Category: Statistics

Vaccine. 2023 Dec 2:S0264-410X(23)01399-3. doi: 10.1016/j.vaccine.2023.11.053. Online ahead of print.

ABSTRACT

BACKGROUND: To address the lack of an active vaccine safety surveillance system in Japan, the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study was initiated in 2021 as a pilot system using existing health insurance claims data and vaccination records.

METHODS: This study evaluated the value of the VENUS study by assessing the incidence of immune thrombocytopenic purpura (ITP) and Guillain-Barré syndrome (GBS) following vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) using a self-controlled case series (SCCS) design.

RESULTS: Incidence rate ratios for ITP during 28-day and 42-day risk periods were 0.89 (95% confidence interval [CI], 0.12-6.4), and 0.58 (95% CI, 0.081-4.2), respectively. Neither was statistically significant. Incidence rate ratios could not be estimated for GBS due to the limited sample size.

CONCLUSION: The VENUS study can provide valuable insights to facilitate the establishment of an advanced vaccine monitoring system in Japan.

PMID:38044244 | DOI:10.1016/j.vaccine.2023.11.053

Surgeon. 2023 Dec 2:S1479-666X(23)00136-1. doi: 10.1016/j.surge.2023.11.003. Online ahead of print.

ABSTRACT

BACKGROUND: Readmissions following colorectal surgery (CRS) have negative clinical, psychological and financial implications. Identifying patients at risk of readmission remains challenging.

AIMS: To determine factors predictive of those likely to require readmission at 40-days following major CRS and to identify novel strategies capable of reducing readmissions.

METHODS: Consecutive patients were studied from a prospectively maintained database. All patients were operated on by a single surgeon in a high-volume centre. Where applicable, photography was recorded by patients and emailed directly to the institutional email of the consultant surgeon. Data was recorded and analysed using descriptive statistics.

RESULTS: 515 patients were included over a 15-year period (2007-2022). The mean age at surgery was 64 years (18-93). The majority of patients were male (56.9%, n=293) and underwent cancer surgery (58.2%, n=299). Overall, 55 patients were readmitted within 40 days of major CRS (10.7%). Patients with pre-treatment diagnoses of heart failure (P=0.012), ischemic heart disease (P=0.002), renal impairment (P<0.001), atrial fibrillation (P=0.006), hypercholesterolemia (P=0.001), asthma (P=0.013) and hypertension (P=0.001) were more likely to require readmission. The majority of patients were readmitted for definitive management of surgical site issues (SSIs) (43.7% n=24). Other reasons included bowel obstruction (9.1%, n=5), pelvic sepsis (7.3%, n=4) and gastrointestinal upset (7.3%, n=4).

CONCLUSION: This series demonstrated that patients with cardiopulmonary comorbidities were more likely to be readmitted following major CRS and most readmissions are SSI related. Readmissions for SSIs can be reduced by patients sending photography to the treating surgeon which could reduce readmissions and A&E attendances.

PMID:38044235 | DOI:10.1016/j.surge.2023.11.003

Schizophr Res. 2023 Dec 2:S0920-9964(23)00423-1. doi: 10.1016/j.schres.2023.11.011. Online ahead of print.

ABSTRACT

BACKGROUND: Previous longitudinal magnetic resonance imaging studies have shown progressive gray matter (GM) reduction during the earliest phases of schizophrenia. It is unknown whether these progressive processes are homogeneous in all groups of patients. One way to obtain more valid findings is to focus on the symptoms. Auditory hallucinations (AHs) are frequent and reliable symptoms of psychosis. The present study aims to analyze whether longitudinal changes in structural abnormalities in cortical regions are related to the presence of AHs and the intensity of psychotic symptoms in a large sample.

METHODS: A Magnetic Resonance (MR) voxel-based morphometry analysis was applied to a group of 128 first episodes psychosis (FEP) patients (63 patients with AHs and 65 patients without AHs) and 78 matched healthy controls at baseline and at a 2-year follow-up.

RESULTS: At baseline, FEP patients exhibited significant GM volume reductions in the temporal, frontal and precentral regions. At follow-up, FEP patients exhibited GM volume changes in the temporal, Rolandic, frontal, precentral and insula regions. At baseline, no significant differences were found between FEP patients with and without AHs. At follow-up, while FEP patients with AHs showed less GM volume in temporal and frontal lobes, non-AH FEP patients showed reductions in the frontal, precentral and fusiform areas. PANSS scores showed statistically significant correlations with GM volume reductions at baseline and follow-up.

CONCLUSIONS: Brain cortical loss in the early phases of psychosis is not associated with potentially transitory AHs; however, brain structural changes may emerge as AHs appear in chronic patients.

PMID:38044223 | DOI:10.1016/j.schres.2023.11.011

Int Dent J. 2023 Dec 2:S0020-6539(23)00964-4. doi: 10.1016/j.identj.2023.10.020. Online ahead of print.

ABSTRACT

BACKGROUND: Dental sleep medicine education (DSME) should be emphasised in postgraduate orthodontic training; however, there appears to be no clear guideline for its implementation into the curriculum.

OBJECTIVE: The aim was to investigate the current status of DSME as well as its feasibility and implementation in postgraduate orthodontic programmes.

METHODS: A structured interview with predetermined response options was chosen as a data collection method to gather relevant information from representatives of all accredited postgraduate orthodontic programmes in Thailand. These interviews were conducted online via the Cisco Webex Meeting platform. A combination of data analysis techniques was employed to achieve a thorough comprehension of the research findings, including descriptive statistics, quantitative content analysis, thematic analysis, and alignment analysis.

RESULTS: All participating programmes reported the inclusion of DSME in their curricula. A didactic approach was adopted by all programmes. However, only 2 out of 7 programmes offered clinical sessions for their students. Several challenges in implementing DSME within orthodontic programmes were identified, including a shortage of expertise and limited patient access. The participants also suggested that knowledge and resource sharing amongst institutions could serve as a potential solution to enhance the feasibility of DSME.

CONCLUSIONS: This research highlighted the significant disparities and inadequacy of DSME within postgraduate orthodontic programmes in Thailand due to various challenges. Consequently, there is a compelling need to place greater emphasis on DSME and establish a national-level standardisation within orthodontic programmes. This effort is essential for enhancing the awareness and competency of orthodontists in the field of DSME.

PMID:38044215 | DOI:10.1016/j.identj.2023.10.020

J Formos Med Assoc. 2023 Dec 2:S0929-6646(23)00439-4. doi: 10.1016/j.jfma.2023.10.021. Online ahead of print.

ABSTRACT

BACKGROUND: Alzheimer’s disease (AD) is complicated by multiple environmental and polygenetic factors. The accuracy of artificial neural networks (ANNs) incorporating the common factors for identifying AD has not been evaluated.

METHODS: A total of 184 probable AD patients and 3773 healthy individuals aged 65 and over were enrolled. AD-related genes (51 SNPs) and 8 environmental factors were selected as features for multilayer ANN modeling. Random Forest (RF) and Support Vector Machine with RBF kernel (SVM) were also employed for comparison. Model results were verified using traditional statistics.

RESULTS: The ANN achieved high accuracy (0.98), sensitivity (0.95), and specificity (0.96) in the intrinsic test for AD classification. Excluding age and genetic data still yielded favorable results (accuracy: 0.97, sensitivity: 0.94, specificity: 0.96). The assigned weights to ANN features highlighted the importance of mental evaluation, years of education, and specific genetic variations (CASS4 rs7274581, PICALM rs3851179, and TOMM40 rs2075650) for AD classification. Receiver operating characteristic analysis revealed AUC values of 0.99 (intrinsic test), 0.60 (TWB-GWA), and 0.72 (CG-WGS), with slightly lower AUC values (0.96, 0.80, 0.52) when excluding age in ANN. The performance of the ANN model in AD classification was comparable to RF, SVM (linear kernel), and SVM (RBF kernel).

CONCLUSIONS: The ANN model demonstrated good sensitivity, specificity, and accuracy in AD classification. The top-weighted SNPs for AD prediction were CASS4 rs7274581, PICALM rs3851179, and TOMM40 rs2075650. The ANN model performed similarly to RF and SVM, indicating its capability to handle the complexity of AD as a disease entity.

PMID:38044212 | DOI:10.1016/j.jfma.2023.10.021

J Formos Med Assoc. 2023 Dec 2:S0929-6646(23)00476-X. doi: 10.1016/j.jfma.2023.11.010. Online ahead of print.

ABSTRACT

BACKGROUND/PURPOSE: Predictive modeling aids in identifying patients at high risk of adverse events. Using routinely collected data, we report a competing risk prediction model for kidney failure.

METHODS: A total of 5138 patients with CKD stages 3b-5 were included and randomized into the development and validation cohorts at a ratio of 7:3. The outcome was end-stage kidney disease, defined as the initiation of dialysis or kidney transplantation. All patients were followed-up until December 31, 2020. A Fine and Gray model was applied to estimate the sub-hazard ratio of kidney failure, with death as a competing event.

RESULTS: In the development cohort, the mean age was 67.6 ± 13.9 years and 60 % were male. The mean index eGFR and median urinary protein-creatinine ratio (UPCR) were 26.5 ± 12.8 mL/min/1.73 m² and 1051 mg/g, respectively. The median follow-up duration was 1051 days. The proportion of patients with kidney failure and death was 25.4 % and 14.1 %, respectively. Four models were applied, including eGFR, age, sex, UPCR, systolic and diastolic blood pressure, serum albumin, phosphate, uric acid, haemoglobin, and potassium levels had the best goodness of fit. All models had good discrimination with time-to-event c statistics of 0.89-0.95 in the development cohort and 0.86-0.95 in the validation cohort. The prediction models showed excellent and fairly good calibration at 2 and 5-year risk, respectively.

CONCLUSION: Using real-world data, our competing risk model can accurately predict progression to kidney failure over 2 years in patients with advanced CKD.

PMID:38044210 | DOI:10.1016/j.jfma.2023.11.010

Eur J Intern Med. 2023 Dec 2:S0953-6205(23)00415-6. doi: 10.1016/j.ejim.2023.11.018. Online ahead of print.

NO ABSTRACT

PMID:38044167 | DOI:10.1016/j.ejim.2023.11.018

Circ J. 2023 Dec 1. doi: 10.1253/circj.CJ-23-0409. Online ahead of print.

ABSTRACT

BACKGROUND: This study was performed to clarify the clinical findings of pediatric patients diagnosed with long QT syndrome (LQTS) through electrocardiographic screening programs and to predict their outcome using Holter electrocardiographic approaches.Methods and Results: This retrospective study included pediatric patients with a Schwartz score of ≥3.5 who visited the National Hospital Organization Kagoshima Medical Center between April 2005 and March 2019. Resting 12-lead and Holter electrocardiograms were recorded at every visit. The maximum resting QTc and maximum Holter QTc values among all recordings were used for statistical analyses. To test the prognostic value of QTc for the appearance of cardiac events after the first hospital visit, receiver operating characteristic curves were used to calculate the area under the curve (AUC). Among 207 patients, 181 (87%) were diagnosed through screening programs. The prevalence of cardiac events after the first hospital visit was 4% (8/207). Among QTc at diagnosis, maximum resting QTc, and maximum Holter QTc, only maximum Holter QTc value was a predictor (P=0.02) of cardiac events after the hospital visit in multivariate regression analysis. The AUC of the maximum Holter QTc was significantly superior to that of maximum resting QTc.

CONCLUSIONS: The maximum Holter QTc value can be used to predict the appearance of symptoms in pediatric patients with LQTS.

PMID:38044147 | DOI:10.1253/circj.CJ-23-0409

Curr Opin Psychol. 2023 Nov 17;55:101753. doi: 10.1016/j.copsyc.2023.101753. Online ahead of print.

ABSTRACT

Children have a reputation for credulity that is undeserved; even preschoolers have proven adept at identifying implausible claims and unreliable informants. Still, the strategies children use to identify and reject dubious information are often superficial, which leaves them vulnerable to accepting such information if conveyed through seemingly authoritative channels or formatted in seemingly authentic ways. Indeed, children of all ages have difficulty differentiating legitimate websites and news stories from illegitimate ones, as they are misled by the inclusion of outwardly professional features such as graphs, statistics, and journalistic layout. Children may not be inherently credulous, but their skepticism toward dubious information is often shallow enough to be overridden by the deceptive trappings of online misinformation.

PMID:38043147 | DOI:10.1016/j.copsyc.2023.101753

Injury. 2023 Nov 24;55(2):111231. doi: 10.1016/j.injury.2023.111231. Online ahead of print.

ABSTRACT

BACKGROUND: Our study examined if there were any limitations when using various measurement techniques in the literature to quantify osseous exposure. Additionally, we also examined if surface contour had any influence on obtained measurements, which no previous study has attempted.

MATERIALS AND METHODS: Three methods used to quantify osseous exposure area were identified, one in which involves manually applying mesh over exposure area. The other two use digital image capture software (ImageJ, Bethesda, MD). We simulated flat, convex, and mixed surface types using synthetic bone analogs. We assessed the degree of variability between mean values using an ANOVA or Kruskal-Wallis equality of populations rank test. Cronbach’s alpha test of internal reliability was used to assess the internal reliability of measurement technique.

RESULTS: ANOVA test for difference in measurement techniques on all three surface types was statistically significant (p < 0.05). Cronbach’s alpha test of internal reliability for each technique on the convex surface did not obtain adequate significance (alpha >0.70). Only the mesh method obtained adequate alpha value for significance when applied to the flat and mixed surface types.

DISCUSSION: Each of the three measurement techniques tested demonstrated poor internal reliability. We suggest taking care when comparing studies that use different quantification techniques when calculating osseous exposure for different surgical approaches. Future studies should explore alternative methods of osseous exposure quantification.

PMID:38043145 | DOI:10.1016/j.injury.2023.111231