Category: Statistics

Epilepsy Behav. 2021 Dec 15;126:108480. doi: 10.1016/j.yebeh.2021.108480. Online ahead of print.

ABSTRACT

AIM: We aimed to evaluate the knowledge levels and attitudes of the students of the Department of Health Management about epilepsy.

METHOD: This descriptive and cross-sectional study was conducted with the voluntary participation of 238 health management department students in their first and third years of study who were registered at the Faculty of Health Sciences summer school exam. We collected the data through a research questionnaire form and the Epilepsy Knowledge and Attitude Scales.

RESULTS: Girls accounted for 66.6% (n = 157) all participants, 53.4% of them were 1st year (n = 127), whereas 46.6% (n = 111) were third-year students. Their mean age was 19.97 ± 1.46 years. Among these participants, 52.9% grew in the province (n = 126), 20.6% were smoking, 5% had epilepsy, and 36.6% had relatives with epilepsy. The mean epilepsy knowledge scale score was 5.64 ± 4.41 and the mean epilepsy attitude scale score was 52.55 ± 9.98. The third-year students’ epilepsy knowledge score was significantly higher than their first-year counter parts (p < 0.001). We found no statistically significant difference between the first and third-year participants in attitude scores (p = 0.907). A moderate positive correlation was found between the students’ knowledge level scores about epilepsy and their total attitude scores (r = 0.405, p < 0.001). The female students had a more positive attitude toward epilepsy and higher scores on the epilepsy knowledge scale than their male counterparts (p = 0.001, p = 0.005, respectively). Students who knew someone with epilepsy had higher epilepsy knowledge and attitude scale scores than those who did not (p = 0.001, p = 0.005 respectively).

CONCLUSION: The epilepsy knowledge levels and attitude scale scores of health management students were found to be low. Third-year students were found to have higher knowledge levels than first-year students but there was no statistically significant difference between their attitude scores. More education opportunities should be provided for students of the Department of Health Management about this common chronic disease.

PMID:34922330 | DOI:10.1016/j.yebeh.2021.108480

Health Policy Plan. 2021 Dec 18:czab151. doi: 10.1093/heapol/czab151. Online ahead of print.

ABSTRACT

Community health workers (CHWs) effectively improve maternal, newborn, and child health (MNCH) outcomes in low-to-middle-income countries. However, CHW retention remains a challenge. This retrospective registry analysis evaluated medium-term retention of volunteer CHWs in two rural Ugandan districts, trained during a district-wide MNCH initiative. From 2012-14, the Healthy Child Uganda partnership facilitated district-led CHW program scale-up. CHW retention was tracked prospectively from the start of the intervention up to two years. Additional follow up occurred at five years to confirm retention status. Database analysis assessed CHW demographic characteristics, retention rates, and exit reasons five-years post-intervention. A multivariable logistic regression model examined five-year retention-associated characteristics. Of the original cohort of 2,317 CHWs, 70% were female. The mean age was 38.8 years (SD: 10.0). Sixty-months (five years) after the start of the intervention, 84% of CHWs remained active. Of those exiting (n=377), 63% reported a ‘logistical’ reason, such as relocation (n=96), new job (n=51), or death (n=30). Sex (male, female; OR=1.53; 95% CI: 1·20-1·96) and age group (<25years, 30-59; OR=0.40; 95% CI: 0.25-0.62) were significantly associated with five-year retention in multivariable modeling. Education completion (secondary school, primary) was not significantly associated with retention in adjusted analyses. CHWs in this relatively large cohort, trained and supervised within a national CHW program and district-wide MNCH initiative, were retained over the medium-term. Importantly, high five-year retention in this intervention counters findings from other studies suggesting high retention in government-led and volunteer CHW programs. Encouragingly, findings from our study suggest retention was low, not significantly associated with timing of external partner support, and largely not attributed to the CHW role i.e. workload, program factors. Our study showcases the potential for sustainable volunteer CHW programming at scale and can inform planners and policymakers considering program design, including selection and replacement planning for CHW networks.

PMID:34922343 | DOI:10.1093/heapol/czab151

Epilepsy Behav. 2021 Dec 15;126:108477. doi: 10.1016/j.yebeh.2021.108477. Online ahead of print.

ABSTRACT

AIM: This study was conducted to examine the knowledge of and attitudes toward epilepsy among nursing students.

METHOD: This descriptive and cross-sectional study was conducted with 369 nursing students. Data were collected through an anonymous online questionnaire prepared using the Introductory Information Form, Epilepsy Knowledge Scale (EKS), and Epilepsy Attitude Scale (EAS). Descriptive statistics, the Mann-Whitney U test, Student’s t test, one-way ANOVA, and Pearson correlation test were used in the data analysis. A p value of 0.05 was considered the threshold for statistical significance.

FINDINGS: The sample of the study consisted of nursing students, and more than half of the students (63.4%) were females. 32.2% of the students were third-year students, and the mean age was 21.36 ± 2.12 years. The mean scores obtained on the EKS and the EAS were 10.03 ± 33.21 and 56.39 ± 5.40, respectively. A significant positive correlation was found between the knowledge and attitude scores of the students regarding epilepsy (p < 0.05), and students’ attitude scores toward epilepsy increased with increased knowledge of the subject matter. Overall, female students had better knowledge levels and a more positive attitude toward epilepsy than male students (p < 0.05). Further, the students who had witnessed an epileptic seizure, knew someone with epilepsy, or provided care for patients with epilepsy, had higher scores on the EKS, and displayed better knowledge toward epilepsy (p < 0.05).

CONCLUSION: Nursing students were found to have moderate knowledge of and a positive attitude toward epilepsy. The positive attitude toward epilepsy increased with the increasing knowledge of epilepsy.

PMID:34922329 | DOI:10.1016/j.yebeh.2021.108477

Epilepsy Behav. 2021 Dec 3;126:108487. doi: 10.1016/j.yebeh.2021.108487. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the factors affecting the unwillingness of physicians involved in epilepsy care to continue telemedicine during the coronavirus disease 2019 (COVID-19) pandemic in Japan.

METHOD: This was a national-level cross-sectional survey initiated by Japan Young Epilepsy Section (YES-Japan) which is a national chapter of The Young Epilepsy Section of the International League Against Epilepsy (ILAE-YES). We asked physicians who conducted telemedicine in patients with epilepsy (PWE) during the COVID-19 pandemic at four clinics and 21 hospitals specializing in epilepsy care in Japan from March 1 to April 30, 2021. The following data were collected: (1) participant profile, (2) characteristics of PWE treated by telemedicine, and (3) contents and environmental factors of telemedicine. Statistically significant variables (p < 0.05) in the univariate analysis were analyzed in a multivariate binary logistic regression model to detect the independently associated factors with the unwillingness to continue telemedicine.

RESULT: Among the 115 respondents (response rate: 64%), 89 were included in the final analysis. Of them, 60 (67.4%) were willing to continue telemedicine, and 29 (32.6%) were unwilling. In the univariate binary logistic regression analysis, age (Odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.10-3.09, p = 0.02), psychiatrist (OR = 5.88, 95% CI 2.15-16.08, p = 0.001), hospital (OR = 0.10, 95% CI 0.01-0.94, p = 0.04), the number of COVID-19 risk factors in the participant (OR = 2.88, 95% CI 1.46-5.69, p = 0.002), the number of COVID-19 risk factors in the cohabitants (OR = 2.52, 95% CI 1.05-6.01, p = 0.04), COVID-19 epidemic area (OR = 4.37, 95% CI 1.18-16.20, p = 0.03), consultation time during telemedicine (OR = 2.51, 95% CI 1.32-4.76, p = 0.005), workload due to telemedicine (OR = 4.17, 95% CI 2.11-8.24, p < 0.001) were statistically significant. In the multivariate binary logistic regression analysis, workload due to telemedicine (OR = 4.93, 95% CI 1.96-12.35) was independently associated with the unwillingness to continue telemedicine.

CONCLUSION: This national-level cross-sectional survey found that workload due to telemedicine among physicians involved in epilepsy care was independently associated with the unwillingness to continue telemedicine.

PMID:34922326 | DOI:10.1016/j.yebeh.2021.108487

Mar Genomics. 2021 Dec 15;61:100916. doi: 10.1016/j.margen.2021.100916. Online ahead of print.

ABSTRACT

Microbial communities of marine coastal recreation waters have become large reservoirs of AMR genes (ARGs), contributing to the emergence and transmission of various zoonotic, foodborne and other infections that exhibit resistance to various antibiotics. Thus, it is highly imperative to determine ARGs assemblages as well as mechanisms and trajectories of their transmission across these microbial communities for our better understanding of the evolutionary trends of AMR (AMR). In this study, using metagenomics approaches, we screened for ARGs in recreation waters of the Black Sea coastal areas of the Batumi City (Georgia). Also, a large array of the recombination detection algorithms of the SplitsTree, RDP4, and GARD was applied to elucidate genetic recombination of ARGs and trajectories of their transmission across various marine microbial communities. The metagenomics analyses of sea water samples, obtained from across the above marine sites, could identify putative ARGs encoding for multidrug resistance efflux transporters mainly from the Major Facilitator and Resistance Nodulation Division superfamilies. The data, generated by SplitsTree (fit ≥95.619; bootstrap values ≥ 95; Phi p ≤ 0.0494), RDP4 (p ≤ 0.0490), and GARD, provided strong statistical evidence not only for intrageneric recombination of these ARGs, but also for their intergeneric recombination across fairly large and diverse microbial communities of marine environment. These bacteria included both human pathogenic and nonpathogenic species, exhibiting collectively the genera of Vibrio, Aeromonas, Synechococcus, Citromicrobium, Rhodobacteraceae, Pseudoalteromonas, Altererythrobacter, Erythrobacter, Altererythrobacter, Marivivens, Xuhuaishuia, and Loktanella. The above nonpathogenic bacteria are strongly suggested to contribute to ARGs transmission in marine ecosystems.

PMID:34922301 | DOI:10.1016/j.margen.2021.100916

J Mech Behav Biomed Mater. 2021 Dec 10;126:105031. doi: 10.1016/j.jmbbm.2021.105031. Online ahead of print.

ABSTRACT

OBJECTIVE: Rehabilitation of endodontically treated premolars with extensive coronal destruction through endocrown approach remains a controversial topic in reconstructive dentistry. There is no clear consensus in the literature which endocrown design with which material is the most effective restoration option for severely-destructed endodontically treated premolars. The aim of this study was to assess the biomechanical behavior of endodontically treated maxillary first premolars restored with a novel endocrown system compared to the conventional one varying the applied load type through finite element and in vitro analyses.

MATERIALS AND METHODS: For finite element analysis, two models representing two endocrown systems used for restoration of severely-destructed endodontically treated maxillary first premolar tooth were generated: Model C for the conventional monolithic IPS e.max CAD endocrown and Model P for the novel bi-layered endocrown (PEKKTON ivory coping veneered with cemented IPS e.max CAD). Modified von Mises stress values on the remaining tooth structure, cement lines and restorative materials were evaluated separately under axial and oblique loading of 450 N. For in vitro analysis, forty sound human bifurcated maxillary first premolars were collected, endodontically-treated, and divided into 2 main groups (n = 20) according to the system used for endocrown fabrication; Group C: the conventional monolithic endocrowns and Group P: the novel bi-layered endocrowns. All specimens were subjected to an artificial thermomechanical aging protocol. Each main group was subdivided into two subgroups (n = 10) according to the loading type (axial and oblique) applied during the fracture resistance test. Qualitative analysis using Stereomicroscopy and Scanning Electron Microscopy was performed. Data were statistically analyzed at p-value ≤ 0.05.

RESULTS: Regarding stress distribution pattern of remaining tooth structure (enamel and dentin), both endocrown systems and cement lines under both axial and oblique load application, Model P resulted in lower stresses than Model C. The oblique stress values of all analyzed structures were higher than corresponding values resulted axially. Considering failure load, a significantly higher load was recorded for Group P when axial or oblique loading was applied (p = 0.00). A significantly higher failure load was recorded with axial loading for both main groups. With regard to failure mode, a statistically significant difference was observed between main groups (p = 0.033), with more favorable failures detected for Group P axially.

CONCLUSIONS: Compared to the conventional endocrown system, the studied novel system improved the biomechanical behavior within tooth/restoration complex of the restored severely-destructed endodontically treated maxillary first premolar teeth, whatever the applied load type.

CLINICAL SIGNIFICANCE: The novel endocrown system using a PEKK coping veneered with cemented IPS e.max CAD can be considered a favorable promising option for restoration of severely-destructed endodontically treated premolar teeth, with more protection for residual tooth structure. It can be considered as a conservative alternative option to the conventional treatment modalities not only for normal clinical conditions, but also for parafunctional cases.

PMID:34922296 | DOI:10.1016/j.jmbbm.2021.105031

J Mech Behav Biomed Mater. 2021 Nov 29;126:105001. doi: 10.1016/j.jmbbm.2021.105001. Online ahead of print.

ABSTRACT

The effect of bleach treatments on the morphology and mechanical properties of hair surfaces was measured at the nanometer scale using atomic force microscopy. We used an ultrahigh-precision relocation technique to observe the variations in these properties at precise locations on hair surfaces in their virgin state and then after each of the two bleach treatments, to rule out position-dependent fluctuations. We demonstrate that statistically significant variations in roughness and Young’s modulus are observed as a result of exposure to bleach, which is known to disrupt the disulfide linkage network throughout the fiber. The rate at which surface roughness changes increased with the number of treatments, with very little effect seen after 10 min, and an increase of up to 65% was observed after a further 10 min. The Young’s modulus decreased by up to 40% after each treatment. We also investigate micropores and show that they are subsurface, but revealed through bleaching, and oriented along the direction of the hair shaft with a characteristic aspect ratio. This work demonstrates the profound effect bleaching has on the molecular structure of hair, which manifests as changes in morphology and stiffness, and this should be taken into account in the formulation of future hair-care products.

PMID:34922297 | DOI:10.1016/j.jmbbm.2021.105001

Forensic Sci Int. 2021 Nov 29;331:111126. doi: 10.1016/j.forsciint.2021.111126. Online ahead of print.

ABSTRACT

Shoe prints are commonly found at the scene of a crime and can sometimes help link a suspect to the scene. Because prints tend to be partially observed or smudgy, comparing crime scene prints with reference images from a putative shoe can be challenging. Footwear examiners rely on guidelines such as those published by SWGTREAD [1] to visually assess the similarity between two or more footwear impressions, one reason being that reliable, quantitative methods have yet to be validated for use in real cases. To help in the development of such methods, we created a study dataset of images of outsole impressions that shared class characteristics and degree of wear and that were subject to a specific type of degradation. We also propose a method to quantify the similarity between two outsole images that extends the capabilities of MC-COMP [2]. The proposed method is composed of three steps; (1) extracting image descriptors, (2) aligning images using the maximum clique, (3) calculating similarity values using two different classifiers; (a) degree of overlap between the two images, and (b) a score produced by a random forest. To explore the performance of the algorithm we propose, we compared degraded, crime scene-like images to high-quality reference images produced by the same or by different shoes. Even though comparisons involved matches or very close non-matches, and one of the images was blurry, the algorithm shows good source classification performance.

PMID:34922283 | DOI:10.1016/j.forsciint.2021.111126

Clin Neurol Neurosurg. 2021 Dec 14;212:107090. doi: 10.1016/j.clineuro.2021.107090. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective Review INTRODUCTION/OBJECTIVE: The aim of this study is to utilize a national database to identify how age affects patient outcomes following anterior lumbar interbody fusion (ALIF). There are no established age guidelines for the geriatric population within the spine specialty, which makes patient selection challenging. Furthermore, there are conflicting studies for the risks of performing spine surgeries in the elderly.

METHODS: A retrospective review of the Mariner Claims Database was conducted on patients who underwent a single level ALIF (CPT 22558) between 2010 and 2018. Patients were separated into three groups by age: 50-64, 65-74, and 75-84 and matched with respect to gender, smoking, and comorbidity burden. Multivariable logistic regression was used to determine the independent effect of outpatient surgery on the postoperative outcomes after adjusting for demographic factors and pertinent comorbidities. Statistical significance was set at p < 0.05.

RESULTS: The study identified 8459 matched patients (3350 50-64; 3350 65-74; and 1759 75-84). Compared with patients aged 50-64, patients aged 65-74 and 75-84 had significantly increased risks of pneumonia (65-74: OR 1.53, 95% CI 1.06-2.24, p = 0.025; 75-84: OR 1.62, 95% CI 1.07-2.42, p = 0.022), sepsis (65-74: OR 2.20, 95% CI 1.36-3.76, p = 0.002; 75-84: OR 2.42, 95% CI 1.43-4.13, p = 0.001), and major complications (65-74: OR 1.35, 95% CI 1.05-1.74, p = 0.021; 75-84: OR 1.48, 95% CI 1.11-1.95, p = 0.006) (Table 2). There were no significant differences between patients aged 65-74 and 75-84 for risks of postoperative pneumonia, sepsis, and major complications (p > 0.05). There were no differences between any groups in terms of long-term outcomes such as pseudoarthrosis, implant related complications, or reoperation (p > 0.05) (Table 3).

DISCUSSION/CONCLUSION: The study showed that those older than 65 had a significant increase in risk of pneumonia, sepsis, and major complications following ALIF. In the two cohorts above the age of 65 (65-74 and 75-84) there was no significant differences in postoperative outcomes.

LEVEL OF EVIDENCE: 3.

PMID:34922291 | DOI:10.1016/j.clineuro.2021.107090

J Surg Res. 2021 Dec 15;272:9-16. doi: 10.1016/j.jss.2021.11.007. Online ahead of print.

ABSTRACT

BACKGROUND: While many factors influence medical student career choice, interactions with attending and resident physicians during clinical rotations are particularly important. To evaluate the influence of attending and resident physicians on medical students’ career choices, particularly for those pursuing surgical careers, we quantified their respective influence in the context of other known influences.

METHODS: Rising fourth-year medical students and new graduates were given an IRB-exempt, 14-item online survey. Descriptive statistics were performed on the demographic information. Chi-square analysis was used, as were Kruskal-Wallis and Mann-Whitney analyses on the Likert responses (α = 0.05).

RESULTS: Survey response was 24%. Students pursuing general surgery rated residents greater than or equal to attendings on 7 of 8 key mentoring characteristics. Of students choosing a different specialty than the one they intended to pursue upon entering medical school, the influence of residents was cited by 100% of the students pursuing general surgery, compared to 59% of the entire cohort. Identification of a role model and perceived personality fit were significantly more important than other factors (P < 0.0001). Students pursuing general surgery rated the importance of identifying a role model and perceived personality fit greater than their peers.

CONCLUSIONS: Residents have greater influences on medical students’ career choice compared to attendings. Students pursuing a surgical specialty, particularly general surgery, considered the influence of role models and perceived personality fit to be the most important factors in their specialty decision. These findings provide valuable insights to improve student experiences and career recruitment in surgical specialties, particularly general surgery.

PMID:34922268 | DOI:10.1016/j.jss.2021.11.007