Category: Statistics

Int J Retina Vitreous. 2024 Jun 21;10(1):44. doi: 10.1186/s40942-024-00564-2.

ABSTRACT

Macular holes (MHs), including atraumatic idiopathic and refractory MHs, affect central vision acuity due to full-thickness defects in the retinal tissue. The existing controversy regarding the pathophysiology and management of MHs has significantly improved with the implementation of internal limiting membrane (ILM) surgical techniques and improved MH closure rates. Thus, to determine the effect of ILM techniques on large idiopathic and refractory MH management, the present study systematically reviewed 5910 original research articles extracted from online literature databases, including PubMed, Cochrane, Google Scholar, and Embase, following the PRISMA guidelines. The primary outcome measures were MH closure rate and postoperative visual acuity. A total of 23 randomized controlled trials (RCTs) with adequate patient information and information on the effect of ILM peeling, inverted ILM flaps, autologous retinal transplantation (ART), and ILM insertion techniques on large idiopathic and refractory MH patients were retrieved and analyzed using RevMan software (version 5.3) provided by the Cochrane Collaboration. Statistical risk of bias analysis was also conducted on the selected sources using RoB2, which showed a low risk of bias in the included studies. A meta-analysis indicated that the inverted ILM flap technique had a significantly greater MH closure rate for primary MH than the other treatment methods (OR = 3. 22, 95% CI 1.34-7.43; p = 0.01). Furthermore, the findings showed that the inverted ILM flap group had significantly better postoperative visual acuity than did the other treatment options for patients with idiopathic MH (WMD = – 0.13; 95% CI = 0.22-0.09; p = 0.0002). The ILM peeling technique had the second highest statistical significance for MH closure rates in patients with idiopathic MH (OR = 2. 72, 95% CI: 1.26-6.32; p = 0.016). In refractory MHs, autologous retinal transplant (ART) and multilayer ILM plug (MIP) techniques improve the closure rate and visual function; human amniotic membrane grafting (hAMG) provides a high degree of anatomical outcomes but disappointing visual results. This study demonstrated the reliability and effectiveness of ILM techniques in improving the functional and anatomical outcomes of large idiopathic and refractory MH surgery. These findings will help clinicians choose the appropriate treatment technique for patients with idiopathic and refractory MH.

PMID:38907361 | DOI:10.1186/s40942-024-00564-2

J Anesth Analg Crit Care. 2024 Jun 21;4(1):36. doi: 10.1186/s44158-024-00171-5.

ABSTRACT

BACKGROUND: Burnout is a maladaptive response to chronic stress, particularly prevalent among clinicians. Anesthesiologists are at risk of burnout, but the role of maladaptive traits in their vulnerability to burnout remains understudied.

METHODS: A secondary analysis was performed on data from the Italian Association of Hospital Anesthesiologists, Pain Medicine Specialists, Critical Care, and Emergency (AAROI-EMAC) physicians. The survey included demographic data, burnout assessment using the Maslach Burnout Inventory (MBI) and subscales (emotional exhaustion, MBI-EE; depersonalization, MBI-DP; personal accomplishment, MBI-PA), and evaluation of personality disorders (PDs) based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition) criteria using the assessment of DSM-IV PDs (ADP-IV). We investigated the aggregated scores of maladaptive personality traits as predictor variables of burnout. Subsequently, the components of personality traits were individually assessed.

RESULTS: Out of 310 respondents, 300 (96.77%) provided complete information. The maladaptive personality traits global score was associated with the MBI-EE and MBI-DP components. There was a significant negative correlation with the MBI-PA component. Significant positive correlations were found between the MBI-EE subscale and the paranoid (r = 0.42), borderline (r = 0.39), and dependent (r = 0.39) maladaptive personality traits. MBI-DP was significantly associated with the passive-aggressive (r = 0.35), borderline (r = 0.33), and avoidant (r = 0.32) traits. Moreover, MBI-PA was negatively associated with dependent (r = – 0.26) and avoidant (r = – 0.25) maladaptive personality features.

CONCLUSIONS: There is a significant association between different maladaptive personality traits and the risk of experiencing burnout among anesthesiologists. This underscores the importance of understanding and addressing personality traits in healthcare professionals to promote their well-being and prevent this serious emotional, mental, and physical exhaustion state.

PMID:38907360 | DOI:10.1186/s44158-024-00171-5

J Health Popul Nutr. 2024 Jun 21;43(1):91. doi: 10.1186/s41043-024-00575-7.

ABSTRACT

BACKGROUND: Observational studies have elucidated the associations between dietary factors and hypertension. Nevertheless, the exploration of these relationships using Mendelian randomization remains scarce currently.

METHODS: The Mendelian randomization approach investigated the potential causal relationships between 16 dietary factors and hypertension. To achieve this, we identified genetic variants associated with these dietary factors by utilizing data from European-descent genome-wide association studies with a stringent significance threshold (P < 5 × 10 – 8). Subsequently, we obtained genetic associations with hypertension from the extensive FinnGen Study, encompassing 92,462 cases and 265,626 controls. Our primary analytical method was the inverse variance weighted method, and we also conducted assessments for heterogeneity and pleiotropy to ensure the robustness and reliability of our findings.

RESULTS: The study revealed significant associations with hypertension risk for various dietary factors. Specifically, higher weekly alcohol consumption (OR: 1.53, 95% CI: 1.19-1.96) and more frequent alcohol intake (OR: 1.20, 95% CI: 1.08-1.33) were positively correlated with an increased risk of hypertension. Likewise, increased poultry intake (OR: 3.25, 95% CI: 1.83-5.78) and beef intake (OR: 1.80, 95% CI: 1.09-2.97) were also linked to a higher risk of hypertension. Conversely, there were protective factors associated with a decreased risk of hypertension. These included consuming salad and raw vegetables, dried fruits, cheese, and cereals. It is important to note that no evidence of pleiotropy was detected, underscoring the robustness of these findings.

CONCLUSIONS: This study uncovered causal relationships between various dietary factors and hypertension risk. Specifically, alcohol consumption in terms of drinks per week and intake frequency, as well as poultry and beef intake, were causally associated with an elevated risk of hypertension. In contrast, consuming salad/raw vegetables, dried fruits, cheese, and cereals demonstrated an inverse causal association with hypertension, suggesting a potential protective effect.

PMID:38907314 | DOI:10.1186/s41043-024-00575-7

BMC Sports Sci Med Rehabil. 2024 Jun 21;16(1):138. doi: 10.1186/s13102-024-00932-3.

ABSTRACT

BACKGROUND: Exposure of the human body to cold water triggers numerous beneficial physiological changes. The study aimed to assess the impact of regular winter swimming on blood morphological, rheological, and biochemical indicators and activity of antioxidant enzymes in males.

METHODS: The study involved 10 male winter swimmers (the same participants examined before the season and after the season) and 13 males (not winter swimming, leading a sedentary lifestyle) in the control group. Fasting blood was collected twice: in November and in March of the following year. Basic blood morphological indicators, red cell elongation index (EI) and aggregation index (AI), concentrations of testosterone, cortisol, urea, and creatinine, as well as plasma activity of antioxidant enzymes of catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx) were determined.

RESULTS: The data were collected from the same winter swimmers at the beginning and end of the season. Winter swimming resulted in a significant increase of EI values at a shear stress of 0.30 (p = 0.40), 0.58 (p < 0.001), 4.24 (p = 0.021), 8.23 (p = 0.001), 15.59 (p = 0.001), 30.94 (p = 0.004), and 60.00 Pa (p = 0.043); haemoglobin was lower than before the season (p < 0.027). No significant changes were observed in AI, AMP, T1/2, the levels of urea, creatinine, eGFR, testosterone, cortisol, or the activity of CAT or SOD. There was a statistically significant increase in GPx activity (p = 0.014) and increase in testosterone concentration (p = 0.035) in the group of winter swimmers examined before the season as compared with the control group. No statistically significant differences were found for the mean values of blood morphological indicators and other parameters.

CONCLUSIONS: Winter swimming can prove to be a health-promoting factor in males, as indicated by a rise in the deformability of red blood cells in the blood vessel system after a full season of winter swimming, leading to better body oxygenation, and improves the antioxidant defence and testosterone concentration (within standard limits) in the group of winter swimmers examined before the season as compared with the control group. Winter swimming helps maintain appropriate levels of blood rheological indicators, urea, creatinine, eGFR, cortisol, testosterone, and activity of antioxidant enzymes.

TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT06223087, 15.01.2024.

PMID:38907310 | DOI:10.1186/s13102-024-00932-3

Am J Epidemiol. 2024 Jun 21:kwae133. doi: 10.1093/aje/kwae133. Online ahead of print.

ABSTRACT

Alzheimer’s disease and related dementias (ADRD) present a growing public health burden in the United States. One actionable risk factor for ADRD is air pollution: multiple studies have found associations between air pollution and exacerbation of ADRD. Our study builds on previous studies by applying modern statistical causal inference methodologies-generalized propensity score (GPS) weighting and matching-on a large, longitudinal dataset. We follow 50 million Medicare enrollees to investigate impacts of three air pollutants-fine particular matter (PM${}_{2.5}$), nitrogen dioxide (NO${}_2$), and summer ozone (O${}_3$)-on elderly patients’ rate of first hospitalization with ADRD diagnosis. Similar to previous studies using traditional statistical models, our results found increased hospitalization risks due to increased PM${}_{2.5}$ and NO${}_2$ exposure, with less conclusive results for O${}_3$. In particular, our GPS weighting analysis finds IQR increases in PM${}_{2.5}$, NO${}_2$, or O${}_3$ exposure results in hazard ratios of 1.108 (95% CI: 1.097-1.119), 1.058 (1.049-1.067), or 1.045 (1.036-1.054), respectively. GPS matching results are similar for PM${}_{2.5}$ and NO${}_2$ with attenuated effects for O${}_3$. Our results strengthen arguments that long-term PM${}_{2.5}$ and NO${}_2$ exposure increases risk of hospitalization with ADRD diagnosis. Additionally, we highlight strengths and limitations of causal inference methodologies in observational studies with continuous treatments. Keywords: Alzheimer’s disease and related dementias, air pollution, Medicare, causal inference, generalized propensity score.

PMID:38907309 | DOI:10.1093/aje/kwae133

Int J Equity Health. 2024 Jun 21;23(1):126. doi: 10.1186/s12939-024-02206-3.

ABSTRACT

BACKGROUND: South Korea’s National Health Insurance (NHI) system pursues universal health coverage, but it has not been able to alleviate patients’ financial burden owing to limited coverage and a high proportion of out-of-pocket expenses. In 2017, the government announced a plan to strengthen universality by providing coverage for all unincluded services, expanding coverage, and alleviating household financial burden. We aimed to evaluate the effect of “Moon Care” with a focus on changes in health expenditures following policy implementation, and to provide empirical evidence for future policies to strengthen the NHI system’s universality.

METHODS: Using data from the 2016 and 2018 Korea Health Panel (KHP), we established a treatment group affected by the policy and an unaffected control group; we ensured homogeneity between the groups using propensity score matching (PSM). Subsequently, we examined changes in NHI payments, non-payments, and out-of-pocket payments (OOP); we performed difference-in-differences (DID) analysis to evaluate the policy’s effect.

RESULTS: Following policy implementation, the control group had a higher increase than the treatment group in all categories of health expenditures, including NHI payments, non-payments, and OOP. We noted significant decreases in all three categories of health expenditures when comparing the differences before and after policy implementation, as well as between the treatment and control groups. However, we witnessed a significant decrease in the interaction term, which confirms the policy’s effect, but only for non-payments.

CONCLUSIONS: We observed the policy’s intervention effect over time as a decrease in non-payments, on the effectivity of remunerating covered medical services. However, the policy did not work for NHI payments and OOP, suggesting that it failed to control the creation of new non-covered services as noncovered services were converted into covered ones. Thus, it is crucial to discuss the financial spending of health insurance regarding the inclusion of non-covered services in the NHI benefits package.

PMID:38907297 | DOI:10.1186/s12939-024-02206-3

BMC Health Serv Res. 2024 Jun 21;24(1):755. doi: 10.1186/s12913-024-11210-w.

ABSTRACT

BACKGROUND: Among the various methods used, administrative data collected for claims and billing purposes, such as diagnosis codes and present-on-admission (POA) indicators, can easily be employed to assess patient safety status. However, it is crucial that administrative data be accurate to generate valid estimates of adverse event (AE) occurrence. Thus, we aimed to evaluate the accuracy of diagnosis codes and POA indicators in patients with confirmed AEs in the hospital admission setting.

METHODS: We analysed the diagnosis codes of 1,032 confirmed AE cases and 6,754 non-AE cases from the 2019 Patient Safety Incidents Inquiry, which was designed as a cross-sectional study, to determine their alignment with the Korean Patient Safety Incidents (PSIs) Code Classification System. The unit of analysis was the individual case rather than the patient, because two or more AEs may occur in one patient. We examined whether the primary and secondary diagnostic codes had PSIs codes matching the AE type and checked each PSI code for whether the POA indicator had an ‘N’ tag. We reviewed the presence of PSI codes in patients without identified AEs and calculated the correlation between the AE incidence rate and PSI code and POA indicator accuracy across 15 hospitals.

RESULTS: Ninety (8.7%) of the AE cases had PSI codes with an ‘N’ tag on the POA indicator compared to 294 (4.4%) of the non-AE cases. Infection- (20.4%) and surgery/procedure-related AEs (13.6%) had relatively higher instances of correctly tagged PSI codes. We did not identify any PSI codes for diagnosis-related incidents. While we noted significant differences in AE incidence rates, PSI code accuracy, and POA indicator accuracy among the hospitals, the correlations between these variables were not statistically significant.

CONCLUSION: Currently, PSI codes and POA indicators in South Korea appear to have low validity. To use administrative data in medical quality improvement activities such as monitoring patient safety levels, improving the accuracy of administrative data should be a priority. Possible strategies include targeted education on PSI codes and POA indicators and introduction of new evaluation indicators regarding the accuracy of administrative data.

PMID:38907291 | DOI:10.1186/s12913-024-11210-w

Genomics Inform. 2024 May 21;22(1):1. doi: 10.1186/s44342-024-00001-8.

ABSTRACT

The goal of the study was to investigate the changes in the gut microbiota during the advancement of gastric cancer (GC) and identify pertinent taxa associated with the disease. We used a public fecal amplicon gastric cancer dataset from the Sequence Retrieval Archive (SRA), of patients with GC, gastritis, and healthy individuals. We did sequence pre-processing, including quality filtering of the sequences. Then, we performed a diversity analysis, evaluating α- and β-diversity. Next, taxonomic composition analysis was performed and the relative abundances of different taxa at the phylum and genus levels were compared between GC, gastritis, and healthy controls. The obtained results were subsequently subjected to statistical validation. To conclude, metagenomic function prediction was carried out, followed by correlation analysis between the microbiota and KEGG pathways. α analysis revealed a significant difference between male and female categories, while β analysis demonstrated significant distinctions between GC, gastritis, and healthy controls, as well as between sexes within the GC and gastritis groups. The statistically confirmed taxonomic composition analysis highlighted the presence of the microbes Bacteroides and Veillonella. Furthermore, through metagenomic prediction analysis and correlation analysis with pathways, three taxa, namely Akkermansia, Gammaproteobacteria, and Veillonella, were identified as potential biomarkers for GC. Additionally, this study reports, for the first time, the presence of two bacteria, Desulfobacteriota and Synergistota, in GC, necessitating further investigation. Overall, this research sheds light on the potential involvement of gut microbiota in GC pathophysiology; however, additional studies are warranted to explore its functional significance.

PMID:38907281 | DOI:10.1186/s44342-024-00001-8

J Cheminform. 2024 Jun 21;16(1):72. doi: 10.1186/s13321-024-00873-6.

ABSTRACT

Temperature-responsive liquid chromatography (TRLC) offers a promising alternative to reversed-phase liquid chromatography (RPLC) for environmentally friendly analytical techniques by utilizing pure water as a mobile phase, eliminating the need for harmful organic solvents. TRLC columns, packed with temperature-responsive polymers coupled to silica particles, exhibit a unique retention mechanism influenced by temperature-induced polymer hydration. An investigation of the physicochemical parameters driving separation at high and low temperatures is crucial for better column manufacturing and selectivity control. Assessment of predictability using a dataset of 139 molecules analyzed at different temperatures elucidated the molecular descriptors (MDs) relevant to retention mechanisms. Linear regression, support vector regression (SVR), and tree-based ensemble models were evaluated, with no standout performer. The precision, accuracy, and robustness of models were validated through metrics, such as r and mean absolute error (MAE), and statistical analysis. At $45_{}^{\circ }\text{C}$ , logP predominantly influenced retention, akin to reversed-phase columns, while at $5^{\circ }\text{C}$ , complex interactions with lipophilic and negative MDs, along with specific functional groups, dictated retention. These findings provide deeper insights into TRLC mechanisms, facilitating method development and maximizing column potential.

PMID:38907264 | DOI:10.1186/s13321-024-00873-6

BMC Health Serv Res. 2024 Jun 21;24(1):754. doi: 10.1186/s12913-024-11211-9.

ABSTRACT

BACKGROUND: Emotional abuse in childhood is the most common type of childhood abuse worldwide and is associated with a variety of somatic and mental health issues. However, globally and in indigenous contexts, research on the associations between emotional abuse in childhood and somatic and mental specialist healthcare utilization in adulthood is sparse.

AIM: The main aim of this study was to investigate the association between emotional abuse in childhood and somatic and mental specialist healthcare utilization in adulthood in Sami and non-Sami populations, and to examine whether this association differs between the two ethnic groups.

METHOD: This study used cross-sectional data from the SAMINOR 2 Questionnaire Survey – a population-based study on health and living conditions in areas with Sami and non-Sami populations in Middle and Northern Norway. In total, 11 600 individuals participated in SAMINOR 2. Logistic regression was used to present the association between emotional abuse in childhood and somatic and mental specialist healthcare utilization.

RESULTS: Emotional abuse in childhood was significantly associated with somatic specialist healthcare utilization in adulthood (fully adjusted odds ratio [OR] 1.31, 95% confidence interval [CI] 1.15-1.49), with no differences observed between ethnic groups. Emotional abuse in childhood was also associated with mental specialist healthcare utilization (fully adjusted OR 3.99, 95% CI 3.09-5.14), however this association was weaker among Sami (crude OR 2.38, 95% CI 1.37-4.13) compared with non-Sami (crude OR 5.40, 95% Cl 4.07-7.15) participants.

CONCLUSIONS: Emotional abuse in childhood is associated with somatic and mental specialist healthcare utilization in adulthood, with a stronger association to mental healthcare utilization. The association between emotional abuse in childhood and mental specialist healthcare utilization was weaker among Sami than non-Sami participants. Future studies should investigate the reason for this ethnic difference. Our results highlight the need to strengthen efforts to prevent childhood abuse and develop strategies to reduce its societal and personal burden.

PMID:38907253 | DOI:10.1186/s12913-024-11211-9