuting mode, WalkScore©, sociodemographic, and behavioral covariates using a multilevel regression modeling approach.

RESULTS: For women, BMI significantly increased during the COVID-19 pandemic, but telecommuting frequency, and more specifically telecommuting as a replacement of driving, led to a statistically significant decrease in BMI. For men, higher levels of residential local accessibility decreased BMI, while telecommuting did not have a statistically significant effect on BMI.

CONCLUSIONS: This study’s findings confirm previously observed gendered differences in the relations between the built environment, transport behaviors, and BMI, while offering new insights regarding the impacts of the changes in commute patterns linked to the COVID-19 pandemic. Since some of the COVID-19 impacts on commute are expected to be lasting, findings from this research can be of use by health and transport practitioners as they work towards generating policies that improve population health.

PMID:37096134 | PMC:PMC10099220 | DOI:10.1016/j.jth.2023.101615

J Perinat Med. 2023 Apr 26. doi: 10.1515/jpm-2023-0092. Online ahead of print.

ABSTRACT

OBJECTIVES: To study whether the free energy principle can explain fetal brain activity and the existence of fetal consciousness via a chaotic dimension derived using artificial intelligence.

METHODS: In this observational study, we used a four-dimensional ultrasound technique obtained to collect images of fetal faces from pregnancies at 27-37 weeks of gestation, between February and December 2021. We developed an artificial intelligence classifier that recognizes fetal facial expressions, which are thought to relate to fetal brain activity. We then applied the classifier to video files of facial images to generate each expression category’s probabilities. We calculated the chaotic dimensions from the probability lists, and we created and investigated the free energy principle’s mathematical model that was assumed to be linked to the chaotic dimension. We used a Mann-Whitney test, linear regression test, and one-way analysis of variance for statistical analysis.

RESULTS: The chaotic dimension revealed that the fetus had dense and sparse states of brain activity, which fluctuated at a statistically significant level. The chaotic dimension and free energy were larger in the sparse state than in the dense state.

CONCLUSIONS: The fluctuating free energy suggests consciousness seemed to exist in the fetus after 27 weeks.

PMID:37096665 | DOI:10.1515/jpm-2023-0092

Neuropsychopharmacol Rep. 2023 Apr 25. doi: 10.1002/npr2.12341. Online ahead of print.

ABSTRACT

AIM: Owing to the stress caused by the behavioral restrictions and lifestyle changes during the COVID-19 pandemic, suicide rates have increased in Japan, especially among young people. This study aimed to identify the differences in the characteristics of patients hospitalized for suicide attempts in the emergency room, requiring inpatient care before and during the pandemic over 2 years.

METHODS: This study was a retrospective analysis. Data were collected from the electronic medical records. A descriptive survey was conducted to examine changes in the pattern of suicide attempts during the COVID-19 outbreak. Two-sample independent t-tests, Chi-square tests, and Fisher’s exact test were used for data analysis.

RESULTS: Two hundred one patients were included. No significant differences were found in the number of patients hospitalized for suicide attempts, average age, or sex ratio before and during the pandemic periods. Acute drug intoxication and overmedication in patients increased significantly during the pandemic. The self-inflicted means of injury with high fatality rates were similar during the two periods. The rate of physical complications significantly increased during the pandemic, while the proportion of unemployed individuals significantly decreased.

CONCLUSIONS: Despite studies predicting an increase in suicides based on past statistics of young people and of women, no significant changes were observed in this survey of the Hanshin-Awaji region, including Kobe. This may have been owing to the effect of suicide prevention measures and mental health measures implemented by the Japanese government after an increase in suicides and after past natural disasters.

PMID:37096596 | DOI:10.1002/npr2.12341

Multivariate Behav Res. 2023 Apr 25:1-4. doi: 10.1080/00273171.2023.2201277. Online ahead of print.

ABSTRACT

The multivariate delta method was used by Yuan and Chan to estimate standard errors and confidence intervals for standardized regression coefficients. Jones and Waller extended the earlier work to situations where data are nonnormal by utilizing Browne’s asymptotic distribution-free (ADF) theory. Furthermore, Dudgeon developed standard errors and confidence intervals, employing heteroskedasticity-consistent (HC) estimators, that are robust to nonnormality with better performance in smaller sample sizes compared to Jones and Waller’s ADF technique. Despite these advancements, empirical research has been slow to adopt these methodologies. This can be a result of the dearth of user-friendly software programs to put these techniques to use. We present the betaDelta and the betaSandwich packages in the R statistical software environment in this manuscript. Both the normal-theory approach and the ADF approach put forth by Yuan and Chan and Jones and Waller are implemented by the betaDelta package. The HC approach proposed by Dudgeon is implemented by the betaSandwich package. The use of the packages is demonstrated with an empirical example. We think the packages will enable applied researchers to accurately assess the sampling variability of standardized regression coefficients.

PMID:37096594 | DOI:10.1080/00273171.2023.2201277

Integr Environ Assess Manag. 2023 Apr 25. doi: 10.1002/ieam.4778. Online ahead of print.

ABSTRACT

Wastewater treatment plants (WWTPs) are deemed a major conveyor and point source of per- and polyfluoroalkyl substances (PFAS) to the environment. This statistical meta-analysis of existing literature from the past 15 years focused on the significance of treatment type for PFAS removal efficiencies and the influence of PFAS sources (domestic vs. industrial) on their removal. Different sampling events, WWTPs across the world, different treatment technologies, configurations, and processes, as well as different PFAS classes and compounds were all considered. This study evaluated 13 PFAS analyzed predominately in 161 WWTPs across the world. The statistical test results showed that these 13 frequently detected and reported PFAS can be divided into four groups based on their behavior during wastewater treatment, namely 1) C6-10 perfluorocarboxylic acids (PFCAs), 2) C4,5,11,12 PFCAs, 3) C4,6,8 perfluoroalkane sulfonic acids (PFSAs), and 4) C10 PFSA. Within this study, biological treatments such as 1) membrane bioreactors, 2) combination of two or more biological treatments and 3) biofilm processes showed the highest PFAS removals, while the addition of a tertiary treatment actually had a non-beneficial effect on PFAS removal. Moreover, a strong statistical correlation was observed between industrial wastewater sources and the presence of high influent PFAS concentrations in the receiving WWTPs. This is an indication that industrial sources were the main contributors for the PFAS load in the analyzed WWTPs.

PMID:37096563 | DOI:10.1002/ieam.4778

Am J Hematol. 2023 Apr 25. doi: 10.1002/ajh.26939. Online ahead of print.

NO ABSTRACT

PMID:37096490 | DOI:10.1002/ajh.26939

Int J Technol Assess Health Care. 2023 Apr 25;39(1):e22. doi: 10.1017/S026646232300020X.

ABSTRACT

BACKGROUND: Systematic reviews (SRs) are usually conducted by a highly specialized group of researchers. The routine involvement of methodological experts is a core methodological recommendation. The present commentary describes the qualifications required for information specialists and statisticians involved in SRs, as well as their tasks, the methodological challenges they face, and potential future areas of involvement.

TASKS AND QUALIFICATIONS: Information specialists select the information sources, develop search strategies, conduct the searches, and report the results. Statisticians select the methods for evidence synthesis, assess the risk of bias, and interpret the results. The minimum requirements for their involvement in SRs are a suitable university degree (e.g., in statistics or librarian/information science or an equivalent degree), methodological and content expertise, and several years of experience.

KEY ARGUMENTS: The complexity of conducting SRs has greatly increased due to a massive rise in the amount of available evidence and the number and complexity of SR methods, largely statistical and information retrieval methods. Additional challenges exist in the actual conduct of an SR, such as judging how complex the research question could become and what hurdles could arise during the course of the project.

CONCLUSION: SRs are becoming more and more complex to conduct and information specialists and statisticians should routinely be involved right from the start of the SR. This increases the trustworthiness of SRs as the basis for reliable, unbiased and reproducible health policy, and clinical decision making.

PMID:37096439 | DOI:10.1017/S026646232300020X

Cancer Med. 2023 Apr 25. doi: 10.1002/cam4.5896. Online ahead of print.

ABSTRACT

BACKGROUND: Excess body fatness and hyperinsulinemia are both associated with an increased risk of postmenopausal breast cancer. However, whether women with high body fatness but normal insulin levels or those with normal body fatness and high levels of insulin are at elevated risk of breast cancer is not known. We investigated the associations of metabolically defined body size and shape phenotypes with the risk of postmenopausal breast cancer in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition.

METHODS: Concentrations of C-peptide-a marker for insulin secretion-were measured at inclusion prior to cancer diagnosis in serum from 610 incident postmenopausal breast cancer cases and 1130 matched controls. C-peptide concentrations among the control participants were used to define metabolically healthy (MH; in first tertile) and metabolically unhealthy (MU; >1st tertile) status. We created four metabolic health/body size phenotype categories by combining the metabolic health definitions with normal weight (NW; BMI < 25 kg/m² , or WC < 80 cm, or WHR < 0.8) and overweight or obese (OW/OB; BMI ≥ 25 kg/m² , or WC ≥ 80 cm, or WHR ≥ 0.8) status for each of the three anthropometric measures separately: (1) MHNW, (2) MHOW/OB, (3) MUNW, and (4) MUOW/OB. Conditional logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS: Women classified as MUOW/OB were at higher risk of postmenopausal breast cancer compared to MHNW women considering BMI (OR = 1.58, 95% CI = 1.14-2.19) and WC (OR = 1.51, 95% CI = 1.09-2.08) cut points and there was also a suggestive increased risk for the WHR (OR = 1.29, 95% CI = 0.94-1.77) definition. Conversely, women with the MHOW/OB and MUNW were not at statistically significant elevated risk of postmenopausal breast cancer risk compared to MHNW women.

CONCLUSION: These findings suggest that being overweight or obese and metabolically unhealthy raises risk of postmenopausal breast cancer while overweight or obese women with normal insulin levels are not at higher risk. Additional research should consider the combined utility of anthropometric measures with metabolic parameters in predicting breast cancer risk.

PMID:37096432 | DOI:10.1002/cam4.5896