Category: Statistics

J Telemed Telecare. 2023 Jul 24:1357633X231182405. doi: 10.1177/1357633X231182405. Online ahead of print.

ABSTRACT

INTRODUCTION: Teledentistry is an innovative health care delivery platform that can potentially improve oral health access and outcomes. The purpose of this study was to predict teledentistry utilization intentions of U.S. adults using the Unified Theory of Acceptance and Use of Technology (UTAUT) as a framework.

METHODS: This mixed-method, cross-sectional study surveyed 899 participants from two independent samples in August and September 2021. Convenience samples of Minnesota State Fair attendees and ResearchMatch volunteers completed electronic surveys to identify the behavioral intention (BI) for teledentistry use within the next 6 months. Independent variables were the UTAUT constructs of performance expectancy (PE), effort expectancy (EE), social influence (SI), and facilitating conditions (FC). Data were analyzed using univariate analysis and multiple linear regression adjusting for age, gender and educational level. Qualitative analysis used thematic analysis using UTAUT as a coding framework.

RESULTS: Univariate analysis showed statistical significance between each construct with BI (P < 0.0001). Adjusted multiple linear regression revealed statistical significance between PE and SI with BI (P < 0.0001). Qualitative responses corroborated quantitative results and revealed a lack of teledentistry knowledge.

CONCLUSION: The majority of participants indicated an intention not to use teledentistry within the next 6 months. The lack of prior experience of telehealth or teledentistry use in addition to lack of knowledge regarding teledentistry may contribute to these results. Future interventions to improve the BI to use teledentistry may benefit from focusing on PE and SI constructs for educational and marketing strategies.

PMID:37487219 | DOI:10.1177/1357633X231182405

Ann Intern Med. 2023 Jul 25. doi: 10.7326/M23-0724. Online ahead of print.

ABSTRACT

BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) decrease serum urate levels, but whether this translates into prevention of recurrent flares among patients with gout and gout-primary emergency department (ED) visits or hospitalizations is unknown.

OBJECTIVE: To compare gout flares and cardiovascular events among patients with gout initiating SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP-4is), another second-line glucose-lowering agent not associated with serum urate levels or cardiovascular risk.

DESIGN: Propensity score-matched, new-user cohort study.

SETTING: General population database from 1 January 2014 to 30 June 2022.

PARTICIPANTS: Patients with gout and type 2 diabetes.

MEASUREMENTS: The primary outcome was recurrent gout flare counts ascertained by ED, hospitalization, outpatient, and medication dispensing records. Secondary outcomes included myocardial infarction and stroke; genital infection (positive control) and osteoarthritis encounter (negative control) were also assessed. Poisson and Cox proportional hazards regressions were used with 1:1 propensity score matching (primary analysis) and overlap weighting (sensitivity analysis).

RESULTS: After propensity score matching, the flare rate was lower among SGLT2i initiators than DPP-4i initiators (52.4 and 79.7 events per 1000 person-years, respectively), with a rate ratio (RR) of 0.66 (95% CI, 0.57 to 0.75) and a rate difference (RD) of -27.4 (CI, -36.0 to -18.7) per 1000 person-years. The corresponding RR and RD for gout-primary ED visits and hospitalizations were 0.52 (CI, 0.32 to 0.84) and -3.4 (CI, -5.8 to -0.9) per 1000 person-years, respectively. The corresponding hazard ratio (HR) and RD for myocardial infarction were 0.69 (CI, 0.54 to 0.88) and -7.6 (CI, -12.4 to -2.8) per 1000 person-years; the HR for stroke was 0.81 (CI, 0.62 to 1.05). Those who initiated SGLT2is showed higher risk for genital infection (HR, 2.15 [CI, 1.39 to 3.30]) and no altered risk for osteoarthritis encounter (HR, 1.07 [CI, 0.95 to 1.20]). Results were similar when propensity score overlap weighting was applied.

LIMITATION: Participants had concurrent type 2 diabetes.

CONCLUSION: Among patients with gout, SGLT2is may reduce recurrent flares and gout-primary ED visits and hospitalizations and may provide cardiovascular benefits.

PRIMARY FUNDING SOURCE: National Institute of Arthritis and Musculoskeletal and Skin Diseases.

PMID:37487215 | DOI:10.7326/M23-0724

Nutr Health. 2023 Jul 24:2601060231189314. doi: 10.1177/02601060231189314. Online ahead of print.

ABSTRACT

Based on a recent cross-sectional study using self-report questionnaires, Dinse and colleagues (2023) claim that this study shows that “the SARS-CoV-2 pandemic causes a dysfunctional dietary behavior” (title) and that the “data clearly show that psychological burdens affect an individual’s dietary behavior” (abstract). This commentary argues that these claims are unfounded. Specifically, it highlights some issues regarding the statistical analyses that refer to artificial categorization of continuous variables, use of covariates, and interpreting differential associations between two variables as a function of third variables, which would require formal tests of interaction effects. Importantly, not only the cross-sectional nature of the study but also the wording used in the questionnaires prevents drawing any causal inferences about associations between study variables. Thus, the results of this study neither indicate that the SARS-CoV-2 pandemic causes dysfunctional dietary behavior nor that such a dietary behavior is affected by psychological distress.

PMID:37487209 | DOI:10.1177/02601060231189314

Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231188425. doi: 10.1177/10760296231188425.

ABSTRACT

To assess individual participants’ baseline thrombosis risk calculated by Caprini Risk Score (CRS) before injury, illness, or hospitalization occur, to increase the awareness of venous thromboembolism (VTE) by viewing 2 short videos. A cross-sectional study was conducted online between August 2022 and January 2023 in the USA, UK, and India to assess the risk of thrombosis of individuals as a baseline. One nursing practitioner and 4 high school students were on the research team. Descriptive statistical methods were used in data analysis. A total of 928 usable completed questionnaires from 945 participants were analyzed. The mean CRS was 4.93 ± 3.175; 0 to 4 (N = 460, 49.6%), 5 to 8 (N = 394, 42.5%), and 9 (N = 74: 8.0%). History of blood clots (N = 247, 26.6%), <40 years old (N = 133, 52.6%); women on oral contraceptives (N = 324, 34.9%), history of smoking (30%), diabetes (26%), and inflammatory bowel disease (IBD; 17.3%). Top-level findings: High incidence of family history of thrombosis (26.6%), smoking, diabetes, contraceptives, and IBD. The average CRS (7.9) in patients over 75 years indicates that even a minor surgical procedure may be associated with significant VTE risk. We achieved an important goal by increasing awareness of VTE using this unique method involving high school students and a nurse working with friends and families to complete the CRS assessment. Encouraging the respondents to share information with their personal physicians prior to the event and keep these data in their medical file is a potential valuable source of saving time. This study emphasizes the importance of individuals collecting baseline information prior to illness or hospitalization.

PMID:37487194 | DOI:10.1177/10760296231188425

J Sex Res. 2023 Jul 24:1-12. doi: 10.1080/00224499.2023.2232354. Online ahead of print.

ABSTRACT

Sexual harassment affects a large percentage of higher education students in the US. A previous study identified several risk factors for sexual harassment using hurdle models and classification and regression tree (CART) analyses. The purpose of the present study was to assess the robustness of these findings by replicating the analyses with a new sample of students. Secondary data analysis was conducted using data from 9,552 students from two- and four-year colleges. Hurdle model coefficients were assessed for replicability based on statistical significance and consistency of the replication effect size relative to the original effect size. Kotzé et al.’s findings were robust, with 91% of all tested effects meeting at least one of two replication criteria in the hurdle models and 88% of the variables replicating in the CARTs. Being younger, consuming alcohol more frequently, attending a four-year college, and having experienced more prior victimization and adversity were important predictors of peer harassment whereas being LGBQ+ was an important predictor of sexual harassment from faculty/staff. These findings can inform targeted prevention and intervention programs. More research is needed to understand why certain demographic and contextual variables are associated with greater harassment risk.

PMID:37487179 | DOI:10.1080/00224499.2023.2232354

J Cataract Refract Surg. 2023 Jul 24. doi: 10.1097/j.jcrs.0000000000001270. Online ahead of print.

ABSTRACT

PURPOSE: To demonstrate the safety and efficacy of allogenic corneal inlays designed to increase the depth of focus in treated eyes.

SETTINGS: Medipol University Hospital, Istanbul, Turkey.

DESIGN: Prospective case series.

METHODS: This study includes 50 eyes of 25 patients with a follow-up of 3 years. Emmetropic patients with presbyopia had implantation of allogenic corneal inlays (Allotex) in the nondominant eye. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and uncorrected near visual acuity (UNVA) were evaluated in all eyes. A subjective visual acuity test system (Multifocal Lens Analyzer 3.0 application, Q Vision Academy, Spain) was used to analyze the depth of focus by measuring the defocus curves.

RESULTS: No significant difference between the treated and fellow eyes in UDVA and CDVA was found, whereas UNVA was significantly better in the treated eyes (p=0.20, p=0.07, p<0.01, respectively). Comparing to the preoperative CDVA, there was a 1-line decrease in CDVA in 6 (%24) patients. The mean defocus curves reveal a depth of focus of 1.1D for the untreated eye at the logMAR=0.2 threshold. By contrast, the mean depth of focus of the treated eye and binocularly was 2.8D. The areas under the curve were significantly better in the near, intermediate, and total distances in the treated eyes, whereas it was better for the far distances in the untreated eyes. All values were significant (p=0.023 total, p<0.01 others).

CONCLUSIONS: Allogenic presbyopic inlay implantation may be safe and provided a clinically and statistically significant increase in the depth of focus leading to good far, intermediate, and near-visual acuity in emmetropic presbyopic patients.

PMID:37487178 | DOI:10.1097/j.jcrs.0000000000001270

Cornea. 2023 Jul 17. doi: 10.1097/ICO.0000000000003348. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to assess the repeatability of keratometry parameters obtained using the Eye Surface Profiler (ESP) system and their agreement with the IOL Master 500 device.

METHODS: Seventy-one eyes of 71 healthy participants were evaluated. Three repeated measurements were performed using the ESP system. Simulated keratometry in the flat (SimKf) and steep (SimKs) meridians, astigmatism, and axis were obtained. The same parameters were measured using the IOL Master 500 device. The J0 and J45 vector components of the astigmatism were calculated. The intrasession repeatability was analyzed using within-subject SD (Sw) and intraclass correlation coefficient (ICC). Agreement was assessed using paired statistical tests and the Bland-Altman method.

RESULTS: The Sw was 0.07 mm, 0.04 mm, 0.51 D, 0.33 D, and 0.22 D, and the ICC was 0.96, 0.98, 0.74, 0.61, and 0.55 for SimKf, SimKs, astigmatism, J0, and J45, respectively. The mean difference and limits of agreement when comparing the ESP system with the IOL Master 500 device were 0.37 mm (0.08/0.66) for SimKf (P < 0.001), 0.18 mm (0.00/0.35) for SimKs (P < 0.001), -0.93 D (-2.42/0.56) for astigmatism (P < 0.001), 0.51 D (-0.22/1.24) for J0 (P < 0.001), and 0.06 D (-0.48/0.60) for J45 (P = 0.09).

CONCLUSIONS: The ESP system provides consistent values for simulated keratometry, showing moderate consistency for astigmatism parameters. Contact lens practitioners should be aware that the ESP system and IOL Master 500 device provide different simulated keratometry from a clinically viewpoint.

PMID:37487176 | DOI:10.1097/ICO.0000000000003348

J Cardiovasc Nurs. 2023 Jul 20. doi: 10.1097/JCN.0000000000001010. Online ahead of print.

ABSTRACT

BACKGROUND: Exercise rehabilitation is conducive to increasing functional ability and improving health outcomes, but its effectiveness in patients with acute heart failure (AHF) is still controversial.

PURPOSE: In this study, our aim was to systematically examine the efficacy of exercise rehabilitation in people with AHF.

METHODS: A search was conducted for randomized controlled trial studies on exercise rehabilitation in patients with AHF up to November 2021. Two investigators conducted literature selection, quality assessments, and data extractions independently. The primary outcome was 6-minute walk distance, and the secondary outcomes were left ventricular ejection fraction, quality of life, Short Physical Performance Battery, readmission, and mortality. RevMan (version 5.3) software was used for the meta-analysis.

RESULTS: Twelve studies with 1215 participants were included. Exercise rehabilitation significantly improved the 6-minute walk distance (mean difference [MD], 33.04; 95% confidence interval [CI], 31.37-34.70; P < .001; I2 = 0%), quality of life (MD, -11.57; 95% CI, -19.25 to -3.89; P = .003; I2 = 98%), Short Physical Performance Battery (MD, 1.40; 95% CI, 1.36-1.44; P < .001; I2 = 0%), and rate of readmission for any cause (risk ratio, 0.48; 95% CI, 0.26-0.88; P = .02; I2 = 7%), compared with routine care. However, no statistically significant effects on left ventricular ejection fraction (MD, 0.94; 95% CI, -1.62 to 3.51; P = .47; I2 = 0%) and mortality (risk ratio, 1.07; 95% CI, 0.64-1.80; P = .79; I2 = 0%) were observed.

CONCLUSIONS: Compared with routine care, exercise rehabilitation improved functional ability and quality of life, reducing readmission in patients with AHF.

PMID:37487171 | DOI:10.1097/JCN.0000000000001010

JCO Precis Oncol. 2023 Jul;7:e2300087. doi: 10.1200/PO.23.00087.

ABSTRACT

PURPOSE: Recently, the strategy for dose optimization in oncology has shifted toward conducting phase II randomized controlled trials with multiple doses. Optimal biologic dose (OBD) selection from phase I trial data to determine candidate doses for phase II trials has been gaining attention. Trials to identify the OBD have a fixed cohort size, which increases the trial duration. We propose a method to increase the cohort size using trial data and shorten the trial duration while maintaining accuracy.

METHODS: We propose a novel adaptive cohort size determination method in which the increase of cohort size is determined using desirability probability on the basis of toxicity and efficacy data. The desirability probability is a measure of how desirable a dose is and thus how close it is to the OBD. However, during the trial, the desirability probability does not need to be calculated. Instead, the cohort size expansion can be determined by a simple table generated in advance from toxicity and efficacy data. An illustrated example is provided and the performance was evaluated in a simulation study with 16 scenarios.

RESULTS: In the simulation study, the trial duration was reduced by an average of 20% compared with the conventional design. The percentages of correct OBD selection are almost the same as those with the conventional design.

CONCLUSION: The proposed adaptive cohort size determination method described in this study reduces trial duration while maintaining accuracy.

PMID:37487148 | DOI:10.1200/PO.23.00087

Proc Natl Acad Sci U S A. 2023 Aug;120(31):e2216543120. doi: 10.1073/pnas.2216543120. Epub 2023 Jul 24.

ABSTRACT

Most phenylpropanoid pathway flux is directed toward the production of monolignols, but this pathway also generates multiple bioactive metabolites. The monolignols coniferyl and sinapyl alcohol polymerize to form guaiacyl (G) and syringyl (S) units in lignin, components that are characteristic of plant secondary cell walls. Lignin negatively impacts the saccharification potential of lignocellulosic biomass. Although manipulation of its content and composition through genetic engineering has reduced biomass recalcitrance, in some cases, these genetic manipulations lead to impaired growth. The reduced-growth phenotype is often attributed to poor water transport due to xylem collapse in low-lignin mutants, but alternative models suggest that it could be caused by the hyper- or hypoaccumulation of phenylpropanoid intermediates. In Arabidopsis thaliana, overexpression of FERULATE 5-HYDROXYLASE (F5H) shifts the normal G/S lignin ratio to nearly pure S lignin and does not result in substantial changes to plant growth. In contrast, when we overexpressed F5H in the low-lignin mutants cinnamyl dehydrogenase c and d (cadc cadd), cinnamoyl-CoA reductase 1, and reduced epidermal fluorescence 3, plant growth was severely compromised. In addition, cadc cadd plants overexpressing F5H exhibited defects in lateral root development. Exogenous coniferyl alcohol (CA) and its dimeric coupling product, pinoresinol, rescue these phenotypes. These data suggest that mutations in the phenylpropanoid pathway limit the biosynthesis of pinoresinol, and this effect is exacerbated by overexpression of F5H, which further draws down cellular pools of its precursor, CA. Overall, these genetic manipulations appear to restrict the synthesis of pinoresinol or a downstream metabolite that is necessary for plant growth.

PMID:37487096 | DOI:10.1073/pnas.2216543120