Category: Statistics

Arq Gastroenterol. 2024 Oct 21;61:e24047. doi: 10.1590/S0004-2803.24612024-047. eCollection 2024.

ABSTRACT

BACKGROUND: •Due to the invasive nature of the liver biopsy, there is a growing interest in the use of non-invasive markers of liver fibrosis.

BACKGROUND: •There is a significant and positive correlation between APRI.

BACKGROUND: FIB-4 and platelet count and liver stiffness measurement evaluated by transient elastography in pediatric autoimmune hepatitis.

BACKGROUND: There is limited evidence focusing on the use of non-invasive markers to assess liver fibrosis in pediatric chronic liver diseases.

OBJECTIVE: The aim of the study was to evaluate the correlation between liver stiffness measurement (LSM) using transient liver elastography (TLE) and serum non-invasive markers in pediatric autoimmune hepatitis (AIH).

METHODS: Cross-sectional study between May 2016 and February 2020. Twenty-eight children with AIH (age range between 3 and 20 years old) who had undergone TLE and had routine serum tests were enrolled. Patients were divided into 2 groups: (1) Liver fibrosis degree ≥F2 (TLE ≥6.45 kPa) and (2) <F2 (TLE <6.45 kPa). The groups were compared using Fisher’s exact test for categorical variables and the Mann-Whitney test for quantitative variables. The correlation between TLE, APRI, FIB-4 and platelet count was assessed using the Spearman coefficient (Rs).

RESULTS: Twenty-eight AIH pediatric patients were enrolled, 21 were female and 22 had AIH type 1. Following the cut-off of 6.45 kPa in TLE, 20 patients (71%) were included in group 1, and 8 in group 2. A statistically significant difference was found between the two groups on APRI and FIB-4 results (P=0.0306 and P=0.0055, respectively). There was a significant correlation between TLE with APRI and FIB-4 (Rs=0.67 and 0.78, respectively; P<0.01) as well as with platelet count (Rs=-0.68; P<0.01).

CONCLUSION: APRI, FIB-4 and Platelet Count showed a good and positive correlation with transient liver elastography in pediatric patients with AIH.

PMID:39442125 | DOI:10.1590/S0004-2803.24612024-047

Arq Gastroenterol. 2024 Oct 21;61:e24027. doi: 10.1590/S0004-2803.24612024-027. eCollection 2024.

ABSTRACT

BACKGROUND: •The impact of the COVID-19 pandemic on the diagnosis of adenomatous polyps and colorectal cancer.

BACKGROUND: •A cross-sectional study evaluating COL performed during the periods from 20 March to 31 October of 2019 and of 2020, which analyzed 10,232 colonoscopies.

BACKGROUND: •There was a 51,0% reduction in the number of COL performed in 2020 when compared to 2019. Of the altered exams, adenomatous polyps were diagnosed in 68.8% in 2019 and 78.3% in 2020. CRC was diagnosed in 0.9% in 2019 and 1.6% in 2020.

BACKGROUND: •The increase in adenomatous polyps and colorectal cancer diagnoses was observed, it was not enough to compensate for the reduction in the number of exams.

BACKGROUND: Colorectal cancer (CRC) is globally the third most common malignant neoplasm and the second leading cause of cancer-related death worldwide. The COVID-19 pandemic led to the suspension of routine screening tests by health services. A 35.5% drop in total cancer diagnoses in 2020 is estimated when compared to 2019.

OBJECTIVE: To evaluate the impact of the COVID-19 pandemic on the diagnosis of adenomatous polyps (AP) and CRC in a population undergoing colonoscopy (COL) in a clinic in Goiânia, Brazil.

METHODS: A cross-sectional study evaluating COL performed during the periods from 20 March to 31 October of 2019 and of 2020, was approved by the Research Ethics Committee (CAAE-45631421.0.0000.0037). We analyzed data related to identification, referral for medical examination, colonoscopic and histopathological findings.

RESULTS: We evaluated 10,232 (93.4%) COL, divided into two groups according to the year of performance. In 2019, 6,777 (66.2%) COL were performed and in 2020, 3,455 (33.8%), demonstrating a reduction of 51.0%. A total of 3,267 (31.9%) colonoscopies found polyps, 72.1% of which were AP (68.8% in 2019 and 78.3% in 2020, P<0.001). High-grade dysplasia was found in 5.0% of the AP (4.9% in 2019 and 5.8% in 2020, P<0.34). CRC was diagnosed in 121 (1.2%) (0.9% in 2019 and 1.6% in 2020, P<0.001).

CONCLUSION: The COVID-19 pandemic significantly reduced COL in 2020, mainly due to infection fears and restrictions. However, the detection rate of cancer and polyps per procedure increased, indicating more symptomatic patients sought medical attention. Despite this, the absolute number of tumors and adenomas found decreased, potentially causing diagnostic losses and fewer prevented colorectal cancer cases. Thus, adaptive strategies are vital for maintaining essential healthcare services during similar crises.

PMID:39442123 | DOI:10.1590/S0004-2803.24612024-027

Rev Saude Publica. 2024 Oct 18;58:46. doi: 10.11606/s1518-8787.2024058005636. eCollection 2024.

ABSTRACT

OBJECTIVE: To investigate the relationship between childhood consumption of ultra-processed foods and symptoms of hyperactivity/inattention in adolescents from São Leopoldo, a city in southern Brazil.

METHODS: Data were collected at four distinct stages: when participants were 12-16 months old in 2001 and 2002 and later when they were 3-4, 7-8, and 12-13 years old. During the interview at 12-16 months, mothers were asked about the introduction of sugar in their child’s diet. Two 24-hour recall surveys were conducted with children aged 3-4, 7-8, and 12-13 years to assess their consumption of ultra-processed foods. At the age of 12-13 years, the participants completed the Hyperactivity/Inattention subscale of the Strengths and Difficulties Questionnaire (SDQ), which screens for mental health problems.

RESULTS: Among the 173 adolescents, 22.5% exhibited hyperactivity symptoms. The consumption of ultra-processed foods in grams, kilocalories, and as a percentage of energy intake at 3-4 years old were found to be predictors of hyperactivity/inattention symptoms (RR: 0.81, 95%CI: 0.69-0.95; RR: 1.01, 95%CI: 1.00-1.02; RR: 1.02, 95%CI:1.01-1.02; RR: 1.25, 95%CI:1.04-1.51, respectively).

CONCLUSION: The consumption of ultra-processed foods at an early age was associated with hyperactivity and inattention symptoms in adolescence.

PMID:39442121 | DOI:10.11606/s1518-8787.2024058005636

Rev Peru Med Exp Salud Publica. 2024 Oct 21;41(3):273-280. doi: 10.17843/rpmesp.2024.413.13456.

ABSTRACT

BACKGROUND: Motivation for the study. In Ecuador, foodborne disease (FBD) incidence rates adjusted for population size have not been estimated, which will serve to identify priority geographic areas.

BACKGROUND: Main findings. Between 2015-2020, 113,695 cases of FBD were identified, with “other food poisoning” and hepatitis A being most common. The highest incidence rates were found in the Amazon region. There is marked variability by geographic region in the incidence rates during the study period.

BACKGROUND: Public health implications. It is necessary to optimize the registry system, establish detection and treatment protocols, analyze the causes related to the higher incidence of FBD in the Amazon region, and design a health promotion program focused on preventing contamination and establishing diagnostic and treatment protocols.

BACKGROUND: In order to describe the incidence rates per 100 000 population of foodborne disease (FBD) cases during the period 2015-2020 in Ecuador, we carried out a secondary analysis of epidemiological surveillance records and population projections from the National Institute of Statistics and Census. A total of 113,695 cases were reported with an incidence of more than 100 cases per 100 000 population (2015-2019). In 2020, the records are considerably lower than those reported in previous years. Most cases were reported as “other food poisoning”. The highest incidence rates of FBD were found in the Amazon region. In general, there is a marked annual variability in the incidence of FBD according to the geographic regions of Ecuador. In conclusion, FBD represent a public health problem in Ecuador. Comprehensive preventive strategies should be designed with special emphasis on the Amazon region.

PMID:39442109 | DOI:10.17843/rpmesp.2024.413.13456

JMIR Form Res. 2024 Oct 23;8:e58994. doi: 10.2196/58994.

ABSTRACT

BACKGROUND: The ongoing mental health crisis, especially among youth, has led to a greater demand for intensive treatment at the intermediate level, such as intensive outpatient programs (IOPs). Defining best practices in remote IOPs more broadly is critical to understanding the impact of these offerings for individuals with high-acuity mental health service needs in the outpatient setting. Measurement-based care (MBC), or the routine and systematic collection of patient-reported data throughout the course of care to make meaningful changes to treatment, is one such practice that has been shown to improve patient outcomes in mental health treatment. Despite the literature linking MBC to beneficial clinical outcomes, the adoption of MBC in clinical practice has been slow and inconsistent, and more research is needed around MBC in youth-serving settings.

OBJECTIVE: The aim of this paper is to help bridge these gaps, illustrating the implementation of MBC within an organization that provides remote-first, youth-oriented IOP for individuals with high-acuity psychiatric needs.

METHODS: A series of 2 quality improvement pilot studies were conducted with select clinicians and their clients at Charlie Health, a remote IOP program that treats high-acuity teenagers and young adults who present with a range of mental health disorders. Both studies were carefully designed, including thorough preparation and planning, clinician training, feedback collection, and data analysis. Using process evaluation data, MBC deployment was repeatedly refined to enhance the clinical workflow and clinician experience.

RESULTS: The survey completion rate was 80.08% (3216/4016) and 86.01% (4218/4904) for study 1 and study 2, respectively. Quantitative clinician feedback showed marked improvement from study 1 to study 2. Rates of successful treatment completion were 22% and 29% higher for MBC pilot clients in study 1 and study 2, respectively. Depression, anxiety, and psychological well-being symptom reduction were statistically significantly greater for MBC pilot clients (P<.05).

CONCLUSIONS: Our findings support the feasibility and clinician acceptability of a rigorous MBC process in a real-world, youth-serving, remote-first, intermediate care setting. High survey completion data across both studies and improved clinician feedback over time suggest strong clinician buy-in. Client outcomes data suggest MBC is positively correlated with increased treatment completion and symptom reduction. This paper provides practical guidance for MBC implementation in IOPs and can extend to other mental health care settings.

PMID:39441653 | DOI:10.2196/58994

JMIR Form Res. 2024 Oct 23;8:e60491. doi: 10.2196/60491.

ABSTRACT

BACKGROUND: To expand veterans’ access to health care, the Veterans Affairs (VA) Office of Connected Care explored a novel software feature called “Vitals” on its VA Video Connect telehealth platform. Vitals uses contactless, video-based, remote photoplethysmography (rPPG) through the infrared camera on veterans’ smartphones (and other devices) to automatically scan their faces to provide real-time vital statistics on screen to both the provider and patient.

OBJECTIVE: This study aimed to assess VA clinical provider and veteran patient attitudes regarding the usability of Vitals.

METHODS: We conducted a mixed methods evaluation of Vitals among VA providers and patients, collecting data in July and August 2023 at the VA Boston Healthcare System and VA San Diego Healthcare System. We conducted analyses in October 2023. In-person usability testing sessions consisted of a think-aloud procedure while using the software, a semistructured interview, and a 26-item web-based survey.

RESULTS: Usability test sessions with 20 VA providers and 13 patients demonstrated that both groups found Vitals “useful” and “easy to use,” and they rated its usability highly (86 and 82 points, respectively, on a 100-point scale). Regarding acceptability or willingness/intent to use, providers and patients generally expressed confidence and trust in Vitals readings, with high ratings of 90 and 85 points, respectively. Providers and patients rated Vitals highly for its feasibility and appropriateness for context (90 and 90 points, respectively). Finally, providers noted that Vitals’ flexibility makes it appropriate and advantageous for implementation in a wide range of clinical contexts, particularly in specialty care. Providers believed that most clinical teams would readily integrate Vitals into their routine workflow because it saves time; delivers accurate, consistently collected vitals; and may reduce reporting errors. Providers and veterans suggested training and support materials that could improve Vitals adoption and implementation.

CONCLUSIONS: While remote collection of vital readings has been described in the literature, this is one of the first accounts of testing a contactless vital signs measurement tool among providers and patients. If ongoing initiatives demonstrate accuracy in its readings, Vitals could enhance telemedicine by providing accurate and automatic reporting and recording of vitals; sending patients’ vital readings (pending provider approval) directly to their electronic medical record; saving provider and patient time; and potentially reducing necessity of some home-based biometric devices. Understanding usability issues before US Food and Drug Administration approval of Vitals and its implementation could contribute to a seamless introduction of Vitals to VA providers and patients.

PMID:39441645 | DOI:10.2196/60491

Proc Natl Acad Sci U S A. 2024 Oct 29;121(44):e2402340121. doi: 10.1073/pnas.2402340121. Epub 2024 Oct 23.

ABSTRACT

As their statistical power grows, genome-wide association studies (GWAS) have identified an increasing number of loci underlying quantitative traits of interest. These loci are scattered throughout the genome and are individually responsible only for small fractions of the total heritable trait variance. The recently proposed omnigenic model provides a conceptual framework to explain these observations by postulating that numerous distant loci contribute to each complex trait via effect propagation through intracellular regulatory networks. We formalize this conceptual framework by proposing the “quantitative omnigenic model” (QOM), a statistical model that combines prior knowledge of the regulatory network topology with genomic data. By applying our model to gene expression traits in yeast, we demonstrate that QOM achieves similar gene expression prediction performance to traditional GWAS with hundreds of times less parameters, while simultaneously extracting candidate causal and quantitative chains of effect propagation through the regulatory network for every individual gene. We estimate the fraction of heritable trait variance in cis- and in trans-, break the latter down by effect propagation order, assess the trans- variance not attributable to transcriptional regulation, and show that QOM correctly accounts for the low-dimensional structure of gene expression covariance. We furthermore demonstrate the relevance of QOM for systems biology, by employing it as a statistical test for the quality of regulatory network reconstructions, and linking it to the propagation of nontranscriptional (including environmental) effects.

PMID:39441639 | DOI:10.1073/pnas.2402340121

JMIR Res Protoc. 2024 Oct 23;13:e60962. doi: 10.2196/60962.

ABSTRACT

BACKGROUND: HIV continues to have a disproportionate impact on specific populations in Malaysia, particularly men who have sex with men (MSM). HIV self-testing (HIVST) is a strategy that has been shown to scale up HIV testing rates. However, it faces shortcomings because of concerns about self-efficacy, result interpretation, and lack of counseling and linkage to care. This underscores the need for an innovative approach that integrates HIVST with timely counseling, expert guidance, and referrals to enhance engagement in relevant HIV prevention or treatment.

OBJECTIVE: This study aims to describe the protocol used in developing and testing a web-based platform (ie, CINTAI) providing an HIVST kit and real-time e-counseling to support online-to-offline linkage to HIV care services for MSM in Malaysia.

METHODS: The methods are reported according to the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 guidelines. In phase I, we will adapt existing HIVST web-based platforms to create a new online-to-offline HIVST and counseling platform called “CINTAI” for Malaysian MSM. In phase II, we will use a type 1 hybrid implementation trial design to determine the feasibility, acceptability, and preliminary efficacy of “CINTAI” compared with treatment as usual among Malaysian MSM, with assessments conducted over 6 months. Multilevel implementation factors will also be collected to guide future adoption and scale-up. We will enroll 78 MSM in the pilot randomized controlled trial. Baseline characteristics will be tested for homogeneity between groups using appropriate statistical tests. A generalized linear mixed model with random subject effects will account for within-subject correlation. Treatment assignment, time, interaction, and confounders will be included. The proportion of MSM tested for HIV over 6 months and other outcomes (pre-exposure prophylaxis for HIV or antiretroviral therapy linkage, HIV risk behaviors, and chemsex harm reduction) will be compared using linear contrasts.

RESULTS: We completed phase I of the proposed study in April 2024 and started phase II in May 2024, with 15 participants recruited (7 in the CINTAI and 8 in the treatment-as-usual groups). On the basis of a series of formative works completed during phase I, we developed a fully functional, web-based platform that provides a digital platform for MSM in Malaysia to order HIVST kits for free and to receive HIV counseling, followed by offline linkage to HIV prevention services (if HIV negative) or HIV treatment services (if HIV positive).

CONCLUSIONS: Despite being at high risk for HIV transmission, MSM in Malaysia have alarmingly low testing and linkage to HIV care services, prompting the need for innovative approaches to support HIV prevention efforts. If found to be feasible and acceptable, CINTAI can be easily adapted for a range of health outcomes and health care delivery services for MSM, including adaptation to other low- and middle-income countries.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/60962.

PMID:39441624 | DOI:10.2196/60962

J Laparoendosc Adv Surg Tech A. 2024 Oct 23. doi: 10.1089/lap.2024.0325. Online ahead of print.

ABSTRACT

Background: With the rising demand for minimally invasive and cosmetically appealing surgeries, transumbilical single-incision laparoscopic cholecystectomy (SILC) has been increasingly adopted, albeit in a limited number of medical centers. Our team has successfully executed transumbilical SILC for benign gallbladder diseases. This study retrospectively analyzed and compared the efficacy of transumbilical SILC with that of conventional laparoscopic cholecystectomy (CLC). Methods: We analyzed data from 358 cases of laparoscopic cholecystectomy performed at Shanghai East Hospital of Tongji University between January 2021 and October 2023. Of these, 186 cases underwent SILC (observation group), while 172 cases underwent CLC (control group). We compared patient demographics, perioperative outcomes, and satisfaction with incision scars. Primary outcomes included surgical efficacy and safety, whereas secondary outcomes encompassed postoperative hospitalization duration, pain levels, hospital costs, and scar satisfaction. Results: No significant differences were observed in patient demographics between the two groups. Both the SILC and CLC groups exhibited similar operative times (39.56 ± 14.55 minutes versus 41.82 ± 16.13 minutes, P = .164) and intraoperative blood loss (11.34 ± 3.90 mL versus 11.28 ± 3.87 mL, P = .885). The single-incision approach led to earlier postoperative bowel function recovery (22.03 ± 3.60 hours versus 24.17 ± 3.22 hours, P < .01), lower 24-hour postoperative pain scores (2.06 ± 0.84 versus 2.35 ± 0.72, P < .01), shorter postoperative hospital stays (2.88 ± 0.86 days versus 3.33 ± 0.96 days, P < .01), comparable hospitalization costs (3411.67 ± 790.86$ versus 3494.50 ± 558.76$, P = .257), and better Scar Cosmesis Assessment and Rating scores (1.78 ± 0.70 versus 2.17 ± 0.89, P < .01). Patient satisfaction was higher with the single-incision technique (8.52 ± 0.79 versus 7.80 ± 0.75, P < .01). Both groups experienced one case of incision infection (SILC 0.54%, CLC 0.58%), and there was one case of postoperative bile leakage in the CLC group (0.58%). However, the difference in complications was not statistically significant (P > .05). Conclusion: Transumbilical SILC demonstrates safe and effective near-term efficacy, offering benefits such as reduced postoperative pain and improved cosmetic outcomes, which support its clinical adoption.

PMID:39441619 | DOI:10.1089/lap.2024.0325

Transl Vis Sci Technol. 2024 Oct 1;13(10):34. doi: 10.1167/tvst.13.10.34.

ABSTRACT

PURPOSE: To evaluate the clinical usefulness of a deep learning-based detection device for multiple abnormal findings on retinal fundus photographs for readers with varying expertise.

METHODS: Fourteen ophthalmologists (six residents, eight specialists) assessed 399 fundus images with respect to 12 major ophthalmologic findings, with or without the assistance of a deep learning algorithm, in two separate reading sessions. Sensitivity, specificity, and reading time per image were compared.

RESULTS: With algorithmic assistance, readers significantly improved in sensitivity for all 12 findings (P < 0.05) but tended to be less specific (P < 0.05) for hemorrhage, drusen, membrane, and vascular abnormality, more profoundly so in residents. Sensitivity without algorithmic assistance was significantly lower in residents (23.1%∼75.8%) compared to specialists (55.1%∼97.1%) in nine findings, but it improved to similar levels with algorithmic assistance (67.8%∼99.4% in residents, 83.2%∼99.5% in specialists) with only hemorrhage remaining statistically significantly lower. Variances in sensitivity were significantly reduced for all findings. Reading time per image decreased in images with fewer than three findings per image, more profoundly in residents. When simulated based on images acquired from a health screening center, average reading time was estimated to be reduced by 25.9% (from 16.4 seconds to 12.1 seconds per image) for residents, and by 2.0% (from 9.6 seconds to 9.4 seconds) for specialists.

CONCLUSIONS: Deep learning-based computer-assisted detection devices increase sensitivity, reduce inter-reader variance in sensitivity, and reduce reading time in less complicated images.

TRANSLATIONAL RELEVANCE: This study evaluated the influence that algorithmic assistance in detecting abnormal findings on retinal fundus photographs has on clinicians, possibly predicting its influence on clinical application.

PMID:39441571 | DOI:10.1167/tvst.13.10.34