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Nevin Manimala Statistics

What Proportion of Patients With Musculoskeletal Sarcomas Demostrate Symptoms of Depression or Anxiety?

Clin Orthop Relat Res. 2022 Jun 30. doi: 10.1097/CORR.0000000000002295. Online ahead of print.

ABSTRACT

BACKGROUND: It is estimated that the 12-month prevalence of depression in the United States is 8.6%, and for anxiety it is 2.9%. Although prior studies have evaluated depression and anxiety in patients with carcinoma, few have specifically evaluated patients with sarcoma, who often have unique treatment considerations such as mobility changes after surgery.

QUESTIONS/PURPOSES: We evaluated patients with sarcoma seen in our orthopaedic oncology clinic to determine (1) the proportion of patients with depression symptoms, symptom severity, how many patients triggered a referral to mental health professionals based upon our prespecified cutoff scores on the nine-item Patient Health Questionnaire (PHQ-9), and if their symptoms varied by disease state; (2) the proportion of patients with anxiety symptoms, symptom severity, how many patients triggered a referral to mental health professionals based upon our prespecified cutoff scores on the seven-item Generalized Anxiety Disorder Scale (GAD-7), and if they symptoms varied by disease state; (3) whether other factors were associated with the proportion and severity of symptoms of anxiety or depression, such as tumor location in the body (axial skeleton, upper extremity, or lower extremity), general type of tumor (bone or soft tissue), specific diagnosis, use of chemotherapy, length of follow-up (less than 1 year or greater than 1 year), and gender; and (4) what proportion of patients accepted referrals to mental health professionals, when offered.

METHODS: This study was a cross-sectional survey study performed at a single urban National Cancer Institute-designated Comprehensive Cancer Center from April 2021 until July 2021. All patients seen in the orthopaedic clinic 18 years of age and older with a diagnosis/presumed diagnosis of sarcoma were provided the PHQ-9 as well as the GAD-7 in our clinic. We did not track those who elected not to complete the surveys. Surveys were scored per survey protocol (each question was scored from 0 to 3 and summed). Specifically, PHQ-9 scores the symptoms of depression as 5 to 9 (mild), 10 to 14 (moderate), 15 to 19 (moderately severe), and 20 to 27 (severe). The GAD-7 scores symptoms of anxiety as 5 to 9 (mild), 10 to 14 (moderate), and 15 to 21 (severe). Patients with PHQ-9 or GAD-7 scores of 10 to 14 were referred to social work and those with scores 15 or higher were referred to psychiatry. Patients with thoughts of self-harm were referred regardless of score. Patients were divided based on disease state: patients during their initial management; patients with active, locally recurrent disease; patients with active metastatic disease; patients with prior recurrence or metastatic lesions who were subsequently treated and now have no evidence of disease (considered to be patients with discontinuous no evidence of disease); patients with no evidence of disease; and patients with an active, noncancerous complication but otherwise no evidence of disease. We additionally looked at the association of gender, chemotherapy administration, and tumor location on survey responses. Data are summarized using descriptive statistics. Differences across categories of disease state were tested for statistical significance using Kruskal-Wallis tests for continuous variables and Fisher exact tests for categorical variables as well as pairwise Wilcoxon rank sum tests.

RESULTS: Overall, symptoms of depression were seen in 35% (67 of 190) of patients, at varying levels of severity: 19% (37 of 190) had mild symptoms, 9% (17 of 190) had moderate symptoms, 6% (12 of 190) had moderately severe symptoms, and 1% (1 of 190) had severe symptoms. Depresssion symptoms severe enough to trigger a referral were seen in 17% (32 of 190) of patients overall. Patients scored higher on the PHQ-9 during their initial treatment or when they had recurrent or metastatic disease, and they were more likely to trigger a referral during those timepoints as well. The mean PHQ-9 was 5.7 ± 5.8 during initial treatment, 6.1 ± 4.9 with metastatic disease, and 7.4 ± 5.2 with recurrent disease as compared with 3.2 ± 4.2 if there was no evidence of disease (p = 0.001). Anxiety symptoms were seen in 33% (61 of 185) of patients: 17% (32 of 185) had mild symptoms, 8% (14 of 185) had moderate symptoms, and 8% (15 of 185) had severe symptoms. Anxiety symptoms severe enough to trigger a referral were seen in 16% (29 of 185) of patients overall. Patients scored higher on the GAD-7 during initial treatment and when they had recurrent disease or an active noncancerous complication. The mean GAD-7 was 6.3 ± 3.2 in patients with active noncancerous complications, 6.8 ± 5.8 in patients during initial treatment, and 8.4 ± 8.3 in patients with recurrent disease as compared with 3.1 ± 4.2 in patients with no evidence of disease (p = 0.002). Patients were more likely to trigger a referral during initial treatment (32% [9 of 28]) and with recurrent disease (43% [6 of 14]) compared with those with no evidence of disease (9% [9 of 97]) and those with discontinuous no evidence of disease (6% [1 of 16]; p = 0.004). There was an increase in both PHQ-9 and GAD-7 scores among patients who had chemotherapy. Other factors that were associated with higher PHQ-9 scores were location of tumor (upper extremity versus lower extremity or axial skeleton) and gender. Another factor that was associated with higher GAD-7 scores included general category of diagnosis (bone versus soft tissue sarcoma). Specific diagnosis and length of follow-up had no association with symptoms of depression or anxiety. Overall, 22% (41 of 190) of patients were offered referrals to mental health professionals; 73% (30 of 41) accepted the referral.

CONCLUSION: When treating patients with sarcoma, consideration should be given to potential concomitant psychiatric symptoms. Screening, especially at the highest-risk timepoints such as at the initial diagnosis and the time of recurrence, should be considered. Further work should be done to determine the effect of early psychiatric referral on patient-related outcomes and healthcare costs.

LEVEL OF EVIDENCE: Level III, therapeutic study.

PMID:35901433 | DOI:10.1097/CORR.0000000000002295

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Nevin Manimala Statistics

Thinking about thinking: People underestimate how enjoyable and engaging just waiting is

J Exp Psychol Gen. 2022 Jul 28. doi: 10.1037/xge0001255. Online ahead of print.

ABSTRACT

The ability to engage in internal thoughts without external stimulation is a unique characteristic in humans. The current research tested the hypothesis that people metacognitively underestimate their capability to enjoy this process of “just thinking.” Participants (university students; total N = 259) were asked to sit and wait in a quiet room without doing anything. Across six experiments, we consistently found that participants’ predicted enjoyment and engagement for the waiting task were significantly less than what they actually experienced. This underappreciation of just thinking also led participants to proactively avoid the waiting task in favor of an alternative task (i.e., Internet news checking), despite their experiences not being statistically different. These results suggest an inherent difficulty in accurately appreciating how engaging just thinking can be, and could explain why people prefer keeping themselves busy, rather than taking a moment for reflection and imagination in our daily life. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35901414 | DOI:10.1037/xge0001255

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Nevin Manimala Statistics

Relations among gratitude, adaptation to disability, and flourishing among adults with disabilities: A longitudinal mediation model

Rehabil Psychol. 2022 Jul 28. doi: 10.1037/rep0000448. Online ahead of print.

ABSTRACT

PURPOSE/OBJECTIVE: Flourishing, a primary outcome of rehabilitation psychology, is understudied among adults with disabilities. Gratitude has emerged as an individual strength that is both malleable and robust in predicting flourishing and adaptation to disability. The purpose of this study was to assess the influence of gratitude on flourishing over time and to analyze the potential mediating role of adaptation to disability on this relationship for a group of adults with disabilities.

RESEARCH METHOD/DESIGN: Data were collected at 3 time points over 21 months (N = 429). A single mediator model with external demographic variables was tested to determine the relationship of gratitude (Time 1) with adaptation to disability (Time 2) and flourishing (Time 3). Approximately 40% of the initial sample was retained across all time points.

RESULTS: Gratitude predicted later flourishing and adaptation to disability accounted for a significant portion of this relationship, accounting for 27% of the total effect.

CONCLUSIONS/IMPLICATIONS: Results of this single mediator model indicate that adaptation to disability serves as a partial mediator of the relationship between gratitude and flourishing, with both gratitude and adaptation to disability having a significantly positive influence on flourishing. Understanding gratitude’s influence on later adaptation and flourishing provides data to inform rehabilitation psychology interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35901402 | DOI:10.1037/rep0000448

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Nevin Manimala Statistics

On the white, the black, and the many shades of gray in between: Our reply to Van Ravenzwaaij and Wagenmakers (2021)

Psychol Methods. 2022 Jun;27(3):466-475. doi: 10.1037/met0000505.

ABSTRACT

In 2019 we wrote an article (Tendeiro & Kiers, 2019) in Psychological Methods over null hypothesis Bayesian testing and its working horse, the Bayes factor. Recently, van Ravenzwaaij and Wagenmakers (2021) offered a response to our piece, also in this journal. Although we do welcome their contribution with thought-provoking remarks on our article, we ended up concluding that there were too many “issues” in van Ravenzwaaij and Wagenmakers (2021) that warrant a rebuttal. In this article we both defend the main premises of our original article and we put the contribution of van Ravenzwaaij and Wagenmakers (2021) under critical appraisal. Our hope is that this exchange between scholars decisively contributes toward a better understanding among psychologists of null hypothesis Bayesian testing in general and of the Bayes factor in particular. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35901398 | DOI:10.1037/met0000505

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Nevin Manimala Statistics

Model fit is a fallible indicator of model quality in quantitative psychopathology research: A reply to Bader and Moshagen

J Psychopathol Clin Sci. 2022 Aug;131(6):696-703. doi: 10.1037/abn0000770.

ABSTRACT

As evidenced by our exchange with Bader and Moshagen (2022), the degree to which model fit indices can and should be used for the purpose of model selection remains a contentious topic. Here, we make three core points. First, we discuss the common misconception about fit statistics’ abilities to identify the “best model,” arguing that mechanical application of model fit indices contributes to faulty inferences in the field of quantitative psychopathology. We illustrate the consequences of this practice through examples in the literature. Second, we highlight the parsimony-adjacent concept of fitting propensity, which is not accounted for by commonly used fit statistics. Finally, we present specific strategies to overcome interpretative bias and increase generalizability of study results and stress the importance of carefully balancing substantive and statistical criteria in model selection scenarios. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35901397 | DOI:10.1037/abn0000770

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Creating a developmental scale to chart the development of psychopathology with different informants and measures across time

J Psychopathol Clin Sci. 2022 Aug;131(6):611-625. doi: 10.1037/abn0000649.

ABSTRACT

Research Domain Criteria (RDoC) aims to advance a dimensional, multilevel understanding of psychopathology across the life span. Two key challenges exist in applying a developmental perspective to RDoC: First, the most accurate informants for assessing a person’s psychopathology often differ across development (e.g., parents and teachers may be better informants of a person’s externalizing problems in early childhood, whereas peer- and self-report may also be important to assess in adolescence). Second, many constructs change in their behavioral manifestation across development (i.e., heterotypic continuity). Thus, different informants and measures across time may be necessary to account for the construct’s changing manifestation. The challenge of using different informants and measures of a construct across time is ensuring that the same construct is assessed in a comparable way across development. Vertical scaling creates a developmental scale to link scores from changing informants and measures to account for heterotypic continuity and study people’s development of psychopathology across the life span. This is the first study that created a developmental scale to assess people’s development by putting different informants and measures on the same scale. We examined the development of externalizing problems from ages 2 to 15 years (N = 1,364) using annual ratings by mothers, fathers, teachers, other caregivers, and self-report. The developmental scale linked different informants and measures on the same scale. This allowed us to chart people’s growth trajectories and to identify multilevel risk factors, including poor verbal comprehension. Creating a developmental scale may be crucial to advance RDoC’s goal of studying the development of psychopathology across the life span. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35901391 | DOI:10.1037/abn0000649

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Progress feedback narrows the gap between more and less effective therapists: A therapist effects meta-analysis of clinical trials

J Consult Clin Psychol. 2022 Jul;90(7):559-567. doi: 10.1037/ccp0000747.

ABSTRACT

OBJECTIVE: Some psychotherapists are more effective than others, which means that patients’ treatment outcomes partly depend on therapist effects (TEs). This study investigated whether the use of progress feedback influences TE.

METHOD: Data from N = 4,549 participants and 131 therapists across six clinical trials of progress feedback were analyzed. All trials used the Outcome-Questionnaire-45 (OQ-45) outcome measure and assigned psychotherapy patients to a usual psychological care condition or feedback condition. We examined whether feedback utilization moderated TE using multilevel modeling and random-effects meta-analysis.

RESULTS: TE explained a small proportion (intracluster correlation coefficient [ICC] = .011) of variability in posttreatment OQ-45 scores in the pooled multistudy sample, after controlling for intake severity. Feedback utilization was associated with a statistically significant reduction of the magnitude of the TE (ICC = .009) by approximately 18.2%. Secondary analyses of OQ-45 subscales indicated that TEs were statistically significant in relation to symptom distress, but not interpersonal relations or social role. Feedback was associated with better treatment outcomes and narrower variability between therapists.

CONCLUSIONS: Feedback-informed treatment reduces the gap between more and less effective therapists, leading to more equitable and effective psychological care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35901368 | DOI:10.1037/ccp0000747

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Nevin Manimala Statistics

Immunohistochemical Expression of Programmed Death Ligand 1(PDL1) in Endometrial Carcinoma and Its Relation to CD4 and CD8 Positive Immune Cells

Asian Pac J Cancer Prev. 2022 Jul 1;23(7):2491-2496. doi: 10.31557/APJCP.2022.23.7.2491.

ABSTRACT

OBJECTIVES: Endometrial cancer (EC) is the most common cancer of the female genital tract. Egypt showed a significant increase in incidence lately of which 25% were premenopausal. Advanced or recurrent disease are mostly unresectable and the traditional adjuvant therapy give modest results with devastating side effects. Late discoveries of immune checkpoint inhibitors have produced promising results. Programmed cell death 1 (PD1) is an immune inhibiting receptor on surface of lymphocytes, which plays critical roles in maintaining immunological self-tolerance. There are two ligands for this receptor, PDL1 and PDL2. PD-L1 is expressed on tumor cells; attaches to PD1, allowing tumor cells to escape from the host immune response. Its prognostic significance in various tumors is controversial and its significance in ECs has just begun to be investigated. Therefore, we investigated the relationship between PDL1 expression and different clinicopathologic parameters in EC cases and its correlation with CD4 and CD8 immune cells, in order to identify the predictive biomarkers for the outcome by immune therapy.

METHODS: Hundred, paraffin tissue blocks of EC cases were collected and stained with antibodies against PDL1,CD4 and CD8.

RESULTS: PDL1 was positive in 67% of cases in tumor cells and in 61% of cases in immune cells. CD4 and CD8 were expressed in 79% of cases. Statistically significant correlations were observed between PDL1 expression and patients mean age, LVSI, TILS score and CD4+/CD8+ expression.

CONCLUSION: Those variables can stratify candidates who can benefit most from immunotherapy, or can be chosen for further high cost molecular investigations application.

PMID:35901358 | DOI:10.31557/APJCP.2022.23.7.2491

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Nevin Manimala Statistics

Genotype Distribution and Prevalence of High-Risk Human Papillomavirus Infection among Women in Samsun Province of Turkey

Asian Pac J Cancer Prev. 2022 Jul 1;23(7):2477-2482. doi: 10.31557/APJCP.2022.23.7.2477.

ABSTRACT

BACKGROUND: The human papillomavirus (HPV) is an important public health problem that can cause cervical cancer. HPVs were classified into high-risk (HR-HPV) and low-risk (LR-HPV) types. In this study, we aimed to determine the prevalence and genotype distribution of HR-HPV infection in Samsun province in Turkey.

METHODS: Cervical smear samples taken from 5406 women over a 23-month period were evaluated for the presence of HPV infection. The detection of HPV genotypes was performed using RT-PCR technology. HPV detection and genotyping were performed using RT-PCR method. HR- HPV types are divided into 3 groups as type 16, type 18 and other types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, with or without type 16 and 18). The results were evaluated statistically.

RESULTS: The mean age of HR-HPV positive patients was 39.56 years (20-68 years). The prevalance of HR-HPV types did not differ between different age groups (p˃0.05). Overall, 9.17% of women (496/5406 samples) were found to be positive at least one type of HR-HPV. HPV type 16 was detected in 28.62%, type 18 in 9.67%, and other types in 78.83%. The most common HR-HPV type was other types (p˂0.001). Type 16 was most common than type 18 (p˂0.001). The patients were evaluated by dividing them into 6 age groups. Type 16 positivity was higher in 30-39 ages while type18 and other types positivity were higher in the 40-49 age group. When the 23-month period of HPV test was evaluated according to months and seasons, the highest prevalance was seen in June 2021 and Summer 2021.

CONCLUSION: To our knowledge, this is the first large-scale study of HR-HPV prevalence and genotype distribution among women in Samsun Province of Turkey. The other types containing one or more types made up the majority of the studied population.

PMID:35901356 | DOI:10.31557/APJCP.2022.23.7.2477

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Expression of CD44v6 and RCAS1 in Uterine Cervical Carcinoma Infected with Human Papillomavirus and Its Effect on Cell Proliferation and Differentiation

Asian Pac J Cancer Prev. 2022 Jul 1;23(7):2431-2439. doi: 10.31557/APJCP.2022.23.7.2431.

ABSTRACT

OBJECTIVE: To investigate the expression of CD44v6 and RCAS1 and the presence of HPV in cervical cancer tissues, to determine serum RCAS1 levels, and to evaluate these components in correlation with clinicopathologic features and survival.

METHODS: A total of 52 patients consisting of 28 squamous cell carcinoma (SCC) and 24 adenocarcinoma cases, were studied. RCAS1 and CD44v6 expression was evaluated using immunohistochemical staining. HPV 16 and 18 E6 genes were detected using PCR, and serum RCAS1 concentrations were measured using ELISA. Associations between these factors and clinicopathologic features and survival were analyzed.

RESULTS: CD44v6 expression was significantly higher in SCC compared with that in adenocarcinoma (P<0.001). It also showed a significant relation to histologic grade (P<0.001) and tumor size (P=0.03). RCAS1 expression was higher in adenocarcinoma than in SCC (P=0.001), and it showed a borderline relation with histological grade (P=0.057). Overall survival was not significantly different in both CD44v6 and RCAS1 expression; however, FIGO stage (P=0.025) and tumor size (P=0.042) resulted statistically different. The pre-surgical treatment serum RCAS1 levels were not associated with any clinicopathological variables. The presence of HPV 16 E6 was higher in SCC, while the presence of HPV 18 E6 was higher in adenocarcinoma (P<0.001). Detection of HPV 16 E6 was significantly associated with expression of CD44v6. The presence of HPV both HPV 16 E6 and HPV 18 E6 was found in cancer tissues with RCAS1 expression, but without any statistical significance.

CONCLUSION: CD44v6 and RCAS1 expression seems to be involved in tumor proliferation and differentiation, but it is not implicated in the progression and invasion of cervical cancer infected by HPV. Pre-treatment levels of serum RCAS1 in cervical cancer are not a diagnostic and predictive biomarker.

PMID:35901351 | DOI:10.31557/APJCP.2022.23.7.2431