Category: Statistics

Psychol Med. 2023 Jul 24:1-9. doi: 10.1017/S0033291723001964. Online ahead of print.

ABSTRACT

BACKGROUND: Older brain age – as estimated from structural MRI data – is known to be associated with detrimental mental and physical health outcomes in older adults. Social isolation, which has similar detrimental effects on health, may be associated with accelerated brain aging though little is known about how different trajectories of social isolation across the life course moderate this association. We examined the associations between social isolation trajectories from age 5 to age 38 and brain age assessed at age 45.

METHODS: We previously created a typology of social isolation based on onset during the life course and persistence into adulthood, using group-based trajectory analysis of longitudinal data from a New Zealand birth cohort. The typology comprises four groups: ‘never-isolated’, ‘adult-only’, ‘child-only’, and persistent ‘child-adult’ isolation. A brain age gap estimate (brainAGE) – the difference between predicted age from structural MRI date and chronological age – was derived at age 45. We undertook analyses of brainAGE with trajectory group as the predictor, adjusting for sex, family socio-economic status, and a range of familial and child-behavioral factors.

RESULTS: Older brain age in mid-adulthood was associated with trajectories of social isolation after adjustment for family and child confounders, particularly for the ‘adult-only’ group compared to the ‘never-isolated’ group.

CONCLUSIONS: Although our findings are associational, they indicate that preventing social isolation, particularly in mid-adulthood, may help to avert accelerated brain aging associated with negative health outcomes later in life.

PMID:37485695 | DOI:10.1017/S0033291723001964

Med Teach. 2023 Jul 24:1-8. doi: 10.1080/0142159X.2023.2236779. Online ahead of print.

ABSTRACT

Medical education was greatly affected by the COVID-19 pandemic, and remote teaching through lectures and classes through videoconferencing was heavily used. However, the need to use cameras led to scopophobia, which is the fear of being watched, which can lead to psychological symptoms. Despite the relevance and prevalence of depression and the increase in the use of cameras for learning, research evaluating the impact of scopophobia on students’ mental health is surprisingly scarce. Hence, to fill up this gap, a cross-sectional study was carried out in medical schools in Brazil. To assess the presence of depressed mood, the Patient Health Questionnaire-9 (PHQ-9) was applied. We used logistic regression models to verify the associations. The overall prevalence of positive PHQ9 found in our study was 62%. By studying the factors associated with a high risk of scopophobia, we could identify that the PHQ was statistically associated with scopophobia (odds ratio 2.43 (confidence interval 1.11-5.26), adjusted p value = .0269). Also, a lower family income, a higher number of household inhabitants, and female gender were associated. These results suggest that scopophobia is associated with depression, leading us to believe that interventions to mitigate this risk in students are opportune, especially if targeted at lower-income students.

PMID:37485691 | DOI:10.1080/0142159X.2023.2236779

J Clin Sleep Med. 2023 Jul 24. doi: 10.5664/jcsm.10728. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Evaluate the quality of ChatGPT responses to questions on obstructive sleep apnea (OSA) for patient education. Assess how prompting the chatbot influences correctness, estimated grade level, and references of answers.

METHODS: ChatGPT was queried four times with 24 identical questions. Queries differed by initial prompting: no prompting, patient-friendly prompting, physician-level prompting, and prompting for statistics/references. Answers were scored on a hierarchical scale: incorrect, partially correct, correct, correct with either statistic or referenced citation (“correct+”), or correct with both a statistic and citation (“perfect”). Flesch-Kincaid (FK) grade level and citation publication years were recorded for answers. Proportions of responses at incremental score thresholds were compared by prompt type using chi-squared analysis. The relationship between prompt type and grade level was assessed using ANOVA.

RESULTS: Across all prompts (n=96 questions), 69 answers (71.9%) were at least correct. Proportions of responses that were at least partially correct (p=0.387) or correct (p=0.453) did not differ by prompt; responses that were at least correct+ (p<0.001) or perfect (p<0.001) did. Statistics/references prompting provided 74/77 (96.1%) references. Responses from patient-friendly prompting had a lower mean grade level (12.45 ± 2.32) than no prompting (14.15 ± 1.59), physician-level prompting (14.27 ± 2.09), and statistics/references prompting (15.00 ± 2.26) (p<0.0001).

CONCLUSIONS: ChatGPT overall provides appropriate answers to most questions on OSA regardless of prompting. While prompting decreases response grade level, all responses remained above accepted recommendations for presenting medical information to patients. Given ChatGPT’s rapid implementation, sleep experts may seek to further scrutinize its medical literacy and utility for patients.

PMID:37485676 | DOI:10.5664/jcsm.10728

Public Health Nutr. 2023 Jul 24:1-29. doi: 10.1017/S1368980023001271. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to explore the association between coffee consumption and the prevalence of hearing loss in American adults based on a national population-based survey.

DESIGN: Cross-sectional analysis of reported audiometric status and coffee intake from the 2003-2006 National Health and Nutrition Examination Survey (NHANES). Multivariate logistic regression, forest plots and restricted cubic spline (RCS) analyses were used to explore the associations and dose-response relationships between coffee consumption frequency and hearing loss.

SETTING: The USA.

PARTICIPANT: This study included 1894 individuals aged ≥ 20 from the 2003-2006 NHANES.

RESULTS: In this study, the prevalence of speech-frequency hearing loss (SFHL) and high-frequency hearing loss (HFHL) among the participants was 35.90% and 51.54%, respectively. Compared with those who no consumed coffee, non-Hispanic White who consumed ≥ 4 cups/d had higher prevalence of SFHL (Odds Ratio[OR]: 1.87; 95% Confidence Interval[CI]: 1.003-3.47). And a positive trend of coffee consumption frequency with the prevalence of HFHL was found (P_trend = 0.001). This association of HFHL was similar for aged 20-64 participants (P_trend = 0.001), non-Hispanic White (P_trend = 0.002), non-noise exposure participants (P_trend = 0.03), and noise exposed participants (P_trend = 0.003). The forest plots analysis found that the association between 1 cup-increment of daily coffee consumption and the prevalence of HFHL was statistically significant in males. RCS model supported a positive linear association of coffee consumption with SFHL (P for overall association = 0.02, P for nonlinearity = 0.48), and a positive non-linear association of coffee consumption with HFHL (P for overall association = 0.001, P for nonlinearity = 0.001).

CONCLUSION: Our findings suggested that coffee consumption was associated with higher prevalence of hearing loss. Further cohort studies in larger population are needed to investigate these findings.

PMID:37485659 | DOI:10.1017/S1368980023001271

Cancer Med. 2023 Jul 23. doi: 10.1002/cam4.6351. Online ahead of print.

ABSTRACT

BACKGROUND: Transportation has been identified as a specific source of burden for cancer caregivers. This study examined cancer caregivers’ subjective experiences and objectives costs associated with transportation over a 6-month period of providing end-of-life care to a family member or friend.

METHODS: This was a multi-site longitudinal, prospective cohort study that followed 223 caregiver-patient dyads. Data were collected using biweekly, semi-structured interviews for up to 6 months and collection of all caregiving related receipts. Interviews were coded and analyzed using a comparative, iterative analysis and actual out of pockets costs were described using descriptive statistics.

RESULTS: Over the 6-month study period most caregivers (n = 143; 74%) discussed transportation at one or more timepoints. Average biweekly transportations costs to caregivers were $43.6. Caregivers described (n = 56; 39%) multiple direct and indirect costs of transportation, and 58% (n = 84) discussed the need for transportations services or assistance at the institutional level.

CONCLUSIONS: Caregivers described the multifaceted costs of transportation they experienced which are in line with previous work. Alongside descriptions of direct costs, caregivers described key opportunity costs, such as personal and work time forgone to transporting patients. Caregivers also made suggestions for institutional and/or civic based solutions to facilitate reliable modes of transportation, rather than individual-level intervention.

PMID:37485648 | DOI:10.1002/cam4.6351

J Viral Hepat. 2023 Jul 23. doi: 10.1111/jvh.13876. Online ahead of print.

ABSTRACT

Data on the acceptability and usability of hepatitis C virus self-testing (HCVST) remain scarce. We estimated the pooled rates of acceptability/feasibility and re-reading/re-testing agreement of HCVST using oral fluid tests (PROSPERO-CRD42022349874). We searched online databases for studies that evaluated acceptability, usability and inter-reader/operator variability for HCVST using oral fluid tests. Pooled estimates of feasibility, agreement and post-testing perspectives were analysed. Sensitivity analyses were performed in men who have sex with men (MSM) and people who inject drugs (PWID). Heterogeneity was assessed using the I² statistics. A total of six studies comprising 870 participants were identified: USA (n = 95 with liver disease), Kenya (n = 150 PWID), Egypt (n = 116 from the general population), Vietnam (n = 104 MSM and n = 105 PWID), China (n = 100 MSM) and Georgia (n = 100 MSM and n = 100 PWID)]. All studies used OraQuick® HCV Rapid Antibody Test. The pooled overall estimates for correct sample collection and for people who performed HCVST without needing assistance in any step (95% confidence interval [CI]) were 87.2% [76.0-95.3] (n = 755; I² = 93.7%) and 62.6% [37.2-84.8] (n = 755; I² = 98.0%), respectively. The pooled estimate of agreement for re-reading was 95.0% [95% CI 91.5-97.6] (n = 831; I² = 74.0%) and for re-testing was 94.4% [90.3-97.5] (n = 726; I² = 77.1%). The pooled estimate of those who would recommend HCVST was 94.4% [84.7-99.6] (n = 625; I² = 93.7%). Pooled estimates (95% CI) of correct sample collection (72.8% [63.3-81.5] vs. 90.8% [85.9-94.8]) and performance of HCVST without needing assistance (44.1% [14.1-76.7] vs. 78.1% [53.4-95.3]) was lower in PWID compared to MSM. In summary, HCV testing with oral fluid HCVST was feasible and well-accepted. Oral fluid HCVST should be considered in key populations for uptake HCV testing.

PMID:37485619 | DOI:10.1111/jvh.13876

Stat Med. 2023 Jul 23. doi: 10.1002/sim.9851. Online ahead of print.

ABSTRACT

Diabetic neuropathy is a disorder characterized by impaired nerve function and reduction of the number of epidermal nerve fibers per epidermal surface. Additionally, as neuropathy related nerve fiber loss and regrowth progresses over time, the two-dimensional spatial arrangement of the nerves becomes more clustered. These observations suggest that with development of neuropathy, the spatial pattern of diminished skin innervation is defined by a thinning process which remains incompletely characterized. We regard samples obtained from healthy controls and subjects suffering from diabetic neuropathy as realisations of planar point processes consisting of nerve entry points and nerve endings, and propose point process models based on spatial thinning to describe the change as neuropathy advances. Initially, the hypothesis that the nerve removal occurs completely at random is tested using independent random thinning of healthy patterns. Then, a dependent parametric thinning model that favors the removal of isolated nerve trees is proposed. Approximate Bayesian computation is used to infer the distribution of the model parameters, and the goodness-of-fit of the models is evaluated using both non-spatial and spatial summary statistics. Our findings suggest that the nerve mortality process changes as neuropathy advances.

PMID:37485617 | DOI:10.1002/sim.9851

Global Spine J. 2023 Jul 24:21925682231191414. doi: 10.1177/21925682231191414. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective review of prospective cohort.

OBJECTIVES: Reoperation at L3-L4 for adjacent segment disease (ASD) is common after L4-L5 spine fusion. L4-S1 lower lumbar lordosis (LLL) accounts for the majority of global lumbar lordosis (GLL) and is modifiable during surgery. We sought to determine if a reduction in LLL leads to an increase in L3-L4 focal lumbar lordosis (L3-L4 FLL) and resulting risk of ASD at L3-L4.

METHODS: We reviewed the records of a prospective cohort with lumbar spinal stenosis who underwent L4-L5 or L4-L5-S1 fusion between 2006 and 2012. Radiographic parameters-GLL, LLL, L3-L4 FLL, upper lumbar lordosis, lordosis distribution index, pelvic tilt, and pelvic incidence-were extracted from preoperative and postoperative lumbar spine radiographs. Statistical comparisons were made between those who underwent revision for post-fusion adjacent level stenosis at L3-L4 (REVISION) and those who did not (NO REVISION).

RESULTS: Inclusion criteria were met by 104 patients. The REVISION cohort included 19 individuals. No significant differences in baseline demographics or operative details for the index procedure were found between groups. Postoperatively, when compared to the NO REVISION cohort, the REVISION cohort had a decrease in LLL (-2.6° vs + 1.5°, P = .011) and LDI (-5.1% vs + 1.3%, P = .039), and an increase in L3-L4 FLL (+2.6° vs -.6°, P = .001).

CONCLUSIONS: A reduction in LLL and compensatory increase in L3-L4 FLL after initial lower lumbar fusion surgery resulted in more reoperation at L3-L4 for post-fusion adjacent level spinal stenosis.

PMID:37485611 | DOI:10.1177/21925682231191414

J Viral Hepat. 2023 Jul 23. doi: 10.1111/jvh.13875. Online ahead of print.

ABSTRACT

Hepatitis C virus (HCV) is highly prevalent in people with mental disorders (PWMDs). However, in the international context of HCV elimination, no previous study has explored the features of seropositive PWMDs with vs. without a positive viral load (VL). We retrospectively retrieved all HCV serology results of patients hospitalized in 2019, 2020 and 2021 in the second-largest psychiatric hospital of France. Using the medical records of all patients found seropositive for HCV, the following data were collected: sex (male, female), age (in years), previous history of illicit drug use except cannabis (yes or no) and previous history of incarceration (yes or no). We conducted a case-control comparison of these variables between the PWMDs who had and did not have a positive VL, thus providing odds ratios and 95% confidence intervals (ORs [95% CI]). In a total of 13,276 inpatients, 2540 (19.1%) underwent at least one HCV serology; 55 of them (2.16%) were found positive. A VL count was performed for 48 of them, finding 15 (31.3%) individuals with active HCV. Compared with those with a negative VL, these 15 individuals were less likely to have previous documented illicit drug use (OR = 0.18; 95% CI [0.05-0.68]) and to have been previously incarcerated (OR = 0.23; 95% CI [0.06-0.99]); age and sex did not statistically differ. In the context of HCV elimination, PWMDs yet to be treated for HCV are more likely to be those with no identified risk factor for HCV, which supports a strategy of systematic screening for HCV among PWMDs.

PMID:37485610 | DOI:10.1111/jvh.13875

J Sleep Res. 2023 Jul 23:e14004. doi: 10.1111/jsr.14004. Online ahead of print.

ABSTRACT

Obstructive sleep apnea (OSA) is caused by temporary partial or complete constriction of the upper airway during sleep which leads to reduced blood oxygen and cardiovascular risks. Main symptoms vary between adults and children leading to misdiagnosis or delayed patient identification. To improve early diagnosis, lateral cephalograms can provide craniofacial measurements associated with a higher risk of OSA. In order to identify the most relevant craniofacial measurements, a systematic literature review with meta-analysis was conducted combining the terms ‘orthodontic*’, ‘craniofacial’, ‘cephalometr*’, ‘cephalogram’, ‘OSA*’, ‘UARS’, ‘SDB’, ‘sleep disordered breathing’, ‘sleep apnea’ and ‘sleep apnoea’. Of 3016 publications, 19 were included in the systematic review and meta-analysis, 15 with adult patients and four with children. A total of 16 measurements (six angles, 10 distances) were compared, nine showed a possible influence in patients with OSA compared to controls: NSBa angle (-0.28°), ANB angle (+0.33°), ML-NSL angle (+0.34°), Me-Go-Ar angle (+0.33°), SN distance (-0.70 mm), N-ANS distance (-0.36 mm), MP-H distance (+1.18 mm), uvula length (+1.07 mm) and thickness (+0.96 mm). Posterior airway measurements were not sufficiently described or comparably measured to be statistically analysed. There is some evidence for altered craniofacial anatomy in patients with OSA compared to controls. Lateral cephalograms should be screened for these aspects routinely to improve early diagnosis of OSA and craniofacial orthopaedics should complement the interdisciplinary treatment plan for young patients with OSA.

PMID:37485571 | DOI:10.1111/jsr.14004