Category: Statistics

JMIR Public Health Surveill. 2024 Nov 14;10:e52478. doi: 10.2196/52478.

ABSTRACT

BACKGROUND: Internet gaming disorder (IGD) is a global public health concern for adolescents due to its potential severe negative consequences. Professional help-seeking is important for early screening, diagnosis, and treatment of IGD. However, research on the factors associated with professional help-seeking for IGD as well as relevant mediation mechanisms among adolescents is limited.

OBJECTIVE: Based on the stress coping theory, the conservation of resource theory, and behavioral change theories, this study investigated the prevalence and factors influencing the behavioral intention of professional help-seeking for internet gaming disorder (BI-PHSIGD). The research also explored the underlying mechanisms, including psychosocial resources like resilience and social support, perceived resource loss due to reduced gaming time, and self-efficacy, in professional help-seeking among adolescent internet gamers.

METHODS: A cross-sectional survey was conducted among secondary school students who were internet gamers in 2 Chinese cities from October 2019 to January 2020. Data from the full sample (N=1526) and a subsample of 256 IGD cases (according to the 9-item DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition] IGD Checklist) were analyzed. Multivariate logistic regression analysis was conducted to examine the factors of BI-PHSIGD, while structural equation modeling was performed to test the proposed mediation mechanisms.

RESULTS: The prevalence of BI-PHSIGD was 54.3% (829/1526) in the full sample and 40.6% (104/256) in the IGD subsample (vs 708/1239, 57.1% among non-IGD cases). In the full sample, psychosocial resources of resilience (adjusted odds ratio [aOR] 1.03, 95% CI 1.02-1.05) and social support (aOR 1.03, 95% CI 1.02-1.04) as well as self-efficacy in professional help-seeking (aOR 1.64, 95% CI 1.49-1.81) were positively associated with BI-PHSIGD, while perceived resource loss due to reduced gaming time was negatively associated with BI-PHSIGD (aOR 0.97, 95% CI 0.96-0.98); the positive association between psychosocial resources and BI-PHSIGD was fully mediated via 2 single-mediator indirect paths (via self-efficacy in professional help-seeking alone: effect size=53.4%; indirect effect/total effect=0.10/0.19 and via perceived resource loss due to reduced gaming time alone: effect size=17.8%; indirect effect/total effect=0.03/0.19) and one 2-mediator serial indirect path (first via perceived resource loss due to reduced gaming time then via self-efficacy in professional help-seeking: effect size=4.7%; indirect effect/total effect=0.009/0.19). In the IGD subgroup, a full mediation via self-efficacy in professional help-seeking alone but not the other 2 indirect paths was statistically significant.

CONCLUSIONS: Many adolescent internet gamers, especially those with IGD, were unwilling to seek professional help; as a result, early treatment is often difficult to achieve. To increase BI-PHSIGD, enhancing psychosocial resources such as resilience and social support, perceived resource loss due to reduced gaming time, and self-efficacy in professional help-seeking may be effective. Future longitudinal and intervention studies are needed to confirm and extend the findings.

PMID:39588703 | DOI:10.2196/52478

Alzheimer Dis Assoc Disord. 2024 Oct-Dec 01;38(4):351-357. doi: 10.1097/WAD.0000000000000648. Epub 2024 Nov 13.

ABSTRACT

BACKGROUND: Previous studies were examined effects of social restriction by COVID-19 pandemic on elderly peoples or compared difference of before/after restrictions on patients with Alzheimer disease-related dementia (ADRD). Here, we assessed the effects of restrictions on the cognitive function of the patients by comparing control group.

METHODS: We examined the impact on cognitive function using the Alzheimer Disease Assessment Scale (Japanese version) cognitive subscale (ADAS-JCOG), in patients with mild to moderate ADRD by a post hoc subgroup analysis of double-blinded, noninferiority study of donepezil 27.5 mg patches and donepezil hydrochloride 5 mg tablets (JapicCTI-194582). After demonstrating the noninferiority of both treatments, we used combined data for this analysis.

RESULTS: The analyzed subpopulation of the per-protocol set groups was balanced (n=126 and 135, respectively). Patient demographics were similar between subgroups. The difference of ADAS-JCOG scores [least-squares mean (95%CI)] between the groups was 0.388 (-0.377 to 1.152, not statistically significant).

CONCLUSION: Social isolation affects cognitive function on ADRD and this knowledge should be considered in future.

PMID:39588690 | DOI:10.1097/WAD.0000000000000648

Alzheimer Dis Assoc Disord. 2024 Oct-Dec 01;38(4):311-318. doi: 10.1097/WAD.0000000000000641. Epub 2024 Nov 26.

ABSTRACT

PURPOSE: The National Institute of Health Toolbox Cognition Battery (NIHTB-CB) is increasingly used in Alzheimer disease (AD) research. We examined the relation of AD biomarkers with performance in the NIHTB-CB in late middle age.

METHODS: This is a cross-sectional analysis of 334 Hispanic participants aged 64.22±3.35 years from a study of AD biomarkers. White matter hyperintensities (WMH), infarcts, and cortical thickness in AD regions (CT) were assessed with 3T magnetic resonance imaging. Amyloid and tau were assessed with 18F-Florbetaben and 18F-MK6240 positron emission tomography, respectively.

RESULTS: Lower CT and infarcts were associated with worse Oral Reading Recognition and Cognition Crystallized Composite scores. Lower CT and higher WMH were associated with worse Pattern Comparison Processing Speed. Amyloid and tau were not associated with any test.

DISCUSSION: Amyloid and tau, the culprits of AD, are not related to the NIHTB-CB in late middle age. Continued follow-up will reveal if AD impacts performance on the NIHTB-CB.

PMID:39588688 | DOI:10.1097/WAD.0000000000000641

J Magn Reson Imaging. 2024 Nov 26. doi: 10.1002/jmri.29667. Online ahead of print.

ABSTRACT

BACKGROUND: The brain aging in the general population and patients with neurological disorders is not well understood.

PURPOSE: To characterize brain aging in the above conditions and its clinical relevance.

STUDY TYPE: Retrospective.

POPULATION: A total of 2913 healthy controls (HC), with 1395 females; 331 multiple sclerosis (MS); 189 neuromyelitis optica spectrum disorder (NMOSD); 239 Alzheimer’s disease (AD); 244 Parkinson’s disease (PD); and 338 cerebral small vessel disease (cSVD).

FIELD STRENGTH/SEQUENCE: 3.0 T/Three-dimensional (3D) T1-weighted images.

ASSESSMENT: The brain age was estimated by our previously developed model, using a 3D convolutional neural network trained on 9794 3D T1-weighted images of healthy individuals. Brain age gap (BAG), the difference between chronological age and estimated brain age, was calculated to represent accelerated and resilient brain conditions. We compared MRI metrics between individuals with accelerated (BAG ≥ 5 years) and resilient brain age (BAG ≤ -5 years) in HC, and correlated BAG with MRI metrics, and cognitive and physical measures across neurological disorders.

STATISTICAL TESTS: Student’s t test, Wilcoxon test, chi-square test or Fisher’s exact test, and correlation analysis. P < 0.05 was considered statistically significant.

RESULTS: In HC, individuals with accelerated brain age exhibited significantly higher white matter hyperintensity (WMH) and lower regional brain volumes than those with resilient brain age. BAG was significantly higher in MS (10.30 ± 12.6 years), NMOSD (2.96 ± 7.8 years), AD (6.50 ± 6.6 years), PD (4.24 ± 4.8 years), and cSVD (3.24 ± 5.9 years) compared to HC. Increased BAG was significantly associated with regional brain atrophy, WMH burden, and cognitive impairment across neurological disorders. Increased BAG was significantly correlated with physical disability in MS (r = 0.17).

DATA CONCLUSION: Healthy individuals with accelerated brain age show high WMH burden and regional volume reduction. Neurological disorders exhibit distinct accelerated brain aging, correlated with impaired cognitive and physical function.

LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 2.

PMID:39588683 | DOI:10.1002/jmri.29667

Otolaryngol Head Neck Surg. 2024 Nov 26. doi: 10.1002/ohn.1063. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the efficacy of 2 drug combinations on tinnitus severity and associated stress, depression, sleep, and anxiety.

STUDY DESIGN: A randomized, double-blind, placebo-controlled clinical trial conducted between 2019 and 2023 for an 8-week duration.

SETTING: Single institution tertiary care center.

METHODS: The study recruited adult patients with moderate to severe tinnitus for 6 months or more. In total, 81 patients were assessed for eligibility, 78 were enrolled and randomized, and 67 were included in the per-protocol analysis. Patients were randomized into 3 groups (1:1:1). Group NT received nortriptyline-topiramate, group VP received verapamil-paroxetine, and group P received placebo.

RESULTS: A total of 19 patients in group NT, 22 in group VP, and 26 patients in group P were included in the per-protocol analysis. In group NT, the Tinnitus Functional Index (TFI) score decreased from 58.4 ± 13.9 (baseline) to 46.3 ± 17.5 (end-of-trial) (P < .001). Similarly, in group VP, the TFI score decreased from 54.6 ± 17.5 to 42.2 ± 16.1 (P = .004). However, group P did not demonstrate any significant decrease in the TFI score from 51.2 ± 18.6 to 45.2 ± 20.1 (P = .086). The between-arm analysis did not yield any statistical significance decrease in the TFI score (analysis of variance, P = .265).

CONCLUSION: Both combinations of drugs were promising in improving tinnitus severity. However, larger-scale trials with longer follow-up periods are warranted to validate our findings between groups.

PMID:39588680 | DOI:10.1002/ohn.1063

Otolaryngol Head Neck Surg. 2024 Nov 26. doi: 10.1002/ohn.1065. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to assess the efficacy and complication rates of interarytenoid injection augmentation (IAIA) for the treatment of dysphagia in patients 1 year of age and under and to determine if concurrent feeding therapy (FT) affects outcome.

STUDY DESIGN: Retrospective case series.

SETTING: Tertiary pediatric hospital.

METHODS: Retrospective review of patients 13 months of age and younger with dysphagia treated by IAIA over a 4-year period. The efficacy of IAIA was determined by comparing perioperative videofluoroscopic swallow studies (VFSS) and Dysphagia Outcome and Severity Scale (DOSS) scores. Complication rates and utilization of concomitant FT were determined by evaluating postoperative admission and follow-up records.

RESULTS: Sixty-five patients met inclusion criteria (median age 8 months, interquartile range [IQR]: 7-11). Sixty-seven percent of patients improved on postoperative VFSS scores (median improvement in aspiration of 2 thickness levels, IQR 0-3, P < .0001), and 56% improved in DOSS scores (median increase of 1, IQR: 0-1.5, P < .0001). Ninety-two percent of patients were discharged home on the day of surgery. The 30-day relevant readmission rate was 5%. No patients had intraoperative complications or severe complications at follow-up. No statistical difference in aspiration or DOSS was noted in the concomitant FT cohort due to a lack of sample size.

CONCLUSION: This study demonstrates that IAIA in children under 13 months old shows comparable rates of success and complications to older patients reported in the literature. No patients had long-term complications and most were discharged home on the day of surgery. More studies are needed to determine the effect of concomitant FT on IAIA.

PMID:39588667 | DOI:10.1002/ohn.1065

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2024 Nov 26. doi: 10.3881/j.issn.1000-503X.16068. Online ahead of print.

ABSTRACT

Objective To explore the application value of multi-model adaptive statistical iterative reconstruction-Veo (ASiR-V) in ultra-low dose chest CT examination of children in the plateau area. Methods The children who underwent chest CT examination in Xizang Autonomous Region People’s Hospital were enrolled in this study and assigned into two groups according to the scanning conditions.Group A underwent scanning at a tube voltage of 100 kV and ASiR-V 50% reconstruction,and group B underwent scanning at a tube voltage of 80 kV and ASiR-V 0 (Group B1) and ASiR-V 50% (Group B2) reconstruction.The image quality of each group was evaluated objectively and subjectively.The radiation dose and image quality were compared between groups. Results Groups A and B showed the volume CT dose indexes of (2.33±0.62) mGy and (0.86±0.01) mGy and the dose length products of (65.01±25.12) mGy·cm and (23.55±3.38) mGy·cm,respectively,which presented differences between groups (both P<0.001).The image noise in the bilateral upper and middle lung areas in group B2 was lower than that in group B1 but higher than that in group A (all P<0.001).There was no significant difference in image quality score of the lung window among groups (all P>0.05).Groups A,B1,and B2 had no significant differences in ascending aorta (P=0.538) or liver CT value (P=0.175) in the mediastinal window.The signal-to-noise ratios and contrast-to-noise ratios of ascending aorta and liver in group B2 were higher than those in group B1 (all P<0.001) and lower than those in group A (all P<0.05).The image quality score of the mediastinal window followed a descending order of group A>group B2>group B1 (all P<0.001). Conclusion ASiR-V combined with low tube voltage can effectively reduce the radiation dose and guarantee the image quality of chest CT of children in the plateau area.

PMID:39588659 | DOI:10.3881/j.issn.1000-503X.16068

G Ital Cardiol (Rome). 2024 Dec;25(12):875-884. doi: 10.1714/4372.43699.

ABSTRACT

In heart failure management, hospitalization is the main cause of medical costs and is associated with an increased risk of adverse events. This review reports evidence on hospitalization as the ideal setting for disease-modifying therapy implementation, with a particular focus on gliflozins in patients with stabilized acute heart failure. The authors analyze data from the EMPULSE trial, the largest clinical study that evaluated a gliflozin in acute heart failure in patients with both reduced and preserved systolic function. The win ratio approach for statistical analysis is also discussed. The EMPULSE trial showed that empagliflozin improved clinical outcomes in patients hospitalized for acute heart failure. Subsequent analyses have also highlighted favorable effects in terms of decongestion. Since clinical benefits due to gliflozin use occur early (after a few weeks) and in order to increase heart failure polypharmacy tolerability, the initiation of gliflozin treatment should be a priority over other treatment titration. Even in complex clinical settings, as in the elderly and in patients with kidney disease, evidence supports safety and good tolerability of gliflozins, which may facilitate initiation/titration of other treatments.

PMID:39588624 | DOI:10.1714/4372.43699

Evolution. 2024 Nov 26:qpae170. doi: 10.1093/evolut/qpae170. Online ahead of print.

ABSTRACT

Reciprocal selection between extended and somatic phenotypes is an active area of investigation. Recent research on the influence of web building on somatic evolution in spiders has produced conflicting results, with some finding no effect of web use on somatic evolution and others showing significant effects. These studies differed in focus, with the former surveying general anatomical traits and the latter concentrating on somatic systems with significant functional roles in prey capture. Here we propose and test the hypothesis that prey immobilization by webs is broadly synergistic with cheliceral biting force and that web builders have lower cheliceral forces compared to free hunters. Our analysis focused on the intercheliceral (IC) sclerite and muscles, a newly characterized system that is synapomorphic and ubiquitously distributed in spiders. Using µCT scans, we quantify IC sclerite shape and model IC muscle function. Statistical analyses show that inferred size-corrected isometric muscle force is lower in web-builders than in free-hunters. No such association was found for IC sclerite shape. In the investigation of reciprocal selective effects between extended and somatic phenotypes, our results highlight the importance that these traits be functionally linked and adaptive.

PMID:39588588 | DOI:10.1093/evolut/qpae170

Stat Methods Med Res. 2024 Nov 26:9622802241298706. doi: 10.1177/09622802241298706. Online ahead of print.

ABSTRACT

The difference between two proportions is the most important parameter in comparing two treatments based on independent two binomials and has garnered widespread application across various fields, particularly in clinical trials. There exists significant interest in devising optimal confidence intervals for the difference. Approximate intervals relying on asymptotic normality may lack reliability, thus calling for enhancements in exact confidence interval construction to bolster reliability and precision. In this paper, we present a novel approach that leverages the most probable test statistic and employs the $h$-function method to construct an optimal exact interval for the difference. We juxtapose the proposed interval against other exact intervals established through methodologies such as the Agresti-Min exact unconditional method, the Wang method, the fiducial method, and the hybrid score method. Our comparative analysis, employing the infimum coverage probability and total interval length as evaluation metrics, underscores the uniformly superior performance of the proposed interval. Additionally, we elucidate the application of these exact intervals using two real datasets.

PMID:39588571 | DOI:10.1177/09622802241298706