Category: Statistics

Acta Anaesthesiol Scand. 2022 Mar 26. doi: 10.1111/aas.14063. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed at investigating the incidence, characteristics and outcome of ventilator-associated pneumonia (VAP) in patients after cardiac arrest (CA) and its potential association with mild therapeutic hypothermia (MTH). We hypothesised, that MTH might increase the risk of VAP.

METHODS: Prospective observational study including comatose adult patients after successful resuscitation from out-of-hospital or in-hospital CA with presumed cardiac cause admitted to ICU and treated with MTH at 33°C for 24h or normothermia (NT) with treatment of fever ≥ 38°C by pharmacological means. The primary outcome measure was the development of VAP. VAP diagnosis included mechanical ventilation >48h combined with clinical and radiologic criteria. For a microbiologically confirmed VAP (mcVAP) a positive respiratory culture was required.

RESULTS: 23% of 171 patients developed VAP, 6% presented with mcVAP. VAP was associated with increased ICU-LOS (9 (IQR 5-14) vs. 6 (IQR 3-9) days; p<0.01), ventilator-dependent days (6 (IQR 4-9) vs. 4 (IQR 2-7) days; p<0.01) and duration of antibiotic treatment (9 (IQR 5-13) vs. 5 (IQR 2-9) days; p<0.01), but not with mortality (OR 0.88 (95% CI: 0.43-1.81); p=0.74). Patients treated with MTH (47%) presented higher VAP (30 vs. 17%; p=0.04) and mcVAP rates (11 vs. 2%; p=0.03). MTH was associated with VAP in multivariable logistic regression analysis with an OR of 2.67 (95% CI: 1.22-5.86); p=0.01.

CONCLUSIONS: VAP appears to be a common complication in patients after CA, accompanied by more ventilator-dependent days, prolonged antibiotic treatment and ICU-LOS. Treatment with MTH is significantly associated with development of VAP.

PMID:35338658 | DOI:10.1111/aas.14063

Med J Malaysia. 2022 Mar;77(2):237-240.

ABSTRACT

INTRODUCTION: Isolation of SARS-CoV-2-infected individuals is an important COVID-19 pandemic control measure. While most cases have uncomplicated infection, a small proportion of them has developed life-threatening disease. We set up a retrospective study to determine preadmission triaging tool to predict the development of severe COVID-19.

MATERIALS AND METHODS: A retrospective study was conducted from 1 October 2020 to 31 January 2021 with enrolment of all SARS-CoV-2 PCR-confirmed persons aged ≥13 years. The disease severity was assessed on admission and daily throughout the hospitalisation. Test-positive individuals were considered as having “severe COVID-19” if they had ≥1 of the following: room air oxygen saturation 30 breaths/minute, signs of severe respiratory distress, or received mechanical ventilation and/or vasopressor therapy. Uni- and multi-variate analyses using SPSS Statistics Ver. 26 were performed.

RESULTS: We showed that age ≥ 60 years, BMI ≥ 30.0, presentation on days 7-12 of illness, and ≥1 comorbidity were associated with development of severe COVID-19. A scoring system based on the four variables is a useful COVID-19 risk assessment tool. A total score ≥2 had a sensitivity of 60.9%, specificity of 88.2%, positive predictive value of 37.8% and negative predictive value of 95.0%.

CONCLUSION: Development of preadmission triaging tool can help health care providers (HCPs) decide on the placement of test-positive individuals to appropriate isolation facilities according to the risk of developing severe COVID-19.

PMID:35338633

Laryngoscope. 2022 Mar 26. doi: 10.1002/lary.30113. Online ahead of print.

ABSTRACT

OBJECTIVES: (1) Measure the cartilaginous Eustachian tube (ET) length using a computed tomography (CT) scan and (2) develop a prediction model to measure this length without the need of a CT scan.

STUDY DESIGN: CT measurements in children.

SETTING: Children’s Hospital.

METHODS: CT scans were reformatted to project the cranial and caudal limits of the cartilaginous ET. The length was measured in 193 children who underwent a neck CT scan for nonotologic indications. Five physicians independently reviewed all or some of these measures. Four different models based on age, age ranges, weight, and height were created and compared to predict ET length.

RESULTS: The cartilaginous ET length was 25.3 ± 3.1 mm for the right and for the left ear. The mean ET length for the females was statistically significantly less than the length in males. The lower ET lengths in children as old as 5 years of age were less than the 2 cm adult criteria used for catheter insertion. All 4 models performed equally well in predicting ET length. Model number 4, which is based on height, was the easiest to calculate ET length.

CONCLUSION: The cartilaginous portion of the pediatric ET can be measured with good precision using reformatted CT images. We caution against using the “adult” criteria of 2 cm for catheter insertion in children, especially those younger than 5 years of age. We recommend using a model utilizing height measures to estimate ET length or direct measurements from a reformatted CT scan.

LEVEL OF EVIDENCE: NA Laryngoscope, 2022.

PMID:35338653 | DOI:10.1002/lary.30113

Med J Malaysia. 2022 Mar;77(2):224-231.

ABSTRACT

INTRODUCTION: In Malaysia, the prevalence of diabetes mellitus has been increasing annually, currently affecting 18.3% of the population. Diabetic foot ulcer, a common complication of diabetes, is associated with high morbidity and mortality, consequently increasing health care expenditure. A previous study showed that foot care knowledge and foot self-care practices help to reduce the development of ulcers.1,2 This study aims to identify the level of foot care knowledge and self-care practices among diabetic patients in the primary care setting.

OBJECTIVE: This study was to determine the level of foot care knowledge and foot self-care practices among diabetic patients in the primary care setting in Penang Island and its determinants and the correlation between level of foot care knowledge and self-care practices among diabetic patients.

MATERIAL AND METHODS: A cross sectional study was performed on 311 diabetic patients who were registered to two government health clinics in Penang. Information regarding respondents’ demographic status, foot care knowledge, and foot self-care practices were gathered using a self-administered questionnaire. Data were analysed using the Statistical Package for the Social Sciences (SPSS) 22. The Mann-Whitney U test and Kruskal-Wallis test were applied to the analysis. Multiple linear regression was performed to identify the determinants. Correlation between knowledge and self-care practice was determined using the linear regression model.

RESULTS: One hundred and sixty-five (53.1%) respondents achieved good knowledge scores and 196 respondents (63%) achieved good self-care practice scores. The median age of respondents was 61 years, who were mostly females (56.6%), Malays (41.2%), and unemployed (48.6%). Median HbA1c level was 7.5%, and 42.8% of respondents had diabetes for 5 to 10 years. Lowest scores for knowledge and self-care practices were observed in foot skin care questions. Formal foot care education was found to be a significant predictor of foot care knowledge (p<0.05, 95% CI -1.102, -0.098). Foot care knowledge was significantly and positively correlated with foot self-care practices (p<0.001, 95% CI 0.548, 0.727).

CONCLUSION: Foot care knowledge has significant positive correlation with foot self-care practices. Empowering diabetic patients with foot care knowledge may lead to significantly better foot self-care practices.

PMID:35338631

Med J Malaysia. 2022 Mar;77(2):137-142.

ABSTRACT

INTRODUCTION: The main objective of this study was to determine the prevalence of Autism Spectrum Disorder (ASD) in Down Syndrome (DS) children attending the DS clinic at Child Development Centre Universiti Kebangsaan Malaysia Medical Centre (CDC-UKMMC) and to assess the appropriateness of using an M-CHAT as an ASD screener in this population. We traced the karyotype results of our study population from their medical record and compared this to study participant with a dual diagnosis of Down Syndrome- Autism Spectrum Disorder (DS-ASD). Lastly, we assessed the awareness among parents attending our DS follow up clinic regarding the possibility of an ASD diagnosis in DS children.

MATERIALS AND METHODS: This a single-centre cross-sectional study among DS children aged 18-60 months who attend the DS follow up clinic in UKMMC. Overall, 24 children were recruited to our study. The accompanying parent was given the Modified Checklist for Autism in Toddlers (M-CHAT) questionnaire and a data collection sheet prior to their consultation. The chromosomal study was traced from their medical case notes. Children that were eligible for the study had their development assessed using the tool Schedule of Growing Skills II. The diagnosis of ASD was determined by the attending paediatrician using The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) criteria.

RESULTS: The prevalence of dual diagnoses DS-ASD in our study population was 4.2%. Using M-CHAT as a screener, 8 children failed the M-CHAT, of whom only one was diagnosed with ASD. None of the children that passed the MCHAT was diagnosed with ASD. Only 17 chromosomal study results were available for analysis, 2 children had mosaic DS whereas the remaining was caused by non-disjunction; the only DS-ASD patient had non-disjunction. Regarding parental awareness of dual diagnoses of ASD and DS, about 60% of the parents attending UKMMC clinic were aware of the possibility of ASD-DS diagnosis.

CONCLUSIONS: Our results suggest that ASD prevalence in our DS study population is consistent with those previously reported, and that paediatricians managing DS children should be aware of the dual diagnoses of ASD and DS when managing these patients. Even though, we are unable to make a definitive conclusion regarding the use of M-CHAT in this population of children due to the very small sample size, possibly a multi-centre research in the future may help elucidate this issue.

PMID:35338618

Cancer Med. 2022 Mar 26. doi: 10.1002/cam4.4658. Online ahead of print.

ABSTRACT

BACKGROUND: Older patients with non-small cell lung cancer (NSCLC) are a heterogeneous population with varying degrees of frailty. An electronic frailty index such as the Veterans Affairs Frailty Index (VA-FI) can potentially help identify vulnerable patients at high risk of poor outcomes.

METHODS: NSCLC patients ≥65 years old and diagnosed in 2002-2017 were identified using the VA Central Cancer Registry. The VA-FI was calculated using administrative codes from VA electronic health records data linked with Medicare and Medicaid data. We assessed associations between the VA-FI and times to mortality, hospitalization, and emergency room (ER) visit following diagnosis by Kaplan-Meier analysis and multivariable stratified Cox models. We also evaluated the change in discrimination and calibration of reference prognostic models after adding VA-FI.

RESULTS: We identified a cohort of 42,204 older NSCLC VA patients, in which 55.5% were classified as frail (VA-FI >0.2). After adjustment, there was a strong association between VA-FI and the risk of mortality (HR = 1.23 for an increase of four deficits or, equivalently, an increase of 0.129 on VA-FI, p < 0.001), hospitalization (HR = 1.16 for four deficits, p < 0.001), and ER visit (HR = 1.18 for four deficits, p < 0.001). Adding VA-FI to baseline prognostic models led to statistically significant improvements in time-dependent area under curves and did not have a strong impact on calibration.

CONCLUSION: Older NSCLC patients with higher VA-FI have significantly elevated risks of mortality, hospitalizations, and ER visits following diagnosis. An electronic frailty index can serve as an accessible tool to identify patients with vulnerabilities to inform clinical care and research.

PMID:35338613 | DOI:10.1002/cam4.4658

J Occup Health. 2022 Jan;64(1):e12326. doi: 10.1002/1348-9585.12326.

ABSTRACT

OBJECTIVES: Several studies have reported health or safety risk of temporary agency workers (TAW). Since most of the studies are just cross-sectional studies, we intended to identify the risk of occupational injury in TAW, using longitudinal study design.

METHODS: The Korea Health Panel 2009-2018 data were used in the study. For the statistical analysis of this study, we used a panel logit model to identify the risk of occupational injury in TAW compared to direct contract workers (DCW).

RESULTS: There was no significant difference in risk of occupational injury between TAW and DCW among the overall population (adjusted OR 0.920, 95% CI 0.600-1.411). However, there was a significant increase in occupational injury in women (adjusted OR 2.134, 95% CI 1.092-4.170) and the “19-34” age group (adjusted OR 2.744, 95% CI 1.103-6.825) of TAW.

CONCLUSIONS: This study provides evidence for vulnerable groups such as women and younger age groups in the relationship between TAW and occupational injury.

PMID:35338564 | DOI:10.1002/1348-9585.12326

Biol Rev Camb Philos Soc. 2022 Mar 25. doi: 10.1111/brv.12854. Online ahead of print.

ABSTRACT

In a much-cited 1964 paper entitled “Reproductive efficiency in relation to colony size in hymenopterous societies,” Charles Michener investigated the correlation between a colony’s size and its reproductive efficiency – the ability of its adult females to produce reproductives, measured as per-capita output. Based on his analysis of published data from destructively sampled colonies in 18 species, he reported that in most of these species efficiency decreased with increasing colony size. His conclusion that efficiency is higher in smaller groups has since gained widespread acceptance. But it created a seeming paradox: how can natural selection maintain social behaviour when a female apparently enjoys her highest per-capita output by working alone? Here we treat Michener’s pattern as a hypothesis and perform the first large-scale test of its prediction across the eusocial Hymenoptera. Because data on actual output of reproductives were not available for most species, Michener used various proxies, such as nest size, numbers of brood, or amounts of stored food. We show that for each of Michener’s data sets the reported decline in per-capita productivity can be explained by factors other than decreasing efficiency, calling into question his conclusion that declining efficiency is the cause of the pattern. The most prominent cause of bias is the failure of the proxy to capture all forms of output in which the colony invests during the course of its ontogeny. Other biasing factors include seasonal effects and a variety of methodological flaws in the data sets he used. We then summarize the results of 215 data sets drawn from post-1964 studies of 80 species in 33 genera that better control for these factors. Of these, 163 data sets are included in two meta-analyses that statistically synthesize the available data on the relationship between colony size and efficiency, accounting for variable sample sizes and non-independence among the data sets. The overall effect, and those for most taxonomic subgroups, indicates no loss of efficiency with increasing colony size. Two exceptional taxa, the halictid bees and independent-founding paper wasps, show negative trends consistent with the Michener hypothesis in some species. We conclude that in most species, particularly those with large colony sizes, the hypothesis of decreasing efficiency with increasing colony size is not supported. Finally, we explore potential mechanisms through which the level of efficiency can decrease, be maintained, or even increase, as colonies increase in size.

PMID:35338566 | DOI:10.1111/brv.12854

Stat Med. 2022 Mar 26. doi: 10.1002/sim.9389. Online ahead of print.

ABSTRACT

Genetic interaction is considered as one of the main heritable component of complex traits. With the emergence of genome-wide association studies (GWAS), a collection of statistical methods dedicated to the identification of interaction at the SNP level have been proposed. More recently, gene-based gene-gene interaction testing has emerged as an attractive alternative as they confer advantage in both statistical power and biological interpretation. Most of the gene-based interaction methods rely on a multidimensional modeling of the interaction, thus facing a lack of robustness against the huge space of interaction patterns. In this paper, we study a global testing approaches to address the issue of gene-based gene-gene interaction. Based on a logistic regression modeling framework, all SNP-SNP interaction tests are combined to produce a gene-level test for interaction. We propose an omnibus test that takes advantage of (1) the heterogeneity between existing global tests and (2) the complementarity between allele-based and genotype-based coding of SNPs. Through an extensive simulation study, it is demonstrated that the proposed omnibus test has the ability to detect with high power the most common interaction genetic models with one causal pair as well as more complex genetic models where more than one causal pair is involved. On the other hand, the flexibility of the proposed approach is shown to be robust and improves power compared to single global tests in replication studies. Furthermore, the application of our procedure to real datasets confirms the adaptability of our approach to replicate various gene-gene interactions.

PMID:35338506 | DOI:10.1002/sim.9389

Biometrics. 2022 Mar 25. doi: 10.1111/biom.13665. Online ahead of print.

ABSTRACT

High-dimensional clustering analysis is a challenging problem in statistics and machine learning, with broad applications such as the analysis of microarray data and RNA-seq data. In this paper, we propose a new clustering procedure called Spectral Clustering with Feature Selection (SC-FS), where we first obtain an initial estimate of labels via spectral clustering, then select a small fraction of features with the largest R-squared with these labels, i.e., the proportion of variation explained by group labels, and conduct clustering again using selected features. Under mild conditions, we prove that the proposed method identifies all informative features with high probability and achieves minimax optimal clustering error rate for the sparse Gaussian mixture model. Applications of SC-FS to four real world data sets demonstrate its usefulness in clustering high-dimensional data. This article is protected by copyright. All rights reserved.

PMID:35338489 | DOI:10.1111/biom.13665