Category: Statistics

Medicine (Baltimore). 2024 Nov 29;103(48):e40708. doi: 10.1097/MD.0000000000040708.

ABSTRACT

Acute postoperative urinary retention (APOUR) is 1 of the most common complications of spinal surgery, impacting both postoperative care and the patients’ quality of life. This study is designed to investigate the risk factors and the incidence of APOUR after spinal surgery in Taiwan. We conducted a retrospective analysis using the Taiwanese National Health Insurance Research Database (NHIRD), a nationwide cohort of patients who underwent spinal surgery from the year 2000 to 2013. Patients suffering from APOUR were collected and perioperative parameters were recorded. The risk factors related to APOUR after spinal surgery were examined using multivariate logistic regression analysis. A total of 16,160 patients who underwent spinal surgery were retrieved from NHIRD. Among them, 432 (2.67%) suffered from acute urinary retention after surgery. Multivariate logistic regression analysis revealed that age (adjusted odds ratio [OR] = 1.02, 95% CI = 1.01-1.02), male gender (adjusted OR = 1.35, 95% CI = 1.10-1.60) and undergoing spinal surgery more than 2 times (adjusted OR = 4.78, 95% CI = 2.49-9.20) were statistically significant risk factors for APOUR after spinal surgery. The results of this retrospective cohort study suggest that patients undergoing spinal surgery more than 2 times, male gender and advanced age are significantly associated with an increased risk of APOUR after spinal surgery. This information may assist surgeons to identify patients who have a high risk of APOUR after spinal surgery and proactively provide them with early intervention.

PMID:39612429 | DOI:10.1097/MD.0000000000040708

Medicine (Baltimore). 2024 Nov 29;103(48):e40734. doi: 10.1097/MD.0000000000040734.

ABSTRACT

Serum albumin on admission has been investigated among inpatients with COVID-19. However, studies on the lowest level of serum albumin during hospitalization and adverse outcomes are limited. This research aimed to explore association between them in older adults with COVID-19. A retrospective study was conducted with 300 patients aged 60 or older with first confirmed COVID-19 from January to February 2023. An adverse outcome was defined as development of acute respiratory failure, shock, or death. Data on demographics, comorbidities, laboratory parameters, the initial phase of COVID-19, coinfection, sepsis, receipt of antiviral treatment and outcomes were gathered from the electronic medical records. The association between the lowest level of serum albumin and adverse outcomes was analyzed using univariate and multivariate regression models, along with generalized additive models. After adjusting potential confounders, nonlinear relationship with an inflection point of 29.1 g/L was detected between the lowest level of serum albumin and adverse outcomes in the elderly. The effect sizes and the confidence intervals on the left and right sides of the inflection point were 0.667 (0.520, 0.856) and 1.171 (0.875, 1.568), respectively. This demonstrated that the lowest level of serum albumin was negatively correlated with adverse outcomes when albumin was <29.1 g/L. A rise of 1 unit in the lowest level of albumin equated to a 33.3% decrease in the risk of adverse outcomes. The correlation between the lowest level of serum albumin and adverse outcomes of COVID-19 is a nonlinear. this study indicates that serum albumin levels should be sustained above the critical inflection point identified to reduce the risk of adverse outcomes.

PMID:39612427 | DOI:10.1097/MD.0000000000040734

Medicine (Baltimore). 2024 Nov 29;103(48):e40563. doi: 10.1097/MD.0000000000040563.

ABSTRACT

This study aims to (1) analyze the clinical characteristics and risk factors of patients with type 2 diabetes and comorbid depression and (2) explore the association between SIRT1 gene single-nucleotide polymorphism sites and this comorbidity. A total of 450 type 2 diabetes patients hospitalized in the General Medicine Department at The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology from July 2022 to September 2023, and 300 healthy individuals from the physical examination department were selected as study subjects. Both groups were assessed using general information surveys and questionnaires. Statistical analyses were performed to compare clinical indicators across 3 groups: individuals with only type 2 diabetes, those with comorbid depression, and healthy controls. The age, gender, disease duration, marital status, income and drug expenditure, employment status, fasting blood glucose level, fasting insulin level difference, insulin resistance index difference, glycated hemoglobin, high-density lipoprotein level, and HCY difference among the 3 groups of patients were risk factors for type 2 diabetes comorbid depression patients. The SIRT1 mRNA level was significantly reduced in type 2 diabetes comorbid depression patients. The SIRT1 gene had 3 sites: rs12415800, rs3758391, and rs932658, which were related to the patient’s type 2 diabetes comorbid depression. They were the additive model and dominant model of rs12415800 and rs3758391, respectively. In addition, the GTGGT haplotype composed of rs12415800-rs932658-rs7895833-rs2273773-rs1467568 and the AGACT haplotype composed of rs3758391-rs932658-rs33957861-rs3818292-rs1467568 were significantly associated with type 2 diabetes comorbid depression. Numerous factors influence the presence of depression in patients with type 2 diabetes, with the SIRT1 gene playing a significant role, serving as a potential biomarker for this comorbidity.

PMID:39612426 | DOI:10.1097/MD.0000000000040563

JMIR Res Protoc. 2024 Nov 29;13:e57452. doi: 10.2196/57452.

ABSTRACT

BACKGROUND: Implementation science investigates the processes and factors that influence the successful adoption, implementation, and sustainability of interventions in many settings. Although conventional research places significant emphasis on the advancement and effectiveness of interventions, it is equally imperative to comprehend their performance in practical, real-life situations. Through outcome tracking, implementation science enables researchers to investigate complex implementation dynamics and go beyond efficacy, identifying the various aspects that contribute to the success of interventions.

OBJECTIVE: This study aims to evaluate the implementation outcomes of TAIBU’s intensive case management (ICM) model tailored for African, Caribbean, and Black communities living with HIV in the Greater Toronto Area. Specifically, it seeks to assess the fidelity, reach, and sustainability of the ICM program. Fidelity monitoring will ensure adherence to program protocols and consistency in service delivery, essential for achieving desired health outcomes. Reach assessment will examine the program’s capacity to reach the target population, including demographic coverage and engagement levels among African, Caribbean, and Black individuals. Sustainability assessment will explore the determinants influencing the longevity and impact of the ICM program.

METHODS: The study uses a mixed methods approach, where we will use probing questionnaires, interviews, and focus-group discussions to gather program performance and engagement data, in-depth insights, and perspectives from the implementation team responsible for delivering the ICM intervention. The collected fidelity and reach data through questionnaires will be analyzed using appropriate statistical techniques, such as descriptive statistics, to summarize the responses and identify patterns and trends within the data. Sustainability data collected through the interviews and focus groups will be analyzed and organized based on the Consolidated Framework for Implementation Research, which provides an organized way to identify and comprehend the determinants influencing implementation outcomes.

RESULTS: The study commenced in January 2024, and initial data collection is expected to be completed by December 2024. As of September 2024, we have enrolled 5 participants.

CONCLUSIONS: This study will significantly contribute to improving the implementation of the ICM program. By conducting a study in an organizational or institutional setting, researchers can acquire valuable insights into the implementation process from those who are directly involved. The information gathered will inform strategies for improving implementation effectiveness; removing impediments; and enhancing the overall quality of the ICM program for African, Caribbean, and Black individuals living with HIV.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57452.

PMID:39612213 | DOI:10.2196/57452

J Med Internet Res. 2024 Nov 29;26:e57205. doi: 10.2196/57205.

ABSTRACT

BACKGROUND: Engaging in social activities, interacting with peers, and participating in community events may promote health and well-being. Recently, interventions leveraging information and communications technology have emerged as potent tools for promoting social connections and well-being. Particularly, messenger apps have become an integral part of our daily lives, facilitating communication, information dissemination, and social interaction. However, there remains a gap in the literature regarding the utilization of widely adopted messenger apps for this purpose.

OBJECTIVE: This study aimed to evaluate the impact of messenger app-based information provision aimed at promoting social participation on the enhancement of subjective well-being among Japanese community-dwelling adults.

METHODS: A 2-arm, parallel-group randomized controlled trial was conducted from October 2022 to January 2023 in the Kashiwa-no-ha campus area, Japan-an urban community with active local events. A total of 358 community-dwelling adults who use messenger apps daily were recruited for the study. Of these, 235 (65.6%) participants completed the follow-up survey. Participants were randomly assigned to either the intervention group, receiving the health benefits of social participation and information about local events or spots via a messenger app, or the control group, receiving general health information. The primary outcome was subjective happiness after the intervention, measured on an 11-point scale ranging from 0 (Unhappy) to 10 (Happy). Secondary outcomes included life satisfaction, meaning of life, purpose in life, and participation in local events. The outcomes were analyzed with t tests (2-tailed) and multivariable regression based on the intention-to-treat method.

RESULTS: After the intervention, the intervention group reported a mean happiness score of 7.7 (SD 1.7), while the control group reported a score of 7.5 (SD 2.0), with no statistically significant difference (P=.40). Multivariable linear regression analysis adjusted for baseline outcome values and covariates showed that the coefficient of the intervention for life satisfaction was 0.30 (95% CI -0.07 to 0.68; P=.12), while that for meaning of life was 0.33 (95% CI -0.03 to 0.70; P=.07). There was no significant difference in event participation rates between the 2 groups during the study period (P=.22). However, 82.2% (102/124) of the intervention group acknowledged the utility of the event information provided.

CONCLUSIONS: Messenger app-based information provision did not yield a significant increase in subjective happiness, while there was a positive but not significant trend in life satisfaction. The findings underscore the need for more intensive intervention in future studies to harness the potential of digital interventions.

TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000049047; https://tinyurl.com/2zzrrae8.

PMID:39612209 | DOI:10.2196/57205

J Med Microbiol. 2024 Nov;73(11). doi: 10.1099/jmm.0.001936.

ABSTRACT

Introduction. Obesity is a global health concern, affecting individuals of all ages and genders. One promising strategy to combat obesity is by addressing gut microbiota dysbiosis, with probiotics being a reliable intervention. However, single-strain probiotics may not effectively modulate the complex microbial communities in the gut, suggesting the need for multi-strain approaches.Gap Statement. Probiotics are known to benefit gut health; however, the efficacy of single-strain probiotics in modulating gut microbiota is limited. Multi-strain probiotic community (MSPC) may offer a more effective approach for addressing obesity-related gut dysbiosis, but its specific effects on individuals and microbial diversity require further investigation.Aim. This study aimed to evaluate the potential of a dairy-origin MSPC in modulating obesity-related gut microbiota from lean and obese Pakistani volunteers using a simulated CoMiniGut model.Methodology. Gut microbiota from lean and obese volunteers were treated with MSPC in a simulated CoMiniGut system. Bacterial counts, microbial diversity (α– and β-diversity) and microbial community composition were analysed pre- and post-treatment. The impact of MSPC on specific bacterial genera and microbial metabolites was assessed, with statistical significance determined (P≤0.05).Results. The effect of MSPC was individualized, reducing bacterial counts in lean 1 and lean 2 samples, while significantly increasing bacterial counts in obese 2 and obese 3 samples (P≤0.05). MSPC significantly improved α-diversity in lean 2, lean 3, obese 2 and obese 3 samples (P≤0.05). Proteobacteria decreased in the lean group and increased in the obese group post-MSPC treatment. In the lean group, pathogenic bacteria such as Klebsiella, Escherichia and Enterobacter were significantly reduced (P≤0.05), whereas beneficial bacteria like Bifidobacterium and Lactobacillus increased significantly in the obese group (P≤0.05). Among the selected metabolites, only butanoic acid was detected in all tested samples, with MSPC affecting metabolite concentrations and types.Conclusion. MSPC demonstrated a potential for modulating gut microbiota dysbiosis in both lean and obese individuals, with effects on bacterial counts, microbial diversity and metabolite concentrations. MSPC could serve as a promising option for personalized the modulation of gut microbiota in obesity management.

PMID:39612207 | DOI:10.1099/jmm.0.001936

Hepatol Res. 2024 Nov 29. doi: 10.1111/hepr.14143. Online ahead of print.

ABSTRACT

AIM: The definition of metabolic dysfunction-associated steatotic liver disease (MASLD) has recently been proposed. We aim to investigate the diagnostic efficacy of noninvasive fibrosis markers in predicting liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD), metabolic dysfunction-associated fatty liver disease (MAFLD), and MASLD.

METHODS: This retrospective study involved 2843 patients diagnosed with steatotic liver disease at six tertiary hospitals in South Korea. Liver fibrosis was assessed using vibration-controlled transient elastography, and various noninvasive markers, including the aspartate aminotransferase-to-platelet ratio index (APRI), Fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS), and serum Mac-2-binding protein glycosylation isomer were analyzed.

RESULTS: Among 1106 patients, 79.9% met criteria for NAFLD, MAFLD, and MASLD. The APRI had area under the receiver operating characteristic curve (AUC) values of 0.819, 0.821, and 0.818 for liver fibrosis ≥F2, and 0.819, 0.824, and 0.884 for liver fibrosis ≥F3, and 0.890, 0.884, and 0.889 for fibrosis ≥F4 in NAFLD, MAFLD, and MASLD, respectively. The FIB-4 index showed AUC values of 0.776, 0.793, and 0.778 for fibrosis ≥F2, 0.788, 0.814, and 0.79 for fibrosis ≥F3, and 0.846, 0.859, and 0.856 for fibrosis ≥F4. The APRI consistently had the highest AUC values, except in individuals older than 64 years for fibrosis ≥F4.

CONCLUSIONS: The APRI was the most effective noninvasive fibrosis marker across NAFLD, MAFLD, and MASLD, particularly in age-stratified analyses. Further research is needed to establish standardized cut-off values and enhance the clinical utility of these markers in managing liver fibrosis.

PMID:39612185 | DOI:10.1111/hepr.14143

J Endourol. 2024 Nov 29. doi: 10.1089/end.2024.0091.fts24. Online ahead of print.

ABSTRACT

Background: Scoring metrics are important to compare outcomes of different percutaneous treatments for small renal masses (RMs). The concept of trifecta (no complications, kidney function preservation, and absence of local recurrence) has been recently introduced in percutaneous thermal ablation of RM. In this context, previous studies have shown that cryoablation (CA) and microwave ablation (MWA) have similar outcomes. We aimed to validate the trifecta in CA and MWA and factors associated with treatment success. Materials and Methods: A retrospective comparative analysis of two cohorts was carried out on 190 consecutive patients with RMs treated using percutaneous CA or MWA. Nephrometry scores described RM complexity. Postoperative complications were categorized according to the Clavien-Dindo system. Glomerular filtration rate (GFR) at the last follow-up was calculated through the chronic kidney disease-epidemiology collaboration (EPI) formula, whereas detection of contrast enhancement during follow-up defined local recurrence. Last, trifecta was defined by the combination of no major (Clavien >2) complications, estimation of GFR (eGFR) decline <10%, and absence of local recurrence. Descriptive statistics and logistic regression models tested the association between predictors and trifecta achievement. Factors associated with recurrence were compared by the log-rank test. Results: Of 175 patients, 121 (69.1%) and 54 (30.8%) patients underwent CA and MWA, respectively. Median (interquartile range [IQR]) age and RM diameter were 75 years (66-80) and 2.4 cm (1.8-3.0). The CA group had a lower preoperative GFR but also had a lower rate of comorbidities (both p = 0.01). Other demographics and tumor characteristics were comparable between groups. In the CA and MWA groups, major complications occurred after 1.6% and 4.8% of procedures (p = 0.33), whereas an eGFR decline >10% was found in 31.5% and 38.8% of cases (p = 0.40), respectively. Similarly, in the CA and MWA groups, at a median follow-up of 21 (8-39) and 24 (9.5-36) months, local recurrence was observed after 10 (8.3%) and 5 (9.3%) cases (p = 0.78), trifecta was accomplished after 72 (59.5%) and 32 (59.3%; p = 1.00) procedures, respectively. Of note, recurrence-free survival (RFS) was comparable among groups (p = 0.57). Moreover, trifecta achievement was comparable when stratifying for demographics and tumor characteristics in the whole cohort and in the CA group (p > 0.05). Conversely, logistic regression showed a lower odds ratio (OR) of trifecta for lesions close to renal collecting system treated by MWA, even when accounting for maximum diameter and preoperative GFR (OR 0.21, confidence interval 0.60-0.72, p = 0.010). Of note, this factor was also associated with a significantly lower RFS (log-rank p = 0.002). Conclusions: Both percutaneous CA and MWA of RM can safely accomplish good oncological outcomes while preserving renal function. Approximately 6 out of 10 patients achieved trifecta after each procedure. Patient selection should account for tumor proximity to the collecting system, as this factor seems to impact the outcomes of MWA.

PMID:39612165 | DOI:10.1089/end.2024.0091.fts24

Child Obes. 2024 Nov 29. doi: 10.1089/chi.2024.0340. Online ahead of print.

ABSTRACT

Background: The high prevalence of obesity in Latino families with low income necessitates prevention beginning in pregnancy and continuing through infancy. Due to systemic inequities, adverse social determinants of health (SDoH) and mental health symptoms may limit program efficacy by presenting barriers to attendance. We sought to assess: (1) the feasibility of the Starting Early Program (StEP) Prenatal, a 17-session intervention beginning early in pregnancy and continuing to 18 months postpartum; and (2) the effects of adverse SDoH (material hardship, low social support) and mental health symptoms (depression, anxiety, stress) on program attendance. Methods: We conducted a single-arm feasibility trial of StEP Prenatal, enrolling from December 2018 to February 2020 (n = 231). We assessed feasibility (recruitment, retention, fidelity, attendance) and direct and interactive effects of adverse SDoH and mental health symptoms on attendance. We used zero-inflated Poisson regression, adjusting for maternal age, marital status, nativity, education, and pandemic timing. Results: We recruited 57% of eligible participants, with 213 remaining eligible to receive the full program. Retention was 75%. Median fidelity for group format was 64%; median attendance per session was 69%; median number of program sessions attended was 13. Baseline material hardship and high perceived stress predicted approximately one additional session attended. Similar effects were seen for low social support in the absence of anxiety symptoms. Conclusion: Despite pandemic disruptions, StEP Prenatal was feasible to deliver and participants with adverse SDoH at baseline were particularly motivated to attend. Futures studies should tailor programs to baseline SDoH and test flexible implementation models.

PMID:39612164 | DOI:10.1089/chi.2024.0340

Infection. 2024 Nov 29. doi: 10.1007/s15010-024-02446-z. Online ahead of print.

ABSTRACT

PURPOSE: To explore the role of supplementing vitamin D in the prevention and treatment of tuberculosis infection through a meta-analysis of randomized controlled trials.

METHODS: The databases of PubMed, Cochrane Library, Embase, and Web of Science were systematically searched from inception to April 21, 2024, to identify studies comparing vitamin D supplementation with non-vitamin D supplementation for tuberculosis infection prevention or treatment. The inclusion criteria were randomized controlled trials involving participants diagnosed with either no tuberculosis or tuberculosis, with the intervention group receiving vitamin D supplementation and the control group receiving a placebo or standard treatment, and reporting outcomes related to tuberculosis prevention or treatment effects. The exclusion criteria were studies without full text and those not meeting the specific participant or treatment criteria. The analysis was performed using the Inverse Variance method with a random-effects model. Subgroup analyses were conducted to explore the impact of different administration routes. The stability of the pooled results was assessed using the leave-one-out method. Publication bias was evaluated with Egger’s and Begg’s tests.

RESULTS: We identified a total of 26 eligible trials, involving 19,586 participants. Four trials compared the preventive effects of vitamin D supplementation on tuberculosis infection, and the results (RR 0·75; 95% CI 0·56 to 1·01) were inconclusive. Regarding the role of vitamin D supplementation in anti-tuberculosis treatment, there were no significant statistical differences between the vitamin D and non-vitamin D groups in sputum smear conversion, sputum culture conversion, or time to sputum culture conversion. However, patients in the vitamin D group showed significantly lower Tuberculosis scores at 8 weeks (MD – 0·39; 95% CI -0·57 to -0 22) and 12 weeks (MD – 0·53; 95% CI – 0·84 to – 0·22). There were similar safety profiles between the two groups. Subgroup analysis based on the frequency of vitamin D intake revealed that patients who received daily vitamin D supplementation had higher rates of sputum smear conversion at 6 weeks and 8 weeks. They also had lower TB scores at 8 weeks.

CONCLUSION: Supplementing with vitamin D during anti-tuberculosis treatment does not accelerate the clearance of tuberculosis bacteria, but it can improve patient symptoms.

PMID:39612153 | DOI:10.1007/s15010-024-02446-z