Category: Statistics

BMC Health Serv Res. 2023 Aug 23;23(1):895. doi: 10.1186/s12913-023-09919-1.

ABSTRACT

BACKGROUND: Hospital services in all parts of the world were severely affected by the crisis caused by the Coronavirus pandemic. This was particularly concerning for patients who suffer from chronic diseases.

AIM: This study aimed to: assess the level of quality and accessibility of chronic disease services from the perspectives of healthcare providers, assess the association between healthcare providers’ socio-demographic factors and their perspectives on accessibility and quality level, and explore the providers’ perspectives on the barriers and facilitators of quality and accessibility to chronic disease health services during the COVID -19 pandemic.

METHOD: Design: An explanatory mixed method design was employed in this study using a questionnaire and focus group discussion approach. The questionnaire consisted of three sections including, demographic, accessibility, and quality.

SAMPLE: A convenience sampling approach was used to collect the quantitative from 412 healthcare providers working at public, private, and teaching hospitals. A purposive sample of 12 healthcare providers were interviewed to collect the qualitative data.

ANALYSIS: The quantitative data were analyzed using SPSS Statistics Version 25. The qualitative data was analyzed using the thematic analysis approach.

RESULTS: This study found that the quality and accessibility of chronic disease services in northern Jordan were affected during COVID-19. Quantitative: The majority of the participants reported moderate level of accessibility and quality. Qualitative: Four main and six subthemes were identified: 1) Accessibility barriers including transportation and fear of infection; 2) Accessibility facilitators including availability of Personal Protective Equipment (PPE) and Covid-19 vaccination; 3) Quality barriers including staff shortage; 4) Quality facilitators including safety protocol.

CONCLUSION: The quality and accessibility of chronic disease services were affected due to the healthcare system restating to address the Covid-19 pandemic. Different barriers and facilitators for chronic disease healthcare services accessibility and quality were identified. The findings of this study lay the ground for healthcare decision and policymakers to develop strategies and formulate polices to ensure these patients receive the needed healthcare services, and hence improve their health outcomes.

PMID:37612605 | DOI:10.1186/s12913-023-09919-1

BMC Cancer. 2023 Aug 23;23(1):786. doi: 10.1186/s12885-023-11305-3.

ABSTRACT

BACKGROUND: It is unknown if participation in a cancer clinical trial confers clinical benefits to patients. There is not enough scientific evidence in this regard and the available publications are scarce and provide ambiguous and limited information.

OBJECTIVE: Compare overall and progression-free survival and response to treatment among those who met the eligibility criteria and accepted to participate and those who refused to participate in cancer clinical trials.

METHODS: An observational cross-sectional study with an analytical component was carried out, which included patients diagnosed with cancer who participated in phase III clinical trials and patients who, being eligible, refused to participate. The patients were cared for at the National Institute of Cancerology in Colombia between 2019 and 2022. Analysis of differences in proportions and means of sociodemographic and clinical variables was included; overall survival and progression-free survival time were described and the survival curves between groups were compared. Variables related to survival were determined using a Cox regression model and Hazard Ratios were calculated.

RESULTS: 62 women and 50 men were included. In the women group, we found a statistical association between clinical trial participation and non-serious events adverse and progression. The stable disease and complete response were higher in participants than in refusers. The median progression-free survival for refusers was 7,4 m meantime for participants the median was not reached and 74,1% remained without progression at 28 months. In the men group, we also found a statistical association between clinical trial participation and the occurrence of non-serious events adverse meanwhile there were no significant differences in overall response, progression, and death, even though the proportion of progression was minor in participants 20% vs. refusers 26% respectively. The median survival was not reached for any group, even though in the participants group 55,2% were still alive at month 20 and in the refusers group still alive at 56,8% at month 45. Covariables included for the multivariate Cox regression only age had a statistical association with overall survival in the women’s group and the men group any covariables reached statistical association.

CONCLUSION: It can be considered that participation in clinical trials could give participants a better response to treatment, without increasing the probability of death and with the probability of decreasing the progression of the disease. Participation in trials could improve the outcomes of clinical response rates, no change in overall survival, and progression-free.

PMID:37612602 | DOI:10.1186/s12885-023-11305-3

Arch Orthop Trauma Surg. 2023 Aug 24. doi: 10.1007/s00402-023-05033-3. Online ahead of print.

ABSTRACT

BACKGROUND: In recent years, increasing interest has arisen for medial pivoting TKA implants, designed to mimic the physiological knee kinematics, maximizing the contact area on the medial compartment of the knee, increasing anterior-posterior stability, and contributing to a ball-in-socket effect that allows the posterior cruciate sacrifice without a post-CAM mechanism. The medial congruent liner works with a J-curve cruciate-retaining (CR) femur without a real ball-in-socket design. The aim of this study was to evaluate the clinical outcomes and survival of these implants, with or without PCL sparing, at a medium follow-up.

METHODS: Between October 2016 and October 2018, 165 TKRs were performed in 161 patients (69.2% females and 30.8% males) and prospectively followed. Mean follow-up was 72 ± 12 months. All surgeries were performed using an extramedullary device and the same prosthetic implant. Patients were matched in two groups: in 80 patients, the PCL was preserved; in 85 patients, the PCL was sacrificed with a reduction of the tibial slope.

RESULTS: The OKS and KSS improved in both groups. The difference between the two groups at the final follow-up was not statistically significant. Good-to-excellent clinical results according to the KSS were achieved in 93% of the knees in the PCP group and in 95% in the PCS group. At final follow-up, the Forgotten Joint Score (FJS) was 73.6 in the PCP group and 74.1 in the PCS group with no statistical difference between the two groups (P > 0.05).

CONCLUSIONS: TKA with a medially congruent insert, showed promising results at mid-term follow-up, PCL preservation or sacrifice did not affect the clinical outcomes and survival. Further follow-up will be needed to evaluate these results at long term.

PMID:37612567 | DOI:10.1007/s00402-023-05033-3

Environ Sci Pollut Res Int. 2023 Aug 23. doi: 10.1007/s11356-023-29423-7. Online ahead of print.

ABSTRACT

The results of environmental epidemiological studies regarding the relationship between human exposure to nickel and the risk of diabetes remain controversial. Therefore, we performed a meta-analysis to investigate the relationship between nickel exposure and diabetes. PubMed, Web of Science, and Embase electronic databases were thoroughly searched from their inception to May 2023 to obtain relevant studies. The random-effects model was employed to determine pooled odds ratios (ORs) and 95% confidence intervals (CIs). Stratified and sensitivity analyses were also performed. Cochran Q test and I² statistic were employed to assess heterogeneity between studies. Begg’s and Egger’s tests were employed to evaluate publication bias. The indicated studies were evaluated using the ROBINS-E risk of bias tool. The dose-response relationship between nickel in urine and diabetes risk was estimated by restricted cubic spline. A total of 12 studies with 30,018 participants were included in this study. In this meta-analysis, comparing the highest vs. lowest levels of nickel exposure, the pooled ORs for diabetes were 1.42 (95% confidence interval 1.14-1.78) for urine and 1.03 (0.57-1.86) for blood, respectively. A linear relationship between urinary nickel and diabetes risk was discovered in the dose-response analysis (P _nonlinearity = 0.6198). Each 1 µg/L increase of urinary nickel, the risk of diabetes increased by 7% (OR = 1.07, 95% CI 1.04-1.10). The risk of diabetes was positively correlated with urine nickel exposure, whereas the risk was not significantly correlated with blood nickel. In the future, more high-quality prospective studies are needed to validate this conclusion.

PMID:37612551 | DOI:10.1007/s11356-023-29423-7

J Neurol. 2023 Aug 24. doi: 10.1007/s00415-023-11939-0. Online ahead of print.

ABSTRACT

BACKGROUND: Parkinson’s disease (PD) is the fastest-growing neurological condition with over 10 million cases worldwide. While age and sex are known predictors of incident PD, there is a need to identify other predictors. This study compares the prediction performance of accelerometry-derived physical activity (PA) measures and traditional risk factors for incident PD in the UK Biobank.

METHODS: The study population consisted of 92,352 UK Biobank participants without PD at baseline (43.8% male, median age 63 years with interquartile range 43-69). 245 participants were diagnosed with PD by April 1, 2021 (586,604 person-years of follow-up). The incident PD prediction performances of 10 traditional predictors and 8 objective PA measures were compared using single- and multi-variable Cox models. Prediction performance was assessed using a novel, stable statistic: the repeated cross-validated concordance (rcvC). Sensitivity analyses were conducted where PD cases diagnosed within the first six months, one year, and two years were deleted.

RESULTS: Single-predictor Cox regression models indicated that all PA measures were statistically significant (p-values < 0.0001). The highest-performing individual predictors were total acceleration (TA) (rcvC = 0.813) among PA measures, and age (rcvC = 0.757) among traditional predictors. The two-step forward-selection process produced a model containing age, sex, and TA (rcvC = 0.851). Adding TA to the model increased the rcvC by 9.8% (p-value < 0.0001). Results were largely unchanged in sensitivity analyses.

CONCLUSIONS: Objective PA summaries have better single-predictor model performance than known risk factors and increase the prediction performance substantially when added to models with age and sex.

PMID:37612539 | DOI:10.1007/s00415-023-11939-0

Brain Cogn. 2023 Aug 21;171:106073. doi: 10.1016/j.bandc.2023.106073. Online ahead of print.

ABSTRACT

Older adults with and without Parkinson’s disease show impaired retention after training of motor or cognitive skills. This systematic review with meta-analysis aims to investigate whether adding transcranial direct current stimulation (tDCS) to motor or cognitive training versus placebo boosts motor sequence and working memory training. The effects of interest were estimated between three time points, i.e. pre-training, post-training and follow-up. This review was conducted according to the PRISMA guidelines (PROSPERO: CRD42022348885). Electronic databases were searched from conception to March 2023. Following initial screening, 24 studies were eligible for inclusion in the qualitative synthesis and 20 could be included in the meta-analysis, of which 5 studies concerned motor sequence learning (total n = 186) and 15 working memory training (total n = 650). Results were pooled using an inverse variance random effects meta-analysis. The findings showed no statistically significant additional effects of tDCS over placebo on motor sequence learning outcomes. However, there was a strong trend showing that tDCS boosted working memory training, although methodological limitations and some heterogeneity were also apparent. In conclusion, the present findings do not support wide implementation of tDCS as an add-on to motor sequence training at the moment, but the promising results on cognitive training warrant further investigations.

PMID:37611344 | DOI:10.1016/j.bandc.2023.106073

Appl Physiol Nutr Metab. 2023 Aug 23. doi: 10.1139/apnm-2023-0137. Online ahead of print.

ABSTRACT

Many reports describe using a supramaximal verification phase – exercising at a power output higher than the highest power output recorded during an incremental cardiopulmonary test – to validate VO2max. The impact of verification phases on estimating proportion of VO2max response remains an underexplored area of the individual response literature. This analysis investigated the influence of same-day and separate-day verification phases during repeated measurements (incremental tests – INCR1 and INCR2; incremental tests + supramaximal verification phases – INCR1+ and INCR2+) of VO2max on typical error (TE) and the proportion of individuals classified as responders (i.e. the response rate) following four weeks of aerobic exercise training or a no-exercise control period. Incorporation of supramaximal verification consistently reduced the standard deviation of individual response, typical error, and confidence interval widths. However, variances were statistically similar across all groups (p>0.05). Response rates increased when incorporating either one (INCR1 to INCR1+; 24% to 48%, p=0.07) or two (INCR2 to INCR2+; 28% to 48%, p=0.063) supramaximal verification phase(s). However, response rates remained unchanged when either zero-based thresholds or smallest worthwhile difference response thresholds were used (50% and 90% confidence intervals, all p>0.05). In conclusion, supramaximal verification phases reduced random variability in VO2max response. Compared to separate-day testing (INCR2 and INCR2+), incorporation of a same-day verification (INCR1+) reduced CI widths the most. Researchers should consider using a same-day verification phase to reduce uncertainty and better estimate VO2max response rate to aerobic exercise training.

PMID:37611323 | DOI:10.1139/apnm-2023-0137

J Infus Nurs. 2023 Sep-Oct 01;46(5):272-280. doi: 10.1097/NAN.0000000000000516.

ABSTRACT

An observational study was developed with 108 nursing professionals who managed vascular access devices in 4 intensive care units of a university hospital in Rio de Janeiro, Brazil. The objective was to analyze the practice of the nursing staff in performing flushing for the maintenance of vascular access devices in critically ill patients. Data were collected by observing the flushing procedure using a structured checklist and analyzed using descriptive and inferential statistics. In 23% of the 404 observations, there was no flushing. When performed at some point during catheter management (77%), flushing was predominant after drug administration with 1 or 2 drugs administered. There were flaws in the flushing technique applied in terms of volume and method of preparation. Time of professional experience >5 years, knowledge about recommendations, and training on flushing were variables associated with technique performance. It was concluded that the flushing procedure did not meet the recommendations of good practices, with failures that constituted medication errors.

PMID:37611285 | DOI:10.1097/NAN.0000000000000516

ACS Appl Mater Interfaces. 2023 Aug 23. doi: 10.1021/acsami.3c07938. Online ahead of print.

ABSTRACT

Oxygen- and nitrogen-heteroatom-doped, water-dispersible, and bright blue-fluorescent carbon dots (ON-CDs) were prepared for the selective and sensitive determination of 2,4,6-trinitrophenol (picric acid, PA). ON-CDs with 49.7% quantum yield were one-pot manufactured by the reflux method using citric acid, d-glucose, and ethylenediamine precursors. The surface morphology of ON-CDs was determined by scanning transmission electron microscopy, high-resolution transmission electron microscopy, dynamic light scattering, Raman, infrared, and X-ray photoelectron spectroscopy techniques, and their photophysical properties were estimated by fluorescence spectroscopy, UV-vis spectroscopy, fluorescence lifetime measurement, and 3D-fluorescence excitation-emission matrix analysis. ON-CDs at an average particle size of 3.0 nm had excitation/emission wavelengths of 355 and 455 nm, respectively. With the dominant inner-filter effect- and hydrogen-bonding interaction-based static fluorescence quenching phenomena supported by ground-state charge-transfer complexation (CTC), the fluorescence of ON-CDs was selectively quenched with PA in the presence of various types of explosives (i.e., 2,4,6-trinitrotoluene, tetryl, 1,3,5-trinitroperhydro-1,3,5-triazine, 1,3,5,7-tetranitro-1,3,5,7-tetraazacyclooctane, pentaerythritol tetranitrate, 3-nitro-1,2,4-triazole-5-one, and TATP-hydrolyzed H₂O₂). The analytical results showed that the emission intensity varied linearly with a correlation coefficient of 0.9987 over a PA concentration range from 1.0 × 10^-9 to 11.0 × 10^-9 M. As a result of ground-state interaction (H-bonding and CTC) of ON-CDs with PA, an orange-colored complex was formed different from the characteristic yellow color of PA in an aqueous medium, allowing naked-eye detection of PA. The detection limits for PA with ON-CDs were 12.5 × 10^-12 M (12.5 pM) by emission measurement and 9.0 × 10^-10 M (0.9 nM) by absorption measurement. In the presence of synthetic explosive mixtures, common soil cations/anions, and camouflage materials, PA was recovered in the range of 95.2 and 102.5%. The developed method was statistically validated against a reference liquid chromatography coupled to tandem mass spectrometry method applied to PA-contaminated soil. In addition, a poly(vinyl alcohol)-based polymer composite film {PF(ON-CDs)} was prepared by incorporating ON-CDs, enabling the smartphone-assisted fluorometric detection of PA.

PMID:37611222 | DOI:10.1021/acsami.3c07938

Genetics. 2023 Aug 23:iyad157. doi: 10.1093/genetics/iyad157. Online ahead of print.

ABSTRACT

Principal component analysis (PCA) is commonly used in genetics to infer and visualize population structure and admixture between populations. PCA is often interpreted in a way similar to inferred admixture proportions, where it is assumed that individuals belong to one of several possible populations or are admixed between these populations. We propose a new method to assess the statistical fit of PCA (interpreted as a model spanned by the top principal components) and to show that violations of the PCA assumptions affect the fit. Our method uses the chosen top principal components to predict the genotypes. By assessing the covariance (and the correlation) of the residuals (the differences between observed and predicted genotypes), we are able to detect violation of the model assumptions. Based on simulations and genome wide human data we show that our assessment of fit can be used to guide the interpretation of the data and to pinpoint individuals that are not well represented by the chosen principal components. Our method works equally on other similar models, such as the admixture model, where the mean of the data is represented by linear matrix decomposition.

PMID:37611212 | DOI:10.1093/genetics/iyad157