Category: Statistics

Brain Behav. 2023 Jan 9:e2885. doi: 10.1002/brb3.2885. Online ahead of print.

ABSTRACT

BACKGROUND: Side effects in psychotherapy are common and have a negative impact on patients or clients. However, effective evaluation tools are still lacking and have not been fully studied. The present study aims to develop a scale with good reliability and validity to measure the side effects of psychotherapy.

METHODS: The 25 items in the Psychotherapy Side Effects Scale (PSES) were condensed and distributed to 420 subjects online to test its psychometric properties.

RESULTS: The internal consistency of the PSES was satisfactory to excellent (Cronbach’s ɑ coefficient was .95, and the Guttman split-half coefficient was 0.88). A statistically significant negative correlation between the satisfaction score and the total score of the PSES was shown (r = -0.51, p < .001). The PSES could effectively discriminate between two groups with and without side effects (F = 250.95, p < .001) and was able to predict the occurrence of side effects in psychotherapy with an area under curve of 0.932 and a 95% confidence interval of 0.900-0.964 (p < .001). A cutoff was set at 36 points in total PSES score, from which the maximum Youden’s index (= 0.72) could be obtained. The positive rate of the PSES was 24% (101/420).

CONCLUSION: The PSES showed good internal consistency, content validity, concurrent validity, discriminant validity and predictive validity in evaluating and identifying side effects in psychotherapy. More advanced reliability testing methods and structural validity testing for PESE need to be practiced in the future to better serve clinical practice.

PMID:36621871 | DOI:10.1002/brb3.2885

Brain Behav. 2023 Jan 9:e2888. doi: 10.1002/brb3.2888. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Periodontitis has been implicated in the incidence of ischemic stroke. However, the generalizability of results to individuals with different subtypes of periodontitis is unknown. We aimed to investigate the causal relationship of chronic periodontitis (CP) and aggressive periodontitis (AgP) with ischemic stroke and its subtypes in the Mendelian randomization framework.

METHODS: The genetic proxies of CP were derived from large-scale summary statistics from the UK Biobank datasets (950 cases and 455,398 controls). The genetic associations of AgP were selected from another large genome-wide association study of European ancestry (851 cases and 6836 controls). The instruments of ischemic stroke (34,217 cases and 406,111 controls) and its subtypes were selected from the MEGASTROKE consortium of European ancestry. The inverse variant weighted method was performed to determine the causal inference and a comprehensive set of sensitivity analyses to test the robustness of the results.

RESULTS: In population-wide genetic analysis, there was no association of genetically predicted AgP (odds ratio [OR], 0.982; 95% confidence interval [CI], 0.956-1.009; p = .197) with ischemic stroke or its subtypes. For patients with CP, there was also no significant causal inference on ischemic stroke (OR, 1.017; 95% CI, 0.992-1.043; p = .184). However, regarding the stroke subtypes, the genetic analysis provided evidence of a causal relationship of CP with cardioembolic stroke (OR, 1.052; 95% CI, 1.002-1.104; p = .042), but not with large artery atherosclerosis (OR, 1.005; 95% CI, 0.944-1.069; p = .875) or small vessel occlusion (OR, 1.039; 95% CI, 0.981-1.101; p = .193).

CONCLUSION: This study suggested that there was a potential causal effect of CP on cardioembolic stroke.

PMID:36621868 | DOI:10.1002/brb3.2888

Eur J Anaesthesiol. 2023 Jan 10. doi: 10.1097/EJA.0000000000001796. Online ahead of print.

ABSTRACT

BACKGROUND: Monitoring peri-operative body temperature in children is currently mainly achieved through invasive devices. The Temple Touch Pro Temperature Monitoring System estimates core temperature noninvasively based on heat flux thermometry.

OBJECTIVE: To investigate the agreement of this noninvasive sensor against standard oesophageal core temperature.

DESIGN: A prospective observational study.

SETTING: University hospital recruiting between April and July 2021.

PATIENTS: One hundred children (32 girls) aged 6 years or younger scheduled for noncardiac surgery, resulting in 6766 data pairs. Exclusion criteria were contraindication for the insertion of an oesophageal temperature probe, and procedures in which one of the measurement methods would interfere with the surgical field.

MAIN OUTCOME MEASURES: Primary outcome was the agreement analysis by a Bland-Altman comparison with multiple measurements. Posthoc, we performed another agreement analysis after exclusion of a statistically determined equilibration time. Secondary outcomes were the temperature differences over time and subgroup analysis of hypothermic, normothermic and hyperthermic temperature ranges, age, sex and sensor’s side by type III analysis of variance. Further, we correlated the sonographically determined depth of the artery with trueness.

RESULTS: The mean difference was -0.07°C (95% CI -0.15 to +0.05) with limits of agreement of -1.00 and +0.85°C. After adjusting for an equilibration time of 13 min, the mean difference improved to -0.04°C (95% CI -0.08 to +0.01) with limits of agreement of -0.68 and +0.60°C. Concordance correlation coefficient was 0.83 (95% CI 0.82 to 0.84). Differences between the skin sensor and oesophageal reference increased over time by -0.05°C per hour. Subgroup analysis showed no clinically relevant differences. Depth of artery negatively correlated with trueness by 0.03°C per millimetre.

CONCLUSIONS: Although the Temple Touch Pro sensor showed acceptable accuracy after allowing for an equilibration time, it still needs further investigation for routine use in children. This particularly affects accuracy in hypothermic ranges, imprecise positioning and applicability in children with immature or vulnerable skin.

TRIAL REGISTRATION: German Clinical Trials Register, identifier: DRKS00024703.

PMID:36621856 | DOI:10.1097/EJA.0000000000001796

Vet Radiol Ultrasound. 2023 Jan 9. doi: 10.1111/vru.13209. Online ahead of print.

ABSTRACT

Sternal carina damage (keel bone damage, KBD) is an important welfare concern for laying hen producers and backyard flock owners. Quantitative radiographic measures of KBD severity are helpful for researchers who study causes for this problem and the effects of novel interventions. The objectives of the current retrospective secondary analysis study were to develop and test intraobserver repeatability for a standardized protocol to quantify three categories of radiographic KBD using open-source image analysis software and discrete and continuous variables. The standardized protocol was developed and evaluated using triplicate measurements of 470 keel bone radiographs that had been previously acquired for a prospective study. Intraobserver repeatability was assessed using intra-class correlation coefficient (ICC) and control chart methods. Based on control chart analyses, measures within the acceptable range of intra-observer variation using the standardized protocol were the number of complete cranial fractures (97.02%), incomplete cranial fractures (96.38%), complete caudal fractures (95.32%), incomplete caudal fractures (98.09%), cranial calluses (99.79%), and caudal calluses (98.09%); proportion of deviation (POD) measurements (97.87%); and angle of displacement (AOD) measurements (93.60%). Findings can be used as background to support future research studies on KBD in laying hens.

PMID:36621852 | DOI:10.1111/vru.13209

Cancer Med. 2023 Jan 9. doi: 10.1002/cam4.5486. Online ahead of print.

ABSTRACT

BACKGROUND: Stomach hemorrhage and perforation are very severe and common complications in patients with primary gastric diffuse large B-cell lymphoma (PG-DLBCL) during treatment with immunochemotherapy. However, no relevant clinical studies have been performed on the prevention of these serious complications.

METHODS: Patients diagnosed with PG-DLBCL were enrolled in this retrospective study. The prevention group received standard rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) treatment without prednisone combined with antacids and anti-Helicobacter pylori (Hp) therapy. These patients received R-CHOP-based treatment until the complete recovery of gastric ulcers, as proven by gastroscopy. The control group received a standard R-CHOP regimen. Toxicity and survival were the main endpoints.

RESULTS: A total of 52 patients received preventative treatment, while 146 patients did not. Among patients with stage I, II-1, and II-2 disease, the prevention group had a lower rate of hemorrhage and perforation (0/40) than the control group (10/78, p = 0.044). At a median follow-up time of 25 months, the 5-year event-free survival (EFS) rates were 97.1% in the prevention group and 66.1% in the control group (p = 0.025), and the 5-year overall survival (OS) rates were 100% and 72.0%, respectively (p = 0.021). However, the differences in the 5-year EFS and OS of patients with disseminated disease were not statistically significant.

CONCLUSIONS: Preventative treatment can decrease the risk of hemorrhage and perforation in patients with localized PG-DLBCL during immunochemotherapy, leading to better EFS and OS in these patients. However, preventative treatment failed to reduce the risk of gastric hemorrhage and perforation and did not improve survival (EFS and OS) in advanced-stage patients.

PMID:36621835 | DOI:10.1002/cam4.5486

J Psychosoc Oncol. 2023 Jan 9:1-14. doi: 10.1080/07347332.2022.2160943. Online ahead of print.

ABSTRACT

OBJECTIVE: To present the initial assessment of psychosocial adaptation among Greek parents whose children were newly diagnosed with cancer amidst the turmoil of an ongoing financial crisis.

STUDY DESIGN: This prospective observational study used a quantitative approach.

PARTICIPANTS: Sixty-one parents of children with cancer treated at a large urban tertiary-care children’s hospital were prospectively recruited to participate in our study during the first week of their child’s diagnosis (2013-2016).

METHODS: The parents were asked to complete the psychosocial assessment tool (PAT 2.0), Zung Depression Scale, State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, and World Health Organization Quality of Life-Bref Instrument; Moreover, three female healthcare providers (the physician oncologist, the head nurse and a senior nurse) completed the relevant PAT 2.0 -Staff Perceptions questionnaire the results of which were then compared to those of the child’s parent.

FINDINGS: The majority of parents had PAT 2.0 scores indicative of increased psychosocial risk :54% were stratified into the “Targeted” (moderate risk) and 15% into the “Clinical” (highest risk) categories, whereas healthcare providers underestimated psychosocial risk in 57%-59% of the cases. The subscales that most contributed to the increased scores were Parental Stress Reaction, Family Structure and Resources, and Family Social Support. The PAT 2.0 had statistically significant correlations with most of the anxiety and depression scales, with Zung having the strongest correlation (r-value: +0.5, p-value <0.01). Our cohort presented more anxiety and depression compared to the general Greek population (14% for depression versus 2,9% for the general population and 46% for anxiety compared to 4,1%) in the years of financial recession in Greece.

CONCLUSIONS: The parents of children newly diagnosed with cancer in Greece are at increased risk for developing anxiety and depression in the years of financial recession in Greece compared to general population.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: Parental stress reaction to diagnosis as well as lack of family resources and social support may contribute to this difference. Screening for psychosocial risk factors is essential for the early identification of these families and for the optimal utilization of the limited available resources in times of economic hardship.

PMID:36621825 | DOI:10.1080/07347332.2022.2160943

Stroke. 2023 Jan 9. doi: 10.1161/STROKEAHA.122.041302. Online ahead of print.

ABSTRACT

BACKGROUND: Noncontrast computed tomography hypodensities are a validated predictor of hematoma expansion (HE) in intracerebral hemorrhage and a possible alternative to the computed tomography angiography (CTA) spot sign but their added value to available prediction models remains unclear. We investigated whether the inclusion of hypodensities improves prediction of HE and compared their added value over the spot sign.

METHODS: Retrospective analysis of patients admitted for primary spontaneous intracerebral hemorrhage at the following 8 university hospitals in Boston, US (1994-2015, prospective), Hamilton, Canada (2010-2016, retrospective), Berlin, Germany (2014-2019, retrospective), Chongqing, China (2011-2015, retrospective), Pavia, Italy (2017-2019, prospective), Ferrara, Italy (2010-2019, retrospective), Brescia, Italy (2020-2021, retrospective), and Bologna, Italy (2015-2019, retrospective). Predictors of HE (hematoma growth >6 mL and/or >33% from baseline to follow-up imaging) were explored with logistic regression. We compared the discrimination of a simple prediction model for HE based on 4 predictors (antitplatelet and anticoagulant treatment, baseline intracerebral hemorrhage volume, and onset-to-imaging time) before and after the inclusion of noncontrast computed tomography hypodensities, using receiver operating characteristic curve and De Long test for area under the curve comparison.

RESULTS: A total of 2465 subjects were included, of whom 664 (26.9%) had HE and 1085 (44.0%) had hypodensities. Hypodensities were independently associated with HE after adjustment for confounders in logistic regression (odds ratio, 3.11 [95% CI, 2.55-3.80]; P<0.001). The inclusion of noncontrast computed tomography hypodensities improved the discrimination of the 4 predictors model (area under the curve, 0.67 [95% CI, 0.64-0.69] versus 0.71 [95% CI, 0.69-0.74]; P=0.025). In the subgroup of patients with a CTA available (n=895, 36.3%), the added value of hypodensities remained statistically significant (area under the curve, 0.68 [95% CI, 0.64-0.73] versus 0.74 [95% CI, 0.70-0.78]; P=0.041) whereas the addition of the CTA spot sign did not provide significant discrimination improvement (area under the curve, 0.74 [95% CI, 0.70-0.78]).

CONCLUSIONS: Noncontrast computed tomography hypodensities provided a significant added value in the prediction of HE and appear a valuable alternative to the CTA spot sign. Our findings might inform future studies and suggest the possibility to stratify the risk of HE with good discrimination without CTA.

PMID:36621819 | DOI:10.1161/STROKEAHA.122.041302

Cancer Med. 2023 Jan 9. doi: 10.1002/cam4.5592. Online ahead of print.

ABSTRACT

BACKGROUND: To our knowledge, the different situations of identifying second primary malignant tumors (SPMTs) in lymphoma patients with synchronous solid tumors remain to be comprehensively investigated.

METHODS: We retrospectively collected information pertaining to lymphoma patients with synchronous solid tumors (diagnosed within 6 months) at Peking University Cancer Hospital & Institute between 2009 and 2019. The non-parametric Aalen-Johansen estimator was applied to calculate cumulative incidence function in the competing risk model. Furthermore, propensity score-matched analysis was performed to compare survival differences in lymphoma patients with or without synchronous solid tumors.

RESULTS: Thirty-eight patients were enrolled. There were three situations of identifying SPMTs. First, in 15 patients (39.5%), SPMTs were identified before the initiation of any treatment. Among them, priority was given to anti-lymphoma treatment in case of only three patients. Second, in 17 patients (44.7%), SPMTs were unexpectedly detected on surgical specimen assessment; of them, 13 received anti-lymphoma treatment after surgery. Third, in six patients (15.8%), SPMTs were identified after the outset of treatment for the primary tumor; in this population, three of four patients with lymphoma switched toward the treatment plan for SPMTs. The 5-year overall survival was 58.7%. The cumulative incidence function within 5 years was 26.6% for lymphoma and 14.7% for other solid tumors. The early identification of SPMTs was associated with better outcomes (p = 0.048). After balancing the baseline characteristics, no differences in survival were observed between lymphoma patients with and without synchronous solid tumors (p = 0.664).

CONCLUSIONS: This is the first study to present the different situations of identifying SPMTs in lymphoma patients with synchronous solid tumors. In only <50% patients, SPMTs were identifiable at baseline. SPMT identification at different situations may make it difficult to choose the optimal therapeutic option, which may consequently impact patient survival.

PMID:36621802 | DOI:10.1002/cam4.5592

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2022 Dec;44(6):1028-1032. doi: 10.3881/j.issn.1000-503X.14918.

ABSTRACT

Objective To validate the performance of the model for predicting the risk of intraoperative hypothermia.Methods This observational prospective study enrolled the adult patients who were of American Society of Anesthesiologists Ⅰ-Ⅲ and underwent elective surgery with general anesthesia in Peking Union Medical College Hospital,Beijing Hospital,and Xuanwu Hospital of Capital Medical University from October 2019 to August 2021.The risk prediction model of intraoperative hypothermia was used to calculate the predictors score of each patient.The body temperature of each patient was monitored throughout the perioperative period,and perioperative temperature management were entirely at the discretion of the anesthesiologists.The area under the receiver operating characteristic curve(AUC),Hosmer-Lemeshow goodness-of-fit test,and Brier score were employed to evaluate the prediction performance of the model.Results Of the 472 participants included in this study,141(29.9%)developed intraoperative hypothermia and 124(26.3%)received intraoperative active warming.For predicting intraoperative hypothermia in the overall cohort,the model demonstrated good discrimination capacity with an AUC of 0.729(95% CI=0.680-0.777),adequate calibration(Hosmer-Lemeshow χ²=3.143,P=0.925),and good overall performance(Brier score of 0.34).For the patients with passive warming only,the model showed good discrimination(AUC=0.756;95% CI=0.704-0.808),good calibration(Hosmer-Lemeshow χ²=7.457,P=0.488),and the Brier score of 0.29.For the patients with active warming,the model presented the AUC of 0.747(95% CI=0.632-0.863),Hosmer-Lemeshow χ² of 4.754(P=0.783)and the Brier score of 0.47.Furthermore,we stratified the risk scores as low,moderate and high risk groups,in which the incidence of intraoperative hypothermia was 14.4%(95% CI=9.6%-19.1%),36.7%(95% CI=29.9%-43.5%),and 58.2%(95% CI=46.1%-70.3%),respectively.The differences between the three groups were statistically significant(χ²=54.112,P<0.001).Conclusion The intraoperative hypothermia prediction model demonstrates good overall differentiation capacity and has good prediction performance for the patients with or without active warming.

PMID:36621793 | DOI:10.3881/j.issn.1000-503X.14918

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2022 Dec;44(6):996-1003. doi: 10.3881/j.issn.1000-503X.15058.

ABSTRACT

Objective To understand the status quo and analyze the influencing factors of new hepatitis B virus(HBV) infection in Anzhou district,Mianyang city,Sichuan province,so as to provide a scientific basis for the formulation of hepatitis B prevention and control measures.Methods This study enrolled 71 418 residents of Anzhou District,Mianyang City,who participated in the physical examination of “Mianyang Comprehensive Prevention and Control Demonstration Study of Major Infectious Diseases” in 2013 and were tested negative for the hepatitis B surface antigen.The residents were followed for 5 years and underwent serological test again in 2018.The new infection rate of HBV was calculated and the influencing factors were analyzed by multivariate Logistic regression analysis.Results In 2018,the new infection rate of HBV among 71 418 residents in Anzhou district was 1.61%.The new infection rate varied with the differences in gender,age,occupation,marital status,smoking status,drinking frequency,place of residence,family history of hepatitis B,and history of hepatitis B vaccination(P<0.001).Multivariate Logistic regression results showed that male(OR=1.29,95%CI=1.12-1.48,P<0.001),farmer(OR=2.01,95%CI=1.39-2.90,P<0.001),and family history of hepatitis B(OR=1.97,95%CI=1.44-2.70,P<0.001)were the independent risk factors for new HBV infection(P<0.001).Conclusions The new infection rate of HBV is high in Anzhou district of Mianyang city.Males,farmers,and those with family history of hepatitis B are high-risk groups of HBV infection.

PMID:36621789 | DOI:10.3881/j.issn.1000-503X.15058