Category: Statistics

JMIR Hum Factors. 2024 Aug 7;11:e57082. doi: 10.2196/57082.

ABSTRACT

BACKGROUND: Digital Mental Health (DMH) tools are an effective, readily accessible, and affordable form of mental health support. However, sustained engagement with DMH is suboptimal, with limited research on DMH engagement. The Health Action Process Approach (HAPA) is an empirically supported theory of health behavior adoption and maintenance. Whether this model also explains DMH tool engagement remains unknown.

OBJECTIVE: This study examined whether an adapted HAPA model predicted engagement with DMH via a self-guided website.

METHODS: Visitors to the Mental Health America (MHA) website were invited to complete a brief survey measuring HAPA constructs. This cross-sectional study tested the adapted HAPA model with data collected using voluntary response sampling from 16,078 sessions (15,619 unique IP addresses from United States residents) on the MHA website from October 2021 through February 2022. Model fit was examined via structural equation modeling in predicting two engagement outcomes: (1) choice to engage with DMH (ie, spending 3 or more seconds on an MHA page, excluding screening pages) and (2) level of engagement (ie, time spent on MHA pages and number of pages visited, both excluding screening pages).

RESULTS: Participants chose to engage with the MHA website in 94.3% (15,161/16,078) of the sessions. Perceived need (β=.66; P<.001), outcome expectancies (β=.49; P<.001), self-efficacy (β=.44; P<.001), and perceived risk (β=.17-.18; P<.001) significantly predicted intention, and intention (β=.77; P<.001) significantly predicted planning. Planning was not significantly associated with choice to engage (β=.03; P=.18). Within participants who chose to engage, the association between planning with level of engagement was statistically significant (β=.12; P<.001). Model fit indices for both engagement outcomes were poor, with the adapted HAPA model accounting for only 0.1% and 1.4% of the variance in choice to engage and level of engagement, respectively.

CONCLUSIONS: Our data suggest that the HAPA model did not predict engagement with DMH via a self-guided website. More research is needed to identify appropriate theoretical frameworks and practical strategies (eg, digital design) to optimize DMH tool engagement.

PMID:39110965 | DOI:10.2196/57082

Int J Prosthodont. 2024 Aug 2:1-24. doi: 10.11607/ijp.9147. Online ahead of print.

ABSTRACT

Purpose: To investigate the available evidence on the accuracy of conventional and digital workflows for complete arch implant supported frameworks. Materials and methods: This scoping review was conducted according to the 5-stage framework of Arksey and O’Malley. A systematic literature search was performed adhering to the PRISMA guidelines to identify studies with a direct comparison of conventional and digital methods for the fabrication of complete arch implant supported frameworks. 58 in-vitro studies with the focus on edentulous arches with at least four implants published between 2000 and 2024 were included. The reported outcomes were examined to determine the value of a statistical analysis for adding up the individual errors to a cumulative error of the workflow. Results: Evidence on the accuracy assessment of digital and conventional workflows for complete arch implant supported frameworks is available. However, also studies with the same assessment methods and outcome units appear to be too heterogeneous to perform a statistical analysis of error accumulation. While there is no consensus in the impression and cast fabrication stage, digital techniques show a superior accuracy for the fabrication of complete arch implant supported frameworks compared to conventional casting. Conclusion: In-vitro studies assessing the accuracy of entire workflows and classifying their outcomes regarding the clinical relevance are lacking.

PMID:39110949 | DOI:10.11607/ijp.9147

Rev Med Inst Mex Seguro Soc. 2024 Jan 8;62(1):1-9. doi: 10.5281/zenodo.10278156.

ABSTRACT

This article is a systematic review (SR) and meta-analysis (MA) whose objective was to identify the association between induced abortion and the development of depression, based on the Cochrane guidelines for SRs. A systematic search was carried out in the WoS, PubMed and Scopus databases. Retrospective and prospective cohort studies, carried out until November 2020, that evaluated a population of women in childbearing age (12 to 46 years) with at least 1 induced and/or provoked abortion, including pharma-cological and surgical abortion. Only studies with healthy women at the beginning of the research were included, i.e., with absence of psychiatric pathology prior to induced abor-tion. The quality of the included studies was measured with the Newcastle-Ottawa Scale (NOS), and for the MA random-effects models were specified using the DerSimonian & Laird method, grouping them into follow-up after abortion before and after one year. The results of the SR were measured with relative risk (RR), hazard ratio (HR), odds ratio (OR), and the chi-square test, which assessed the intensity of the statistical relationship between population and exposure. Systematic review demonstrated an OR of 1.38 (95% CI 1.14-1.68) of depression after induced abortion. Meta-analysis demonstrated a statis-tically significant association between depression and induced abortion when the as-sessment after one year was performed OR: 1.37 (95% CI 1.09-1.71). The risks, harms and mental health consequences of induced abortion, such as depression, should be in-vestigated and warned.

PMID:39110948 | DOI:10.5281/zenodo.10278156

Wounds. 2024 Jul;36(7):227-233.

ABSTRACT

BACKGROUND: Little is known about the usefulness of collagen powder in secondary intention healing in patients undergoing cutaneous surgery.

OBJECTIVE: To investigate the clinical outcomes associated with application of collagen powder in cutaneous surgery and patients’ perceptions of the procedure.

METHODS: A retrospective chart review of 266 patients who underwent Mohs surgery or excisional surgery at a single institution between January 2020 and January 2022, and who had secondary intention healing of wounds assisted by powdered collagen was conducted. Personal interviews were conducted with 63 of those patients (23.7%). Tumor characteristics, estimated healing times, and patient satisfaction were scored. The Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale were used to assess the resulting wound bed. All data underwent statistical analysis.

RESULTS: Of 266 granulating wounds with an average defect size of 6.0 cm2, excisional surgery was performed in 143 (54%) and Mohs surgery in 123 (46%). Most procedures (92.1%) were undertaken for nonmelanoma skin cancers. The average healing time was 6.3 weeks. The mean patient score for ease of use and overall impression of collagen application was 8.2 on a scale of 1 to 10, with 10 being most favorable.

CONCLUSION: When clinically appropriate, granulation assisted by collagen powder should be considered for augmenting secondary intention healing.

PMID:39110946

Dis Esophagus. 2024 Aug 8:doae059. doi: 10.1093/dote/doae059. Online ahead of print.

ABSTRACT

The standard treatment regimen for esophageal cancer is chemoradiation followed by esophagectomy. However, the use of neoadjuvant chemoradiotherapy damages the surrounding tissue, which potentially increases the risk of postoperative complications, including anastomotic leakage. The impact of definitive chemoradiotherapy (dCRT, 50.4 Gy radiotherapy) compared to the standard neoadjuvant scheme (nCRT, 41.4 Gy radiotherapy) prior to surgery on the incidence of anastomotic leakage remains poorly understood. To study this, all patients who received dCRT between 2011 and 2021 followed by esophagectomy were included. For each patient, two patients who received nCRT were selected as matched controls. Outcomes included postoperative anastomotic leakage, pulmonary and other complications, anastomotic stenosis, pulmonary and other postoperative complications (Clavien Dindo Classification ≥1), and overall survival. One hundred and eight patients were included with a median follow-up of 28 months. The time between neoadjuvant treatment and surgery was longer in the dCRT group compared to the nCRT group (65 vs. 48 days, P < 0.001). Postoperatively, significantly more patients in the dCRT group suffered from anastomotic leakage (11% vs. 1%, P = 0.04) and anastomotic stenosis (42% vs. 17%, P < 0.01). No differences were found for other complications or overall survival between both groups. In conclusion, preoperative dCRT is associated with a higher risk of anastomotic leakage and stenosis. These complications, however, can be treated effectively. Therefore, esophagectomy after dCRT is considered to be an appropriate treatment strategy in a selected patient group.

PMID:39110921 | DOI:10.1093/dote/doae059

Rev Med Inst Mex Seguro Soc. 2024 Jan 8;62(1):1-7. doi: 10.5281/zenodo.10278140.

ABSTRACT

BACKGROUND: The medical care paradigm is face-to-face; however, technological development has led to the digital modality.

OBJECTIVE: To determine cost-effectiveness of digital care and face-to-face care at the first level of care.

MATERIAL AND METHODS: Cost-effectiveness study. 2 groups were integrated: the digital service and the face-to-face service. The sample size was calculated with the percentage formula for 2 groups, and the result was 217 per group. The effectiveness was evaluated in 3 dimensions: the satisfaction of the patient, of the doctor and of the medical assistant. In all 3 cases the Visual analogue scale was used. The cost corresponded to the fixed unit cost estimated with the technique of times and movements adjusted for the duration of care. The statistical analysis included averages, percentages and cost-effectiveness ratio.

RESULTS: The cost of digital attention is $343.83 and face-to-face attention is $171.91 (all estimated in Mexican pesos). From the patient’s perspective, the effectiveness in digital care is $9.47 and in face-to-face is $9.25. The cost to reach effectiveness of 10 in face-to-face care is $185.85 and in digital care $363.20. From the physician’s perspective, the cost to achieve effectiveness of 10 is $419.13 in digital care and $184.52 in face-to-face care. From the perspective of the medical assistant, to achieve effectiveness of 10, the cost in digital care is $468.43 and in face-to-face $179.83.

CONCLUSIONS: Currently, the best cost-effectiveness ratio corresponds to face-to-face care; however, digital care is an option that will have to evolve.

PMID:39110885 | DOI:10.5281/zenodo.10278140

Rev Med Inst Mex Seguro Soc. 2024 Jan 8;62(1):1-6. doi: 10.5281/zenodo.10278123.

ABSTRACT

BACKGROUND: Necrotizing fasciitis (NF) can affect any soft tissue and skin of the body. Its progression is rapid and it is associated with a high mortality rate. Therefore, the search for easily accessible and low-cost biomarkers that could predict the prognosis of patients with NF is necessary.

OBJECTIVE: To evaluate the role of neutrophil-lymphocyte ratio (NLR) as a predictor of mortality in patients with NF.

MATERIAL AND METHODS: Observational, cross-sectional, retrospective and analytical study of patients admitted between April and October 2020 in a tertiary-care hospital. The statistical tests used for the comparison of variables between the study groups were chi-square, Fisher’s exact, Student’s t and Mann-Whitney U. A receiver operating characteristic (ROC) curve was performed to determine the accuracy of NLR in predicting mortality in patients with NF.

RESULTS: A total of 25 patients were included and stratified into non-survivors and survivors. The non-survivor group had an elevated NLR value compared to survivors (15.57 [13.75] vs. 7.91 [4.13]; p = 0.065). The NLR had an area under the curve (AUC) of 0.729 (95% confidence interval [95% CI] 0.516-0.886; p = 0.044), sensitivity of 77.78% (40-97.2), and specificity of 75% (47.6-92.7). The optimal cut-off point obtained for NLR was > 9.21.

CONCLUSIONS: An NLR value > 9.21 could be a predictor of mortality in patients with NF.

PMID:39110816 | DOI:10.5281/zenodo.10278123

J Speech Lang Hear Res. 2024 Aug 7:1-13. doi: 10.1044/2024_JSLHR-23-00602. Online ahead of print.

ABSTRACT

PURPOSE: Our goal was to compare statistical learning abilities between preschoolers with developmental language disorder (DLD) and peers with typical development (TD) by assessing their learning of two artificial grammars.

METHOD: Four- and 5-year-olds with and without DLD were compared on their statistical learning ability using two artificial grammars. After learning an aX grammar, participants learned a relatively more complex abX grammar with a nonadjacent relationship between a and X. Participants were tested on their generalization of the grammatical pattern to new sequences with novel X elements that conformed to (aX, abX) or violated (Xa, baX) the grammars.

RESULTS: Results revealed an interaction between age and language group. Four-year-olds with and without DLD performed equivalently on the aX and abX grammar tests, and neither of the 4-year-old groups’ accuracy scores exceeded chance. In contrast, among 5-year-olds, TD participants scored significantly higher on aX tests compared to participants with DLD, but the groups’ abX scores did not differ. Five-year-old participants with DLD did not exceed chance on any test, whereas 5-year-old TD participants’ scores exceeded chance on all grammar learning outcomes. Regression analyses indicated that aX performance positively predicted learning outcomes on the subsequent abX grammar for TD participants.

CONCLUSION: These results indicate that preschool-age participants with DLD show deficits relative to typical peers in statistical learning, but group differences vary with participant age and type of grammatical structure being tested.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26487376.

PMID:39110814 | DOI:10.1044/2024_JSLHR-23-00602

Sci Adv. 2024 Aug 9;10(32):eadn1607. doi: 10.1126/sciadv.adn1607. Epub 2024 Aug 7.

ABSTRACT

Glioblastoma (GBM) is the most prevalent and aggressive malignant primary brain tumor. GBM proximal to the lateral ventricles (LVs) is more aggressive, potentially because of subventricular zone contact. Despite this, cross-talk between GBM and neural stem/progenitor cells (NSC/NPCs) is not well understood. Using cell-specific proteomics, we show that LV-proximal GBM prevents neuronal maturation of NSCs through induction of senescence. In addition, GBM brain tumor-initiating cells (BTICs) increase expression of cathepsin B (CTSB) upon interaction with NPCs. Lentiviral knockdown and recombinant protein experiments reveal that both cell-intrinsic and soluble CTSB promote malignancy-associated phenotypes in BTICs. Soluble CTSB stalls neuronal maturation in NPCs while promoting senescence, providing a link between LV-tumor proximity and neurogenesis disruption. Last, we show LV-proximal CTSB up-regulation in patients, showing the relevance of this cross-talk in human GBM biology. These results demonstrate the value of proteomic analysis in tumor microenvironment research and provide direction for new therapeutic strategies in GBM.

PMID:39110807 | DOI:10.1126/sciadv.adn1607

PLoS One. 2024 Aug 7;19(8):e0308568. doi: 10.1371/journal.pone.0308568. eCollection 2024.

ABSTRACT

INTRODUCTION: The impact of SARS-CoV-2 infection among people living with HIV (PLWH) has been a matter of research. We evaluated the incidence and factors associated with SARS-CoV-2 diagnosis among PLWH. We also assessed factors related to vaccination coverage in the Balearic Islands.

METHODS: A retrospective analytical study was performed, including patients from the Balearic cohort (EVHIA) who were visited at least twice between 1st January 2020 and 31st March 2022. Chi-square test and Mann-Whitney U test were used to compare categorical and continuous variables respectively. Multivariable Cox proportional hazards regression models were estimated to identify risk factors.

RESULTS: A total of 3567 patients with HIV were included. The median age was 51 years (IQR 44-59). Most of them were male (77,3%), from Europe (82,1%) or South America (13,8%). During the study period 1036 patients were diagnosed with SARS-CoV-2 infection (29%). The incidence rate was 153,24 cases per 1000 person-year. After multivariable analysis, men who have sex with men (MSM) were associated with an increased risk of SARS-CoV-2 infection (adjusted hazard ratio 1,324, 95% CI 1,138-1,540), whereas African origin, tobacco use and complete or booster vaccination coverage were negatively related. Overall, complete vaccination or booster coverage was recorded in 2845 (79,75%) patients. When analysing vaccination uptake, older patients (adjusted hazard ratio 5,122, 95% CI 3,170-8,288) and those with a modified comorbidity index of 2-3 points (adjusted hazard ratio 1,492, 95% CI 1,056-2,107) had received more vaccine doses.

CONCLUSIONS: In our study no HIV related factor was associated with an increased risk of SARS-CoV-2 infection, except for differences in the transmission route. Possible confounding variables such as mask wearing or social interactions could not be measured. Vaccines were of utmost importance to prevent SARS-CoV-2 infection. Efforts should be made to encourage vaccination in those groups of PLWH with less coverage.

PMID:39110761 | DOI:10.1371/journal.pone.0308568