Category: Statistics

BMJ Health Care Inform. 2023 Aug;30(1):e100769. doi: 10.1136/bmjhci-2023-100769.

ABSTRACT

BACKGROUND: In achieving the WHO’s Universal Health Coverage and the Global Developmental Agenda: Sustainable Development Goal 3 and 9, the Ministry of Health launched a nationwide deployment of the lightwave health information management system (LHIMS) in the Central Region to facilitate health service delivery. This paper assessed the efficient use of the LHIMS among health professionals in the Central Region.

METHODS: A non-interventional descriptive cross-sectional study design was employed for this research. The study used stratified and simple random sampling for selecting 1126 study respondents from 10 health facilities that use the LHIMS. The respondents included prescribers, nurses, midwives and auxiliary staff. Descriptive statistics (weighted mean) was computed to determine the average weighted score for all the indicators under efficiency. Also, bivariate (χ²) and multivariate (ordinal logistic regression) analyses were conducted to test the study’s hypotheses.

RESULTS: Findings revealed that the LHIMS enhanced efficient health service delivery. From the bivariate analysis, external factors; sex, educational qualification, work experience, profession type and computer literacy were associated with the efficient use of the LHIMS. However, training offered prior to the use of the LHIMS, and the duration of training had no association. At the multivariate level, only work experience and computer literacy significantly influenced the efficient use of the LHIMS.

CONCLUSION: The implementation of LHIMS has the potential to significantly improve health service delivery. General computing skills should be offered to system users by the Ministry of Health to improve literacy in the use of computers. Active participation in the use of LHIMS by all relevant healthcare professionals should be encouraged.

PMID:37586751 | DOI:10.1136/bmjhci-2023-100769

BMJ. 2023 Aug 16;382:e073713. doi: 10.1136/bmj-2022-073713.

ABSTRACT

OBJECTIVE: To estimate the effects of providing access to an alcohol intervention based on a smartphone.

DESIGN: Randomised controlled trial..

SETTING: Four higher education institutions in Switzerland.

PARTICIPANTS: 1770 students (≥18 years) who screened positive for unhealthy alcohol use (ie, a score on the alcohol use disorders identification test-consumption (AUDIT-C) of ≥4 for men and ≥3 for women) were randomly assigned by 1:1 allocation ratio in blocks of 10.

INTERVENTION: Providing access to a brief, smartphone based alcohol intervention.

OUTCOME MEASURES: The primary outcome studied was number of standard drinks per week at six months and the secondary outcome was number of heavy drinking days (past 30 days). Additional outcomes were maximum number of drinks consumed on one occasion, alcohol related consequences, and academic performance. Follow-up assessments occurred at months three, six, and 12. Data were analysed by intention to treat and by using generalised linear mixed models with random intercepts for the recruitment site and participants nested within the recruitment site, and with intervention (v control), time (three months v six months; 12 months v six months), and baseline outcome values as fixed effects.

RESULTS: Between 26 April 26 2021 and 30 May 2022, 1770 participants (intervention group (n=884); control group (n=886)) were included. Mean age was 22.4 years (standard deviation 3.07); 958 (54.1%) were women; and 1169 (66.0%) were undergraduate students, 533 (30.1%) were studying for a master’s degree, 43 (2.4%) were studying for a doctorate, and 25 (1.4%) were students of other higher education programme. The baseline mean number of standard drinks per week was 8.59 (standard deviation 8.18); the baseline number of heavy drinking days was 3.53 (4.02). Of 1770 participants, follow-up rates were 1706 (96.4%) at three months, 1697 (95.9%) at six months, and 1660 (93.8%) at 12 months. Of 884 students randomly assigned to the intervention group, 738 (83.5%) downloaded the smartphone application. The intervention had a significant overall effect on the number of standard drinks per week (incidence rate ratio 0.90 (95% confidence interval 0.85 to 0.96)), heavy drinking days (0.89 (0.83 to 0.96)), and the maximum number of drinks consumed on one occasion (0.96 (0.93 to 1.00), P=0.029), indicating significantly lower drinking outcomes in the intervention group than in the control group during the follow-up period. The intervention did not affect alcohol related consequences or academic performance.

CONCLUSIONS: Providing access to the smartphone application throughout the 12 month follow-up was effective at limiting the average drinking volume of university students who had self-reported unhealthy alcohol use at baseline.

TRIAL REGISTRATION: ISRCTN 10007691.

PMID:37586742 | DOI:10.1136/bmj-2022-073713

BMJ. 2023 Aug 16;382:p1893. doi: 10.1136/bmj.p1893.

NO ABSTRACT

PMID:37586728 | DOI:10.1136/bmj.p1893

Ultrasonography. 2023 Jun 30. doi: 10.14366/usg.23084. Online ahead of print.

ABSTRACT

PURPOSE: The objective of this study was to evaluate pain and image quality associated with the use of two different ultrasound transducers.

METHODS: Fifty healthy male participants aged 30 years or older were prospectively enrolled. All ultrasound procedures were performed using a V8 machine (Samsung Medison, Seoul, Korea) equipped with EA2-11 (conventional) and miniER7 (small-caliber) transrectal transducers, operated by a single genitourinary radiologist. To minimize bias, one group of volunteers underwent ultrasonography with the conventional transducer first, followed by the small transducer. For the remaining participants, the examinations were performed in the opposite order. Ultrasonography, including the measurement of total prostate and transitional zone volumes, was conducted in accordance with standard practice. After testing with both probes, participants were asked to rate their pain on a 10-point numerical rating scale (NRS). A radiologist then evaluated the quality of the images acquired with each probe using a 5-point numeric scale and compared the prostate volume measurements obtained by each method.

RESULTS: The mean NRS scores associated with the conventional and small transducers were 4.7±1.8 and 2.7±1.2, respectively (P<0.05). The mean ultrasound image qualities from the two transducers were statistically similar (4.78 and 4.74, P>0.05). The whole prostate gland volume as measured with the conventional transducer (mean±standard deviation, 24.2±9.1 mL) was greater than the measurement (22.1±8.7 mL) obtained with the small-caliber transducer (P<0.05). However, only two of the 50 whole gland volume measurements differed by more than two standard deviations.

CONCLUSION: The use of a small transrectal probe significantly reduced pain without compromising image quality.

PMID:37586719 | DOI:10.14366/usg.23084

Clin Respir J. 2023 Aug 16. doi: 10.1111/crj.13687. Online ahead of print.

ABSTRACT

BACKGROUND: To help elderly patients with severe or very severe chronic obstructive pulmonary disease (COPD) with pulmonary rehabilitation, we have developed Zheng’s supine rehabilitation exercise (ZSRE). Currently, none of the terminal or critically ill patients with severe exercise limitation can complete the 6-min walking distance (6MWD) and cardiopulmonary exercise testing (CPET).

METHODS: In this study, we discuss the definition of the standardized 3-min simulated pedal motion (3MSPM) test and its operational specifications. Also, we evaluate the minimal clinically important difference (MCID) value of the 3MSPM.

RESULTS: The results showed that the mMRC score of COPD patients with acute exacerbation of dyspnea was progressively reduced from the second day of respiratory rehabilitation, and the difference between the first and seventh days was statistically significant (p < 0.000, χ² = 176.664). 6MWD increased progressively, and the difference between 6MWD on day 1-7 was statistically significant (p = 0.024, F = 2.443). The difference between 3MSPM on day 1-7 was also statistically significant (p < 0.000, F = 4.481). Further analysis showed that 6MWD was negatively correlated with mMRC (p < 0.000, OR = -0.524). 3MSPM was positively correlated with 6MWD (p < 0.000, OR = 0.640) but negatively correlated with mMRC (p < 0.000, OR = -0.413). There is a linear regression relationship between 6MWD and 3MSPM, that is, 6MWD = 14.151 + 0.301 * 3MSPM, adjusted R² = 0.401.

CONCLUSION: Based on the regression equation, 3MSPM can predict 6MWD, and it can be used as a simple exercise endurance method to evaluate patients with safety hazards in underground activities or who cannot complete the 6MWD test. The minimum clinically important difference value is increased by 23.

PMID:37586707 | DOI:10.1111/crj.13687

J Am Vet Med Assoc. 2023 Aug 16:1-7. doi: 10.2460/javma.23.05.0239. Online ahead of print.

ABSTRACT

OBJECTIVE: To report the short-term and long-term outcomes of dogs that underwent the modified closed and traditional closed anal sacculectomy procedures for the treatment of anal sac neoplasia.

ANIMALS: 90 client-owned dogs.

METHODS: The medical records of 2 tertiary referral hospitals were reviewed to identify dogs that underwent anal sacculectomy for treatment of anal sac neoplasia between January 2016 and December 2020. Data collected included signalment and preoperative diagnostic findings. The occurrence of intraoperative and postoperative complications, short-term outcomes, and long-term outcomes were also collected. Descriptive statistics were calculated to summarize dog signalment information, and recurrence, metastasis, and survival proportions were compared between techniques using Fisher exact tests.

RESULTS: 35 and 55 dogs, respectively, underwent the modified or traditional closed anal sacculectomy procedure. Minor postoperative complications that resolved with minimal intervention occurred in 5 of 35 (14.3%) modified approach dogs and 12 of 55 (21.8%) traditional approach dogs. Tumor recurrence was confirmed in 8 of 35 (22.9%) modified and 8 of 55 (26.4%) traditional approach dogs and was suspected in 3 of 35 (8.6%) and 6 of 55 (13.2%; P = .68), respectively. Confirmed metastatic disease was identified in 8 of 35 (22.9%) and 14 of 53 (26.4%) modified and traditional approach dogs, respectively, and was suspected in 4 of 35 (11.4%) and 7 of 53 (13.2%). Sixty-three (70%) dogs survived to study conclusion.

CLINICAL RELEVANCE: No benefits in complication rate or local recurrence were identified in dogs following the modified approach as opposed to the traditional closed anal sacculectomy technique.

PMID:37586695 | DOI:10.2460/javma.23.05.0239

Am J Vet Res. 2023 Aug 21:1-11. doi: 10.2460/ajvr.23.03.0052. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate behaviors associated with inflammatory pain induced by carrageenan injection in the cockatiel and determine interobserver agreement.

ANIMALS: 16 adult cockatiels.

METHODS: Cockatiels were randomly assigned as either treatment (carrageenan injection) or control (sham injection) group. The treatment group received a subcutaneous injection of 0.05 mL of a 1% lambda carrageenan solution into the left footpad. Following treatment or control procedures, all cockatiels were video recorded individually for 9.5 hours. Ten minutes of video at each of 11 time points postinjection and/or handling were evaluated by 3 different observers. Twenty-five behaviors within 6 categories (resting, locomotion, maintenance, intake, interaction with environment, and limb and body posture) were assessed, in addition to crest position and mentation. Differences in individual behaviors tallies were assessed using serial Wilcoxon sum rank tests. Interobserver agreement was assessed using an intraclass correlation coefficient for a 2-way design for consistency among multiple observers.

RESULTS: Treatment cockatiels exhibited significantly increased focal preening (q = .023) and increased burst preening (q = .036), while control cockatiels spent significantly more time in an upright stance (q = .036). Although the remainder of behaviors observed were not statistically significant between groups, additional variables of interest seen more frequently in treatment cockatiels included non-weight-bearing stance, holding of the body low, and being nonvigilant. The level of agreement between observers was variable based on the specific behaviors; nevertheless, the dynamic behaviors were substantial to strong.

CLINICAL RELEVANCE: Carrageenan-induced inflammation-associated behaviors may be valuable in developing a pain scale and evaluating mild inflammatory pain in small psittacine species.

PMID:37586693 | DOI:10.2460/ajvr.23.03.0052

J Speech Lang Hear Res. 2023 Aug 16:1-21. doi: 10.1044/2023_JSLHR-23-00091. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to examine the growth of previously established clinical markers of developmental language disorder (DLD) in Spanish-speaking bilingual children with and without DLD.

METHOD: Forty-three bilingual children with DLD and 57 typically developing children were tested 3 times over a 2-year period. Their average age at Time 1 was 5;10 (years;months). All children completed an elicitation task examining the production of articles, clitics, verbs, and the subjunctive mood in Spanish at each time point, in addition to other behavioral testing in Spanish and English. We used growth curve analysis to examine change patterns of the morphosyntactic structures over time.

RESULTS: At the onset of the study, children without DLD produced higher accuracy rates than children with DLD across all morphosyntactic structures. In addition, there was a positive effect of time on all structures. Furthermore, the interaction between time and DLD was statistically significant for clitic pronouns.

CONCLUSION: In agreement with previous literature on language growth in monolingual children with DLD, bilingual children with DLD showed language growth that was parallel to that of bilingual children without DLD but with significantly lower levels of attainment.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23810820.

PMID:37586692 | DOI:10.1044/2023_JSLHR-23-00091

Environ Pollut. 2023 Aug 14:122382. doi: 10.1016/j.envpol.2023.122382. Online ahead of print.

ABSTRACT

Assessing natural background levels (NBLs) in groundwater is a global concern. Knowledge on groundwater NBLs in urbanized areas is challenging due to the impact of complex human activities. Preselection related methods are common ones for assessing groundwater NBLs. The present study used three preselection related methods to assess groundwater heavy metals (lead, zinc, barium) NBLs in four groundwater units of the Pearl River Delta (PRD) where urbanization continues, and to identify the best one for assessing groundwater NBLs in urbanized areas. Here, methods include a preselection method (method-P), a preselection dominated method (method-PD), and a statistic dominated method (method-SD). Results showed that the method-PD was better than other two methods for assessing groundwater NBLs of heavy metals in the PRD. This is supported by the evidence that differences among heavy metals concentrations in various land-use types in residual datasets formed by the method-PD were insignificant. NBLs of lead in groundwater units I to IV assessed by the method-PD were 2.8 μg/L, 5.9 μg/L, 5.8 μg/L, and 2.6 μg/L, respectively. NBLs of zinc in groundwater units I to IV assessed by the method-PD were 30 μg/L, 180 μg/L, 160 μg/L, and 100 μg/L, respectively. NBLs of barium in groundwater units I to IV assessed by the method-PD were 120 μg/L, 120 μg/L, 90 μg/L, and 50 μg/L, respectively. Compared to the method-PD, the method-SD often underestimates groundwater NBLs of heavy metals because of using the experiential evaluation for residual datasets. The method-P also has an inaccurate evaluation of groundwater NBLs of heavy metals in comparison with the method-PD, owing to both of using the experiential evaluation and the absence of a function for outliers test. The method-P combining with an outliers test would be better than itself for assessing groundwater NBLs. Therefore, the method-PD is the first choice to be recommended for assessing groundwater NBLs in urbanized areas such the PRD. However, this method should not be taken into account for assessing groundwater NBLs in areas where groundwater Cl/Br mass ratios are invalid. Instead, the method-SD and the method-P combining with one outliers test may be choices, because no constraint for these two methods.

PMID:37586681 | DOI:10.1016/j.envpol.2023.122382

Clin Immunol. 2023 Aug 14:109740. doi: 10.1016/j.clim.2023.109740. Online ahead of print.

ABSTRACT

Anti-fibroblast antibodies (AFA) have been reported in systemic sclerosis (SSc) and are known to promote fibroblast activation. Aim of this study was to characterize the fine specificity of AFA and to analyze any correlations with clinical parameters associated to fibrosis. To this end, AFA were affinity-purified from a patient with diffuse cutaneous SSc (dcSSc) and interstitial lung disease (ILD). Panning of a phage display peptide library with purified AFA identified the motif <KxywxQ>. The peptide p121, bearing the AFA-specific motif, was used in ELISA to screen sera from 186 SSc patients and 81 healthy donors. Anti-p121 Ab serum levels were statistically higher in SSc than in healthy groups, and directly associated with dcSSc, reduced FVC (FVC < 70), and ILD. Given these clinical correlates, this study lays the groundwork for the identification of the antigen recognized by anti-p121 Ab, which might represent a novel therapeutic target for ILD.

PMID:37586673 | DOI:10.1016/j.clim.2023.109740