Category: Statistics

JAMA Netw Open. 2024 Oct 1;7(10):e2441765. doi: 10.1001/jamanetworkopen.2024.41765.

ABSTRACT

IMPORTANCE: Cardiovascular disease (CVD) can be recurrent during type 2 diabetes (T2D) progression in this aging population. The effectiveness of sodium-glucose cotransporter 2 inhibitor (SGLT2i) therapy on total (ie, first and subsequent) CVD among patients with T2D in clinical practice remains uncertain.

OBJECTIVE: To analyze the comparative association of SGLT2i vs dipeptidyl peptidase 4 inhibitor (DPP4i) therapy with total CVD among patients with T2D in clinical practice.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used electronic medical records at the National Cheng Kung University Hospital, a leading medical center in Taiwan, from 2015 through 2021. Adult patients with T2D who initiated first use of the study drugs from 2016 through 2019, with up to 6 years of follow-up, were identified.

MAIN OUTCOMES AND MEASURES: The primary outcomes included total composite CVD events and individual CVD subtypes (ie, atrial fibrillation, coronary heart disease, heart failure, stroke, myocardial infarction, and transient ischemic attack). A shared frailty model analysis was used to assess the association of treatment with repeat CVD events. Data from patients at high risk for CVD recurrence were further analyzed. Data were analyzed from September 1, 2022, to December 31, 2023.

RESULTS: Overall, 8384 patients with T2D were identified (mean [SD] age, 63.7 [12.4] years; 4645 [55.4%] male). A total of 1632 propensity score-matched pairs of SGLT2i (mean [SD] age, 57.8 [12.0] years; 673 [41.2%] female and 959 [58.8%] male) and DPP4i (mean [SD] age, 58.2 [12.9] years; 655 [40.1%] female and 977 [59.9%] male) users were included. SGLT2i was associated with reduced total CVD risk vs DPP4i therapy (hazard ratio [HR], 0.82 [95% CI, 0.69-0.98]) but not the first CVD event (with the use of SGLT2i therapy were more prominent for patients at high risk of CVD (ie, HR, 0.70 [95% CI, 0.62-0.80] for individuals with estimated glomerular filtration rate lower than 60 mL/min/1.73 m2; HR, 0.70 [95% CI, 0.64-0.78]; for individuals having any diabetes-related complications; and HR, 0.72 [95% CI, 0.65-0.80] for individuals with a history of CVD) compared with the overall cohort. Among patients at high risk of CVD, greater reduced total CVD burden associated with SGLT2i therapy was observed for women vs men (eg, HR, 0.59 [95% CI, 0.49-0.72] in the subgroup with CVD history).

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with T2D, the use of SGLT2is vs DPP4is was associated with reduced total cardiovascular burden, suggesting that long-term use of this therapy may optimize treatment benefit among patients with chronic CVD. The SGLT2i-associated benefit among patients with high risk of CVD encourages the prioritization of SGLT2i use for these vulnerable individuals.

PMID:39476235 | DOI:10.1001/jamanetworkopen.2024.41765

JAMA Netw Open. 2024 Oct 1;7(10):e2442218. doi: 10.1001/jamanetworkopen.2024.42218.

ABSTRACT

IMPORTANCE: An improved understanding of autism spectrum disorder (ASD) prevalence over time and across the lifespan can inform health care service delivery for the growing population of autistic children and adults.

OBJECTIVE: To describe trends in the prevalence of ASD diagnoses using electronic records data from a large network of health systems in the US.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined annual diagnosis rates in health records of patients in US health systems from January 1, 2011, to December 31, 2022. Eligible individuals were included in the study sample for a given calendar year if they were enrolled in a participating health system for at least 10 months out of the year. Data were extracted from 12 sites participating in the Mental Health Research Network, a consortium of research centers embedded within large, diverse health care systems.

MAIN OUTCOME AND MEASURES: Diagnoses of ASD were ascertained using International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) revision codes. Annual diagnosis rates were calculated as the number of unique members diagnosed, divided by the total members enrolled.

RESULTS: A total of 12 264 003 members were enrolled in 2022 (2 359 359 children aged 0 to 17 years [19.2%]; 6 400 222 female [52.2%]; 93 002 American Indian or Alaska Native [0.8%], 1 711 950 Asian [14.0%], 952 287 Black or African American [7.8%], 2 971 355 Hispanic [24.2%], 166 144 Native Hawaiian or Pacific Islander [1.4%], and 6 462 298 White [52.7%]). The ASD diagnosis rate was greatest among 5-to-8-year-olds throughout the study period and increased by 175% among the full sample, from 2.3 per 1000 in 2011 to 6.3 per 1000 in 2022. The greatest relative increase in diagnosis rate from 2011 to 2022 occurred among 26-to-34-year-olds (450%) and increases were greater for female vs male individuals among children (305% [estimated annual percentage change (EAPC), 13.62 percentage points; 95% CI, 12.49-14.75 percentage points] vs 185% [EAPC, 9.63 percentage points; 95% CI, 8.54-10.72 percentage points], respectively) and adults (315% [EAPC, 13.73 percentage points; 95% CI, 12.61-14.86 percentage points] vs 215% [EAPC, 10.33 percentage points; 95% CI, 9.24-11.43 percentage points]). Relative increases were greater in racial and ethnic minority groups compared with White individuals among children, but not adults.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of children and adults in the US, ASD diagnosis rates increased substantially between 2011 and 2022, particularly among young adults, female children and adults, and children from some racial or ethnic minority groups. Diagnosis prevalence trends generated using health system data can inform the allocation of resources to meet the service needs of this growing, medically complex population.

PMID:39476234 | DOI:10.1001/jamanetworkopen.2024.42218

JAMA Netw Open. 2024 Oct 1;7(10):e2442319. doi: 10.1001/jamanetworkopen.2024.42319.

ABSTRACT

IMPORTANCE: Resting heart rate (RHR) is a widely available measure of cardiovascular fitness that has been associated with several cardiovascular outcomes. RHR has previously been associated with the risk of atrial fibrillation (AF) among individuals of European ancestry, but little is known about this association in Black adults.

OBJECTIVE: To evaluate the association between RHR and incident AF in a large community-based sample of Black adults, independently of established risk factors.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study uses data from the Jackson Heart Study, a prospective community-based cohort in Jackson, Mississippi. Participants without prevalent AF were included and were monitored for new-onset AF during follow-up, from 2000 through 2016. Data analysis was performed from August 1 to December 11, 2023.

EXPOSURE: RHR was assessed from resting 12-lead electrocardiograms performed at examination 1 (2000-2004) and examination 3 (2009-2013).

MAIN OUTCOMES AND MEASURES: AF was identified from study electrocardiograms, hospitalization discharge diagnosis codes, and Medicare claims diagnosis codes. Cox regression was used to evaluate the association between baseline (examination 1) RHR and incident AF, adjusting for established AF risk factors.

RESULTS: Among 4965 Black adults eligible for analysis, the mean (SD) age was 55 (13) years, 1830 (37%) were male, and the mean (SD) RHR at baseline was 65 (11) beats per minute (bpm). During a median (IQR) 14 (12-15) years of follow-up, there were 458 incident AF events, resulting in an incident rate of 7.5 per 1000 person-years (95% CI, 6.8-8.2 incidents per 1000 person-years). Each 10-bpm higher RHR was associated with a 9% higher risk of incident AF after adjustment for AF risk factors (hazard ratio, 1.09; 95% CI, 1.00-1.19). In a sensitivity analysis that excluded individuals with prior heart failure, prior myocardial infarction, and antiarrhythmic medication use at baseline, the hazard ratio was 1.14 (95% CI, 1.02-1.28). There was little evidence of effect modification of these associations by age, sex, body mass index, hypertension, or physical activity level.

CONCLUSIONS AND RELEVANCE: In this large prospective cohort study of Black adults, elevated baseline RHR was associated with increased risk of incident AF, consistent with findings from previous studies of European ancestry populations. Future research should focus on determining whether RHR can be used to screen patients at high risk of AF.

PMID:39476232 | DOI:10.1001/jamanetworkopen.2024.42319

J Neurophysiol. 2024 Oct 30. doi: 10.1152/jn.00298.2024. Online ahead of print.

ABSTRACT

Recent interest in dynamic sound localisation models has created a need to better understand the head movements made by humans. Previous studies have shown that static head positions and small oscillations of the head obey Donders’ law: for each facing direction there is one unique three-dimensional orientation. It is unclear whether this same constraint applies to audiovisual localisation, where head movement is unrestricted and subjects may rotate their heads depending on the available auditory information. In an auditory guided visual search task, human subjects were instructed to localise an audiovisual target within a field of visual distractors in the frontal hemisphere. During this task, head and torso movements were monitored using a motion capture system. Head rotations were found to follow Donders’ law during search tasks. Individual differences were present in the amount of roll that subjects deployed, though there was no statistically significant improvement in model performance when including these individual differences in a gimbal model. The roll component of head rotation could therefore be predicted with a truncated Fick gimbal, which consists of a pitch axis nested within a yaw axis. This led to a reduction from three to two degrees of freedom when modelling head movement during localisation tasks.

PMID:39475488 | DOI:10.1152/jn.00298.2024

Death Stud. 2024 Oct 30:1-12. doi: 10.1080/07481187.2024.2419605. Online ahead of print.

ABSTRACT

Insecure attachment styles have been linked to an increased risk for suicidality, functioning as a distal risk factor for suicide behaviors in adulthood. Studies on the subject are numerous, but heterogeneous in methodology. This study aimed to sensibly group study findings and quantify the magnitude of this relationship. We performed a systematic literature search to select studies investigating insecure adult attachment styles and suicidal ideation and attempt, and present quantitative data that could be pooled into a meta-analysis. Six random-effect meta-analyses were performed, comprising 47 studies with 50,214 individuals. A small effect size association was found for the relationship between suicidal ideation and insecure attachment styles (anxious, avoidant, and fearful); similar findings were found for the relationship between suicide attempt and insecure attachment (Pearson’s r ranged from 0.16 to 0.26, all ps <0.05). The type of attachment measure moderated the association of suicidal ideation with anxious and avoidant attachment.

This review has been preregistered at The International Prospective Register of Systematic Reviews (PROSPERO) – Registration number CRD42023401459.

PMID:39475484 | DOI:10.1080/07481187.2024.2419605

Glob Health Action. 2024 Dec 31;17(1):2401849. doi: 10.1080/16549716.2024.2401849. Epub 2024 Oct 30.

ABSTRACT

BACKGROUND: Abortion stigma as reported globally has been inadequately documented empirically in Nigeria, Africa’s most populous country with a restrictive abortion law and a high rate of unsafe abortions.

OBJECTIVE: The objectives of this study were to investigate the ways in which abortion stigma is experienced by Nigerian health professionals and how such experiences influence health professionals’ practice of safe abortion and post-abortion care.

METHODS: The study utilized qualitative research consisting of in-depth interviews with 10 abortion providers. We elicited information with an open-ended interview guide that investigated the understanding of participants’ experiences of abortion stigma in Nigeria. The data were analysed qualitatively and thematically using Atlas.ti.

RESULTS: The themes centred on perceptions and experiences of stigma among the providers interviewed. Participants’ experiences of abortion stigma included the following: being treated differently to other health professionals; experiencing disapproval and disrespect; name-calling and societal judgement; tagging and profiling of clinics by anti-abortionists; and social isolation. Participants attributed stigma to cultural and religious beliefs, the restrictive national abortion law, and pointed to hypocrisy. Some reported effects of stigma on providers included a feeling of insecurity, social exclusion, secrecy, and insincerity in clinical practice, discouragement, and guilt feelings. Despite the negative impacts, many respondents reported a sense of satisfaction stemming from their views that they were saving lives.

CONCLUSION: Systematic efforts to address these adverse factors could reduce the level of stigma experienced by providers, with a potential follow-through effect of improving women’s access to safe abortion care in Nigeria.

PMID:39475477 | DOI:10.1080/16549716.2024.2401849

J Gerontol Nurs. 2024 Nov;50(11):6-12. doi: 10.3928/00989134-20241014-02. Epub 2024 Nov 1.

ABSTRACT

PURPOSE: The current study explored the association of nursing home (NH) residents’ demographic and clinical attributes and NH characteristics with resident-reported satisfaction with NH communities.

METHOD: Pearson correlations and multiple linear regression were used to test the association of demographic and clinical attributes of residents and NH characteristics with resident-reported NH satisfaction with 197 NH residents from 28 NHs.

RESULTS: Correlational analysis and regressions indicated an association among residents’ demographic and clinical characteristics, NH characteristics, and self-reported NH satisfaction. Higher age, higher education, and race (minority status) were associated with greater resident-reported NH satisfaction. Greater NH staffing and for-profit ownership status were associated with less NH satisfaction. Greater resident depressive symptoms and dressing assistance were associated with lower resident-reported NH satisfaction.

CONCLUSION: Administrators and staff should look beyond NH characteristics and consider their residents’ diverse personal characteristics to create an environment that promotes satisfaction and well-being. [Journal of Gerontological Nursing, 50(11), 6-12.].

PMID:39475472 | DOI:10.3928/00989134-20241014-02

Orthod Craniofac Res. 2024 Oct 30. doi: 10.1111/ocr.12870. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to assess the efficacy of active presurgical orthopaedics appliances in infants presenting with complete unilateral cleft lip and overlapped alveolus (T-shaped alveolus).

MATERIALS AND METHODS: A retrospective and prospective longitudinal study was performed. Infants diagnosed with complete unilateral cleft lip and overlapped alveolus, received treatment with the active presurgical orthopaedics appliances from June 2020 to June 2023, at Children’s Hospital 1, Ho Chi Minh City. The treatment duration averaged 3 months. Pre- and posttreatment casts of noses and alveolus were scanned using TRIOS3 Wireless intraoral scanner (3Shape, Denmark) and analysed with Slicer 5.2.2 software. There were 16 quantitative variables. A pair t-test and Wilcoxon signed ranks were used for analysis. The statistical significance was adopted as p < 0.05.

RESULTS: A total 40 patients (17 males, 23 females, mean age 23.85 ± 19.22 days) were evaluated. After treatment, the nostril height increased by 2.62 ± 0.22 mm and the deviation columella decreased by -23.45° ± 2.29°. There was a reduction in cleft gap (-3.77 ± 2.01 mm), and in the overlap of alveolus (-3.71 ± 1.83 mm), the growth of cleft segment increased by 2.27 ± 2.00 mm, while the rotation of the noncleft side alveolus decreased by -5.29° ± 5.31°. The changes were statistically significant (p < 0.001).

CONCLUSIONS: Active presurgical orthopaedics appliances improved the nasal deformity and overlapped alveolus morphology in infants with complete unilateral cleft lip and T-shaped alveolus.

PMID:39475444 | DOI:10.1111/ocr.12870

Interdiscip Cardiovasc Thorac Surg. 2024 Oct 30:ivae179. doi: 10.1093/icvts/ivae179. Online ahead of print.

ABSTRACT

OBJECTIVES: In some centrally located lung cancers, complete excision of the mass cannot be achieved with parenchymal sparing procedures, and pneumonectomy may be required. The mortality and morbidity rates of pneumonectomy were reported considerably high. Here, we investigated the effectivity of modified frailty index-5 (MFI-5) in patients undergoing pneumonectomy for non-small cell lung cancer (NSCLC).

METHODS: Data of patients who underwent pneumonectomy for NSCLC between January 2018 and December 2023 were reviewed retrospectively. MFI-5 score was determined by preoperative diabetes mellitus, hypertension, chronic obstructive pulmonary diseases, congestive heart failure, and functional status. The effectiveness of the MFI-5 score for the presence of postoperative major complications and 30-day mortality was investigated by multivariate logistic regression analysis. A p-value less than 0.05 was considered statistically significant.

RESULTS: A total of 107 patients who met the inclusion criteria were included in the study. Eight (7,5%) of patients were female, and the mean age was 61,4 ± 8,7. MFI-5 score was 0 in 48 patients (44.9%), 1 in 27 patients (25.2%), and 2 in 20 patients (18.7%). Postoperative 30-day mortality was detected in 4 patients (3,7%), and the major complications occurred in 42 patients (39,3%). In multivariate analysis, an MFI-5 score of 2 or higher (p = 0,008, OR: 4,9) was statistically significant for complications, whereas age, gender, side of operation, less than 2 MFI-5 score, tumour diameter, type of surgery, and lymph node metastasis status were not statistically significant (p > 0,05).

CONCLUSIONS: The MFI-5 score is a significant indicator for predicting major postoperative events in patients who underwent pneumonectomy for NSCLC.

PMID:39475437 | DOI:10.1093/icvts/ivae179

Int J Gynaecol Obstet. 2024 Oct 30. doi: 10.1002/ijgo.15961. Online ahead of print.

ABSTRACT

Arcuate uterus does not impact the success of infertility treatments, but there is no consensus on whether it influences perinatal outcomes. The objective of the present study was to investigate whether minor congenital uterine anomalies such as an arcuate uterus contribute to perinatal complications. This was a retrospective cohort study at a single institution. The study included 1097 deliveries after 22 weeks of gestation. Transvaginal ultrasound, with three-dimensional functionality, assessed uterine morphology based on American Society for Reproductive Medicine criteria. We compared maternal backgrounds and perinatal complications between arcuate uterus and normal uterus groups. Statistical analyses, including multivariate analysis, aimed to identify independent risk factors. A total of 69 patients (7.5%) with diagnosed arcuate uterus were included. Maternal background factors showed no significant differences between groups. In perinatal complications, an arcuate uterus was associated with a significantly higher incidence of preterm delivery (13% versus 4.7%, P = 0.01), preterm premature rupture of membranes (7.2% versus 1.6%, P = 0.01), fetal growth restriction (FGR; 16% versus 6.7%, P = 0.01), and abnormal placental cord insertion (33% versus 7.6%, P < 0.01). After multivariate analysis, arcuate uterus emerged as an independent risk factor for preterm delivery (adjusted odds ratio [aOR], 4.0 [95% confidence interval (CI), 1.6-9.9], P < 0.01), FGR (aOR, 2.6 [95% CI, 1.2-5.6], P = 0.02), and abnormal placental cord insertion (aOR, 6.0 [95% CI, 3.4-10.6], P < 0.01). Arcuate uterus stands as an independent risk factor for preterm delivery, FGR, and abnormal placental cord insertion. The findings emphasize the importance of recognizing even minor uterine morphological abnormalities in assessing and managing perinatal complications.

PMID:39475428 | DOI:10.1002/ijgo.15961