Category: Statistics

J Glob Health. 2024 Dec 30;14:04235. doi: 10.7189/jogh.14.04235.

ABSTRACT

BACKGROUND: Risk prediction tools for acutely ill children have been developed in high- and low-income settings, but few are validated or incorporated into clinical guidelines. We aimed to assess the performance of existing paediatric early warning scores for use in low- and middle-income countries using clinical data from a recent large multi-country study in Africa and South-Asia.

METHODS: We used data (children across three nutritional strata) from the Childhood Acute Illness and Nutrition (CHAIN) Network cohort study (n = 3101). We assessed 10 scores where similar predictor variables were available in the CHAIN cohort. We evaluated performance using the area under the receiver operating curve (AUC) (primary outcome), sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio (secondary outcomes).

RESULTS: Most scores showed poor discrimination, and all scores had low sensitivity. The paediatric early death index for Africa (AUC = 0.80; 95% confidence interval (CI) = 0.77-0.83), respiratory index of severity in children (AUC = 0.77; 95% CI = 0.74-0.81), and respiratory index of severity in children in Malawi (AUC = 0.78; 95% CI = 0.75-0.82) showed acceptable/good overall discrimination. Among children without wasting, most scores had acceptable/good performance, some even excellent. Poor discrimination was found for most scores among children with moderate and severe wasting or kwashiorkor.

CONCLUSIONS: All scores demonstrated lower validation performance than originally reported. Among children without wasting, most risk prediction scores performed acceptably whilst in malnourished children they performed poorly. There is a need for a malnutrition specific score. Further research is needed on specific actions in responding to scores. Integration into future guidelines will require acknowledging staffing, resources and workflows.

PMID:39886744 | DOI:10.7189/jogh.14.04235

Disaster Med Public Health Prep. 2025 Jan 31;19:e19. doi: 10.1017/dmp.2024.334.

ABSTRACT

OBJECTIVES: Plastics in the environment have moved from an “eye-sore” to a public health threat. Hospitals are one of the biggest users of single-use plastics, and there is growing literature looking at not only plastics in the environment but health care’s overall contribution to its growth.

METHODS: This study was a retrospective review at a 411-bed level II trauma hospital over 47 months pre and post the last wave of COVID-19 affecting this hospital. Deidentified data were gathered: daily census in the emergency department, hospital census, and corresponding number of admitted COVID-19 patients. Additionally, for the same time frame, personal protective equipment (PPE) supply purchases and gross tonnage of nonhazardous refuse were obtained.

RESULTS: There was a large increase in PPE purchased without a significant change in gross tonnage of weight of trash.

CONCLUSIONS: PPE is incredibly important to protect health care workers. However, single-use plastic is not sustainable for the environment or public health. Understanding the full effect of the pandemic on hospital waste production is critically important as health care institutions focus on strategies to decrease their carbon footprint and increase positive impacts on public health and the environment.

PMID:39886740 | DOI:10.1017/dmp.2024.334

Cureus. 2024 Dec 31;16(12):e76667. doi: 10.7759/cureus.76667. eCollection 2024 Dec.

ABSTRACT

Background Artificial Intelligence (AI) is revolutionizing medical science, with significant implications for radiology. Understanding the knowledge, attitudes, perspectives, and practices of medical professionals and residents related to AI’s role in radiology is crucial for effective integration. Methods A cross-sectional survey was conducted among members of the Indian Radiology & Imaging Association (IRIA), targeting practicing radiologists and residents across academic and non-academic institutions. An anonymous, self-administered online questionnaire assessed AI awareness, usage, and perceptions, distributed via medical networks and social media. Descriptive statistics and chi-square tests were used to analyze the data, with statistical analysis performed using R version 4.2.2 (R Core Team (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/). Results The survey gathered responses from 404 participants nationwide. A significant portion (95.3%) demonstrated a keen interest in expanding their knowledge of AI and recommended implementing educational initiatives that increase exposure to AI. Considerable concern about losing their jobs to AI was observed only in 27.9% of respondents. More than two-thirds (86.6%) of the respondents opined that the AI curriculum should be taught during residency and 75.7% are interested in collaborating with software developers to learn and start AI at their workplace. Conclusion The survey highlights the growing importance of AI in radiology, underscoring the need for enhanced AI education and training in medical curricula.

PMID:39886734 | PMC:PMC11781242 | DOI:10.7759/cureus.76667

Cureus. 2024 Dec 31;16(12):e76662. doi: 10.7759/cureus.76662. eCollection 2024 Dec.

ABSTRACT

INTRODUCTION: Alterations in occlusal relationships in individuals with complete edentulism considerably disrupt the equilibrium of the stomatognathic system. Evaluation of the temporomandibular joint (TMJ) is crucial during the edentulous phase, as it influences both aesthetic and functional outcomes. This investigation sought to assess alterations in condylar positioning one year after the placement of complete dentures in edentulous patients, with additional objectives to examine variations based on sex and side.

MATERIALS AND METHODS: This cross-sectional prospective cohort investigation was carried out in the Department of Prosthodontics, involving 15 participants who were systemically healthy, aged between 45 and 60 years, completely edentulous for a minimum duration of one year, and were first-time denture recipients. Following denture insertion, a one-year follow-up evaluation of condylar positioning was conducted using cone-beam computed tomography (CBCT). Analyses were performed on the intercondylar angle, interocclusal gap, and TMJ space (anterior, posterior, superior, and medial). Statistical evaluations were performed using paired and independent t-tests. The significance threshold was set at P < 0.05.

RESULTS: The mean ages of the male and female participants were 55.43 years and 56.38 years, respectively. Significant changes were observed in the TMJ spaces and condylar dynamics at the one-year follow-up. The posterior, superior, and medial joint spaces decreased significantly (p = 0.001), indicating the posterior, superior, and medial displacement of the condyle. The interocclusal gap increased significantly from 1.47 mm in males and 1.51 mm in females at denture insertion to 1.79 mm and 1.80 mm, respectively, at follow-up (p = 0.001). The intercondylar angle significantly decreased (p = 0.001). Sex-based differences were noted in the medial joint space and condylar angle on the left side, with larger mean changes in males (p < 0.05). Side-based differences revealed greater superior space, medial space, and condylar angle on the right side than on the left (p < 0.05).

CONCLUSION: This investigation revealed substantial morphometric alterations in the TMJ spaces and condylar positioning following one-year post-complete denture placement, characterized by pronounced increases in interocclusal gap and reductions in intercondylar angle. Consistent monitoring and prompt repair or replacement of dentures are essential for preserving the TMJ integrity and occlusal equilibrium in edentulous individuals.

PMID:39886725 | PMC:PMC11780681 | DOI:10.7759/cureus.76662

Cureus. 2024 Dec 30;16(12):e76647. doi: 10.7759/cureus.76647. eCollection 2024 Dec.

ABSTRACT

Background The escalating global obesity epidemic requires comprehensive investigations for effective weight management strategies. Understanding the patterns, barriers, and facilitators of dietary interventions is crucial for developing effective weight management protocols. This research aims to assess dietary modification interventions among weight loss subjects in Tamilnadu, South India. Specific objectives included evaluating various weight loss interventions, analyzing dietary patterns adopted by subjects, and examining characteristics, barriers, and facilitators associated with specific dietary modification approaches. Methodology A cross-sectional study was conducted among 432 participants from Tamilnadu, South India. The research employed a comprehensive data collection approach, gathering information on demographic characteristics, anthropometric measurements, dietary modification patterns, and intervention outcomes. Participants were categorized based on their chosen dietary interventions, particularly distinguishing between intermittent fasting and alternative dietary approaches. The study systematically evaluated various parameters, including regular adherence, physiological effects, psychological impacts, and barriers to maintenance. Statistical analysis utilized chi-square and Fischer’s exact tests for categorical variables, while independent t-tests were employed for continuous variables. Results This study encompassed 432 participants, with demographically diverse participants characterized by a predominance of urban residents (295, 68.3%), highly educated individuals (383, 88.6%), and students (190, 44%). The mean age was 27.93 years, with a mean body mass index of 25.21 kg/m². Regarding dietary intervention objectives, the study revealed that 289 (66.9%) were not engaged in any healthcare intervention, while 102 (23.6%) pursued intermittent fasting and 41 (9.5%) adopted alternative dietary strategies such as Paleo and ketogenic diets. Among participants implementing dietary modifications, the mean intervention duration was 5.21 months, ranging from half a month to 60 months. Intermittent fasting participants exhibited statistically significant characteristics, including a younger mean age (27.09 years) compared with alternative diet groups (37.37 years). Notably, 73 (71.6%) reported significant weight loss, with 69 (67.6%) experiencing weight regain during non-adherence. Psychological and physiological benefits were prominently observed, with 73 (71.6%) reporting mood improvements, 71 (69.6%) experiencing enhanced concentration, and 72 (70.6%) noting improved bowel habits. Barriers to dietary modifications included timing challenges (50, 49%), family mealtime conflicts (43, 42.2%), and work schedule interruptions (39, 38.2%). Conclusion The research provides comprehensive insights into dietary modification patterns among young Indian adults, highlighting intermittent fasting’s potential as an effective weight management strategy. The findings underscore the complex interplay between dietary choices, individual characteristics, and holistic health outcomes. While demonstrating promising weight loss and cognitive benefits, the study emphasizes the necessity of personalized, context-sensitive nutritional interventions. These insights contribute significantly to understanding dietary modification dynamics and inform the development of more effective, tailored weight management strategies.

PMID:39886723 | PMC:PMC11779999 | DOI:10.7759/cureus.76647

Cureus. 2024 Dec 31;16(12):e76676. doi: 10.7759/cureus.76676. eCollection 2024 Dec.

ABSTRACT

AIM: This study aimed to evaluate the impact of using melatonin and vitamin C as adjuncts to the non-surgical treatment of chronic periodontitis.

MATERIALS AND METHODS: This triple-blind randomized clinical trial involved 100 participants with chronic periodontitis. Subjects were randomly assigned to three groups: (1) non-surgical periodontal therapy (NSPT) alone (n = 33); (2) NSPT with melatonin (n = 33); and (3) NSPT with melatonin and vitamin C (n = 34). Clinical parameters, including gingival index (GI), probing depth (PD), and clinical attachment loss (CAL), were assessed at baseline and at one week, one month, and three months post treatment. Statistical significance was set at p ≤ 0.05.

RESULTS: Compared to baseline, all groups showed significant improvements in periodontal parameters (p ≤ 0.001). At three months, the group receiving both melatonin and vitamin C demonstrated the greatest reduction in PD (mean reduction: 1.96 mm, p ≤ 0.001) and CAL (mean reduction: 1.87 mm, p ≤ 0.001). This group also achieved the most significant improvement in GI (mean reduction: 1.74, p ≤ 0.001).

CONCLUSIONS: The combined adjunctive therapy of melatonin and vitamin C demonstrated superior improvements in periodontal indices compared to NSPT alone, supporting its potential as an effective adjunctive treatment for chronic periodontitis.

PMID:39886720 | PMC:PMC11781506 | DOI:10.7759/cureus.76676

Cureus. 2024 Dec 30;16(12):e76607. doi: 10.7759/cureus.76607. eCollection 2024 Dec.

ABSTRACT

AIM: The aim of the study is to test the null hypothesis that the specificities and sensitivities of the p-value-based significance test for differences between baseline variables and the I² test for single trials do not significantly differ in detecting selection bias in randomised controlled trials (RCTs).

METHODS: In MS Excel (Microsoft Corp., Redmond, WA, US), 100 trials were simulated, each consisting of two treatment groups (A and B), with 100 subjects in each group. Fifty trials were biased, while 50 remained non-biased. Both tests were applied to all trials, yielding true positive, false positive, false negative, and true negative per test. Subsequently, sensitivities and specificities with a 95% confidence interval (CI) were calculated and statistically compared using the z-test.

RESULTS: No false positive results were observed, and subsequently, the specificities of both tests were identical (100.00%; 95% CI: 92.89%-100.00%). The sensitivity for the significance test and I² test was 24.00% (95% CI: 13.06%-38.17%) and 76.00% (95% CI: 61.83%-86.94%), respectively. A statistical comparison of the test sensitivities yielded a significant result in favour of the I² test (z = 5.2; p < 0.0001). Consequently, the null hypothesis for the tests’ sensitivities was rejected.

CONCLUSION: The I² test appears to be a more effective method than the p-value-based significance test for detecting selection bias in RCTs.

PMID:39886704 | PMC:PMC11779566 | DOI:10.7759/cureus.76607

Cureus. 2024 Dec 31;16(12):e76669. doi: 10.7759/cureus.76669. eCollection 2024 Dec.

ABSTRACT

Optic nerve disorders significantly contribute to visual impairment with irreversible visual deficits. Current treatments have limited efficacy in resolving chronic visual deficits, necessitating novel therapeutic strategies. Neurorehabilitation techniques, including repetitive transorbital alternating current stimulation (rtACS), have emerged as promising approaches to restore lost visual function through the ability to modulate brain activity. However, the evidence on the effectiveness of rtACS remains inconclusive, warranting a systematic review to assess its potential as a therapeutic intervention for optic nerve-related visual deficits. This study exclusively evaluated the effectiveness of rtACS for visual field restoration in patients with optic nerve damage, including only randomized controlled trials (RCTs) that met the strict eligibility criteria. A thorough screening and data extraction process was conducted by independent reviewers, followed by a meta-analysis to assess the statistical significance and heterogeneity of the included studies. The improvement in the visual field in the rtACS compared to the sham group was the primary outcome, and visual acuity improvement was the secondary outcome. This study included three RCTs that evaluated the effects of rtACS compared to sham control in treating optic nerve damage. In regard to visual field (VF), the results revealed a significant improvement in the detection accuracy of the rtACS group compared to the control group, with a pooled mean difference of 32.06 [95% CI: 19.2, 51.2] (p=0.001, I2= 0%). The near and far vision revealed no statistically significant difference between both groups. Based on the systematic review, the use of rtACS shows a promising effect in improving the detection accuracy of the VF for patients with optic nerve damage, with a significant benefit over sham control. However, the effects on other visual outcomes were minimal, and safety data was limited. Further high-quality trials are needed to corroborate the findings and provide a more comprehensive evaluation of its efficacy and safety for treating optic nerve-related visual deficits.

PMID:39886696 | PMC:PMC11781289 | DOI:10.7759/cureus.76669

Front Oncol. 2025 Jan 16;14:1326355. doi: 10.3389/fonc.2024.1326355. eCollection 2024.

ABSTRACT

INTRODUCTION: This retrospective study aims to evaluate the long-term efficacy and urinary toxicity of LDR-brachytherapy for localized prostate cancer.

MATERIALS AND METHODS: 235 primary prostate cancer patients treated with LDR-brachytherapy and subsequently followed up in our center were included in this study. Biochemical relapse free survival (bRFS), overall survival (OS), and cancer-specific survival (CSS) were evaluated. Additionally, the incidence of late urinary complications was recorded.

RESULTS: Median follow-up time was 11,6 years. 181 patients (77%) were classified as low-risk patients, while 52 patients (22,1%) were intermediate risk. The overall bRFS was 83,8% at 5 years and 72,4% at 10 years. 5- and 10-year OS were 97,8% and 87,8% respectively. There was no statistically significant difference in bRFS or OS between different risk groups. The rate of late urinary complications was 8,9%. Volume of prostate had a statistically significant effect on bRFS, as smaller prostate volumes led to worse bRFS.

CONCLUSIONS: This retrospective study shows that LDR brachytherapy is an effective treatment for low- and intermediate risk prostate cancer patients with relatively low but still significant risk of late urinary complications.

PMID:39886674 | PMC:PMC11779706 | DOI:10.3389/fonc.2024.1326355

Front Oncol. 2025 Jan 16;14:1522009. doi: 10.3389/fonc.2024.1522009. eCollection 2024.

ABSTRACT

OBJECTIVE: To investigate the optimal cut-off value of immunohistochemical marker Ki67 as a prognostic factor to predict the recurrence of non-muscle invasive bladder urothelial carcinoma (NMIBUC).

METHODS: A total of 331 patients diagnosed with NMIBUC who underwent surgery in the Yongchuan Hospital and the Second Affiliated Hospital of Chongqing Medical University from January 2012 to January 2020 were finally included in this study. The optimal cut-off value of Ki67 for predicting recurrence of NMIBUC was calculated by ROC curve and Youden index. According to the cut-off value, the patients were divided into high ratio group and low ratio group, and the clinicopathological data of the two groups were compared. Univariate and multivariate regression analysis were used to analyze the relationship between the expression of Ki67 and postoperative recurrence of NMIBUC. The Kaplan-Meier curve was used for survival analysis.

RESULTS: 18% is the optimal cut-off value of Ki67 for predicting postoperative recurrence of NMIBUC. High Ki67 expression (Ki67>18%) was significantly correlated with tumor stage (P=0.001), tumor grade (P=0.014), immediate postoperative instillation (P=0.001), the expression of P53 (P=0.019) and CK20 (P=0.001). Ki67 expression greater than 18% was an independent risk factor for high recurrence rate of NMIBUC (P=0.001). Moreover, the 1-year and 3-year recurrence-free survival (RFS) of the high Ki67 group were 56.6% (95%CI 51.2%-62%) and 43.6% (95%CI 37.5%-49.7%) respectively, which were significantly lower than those in low Ki67 group which present as 92.9% (95%CI 89.0%-96.8%) and 88.3% (95%CI 82.4%-94.2%) respectively, and the difference was statistically significant (P<0.001).

CONCLUSIONS: 18% is the optimal cut-off value of Ki67 for predicting recurrence of NMIBUC. Ki67>18% is an independent risk factor for high recurrence rate of NMIBUC. This cut-off value can more accurately predict the risk of recurrence and has the potential clinical value for guiding the postoperative adjuvant treatment and follow-up strategy of NMIBUC.

PMID:39886663 | PMC:PMC11779619 | DOI:10.3389/fonc.2024.1522009