Category: Statistics

Int Heart J. 2023 May 16. doi: 10.1536/ihj.22-442. Online ahead of print.

ABSTRACT

Platelets play an important role in the pathophysiology of coronary artery disease. However, the clinical value of platelet indices in premature coronary heart disease remains largely unknown.Consecutive patients referred for coronary angiography were evaluated (n = 1675). Patients were stratified into premature coronary heart disease (n = 679, age < 55 for male and age < 65 for female), late-onset coronary heart disease (n = 772, age ≥ 55 for male and age ≥ 65 for female), and control (n = 224, age < 55 for male and age < 65 for female). Their clinical and laboratory parameters were collected. The relationship between platelet indices and premature coronary artery disease was analyzed.In univariate analysis, platelet indices showed no significant association with the presence of premature coronary heart disease (P > 0.05). After adjustment for traditional risk factors, mean platelet volume (0.823 [0.683-0.993], P = 0.042) and platelet-large cell ratio (0.976 [0.954-0.999], P = 0.040) were negatively correlated with the presence of premature coronary heart disease. The platelet-to-lymphocyte ratio was statistically significant among different numbers of coronary lesions (P = 0.035). In subgroup analysis, platelet-large cell ratio (1.190 [1.010-1.403], P = 0.038) was an independent risk factor of coronary restenosis after percutaneous coronary intervention.Platelet indices were associated with the prevalence, severity, and coronary restenosis after percutaneous coronary intervention suggesting their possible clinical application in premature coronary heart disease.

PMID:37197919 | DOI:10.1536/ihj.22-442

Arch Psychiatr Nurs. 2023 Jun;44:122-128. doi: 10.1016/j.apnu.2023.04.005. Epub 2023 Apr 20.

ABSTRACT

AIM: This study aimed to determine the effect of Self-Regulation Based Cognitive Psychoeducation Program on emotion regulation and self-efficacy in children diagnosed with attention deficit hyperactivity disorder (ADHD) and receiving medication.

METHOD: The sample of this study with control group and pre-test, post-test and follow-up randomized experimental design consisted of children followed in the child and adolescent mental health outpatient clinic of a state hospital. The data were evaluated by parametric and non-parametric analyses.

RESULTS: A statistically significant increase was determined in the internal functional emotion regulation mean scores of children, who participated in the Self-Regulation Based Cognitive Psychoeducation Program, measured before, immediately after, and 6 months after the intervention (p < 0.05). A statistically significant increase was also found in their external functional emotion regulation mean scores measured before and 6 months after the intervention (p < 0.05). In addition, a statistically significant difference was found between their internal dysfunctional and external dysfunctional emotion regulation mean scores measured before and 6 months after the intervention; however the mean scores of those in the control group 6 months after the intervention were higher than those in the intervention group (p < 0.05). Furthermore, there was a statistically significant increase in their self-efficacy mean scores measured before and 6 months after the intervention (p < 0.05).

CONCLUSION: The Self-Regulation Based Cognitive Psychoeducation Program was found be effective in increasing the levels of emotion regulation and self-efficacy in children with ADHD.

PMID:37197856 | DOI:10.1016/j.apnu.2023.04.005

Arch Psychiatr Nurs. 2023 Jun;44:114-121. doi: 10.1016/j.apnu.2023.04.025. Epub 2023 May 5.

ABSTRACT

BACKGROUND: Living with the experience of hearing voices without trying to ignore or suppress them is referred to as accepting auditory verbal hallucinations (AVH). It varies depending on the phenomenology of AVH itself; some clients may find it challenging to acquire new coping mechanisms with the voices.

AIM: Examine the association between the phenomenology of AVH and acceptance or autonomous action among clients with schizophrenia.

DESIGN: A descriptive correlational study was conducted on 200 clients with schizophrenia using the following instruments; Sociodemographic and clinical data tools, Psychotic Symptom Rating Scales (PSYRATS-AH), and Voices Acceptance and Action Scale (VAAS).

RESULTS: Most patients have moderate to severe levels of AVH (95.5 %), with a mean score of 25.34. The emotional characteristics reflected the high mean score (11.24). A highly statistically negative correlation was found between the total Voices Acceptance and Action Scale and severity of AVH (P = -0.448, sig = 0.000). A predictable significant effect of user acceptance and autonomous actions response coping with decreasing the severity of AVH was found (adjusted r square = 0.196, sig = 0.000) and model equation = Severity of Verbal auditory hallucinations = 31.990-0.257 X Total of Voice Acceptance and Autonomous Action Scale (VAAS).

CONCLUSION: The severity of all phenomenological characteristics of AVH can be successfully reduced by using voice acceptance and autonomous action responses rather than resistance or engagement responses. Subsequently, it must be improved and learned by psychiatric nurses the patients with schizophrenia in the hospitals by applying Acceptance and Commitment Therapy as a crucial intervention.

PMID:37197855 | DOI:10.1016/j.apnu.2023.04.025

J Am Coll Cardiol. 2023 May 23;81(20):2028-2039. doi: 10.1016/j.jacc.2023.03.403.

ABSTRACT

BACKGROUND: Myocardial injury is currently defined as a cardiac troponin above the sex-specific 99th percentile of a healthy reference population (upper reference limit [URL]).

OBJECTIVES: The purpose of this study was to estimate high-sensitivity (hs) troponin URLs in a representative sample of the U.S. adult population; overall and by sex, race/ethnicity, and age group.

METHODS: Among adults participating in the 1999-2004 National Health and Nutrition Examination Survey (NHANES), we measured hs-troponin T using 1 assay (Roche) and hs-troponin I using 3 assays (Abbott, Siemens, and Ortho). In a strictly defined healthy reference subgroup, we estimated 99th percentile URLs for each assay using the recommended nonparametric method.

RESULTS: Of 12,545 participants, 2,746 met criteria for the healthy subgroup (mean age 37 years, 50% men). The NHANES 99th percentile URL for hs-troponin T (19 ng/L) matched the manufacturer-reported URL (19 ng/L). NHANES URLs were 13 ng/L (95% CI: 10-15 ng/L) for Abbott hs-troponin I (manufacturer: 28 ng/L), 5 ng/L (95% CI: 4-7 ng/L) for Ortho hs-troponin I (manufacturer: 11 ng/L), and 37 ng/L (95% CI: 27-66 ng/L) for Siemens hs-troponin I (manufacturer: 46.5 ng/L). There were significant differences in URLs by sex, but none by race/ethnicity. Furthermore, the 99th percentile URLs for all 4 hs-troponin assays were statistically significantly lower in healthy adults aged <40 years compared with healthy adults ≥60 years (all P < 0.001 by rank sum testing).

CONCLUSIONS: We found URLs for hs-troponin I assays that were substantially lower than currently listed 99th percentile URLs. There were significant differences in hs-troponin T and I URLs by sex and by age group in healthy U.S. adults but none by race/ethnicity.

PMID:37197846 | DOI:10.1016/j.jacc.2023.03.403

BMJ Open. 2023 May 17;13(5):e064382. doi: 10.1136/bmjopen-2022-064382.

ABSTRACT

OBJECTIVE: The objective of this study was to finalise the development of the Young Disability Questionnaire (YDQ-spine) to measure the consequences of neck, midback and low back pain, relevant for schoolchildren aged 9-12 years.

DESIGN: A cross-sectional field test of the YDQ-spine was carried out.

SETTING: Danish primary schools.

PARTICIPANTS: Children aged 9-12 years from all Danish schools were invited to complete the questionnaire.

METHODS: Eight hundred and seventy-three schools were invited to participate. Consenting schools received information material, instructions and a link to an electronic version of the prefinal YDQ-spine. Local teachers distributed the electronic YDQ-spine to children aged 9-12 years. Descriptive statistics and item characteristics were carried out. Item reduction was performed using partial interitem correlations (scrutinising correlations>0.3) and factor analyses (items loading>0.3 were retained) to eliminate redundant items and to obtain insight into the structure of the questionnaire.

RESULTS: A total of 768 children from 20 schools answered of the questionnaire and 280 fulfilled the inclusion criteria of having back and/or neck pain (36%). Multisite pain was reported by 38%. Partial interitem correlations and factor analyses resulted in elimination of four items which were considered redundant leaving 24 items in the final YDQ-spine with an optional section on what matters most to the child. The factor analyses showed a two-factor structure with a physical component (13 items) and a psychosocial component (10 items) in addition to one standalone item (sleep).

CONCLUSION: The YDQ-spine is a novel questionnaire with satisfactory content validity measuring physical and psychosocial components (including sleep disturbances) of spinal pain in children aged 9-12 years. It also offers an optional section on what matters most to the child allowing targeted care in clinical practice.

PMID:37197823 | DOI:10.1136/bmjopen-2022-064382

BMJ Open. 2023 May 17;13(5):e070203. doi: 10.1136/bmjopen-2022-070203.

ABSTRACT

OBJECTIVE: This study aimed to assess the sociodemographic and institutional determinants of zinc bundled with oral rehydration salt (ORS) utilisation among under-five children with diarrhoeal diseases in East Wallaga zone, western Ethiopia, in 2022.

METHODS: A community-based cross-sectional study was conducted among 560 randomly selected participants from 1 to 30 April 2022. Data were entered into EpiData V.3.1, then exported to the Statistical Package for Social Science (SPSS) V.25 for analysis. An adjusted OR (AOR) along with a 95% confidence level was estimated to assess the strength of the association, and a p value <0.05 was considered to declare the statistical significance.

RESULTS: About 39.6% of the participants had used zinc bundled with ORS for their children with diarrhoea at least once in the last 12 months. Being aged 40-49 years for mothers or caregivers (AOR 3.48, 95% CI 1.41, 8.53); merchant (AOR 4.11, 95% CI 1.73, 8.12); mothers or caregivers able to read and write (AOR 5.77, 95% CI 1.22, 11.67); visited secondary level (AOR 2.82, 95% CI 1.30, 6.10) and tertiary level health facilities (AOR 0.016, 95% CI 0.03, 0.97); degree and above (AOR 0.06, 95% CI 0.03, 0.12) and doctorate (AOR 0.13, 95% CI 0.04, 0.44) holder healthcare professionals were statistically associated with utilisation of zinc bundled with ORS.

CONCLUSION: The study found that about two in five of the participants had used zinc bundled with ORS for their under-five children with diarrhoeal diseases. Age, occupation, educational status, level of health facilities visited and level of health professionals provided care were determinants of zinc bundled with ORS utilisation. So, health professionals at different levels of the health system have to enhance the maximisation of its bundled uptake.

PMID:37197822 | DOI:10.1136/bmjopen-2022-070203

BMJ Open. 2023 May 17;13(5):e066702. doi: 10.1136/bmjopen-2022-066702.

ABSTRACT

OBJECTIVES: Examine the association between multiple clinical staff levels and case-mix adjusted patient mortality in English hospitals. Most studies investigating the association between hospital staffing levels and mortality have focused on single professional groups, in particular nursing. However, single staff group studies might overestimate effects or neglect important contributions to patient safety from other staff groups.

DESIGN: Retrospective observational study of routinely available data.

SETTING AND PARTICIPANTS: 138 National Health Service hospital trusts that provided general acute adult services in England between 2015 and 2019.

OUTCOME MEASURE: Standardised mortality rates were derived from the Summary Hospital level Mortality Indicator data set, with observed deaths as outcome in our models and expected deaths as offset. Staffing levels were calculated as the ratio of occupied beds per staff group. We developed negative binomial random-effects models with trust as random effects.

RESULTS: Hospitals with lower levels of medical and allied healthcare professional (AHP) staff (e.g, occupational therapy, physiotherapy, radiography, speech and language therapy) had significantly higher mortality rates (rate ratio: 1.04, 95% CI 1.02 to 1.06, and 1.04, 95% CI 1.02 to 1.06, respectively), while those with lower support staff had lower mortality rates (0.85, 95% CI 0.79 to 0.91 for nurse support, and 1.00, 95% CI 0.99 to 1.00 for AHP support). Estimates of the association between staffing levels and mortality were stronger between-hospitals than within-hospitals, which were not statistically significant in a within-between random effects model.

CONCLUSIONS: In additional to medicine and nursing, AHP staffing levels may influence hospital mortality rates. Considering multiple staff groups simultaneously when examining the association between hospital mortality and clinical staffing levels is crucial.

TRIAL REGISTRATION NUMBER: NCT04374812.

PMID:37197808 | DOI:10.1136/bmjopen-2022-066702

BMJ Ment Health. 2023 Feb;26(1):e300677. doi: 10.1136/bmjment-2023-300677.

ABSTRACT

In recent years, network meta-analyses have been increasingly carried out to inform clinical guidelines and policy. This approach is under constant development, and a broad consensus on how to carry out several of its methodological and statistical steps is still lacking. Therefore, different working groups might often make different methodological choices based on their clinical and research experience, with possible advantages and shortcomings. In this contribution, we will critically assess two network meta-analyses on the topic of pharmacological prevention of relapse in schizophrenia, carried out by two different research groups. We will highlight the implications of different methodological choices on the analysis results and their clinical-epidemiological interpretation. Moreover, we will discuss some of the most relevant technical issues of network meta-analyses for which there is not a broad methodological agreement, including the assessment of transitivity.

PMID:37197798 | DOI:10.1136/bmjment-2023-300677

J Med Genet. 2023 May 16:jmg-2022-109132. doi: 10.1136/jmg-2022-109132. Online ahead of print.

ABSTRACT

BACKGROUND: Limb-girdle muscular dystrophies (LGMD) are a heterogeneous group of genetically determined muscle disorders. TRAPPC11-related LGMD is an autosomal-recessive condition characterised by muscle weakness and intellectual disability.

METHODS: A clinical and histopathological characterisation of 25 Roma individuals with LGMD R18 caused by the homozygous TRAPPC11 c.1287+5G>A variant is reported. Functional effects of the variant on mitochondrial function were investigated.

RESULTS: The c.1287+5G>A variant leads to a phenotype characterised by early onset muscle weakness, movement disorder, intellectual disability and elevated serum creatine kinase, which is similar to other series. As novel clinical findings, we found that microcephaly is almost universal and that infections in the first years of life seem to act as triggers for a psychomotor regression and onset of seizures in several individuals with TRAPPC11 variants, who showed pseudometabolic crises triggered by infections. Our functional studies expanded the role of TRAPPC11 deficiency in mitochondrial function, as a decreased mitochondrial ATP production capacity and alterations in the mitochondrial network architecture were detected.

CONCLUSION: We provide a comprehensive phenotypic characterisation of the pathogenic variant TRAPPC11 c.1287+5G>A, which is founder in the Roma population. Our observations indicate that some typical features of golgipathies, such as microcephaly and clinical decompensation associated with infections, are prevalent in individuals with LGMD R18.

PMID:37197784 | DOI:10.1136/jmg-2022-109132

J Appl Stat. 2022 Apr 24;50(7):1650-1663. doi: 10.1080/02664763.2022.2064439. eCollection 2023.

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus has spread seriously throughout the world. Predicting the spread, or the number of cases, in the future can facilitate preparation for, and prevention of, a worst-case scenario. To achieve these purposes, statistical modeling using past data is one feasible approach. This paper describes spatio-temporal modeling of COVID-19 case counts in 47 prefectures of Japan using a nonlinear random effects model, where random effects are introduced to capture the heterogeneity of a number of model parameters associated with the prefectures. The negative binomial distribution is frequently used with the Paul-Held random effects model to account for overdispersion in count data; however, the negative binomial distribution is known to be incapable of accommodating extreme observations such as those found in the COVID-19 case count data. We therefore propose use of the beta-negative binomial distribution with the Paul-Held model. This distribution is a generalization of the negative binomial distribution that has attracted much attention in recent years because it can model extreme observations with analytical tractability. The proposed beta-negative binomial model was applied to multivariate count time series data of COVID-19 cases in the 47 prefectures of Japan. Evaluation by one-step-ahead prediction showed that the proposed model can accommodate extreme observations without sacrificing predictive performance.

PMID:37197760 | PMC:PMC10184601 | DOI:10.1080/02664763.2022.2064439