Category: Statistics

Kardiologiia. 2024 Nov 30;64(11):106-116. doi: 10.18087/cardio.2024.11.n2794.

ABSTRACT

Aim To identify metabolomic and structure and function markers of remote left ventricular (LV) remodeling in patients with chronic heart failure (CHF) of ischemic etiology and LV ejection fraction (EF) <50%.Material and methods This prospective study included 56 patients with 3-4 NYHA functional class CHF of ischemic etiology (mean age, 66±7 years) and 50 patients with ischemic heart disease (IHD) without signs of CHF (69 [64; 73.7] years). Concentration of 19 amino acids, 11 products of kynurenine catabolism of tryptophan, 30 acylcarnitines with different chain lengths were measured in all participants. The metabolites that showed statistical differences between the comparison groups were then used for the analysis. Echocardiography was used to assess LV cavity remodeling at the time of the CHF patient inclusion in the study and after 6 months of follow-up. Predictors of long-term LV cavity remodeling were assessed for this cohort taking into account statistically significant echocardiographic parameters and metabolites.Results Patients with CHF of ischemic etiology, predominantly (81%) had pathological calculated types of LV remodeling (concentric and eccentric hypertrophy, 46 and 35%, respectively). However, this classification had limitations in describing this cohort. In addition, in this group, the concentrations of alanine, proline, asparagine, glycine, arginine, histidine, lysine, valine, indolyl-3-acetic acid, indolyl-3-propionic acid, C16-1-OH, and C16-OH were significantly (p<0.05) lower, and the concentrations of most medium- and long-chain acylcarnitines were higher than in patients with IHD without signs of CHF. The long-term (6 months) reverse remodeling of the LV cavity in CHF of ischemic etiology was influenced by changes in the interventricular septum thickness (hazard ratio, HR, 19.07; 95% confidence interval, CI, 1.76-206.8; p=0.006) and concentrations of anthranilic acid (HR 19.8; 95% CI 1.01-387.8; p=0.019) and asparagine (HR 8.76; 95% CI 1.07-71.4; p=0.031).Conclusion The presence of an interventricular septum thickness of more than 13.5 mm, anthranilic acid concentrations of higher than 0.235 μM/l, or an asparagine concentration of less than 135.2 μM/l in patients with CHF of ischemic etiology after 6 months of follow-up affects their achievement of LV cavity reverse remodeling.

PMID:39637396 | DOI:10.18087/cardio.2024.11.n2794

Kardiologiia. 2024 Nov 30;64(11):96-105. doi: 10.18087/cardio.2024.11.n2781.

ABSTRACT

Aim To evaluate the cumulative incidence and prognostic value of rehospitalizations in patients with heart failure (HF) within one year after discharge.Material and methods The data of patients with HF hospitalized for the first time (code I50.x in the diagnosis) for the period from January 01, 2022 through February 13, 2024 were selected from the St. Petersburg Chronic Heart Failure Registry. Age and gender characteristics, comorbidities, risk of rehospitalization and death after discharge from the hospital depending on the number of rehospitalizations were analyzed. Descriptive statistics methods, Kaplan-Meier survival analysis, and the Fine and Gray competing risks model were used. P<0.001 was considered significant.Results The study included 43,143 patients with HF who were hospitalized for the first time. During a median observation time of 242 days, 6,395 (14.8%) patients were readmitted, most often once (78.4%). A greater number of rehospitalizations was typical for men, patients with HF of ischemic genesis, atrial fibrillation, diabetes mellitus, obstructive pulmonary diseases, and a history of COVID-19. The cumulative incidence of rehospitalizations for HF during 1, 3, 6, and 12 months was 3.2%, 7.0%, 10.8%, and 17.2%, respectively, taking into account the competing risk of death. With an increasing number of hospitalizations, the median time to the next hospitalization decreased, and the risk of readmission increased (p<0.001). The probability of death within a year of the index hospitalization was 14.9% (95% confidence interval [CI]: 14.5%-15.3%). The all-cause death rate was 30, 44, and 54 cases per 100 patient-years for patients with one, two, and at least three readmissions vs. 19 cases per 100 patient-years for those without readmissions. Readmitted patients were characterized by an increased risk of death: the adjusted hazard ratios of death in patients with one, two, and at least three readmissions were 1.47 (95% CI: 1.36-1.59), 1.97 (95% CI: 1.69-2.30), and 2.24 (95% CI: 1.81-2.78), respectively.Conclusion In patients hospitalized with HF for the first time, the cumulative one-year HF readmission rate adjusted for the competing risk of death was 17.2%. Increased readmission rates were independently associated with increased odds of readmission and death.

PMID:39637395 | DOI:10.18087/cardio.2024.11.n2781

Kardiologiia. 2024 Nov 30;64(11):84-95. doi: 10.18087/cardio.2024.11.n2783.

ABSTRACT

Aim To evaluate the risks of all-cause death (ACD), cardiovascular death (CVD), death from recurrent acute decompensated heart failure (ADHF), and a composite index of CVD and death from recurrent ADHF in patients with chronic heart failure (CHF) after the first hospitalization for ADHF during a long-term, five-year follow-up in the conditions of specialized medical care and in real clinical practice.Material and methods This prospective cohort observational study included 942 patients after ADHF. Group 1 consisted of 510 patients who continued the outpatient follow-up at a specialized center for the treatment of CHF (cCHF); group 2 consisted of 432 patients followed up at outpatient and polyclinic institutions (OPI) at the place of residence. During the five-year follow-up, the causes of death were determined based on the medical records of inpatients, postmortem examinations, or the conclusion in the medical records of outpatients. Rates of ACD, CVD, death from recurrent ADHF, and the composite index (CVD and death from ADHF) were analyzed. Statistical analysis was performed with a R statistical package.Results ACD was 32.3% and 53.5% in groups 1 and 2, respectively (p<0.001). Based on the results of Cox proportional hazards models, it was shown that the follow-up in group 1, regardless of other factors, was associated with a decrease in the ACD risk (HR 2.07; 95% CI 1.68-2.54; p<0.001), CVD (HR 1.94; 95% CI 1.26-2.97; p=0.002), death from recurrent ADHF (HR 2.4; 95% CI 1.66-3.42; p<0.001) and the composite mortality index (HR 2.2; 95% CI 1.65-2.85; p<0.001) compared to group 2. The risks of death in CHF patients with moderately reduced left ventricular ejection fraction (LVEF) (HFmrEF) were consistent with the death rates in CHF patients with low LVEF (HFrEF) and were significantly higher than in CHF patients with preserved LVEF (HFpEF). The prognosis of life worsened with an increase in the Clinical Condition Assessment Scale score and age. The prognosis of life was better in women, as well as with higher values of systolic blood pressure (BP) and 6-minute walk test. In the structure of death in both groups, death from ADHF and sudden cardiac death (SCD) prevailed.Conclusion The absence of specialized follow-up at an outpatient CHF center increases the risks of ACD, CVD, death from recurrent ADHF, and the composite endpoint at a depth of five-year observation. The leading causes of death were recurrent ADHF and SCD.

PMID:39637394 | DOI:10.18087/cardio.2024.11.n2783

Kardiologiia. 2024 Nov 30;64(11):76-83. doi: 10.18087/cardio.2024.11.n2733.

ABSTRACT

Aim To analyze the results of myocardial revascularization in the Russian Federation (RF) for ACS in 2023 compared to previous years.Material and methods The analysis included the number of cases of ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation acute coronary syndrome (NSTE-ACS), myocardial revascularization in the above-listed ACS forms, the number of fatal outcomes depending on the ACS form and the revascularization method used. The data for this analysis were obtained from the 2023 Ministry of Health of Russia monitoring in the section of revascularization in ACS and were compared with the data for the past 8 years.Results, conclusion In 2023, 438,315 patients were hospitalized for ACS in the Russian Federation: 309,158 with NSTE-ACS and 148,729 with STEMI. The total number of hospitalizations for ACS per 1 million of the Russian population was 2,982: 1,011 with STEMI and 2,103 with NSTE-ACS. The availability of primary PCI in 2023 reached its maximum of 55.3% compared to previous years; the total number of PCI for STEMI was 75.7%, and the mortality rate in the whole STEMI group was a minimum of 10.7% for the past 8 years. In 2023, the maximum number of PCIs for NSTE-ACS for the past 8 years was recorded, both in absolute values (120,990) and in relative values (39.1%). In the whole NSTE-ACS group, mortality was 2.5%, which was also the lowest for the past 8 years.

PMID:39637393 | DOI:10.18087/cardio.2024.11.n2733

J Med Internet Res. 2024 Dec 5;26:e49927. doi: 10.2196/49927.

ABSTRACT

BACKGROUND: Previous efforts to apply machine learning-based natural language processing to longitudinally collected social media data have shown promise in predicting suicide risk.

OBJECTIVE: Our primary objective was to externally validate our previous machine learning algorithm, the Suicide Artificial Intelligence Prediction Heuristic (SAIPH), against external survey data in 2 independent cohorts. A second objective was to evaluate the efficacy of SAIPH as an indicator of changing suicidal ideation (SI) over time. The tertiary objective was to use SAIPH to evaluate factors important for improving or worsening suicidal trajectory on social media following suicidal mention.

METHODS: Twitter (subsequently rebranded as X) timeline data from a student survey cohort and COVID-19 survey cohort were scored using SAIPH and compared to SI questions on the Beck Depression Inventory and the Self-Report version of the Quick Inventory of Depressive Symptomatology in 159 and 307 individuals, respectively. SAIPH was used to evaluate changing SI trajectory following suicidal mentions in 2 cohorts collected using the Twitter application programming interface.

RESULTS: An interaction of the mean SAIPH score derived from 12 days of Twitter data before survey completion and the average number of posts per day was associated with quantitative SI metrics in each cohort (student survey cohort interaction β=.038, SD 0.014; F_4,94=3.3, P=.01; and COVID-19 survey cohort interaction β=.0035, SD 0.0016; F_4,493=2.9, P=.03). The slope of average daily SAIPH scores was associated with the change in SI scores within longitudinally followed individuals when evaluating periods of 2 weeks or less (ρ=0.27, P=.04). Using SAIPH as an indicator of changing SI, we evaluated SI trajectory in 2 cohorts with suicidal mentions, which identified that those with responses within 72 hours exhibit a significant negative association of the SAIPH score with time in the 3 weeks following suicidal mention (ρ=-0.52, P=.02).

CONCLUSIONS: Taken together, our results not only validate the association of SAIPH with perceived stress, SI, and changing SI over time but also generate novel methods to evaluate the effects of social media interactions on changing suicidal trajectory.

PMID:39637380 | DOI:10.2196/49927

JMIR Form Res. 2024 Dec 5;8:e60193. doi: 10.2196/60193.

ABSTRACT

BACKGROUND: The landscape of substance use behavior among young adults has observed rapid changes over time. Intensive longitudinal designs are ideal for examining and intervening in substance use behavior in real time but rely on high participant compliance in the study protocol, representing a significant challenge for researchers.

OBJECTIVE: This study aimed to evaluate the effect of including a personalized data dashboard (DD) in a text-based survey prompt on study compliance outcomes among college students participating in a 21-day ecological momentary assessment (EMA) study.

METHODS: Participants (N=91; 61/91, 67% female and 84/91, 92% White) were college students who engaged in recent alcohol and cannabis use. Participants were randomized to either complete a 21-day EMA protocol with 4 prompts/d (EMA Group) or complete the same EMA protocol with 1 personalized message and a DD indicating multiple metrics of progress in the study, delivered at 1 randomly selected prompt/d (EMA+DD Group) via a microrandomized design. Study compliance, completion time, self-reported protocol experiences, and qualitative responses were assessed for both groups.

RESULTS: Levels of compliance were similar across groups. Participants in the EMA+DD Group had overall faster completion times, with significant week-level differences in weeks 2 and 3 of the study (P=.047 and P=.03, respectively). Although nonsignificant, small-to-medium effect sizes were observed when comparing the groups in terms of compensation level (P=.08; Cohen w=0.19) and perceived burden (P=.09; Cohen d=-0.36). Qualitative findings revealed that EMA+DD participants perceived that seeing their progress facilitated engagement. Within the EMA+DD Group, providing a DD at the moment level did not significantly impact participants’ likelihood of completing the EMA or completion time at that particular prompt (all P>.05), with the exception of the first prompt of the day (P=.01 and P<.001).

CONCLUSIONS: Providing a DD may be useful to increase engagement, particularly for researchers aiming to assess health behaviors shortly after a survey prompt is deployed to participants’ mobile devices.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/57664.

PMID:39637378 | DOI:10.2196/60193

JMIR Form Res. 2024 Dec 5;8:e63288. doi: 10.2196/63288.

ABSTRACT

BACKGROUND: Digitalization has profoundly transformed health care delivery, especially within primary health care, as a crucial avenue for providing accessible, cost-effective care. While eHealth services are frequently highlighted for improving health care availability and promoting equality, it is essential to recognize that digitalization can inadvertently exclude individuals who lack the prerequisites to use eHealth services, that is, those with low eHealth literacy. Previous research has identified lower eHealth literacy among older individuals, those with lower educational levels, and those who use the internet less frequently. However, in a Swedish context, only a few studies have investigated eHealth literacy.

OBJECTIVE: This study investigated eHealth literacy and its association with health-related internet use and sociodemographic characteristics among primary health care visitors.

METHODS: This cross-sectional study used a quantitative, descriptive approach. Swedish-speaking patients visiting a primary health care center participated by answering the multidimensional eHealth Literacy Questionnaire (eHLQ) and questions regarding sociodemographic characteristics and internet usage. The study compared mean scores using the Mann-Whitney U test and the Kruskal-Wallis test. A logistic regression analysis also explored the associations between eHealth literacy and significant independent variables identified in the univariate analyses.

RESULTS: As a group, the 172 participants rated highest in understanding and engagement with their health (median eHLQ score 3, IQR 2.8-3.4), as well as in feeling secure about the confidentiality of eHealth services (median eHLQ score 3, IQR 2-3), while they rated lower in motivation to use eHealth (median eHLQ score 2.6, IQR 2-3), the suitability of eHealth services to their personal needs (median eHLQ score 2.75, IQR 2-3), and their perceived ability to understand and use health-related internet information (median eHLQ score 2.6, IQR 2-3). The logistic regression analysis identified that lower eHealth literacy was associated with older age, particularly in domains related to finding, understanding, and using health-related internet information (odds ratio [OR] 1.02, 95% CI 1-1.05; P=.03); digital technology use (OR 1.05, 95% CI 1.02-1.08; P<.001); and accessing well-functioning eHealth services (OR 1.02, 95% CI 1-1.05; P=.03). Additionally, in the logistic regression analysis, perceiving health-related internet information as not useful was linked to lower literacy in all eHLQ domains except one.

CONCLUSIONS: Our findings regarding the primary challenges within our sample underscore the importance of developing and tailoring eHealth services to accommodate users’ individual needs better, enhancing motivation for eHealth use, and continuing efforts to improve overall health literacy. These measures, which both eHealth developers and health care professionals should consider, are crucial for addressing the digital divide and expanding access to eHealth services for as many people as possible.

PMID:39637377 | DOI:10.2196/63288

J Am Acad Orthop Surg Glob Res Rev. 2024 Dec 4;8(12). doi: 10.5435/JAAOSGlobal-D-24-00213. eCollection 2024 Dec 1.

ABSTRACT

INTRODUCTION: Forearm fractures contribute up to 40% of all pediatric fractures, with ≤39% of conservatively managed fractures resulting in malunion. Surgical management of malunion is challenging as precise calculation of multiplanar correction is required to obtain optimal outcomes. Advances in 3D computer modeling and printing have shown promising results in orthopaedics, reducing surgical time, blood loss, and fluoroscopy. This systematic review and meta-analysis are the first to explore the accuracy and functional outcome of 3D techniques in pediatric diaphyseal forearm malunion correction.

METHODS: A systematic review was carried out according to PRISMA guidelines.

RESULTS: Sixteen studies (44 patients) were included. Average 2D residual deformity was 1.84° (SD=1.68°). The average gain in range of movement (ROM) was 76.08° (SD=41.75°), with a statistically significant difference between osteotomies ≤12 months from injury and >12 months (96.36° vs. 64.91°, P = 0.027). Below a 2D residual deformity of 5.28°, no statistically significant difference on gain of ROM was found, indicating this as a nonconsequential residual deformity (P = 0.778). Multivariate regression analysis showed that 2D residual deformity and time to osteotomy only account for 6.3% gain in ROM, indicating that there are more factors to be researched.

CONCLUSION: This study found superior accuracy of 3D techniques, reporting lower residual deformities than published standard osteotomy data; however, the volume of literature was limited. Larger studies are required to explore additional factors that influence accuracy and ROM, such as 3D residual deformity and the effect of particular 3D printed adjuncts. This will aid clarity in determining superiority and improve cost-effectiveness.

PMID:39637302 | DOI:10.5435/JAAOSGlobal-D-24-00213

Pol Przegl Chir. 2024 Jul 11;96(6):70-84. doi: 10.5604/01.3001.0054.6636.

ABSTRACT

&lt;b&gt;Introduction:&lt;/b&gt; The bronchopleural fistula (BPF) remains one of the most severe complications after pneumonectomy. Several surgical methods may enhance bronchial stump healing and reduce the occurrence of BPF. Usually, surgeons use tissue buttressing, such as intercostal muscle flap (IMF), parietal pleura, pericardium fat pad, or mediastinal fat, to reinforce the bronchial stump. This paper reviews the literature describing the impact of different buttressing tissues on the occurrence of early post-pneumonectomy BPF.&lt;b&gt;Material and methods:&lt;/b&gt; We included all studies that described the use of bronchial stump buttressing in patients after pneumonectomy. Studies written in languages other than English were excluded. The search was performed using PubMed, Google Scholar, Embase, COCHRANE databases, and the clinical trial registry on December 1, 2023. We used the following search input: &quot;lung cancer&quot; AND &quot;pneumonectomy&quot; AND (&quot;bronchopleural fistula&quot; OR &quot;BPF&quot;) AND (&quot;tissue buttressing&quot; OR &quot;intercostal muscle flap&quot; OR &quot;mediastinal fat pad&quot;). We analysed the types of studies, the numbers of patients, and the most important conclusions. We performed descriptive statistics.&lt;b&gt;Results:&lt;/b&gt; Twenty-seven articles on the use of bronchial tissue buttressing were identified. Nine papers were rejected due to small sample size (&lt; 20 patients), surgical operation other than pneumonectomy or lobectomy, or papers older than 30 years. Ultimately, 16 articles were included in the analysis. Among them, three papers highlighted the statistically significant influence of bronchial stump buttressing in reducing the risk of BPF formation. Descriptive statistics were reported in nine studies, and two papers included the assessment of the blood perfusion in the buttressing tissue. Only one study was a randomized trial featuring a control group for comparison.&lt;b&gt;Discussion:&lt;/b&gt; Buttressing the bronchial stump remains a controversial issue in thoracic surgery. It could be beneficial for high-risk patients. Among different tissues, the ideal one has still not been identified. Future research should incorporate control groups and intraoperative assessments of the blood supply to the tissue employed for bronchial buttressing.

PMID:39635747 | DOI:10.5604/01.3001.0054.6636

J Pharm Policy Pract. 2024 Dec 3;17(1):2432446. doi: 10.1080/20523211.2024.2432446. eCollection 2024.

ABSTRACT

BACKGROUND: Fraud in pharmaceutical tenders is a severe form of corruption that poses a significant threat to public health, patients, and the community. Due to the substantial financial volume in the pharmaceutical sector, vulnerable points in decision-making for market entry and purchase are at risk. As a result, the objective of this study was to measure the level of transparency and risk of corruption in pharmaceuticals’ procurement practices in South Wollo, North-East Ethiopia.

METHODOLOGY: From October 1 to December 15, 2023, a multi-facility, cross-sectional study was conducted. The participants were pharmaceutical procurement committee (PPC) members. The World Health Organization’s (WHO’s) standardised interviewer-administered questionnaire was used to collect the data. The collected data was entered, cleaned, processed, and analyzed using Statistical Package for Social Sciences (SPSS) version 27. Both descriptive and inferential statistics (univariate and linear regression analyses) were computed. The relationship between the independent (health facility level) and dependent (level of transparency) variables was determined using beta with a p-value of less than 0.05 and a 95% CI.

RESULTS: One hundred eighty-seven respondents, from 47 health centres (low, medium, and high volume) and 14 hospitals (primary, secondary, and tertiary), participated. The aggregate result showed that pharmaceutical procurement practice was very vulnerable to corruption, with a transparency level of only 33.0% (3.3 out of 10). The univariate analysis demonstrated a significant disparity in the mean transparency scores between health centres and hospitals. The linear regression also showed that for every one standard deviation increase in the facility level, there was an associated 0.39 increase in the transparency level of pharmaceutical procurement (β = 0.39, 95% CI: 0.02-0.04).

CONCLUSION: The pharmaceutical procurement practice at the health facilities was generally found to be very vulnerable to corruption, which slightly increased with a decrease in facility levels and vice versa.

PMID:39635710 | PMC:PMC11616756 | DOI:10.1080/20523211.2024.2432446