Category: Statistics

Tob Control. 2023 Aug 10:tc-2023-057933. doi: 10.1136/tc-2023-057933. Online ahead of print.

ABSTRACT

INTRODUCTION: While previous research has examined misperceptions related to Natural American Spirit (NAS), a premium cigarette brand using ‘natural’-themed marketing, the longitudinal relationship between NAS-related harm beliefs and switching to NAS has not been established.

METHODS: Using data from the PATH study, we modelled the longitudinal relationship between (1) brand switching and subsequent belief that one’s own brand might be less harmful than other brands (Waves 1-5); (2) belief that organic and/or additive-free tobacco products are less harmful and subsequent brand switching (Waves 3-5); and (3) belief that some types of cigarettes are less harmful and subsequent brand switching (Waves 3-5) for NAS and two leading comparator brands (Camel and Marlboro).

RESULTS: Among people who did not think their prior brand might be less harmful, switching to NAS or maintaining NAS preference increased the odds of believing one’s own brand might be less harmful (aOR 19.4; 95% CI: 15.19, 24.8; aOR 6.1; 95% CI: 4.23, 8.67, respectively). Prior belief that organic and additive-free tobacco products were less harmful increased the odds of switching to (aOR 2.5; 95% CI: 1.68, 3.74) and decreased the odds of switching away (0.57; 955 CI: 0.36, 0.92) from NAS in the subsequent wave. Parallel analyses for Marlboro/Camel were largely null or in the opposite direction.

CONCLUSIONS: NAS use may maintain or shape new beliefs that the brand may be less harmful than other brands; holding pre-existing beliefs about the relative harm of some tobacco products may increase risk for NAS use.

PMID:37562949 | DOI:10.1136/tc-2023-057933

Br J Sports Med. 2023 Aug 10:bjsports-2023-106847. doi: 10.1136/bjsports-2023-106847. Online ahead of print.

ABSTRACT

The recognition of myocarditis as a rare side effect of SARS-CoV-2 mRNA vaccination has sparked a global debate on vaccine safety, especially in the realm of sports. The main proposed mechanisms in the pathogenesis of COVID-19 mRNA vaccination-associated myocarditis (C-VAM) are based on the activation of the innate- and adaptive immune system against a susceptible immune-genetic background, including the recognition of mRNA as an antigen by the immune system, molecular mimicry between SARS-CoV-2 spike glycoprotein and cardiac tissue antigens and inflammatory sex-hormone signalling. The relatively younger age of the athlete population hypothetically constellates an increased risk of C-VAM. A subgroup analysis in individuals under 40 years revealed a low incidence of myocarditis following COVID-19 mRNA vaccination when compared to positive SARS-CoV-2 tests. No confirmed cases of athletes experiencing cardiac complications after mRNA vaccination have been reported. Most athletes only reported mild side effects after COVID-19 vaccination. A small but statistically significant decrease in maximal oxygen consumption in recreational athletes occurred after BNT162b2 mRNA booster vaccine administration. The clinical relevance and temporality of which remain to be determined. Many speculative social media reports attribute sudden cardiac arrest/death (SCA/D) in athletes to mRNA vaccination. Large media outlets have thoroughly debunked these claims. There is currently no evidence to support the claim that COVID-19 mRNA vaccination increases the risk of myocardial sequelae or SCA/D in athletes. However, specific vaccine regimen selection and timing may be appropriate to prevent detrimental performance effects.

PMID:37562938 | DOI:10.1136/bjsports-2023-106847

BMJ Open. 2023 Aug 10;13(8):e069818. doi: 10.1136/bmjopen-2022-069818.

ABSTRACT

INTRODUCTION: Subgroups for Targeted Treatment Back Tool (SBT) is a brief multiple-construct risk prediction tool for patients with low back pain (LBP). Thus far, the predictive ability of this tool has been inconsistent. Therefore, we aim to conduct a literature review on the predictive ability of the SBT to determine the outcomes of patients with LBP. The results of this review should improve the ability of the SBT to predict poor outcomes in patients with LBP.

METHODS AND ANALYSIS: Databases including PubMed, EMBASE, Cochrane Central, Web of Science, Chinese National Knowledge Infrastructure Databases, Chinese Science and Technology Journal Database, and Wanfang will be searched for studies on SBT and LBP from their inception until 31 March 2023. Longitudinal studies investigating the association between SBT subgroups and LBP outcomes, including pain, disability and quality of life, will be included. The identified studies will be independently screened for eligibility by two reviewers. A standardised sheet will be used to extract data. The Newcastle-Ottawa Scale will be used to assess the methodological quality of the included studies. Heterogeneity will be evaluated by the χ² test with Cochran’s Q statistic and quantified by the I² statistic. The results will be synthesised qualitatively and presented as pooled risk ratios or beta coefficients quantitatively. The results will also be presented using their 95% confidence limits. Publication bias will be assessed using the method proposed by Egger and by visual inspection of funnel plots.

ETHICS AND DISSEMINATION: This study is a secondary analysis of original studies that received ethics approval. Therefore, prior ethical approval is not required for this study. The findings will be submitted to relevant peer-reviewed journals for publication and presented at profession-specific conferences.

TRIAL REGISTRATION NUMBER: PROSPERO registration numberCRD42022309189.

PMID:37562930 | DOI:10.1136/bmjopen-2022-069818

Indian J Tuberc. 2023 Jul;70(3):311-314. doi: 10.1016/j.ijtb.2022.05.013. Epub 2022 Jun 3.

ABSTRACT

BACKGROUND: Latent tuberculosis is defined as a state of persistent immune response stimulated by Mycobacterium tuberculosis antigens with no evidence and signs of active TB . Health workers have a high risk of developing latent TB disease due to occupational exposure from patients. High sensitivity CRP (hs-CRP) assays have been developed for special values that may indicate low-grade inflammatory lesions as is true in measurement of latent tuberculosis infection. Factors that affect CRP levels are gender and age. Our study is conducted to asses effect of age and gender on Hs- CReactive protein leves serum on health worker with latent tuberculosis and healthy control.

METHOD: This research is a cross sectional study using primary data. The research was conducted at Wahidin Sudirohusodo Makassa Hospital and Community Center For Lung Health In South Sulawesi. Studied subject were recruited by consecutivesampling, in which the patient who met the inclusion criteria and then the serum HsCRP test was measured. Data analysis was performed using SPSS version 25.

RESULT: During the study period , 80 subjects met the inclusion criteria. At age ≤ 32 years, the mean HsCRP was found to be lower in latent TB than in healthy controls, but not statistically significant (p>0.370). At age >32 years, the mean HsCRP was found to be higher in latent TB than in healthy controls, but not statistically significant (p>2.49). In males, the mean HsCRP was found to be higher in latent TB than in healthy controls, but not statistically significant (P =0.584). In women, the mean HsCRP was found to be lower in latent TB than in healthy controls, but not statistically significant (P =0.712).

CONCLUSION: Serum HsCRP levels were found to be higher in latent TB subjects with increasing age and male gender but not statistically significant.

PMID:37562905 | DOI:10.1016/j.ijtb.2022.05.013

Indian J Tuberc. 2023 Jul;70(3):303-310. doi: 10.1016/j.ijtb.2022.05.012. Epub 2022 Jun 1.

ABSTRACT

BACKGROUND: Drug induced liver injury (DILI) is a serious adverse effect caused by first-line anti-TB (ATT) drugs, limiting the TB-treatment. The tissue inflammation induced by free radical burst and poor dietary intake in TB induces oxidative stress, which was proposed as one of the mechanisms responsible for ATT induced DILI. N-acetylcysteine (NAC) exerts a hepato-protective effect by enhancing the cellular antioxidant defense mechanism. There are few studies evaluating the effect of NAC on ATT induced DILI in Indian-population.

METHODS: This is a prospective, randomized, double-blind, placebo-controlled, parallel-group study. Thirty-eight newly diagnosed TB patients on first-line ATT with normal liver function test (LFT) were recruited and randomized to receive either NAC 600 mg tablet or placebo twice daily for 4 weeks and followed-up for next 4 weeks. LFT [AST, ALT, ALP and Total bilirubin] was assessed at baseline, 2, 4 and 8 weeks. Oxidative-stress biomarkers [Malondialdehyde (MDA), Nitric Oxide (NO), Glutathione (GSH)] and quality of life (QOL) by SF-36 questionnaire were assessed at baseline, 4 and 8 weeks. Adverse Drug Reactions (ADRs) were monitored at every visit. Compliance was assessed by pill-count method.

RESULTS: Baseline characteristics were homogenous among both the groups. In the NAC group, there was significant reduction in ALT (p < 0.01), ALP (p < 0.01), total bilirubin (p < 0.001) at 4 weeks compared to baseline. AST, MDA and NO showed a reduction of 19%, 21.6% and 5.5% respectively from baseline and GSH at showed an increase of 2.6% from baseline at 4 weeks in the NAC group, however these were not statistically significant. These effects in LFT and oxidative biomarkers persisted even at the end of 8 weeks. Significant improvement from baseline in QOL was observed in both the groups (p < 0.05). Between group analysis showed, significant reduction in ALT (p < 0.05) and AST (p < 0.05) in NAC group at 4 weeks, whereas bilirubin, MDA, NO and GSH showed improvement at 4 weeks compared to placebo in NAC group, however it was not statistically significant. This improvement in the LFT and oxidative biomarkers continued even at the end of 8 weeks. Itching and rashes were the most common ADRs, with similar incidence in both the groups. Compliance to treatment was good in both the groups.

CONCLUSION: Significant improvement in liver function parameters is suggestive of hepatoprotective effect of NAC. This observed effect at 4 weeks was found to be persistent at 8 weeks, which signifies prolonged hepato-protective effect of NAC. Long duration studies with large sample size are required for further confirmation of hepato-protective action of NAC.

PMID:37562904 | DOI:10.1016/j.ijtb.2022.05.012

Handb Clin Neurol. 2023;195:271-286. doi: 10.1016/B978-0-323-98818-6.00016-9.

ABSTRACT

Electromyography (EMG) focuses on assessment of the motor unit (MU), and a given muscle has several hundred MUs, each innervating hundreds of muscle fibers. Assessment is limited by the recording radius of electrodes, 1-2 fibers with single-fiber electrodes and 7-15 fibers with concentric or monopolar electrodes. Routine qualitative EMG studies rely on observing MUs in free-run mode and qualitatively estimating common metrics. In contrast, quantitative EMG (QEMG) applied to routine studies includes assessment of individual MUs by software available in modern EMG machines with extraction of discrete values for common metrics, and also derived metrics. This results in greater precision and statistical interpretation. Other QEMG techniques assess muscle fiber density within the MU and time variability at the neuromuscular junction. The interference pattern can also be assessed. The number of MUs innervating a muscle can be estimated. Advanced signal processing, called near-fiber EMG, allows for extraction of underlying muscle fiber contributions to MU waveforms. It is also possible to use QEMG to make statistical probabilities of the state of a muscle as to whether normal, myopathic, or neuropathic. Time to acquire QEMG data is minimal. QEMG is most useful in situations where pathology is uncertain.

PMID:37562872 | DOI:10.1016/B978-0-323-98818-6.00016-9

J Neurointerv Surg. 2023 Aug 10:jnis-2023-020686. doi: 10.1136/jnis-2023-020686. Online ahead of print.

ABSTRACT

BACKGROUND: To assess the frequency, imaging appearances, and risk factors of brain microemboli following pediatric neuroangiography, as assessed by early diffusion-weighted MRI imaging (DWI).

METHODS: This single-center, retrospective analysis investigated early DWI post-pediatric neuroangiography. Patients aged 0-18 years who had diagnostic neuroangiography and DWI within a week postprocedure were included. Data on clinical and procedural parameters and MRI findings were recorded. Univariate and multivariate analyses were performed on the following risk factors: age, weight, vasculopathy, antiplatelet drug use, access type, intraprocedural heparin, procedure duration, neck arteries catheterized, and angiographic runs. A p-value<0.05 indicated statistical significance.

RESULTS: Eighty-two children were included (40.2% female), mean age 10.1±4.5 years (range: 7 months-17 years). There were no intraprocedural thromboembolic complications recognized. DWI positivity was seen following 3.6% (3/82) procedures: two with transient symptoms, and one instance of silent microemboli. There were no territorial infarcts or clinical stroke. Children with underlying vasculopathy had a higher risk of microemboli from angiography than children without vasculopathy (OR 31.6, p=0.02), and the OR of microemboli following transradial angiography was 79.1 (p=0.005) as compared with transfemoral angiography. Univariate and multivariate analysis showed a significant association between microemboli and number of angiographic runs (p=0.004). Follow-up MRI in all three patients showed no residual abnormal signal.

CONCLUSIONS: Cerebral microemboli are unusual following uncomplicated neuroangiography in children. However, in the presence of underlying vasculopathy and with transradial technique, the incidence approaches that reported in the adult literature. An increased association with the number of angiographic runs is an important and controllable factor.

PMID:37562819 | DOI:10.1136/jnis-2023-020686

J Am Vet Med Assoc. 2023 Aug 9:1-5. doi: 10.2460/javma.23.05.0273. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare long-term outcomes of lower lid entropion surgery performed in juvenile dogs versus adult dogs and evaluate the success rate of temporary tacking procedures in dogs < 1 year of age.

ANIMALS: 116 client-owned dogs.

METHODS: A retrospective study was performed evaluating dogs younger than 3 years old diagnosed with primary lower lid entropion between 2010 and 2020. Recurrence of entropion following temporary tacking sutures was evaluated. Surgical outcomes were evaluated of entropion surgery in dogs < and > 1 year of age.

RESULTS: 44 dogs with entropion (71 eyes) had a temporary tacking procedure. The entropion resolved in 36.6% of eyes, requiring no further therapy. The median age of dogs successfully treated with a temporary tacking procedure was younger than those that failed. Forty-seven dogs (75 eyes) had entropion surgery at maturity, and 52 dogs (79 eyes) were juvenile. Twenty-seven dogs had temporary tacking procedure prior to surgery, accounting for the difference in number. There was no statistically significant difference in the recurrence rate of entropion between eyes of adult (6/75 [8%]) and juvenile dogs (10/79 [12.7%]) following surgery.

CLINICAL RELEVANCE: Entropion surgery in juvenile dogs is not associated with a higher risk of recurrence and need not be delayed until dogs are older than 1 year of age.

PMID:37562785 | DOI:10.2460/javma.23.05.0273

J Acad Nutr Diet. 2023 Aug 8:S2212-2672(23)01309-6. doi: 10.1016/j.jand.2023.08.003. Online ahead of print.

ABSTRACT

BACKGROUND: Childhood diet can impact health outcomes over the life course. Few studies have assessed dietary quality among infants and children in the U.S.-Affiliated Pacific (USAP) region.

OBJECTIVE: The aim of this study was to examine the differences in diet quality among Pacific children in the Children’s Healthy Living (CHL) program by Pacific jurisdiction and by their World Bank Income Group (WBIG) level.

DESIGN: This cross-sectional study used dietary records collected from 2012 to 2015.

PARTICIPANTS: /Setting: Data were collected on two- to eight-year-old children (n=3,529) enrolled in the Children’s Healthy Living Program for Remote Underserved Minority Populations in the Pacific region, conducted in the USAP jurisdictions of Alaska, Hawai’i, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, Federated States of Micronesia (FSM islands include Chuuk, Kosrae, Pohnpei, Yap), Republic of the Marshall Islands (RMI), and Republic of Palau.

MAIN OUTCOME MEASURE: Diet quality was assessed using the Healthy Eating Index-2005 (HEI-2005). This HEI version was commensurate with the time of dietary data collection for the CHL project and previous studies, thus allowing cross study comparisons.

STATISTICAL ANALYSIS PERFORMED: Means of total HEI-2005 scores between jurisdictions and their WBIG level were compared using linear models, with and without adjustment for age, sex, and dietary energy.

RESULTS: Differences in mean HEI-2005 scores among children were found between jurisdictions and their WBIG level. Alaska had the highest adjusted mean score (63.3). RMI had the lowest adjusted mean score (50.1). By WBIG, lower-middle income jurisdictions had the lowest adjusted mean HEI-2005 score (56.0) whereas high income jurisdictions had the highest adjusted mean HEI-2005 score (60.5).

CONCLUSIONS: Variation in children’s diet quality was found between USAP jurisdictions, notably between jurisdictions of different WBIG levels. Future research is needed to deepen understanding of these differences in diet quality by WBIG level, such as whether differences may be due to the jurisdictions’ varying food systems, and possibly explained by the nutrition transition. Understanding childhood diet quality in this region can inform approaches for nutrition programs in the Pacific region.

PMID:37562772 | DOI:10.1016/j.jand.2023.08.003

Gastroenterol Hepatol. 2023 Aug 8:S0210-5705(23)00379-5. doi: 10.1016/j.gastrohep.2023.08.001. Online ahead of print.

ABSTRACT

INTRODUCTION: portal vein thrombosis (PVT) is the most frequent cause of portal hypertension in paediatric population. Baveno VI Consensus considers endoscopic variceal ligation (EVL) as the second therapeutic option after Meso-Rex bypass (surgical shunt).

AIM: analyse the diagnostic profitability of non-invasive scales in order to predict the risk of oesophageal varices (OV) in children with PVT.

MATERIALS AND METHODS: descriptive retrospective study where every upper gastrointestinal endoscopy (UGE) carried on patients <15 years old with non-cirrhotic PVT were included. There were divided according to the presence of OV and sex, cause, age, previous gastrointestinal bleeding or treatments, results of UGE and scales (Clinical Prediction Rule-CPR), Varices Prediction Rule-VPR), King’s Variceal Prediction Score-K-VaPS) and Platelet count / Spleen diameter Ratio-PSR). Qualitative variables were expressed as absolute frequency and percentage, and quantitative variables as median and intercuartilic range. U Man-Whitney and Hanley-McNeil tests were used for comparisons.

RESULTS: 45 UGE were analysed. 80%(n=36) presented OV: median of 3(2 – 3) and 33,3%(n=12) required EVL. Statistical differences were demonstrated between both groups: CPR (142,39 (132,22 – 166,53) vs. 122,75 (115,24 – 133,15); p=0,003), VPR (9,91 (9,36 – 11,75) vs. 5,6 (3,34 – 8,39) p=0,001), K-VaPS (117,86 (99,66 – 126,58) vs. 99,64 (94,88 – 110,18) p=0,019), PSR (2384,62 (1902,22 – 3201,63) vs. 1252,5 (579,6 – 2144,42) p=0,05), with and area under the curve AUROC>75%, without statistical differences between scales.

CONCLUSIONS: in paediatric patients with non-cirrotic PVT non-invasive scales can be used as a tool to predict the presence of OV and raise the indication of UGE.

PMID:37562768 | DOI:10.1016/j.gastrohep.2023.08.001