Category: Statistics

Maturitas. 2024 Feb 17;183:107946. doi: 10.1016/j.maturitas.2024.107946. Online ahead of print.

ABSTRACT

OBJECTIVES: After the 2002 Women’s Health Initiative (WHI) study, the global use of menopausal hormone therapy (MHT) declined, and despite subsequent studies indicating a low risk of breast cancer, concerns about MHT usage persist. We examined the relationship between changes in MHT use and changes in the incidence of breast cancer from 2002 to 2020 in South Korea.

STUDY DESIGN: This study used tumor registry information from 2002 to 2020 from the Korean Statistical Information Service and analyzed the incidence rate of invasive breast cancer in women, who were divided into two age groups: <50 and >50 years. The numbers of MHT prescriptions in Korea between 2002 and 2020 was determined from pharmacy data.

RESULTS: The incidence of breast cancer per 100,000 women in South Korea increased from 34.3 in 2002 to 96.4 in 2020. Breast cancer incidence rates increased annually in both groups of women (those aged under and over 50 years), with no significant difference between the two (p = 0.614). Prescriptions for estrogen therapy (ET) in 2020 were 52.7 % lower than those in 2002. Prescriptions for estrogen-progesterone therapy (EPT) decreased by 27.9 % over the same period. Conversely, tibolone prescriptions, which had initially decreased by 25.4 % in 2004, subsequently showed a steady increase and were 93.6 % higher in 2020 than in 2002.

CONCLUSION: The incidence of breast cancer increased annually in Korean women of all ages; however, the use of ET and EPT for MHT has declined since 2002, particularly the use of EPT after 2010. MHT, especially EPT, did not significantly increase the incidence of breast cancer in Korean women.

PMID:38412593 | DOI:10.1016/j.maturitas.2024.107946

Behav Res Ther. 2024 Feb 22;175:104499. doi: 10.1016/j.brat.2024.104499. Online ahead of print.

ABSTRACT

Problematic anger is linked with multiple adverse smoking outcomes, including cigarette dependence, heavy smoking, and cessation failure. A smoking cessation intervention that directly targets anger and its maintenance factors may increase rates of smoking cessation. We examined the efficacy of an interpretation bias modification for hostility (IBM-H) to facilitate smoking cessation in smokers with elevated trait anger. Participants were 100 daily smokers (mean age = 38, 62% female, 55% white) with elevated anger were randomly assigned to eight computerized sessions of either IBM-H or a health and relaxation video control condition (HRVC). Participants in both conditions attempted to quit at mid-treatment. Measures of hostility, anger, and smoking were administered at pre-, mid-, post-treatment, as well as at up to three-month follow-up. Compared to HRVC, IBM-H led to greater reductions in hostile interpretation bias, both at posttreatment and follow-up. IBM-H also led to statistically significant reductions in hostility only at posttreatment, and trait anger only at three-month follow-up. Both conditions experienced reductions in smoking, although they did not differ in quit success. We discuss these findings in the context of literature on anger and smoking cessation and provide directions for future research.

PMID:38412574 | DOI:10.1016/j.brat.2024.104499

Sleep Med. 2024 Feb 17;116:27-31. doi: 10.1016/j.sleep.2024.02.021. Online ahead of print.

ABSTRACT

OBJECTIVES: Obstructive sleep apnea (OSA) is a disease that may cause many medical conditions. Neurocognitive disorders may be triggered by OSA. In recent studies, selectively decreased gray matter tissue was observed in patients with OSA. We aimed to determine if there was a substantial difference in patients with extreme OSA by comparing the microstructural changes in different gray matter sub-areas with healthy controls using diffusion-weighted imaging methods.

METHODS: We studied 15 diagnosed severe OSA subjects before any treatment and 32 healthy control subjects. High resolution Magnetic Resonance Imaging (MRI) T1 and T2-weighted scans were visually examined to assess any major brain lesions.

RESULTS: There were no statistically significant differences of age and gender between the groups.The left and right globus pallidus, putamen and thalamus values did not differ significantly between OSA and control subjects. Right putamen values was negatively correlated with Apnea Hypopnea Index (AHI), supine AHI and non-REM AHI in OSA subjects, but no correlations appeared with left putamen values. The other gray matter parameters did not show any correlations with PSG parameters. AHI, Supine AHI, Non-Supine AHI, REM and NON-REM AHI values was not show any correlation with Right and Left Putamen volume sizes.

CONCLUSIONS: We made a morphological comparison of various gray matter areas of OSA patients and healthy volunteers in our study. We observed a significant decrease in right putamen gray matter volumes in patients with higher AHI values. Decreased cognitive functions are found in patients with OSA. In order to demonstrate this cognitive loss in patients with morphologically there is a need for further prospective studies with larger sample sizes.

PMID:38412571 | DOI:10.1016/j.sleep.2024.02.021

Arch Gerontol Geriatr. 2024 Feb 1;121:105359. doi: 10.1016/j.archger.2024.105359. Online ahead of print.

ABSTRACT

OBJECTIVES: While C-reactive protein (CRP) has been solidly linked as a risk factor for cognitive impairment, observational research alone cannot definitively demonstrate a causal relationship. This study therefore sought to determine whether there was an association between CRP and the development of cognitive impairment.

METHODS: This study employed bidirectional Mendelian randomization (MR) to investigate the genetic association between CRP and cognitive impairment. genome-wide association studies (GWAS) summary statistics for both were sourced from IEU Open GWAS or prior reports. Cognitive GWAS’s used were on tests designed to assess cognitive performance, fluid intelligence, prospective memory, and reaction time. The MR analysis applied several methods, including inverse variance-weighted (IVW), MR Egger, weighted median, simple mode, and weighted mode approaches, then use of MR sensitivity analyses to interrogate findings.

RESULTS: Forward MR analysis showed that genetically proxied CRP was associated with prospective memory (P = 0.009), whereas there is little evidence to support an association between CRP and other cognitive tests. Reverse MR analysis indicated a potential association between genetic proxy cognitive performance (P = 0.002) and fluid intelligence score (P = 0.019) with CRP levels. For genetically proxied CRP on prospective memory, the level of pleiotropy (P > 0.05) and no genetic variant heterogeneity (P > 0.05) made bias unlikely, and leave-one-out tests also confirmed robust associations.

CONCLUSIONS: The effect of genetically proxied CRP on prospective memory, with little evidence on other cognitive tests. The reverse MR shows some evidence of genetically proxied cognition (cognitive performance and fluid intelligence) on CRP levels.

PMID:38412560 | DOI:10.1016/j.archger.2024.105359

Int J Epidemiol. 2024 Feb 14;53(2):dyae028. doi: 10.1093/ije/dyae028.

NO ABSTRACT

PMID:38412541 | DOI:10.1093/ije/dyae028

Phys Med Biol. 2024 Feb 27. doi: 10.1088/1361-6560/ad2d80. Online ahead of print.

ABSTRACT

An elevated Interstitial Fluid Pressure (IFP) can lead to strain-induced stiffening of poroelastic biological tissues. As Shear Wave Elastography (SWE) measures functional tissue stiffness based on the propagation speed of acoustically induced shear waves, the Shear Wave Velocity (SWV) can be used as an indirect measurement of the IFP. The underlying biomechanical principle for this stiffening behavior with pressurization is however not well understood, and we therefore studied how IFP affects SWV through SWE experiments and numerical modeling.&#xD;Approach. For model set-up and verification, SWE experiments were performed while dynamically modulating IFP in a chicken breast. To identify the confounding factors of the SWV-IFP relationship, we manipulated the material model (linear poroelastic vs. porohyperelastic), deformation assumptions (geometric linearity vs. nonlinearity), and boundary conditions (constrained vs. unconstrained) in a finite element model mimicking the SWE experiments.&#xD;Main results. The experiments demonstrated a statistically significant positive correlation between the SWV and IFP. The model was able to reproduce a similar SWV-IFP relationship by considering an unconstrained porohyperelastic tissue. Material nonlinearity was identified as the primary factor contributing to this relationship, whereas geometric nonlinearity played a smaller role. The experiments also highlighted the importance of the dynamic nature of the pressurization procedure, as indicated by a different observed SWV-IFP for pressure buildup and relaxation, but its clinical relevance needs to be further investigated.&#xD;Significance. The developed model provides an adaptable framework for SWE of poroelastic tissues and paves the way towards non-invasive measurements of IFP.

PMID:38412537 | DOI:10.1088/1361-6560/ad2d80

Am J Trop Med Hyg. 2024 Feb 27:tpmd230725. doi: 10.4269/ajtmh.23-0725. Online ahead of print.

ABSTRACT

Acute gastroenteritis (AGE) in children can be attributed to a multitude of bacterial and viral pathogens. The objective of this study was to investigate the epidemiology of bacterial and viral AGE in children and to compare clinical characteristics between single and multiple enteric pathogen infections. A total of 456 stool samples were collected from outpatient children under 5 years old with AGE, which were subsequently analyzed for nine bacteria and three viruses using the Luminex xTAG® Gastrointestinal Pathogen Panel. The presence of at least one pathogen was detected in 260 cases (57.0%), with Salmonella being the predominant agent, followed by norovirus, Campylobacter, and rotavirus. A total of 69 cases (15.1%) exhibited positive results for two or more enteric pathogens. Although certain co-infections demonstrated significant differences in primary clinical features compared with mono-infections, no statistical variance was observed in terms of disease severity. In outpatient children from southern China, Salmonella emerged as the most prevalent causative agent of AGE, succeeded by norovirus and Campylobacter. This study underscores the burden posed by coinfections and highlights the clinical characteristics associated with AGE when accompanied by coinfections among children under 5 years old.

PMID:38412529 | DOI:10.4269/ajtmh.23-0725

J Spec Oper Med. 2024 Feb 27:X2OD-UYUQ. doi: 10.55460/X2OD-UYUQ. Online ahead of print.

ABSTRACT

BACKGROUND: The U.S. Military needs fast-acting, non-opioid solutions for battlefield pain. The U.S. Military recently used morphine auto-injectors, which are now unavailable. Off-label ketamine and oral transmucosal fentanyl citrate use introduces challenges and is therefore uncommon among conventional forces. Sublingual suftentanil is the only recent pain medication acquired to fill this gap. Conversely, methoxyflurane delivered by a handheld inhaler is promising, fast-acting, and available to some partner forces. We describe methoxyflurane use reported in the Department of Defense Trauma Registry (DODTR).

METHODS: We requested all available DODTR encounters from 2007 to 2023 with a documented intervention or assessment within the first 72 hours of care. We analyzed casualties who received methoxyflurane in the prehospital setting using descriptive statistics.

RESULTS: There were 22 encounters with documented methoxyflurane administration. The median patient age was 23 (range 21-31) years. All were men. The largest proportion was partner force (50%), followed by U.S. Military (27%). Most (64%) sustained battle injuries. Explosives were the most common mechanism of injury (46%), followed by firearms (23%). The median injury severity score was 5 (range 1-17). The most frequent injuries were serious injuries to the extremities (27%), and 23% of patients (5) received a tourniquet. One-half of the casualties received concomitant pain medications. Only three casualties had multiple pain scores measured, with a median pain score change of -3 on a scale of 10.

CONCLUSION: Methoxyflurane use in deployed combat shows both feasibility and usability for analgesia.

PMID:38412526 | DOI:10.55460/X2OD-UYUQ

Pediatr Emerg Care. 2024 Feb 28. doi: 10.1097/PEC.0000000000003126. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify factors that impact parental willingness to consent to research studies conducted for their children during visits to pediatric emergency departments (EDs).

METHODS: Parents and guardians of children receiving care in our pediatric ED were approached and asked if they would be willing to let their child participate in a research study requiring the child to complete an electronic questionnaire. No such questionnaire existed, however, because the primary purpose was to ascertain the parent’s willingness to let their child participate. All parents were debriefed and informed of the true purpose of the study and asked to complete a survey themselves to help understand factors that influenced their initial decision of whether to consent. Bivariate tests and logistic regression were used to evaluate unadjusted and adjusted associations between parent and patient characteristics and parental consent decision.

RESULTS: We approached 431 eligible parents about the hypothetical research study involving their children, and 386 (89.6%) consented for their children to participate. After the debriefing, 392 (91.0%) parents consented to complete the parental survey. We observed statistically significant associations between shorter length of ED stay to approach for consent for the study (P = 0.048) as well as longer travel time (P = 0.03) and willingness to consent in bivariate analysis, though this did not hold in regression analysis. Regression analysis revealed parents of children who have previously participated in research had 79 times lower odds of consenting to participate in our study adjusted for parent race, ethnicity, actual and perceived length of stay, traveltime to the ED, and altruism.

CONCLUSIONS: A high proportion of parents consented to their child participating in research in our ED with previous child participation in research being associated with lower odds of parental consent even when adjusted for other factors. Our findings may inform future research practices and studies investigating parental perceptions and motivations surrounding research studies.

PMID:38412522 | DOI:10.1097/PEC.0000000000003126

Pediatr Emerg Care. 2024 Feb 28. doi: 10.1097/PEC.0000000000003136. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to investigate and analyze the risk factors of convulsions in children with rotavirus gastroenteritis and to construct a nomogram prediction model.

METHODS: A retrospective analysis was performed on 940 cases of pediatric patients with rotavirus gastroenteritis treated in our hospital from December 2017 to December 2022. Based on whether convulsions occurred during hospitalization, patients were divided into the convulsion group (n = 135) and the convulsion-free group (n = 805). Clinical information of patients in both groups was collected, logistic regression analysis was carried out to analyze the convulsion risk factors pertaining to children with rotavirus gastroenteritis, and a nomogram prediction model was constructed.

RESULTS: The univariate analysis revealed that fever, frequency of diarrhea, white blood cell count, blood calcium level, blood glucose level, CO2CP, creatine kinase myocardial band (CK-MB), and blood pH value were all factors that display statistically significant differences at the level of P = 0.05. Then, logistic regression analysis was carried out, taking the occurrence of such convulsions as the dependent variable and the aforementioned factors as independent variables. The results show that fever, frequency of diarrhea, blood calcium, CO2CP, and CK-MB were the independent risk factors (P < 0.05), whereas the area under the receiver operating characteristic curve (area under the curve) of the constructed nomogram prediction model based on these factors was 0.842 (95% confidence interval, 0.821-0.914).

CONCLUSIONS: Frequency of diarrhea, blood calcium, CO2CP, and CK-MB are independent risk factors for the occurrence of convulsions in children with rotavirus gastroenteritis. The nomogram prediction model constructed based on these risk factors provides guidance and value in effectively preventing and controlling convulsions in children with rotavirus gastroenteritis.

PMID:38412521 | DOI:10.1097/PEC.0000000000003136