Category: Statistics

BMC Emerg Med. 2024 Nov 16;24(1):215. doi: 10.1186/s12873-024-01134-3.

ABSTRACT

BACKGROUND: Non-life-threatening cases treated by emergency services have been increasing in recent years, especially in older people. In a region in Germany with approximately 600,000 inhabitants, the role of a specially trained community paramedic (Gemeindenotfallsanitäter, G-NFS) was introduced in 2019. The G-NFS is dispatched to low-acuity requests, attends the assignment alone and is allowed to treat patients at home.

AIM: The aim of this study was to analyse the assignments attended by the G-NFS relating to the suspected diagnoses, with a focus on older people (≥ 65 years) according to their care setting.

METHODS: In this descriptive, retrospective study, we analysed the anonymous assignment report forms 07/2023-12/2023 of cases where patients were aged ≥ 65 years. The suspected diagnoses (free text field) were categorised according to the International Classification of Primary Care 2nd Edition (ICPC-2) scheme. Furthermore, baseline characteristics, urgency of the assignment, provided measures, transport and further treatment were analysed, stratified by care setting.

RESULTS: Of the 1,643 included anonymous assignment report forms, 52.9% (n = 869) related to patients aged ≥ 65 years. In this population, the mean age was 80.7 years (SD 8.2), 49.6% were female and most were in long-term care, whether as home care recipients (34.8%) or as nursing home residents (26.9%). The most frequent diagnoses were categorised as urological (24.9%), general and unspecified (13.7%), circulatory (13.6%), digestive (12.8%), musculoskeletal (11.5%) and respiratory (10.3%). In 52.7% of the cases no transport was necessary, while 73.7% of urological cases did not need to be transported.

CONCLUSION: The G-NFS was dispatched mainly to older people. Most of them were in long-term care and were not transported. The most common suspected diagnoses were categorised as urological, followed by general and unspecified, and circulatory, and differed by care setting. There is a strong need to strengthen outpatient healthcare structures for low-acuity health issues in older and immobile patients.

PMID:39550591 | DOI:10.1186/s12873-024-01134-3

BMC Med Educ. 2024 Nov 16;24(1):1319. doi: 10.1186/s12909-024-06252-x.

ABSTRACT

BACKGROUND: Sex- and gender-based medicine (SGBM) addresses differences between males/men and females/women with regard to clinical manifestation, diagnostics, treatment and outcomes of diseases. The implementation of SGBM in the medical curriculum varies, and data on the knowledge of lecturers and students about SGBM is scarce. This study aims to evaluate the perceived importance and knowledge of SGBM among lecturers and students.

METHODS: This cross-sectional observational survey was conducted using a questionnaire, including ranked with a Likert Scale. Statistical analysis was performed with the Chi-squared test. All lecturers and students at the Bern University Medical School in Switzerland were invited to voluntarily participate.

RESULTS: 114 (34.1%) lecturers and 903 (41.4%) students participated in the survey. Women perceived education of SGBM to be of greater importance than men in lecturer and student subgroups respectively (lecturers women vs. men median 6.0 vs. 5.0, P = 0.011; students 6.0 vs. 5.0, P < 0.001). No significant differences between genders of self-reported knowledge of SGBM were found (lecturers women vs. men median 4.0 vs. 4.0, P = 0.624; students 3.0 vs. 4.0, P = 0.562). There were significant differences in the perception of the SGBM being actively addressed in lectures between lecturers and students (59.4% vs. 28.8%, P < 0.001) and whether the curriculum should include SGBM (strongly agree 28.9% vs. 51.3%, P < 0.001).

CONCLUSION: Women lecturers and students consider teaching of SGBM during medical studies to be more important than men. Lecturers perceived the amount of SGBM already included in the lectures to be greater compared to students.

PMID:39550584 | DOI:10.1186/s12909-024-06252-x

BMC Psychiatry. 2024 Nov 16;24(1):816. doi: 10.1186/s12888-024-06267-0.

ABSTRACT

INTRODUCTION: Problematic gaming (PG) is a serious issue among adolescents worldwide, and there is evidence suggesting that school bullying behaviors may be associated with increased rates of PG. This study aimed to examine the associations between school bullying behaviors and PG among adolescents, with a focus on sex effects.

METHODS: A total of 20,197 participants were recruited from the 2023 School-based Chinese Adolescents Health Survey. Information about school bullying behaviors and PG was measured. Sampling weights were utilized to estimate the prevalence, and weighted logistic regression models were executed. Stratified analyses by sex were performed.

RESULTS: Among Chinese adolescents, the weighted prevalence of PG was 4.2%, 8.1% were identified as victims, 1.8% as bullies, and 3.4% as bully-victims. A higher frequency of school bullying behaviors corresponds to a higher prevalence of PG. After adjusting for covariates, victims (AOR = 1.34, 95% CI = 1.03-1.73), bullies (AOR = 2.08, 95% CI = 1.39-3.11), and bully-victims (AOR = 2.75, 95% CI = 2.09-3.61) were associated with PG. Moreover, the severity of PG tended to increase with the number of involved in school bullying behaviors. The interaction terms of bully-victims and sex were significant. Further stratified analyses by sex indicated that the association of school bullying behaviors with PG was stronger for females than males, especially those identified as bully-victims.

CONCLUSION: School bullying behaviors are associated with PG among adolescents, with a stronger association found in female adolescents, particularly those identified as bully-victims. These findings suggest that implementing prevention and control measures for school bullying could help reduce PG among adolescents.

PMID:39550573 | DOI:10.1186/s12888-024-06267-0

BMC Psychol. 2024 Nov 16;12(1):669. doi: 10.1186/s40359-024-02162-1.

ABSTRACT

BACKGROUND: Exposure to pesticides in the living environment can be associated with the prevalence of health symptoms. This study investigates associations between health symptoms among residents in areas with fruit crop fields where pesticides are applied, and psychological perceptions and attitudes about environmental aspects and exposures.

METHODS: A cross-sectional survey combined with routine primary care electronic health records (EHR) data was conducted in 2017 in rural areas of the Netherlands with high concentration of fruit crops (n = 3,321, aged ≥ 16 years). Individual exposure to pesticides was estimated using geocoded data on fruit crops around the home. Validated instruments were used to assess symptom report and psychological perceptions and attitudes. Annual prevalence of various health symptoms was derived from EHRs. Multilevel regression models were used to analyze associations between health symptoms (outcome), fruit crops, and multiple psychological perceptions and attitudes (confounders).

RESULTS: Living in the vicinity of fruit crop fields was generally not associated with self-reported symptom duration and general practitioner (GP) registered symptoms. For self-reported symptoms, symptom prevalence decreased when crop density within 250 m and 500 m from the home increased. No associations were found at other distances. Furthermore, higher levels of environmental worries, perceived exposure, and perceived sensitivity to pesticides and attribution of symptoms to environmental exposures were generally associated with a higher number of self-reported symptoms, and longer symptom duration. Symptoms reported to GPs were not associated with psychological perceptions and attitudes, except for perceived sensitivity to pesticides.

CONCLUSION: Psychological perceptions and attitudes appear to be related to self-reported symptoms, but not to GP-registered symptoms, independent of the actual levels of exposure as measured by the size of the area of crop fields. Perceptions about environmental factors should be taken into account in environmental health risk assessment research when studying health symptoms.

PMID:39550569 | DOI:10.1186/s40359-024-02162-1

BMC Gastroenterol. 2024 Nov 16;24(1):412. doi: 10.1186/s12876-024-03510-6.

ABSTRACT

BACKGROUND: This systematic review and meta-analysis aimed to evaluate the impact of perioperative immunonutrition on postoperative outcomes in patients undergoing pancreaticoduodenectomy (PD).

METHODS: Conducted a comprehensive search in PubMed, Embase, Cochrane Library, Medline, and Web of Science databases to identify all randomized controlled trials (RCTs) on the topic of immunonutrition and PD. Subsequently screened literature, extracted data, and assessed the risk of bias in the included studies, and finally conducted a meta-analysis using RevMan 5.3 software.

RESULTS: The analysis included a total of 10 RCTs with 574 patients, among whom 288 were in the immunonutrition group and 283 in the control group. The meta-analysis revealed a significantly lower incidence of postoperative infection-related complications (OR = 0.45; 95% CI: 0.27-0.74; P = 0.002) and severe postoperative complications (OR = 0.61; 95% CI: 0.38-0.98; P = 0.04) in the immunonutrition group compared to the control group. Additionally, patients in the immunonutrition group had a significantly shorter length of hospital stay (MD= -1.87; 95%CI -3.29 – -0.44; P = 0.01). However, the analysis revealed no statistically significant difference in the overall complication rate between the two groups (P = 0.67). Furthermore, the incidence of specific complications and perioperative mortality rates also did not demonstrate any statistically significant differences (all P > 0.05).

CONCLUSIONS: Perioperative immunonutrition in PD patients can reduce postoperative infection-related complications, but more high-quality RCTs are needed for further validation.

PMID:39550568 | DOI:10.1186/s12876-024-03510-6

BMC Geriatr. 2024 Nov 16;24(1):955. doi: 10.1186/s12877-024-05515-y.

ABSTRACT

BACKGROUND: Adverse drug reactions are more prevalent in geriatric patients and are frequently associated with a range of polypharmacy-related issues as well as some physiological aging-related alterations. These affect the pharmacokinetic and pharmacodynamic properties of drugs. This study aimed to assess the magnitude of ADRs and their contributing factors among geriatric patients admitted at Comprehensive Specialized Hospitals of the Amhara Region.

METHODS: A multicenter prospective cohort study was carried out from May 2023 to August 2023 on geriatric patients admitted to four randomly selected comprehensive hospitals in the Amhara region. We used logistic regression to find the factors influencing the occurrence of ADRs. A P value of less than 0.05 was deemed statistically significant.

RESULTS: During the study’s follow-up period, 373 patients in total were included. An incidence rate of 31.10% (95% CI: 26.38-35.82) was obtained from the identification of 121 ADRs in total. The organ most frequently affected by ADRs was the gastrointestinal tract (28.92%), followed by the cardiovascular system (19.01%), and the drug class most often implicated in ADRs was antibiotics (21.49%), then anticoagulants (12.40%). ADRs were substantially linked to being overweight (P < 0.001), having been hospitalized in the previous six months (P = 0.000), and hyperpolypharmacy (p = 0.047). 93.39% of all ADRs received the interventions. 85.12% of the adverse drug reactions were successfully resolved.

CONCLUSIONS: This study found that over one-third of older people and individuals admitted to the hospital experienced ADRs. Overweight, hyperpolypharmacy, and patients who had previously been admitted during the preceding six months were significantly linked with the occurrence of ADRs. Improving the drug safety of elderly patients, particularly those who are admitted, should be a greater priority for healthcare professionals.

PMID:39550566 | DOI:10.1186/s12877-024-05515-y

Syst Rev. 2024 Nov 16;13(1):282. doi: 10.1186/s13643-024-02704-z.

ABSTRACT

BACKGROUND: Men who have sex with men (MSM) are disproportionately affected by sexually transmitted infections (STI) including Neisseria gonorrhoeae (Ng) and Chlamydia trachomatis (Ct). The lack of robust data on STIs among African MSM has limited the development of evidence-based screening strategies. This study aimed at documenting the pooled prevalence of Ng/Ct among MSM in sub-Saharan Africa (SSA).

METHODS: This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) 2020 guidelines. Relevant articles from the following databases were searched: PubMed, Scopus, ISI Web of Science, and the Directory of Open Access Journals (DOAJ). Eligible studies reported on the prevalence of Ng/Ct among the MSM population in SSA. Publication bias was assessed using the Hoy tool, Doi plot, and LFK ratio. Due to heterogeneity among studies, subgroup analyses were performed using the MetaXL add-on tool for Microsoft Excel.

RESULTS: Of 525 articles screened, 20 were selected for inclusion. Six were cross-sectional, four had a prospective cohort study design, and one was an epidemiological study. The pooled prevalence of Ng/Ct in MSM was 27% (95% CI, 19-39%), with an I² of 98% signifying heterogeneity among the studies. Subgroup analysis by country revealed South Africa had the highest prevalence (38%).

DISCUSSION: Interpretation The high prevalence of Ng/Ct infection among MSM in SSA is of concern. Limitations Due to limited data available on Ng/Ct prevalence, the true prevalence of SSA and its associated risk factors is uncertain.

CONCLUSION: As the first study to systematically review the available literature on STI prevalence among the MSM population in SSA, it showed the burden of Ng/Ct is higher than in other regions, warranting the strengthening of health systems to improve education, testing, and treatment in MSM population.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022327095.

PMID:39550563 | DOI:10.1186/s13643-024-02704-z

BMC Cancer. 2024 Nov 16;24(1):1416. doi: 10.1186/s12885-024-13166-w.

ABSTRACT

BACKGROUND AND OBJECTIVES: Currently, research on the role of B cells in esophageal cancer (EC) is limited, and existing studies on their impact are controversial. Therefore, this study was conducted to elucidate the complex causal relationship between B cells and EC, expand the understanding of esophageal cancer immunology.

METHODS: Bidirectional two-sample Mendelian randomization (MR) was performed to assess the causal relationships between 190 B cell phenotypes and EC. To complement the MR analysis, Bayesian Weighted Mendelian Randomization (BWMR) was employed, and sensitivity analyses were conducted to evaluate the robustness of the findings. Positive results were further validated in independent cohorts of esophageal cancer studies. In addition, RNA sequencing (RNA-seq) data from The Cancer Genome Atlas (TCGA) were utilized for validation, incorporating B cell-related gene expression analysis and functional enrichment analysis to support the MR findings.

RESULTS: In the primary analysis, significant causal relationships were observed between 5 B cell types and the risk of EC; the onset of EC was causally linked to 3 B cell phenotypes. Validation in other cohorts revealed that 4 outcomes aligned with the primary analysis, included were CD19 on IgD + CD38-, CD20 on IgD- CD27-, CD20 on IgD- CD38br, and CD38 on PB/PC. Further validation using RNA-seq data showed that CD38 mRNA was significantly overexpressed in EC tissues, whereas CD19 and MS4A1 mRNA levels did not differ significantly between tumor and normal tissues. Functional enrichment analysis revealed that CD19, MS4A1, and CD38 are involved in multiple tumor-related immune pathways, suggesting their pivotal role in regulating the tumor immune microenvironment.

CONCLUSIONS: Our study suggests a potential connection between B cell phenotypes and EC through bidirectional two-sample MR combined with BWMR analysis, providing a preliminary basis for future research.

PMID:39550560 | DOI:10.1186/s12885-024-13166-w

BMC Pulm Med. 2024 Nov 16;24(1):570. doi: 10.1186/s12890-024-03396-w.

ABSTRACT

PURPOSE: Patients with alpha-1 antitrypsin deficiency (AATD) often experience substantial delays from the onset of symptoms to a diagnosis. We explored the impact of delayed diagnosis of AATD on healthcare costs and utilization by assessing costs/utilization before and after diagnosis.

METHODS: Retrospective claims data was used to conduct a longitudinal analysis of a cohort of patients with follow-up over four years in a commercial claims database was conducted. Patients with at least four years of claims experience between the years 2011 – 2017 were included in this study. Outcome measures were calculated for each year (Year 1 pre-index diagnosis, and Years 1, 2, and 3 post-index follow-up). Measures included healthcare costs (pharmacy and medical costs), medical costs, inpatient events, and emergency room visits. Unadjusted measures in the follow-up Year 1, Year 2, and Year 3 were compared to Year 1 pre-index. A separate multivariate analysis adjusting for age, sex, and comorbidities was conducted.

RESULTS: Among 1258 patients, mean adjusted healthcare costs were significantly higher in Year 1 post-index compared to Year 1 pre-index ($51,785 vs $41,441, p = < 0.05). In Year 2 ($36,937 vs $41,441, p = < 0.05) and 3 ($28,558 vs $41,441, p = < 0.05) post-index, mean adjusted healthcare costs decreased compared to Year 1 pre-index. Adjusted medical costs were similar in Year 1 ($25,034) post-index compared to Year 1 ($22,952) pre-index but were significantly lower in Year 2 ($15,242 vs $25,034, p = < 0.05) and Year 3 ($8,779 vs $25,034, p = < 0.05) post-index. The frequency of inpatient and emergency room events was significantly lower in all three observation periods following diagnosis in the unadjusted analysis. The adjusted analysis showed similar findings, except for emergency room visits, which were similar across all observation periods.

CONCLUSION: Patients with AATD had substantial healthcare costs/utilization in the year before diagnosis. Costs were significantly higher in the first year following diagnosis. However, subsequent years showed cost reductions to levels below pre-diagnosis. These data support the need for strategies to reduce the time from symptom onset to diagnosis.

PMID:39550556 | DOI:10.1186/s12890-024-03396-w

BMC Cancer. 2024 Nov 16;24(1):1415. doi: 10.1186/s12885-024-13186-6.

ABSTRACT

BACKGROUND: Cancer cells alter their metabolic phenotypes with nutritional change. Single agent approaches targeting mitochondrial metabolism in cancer have failed due to either dose limiting off target toxicities, or lack of significant efficacy in vivo. To mitigate these clinical challenges, we investigated the potential utility of repurposing FDA approved mitochondrial targeting anthelmintic agents, niclosamide, IMD-0354 and pyrvinium pamoate, to be combined with GLUT1 inhibitor BAY-876 to enhance the inhibitory capacity of the major metabolic phenotypes exhibited by tumors.

METHODS: To test this, we used breast cancer cell lines MDA-MB-231 and 4T1 which exhibit differing basal metabolic rates of glycolysis and mitochondrial respiration, respectively. Metabolic characterization was carried out using Seahorse XFe96 Bioanalyzer and statistical analysis was carried out via ANOVA.

RESULTS: Here, we found that specific responses to mitochondrial and glycolysis targeting agents elicit responses that correlate with tested cell lines basal metabolic rates and fuel preference, highlighting the potential to cater metabolism targeting treatment regimens based on specific tumor nutrient handling. Inhibition of GLUT1 with BAY-876 potently inhibited glycolysis in both MDA-MB-231 and 4T1 cells, and niclosamide and pyrvinium pamoate perturbed mitochondrial respiration that resulted in potent compensatory glycolysis in the cell lines tested.

CONCLUSION: In this regard, combination of BAY-876 with both mitochondrial targeting agents resulted in inhibition of compensatory glycolysis and subsequent metabolic crisis. These studies highlight targeting tumor metabolism as a combination treatment regimen that can be tailored by basal and compensatory metabolic phenotypes.

PMID:39550554 | DOI:10.1186/s12885-024-13186-6