Category: Statistics

Alzheimer Dis Assoc Disord. 2024 Nov 7. doi: 10.1097/WAD.0000000000000647. Online ahead of print.

ABSTRACT

INTRODUCTION: Dementia can adversely affect the quality of life (QoL) of family members/partners of those affected. Measuring this often-neglected burden is critical to planning and providing appropriate support services. This study measures this impact using the Family-Reported Outcome Measure (FROM-16).

METHODS: A large UK cross-sectional online study through patient research platforms, recruited family members/partners of people with dementia, to complete the FROM-16.

RESULTS: Totally, 711 family members/partners (mean age=58.7 y, SD=12.5; females=81.3%) of patients (mean age=81.6, SD=9.6; females=66.9) with dementia completed the FROM-16. The FROM-16 mean total score was 17.5 (SD=6.8), meaning “a very large effect” on QoL of family members, with females being more adversely impacted.

CONCLUSIONS: Dementia profoundly impacts the QoL of family members/partners of patients. Routine use of FROM-16 could signpost provision of care support, reducing family members’ burnout. Such routine data could be used in economic analysis of the burden of dementia as well as in predicting institutionalization.

PMID:39506214 | DOI:10.1097/WAD.0000000000000647

Clin Implant Dent Relat Res. 2024 Nov 6. doi: 10.1111/cid.13404. Online ahead of print.

ABSTRACT

BACKGROUND: Dental implants made of zirconia (ZrO₂) are a potential alternative for titanium implants in dentistry because of their good biocompatibility, mechanical properties and excellent aesthetic results. However, solid long-term scientific data to prove clinical success of ZrO₂ implants are scarce.

AIM: The aim of this study was to describe and to examine the clinical performance of custom-made two-piece ZrO₂ implants, to identify possible influencing factors: a) manipulation of the implant after placement and b) the occlusal scheme on the survival rate, and to evaluate the performance of the implant-supported crown. This follow-up study collected and examined the 5-year data to answer the main question: What are the survival and the success rates of custom-made ZrO₂ implants in the maxillary premolar region after 5 years?

MATERIAL AND METHODS: Of the 31 included patients in this prospective 5-year follow-up single-arm clinical trial, 30 received a custom-made ZrO₂ implant to replace a missing single maxillary premolar, which was subsequently restored with a lithium disilicate crown. Parameters regarding clinical performance, marginal bone-level (MBL) changes, and patient-related outcome measures (PROMs) were assessed preoperatively, at the baseline, as well as 1 and 5 years after crown placement. Chances of survival and success of the implant were calculated and displayed using Kaplan-Meier statistics. Kaplan-Meier survival analysis was also performed with stratification based on the variables “manipulation of the implant prior to impression taking” and “occlusal scheme” and compared using log-rank tests. Bone-level moderation in time was compared using a paired samples t-test. Patient’s expectations and satisfaction after 5 years were compared as a measure of fulfilled expectations, using a Wilcoxon signed-rank test. Performance of the implant-supported crowns was evaluated using validated criteria.

RESULTS: Survival and success probabilities after 5 years were, respectively, 75.8% (95% CI [60.0%; 91.0%]) and 71.0% (95% CI [54.0%; 88.0%]) for the custom-made ZV3 implants. No significant differences in survival rate were found after stratification on “manipulation of the implant” and on “occlusal scheme.” Mean bone-level alteration between baseline and the first follow-up was +0.06 mm (95% CI [-0.23 mm; 0.12 mm]; SD = 0.42 mm) and between baseline and the second follow-up was +0.04 mm (95% CI [-0.35 mm; 0.26 mm]; SD = 0.54 mm). Patients’ satisfaction for patients with implants still in function after 5 years was 91.7% (IQR = [90.5%-97.3%]), indicating satisfaction with the treatment. Pooled satisfaction in patients with successful implants after 5 years was significantly higher than patients’ expressed expectations before treatment. None of the crowns failed, and no interventions were required.

CONCLUSION AND CLINICAL IMPLICATIONS: Survival rate of these particular ZV3 implants in our study was lower than expected and clinically not acceptable. Hence, ZV3 implant placement as applied in this study cannot be recommended for clinical practice. Further research on the different appearances of mechanical failure in ZrO₂ implants would be highly recommended before a larger prospective randomized clinical trial is conducted to evaluate treatment with custom-made ZrO₂ dental implants.

PMID:39506212 | DOI:10.1111/cid.13404

BMC Med Educ. 2024 Nov 6;24(1):1270. doi: 10.1186/s12909-024-06257-6.

ABSTRACT

BACKGROUND: Traditional methods of training in ultrasound technology make it difficult for postgraduate reproductive medicine students to rapidly develop into doctors who can perform clinical examinations independently. It is necessary to explore an efficient method for ultrasound training. The purpose of this study was to investigate whether the step-by-step (SBS) teaching improves the ultrasound diagnosis and clinical work level of reproductive medicine graduate students.

METHODS: A total of fifty postgraduate reproductive medicine students who participated in ultrasound room training were selected at random and divided into two groups: a traditional teaching control group and a stepwise teaching experimental group. A comparison was subsequently conducted between the two groups in terms of theoretical level, skill operation, comprehensive ability and teaching evaluation.

RESULTS: In terms of theory, skills, and comprehensive assessment, the experimental group exhibited superior performance compared to the control group (P < 0.05). The experimental group rated the instructors’ teaching ability and methods significantly better than did the control group (P < 0.05). The experimental group’s overall satisfaction with the training was better than that of the control group, but the difference was not statistically significant (P > 0.05).

CONCLUSIONS: The stepped teaching model has the potential to facilitate the acquisition of clinical ultrasound detection and diagnostic techniques by postgraduate reproductive medicine students, thereby enhancing their overall competence and satisfaction with the teaching process.

PMID:39508256 | DOI:10.1186/s12909-024-06257-6

BMC Public Health. 2024 Nov 6;24(1):3064. doi: 10.1186/s12889-024-20557-y.

ABSTRACT

BACKGROUND: Obesity rates among children and adults continue to accelerate in the U.S., particularly among marginalized and low-income populations. Obesity prevention and reduction policies can significantly impact population health by improving environmental conditions and increasing access to health-promoting resources. Limited research has been conducted to examine state obesity policy change over time. The primary aim of this study is to examine legislative approaches used to prevent and reduce obesity in the state of California (U.S.).

METHODS: We used quantitative policy surveillance methods to develop a state database of obesity-related legislation (bills, resolutions) introduced in California’s legislature between 1999 and 2020. Descriptive statistics were used to examine trends of introduced and enacted policy by legislative and policy characteristics. Chi-square tests were used to determine differences in characteristics between enacted and non-enacted legislation. Legislative session and policy characteristics found to be associated with enactment were used to predict adoption in a logistic regression.

RESULTS: A total of 284 obesity-related bills and resolutions were introduced in California’s legislature between 1999 and 2020 with a peak of 43 in 2005-2006. On average, 25.8 bills and resolutions were introduced each 2-year legislative cycle. Findings indicate that (a) children and schools were the most frequently specified population and setting; (b) the most common policy topics were nutrition (45%) and physical activity (33%); and (c) only 15% of legislation mentioned race/ethnicity. Overall, 24.9% of bills were enacted compared to 82.1% of resolutions adopted. Legislation to raise awareness about obesity had 5.4 times the odds of being passed compared to other topics. Yet this difference was not statistically significant in a sensitivity analysis when we excluded resolutions.

CONCLUSIONS: This database can be leveraged to advance our knowledge of effective and equitable policy instruments to prevent and reduce obesity. Results reveal important policy elements that may impact legislative success, including policy topic, and contribute to a nascent evidence base for public health law research, legal epidemiology, and practice. Future work should investigate the role of policy effectiveness research and evidence on legislative policymaking.

PMID:39508251 | DOI:10.1186/s12889-024-20557-y

J Neuroinflammation. 2024 Nov 6;21(1):290. doi: 10.1186/s12974-024-03282-6.

ABSTRACT

BACKGROUND: Chronic ethanol exposure (CEE) is recognized as an important risk factor for depression, and the gut-brain axis has emerged as a key mechanism underlying chronic ethanol exposure-induced anxiety and depression-like behaviors. Short-chain fatty acids (SCFAs), which are the key metabolites generated by gut microbiota from insoluble dietary fiber, exert protective roles on the central nervous system, including the reduction of neuroinflammation. However, the link between gut microbial disturbances caused by chronic ethanol exposure, production of SCFAs, and anxiety and depression-like behaviors remains unclear.

METHODS: Initially, a 90-day chronic ethanol exposure model was established, followed by fecal microbiota transplantation model, which was supplemented with SCFAs via gavage. Anxiety and depression-like behaviors were determined by open field test, forced swim test, and elevated plus-maze. Serum and intestinal SCFAs levels were quantified using GC-MS. Changes in related indicators, including the intestinal barrier, intestinal inflammation, neuroinflammation, neurotrophy, and nerve damage, were detected using Western blotting, immunofluorescence, and Nissl staining.

RESULTS: Chronic ethanol exposure disrupted with gut microbial homeostasis, reduced the production of SCFAs, and led to anxiety and depression-like behaviors. Recipient mice transplanted with fecal microbiota that had been affected by chronic ethanol exposure exhibited impaired intestinal structure and function, low levels of SCFAs, intestinal inflammation, activation of neuroinflammation, a compromised blood-brain barrier, neurotrophic defects, alterations in the GABA system, anxiety and depression-like behaviors. Notably, the negative effects observed in these recipient mice were significantly alleviated through the supplementation of SCFAs.

CONCLUSION: SCFAs not only mitigate damage to intestinal structure and function but also alleviate various lesions in the central nervous system, such as neuroinflammation, and reduce anxiety and depression-like behaviors, which were triggered by transplantation with fecal microbiota that had been affected by chronic ethanol exposure, adding more support that SCFAs serve as a bridge between the gut and the brain.

PMID:39508236 | DOI:10.1186/s12974-024-03282-6

J Neurosurg. 2024 Jan 16;141(1):10-16. doi: 10.3171/2023.9.JNS231616. Print 2024 Jul 1.

ABSTRACT

OBJECTIVE: A sustainable neurosurgery workforce depends on robust training pipelines, but the size and distribution of the global neurosurgery trainee workforce has not been described. The objective of this study was to identify the types of training programs that exist in the global neurosurgery workforce, the support that trainees receive, the diversity of trainee experiences, and the accreditation processes that exist to regulate training programs.

METHODS: This study was a subanalysis of a cross-sectional survey administered online in all 193 countries and 26 territories, independent states, and disputed regions as defined by the World Bank and United Nations. Participants were identified through neurosurgery society leadership, the personal contacts of the coauthors, and bibliometric and search engine searches. Population-weighted statistics were constructed and segregated by country income level and WHO regions.

RESULTS: Data were obtained for 187 countries (96.9%) and 25 additional territories, states, and disputed regions (96.2%). There were an estimated 1261 training programs and 10,546 trainees within the regions sampled, representing a global pooled density of 0.14 neurosurgery trainees per 100,000 people and a median national density of 0.06 trainees per 100,000 people. There was a higher density in high-income countries (HICs; 0.48 trainees per 100,000 people) compared with upper-middle-income countries (0.09 per 100,000), lower-middle-income countries (0.06 per 100,000), and low-income countries (LICs; 0.07 per 100,000). The WHO European (0.36 per 100,000) and Americas (0.27 per 100,000) regions had the highest trainee densities, while the Southeast Asia (0.04 per 100,000) and African (0.05 per 100,000) regions had the lowest densities. Among countries with training programs, LICs had the poorest availability of subspecialty training and resources such as cadaver laboratories and conference stipends for trainees. Training program accreditation processes were more common in HICs (81.8%) than in low- and middle-income countries (LMICs; 69.2%) with training programs.

CONCLUSIONS: The authors estimate that there are at least 1261 neurosurgery training programs with 10,546 total trainees worldwide. The density of neurosurgery trainees was disproportionately higher in HICs than LMICs, and the WHO European and Americas regions had the highest trainee densities. The trainee workforce in LICs had the poorest access to subspecialty training and advanced resources.

PMID:39508227 | DOI:10.3171/2023.9.JNS231616

S Afr Med J. 2024 Oct 3;114(10):e2035.

ABSTRACT

BACKGROUND: Adverse events are common, and impact patients and healthcare systems negatively. Large international systems investigate adverse events at length, but South African data are lacking.

OBJECTIVES: To classify all adverse events that have occurred in our department over the last decade.

METHODS: Ten years of data from a prospectively collated electronic medical record system were analysed for adverse events. All admitted patients were included. Duplicate entries and those that did not describe adverse events were excluded.

RESULTS: The study period was from December 2012 to January 2023. There were 52 835 distinct admissions covering 321 385 inpatient days. After categorisation, a total of 14 537 adverse events were captured, giving an adverse event rate of 22%. Adverse events were categorised into four groups. Of the total, 8 027 events were clinical care related, 3 106 were pathology related, 2 662 were system related and 442 miscellaneous. A total of 300 were excluded. Clinical care-related adverse events comprised 57.3% of the total number. Of those, adverse events related to indwelling devices (32.4%), iatrogenic injuries (12.5%) and intravenous therapy administration (12.5%) contributed most. Pathology-related adverse events contributed 21.4% of the total, of which wound sepsis (29.5%), anastomotic leak (15.1%) and nosocomial pneumonia (14.4%) were the most common. There was a general downward trend in reported adverse events from 2016 to 2022.

CONCLUSION: Adverse events are common, and their aetiology is multifactorial. A sustained and multi-faceted approach is needed to address the challenge they pose.

PMID:39508226

Adv Clin Exp Med. 2024 Nov 7. doi: 10.17219/acem/193367. Online ahead of print.

ABSTRACT

BACKGROUND: Out-of-hospital cardiac arrests (OHCA) are a major global health concern, occurring frequently worldwide. Obesity may impact outcomes in OHCA patients.

OBJECTIVES: This study aimed to assess the impact of obesity on the return of spontaneous circulation (ROSC) in OHCA patients, considering sex differences.

MATERIAL AND METHODS: A retrospective cohort study was conducted, analyzing medical records of patients assisted by the Emergency Medical System (EMS) in Poland from January 2021 to June 2022. The study included 33,636 patients with OHCA. Obesity status was determined using ICD-10 codes (E66) and descriptive diagnoses recorded by EMS teams.

RESULTS: Univariate analysis indicated that obesity decreased the odds of ROSC by 25.47% (odds ratio (OR) = 0.75, 95% confidence interval (95% CI): 0.61-0.92) in women and by 19.76% (OR = 0.80, 95% CI: 0.66-0.97) in men. However, multivariate analysis, adjusting for confounding variables, did not confirm a statistically significant impact of obesity on ROSC outcomes. The likelihood of ROSC was significantly higher in individuals with an initial ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) rhythm compared to Asystole/pulseless electrical activity (PEA), being 4.204 times higher in women (95% CI: 3.525-5.014) and 3.655 times in men (95% CI: 3.320-4.023). Out-of-hospital cardiac arrest in a public place increased the odds of ROSC more than twofold for both sexes (women: OR = 2.20, 95% CI: 2.00-2.43; men: OR = 2.13, 95% CI: 1.98-2.29). Among women without obesity, hypertension decreased the odds of ROSC by 11.11% (OR = 0.89, 95% CI: 0.81-0.99).

CONCLUSIONS: Our study demonstrated that obesity was not an independent predictor of ROSC in OHCA patients. Different predictors of ROSC were identified for men and women. Initial VF/pVT rhythm, location of OHCA and age were the significant factors influencing ROSC.

PMID:39508211 | DOI:10.17219/acem/193367

Biom J. 2024 Dec;66(8):e202300203. doi: 10.1002/bimj.202300203.

ABSTRACT

In practical survival analysis, the situation of no event for a patient can arise even after a long period of waiting time, which means a portion of the population may never experience the event of interest. Under this circumstance, one remedy is to adopt a mixture cure Cox model to analyze the survival data. However, if there clearly exhibits an acceleration (or deceleration) factor among their survival times, then an accelerated failure time (AFT) model will be preferred, leading to a mixture cure AFT model. In this paper, we consider a penalized likelihood method to estimate the mixture cure semiparametric AFT models, where the unknown baseline hazard is approximated using Gaussian basis functions. We allow partly interval-censored survival data which can include event times and left-, right-, and interval-censoring times. The penalty function helps to achieve a smooth estimate of the baseline hazard function. We will also provide asymptotic properties to the estimates so that inferences can be made on regression parameters and hazard-related quantities. Simulation studies are conducted to evaluate the model performance, which includes a comparative study with an existing method from the smcure R package. The results show that our proposed penalized likelihood method has acceptable performance in general and produces less bias when faced with the identifiability issue compared to smcure. To illustrate the application of our method, a real case study involving melanoma recurrence is conducted and reported. Our model is implemented in our R package aftQnp which is available from https://github.com/Isabellee4555/aftQnP.

PMID:39508209 | DOI:10.1002/bimj.202300203

J Interpers Violence. 2024 Nov 7:8862605241293802. doi: 10.1177/08862605241293802. Online ahead of print.

ABSTRACT

This study assessed physical intimate partner violence (IPV) experiences and examined their association with unmet healthcare needs among married women in South Korea. We analyzed data from a nationally representative longitudinal survey of 6,533 women at baseline. Participants were asked yes/no questions about their experiences of physical IPV victimization and perpetration over the past year. The responses were classified into four categories of IPV experience: “none,” “victimization only,” “perpetration only,” and “both victimization and perpetration.” At baseline, 0.9% reported being victimized only, and 25.9% reported both victimization and perpetration. The prevalence of unmet healthcare needs over the past year at baseline was 0.8%. Compared to women without any IPV experience, women in the IPV “victimization only” category had greater unmet healthcare needs (OR: 5.49, 95% CI [2.30, 13.12]) after adjusting for sociodemographic variables. Experiencing IPV perpetration only and both IPV victimization and perpetration were not statistically significantly associated with unmet healthcare needs. These results imply that physical IPV victims face difficulties accessing healthcare services which could exacerbate health inequalities over time. Moreover, this study suggests that it is necessary to distinguish IPV victims from those who experience IPV victimization only and those who experience both IPV victimization and perpetration.

PMID:39508207 | DOI:10.1177/08862605241293802