Category: Statistics

Prog Cardiovasc Dis. 2024 Jul 7:S0033-0620(24)00096-3. doi: 10.1016/j.pcad.2024.06.008. Online ahead of print.

ABSTRACT

INTRODUCTION: Critical limb-threatening ischemia (CLTI) is a severe manifestation of peripheral artery disease (PAD) that can lead to limb amputation and significantly reduce the quality of life. In addition to guideline-directed medical therapy (GDMT), endovascular therapy and surgical revascularization are the two revascularization options for CLTI. In recent years, there has been an ongoing debate about the best approach for CLTI patients. The purpose of this meta-analysis is to examine the current evidence and compare the clinical outcomes of endovascular therapy and surgical revascularization for CLTI.

METHODS: We conducted a systematic search of electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) for studies comparing the outcomes of endovascular therapy versus surgery in patients with CLTI. The primary outcomes were major adverse limb events (MALE) and major adverse cardiovascular events (MACE), while secondary outcomes included risk of bleeding, wound complications, readmission, unplanned reoperation, acute renal failure, and length of hospital stay. Pooled data was analyzed using the fixed-effect model or the random-effect model in Review Manager 5.3. The Newcastle-Ottawa Scale and Cochrane risk of bias assessment tool were used to assess the bias of included studies.

RESULTS: A total of 16 studies (47,609 patients) were included in this meta-analysis. The overall effect favors surgery over endovascular intervention in terms of MALE [odds ratio (OR) 1.13, 95% CI (1.01-1.28), P = 0.04]. Endovascular therapy is associated with lower MACE rates compared to surgery [OR 0.62, 95% CI (0.51-0.76), P < 0.00001]. Furthermore, the risk of bleeding, wound complications, readmission, unplanned reoperation, acute renal failure as well as the length of hospital stay was lower for endovascular intervention. Finally, there was no statistically significant difference in 30-day mortality between the two groups [OR 0.94, 95% CI 0.79-1.12, P = 0.52; Fig. 3i], and the pooled studies were homogeneous [P = 0.39; I2 = 5%].

CONCLUSION: Surgery may be the preferred treatment option for CLTI patients, as it is associated with a lower risk of MALE than endovascular therapy. However, endovascular therapy may be associated with a lower risk of MACE and lower rates of bleeding, wound complications, readmission, unplanned reoperation, acute renal failure, and shorter hospital stays. There was no statistically significant difference in 30-day mortality between the two groups. Ultimately, the decision to use endovascular therapy or surgery as the primary treatment strategy should be based on a multi-disciplinary team approach with careful consideration of patient characteristics and anatomy.

PMID:38981532 | DOI:10.1016/j.pcad.2024.06.008

Asian J Psychiatr. 2024 Jul 5;99:104132. doi: 10.1016/j.ajp.2024.104132. Online ahead of print.

ABSTRACT

OBJECTIVES: Delirium is a significant health concern in acute stroke patients. We aim to systematically summarize existing evidence to conduct a meta-analysis to quantify the occurrence and risk factors for delirium after acute stroke.

METHOD: PubMed, EMBASE and MEDLINE were searched from inception to Feb. 2023 for prospective observational studies that reported the incidence or prevalence of post-stroke delirium and/or evaluated potential risk factors. The search strategy was created using controlled vocabulary terms and text words for stroke and delirium. We performed a meta-analysis of the estimates for occurrence and risk factors using random-effects models. Meta-regression and subgroup meta-analyses were conducted to explore the sources of heterogeneity. Study quality and quality of evidence were assessed using the customized Newcastle-Ottawa Scale and GRADE, respectively.

RESULTS: Forty-nine studies that enrolled 12383 patients were included. The pooled occurrence rate of post-stroke delirium was 24.4 % (95 %CI, 20.4 %-28.9 %, I²=96.2 %). The pooled occurrence of hyperactive, hypoactive, and mixed delirium was 8.5 %, 5.7 % and 5.0 %, respectively. Study location, delirium assessment method and stroke type independently affected the heterogeneity of the pooled estimate of delirium. Statistically significant risk factors were older age, low education level, cigarette smoking, alcohol drinking, atrial fibrillation, lower ADL level, higher pre-stroke mRS score, premorbid cognitive impairment or dementia, aphasia, total anterior circulation impairment, higher National Institute of Health Stroke Scale score and infection.

CONCLUSIONS: Delirium affected 1 in 4 acute stroke patients, although reported rates may depend on assessment method and stroke type. Timely prevention, recognition and intervention require prioritizing patients with dominant risk factors.

PMID:38981150 | DOI:10.1016/j.ajp.2024.104132

Arch Cardiol Mex. 2024 Jul 9. doi: 10.24875/ACM.23000217. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the factors associated with left ventricular diastolic dysfunction (LVDD) in adults residing in a region of the Andes in Peru.

METHOD: A case-control study was conducted on adults living at an altitude of more than 3000 meters in Peru. Cases consisted of patients diagnosed with LVDD through echocardiography, whereas controls were adults without LVDD, as confirmed by echocardiography.

RESULTS: A total of 50 cases and 100 controls were included in the study. Among them, 38.7% had high blood pressure, and 41.3% were overweight. Upon adjusted analysis, age 60 or older (aOR: 4.06; 95%CI: 1.29-12.8), female sex (aOR: 2.24; 95%CI: 1.01-4.96) and left ventricular hypertrophy (aOR: 3.17; 95%CI: 1.41-7.17) were identified as statistically significant factors associated with LVDD.

CONCLUSIONS: The risk of LVDD is associated with older adults, female gender, and left ventricular hypertrophy among individuals residing above 3000 meters altitude in a region of the Andes, in Peru.

PMID:38981138 | DOI:10.24875/ACM.23000217

Appl Physiol Nutr Metab. 2024 Jul 9. doi: 10.1139/apnm-2024-0059. Online ahead of print.

ABSTRACT

Snacking is nearly universal among children but there is growing concern around snacking patterns and energy contribution. This study aimed to characterize temporal snacking patterns among Canadian children and adolescents. A cross-sectional analysis drew on data from 5,209 respondents aged 4 to 18 years from the 2015 Canadian Community Health Survey Nutrition, using one 24-hour dietary recall. Descriptive statistics estimated proportions of morning, afternoon and evening snackers, the mean caloric contribution of each snacking period to total daily energy intake, and the top food categories consumed as snacks (kcal per capita). Snacking was nearly universal and accounted for one of every four calories consumed. Morning snacks were more popular among children vs. adolescents and contributed significantly less energy than afternoon or evening snacking periods for both age groups (P<0.001). The top food groups consumed as snacks were the same for children and adolescents, although the ranking order varied. Fruits was the leading food group in terms of per capita energy for children, and second for adolescents. Aside from fruits and milks, all other top per capita energy contributors were generally more energy-dense, nutrient-poor foods such as cookies, biscuits and cereal bars, and other breads. Among children, morning snacks were higher in desirable nutrients compared with afternoon snacks. Not all snacking periods are equal in terms of energy and nutrients. A better understanding of how time of day may influence the quality of snack foods can inform meal-based guidance and help children achieve the recommended daily amounts of foods and nutrients.

PMID:38981135 | DOI:10.1139/apnm-2024-0059

Ann Work Expo Health. 2024 Jul 9:wxae043. doi: 10.1093/annweh/wxae043. Online ahead of print.

ABSTRACT

This study evaluates the effectiveness of self-assessed exposure (SAE) data collection for characterization of hydrogen sulfide (H2S) risks in water and wastewater management, challenging the adequacy of traditional random or campaign sampling strategies. We compared 3 datasets derived from distinct strategies: expert data with activity metadata (A), SAE without metadata (B), and SAE with logbook metadata (C). The findings reveal that standard practices of random sampling (dataset A) fail to capture the sporadic nature of H2S exposure. Instead, SAE methods enhanced by logbook metadata and supported by reliable detection and calibration infrastructure (datasets B and C) are more effective. When assessing risk, particularly peak exposure risks, it is crucial to adopt measures that capture exposure variability, such as the range and standard deviations. This finer assessment is vital where high H2S peaks occur in confined spaces. Risk assessment should incorporate indices that account for peak exposure, utilizing variability measures like range and standard or geometric standard deviation to reflect the actual risk more accurately. For large datasets, a histogram is just as useful as statistical measures. This approach has revealed that not only wastewater workers but also water distribution network workers, can face unexpectedly high H2S levels when accessing confined underground spaces. Our research underscores the need for continuous monitoring with personal electrochemical gas detector alarm systems, particularly in environments with variable and potentially hazardous exposure levels.

PMID:38981129 | DOI:10.1093/annweh/wxae043

J Med Internet Res. 2024 Jul 9;26:e51538. doi: 10.2196/51538.

ABSTRACT

BACKGROUND: Type 1 diabetes mellitus (T1DM) is the most common chronic autoimmune disease among children and adolescents. Telemedicine has been widely used in the field of chronic disease management and can benefit patients with T1DM. However, existing studies lack high-level evidence related to the effectiveness of telemedicine for glycemic control in children and adolescents with T1DM.

OBJECTIVE: This study aims to systematically review the evidence on the effectiveness of telemedicine interventions compared with usual care on glycemic control among children and adolescents with T1DM.

METHODS: In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Embase, Web of Science (all databases), and CINAHL Complete from database inception to May 2023. We included randomized controlled trials (RCTs) that evaluated the effectiveness of a telemedicine intervention on glycemic control in children and adolescents with T1DM. In total, 2 independent reviewers performed the study selection and data extraction. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Our primary outcome was glycated hemoglobin (HbA_1c) levels. Secondary outcomes were quality of life, self-monitoring of blood glucose, the incidence of hypoglycemia, and cost-effectiveness. A random-effects model was used for this meta-analysis.

RESULTS: Overall, 20 RCTs (1704 participants from 12 countries) were included in the meta-analysis. Only 5% (1/20) of the studies were at high risk of bias. Compared to usual care, telemedicine was found to reduce HbA_1c levels by 0.22 (95% CI -0.33 to -0.10; P<.001; I²=35%). There was an improvement in self-monitoring of blood glucose (mean difference [MD] 0.54, 95% CI -0.72 to 1.80; P=.40; I²=67.8%) and the incidence of hypoglycemia (MD -0.15, 95% CI -0.57 to 0.27; P=.49; I²=70.7%), although this was not statistically significant. Moreover, telemedicine had no convincing effect on the Diabetes Quality of Life for Youth score (impact of diabetes: P=.59; worries about diabetes: P=.71; satisfaction with diabetes: P=.68), but there was a statistically significant improvement in non-youth-specific quality of life (MD -0.24, 95% CI -0.45 to -0.02; P=.04; I²=0%). Subgroup analyses revealed that the effect of telemedicine on HbA_1c levels appeared to be greater in studies involving children (MD -0.41, 95% CI -0.62 to -0.20; P<.001), studies that lasted <6 months (MD -0.32, 95% CI -0.48 to -0.17; P<.001), studies where providers used smartphone apps to communicate with patients (MD -0.37, 95% CI -0.53 to -0.21; P<.001), and studies with medication dose adjustment (MD -0.25, 95% CI -0.37 to -0.12; P<.001).

CONCLUSIONS: Telemedicine can reduce HbA_1c levels and improve quality of life in children and adolescents with T1DM. Telemedicine should be regarded as a useful supplement to usual care to control HbA_1c levels and a potentially cost-effective mode. Meanwhile, researchers should develop higher-quality RCTs using large samples that focus on hard clinical outcomes, cost-effectiveness, and quality of life.

PMID:38981114 | DOI:10.2196/51538

MSMR. 2024 Jun 20;31(6):34-42.

ABSTRACT

This report summarizes incidence rates and trends of sexually transmitted infections (STIs) from 2015 through 2023 among active component service members of the U.S. Armed Forces. The data compiled for this report are derived from the medical surveillance of chlamydia, gonorrhea, and syphilis as nationally notifiable diseases. Case data for 2 additional STIs, human papilloma virus (HPV) and genital herpes simplex virus (HSV), are also presented. The crude total case rates of chlamydia and gonorrhea initially rose by an average of 6.7% and 9.8% per year, respectively, until 2019. From 2020 onwards, rates steadily declined. By 2023, chlamydia rates had dropped by approximately 39%, while gonorrhea rates had fallen by more than 40% for female, and 19% for male, service members. Initially syphilis increased, on average, 10% annually from 2015 to 2019, then declined in 2020, but resumed its upward trend through 2023, nearly doubling the 2015 rate in 2023. The total crude annual incidence rates of genital HPV and HSV exhibited downward trends in general over the surveillance period, decreasing by 30.7% and 24.7%, respectively. Age- and gender-adjusted case rates for chlamydia, gonorrhea, and syphilis remain elevated within the U.S. Armed Forces compared to the general U.S. population, which may be due to factors that include mandatory STI screening, more complete reporting, incomplete adjustment for age distribution, and inequitable comparisons between the military active duty and general U.S. populations. Social restrictions enacted during the COVID-19 pandemic may have contributed to declines in true case rates and screening coverage.

PMID:38981080

MSMR. 2024 Jun 20;31(6):26-33.

NO ABSTRACT

PMID:38981072

MSMR. 2024 Jun 20;31(6):19-25.

NO ABSTRACT

PMID:38981071

Pain. 2024 Jul 9. doi: 10.1097/j.pain.0000000000003336. Online ahead of print.

ABSTRACT

Chronic pain is a serious and prevalent condition that can affect many facets of life. However, uncertainty remains regarding the strength of the association between chronic pain and death and whether the association is causal. We investigate the pain-mortality relationship using data from 19,971 participants aged 51+ years in the 1998 wave of the U.S. Health and Retirement Study. Propensity score matching and inverse probability weighting are combined with Cox proportional hazards models to investigate whether exposure to chronic pain (moderate or severe) has a causal effect on mortality over a 20-year follow-up period. Hazard ratios (HRs) with 95% confidence intervals (CIs) are reported. Before adjusting for confounding, we find a strong association between chronic pain and mortality (HR: 1.32, 95% CI: 1.26-1.38). After adjusting for confounding by sociodemographic and health variables using a range of propensity score methods, the estimated increase in mortality hazard caused by pain is more modest (5%-9%) and the results are often also compatible with no causal effect (95% CIs for HRs narrowly contain 1.0). This attenuation highlights the role of confounders of the pain-mortality relationship as potentially modifiable upstream risk factors for mortality. Posing the depressive symptoms variable as a mediator rather than a confounder of the pain-mortality relationship resulted in stronger evidence of a modest causal effect of pain on mortality (eg, HR: 1.08, 95% CI: 1.01-1.15). Future work is required to model exposure-confounder feedback loops and investigate the potentially cumulative causal effect of chronic pain at multiple time points on mortality.

PMID:38981067 | DOI:10.1097/j.pain.0000000000003336