Category: Statistics

J Subst Use Addict Treat. 2023 Jun 2:209082. doi: 10.1016/j.josat.2023.209082. Online ahead of print.

ABSTRACT

BACKGROUND: Given the lack of access to evidenced-based OUD treatment and the corresponding overdose crisis, researchers must evaluate and report health care inequities involving the treatment of OUD. Additionally, clinicians should be aware of these inequities in the treatment of patients.

METHODS: We carried out a scoping review of the literature regarding health inequities in treatment for OUD in July 2022. The study team retrieved articles published between 2016 and 2021 from MEDLINE and Ovid Embase. After authors received training, screening and data extraction were performed in masked, duplicate fashion. The team screened a total of 3673 titles and abstracts, followed by 172 articles for full-text review. The inequities that we examined were race/ethnicity, sex or gender, income, under-resourced/rural, occupational status, education level, and LGBTQ+. We used Stata 17.0 (StataCorp, LLC, College Station, TX) to summarize data and statistics of the studies within our sample.

RESULTS: A total of 44 studies evaluating inequities in OUD treatment met inclusion criteria. The most common inequity that studies examined was race/ethnicity (34/44 [77.27 %] studies), followed by under-resourced/rural (19/44 [43.18 %] studies), and sex or gender (18/44 [40.91 %] studies). LGBTQ+ (0/44 [0.0 %] studies) was not reported in the included studies. Our results indicate that many historically marginalized populations experience inequities related to access and outcomes in OUD treatment. The included studies in our scoping review occasionally demonstrated inconsistent findings.

CONCLUSIONS: Gaps exist within the literature on health inequities in treatment for OUD. The most examined inequities were race/ethnicity, under-resourced/rural and sex or gender, while studies did not examine LGBTQ+ status. Future research should aim to advance and supplement literature investigating health inequities in OUD treatment to ensure inclusive, patient-centered care.

PMID:37271346 | DOI:10.1016/j.josat.2023.209082

J Hosp Infect. 2023 Jun 2:S0195-6701(23)00161-5. doi: 10.1016/j.jhin.2023.05.008. Online ahead of print.

ABSTRACT

BACKGROUND: Studies have shown that nutritional products are discarded via handwashing sinks by healthcare workers, and this practice may promote bacterial growth, including of pathogens such as Carbapenemase-producing Enterobacterales (CPE). Outbreaks and acquisition of CPE in nosocomial settings are associated with negative outcomes for patients and hospitals.

OBJECTIVES: To investigate potential growth-promoting effect of nutritional support drinks (NSDs) and enteral tube-feed products (ETFPs) on CPE.

METHODS: Six different CPE strains were grown in 5 different diluted NSD, 5 different diluted ETFP, Mueller Hinton Broth (MHB) and M9 minimal salts media to simulate discarding of a small volume of nutritional product in a u-bend, already containing liquid. CPE were enumerated at 0h, 6h and 24h, and compared using two-way ANOVA and Dunett test, with confidence levels at 95%. Spearman’s r (rho) was used to measure strength of correlation between concentrations components in nutritional products and CPE growth.

RESULTS: All NSDs and ETFPs promoted CPE growth that exceeded both M9 (negative growth control) and MHB (positive growth control). In several cases, growth in NSDs/ETFPs reached statistical significance compared to growth in MHB.

CONCLUSION: Nutritional products support CPE growth under in-vitro conditions. The propensity of CPE to survive in drain pipework suggests that inappropriate product disposal, may further nourish established CPE in these environmental reservoirs. The growth observed in diluted NSDs and ETFPs signals that modifiable practices should be optimized to mitigate potential CPE transmission risk from these reservoirs.

PMID:37271316 | DOI:10.1016/j.jhin.2023.05.008

Rev Port Cardiol. 2023 Jun 2:S0870-2551(23)00280-9. doi: 10.1016/j.repc.2022.11.008. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVES: This study reports the results of an online survey carried out by the Portuguese Society of Cardiology about its medical members’ work characteristics before and during the COVID-19 pandemic, their job satisfaction, work motivation, and burnout.

METHODS: A sample of 157 participants answered a questionnaire with demographic, professional, and health-related information, followed by questionnaires on job satisfaction and motivation designed and validated for this study and a Portuguese version of the Maslach Burnout Inventory. Data were analyzed through descriptive statistics, ANOVA, and MANOVA, considering gender, professional level, and sector of activity, respectively. Multiple regression was used to assess the impact of job satisfaction and motivation on burnout.

RESULTS: The only variable that distinguished participants was sector of activity. Cardiologists working in the private sector worked fewer weekly hours during COVID-19, while those in the public sector worked more. The latter expressed more desire to reduce their working hours than those who worked in private medicine and in both sectors. There were no differences between sectors in work motivation, while job satisfaction was higher in the private sector. Moreover, job satisfaction negatively predicted burnout.

CONCLUSIONS: Our findings point to a deterioration in working conditions during the COVID-19 pandemic, with its consequences being felt especially in the public sector, which may have contributed to the lower levels of satisfaction among cardiologists who worked exclusively in this sector, but also for those working in both public and private sectors.

PMID:37271307 | DOI:10.1016/j.repc.2022.11.008

Respir Med. 2023 Jun 2:107307. doi: 10.1016/j.rmed.2023.107307. Online ahead of print.

ABSTRACT

BACKGROUND: Asthma and inflammatory bowel disease (IBD) are common inflammatory diseases. The aim of this study was to investigate the associations of IBD with asthma and respiratory symptoms.

METHODS: This study is based on 13,499 participants from seven northern European countries that filled in a postal questionnaire on asthma, respiratory symptoms, IBD including ulcerative colitis and Crohn’s disease and various lifestyle variables.

RESULTS: There were 195 participants with IBD. The prevalence of asthma (14.5 vs 8.1%, p = 0.001), different respiratory symptoms (range 11.9-36.8% vs range 6.0-18.6%, p < 0.005), non-infectious rhinitis (52.1 vs. 41.6%, p = 0.004) and chronic rhinosinusitis (11.6 vs 6.0%, p = 0.001) were higher in subjects with IBD than in those without IBD. In multivariable regression analysis, the association between IBD and asthma was statistically significant (OR 1.95 (95% CI 1.28-2.96)) after adjusting for confounders such as sex, BMI, smoking history, educational level and physical activity. There was a significant association between asthma and ulcerative colitis (adjusted OR 2.02 (95% CI 1.27-2.19)), and asthma but not Crohn’s disease (adjusted OR 1.66 (95% CI 0.69-3.95)). A significant gender interaction was found with a significant association between IBD and asthma in women but not in men ((OR 2.72 (95% CI 1.67-4.46) vs OR 0.87 (95% CI 0.35-2.19), p = 0.038).

CONCLUSIONS: Patients with IBD, particularly those with ulcerative colitis and female, have a higher prevalence of asthma and respiratory symptoms. Our findings indicate that it is important to consider respiratory symptoms and disorders when examining patients with manifest or suspected IBD.

PMID:37271300 | DOI:10.1016/j.rmed.2023.107307

J Affect Disord. 2023 Jun 2:S0165-0327(23)00752-8. doi: 10.1016/j.jad.2023.06.001. Online ahead of print.

ABSTRACT

BACKGROUND: The mood-concordance bias is a key feature of major depressive disorder (MDD), but the spatiotemporal neural activity associated with emotional processing in MDD remains unclear. Understanding the dysregulated connectivity patterns during emotional processing and their relationship with clinical symptoms could provide insights into MDD neuropathology.

METHODS: We enrolled 108 MDD patients and 64 healthy controls (HCs) who performed an emotion recognition task during magnetoencephalography recording. Network-based statistics (NBS) was used to analyze whole-brain functional connectivity (FC) across different frequency ranges during distinct temporal periods. The relationship between the aberrant FC and affective symptoms was explored.

RESULTS: MDD patients exhibited decreased FC strength in the beta band (13-30 Hz) compared to HCs. During the early stage of emotional processing (0-100 ms), reduced FC was observed between the left parahippocampal gyrus and the left cuneus. In the late stage (250-400 ms), aberrant FC was primarily found in the cortex-limbic-striatum systems. Moreover, the FC strength between the right fusiform gyrus and left thalamus, and between the left calcarine fissure and left inferior temporal gyrus were negatively associated with Hamilton Depression Rating Scale (HAMD) scores.

LIMITATIONS: Medication information was not involved.

CONCLUSION: MDD patients exhibited abnormal temporal-spatial neural interactions in the beta band, ranging from early sensory to later cognitive processing stages. These aberrant interactions involve the cortex-limbic-striatum circuit. Notably, aberrant FC in may serve as a potential biomarker for assessing depression severity.

PMID:37271293 | DOI:10.1016/j.jad.2023.06.001

J Affect Disord. 2023 Jun 2:S0165-0327(23)00754-1. doi: 10.1016/j.jad.2023.06.003. Online ahead of print.

ABSTRACT

BACKGROUND: Lower socioeconomic status is known to be associated with high mental health burden, there have been few epidemiological studies showing how socioeconomic status has modified the effect of COVID-19 on anxiety and depression.

METHODS: We analyzed data from the National Health Interview Survey in the United States between 2019 and 2021 and used respondents with a documented income-to-poverty ratio as a measure of income level (n = 79,468). We used frequency of medication use and self-reported frequency of anxious and depressive episodes as the main outcome measures. We performed a multivariable logistic regression with a two-way interaction term between income and survey year.

RESULTS: We found a statistically significant worsening of depression and anxiety metrics in respondents with higher income levels from 2019 to 2021. We did not observe a significant change in anxiety and depression metrics for low-income respondents over the same period.

LIMITATIONS: The data from the NHIS survey is limited primarily by sampling bias (response rate of 50.7 % in 2021), as well as the self-reported nature of the one of the outcome measures.

CONCLUSION: These findings suggest that, within the limits of the National Health Interview Survey, mental health outcomes were worse but stable in a socioeconomically disadvantaged demographic between 2019 and 2021. In a higher socioeconomic bracket, mental health outcomes were less severe than the disadvantaged demographic but were worsening at a greater rate.

PMID:37271292 | DOI:10.1016/j.jad.2023.06.003

J Stomatol Oral Maxillofac Surg. 2023 Jun 2:101526. doi: 10.1016/j.jormas.2023.101526. Online ahead of print.

ABSTRACT

INTRODUCTION: The mandible’s ongoing development presents a contraindication for combined orthodontic-orthognathic treatment. The aim of this study was to evaluate the mandibular stability before and after preoperative orthodontic treatment in late adolescent patients with skeletal Class III malocclusion and to investigate the most appropriate time to start preoperative orthodontic treatment.

MATERIAL AND METHODS: The study population consisted of 58 adolescents, aged between 15 and 21 years, with skeletal Class III malocclusion; the adolescents underwent CT scans at the beginning (T1) and the end (T2) of preoperative orthodontic treatment. The CT data were analyzed using ITK-SNAP and 3D Slicer software, and the effects of age and gender on mandibular development were investigated.

RESULTS: In these 58 patients, there were no significant local bone alterations in the condyle and anterior chin point between T1 and T2 and no significant changes in the mandibular branch height, mandibular body length, condylar distance, and mandibular angle distance (p>0.05). The mandibular growth at the angel of mandible was statistically significant (p<0.05), but it was not clinically significant because the mean value of the growth was small (right: 0.416±0.986 mm, left: 0.328±0.886 mm). No effect of age and gender on mandibular development was observed.

CONCLUSION: The mandibular morphology was stable during preoperative orthodontic treatment in patients at the late adolescent stage. This study provides evidence for the possibility of early implementation of preoperative orthodontics.

PMID:37271262 | DOI:10.1016/j.jormas.2023.101526

J Arthroplasty. 2023 Jun 2:S0883-5403(23)00571-5. doi: 10.1016/j.arth.2023.05.048. Online ahead of print.

ABSTRACT

BACKGROUND: Orthopaedic surgery has seen improvement in its representation of women, whereas the representation of racial/ethnic minorities has remained stagnant over the past decade. Overall, the surgical field lags behind other specialties in sex and racial/ethnic parity. Although demographic disparities within orthopaedics have been analyzed for both residents and faculty members, information for adult reconstruction fellows remains limited.

METHODS: Sex and race/ethnicity demographics for adult reconstruction orthopaedic fellowship matriculants were collected via a database published by the Accreditation Council for Graduate Medical Education (ACGME) from 2007 to 2021. Statistical analyses including descriptive statistics and significance testing, were performed.

RESULTS: During the 14-year time frame, men trainees remained high with an overall average percentage of 88% and demonstrated increasing representation (P-trend = .012). White Non-Hispanics, Asians, Blacks, and Hispanics represented on average 54, 11, 3, and 4%, respectively. White Non-Hispanics (P-trend = .039) and Asians (P-trend = .030) saw increasing and decreasing representation, respectively. Women, Blacks, and Hispanics remained relatively stagnant throughout the observation period as no trends were appreciable (P-trend > .05, each).

CONCLUSION: Using publicly available demographic data from the Accreditation Council for Graduate Medical Education (ACGME) from 2007 to 2021, we found relatively limited progress in the representation of women and those from traditionally marginalized groups seeking additional training in adult reconstruction. Our findings mark an initial step in measuring the diversity (or lack thereof) among adult reconstruction fellows. Further research is needed to ascertain specific factors likely to attract and retain members from minoritized groups into orthopaedics.

PMID:37271237 | DOI:10.1016/j.arth.2023.05.048

J Arthroplasty. 2023 Jun 2:S0883-5403(23)00568-5. doi: 10.1016/j.arth.2023.05.043. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to compare the postoperative outcomes over a period of 3 years in patients who underwent bilateral total knee arthroplasty (TKA) using mid-vastus versus medial parapatellar approaches.

MATERIAL AND METHODS: In this retrospective study, two propensity-matched cohorts of patients who underwent simultaneous bilateral TKA via midvastus (MV, n=100) and medial parapatellar (MPP, n=100) approaches from January 2017 to December 2018 were compared. Surgical parameters compared were surgery time and the incidence of lateral retinacular release (LRR). Clinical parameters including the visual analog score (VAS) for pain, time for straight leg raise (SLR), range of motion (ROM), the Knee Society Score (KSS), and the Feller patellar score (FPS) were assessed in the early postoperative, and follow-up periods up to 3 years. Radiographs were evaluated for alignment, patellar tilt, and displacement.

RESULTS: LRR was performed on 17 knees (8.5%) in the MPP group and 4 knees (2%) in the MV group which was significant (P=0.03). The time to SLR was significantly lower in the MV group. There was no statistically significant difference in the length of hospital stay between the groups. The VAS, ROM, and KSS were better in the MV group within 1 month (P <0.05), but no significant differences were found later. Patellar scores, rate of patellofemoral complications, radiographic patellar tilt, and displacements were similar at all follow-up periods. The higher LRR needed in the MPP approach did not compromise the outcome scores or complication rate.

CONCLUSION: In our study, the MV approach had faster SLR, less LRR, and better pain and function scores in the first few weeks after TKA. However, its effect on different patient outcomes has not been sustained at 1 month and further follow-up points. The approach and LRR did not affect the patellar scores and patellar tracking. We recommend that surgeons use the surgical approach with which they are most familiar.

PMID:37271236 | DOI:10.1016/j.arth.2023.05.043

J Arthroplasty. 2023 Jun 2:S0883-5403(23)00570-3. doi: 10.1016/j.arth.2023.05.046. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to retrospectively examine the relationship between pre- and post-operative alignment in robotic unicompartmental knee arthroplasty and postoperative patient-reported outcome measures.

METHODS: A retrospective review of 374 patients who underwent robotic-assisted UKA was conducted. Patient demographics, history, and pre- and post-operative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) scores were obtained via chart review. Average follow-up period was 2.4 years (range: 0.4-4.5 years) to chart review and 9.5 months (range: 6-48 months) to latest KOOS-JR. Pre- and post-operative robotically-measured knee alignment was obtained from operative reports. Incidence of conversion to total knee arthroplasty was determined by review of a health information exchange tool.

RESULTS: Multivariate regressions showed no statistically significant relationship between preoperative alignment, postoperative alignment, or degrees of alignment correction and change in KOOS-JR score or achievement of KOOS-JR MCID (P > 0.05). Patients who had > 8 degrees of postoperative varus alignment had on average a 20% lower achievement of KOOS-JR MCID compared to patients who had < 8 degrees of postoperative varus alignment; however, this difference was not statistically significant (P > 0.05). There were three patients who required conversion to total knee arthroplasty in the follow-up period, with no significant relationship to alignment variables (P > 0.05).

CONCLUSION: There was no significant difference in KOOS-JR change for those patients who had a larger or smaller degree of deformity correction, and correction did not predict MCID achievement. The results of this study contributes to the ongoing discussion of expanding indications for UKAs.

PMID:37271235 | DOI:10.1016/j.arth.2023.05.046