Category: Statistics

Crit Care. 2024 Nov 22;28(1):381. doi: 10.1186/s13054-024-05180-y.

ABSTRACT

BACKGROUND: Pneumonia remains a significant global health concern, particularly among those requiring admission to the intensive care unit (ICU). Despite the availability of international guidelines, there remains heterogeneity in clinical management. The D-PRISM study aimed to develop a global overview of how pneumonias (i.e., community-acquired (CAP), hospital-acquired (HAP), and Ventilator-associated pneumonia (VAP)) are diagnosed and treated in the ICU and compare differences in clinical practice worldwide.

METHODS: The D-PRISM study was a multinational, survey-based investigation to assess the diagnosis and treatment of pneumonia in the ICU. A self-administered online questionnaire was distributed to intensive care clinicians from 72 countries between September to November 2022. The questionnaire included sections on professional profiles, current clinical practice in diagnosing and managing CAP, HAP, and VAP, and the availability of microbiology diagnostic tests. Multivariable analysis using multiple regression analysis was used to assess the relationship between reported antibiotic duration and organisational variables collected in the study.

RESULTS: A total of 1296 valid responses were collected from ICU clinicians, spread between low-and-middle income (LMIC) and high-income countries (HIC), with LMIC respondents comprising 51% of respondents. There is heterogeneity across the diagnostic processes, including clinical assessment, where 30% (389) did not consider radiological evidence essential to diagnose pneumonia, variable collection of microbiological samples, and use and practice in bronchoscopy. Microbiological diagnostics were least frequently available in low and lower-middle-income nation settings. Modal intended antibiotic treatment duration was 5-7 days for all types of pneumonia. Shorter durations of antibiotic treatment were associated with antimicrobial stewardship (AMS) programs, high national income status, and formal intensive care training.

CONCLUSIONS: This study highlighted variations in clinical practice and diagnostic capabilities for pneumonia, particularly issues with access to diagnostic tools in LMICs were identified. There is a clear need for improved adherence to existing guidelines and standardized approaches to diagnosing and treating pneumonia in the ICU. Trial registration As a survey of current practice, this study was not registered. It was reviewed and endorsed by the European Society of Intensive Care Medicine.

PMID:39578900 | DOI:10.1186/s13054-024-05180-y

Int J Equity Health. 2024 Nov 22;23(1):246. doi: 10.1186/s12939-024-02324-y.

ABSTRACT

BACKGROUND: The prevalence of gender disparities in physical, mental, and cognitive disorders among elderly hypertensive individuals in rural areas remains unclear. This study evaluates these disparities and the factors contributing to multimorbidity in this demographic.

METHODS: A face-to-face survey was conducted from July 1 to August 31, 2023, involving the hypertensive population registered with the National Basic Public Health Service Program in Jia County. Physical disorder was defined as having one or more self-reported chronic conditions other than hypertension. Participants experiencing anxiety or depression were as having a psychological disorder. The 9-item Patient Health Questionnaire (PHQ-9) was used to assess depression symptomatology, and anxiety symptoms were evaluated using the 7-item Generalized Anxiety Disorder questionnaire (GAD-7). Cognitive disorders were assessed using the Brief Mental Status Examination Scale (MMSE). Multifactorial logistic regression models were used to analyze factors affecting different disorder combinations in both genders. The net difference in multimorbidity prevalence between genders was determined using the propensity score matching (PSM).

RESULTS: Out of 18,447 hypertensive individuals aged 65 years and above (42.28% men), the prevalence of multimorbidity was 30.64% in men and 38.67% in women. Outcomes included seven categories: physical disorders, psychological disorders, cognitive disorders, and four different combinations of these disorders. The primary outcome was the presence of two or more disorders. The prevalence of physical, psychological, and cognitive disorders and their four combinations were higher in women than in men; Key factors influencing multimorbidity risk included subjective health status, illness duration, medication history, blood pressure control, and lifestyle behaviors in both men and women. Post-PSM analysis revealed that women had a 6.74% higher multimorbidity prevalence than men.

CONCLUSIONS: Physical, psychological, and cognitive disorders, along with their various multimorbid combinations, significantly impact the elderly hypertensive population. Prioritizing a healthy lifestyle is essential to mitigate multimorbidity risks. Considering that the prevalence of multimorbidity is higher in women than in men with hypertension, sufficient sleep, maintaining a healthy waist circumference, and medication adherence are vital for managing blood pressure and reducing multimorbidity risks.

PMID:39578886 | DOI:10.1186/s12939-024-02324-y

Crit Care. 2024 Nov 22;28(1):382. doi: 10.1186/s13054-024-05158-w.

ABSTRACT

BACKGROUND: Traumatic rhabdomyolysis (RM) is common and associated with the development of acute kidney injury and potentially with other organ dysfunctions. Thus, RM may increase the risk of death. The primary objective was to assess the effect of severe RM (Creatine Kinase [CK] > 5000 U/L) on 30-day mortality in trauma patients using a causal inference approach.

METHODS: In this multicenter cohort study conducted in France using a national major trauma registry (Traumabase) between January 1, 2012, and July 1, 2023, all patients admitted to a participating major trauma center hospitalized in intensive care unit (ICU) and with CK measurement were included. Confounding variables for both 30-day mortality and exposure were used to establish a propensity score. A doubly robust approach with inverse treatment weighting enabled the calculation of the average treatment effect on the treated (ATT). Analyses were performed in the overall cohort as well as in two subgroups: hemorrhagic shock subgroup (HS) and traumatic brain injury subgroup (TBI). Sensitivity analyses were conducted.

RESULTS: Among the 8592 patients included, 1544 (18.0%) had severe RM. They were predominantly males (78.6%) with median [IQR] age of 41 [27-58] years and severely injured (ISS 20 [13 – 29]) mainly from blunt trauma (90.8%). In the entire cohort, the ATT, expressed as a risk difference, was 0.073 [-0.054 to 0.200]. Considering the 1311 patients in the HS subgroup, the ATT was 0.039 [0.014 to 0.063]. As in the overall cohort, there was no effect on mortality in the TBI subgroup. Severe RM was associated with greater severity of trauma and more complications (whether related to renal function or not) during the ICU stay. Mortality due to multiorgan failure (39.9% vs 12.4%) or septic shock (2.6% vs 0.8%) was more frequent among patients with severe RM.

CONCLUSIONS: Severe RM was not associated with 30-day mortality considering the overall cohort. However, it was associated with a 4.0% increase in 30-day mortality among patients with concurrent hemorrhagic shock. Severe RM plays a significant role in ICU morbidity.

PMID:39578880 | DOI:10.1186/s13054-024-05158-w

Semin Arthritis Rheum. 2024 Nov 16;70:152592. doi: 10.1016/j.semarthrit.2024.152592. Online ahead of print.

ABSTRACT

Chronic musculoskeletal pain (CMP) poses a widespread health and socioeconomic problem, being the most prevalent chronic pain condition. Interdisciplinary multimodal pain treatment (IMPT) is considered the gold standard, offering cost-effective long-term care. Unfortunately, only a subset of patients experiences clinically relevant improvements in pain, fatigue, and disability post-IMPT. Establishing a prediction model encompassing various outcome measures could enhance rehabilitation and personalized healthcare. Thus, the aim was to develop and validate a prediction model for IMPT success in patients with CMP. A prospective cohort study within routine care was performed, including patients with CMP undergoing a 10-week IMPT. Success across four outcome measures was determined: patients’ recovery perspective, quality of life (physical and mental), and disability. Sixty-five demographic and candidate predictors (mainly patient reported outcome measures) were examined. Finally, 2309 patients participated, with IMPT success rates ranging from 30% to 57%. Four models incorporating 33 predictors were developed, with treatment control being the sole consistent predictor across all models. Additionally, predictors effects varied in direction in the models. All models demonstrated strong calibration, fair to good discrimination, and were internally validated (optimism-corrected AUC range 0.69-0.80). Our findings show that treatment success can be predicted using standardized patient-reported measures, exhibiting strong discriminatory power. However, predictors vary depending on the outcome, underscoring the importance of selecting the appropriate measure upfront. Clinically, these results suggest potential for patient-centered care and may contribute to the development of a scientifically sound decision tool.

PMID:39577031 | DOI:10.1016/j.semarthrit.2024.152592

Forensic Sci Int. 2024 Nov 19;366:112304. doi: 10.1016/j.forsciint.2024.112304. Online ahead of print.

ABSTRACT

Skeletonized human remains from Second World War mass graves in Slovenia are a major challenge in genetic identification, and bones with a high DNA yield must be selected for successful identification. The goal of this study was to construct skeletal sampling strategy recommendations through comparison of the most appropriate groups of skeletal elements. Altogether, 566 bones and teeth from the same mass grave were compared, half analyzed in this study and half in previous studies performed by our group. After anthropological examination, mechanical and chemical cleaning was performed, followed by bone and tooth powdering. Total demineralization of 0.5 g of bone and tooth was followed by extraction and purification of DNA with a Biorobot EZ1 device (Qiagen). The qPCR PowerQuant kit (Promega) was used to measure the amount of DNA, and statistical analysis was performed. Skeletal elements were selected according to known better preservation of DNA in the human body, and they were arranged in seven groups: petrous bone, long bones (femur and tibia), torso bones (first rib and 12th vertebra), metacarpals, metatarsals, short and sesamoid bones (talus, navicular, medial cuneiform, cuboid, calcaneus, and patella), and teeth. Sampling strategy recommendations were constructed based on DNA quantity and quality results. The petrous bone group, metacarpal group, torso bone group, and short and sesamoid bone group produced the highest DNA yields. Accordingly, in addition to standard sampling of long bones (femurs and tibias) and teeth, those additional bone types should be collected for Slovenian Second World War victim identification.

PMID:39577023 | DOI:10.1016/j.forsciint.2024.112304

Res Dev Disabil. 2024 Nov 21;155:104881. doi: 10.1016/j.ridd.2024.104881. Online ahead of print.

ABSTRACT

BACKGROUND: Restrictive repetitive behaviors (RRBs) and sensory processing disorders are core symptoms of autism spectrum disorder (ASD). Their relationship is reported, but existing data are conflicting as to whether they are related but distinct, or different aspects of the same phenomenon.

AIMS: This study investigates this relationship using artificial neural networks (ANN) analysis and an innovative data mining analysis known as Auto Contractive Map (Auto-CM), which allows to discover hidden trends and associations among complex networks of variables (e.g. biological systems).

METHODS AND PROCEDURES: The Short Sensory Profile and the Repetitive Behavior Scale-Revised were administered to 45 ASD children’s caregivers (M 78 %; F 22 %; mean age 6 years). Questionnaires’ scores, clinical and demographic data were collected and analyzed applying Auto-CM, and a connectivity map was drawn.

OUTCOMES AND RESULTS: The main associations shown by the resulting maps confirm the known relationship between RBBs and sensory abnormalities, and support the existence of sensory phenotypes, and important links between RRBs and sleep disturbance in ASD.

CONCLUSIONS AND IMPLICATIONS: Our study demonstrates the usefulness of ANNs application and its easy handling to research RBBs and sensory abnormalities in ASD, with the aim to achieve better individualized rehabilitation technique and improve early diagnosis.

PAPER’S CONTRIBUTION: Restricted, repetitive patterns of behaviors and interests and alteration of sensory elaboration are core symptoms of ASD; their impact on patients’ quality of life is known. This study introduces two main novelties: 1) the simultaneous and comparative use of two parent questionnaires (SSP and RBS-R) utilized for RRBs and alteration of sensory profile; 2) the application of ANNs to this kind of research. ANNs are adaptive models particularly suited for solving non-linear problems. While they have been widely used in the medical field, they have not been applied yet to the analysis of RRBs and sensory abnormalities in general, much less in children with ASD. The application of Auto Contractive Map (Auto-CM), a fourth generation ANNs analysis, to a dataset previously explored using classical statistical models, confirmed and expanded the associations emerged between SSP and RBS-R subscales and demographic-clinical variables. In particular, the Low Energy subscale has proven to be the central hub of the system; interesting links have emerged between the subscale Self-Injurious Behaviors and the variable intellectual disability and between sleep disturbance and various RRBs. Expanding research in this area aims to guide and modulate an emerging targeted and personalized rehabilitation therapy.

PMID:39577022 | DOI:10.1016/j.ridd.2024.104881

Nurse Educ Today. 2024 Nov 19;145:106499. doi: 10.1016/j.nedt.2024.106499. Online ahead of print.

ABSTRACT

BACKGROUND: The nursing profession has experienced a growing influx of international nursing students pursuing nursing degrees in the current era. Predicting and controlling culture shock among this special group is a critical issue as it shapes their academic engagement. Building resilience capabilities among this set of students is a pivotal necessity to buffer the effect of culture shock on their academic engagement.

OBJECTIVE: To explore the relationship between culture shock and academic engagement among international nursing students, and investigate the moderating effect of resilience on this relationship.

DESIGN: Cross-sectional correlational study.

SETTING: Three faculties of nursing at Egypt.

PARTICIPANTS: A total of 252 international nursing students were assessed for eligibility. Twelve students were excluded, and out of the 240 respondents to the survey, 233 responses were valid and were ultimately analyzed.

METHODS: A hand-delivered anonymous questionnaire in Arabic and English that consisted of four parts was used to collect the data. It included students’ characteristics and relevant data, the culture shock questionnaire, the academic resilience scale, and the university student engagement inventory. The data collection spans from the beginning of November 2023 to the end of December 2023. Descriptive statistics, correlation analysis, and linear regression were employed via SPSS and Process Macro to test the hypothetical relationships among the study variables.

RESULTS: There was a significant negative correlation between culture shock and the academic engagement of international nursing students. Culture shock and resilience are powerful predictors of their academic engagement. The moderating effect of resilience on the relationship between culture shock and the academic engagement of international nursing students was statistically significant, making it less negative.

CONCLUSION: Culture shock is an inevitable phenomenon among international nursing students and has a negative effect on their academic engagement and performance. This negative effect could be buffered by maximizing the resilience capabilities of this set of students.

PMID:39577017 | DOI:10.1016/j.nedt.2024.106499

Rev Med Inst Mex Seguro Soc. 2024 Sep 2;62(5):1-11. doi: 10.5281/zenodo.12668072.

ABSTRACT

Health systems require instruments that allow the generation of real, concrete, specific and objective information that can be named, classified, shared and compared internationally. Nowadays, this premise is possible, thanks to the specific and particular characteristics of information technologies needs in health, the speed in the generation of knowledge, the technological changes in telecommunications and its current development. However, there are areas of opportunity in information systems that make difficult this paradigm. Many of these areas are in the hands of health professionals themselves, who work directly with primary sources of information. Given this panorama, by applying an awareness and measurement tool, we can contribute to identifying areas of opportunity in order to favor the adequate recording of information, mainly hospital discharges, which has an impact on the biased and incorrect generation of morbidity statistics and hospital mortality, the diversion of financial, human, and material resources and, of course, the impossibility of implementing hospital management tools such as diagnostic related groups (DRG). It is interesting that in order for certain areas of opportunity to occur, in this case those related to the clinical record, it is investigated the feeling that each worker has about the work environment in their organization, that is to say, about the work environment, if they feel taken into account, trained, fed back, valued and part of the positive change in their work environment so that they feel motivated to do their work in accordance with regulations.

PMID:39577016 | DOI:10.5281/zenodo.12668072

Rev Med Inst Mex Seguro Soc. 2024 Sep 2;62(5):1-9. doi: 10.5281/zenodo.12668066.

ABSTRACT

BACKGROUND: Gender-based violence (GBV) is a widely underestimated issue in middle-income countries. Despite the fact that there is documented evidence of its existence, it is unknown the frequency and perception of GBV in primary care. Understanding this is crucial for the development of intervention strategies that can mitigate the impact of GBV in these communities.

OBJECTIVE: To determine the frequency and perception of GBV in women attending a primary care clinic in the North of Mexico.

MATERIAL AND METHODS: A descriptive, observational, and cross-sectional survey study was conducted on female adults, beneficiaries from a family medical unit. Demographic data were collected, and the VIDOFyP questionnaire (Domestic Violence: Frequency and Perception Inventory) was used to assess the frequency and perception of GBV in different domains. Results were compared according to demographic variables, using the JASP software.

RESULTS: A total of 385 women with an average age of 44.2 years were surveyed. Social violence was the most common, followed by psychological and economic violence. The perception of severity was highest for physical violence. Significant differences in the perception of violence were found based on marital status, with separated women reporting higher levels in various domains.

CONCLUSIONS: GBV must be addressed in different domains, especially in separation contexts. The results provide valuable information for developing interventions and policies aimed at preventing and supporting women in vulnerable situations.

PMID:39577010 | DOI:10.5281/zenodo.12668066

R I Med J (2013). 2024 Dec 2;107(12):30-35.

ABSTRACT

BACKGROUND: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities experience significant health disparities related to sexual health, including sexually transmitted infections (STIs). Improved access to culturally congruent primary care and sexual health services, including HIV/STI prevention and care, are needed. We describe how we developed a new community-based LGBTQ+ primary care clinic and implemented safety-net sexual health and STI screening and care services in Providence, Rhode Island.

METHODS: Open Door Health in Providence, Rhode Island, was started in 2020 to improve access to HIV/STI care and prevention services, primary care, and gender- affirming care for the LGBTQ+ community. We reviewed demographics and behaviors of patients presenting for STI screening services from February 2021 to October 2023 at the clinic. Bivariate and multivariate analyses were used to evaluate demographics and behaviors among patients testing positive for HIV and other STIs.

RESULTS: A total of N=1,633 people presented for STI screening. Of these, 56% were 30 years or younger, 65% identified as male, 24% as female, and 9% as non-binary or gender diverse. Forty-three percent were MSM, 19% were Black/African American (B/AA), and 22% were Hispanic/Latino (H/L). Seventy-one percent reported two or more partners in the last three months. The prevalence of STIs was 22.3% (4.4% syphilis, 7.5% gonorrhea, and 9.7% chlamydia). Those who tested positive for an STI were more likely to be B/AA (23.3% of B/AA individuals versus 15.9% of White, p<0.05), H/L (23.1% versus 17.4%, p<0.05), and MSM (25% versus 16.9%, p<0.05).

CONCLUSION: Open Door Health provides important safety-net STI services for the LGBTQ+ community. Individuals presenting for services had a high prevalence of HIV/STIs. Improved approaches are needed for HIV/STI care and prevention in this group, including among B/AA and H/L communities.

PMID:39576999