Category: Statistics

Br J Cancer. 2024 Dec 14. doi: 10.1038/s41416-024-02931-0. Online ahead of print.

ABSTRACT

Monitoring trends of cancer incidence, mortality and survival is vital for the planning and delivery of health services, and the evaluation of diagnostics and treatment at the population level. Furthermore, comparisons are often made between population subgroups to explore inequalities in outcomes. During the COVID-19 pandemic routine delivery of health services were severely disrupted. Resources were redeployed to COVID-19 services and patient risk of COVID-19 infection required serious consideration. Cancer screening services were paused, the availability of healthcare providers was reduced and, in some cases, patients faced difficulty in accessing optimal treatment in a timely manner. Given these major disruptions, much care should be taken when interpreting changes in cancer survival estimates during this period. The impact on cancer incidence and mortality statistics that have already been reported in some jurisdictions should drive further thought on the corresponding impact on cancer survival, and whether any differences observed are real, artificial or a combination of the two. We discuss the likely impact on key cancer metrics, the likely implications for the analysis of cancer registration data impacted by the pandemic and the implications for comparative analyses between population groups and other risk factor groups when using data spanning the pandemic period.

PMID:39674825 | DOI:10.1038/s41416-024-02931-0

Med Microbiol Immunol. 2024 Dec 14;214(1):3. doi: 10.1007/s00430-024-00810-2.

ABSTRACT

Dengue virus (DENV) mediated disease severity leads to fatality among infected patients. Immune sentinels recognize DENV thereby secreting inflammatory mediators, endothelial biomarkers and anticoagulation factors. Absence of any diagnostic biomarkers for early identification of severe dengue (SD) patients has hindered disease management. Present study is aimed to evaluate diagnostic potential of these biomarkers along with their therapeutic targets for disease severity. Dengue infection was screened among 214 symptomatic patients and 25 healthy individuals by qRT-PCR, NS1-antigen, anti-dengue-IgM, anti-dengue-IgG ELISA and categorized them according to WHO-classification, 2009. Dengue viral-load and serotypes were determined by qRT-PCR. Serum-protein concentrations of inflammatory mediators (MIF, PAF, MMP2, MMP9, MCP1, RANTES, STNFRI, ST2, EOTAXIN), endothelial biomarkers (SDC1, VEGF, ANGPT2), anticoagulation factors (sTM, vWF, TF, PAI) were determined by sandwich ELISA. Statistical, PPI-network, hub-proteins, drug prediction analysis were performed by GraphPad-Prism⁹, STRING, Cytoscape-cytoHubba, DrugBank online, TTD, respectively. Among 81 dengue infected patients, significantly higher levels of MIF, PAF, sTNFRI, MMP9, VEGF, ANGPT2, MMP2, RANTES, SDC1 were detected among SD patients compared to non-severe ones, with excellent and good diagnostic potential of first (> 77.11, > 57.57 ng/ml, > 3226 pg/ml) and next three (> 105.3 ng/ml, > 12,380, > 8284 pg/ml) biomarkers, respectively. Serum MIF, PAF, MMP9, sTNFRI levels were significantly higher among hospitalized (p-value: 0.0081-0.0499), high-viral-load (p-value: 0.0266-0.0466) and DENV-2, 4 (p-value: < 0.0001-0.0298) infected patients. PPI-network analysed MMP9, PAI, vWF, ANGPT2, sTM, sTNFRI, MIF as hub-proteins targeted by FDA-approved/experimental drugs. This study recognized serum-biomarkers: MIF, PAF, sTNFRI, MMP9, VEGF, ANGPT2 to have significant diagnostic potential for identification of SD cases.

PMID:39674822 | DOI:10.1007/s00430-024-00810-2

Brachytherapy. 2024 Dec 13:S1538-4721(24)00443-4. doi: 10.1016/j.brachy.2024.10.014. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to evaluate the outcomes of patients treated for low-risk (LR) and favorable intermediate risk (FIR) prostate cancer with brachytherapy (BT) in monotherapy with LDR or HDR and its relationship with nadir PSA (nPSA).

MATERIALS AND METHODS: We retrospectively analyzed 139 patients (2005-2019) with exclusive LDR (46%. 145/160 Gy) /HDR (54%. 2 implants of 13.5 Gy each separated 10 days). 69% LR and 31% FIR. PSA nadir was grouped into two categories: ≤ 0.2 ng/mL and > 0.2 ng/mL.

RESULTS: Median patient age was 69 years (46-84). Seventy-six patients (55%) received androgen deprivation therapy, and 37% received neoadjuvant therapy. Median follow-up period was 90 months. Actuarial biochemical failure-free survival (BFFS), local control (LC), overall survival (OS), and cause-specific survival (CSS) rates for the total cohort were 78%, 87%, 68%, and 98% at 10 years, respectively. BFFS, LC, OS and CSS in nPSA ≤ 0,2 ng/ml was 90%, 96%, 67%, 100% at 10 years respectively, whereas, those with a nPSA > 0.2 ng/ml had a BFFS, LC, OS and CSS of was 37%, 51%, 72%, 90% at 10 years respectively Statistical significance between both groups was reached in BFFS (p=0,000), LC (p=0,000) and CSS (p=0,007)). In the univariate analysis, there was no difference between risk stratification, BT technique, ADT, or the development of bouncing.

CONCLUSIONS: Prostate brachytherapy as monotherapy (LDR and HDR) is an effective treatment option for patients with LR and FIR prostate cancer. nPSA ≤0,2 ng/ml is a representative value that provides prognostic information for favorable outcomes in this group of patients.

PMID:39674772 | DOI:10.1016/j.brachy.2024.10.014

Pain Manag Nurs. 2024 Dec 13:S1524-9042(24)00308-4. doi: 10.1016/j.pmn.2024.11.005. Online ahead of print.

ABSTRACT

OBJECTIVE: The main objective of this review is to demonstrate the use of Peripheral Percutaneous Electrical Nerve Stimulation (PENS), together with its most up-to-date protocols, for the treatment of neuropathies.

DESIGN: We conducted a systematic search for randomised clinical trials evaluating the effectiveness of PENS on pain intensity, sleep quality, oral analgesic intake and depression in patients with neuropathic pain.

DATA SOURCES: The search was performed in Pubmed, PEDro and Cochrane databases.

ANALYSIS METHODS: The meta-analysis was conducted using RevMan 5.4 software. The mean difference was applied for variables with the same measurement scale, while the standardized mean difference was used for different scales. The inverse variance method was employed for statistical analysis, with heterogeneity assessed using the I² and Cochrane Q statistics.

RESULTS: Four articles that met the search requirements were included. After qualitative and quantitative synthesis, the results obtained were an improvement in pain intensity (-3.57 [-4.01, -3.13]; p < .05) and sleep quality (2.48 [1.96, 3.00]; p < .05) and a reduction in medication intake (-2.37 [-4.26, -0.47]; p < .05) and depressive behaviours (-1.10 [-1.55, -0.66]; p < .05). The overall methodological quality was rated as moderate and the risk of bias as unclear.

CONCLUSIONS: The scientific evidence found is still limited for the use of PENS in neuropathies. However, this study suggests an encouraging future for the use of this therapy as a treatment tool in physiotherapy.

NURSING PRACTICE IMPLICATIONS: PENS requires nurse education on electrode/needle placement and patient instruction, with documentation of key parameters. This review emphasizes the need for further research to establish standardized protocols and optimal application parameters for different neuropathic pain conditions.

PMID:39674759 | DOI:10.1016/j.pmn.2024.11.005

Encephale. 2024 Dec 13:S0013-7006(24)00209-4. doi: 10.1016/j.encep.2024.10.002. Online ahead of print.

ABSTRACT

OBJECTIVES: Physicians demonstrate low rates of help seeking for psychiatric disorders, occupational stress, and burnout due to perceived stigma. The Stigma of Occupational Stress Scale for Doctors (SOSS-D) is a brief standardized tool designed to measure stigma (personal, perceived other, and perceived structural) in physicians. The aim of this study was to gather validity evidence for a French version of the SOSS-D.

METHODS: The SOSS-D was translated into French and piloted with 12 physicians. The scale was administered to physicians at the Geneva University Hospitals. We computed descriptive statistics and internal consistency coefficients. Construct validity was analyzed using exploratory (EFA) and confirmatory factor (CFA) analyses.

RESULTS: In total, 323 physicians participated in the survey. The internal consistency coefficient for the French SOSS-D was 0.72, 0.55 for the personal stigma subscale, 0.66 for the perceived other stigma subscale, and 0.65 for the perceived structural stigma subscale. CFA indicated a marginal fit. EFA revealed three factors: personal, perceived other, and perceived structural stigma.

DISCUSSION: Our findings support the hypothesis that stigma is a multi-dimensional construct. However, the French version of the SOSS-D scale did demonstrate some differences when compared to its English version. Identifying stigmatization beliefs among physicians may allow for increased identification of physicians at risk, and increased communication concerning preventive actions. Moreover, being aware of and fighting stigma can reduce barriers to help seeking and increased access to care resources for burnt-out physicians.

CONCLUSION: The results provide evidence of the validity and reliability of the French version of the SOSS-D indicating its suitability for use in a French-speaking physician population.

PMID:39674755 | DOI:10.1016/j.encep.2024.10.002

Nutr Metab Cardiovasc Dis. 2024 Nov 19:103799. doi: 10.1016/j.numecd.2024.103799. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Whether the new standard of metabolic dysfunction-associated fatty liver disease (MAFLD) has more pronounced clinical and population screening diagnostic value than nonalcoholic fatty liver disease (NAFLD) is unclear. This study evaluated the utility of MAFLD and NAFLD for predicting major cardiovascular disease (CVD) risk.

METHODS AND RESULTS: A prospective cohort study approach was utilized to collect 19,399 study participants without CVD at baseline who completed follow-up from the Jinchang cohort platform during 2011-2017. According to clinical ultrasonic diagnosis results and disease diagnosis criteria, the baseline population was divided into MAFLD, NAFLD, Both-FLD and No-FLD groups. Based on the multifactorial Cox proportional risk model to analyze the relationship between three kinds of patients and CVD, the score prediction model of CVD was constructed with reference to the Framingham Risk Score (FRS) and the model was evaluated. Compared with No-FLD, the HRs and 95 % CIs for the risk of CVD development in patients with NAFLD, MAFLD, and Both-FLD were 1.54 (1.34-1.76), 1.57 (1.37-1.79), and 1.62 (1.41-1.87), in that order. The scoring model showed a range of 5.90%-84.59 % risk of CVD in the three groups. As the risk score increased, the risk of developing CVD gradually increased. Evaluation metrics of all three models in the training set and validation set showed that the models have good prediction efficacy.

CONCLUSION: In terms of CVD risk and prognosis, MAFLD had no advantage over NAFLD. However, Both-FLD was found to predict a higher risk of CVD and to have superior predictive efficacy.

PMID:39674723 | DOI:10.1016/j.numecd.2024.103799

Nutr Metab Cardiovasc Dis. 2024 Nov 19:103797. doi: 10.1016/j.numecd.2024.103797. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) often manifest a combination of cardiometabolic risk factors of varying severity. The cardiometabolic phenotypes and their associations with advanced liver fibrosis and all-cause mortality among patients with MASLD warrant further investigation.

METHODS AND RESULTS: A total of 4209 and 1901 eligible participants were obtained from the National Health and Nutrition Examination Survey and included in the original and replication datasets, respectively. In the original dataset, three distinct and stable cardiometabolic phenotypes were identified using unsupervised cluster analyses, including mild cardiometabolic risk factor (MCMRF) phenotype, overweight combined with high diastolic blood pressure dominated (OCHBP) phenotype, and severe glucose and lipid metabolic dysfunction dominated (SGLMD) phenotype. The above phenotypes were subsequently replicated in the replication dataset, demonstrating similar characteristics. After adjusting for potential covariates, the results of logistic and Cox regression models showed that OCHBP and SGLMD phenotypes were significantly associated with higher odds of advanced liver fibrosis (OCHBP: OR = 4.37, 95 % CI: 1.54-12.35, P = 0.020; SGLMD: OR = 9.66, 95 % CI: 4.76-19.61, P = 0.002) and an increased risk of all-cause mortality (OCHBP: HR = 1.39, 95 % CI: 1.17-1.65, P < 0.001; SGLMD: HR = 2.51, 95 % CI: 1.86-3.40, P < 0.001) compared to the MCMRF phenotype. Moreover, the observed associations remained statistically significant in most subgroups, and a series of sensitivity analyses further confirmed the robustness of these findings.

CONCLUSION: Three heterogeneous cardiometabolic phenotypes were identified among participants with MASLD, showing significant associations with two critical outcomes. These novel phenotypes may be of great importance to precision medicine in MASLD.

PMID:39674720 | DOI:10.1016/j.numecd.2024.103797

J Prosthet Dent. 2024 Dec 13:S0022-3913(24)00730-3. doi: 10.1016/j.prosdent.2024.10.034. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: The relationship between hemoglobin A1c (HbA1c) levels and the clinical outcomes of ultrahydrophilic, smooth collar implants in the maxillary molar region remains underexplored.

PURPOSE: The purpose of this clinical study was to investigate the relationship between the HbA1c levels and clinical outcomes of ultrahydrophilic, smooth collar implants in the maxillary molar region of patients with type 2 diabetes mellitus.

MATERIAL AND METHODS: In total, 35 participants with type 2 diabetes mellitus who had received dental implants in the maxillary molar region between January 2016 and June 2020 were enrolled. Marginal bone levels (MBLs) were assessed from radiographs immediately and 1 to 2 years after restoration. Peri-implant tissue health was evaluated clinically and radiographically, and patient satisfaction was measured using the Oral Health Impact Profile-14 scale. The data were organized using a spreadsheet and statistically analyzed with a statistical software package. A t test was used to determine significant differences between groups, specifically comparing patients with HbA1c levels <7% and ≥7% in terms of MBLs, bleeding on probing (BOP), probing depth (PD), and patient satisfaction (OHIP-14 scores) (α=.05). Furthermore, a linear correlation analysis was performed to assess the relationship between HbA1c levels and PD, as well as HbA1c levels and OHIP-14 scores.

RESULTS: Of the 35 participants, 27 were successfully followed up, and 27 ultrahydrophilic, smooth collar implants with a mean ±standard deviation length of 9.30 ±1.16 mm were placed. All implants were considered clinically successful 1 to 2 years after restoration. Those with HbA1c levels <7% exhibited no mesial or distal bone loss, while those with HbA1c levels ≥7% experienced a mean ±standard deviation distal marginal bone loss of 0.25 ±0.30 mm and a mean ±standard deviation mesial marginal bone loss of 0.14 ±0.16 mm. The overall satisfaction and total Oral Health Impact Profile-14 scores in patients with HbA1c levels ≥7.5% significantly differed from those with HbA1c levels <7.5% (P<.05).

CONCLUSIONS: Ultrahydrophilic, smooth collar implants demonstrated favorable clinical and patient satisfaction outcomes in patients with type 2 diabetes mellitus, with HbA1c levels serving as strong indicators of peri-implant health.

PMID:39674716 | DOI:10.1016/j.prosdent.2024.10.034

Injury. 2024 Dec 3:112075. doi: 10.1016/j.injury.2024.112075. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of this trial was to investigate the impact of early thoracic and shoulder girdle exercises on chronic pain and Health-Related Quality of Life in patients with blunt chest wall trauma, when compared to normal care.

METHODS: A multi-centre, parallel, randomised controlled trial, in which adult patients presenting to hospital with blunt chest wall trauma were allocated to either control or intervention group. The intervention was an exercise programme consisting of four simple thoracic and shoulder girdle exercises, completed for one week. Outcomes measures included prevalence and severity of chronic pain using the Brief Pain Inventory, health-related quality of life using EQ-5D-5 L, and cost effectiveness, measured at initial presentation and three months post-injury.

RESULTS: 360 participants were recruited. Participants’ mean age was 63.6 years (standard deviation (SD): 17.9 years) and 213 (59.8 %) were men. After loss-to-follow-up, the survey response rate at three months was 73.0 % (251/344 participants). The primary analysis, for chronic pain prevalence at three months post-injury, found no statistically significant differences between intervention and control groups, with lower rates in the control (intervention: 35/126 (27.8 %), control: 20/117 (17.1 %); adjusted odds ratio 1.862; 95 % CI: 0.892 to 3.893, p = 0.098). There were no statistically significant differences between intervention and control groups for pain severity at three months post-injury, (intervention mean (SD): 2.15 (2.49), control: 1.81 (2.10); adjusted difference 0.196, 95 % CI:0.340 to 0.731; p = 0.473); or Health-Related Quality of Life (intervention mean (SD): 0.715 (0.291), control: 0.704 (0.265); adjusted difference: 0.030; 95 % CI:0.033 to 0.094; p = 0.350). The health economic analysis found the intervention was associated with higher costs compared to normal care.

CONCLUSION: The results of this trial did not support a ‘one-size fits all’ simple, early exercise programme for patients with blunt chest wall trauma. Future research should consider the impact of a personalised exercise programme, commenced by the patient at least one week post-injury.

PMID:39674711 | DOI:10.1016/j.injury.2024.112075

J Pediatr Nurs. 2024 Dec 13:S0882-5963(24)00449-4. doi: 10.1016/j.pedn.2024.12.004. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the effect of instructional therapeutic play on acceptance of nasal lavage in children hospitalized for respiratory conditions.

DESIGN AND METHODS: This quasi-experimental study was conducted at a teaching hospital. For the therapeutic play session, disposable gloves filled with compressed air and designed to resemble a human face, syringes, and saline solution ampoules were used. Children’s acceptance behaviors were assessed before, immediately after, and 6 h after the therapeutic play session. The data were subjected to descriptive and inferential statistical analyses.

RESULTS: Children (N = 42) aged 3-6 years, 50 % female, with a hospitalization duration of 0.2-9 days, showed increased acceptance of nasal lavage (p = 0.01), with the child self-administering the saline solution (p = 0.01), and with reduction of all resistance behaviors to nasal lavage (p < 0.05).

CONCLUSIONS: Instructional therapeutic play was effective as an educational intervention for the acceptance of nasal lavage in hospitalized children.

PRACTICE IMPLICATIONS: This study demonstrates the potential of using instructional therapeutic play, innovating the field of pediatric nursing, and expanding the international knowledge frontier of this subject. In the future, there is a need for clinical trials with control groups, larger and more heterogeneous samples, and implementation studies.

PMID:39674703 | DOI:10.1016/j.pedn.2024.12.004