Category: Statistics

J Neurol Neurosurg Psychiatry. 2023 Aug 3:jnnp-2023-331525. doi: 10.1136/jnnp-2023-331525. Online ahead of print.

ABSTRACT

BACKGROUND: Relapse risk after delivery is increased in women with active multiple sclerosis (MS), the best strategy to reduce it is unknown. We aimed to assess the association of four different postpartum strategies with relapses during the first 6 months post partum.

METHODS: This cohort study includes data prospectively collected through structured telephone interviews from the German Multiple Sclerosis and Pregnancy Registry. Pregnancies with active MS (fingolimod or natalizumab treatment OR relapse within 1 year before pregnancy) and postpartum follow-up of ≥6 months were included. We compared four strategies: (1) intention to breastfeed exclusively without disease-modifying therapy (DMT) (exclusive breast feeding ≥2 months or switching to non-exclusive/weaning within 2 weeks after a relapse during the first 2 months), (2) early treatment with natalizumab/fingolimod and (3) other DMT initiated within 6 weeks post partum before a relapse. If women did not or only partially breastfed, or started DMT≤6 weeks after delivery after a relapse or later, we assumed (4) no-DMT-no-exclusive- breastfeeding-strategy. Main outcome was time to postpartum MS relapses.

RESULTS: In 867 women with 911 pregnancies, most (n=416) intended to breastfeed exclusively or had no-DMT-no-exclusive-breastfeeding-strategy (n=290); fewer started fingolimod (n=38), natalizumab (n=74) or another DMT (n=93) early. Recurrent time-to-event analysis showed a statistically significant reduction in relapse hazard only with the natalizumab/fingolimod-strategy as of months 3-4 post partum compared with intention-to-breastfeed-exclusively-strategy. The very early relapse risk was highest in no-DMT-no-exclusive-breastfeeding-strategy.

CONCLUSION: In active MS, an early postpartum treatment strategy should be determined well before delivery. Natalizumab/fingolimod-strategy reduced postpartum relapse hazard from month 3, but none diminished the early postpartum relapse hazard.

PMID:37536925 | DOI:10.1136/jnnp-2023-331525

Soins. 2023 Jul;68(877):48-51. doi: 10.1016/j.soin.2023.06.016. Epub 2023 Jul 21.

ABSTRACT

In recent years, numerous studies have highlighted the advances made possible by kinesitherapy treatments. These can be used to reduce the frequency, intensity and duration of pain, as well as the functional repercussions of chronic pain. The neurophysiological mechanism involved in primary chronic pain and the pathology producing secondary chronic pain must be taken into account in determining the nature of the treatments to be implemented. This article presents the main physiotherapy interventions recommended for the management of patients with chronic pain, according to the type of pain experienced (nociceptive, neuropathic or nociplastic).

PMID:37536906 | DOI:10.1016/j.soin.2023.06.016

Med Eng Phys. 2023 Aug;118:104016. doi: 10.1016/j.medengphy.2023.104016. Epub 2023 Jun 28.

ABSTRACT

Instrumentation alters the biomechanics of the spine, and therefore prediction of all output quantities that have critical influence post-surgically is significant for engineering models to aid in clinical predictions. Geometrical morphological finite element models can bring down the development time and cost of custom intact and instrumented models and thus aids in the better inference of biomechanics of surgical instrumentation on patient-specific diseased spine segments. A comprehensive hexahedral morphological lumbosacral finite element model is developed in this work to predict the range of motions, disc pressures, and facet contact forces of the intact and instrumented spine. Facet contact forces are needed to predict the impact of fusion surgeries on adjacent facet contacts in bending, axial rotation, and extension motions. Extensive validation in major physiological loading regimes of the pure moment, pure compression, and combined loading is undertaken. In vitro, experimental corridor results from six different studies reported in the literature are compared and the generated model had statistically significant comparable values with these studies. Flexion, extension and bending moment rotation curves of all segments of the developed model were favourable and within two separately established experimental corridor windows as well as recent simulation results. Axial torque moment rotation curves were comparable to in vitro results for four out of five lumbar functional units. The facet contact force results also agreed with in vitro experimental results. The current model is also computationally efficient with respect to contemporary models since it uses significantly smaller number of elements without losing the accuracy in terms of response prediction. This model can further be used for predicting the impact of different instrumentation techniques on the lumbar vertebral column.

PMID:37536837 | DOI:10.1016/j.medengphy.2023.104016

BMJ Support Palliat Care. 2023 Aug 3:spcare-2023-004214. doi: 10.1136/spcare-2023-004214. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to determine the effect of inhaling peppermint essence on pain relief and sleep quality after open-heart surgery.

METHODS: In a double-blind randomised clinical trial carried out in Iran in 2020, 64 cardiac patients were selected by convenience sampling and randomly allocated to aromatherapy (n=32) and placebo (n=32) groups. The aromatherapy and control groups received inhaled aromatherapy using peppermint essence and distilled water, respectively. Data gathering tools were the Numeric Pain Rating Scale and St Mary’s Hospital Sleep Questionnaire. Data were analysed using an independent t-test, χ² test, Mann-Whitney U test and generalised estimating equation analysis.

RESULTS: The mean severity of pain in the aromatherapy and placebo groups was 3.22±0.88 and 4.56±0.90, respectively, which was a statistically significant difference (p=0.0001). The mean sleep scores after the intervention on day 1 were 20.10±4.90 and 25.76±6.36 in the aromatherapy and placebo groups, respectively, and 18.63±5.56 and 22.62±5.69, respectively, on day 2. The difference between the two groups was statistically significantly different after the intervention in terms of sleep quality (p<0.05).

CONCLUSION: Aromatherapy attenuated pain and improved sleep quality after open-heart surgery. Peppermint essence aromatherapy is therefore recommended after surgery.

PMID:37536755 | DOI:10.1136/spcare-2023-004214

Epidemiol Health. 2023 Jul 31:e2023068. doi: 10.4178/epih.e2023068. Online ahead of print.

ABSTRACT

OBJECTIVES: While the Korean government’s response to the coronavirus disease 2019 (COVID-19) pandemic is considered effective given the relatively low motality rate, issues of inequality have been insufficiently addressed. This study explored COVID-19-related health inequalities in South Korea.

METHODS: Age standardization for various health inequality indices was derived using data from the Korean National Health Insurance Service, the Korea Disease Control and Prevention Agency, and the Microdata Integrated Service of Statistics Korea. The slope index of inequality (SII) and relative index of inequality (RII) were calculated for socioeconomic variables, while absolute difference (AD) and relative difference (RD) were used for gender and disability inequalities.

RESULTS: We observed a number of COVID-19-related health outcome inequalities. Gender inequality was particularly noticeable in infection rates, with the rate of women 1.16 times higher than that of men. In contrast, socioeconomic inequality was evident in vaccination rates, with a 4.5-fold (SII, -4.519; 95% confidence interval, -7.403 to -1.634) difference between the highest and lowest household income groups. Regarding clinical progression post-infection, consistent findings indicated higher risk for men (RD for hospitalization, 0.90; severe cases, 0.54; and fatality, 0.65), individuals with disabilities (RD for hospitalization, 2.27; severe cases, 2.29; and fatality, 2.37), and those from lower socioeconomic groups (SII for hospitalization, 1.778; severe cases, 0.089; and fatality, 0.451).

CONCLUSION: While the infection risk was nearly ubiquitous, not everyone faced the same level of risk post-infection. To prevent further health inequalities, it is crucial to develop a thoughtful policy acknowledging individual health conditions and resources.

PMID:37536718 | DOI:10.4178/epih.e2023068

Cancer Res Treat. 2023 Aug 2. doi: 10.4143/crt.2023.341. Online ahead of print.

ABSTRACT

PURPOSE: This study investigated association between smoking habit change and cancer-related mortality risk in Korean women.

MATERIALS AND METHODS: Study population were women aged ≥40 years who underwent two biennial cancer screenings during 2009-2012 and were followed up until 2020. Participants were grouped into sustained nonsmokers, sustained quitters, new quitters, relapsers/smoking initiators, and sustained smokers. Outcomes included all-cause and cancer-related deaths. Cox regression and competing risk analysis was used to assess association between smoking habit change and mortality risk.

RESULTS: Of 2,892,590 women, 54,443 death cases were recorded (median follow-up of 9.0 years). Compared with sustained non-smokers, mortality risk from all causes and cancer-related causes increased in all other smoking groups. Cancer-related risk increased 1.22-fold among sustained quitters (95% CI 1.10-1.36), 1.56-fold (95% CI 1.40-1.75) in new quitters, 1.40-fold (95% CI 1.21-1.62) in relapsers/smoking initiators, and 1.61-fold (95% CI 1.46-1.78) in sustained smokers compared with sustained non-smokers. Women who were sustained smokers with higher smoking intensity had a higher mortality risk in terms of HR compared to non-smokers (<5 pack-years 2.12-fold, 5-10 pack-years 2.15-fold, and >10 pack-years 2.27-fold).

CONCLUSION: Quitting smoking earlier is critical for preventing death from all causes and cancer among female smokers.

PMID:37536711 | DOI:10.4143/crt.2023.341

South Med J. 2023 Aug;116(8):707-711. doi: 10.14423/SMJ.0000000000001589.

ABSTRACT

OBJECTIVES: Approximately half of US adults use dietary supplements, often for dermatologic purposes. When survey respondents in a nationally representative population were asked the reasons for their use of a specific supplement, 87% chose “for healthy skin, hair, and nails.” Despite widespread use, supplements have potential risks and lack regulatory safeguards. Because most supplement users choose to use them without the advice of a healthcare professional, it is important to identify factors predicting use. This study examined demographic predictors of skin, hair, and nail supplement use among 2015-2016 US National Health and Nutrition Examination Survey respondents, a nationally representative sample.

METHODS: Weighted descriptive analysis using χ² tests examined group differences among respondents who took skin, hair, and nail supplements and those who did not take supplements in the past 30 days. Multivariable logistic regression models were performed to identify predictors of skin supplement use.

RESULTS: Statistically significant differences in sex, education, income, and insurance status were observed between dermatologic supplement users and nonsupplement users (P < 0.0001). Factors significantly increasing the likelihood of skin supplement use included age between 30 and 60 years (odds ratio [OR] 1.788, 95% confidence interval [CI] 1.439-2.222), age older than 60 years (OR 4.983, 95% CI 3.838-6.469), having a college degree or above (OR 2.696, 95% CI 1.952-3.724), attending some college or above (OR 1.844, 95% CI 1.364-2.494), having an annual income of >$75,000 (OR 1.285, 95% CI 1.029-1.605), and having health insurance (OR 1.559, 95% CI 1.236-1.967). Male respondents were half as likely to use supplements, compared with females (OR 0.579, 95% CI 0.488-0.687).

CONCLUSIONS: Factors such as age, education, income, and sex predict supplement use. Knowledge of such trends may help practitioners counsel patients on potential supplement risks and the many unknowns related to their use. Any patient could be using skin, hair, and nail supplements over the counter, including pregnant and older adult populations, as well as generally healthy patients. This would help protect patients from the possible dangers of supplements, including laboratory test interference and teratogenicity.

PMID:37536702 | DOI:10.14423/SMJ.0000000000001589

Addiction. 2023 Aug 3. doi: 10.1111/add.16306. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: An apparently protective effect of opioid agonist treatment (OAT) on all-cause and cause-specific mortality risk has been widely reported. Non-fatal overdose (NFO) often precedes subsequent drug-poisoning deaths. We hypothesized that benzodiazepines, gabapentinoids, antipsychotics, antidepressants, Z-drugs or opioids increase the NFO risk when co-prescribed with OAT.

DESIGN: We conducted a cohort study using the Clinical Practice Research Datalink GOLD and Aurum databases. The cohort was linked to Hospital Episode Statistics admitted patient care data (HES-APC), neighbourhood- and practice-level Index of Multiple Deprivation quintiles and mortality records from the Office for National Statistics.

SETTING: Primary care in England.

PARTICIPANTS: We studied patients with opioid use disorder, aged 18-64 years, who were prescribed OAT (15155 methadone and 5743 buprenorphine recipients) between Jan 1, 1998, and Dec 31, 2017.

MEASUREMENTS: The main outcome examined was NFO risk during co-prescription of OAT with benzodiazepines, antipsychotics, gabapentinoids, antidepressants, Z-drugs or opioids. Overdose was defined according to International Classification of Diseases codes from the HES-APC data set. Negative binomial regression models were used to estimate weighted rate ratios (wRR) for NFO during co-prescription of OAT and benzodiazepines, antipsychotics, gabapentinoids, antidepressants, Z-drugs or opioids with periods of exclusive OAT usage.

FINDINGS: Among 20 898 patients observed over 83 856 person-years, we found an elevated overdose risk that resulted in hospital admission during co-prescription of OAT with benzodiazepines [wRR: 1.45; 95% confidence interval (CI) = 1.26-1.67], gabapentinoids (wRR = 2.22; 95% CI = 1.77-2.79), Z-drugs (wRR = 1.60; 95% CI = 1.31-1.96), antipsychotics (wRR = 1.85; 95% CI = 1.53-2.25) and opioids (wRR = 1.28; 95% CI = 1.02-1.60). The risk ratio for antidepressant co-prescriptions was below unity (wRR = 0.90; 95% CI = 0.79-1.02) but this result was not statistically significant.

CONCLUSION: Elevated risk of non-fatal overdose among opioid agonist treatment recipients is associated with concurrent use of medication prescribed for other reasons.

PMID:37536685 | DOI:10.1111/add.16306

J Phys Act Health. 2023 Aug 3:1-9. doi: 10.1123/jpah.2022-0534. Online ahead of print.

ABSTRACT

BACKGROUND: Academic achievement (AA) is an important issue not only during the school period since it is a strong predictor of long-term professional and social success. Physical fitness (PF) components are associated with AA, and previous studies were conducted with relatively small samples, lack of statistical power, and the conclusions are based on simple correlational analyses. The objective of this study was to analyze the association between PF (single and clustered) with AA in a large and representative sample of high school students.

METHODS: Cross-sectional design study conducted with 911 students, aged 13-15 years (38.52% boys) enrolled in the first year of high school. Cardiorespiratory fitness (20-m shuttle run test), muscular strength (dynamometer), and body composition (skinfolds) were measured. PF components were clustered (Z-cardiorespiratory fitness + Z-muscular strength – Z-body fatness). AA was analyzed through standard math tests. Hierarchical linear regression analysis was applied to verify the independent contribution of each single component and PF’s cluster on AA. Age, screen time, maternal education, race, and type of residence were used as covariates.

RESULTS: Among boys, cardiorespiratory fitness was negatively associated with AA (β = -0.137; P = .041), while strength was positively associated with AA (β = 0.188; P = .004). There was no association between clustered PF indicators and AA (β = 0.064; P = .297). There was a negative association between age and AA in girls (β = -0.151; P = .003) and in boys (β = -0.128; P = .045).

CONCLUSIONS: These results support current literature, indicating an association between PF’s component, namely muscular strength and AA (mathematics) in adolescents, even when controlled for several covariates.

PMID:37536682 | DOI:10.1123/jpah.2022-0534

Int J Sports Physiol Perform. 2023 Aug 3:1-5. doi: 10.1123/ijspp.2023-0109. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the accuracy of ChatGPT (Chat generative pretrained transformer), a large language model, in calculating sample size for sport-sciences and sports-medicine research studies.

METHODS: We conducted an analysis on 4 published papers (ie, examples 1-4) encompassing various study designs and approaches for calculating sample size in 3 sport-science and -medicine journals, including 3 randomized controlled trials and 1 survey paper. We provided ChatGPT with all necessary data such as mean, percentage SD, normal deviates (Zα/2 and Z1-β), and study design. Prompting from 1 example has subsequently been reused to gain insights into the reproducibility of the ChatGPT response.

RESULTS: ChatGPT correctly calculated the sample size for 1 randomized controlled trial but failed in the remaining 3 examples, including the incorrect identification of the formula in one example of a survey paper. After interaction with ChatGPT, the correct sample size was obtained for the survey paper. Intriguingly, when the prompt from Example 3 was reused, ChatGPT provided a completely different sample size than its initial response.

CONCLUSIONS: While the use of artificial-intelligence tools holds great promise, it should be noted that it might lead to errors and inconsistencies in sample-size calculations even when the tool is fed with the necessary correct information. As artificial-intelligence technology continues to advance and learn from human feedback, there is hope for improvement in sample-size calculation and other research tasks. However, it is important for scientists to exercise caution in utilizing these tools. Future studies should assess more advanced/powerful versions of this tool (ie, ChatGPT4).

PMID:37536678 | DOI:10.1123/ijspp.2023-0109