Category: Statistics

J Epidemiol. 2024 Oct 26. doi: 10.2188/jea.JE20240158. Online ahead of print.

ABSTRACT

BACKGROUND: Amidst the global coronavirus disease (COVID-19) pandemic, Japan has faced a significant public health challenge, evident from the significant increase in mortality rates since 2021. This study described the variations in all-cause and cause-specific changes in mortality up to 2022 in Japan.

METHODS: This study used official Vital Statistics from the Ministry of Health, Labour and Welfare (MHLW) to assess the impact of the pandemic on mortality trends. An analysis of all-cause and cause-specific age-standardized mortality rates (ASMRs) from 1995 to 2022 was conducted, employing the 2015 Japan Standard Population. Sex- and cause-specific ASMRs for a particular year were compared with those from the preceding year to assess annual changes.

RESULTS: Among men, the annual all-cause ASMR per 100,000 people increased from 1356.3 in 2021 to 1437.8 in 2022 (6.0% increase). Among women, the annual all-cause ASMR increased from 722.1 in 2021 to 785.8 in 2022 (6.5% increase). Compared with the period 2020 to 2021, COVID-19 (+29.1 per 100,000 people for men and +13.4 per 100,000 people for women), senility (+14.1 per 100,000 people for men and +12.5 per 100,000 people for women), heart disease, malignant neoplasms (for women) and “other causes not classified as major causes” substantially contributed to the increase in all-cause ASMR from 2021 to 2022.

CONCLUSIONS: Further long-term monitoring from 2023 onwards is necessary, especially for conditions like senility, cardiovascular disease, and cancer, which may have long-term effects due to changes in healthcare settings, even though the strong countermeasures against COVID-19 were lifted in 2023.

PMID:39462541 | DOI:10.2188/jea.JE20240158

J Epidemiol. 2024 Oct 26. doi: 10.2188/jea.JE20240297. Online ahead of print.

ABSTRACT

BACKGROUND: This study investigated fundamental demographic variables within the Taiwan Biobank (TWBB) and compared them with national demographic statistics. Additionally, a matched cohort analysis compared TWBB participants with nonparticipants to uncover disparities in sociodemographic and clinical characteristics.

METHODS: A total of 128,663 individuals aged 30 to 70 without cancer were recruited within the TWBB, and 514,652 nonparticipants matched by age and sex were randomly selected from the National Health Insurance claims database. Sociodemographic variables, healthcare utilization metrics, underlying medical conditions, and subsequent mortality and cancer risk were analyzed.

RESULTS: TWBB participants were more likely to be female, older, married, higher educated, with higher incomes, and urban residency. Healthcare utilization metrics showed minimal differences. Pre-cohort entry, TWBB participants had a higher prevalence of certain medical conditions, such as peptic ulcer disease, osteoarthritis, osteoporosis, and uterine leiomyoma in females. During follow-up periods, elevated mortality rates were observed among TWBB participants but decreased cancer risk.

CONCLUSION: The TWBB cohort exhibits disparities in sociodemographic and health-related attributes compared to the general population, comprising older, females, married, higher educated, higher income, and predominantly in urban areas. While mortality rates are slightly elevated within the TWBB cohort, cancer incidence rates are lower. Despite limitations in representativeness, the TWBB’s size and exposure measures offer valuable insights into associations between exposures and health conditions.

PMID:39462540 | DOI:10.2188/jea.JE20240297

J Atheroscler Thromb. 2024 Oct 26. doi: 10.5551/jat.64984. Online ahead of print.

ABSTRACT

AIM: D-dimer, lipoprotein (a) (Lp(a)), and high-sensitivity C-reactive protein (hs-CRP) are known predictors of vascular events; however, their impact on the stroke prognosis is unclear. This study used data from the Third China National Stroke Registry (CNSR-III) to assess their combined effect on functional disability and mortality after acute ischemic stroke (AIS).

METHODS: In total, 9,450 adult patients with AIS were enrolled between August 2015 and March 2018. Patients were categorized based on a cutoff value for D-dimer, Lp(a), and hs-CRP in the plasma. Adverse outcomes included poor functional outcomes (modified Rankin Scale (mRS score ≥ 3)) and one- year all-cause mortality. Logistic and multivariate Cox regression analyses were performed to investigate the relationship between individual and combined biomarkers and adverse outcomes.

RESULTS: Patients with elevated levels of all three biomarkers had the highest odds of functional disability (OR adjusted: 2.01; 95% CI (1.47-2.74); P＜0.001) and mortality (HR adjusted: 2.93; 95% CI (1.55-5.33); P＜0.001). The combined biomarkers improved the predictive accuracy for disability (C-statistic 0.80 vs.0.79, P＜0.001) and mortality (C-statistic 0.79 vs.0.78, P=0.01).

CONCLUSION: Elevated D-dimer, Lp(a), and hs-CRP levels together increase the risk of functional disability and mortality one-year post-AIS more than any single biomarker.

PMID:39462537 | DOI:10.5551/jat.64984

Can J Urol. 2024 Oct;31(5):12004-12012.

ABSTRACT

INTRODUCTION: The evidence on the effectiveness of prehabilitation in patients undergoing bladder cancer surgery remains lacking. Thus, the aim of this study is to determine the effectiveness of prehabilitation on reducing postoperative morbidity and length of hospital stay in patients undergoing bladder cancer surgery.

MATERIALS AND METHODS: This systematic review included randomized controlled trials investigating the effect of prehabilitation on postoperative outcomes in patients undergoing bladder cancer surgery. A comprehensive search was conducted, with two reviewers independently screening articles and extracting data. The Cochrane Collaboration’s tool was used to assess risk of bias, and GRADE to rate the quality of evidence. When possible, a random effects meta-analysis was conducted. Estimates were presented as risk ratios or mean differences with their 95% confidence intervals.

RESULTS: Of the 2764 articles identified, five trials comprising 282 patients met the eligibility criteria. Prehabilitation modalities included preoperative exercise (3), preoperative nutrition (1), and multimodal (1). The mean age of patients ranged from 66.0 to 72.1 years. All included trials presented some or high risk of bias. Pooled analyses according to the different prehabilitation modalities demonstrated low to very low quality of evidence of no effect on postoperative complications and length of hospital stay.

CONCLUSION: This study revealed a small number of trials investigating the effectiveness of prehabilitation on patients undergoing bladder cancer surgery. Whether prehabilitation, including preoperative exercise, nutrition and multimodal interventions reduce postoperative morbidity and length of hospital stay following bladder cancer surgery is uncertain, as the quality of evidence is very low.

PMID:39462531

Circulation. 2024 Oct 27. doi: 10.1161/CIRCULATIONAHA.124.072009. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate bleeding risk stratification after percutaneous coronary intervention (PCI) is important for treatment individualization. However, there is still an unmet need for a more precise and standardized identification of high bleeding risk patients. We derived and validated a novel bleeding risk score by augmenting the PRECISE-DAPT score with the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria.

METHODS: The derivation cohort comprised 29,188 patients undergoing PCI, of whom 1136 (3.9%) had a Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding at 1 year, from four contemporary real-world registries and the XIENCE V USA trial. The PRECISE-DAPT score was refitted with a Fine-Gray model in the derivation cohort and extended with the ARC-HBR criteria. The primary outcome was BARC 3 or 5 bleeding within 1 year. Independent predictors of BARC 3 or 5 bleeding were selected at multivariable analysis (p<0.01). The discrimination of the score was internally assessed with apparent validation and cross-validation. The score was externally validated in 4578 patients from the MASTER DAPT trial and 5970 patients from the STOPDAPT-2 total cohort.

RESULTS: The PRECISE-HBR score (age, estimated glomerular filtration rate, hemoglobin, white-blood-cell count, previous bleeding, oral anticoagulation, and ARC-HBR criteria) showed an area under the curve (AUC) for 1-year BARC 3 or 5 bleeding of 0.73 (95% CI, 0.71-0.74) at apparent validation, 0.72 (95% CI, 0.70-0.73) at cross-validation, 0.74 (95% CI, 0.68-0.80) in the MASTER DAPT, and 0.73 (95% CI, 0.66-0.79) in the STOPDAPT-2, with superior discrimination than the PRECISE-DAPT (cross-validation: Δ AUC, 0.01; p=0.02; MASTER DAPT: Δ AUC, 0.05; p=0.004; STOPDAPT-2: Δ AUC, 0.02; p=0.20) and other risk scores. In the derivation cohort, a cut-off of 23 points identified 11,414 patients (39.1%) with a 1-year BARC 3 or 5 bleeding risk ≥4%. An alternative version of the score, including acute myocardial infarction on admission instead of white-blood-cell count, showed similar predictive ability.

CONCLUSIONS: The PRECISE-HBR score is a contemporary, simple 7-item risk score to predict bleeding after PCI, offering a moderate improvement in discrimination over multiple existing scores. Further evaluation is required to assess its impact on clinical practice.

PMID:39462482 | DOI:10.1161/CIRCULATIONAHA.124.072009

Swiss Med Wkly. 2024 Sep 4;154:3836. doi: 10.57187/s.3836.

ABSTRACT

INTRODUCTION: The transition from paediatric to adult medical care is a critical period for adolescents with spina bifida, often marked by deteriorating health and functional status.

OBJECTIVES: To describe the health status and functioning of individuals with spina bifida at the time of transition from paediatric to adult care and to identify risk profiles for potentially modifiable secondary health conditions (urinary tract infections, pressure injuries, respiratory problems and obesity).

METHODS: Descriptive study of data (derived from medical records) from all adolescents and young adults with spina bifida aged 15-25 years who were referred to a single specialised spinal cord injury centre as part of the transition programme during the period from 1 September 2015 to 31 May 2022. Descriptive statistics were used to describe the study population and to analyse the frequency and co-occurrence of congenital and acquired secondary health conditions. The equality of proportions test was used to test the prevalence of secondary health conditions based on important personal and clinical characteristics.

RESULTS: We included 43 adolescents with spina bifida with a mean age of 18.4 years (SD 2.5); in 63% of them the neurological level was lumbar, and around 50% of them were wheelchair-dependent. The median Spinal Cord Injury Measure (SCIM) III score was 72 (IQR 61-89). The mean number of secondary health conditions at time of transition was 8.8. The most prevalent secondary health conditions were lower urinary tract dysfunction, bowel dysfunction, sexual dysfunction and contractures. Respiratory problems were more prevalent in females and in individuals with lower SCIM III scores, whereas no differences were observed in the prevalence of other modifiable secondary health conditions. Clustering of secondary health conditions was mainly seen for urinary tract infection + pressure injury and for urinary tract infection + pressure injury + obesity.

CONCLUSION: The prevalence of secondary health conditions among individuals with spina bifida at time of transition is alarmingly high and functional profiles underscore the need for supporting adolescents and young adults with daily medical issues. The study highlights the critical role of transition programmes and interdisciplinary follow-up care in preventing health problems and improving functioning and independence in everyday life.

PMID:39462478 | DOI:10.57187/s.3836

Swiss Med Wkly. 2024 Sep 2;154:3773. doi: 10.57187/s.3773.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has placed unprecedented pressure on hospitals worldwide. In such a context of tension in healthcare systems, efficiently allocating hospital resources is a crucial aspect of crisis management. The aim of this study was to describe the clinical characteristics of readmitted patients and to determine risk factors for hospital readmission using data from the Swiss COVID-19 Hospital-Based Surveillance system (CH-SUR).

METHODS: We investigated hospital readmissions within 60 days after discharge of patients from the CH-SUR surveillance system with a first hospitalisation between 1 December 2020 and 1 December 2021. Only community-acquired cases were considered. We compared the baseline characteristics of readmitted and non-readmitted patients. We performed univariable and multivariable logistic regression analyses to investigate the risk factors for hospital readmission.

FINDINGS: Of the 8039 eligible patients, 239 (3.0%, 95% confidence interval [CI] 2.6-3.3%) were readmitted to hospital within 60 days of discharge, with no significant variations observed over the study period; 80% of all readmissions occurred within 10 days of discharge of the index hospital stay. Based on our multivariable logistic regression models, factors increasing the odds of hospital readmission were age ≥65 years (odds ratio [OR] 1.63, 95% CI 1.24-2.15), male sex (OR 1.47, 95% CI 1.12-1.93), being discharged to home after first hospitalisation (OR 1.77, 95% CI 1.19-2.62), having oncological pathology (OR 1.82, 95% CI 1.27-2.61) and being immunosuppressed (OR 2.34, 95% CI 1.67-3.29).

INTERPRETATIONS: Age, sex, cardiovascular diseases, oncological pathologies and immunosuppression were the main risk factors identified for hospital readmission.

PMID:39462475 | DOI:10.57187/s.3773

Int J Dent Hyg. 2024 Oct 27. doi: 10.1111/idh.12862. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to assess the selection and sequence of dental hygiene instruments taught during dental hygiene pre-clinical education in the United States.

METHODS: Exempt status was received from the University of New Mexico’s IRB (ID 21-336). A survey was developed with questions to be answered involving decisions for clinical teaching and sequencing on various assessment and implementation instruments during pre-clinic education. The instrument was 11 questions with multiple choice, ranking and short answer. A survey link was included through email invitation and successfully sent to 301 accredited dental hygiene programme directors in the United States. Results were collected and analysed through descriptive statistics.

RESULTS: Forty-three of the invited participants completed the survey, a 14% response rate. Almost half (n = 24) of the participants chose to teach the periodontal probe first and 19 chose the explorer. Twenty-five participants selected they teach the sickle scalers first, 14 teach the universal curette scalers first and 4 teach the Gracey curette scalers first. All participants teach electronically powered scalers with 33 teaching after hand instrumentation and 8 before.

CONCLUSIONS: Results from this study emphasise that educators teach clinical instrumentation from professional opinion, but no attestation specifically suggests the use of evidence-based pedagogical standards for clinical teaching. Dental hygiene programmes could benefit from further research on pre-clinic instrument selection and sequencing as a way of standardised clinical teaching. These clinical implications could advance the science for standardised teaching of clinical instrumentation and sequencing in dental hygiene education.

PMID:39462462 | DOI:10.1111/idh.12862

Dev Med Child Neurol. 2024 Oct 27. doi: 10.1111/dmcn.16136. Online ahead of print.

ABSTRACT

AIM: To determine school attendance and its predictors among children with cerebral palsy (CP) in Bangladesh using population-based data.

METHOD: This study utilized data from the Bangladesh Cerebral Palsy Register (BCPR), a population-based register of children with CP aged less than 18 years in Bangladesh. Sociodemographic, clinical, and educational data were documented, and descriptive statistics and multivariate regression analyses were used to identify potential predictors of school attendance.

RESULTS: Between January 2015 and January 2019, 2725 children with CP were registered into BCPR of which 1582 were school-aged children (i.e. aged 6-18 years). The majority of those children had not attended school (73.9%); 50% (n = 239) children in Gross Motor Function Classification System (GMFCS) levels I to II did not attend schools. Adjusted odds ratios (OR) showed significantly higher odds of school attendance among children whose mothers had completed secondary education or higher (adjusted OR: 2.2; 95% confidence interval [CI]: 1.2-4.0) and received rehabilitation (adjusted OR: 2.1; 95% CI: 1.4-3.1). Conversely, lower odds of school attendance were observed among children aged 15 to 18 years (adjusted OR: 0.4; 95% CI: 0.2-0.8), those with bilateral CP (adjusted OR: 0.5; 95% CI: 0.3-0.8), GMFCS levels III to V (adjusted OR: 0.3; 95% CI: 0.2-0.5), Manual Ability Classification System levels III to V (adjusted OR: 0.5; 95% CI: 0.4-0.8), and speech impairment (adjusted OR: 0.3; 95% CI: 0.2-0.6).

INTERPRETATION: A large number of children with CP in Bangladesh, including half of those with milder forms, do not attend schools. These findings underscore a deficiency in awareness and support, encompassing the provision of resources and trained teachers, highlighting the necessity for policy-level changes. Sociodemographic and clinical predictors should be taken into account when devising educational programmes to enhance school attendance for children with CP in Bangladesh.

PMID:39462437 | DOI:10.1111/dmcn.16136

Neurorehabil Neural Repair. 2024 Oct 27:15459683241292615. doi: 10.1177/15459683241292615. Online ahead of print.

ABSTRACT

BACKGROUND: Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) protocols targeting primary motor cortex (M1) are used in rehabilitation of neurological diseases for their therapeutic potential, safety, and tolerability. Although lower intensity LF-rTMS can modulate M1 neurophysiology, results are variable, and a systematic assessment of its dose effect is lacking.

OBJECTIVES: To determine the dose-response of LF-rTMS on stimulated and non-stimulated M1.

METHODS: In a sham-controlled randomized double-blind crossover study the effect of LF-TMS protocols were determined in 20 right-handed older healthy participants. In 3 sessions, 1 Hz rTMS at 80% (rTMS₈₀), 90% (rTMS₉₀) of motor threshold or sham stimulation were applied to left upper extremity M1. Outcome measures were curve parameters of the stimulus-response curve (maximum motor evoked potential [MEP_MAX], slope and the intensity to evoke 50% MEP_MAX), short-interval intracortical inhibition (SICI), and interhemispheric inhibition (IHI).

RESULTS: Within LF-rTMS sessions, rTMS₉₀, increased MEP_MAX in the stimulated M1. Furthermore, rTMS₉₀, increased the slope in the non-stimulated M1. LF-rTMS effects on SICI were dependent on the participants’ baseline SICI, hemisphere, and intensity of conditioning pulse. Finally, rTMS₉₀ increased whereas rTMS₈₀ decreased IHI, for both IHI directions. These changes were dependent on baseline IHI and hemisphere and were no longer significant when baseline IHI was accounted for.

CONCLUSIONS: Intensity of subthreshold LF-rTMS has differential effects on excitation and inhibition of stimulated and non-stimulated M1. The effects were small and were only demonstrated within the LF-rTMS sessions but were not different when compared to sham. rTMS related changes in SICI and IHI were dependent on baseline level.

CLINICALTRIALS.GOV IDENTIFIER: NCT02544503, NCT01726218.

PMID:39462433 | DOI:10.1177/15459683241292615