Category: Statistics

Hormones (Athens). 2022 Oct 11. doi: 10.1007/s42000-022-00400-y. Online ahead of print.

ABSTRACT

PURPOSE: The purpose was to evaluate the association between medication adherence and health-related quality of life (HRQoL) of patients with diabetes.

METHODS: In this cross-sectional study, a total of 518 patients were recruited from the outpatient departments of different general public and private hospitals in Greece during the COVID-19 pandemic using a consecutive sampling method. HRQoL was assessed with the EQ-5D-5L instrument and medication adherence with the corresponding subscale of the Adherence Starts with Knowledge 20 questionnaire. The relationship between HRQoL and adherence was explored by employing Spearman’s correlations and multiple binary logistic and linear stepwise regressions using robust standard errors.

RESULTS: A total of 15.1 and 1.9% of the patients reported that they had taken a medicine either more or less often than prescribed in the last month and week, respectively. Statistically significant but modest correlations of medication non-adherence with the EQ-5D index (rho = – 0.223), EQ-VAS (rho = – 0.230), and all the HRQoL domains (rho ranging from 0.211, for pain/discomfort, to 0.136, for mobility issues) were found. These significant associations persisted even after controlling for several other known potential factors of HRQoL in the multivariable analyses, except for the mobility and anxiety/depression dimensions.

CONCLUSION: Medication non-adherence appears to be independently associated with lower HRQoL and health levels in patients with diabetes. It is crucial to plan interventions to enhance medication adherence not only to obtain greater value from the available resources, but also to improve HRQoL of patients with diabetes.

PMID:36219341 | DOI:10.1007/s42000-022-00400-y

Behav Res Methods. 2022 Oct 11. doi: 10.3758/s13428-022-01837-0. Online ahead of print.

ABSTRACT

In a wide variety of cognitive domains, participants have access to several alternative strategies to perform a particular task and, on each trial, one specific strategy is selected and executed. Determining how many strategies are used by a participant as well as their identification at a trial level is a challenging problem for researchers. In the current paper, we propose a new method – the non-parametric mixture model – to efficiently disentangle hidden strategies in cognitive psychological data, based on observed response times. The developed method derived from standard hidden Markov modeling. Importantly, we used a model-free approach where a particular shape of a response time distribution does not need to be assumed. This has the considerable advantage of avoiding potentially unreliable results when an inappropriate response time distribution is assumed. Through three simulation studies and two applications to real data, we repeatedly demonstrated that the non-parametric mixture model is able to reliably recover hidden strategies present in the data as well as to accurately estimate the number of concurrent strategies. The results also showed that this new method is more efficient than a standard parametric approach. The non-parametric mixture model is therefore a useful statistical tool for strategy identification that can be applied in many areas of cognitive psychology. To this end, practical guidelines are provided for researchers wishing to apply the non-parametric mixture models on their own data set.

PMID:36219308 | DOI:10.3758/s13428-022-01837-0

Curr Microbiol. 2022 Oct 11;79(12):354. doi: 10.1007/s00284-022-03062-6.

ABSTRACT

Clostridioides difficile is the main pathogen responsible for antibiotic-associated diarrhea in adults. Besides its challenging diagnosis, C. difficile infection (CDI) causes substantial morbidity and mortality. Commercially, there are assays with different targets and performances in sensitivity and specificity. The objectives of this study were to: (1) evaluate the prevalence and seasonal variability of CDI rates at a tertiary hospital in southern Brazil over 12 years and (2) determine the impact of using a two-step algorithm test in the laboratory diagnosis. Between January 2007 and May 2019, fecal samples from 2275 patients were analyzed in a cross-sectional study. Four commercial tests were adopted for the diagnosis of CDI, the immunochromatographic test for toxin A from 2007 to 2010; the enzyme-linked immunosorbent assay method for toxins A and B from 2011 to March 2017; and the rapid enzyme immunoassay (EIA) for GDH and toxins A and B, associated with a Polymerase Chain Reaction (PCR) for the toxin B gene from June 2017 to 2019. The annual prevalence was 8.7% from 2007 to March 2017, increasing between June 2017 and 2019 to 14.7% when the C. diff Quik Chek Complete + GeneXpert C. difficile (two-step algorithm) test was adopted. The number of samples (691) and percentage of CDI cases (10.5%) were higher in winter, but the difference has no statistical significance (P > 0.05). An accurate diagnosis and adequate knowledge of the local seasonality of CDI allow the effective implementation of prevention and control strategies for nosocomial CDI, in addition to effective treatment for patients.

PMID:36219324 | DOI:10.1007/s00284-022-03062-6

J Gen Intern Med. 2022 Oct 11. doi: 10.1007/s11606-022-07791-z. Online ahead of print.

ABSTRACT

BACKGROUND: Patient empowerment through pharmacological self-management is a common strategy in some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure.

OBJECTIVE: This study aimed to assess self-monitoring plus self-titration of antihypertensive medication versus usual care for reducing systolic blood pressure (SBP) at 12 months in poorly controlled hypertensive patients.

DESIGN: The ADAMPA study was a pragmatic, controlled, randomized, non-masked clinical trial with two parallel arms in Valencia, Spain.

PARTICIPANTS: Hypertensive patients older than 40 years, with SBP over 145 mmHg and/or diastolic blood pressure (DBP) over 90 mmHg, were recruited from July 2017 to June 2018.

INTERVENTION: Participants were randomized 1:1 to usual care versus an individualized, pre-arranged plan based on self-monitoring plus self-titration.

MAIN MEASURE: The primary outcome was the adjusted mean difference (AMD) in SBP between groups at 12 months.

KEY RESULTS: Primary outcome data were available for 312 patients (intervention n=156, control n=156) of the 366 who were initially recruited. The AMD in SBP at 12 months (main analysis) was -2.9 mmHg (95% CI, -5.9 to 0.1, p=0.061), while the AMD in DBP was -1.9 mmHg (95% CI, -3.7 to 0.0, p=0.052). The results of the subgroup analysis were consistent with these for the main outcome measures. More patients in the intervention group achieved good blood pressure control (<140/90 mmHg) at 12 months than in the control group (55.8% vs 42.3%, difference 13.5%, 95% CI, 2.5 to 24.5%, p=0.017). At 12 months, no differences were observed in behavior, quality of life, use of health services, or adverse events.

CONCLUSION: Self-monitoring plus self-titration of antihypertensive medication based on an individualized pre-arranged plan used in primary care may be a promising strategy for reducing blood pressure at 12 months compared to usual care, without increasing healthcare utilization or adverse events.

TRIAL REGISTRATION: EudraCT, number 2016-003986-25 (registered 17 March 2017) and clinicaltrials.gov , NCT03242785.

PMID:36219303 | DOI:10.1007/s11606-022-07791-z

Environ Sci Pollut Res Int. 2022 Oct 11. doi: 10.1007/s11356-022-23434-6. Online ahead of print.

ABSTRACT

Today, most of people’s time is spent indoors. Air pollution indoors is much higher than outdoors. Therefore, the effect of indoor air on human health is much more than the outside air. One of the most effective methods of reducing indoor air pollution is the use of plants. However, in order for the plants to be used effectively for this purpose, it is first necessary to determine which plants are the most effective in reducing which pollutants. Within the scope of this study, the Al accumulation potential of seven ornamental plants, which are frequently used in interior architectural designs, was evaluated. Within the scope of the study, the variation of Al concentrations on the basis of species and environment was determined in plants grown in control, smoking environment, and traffic environment. As a result of the study, it was determined that Al concentrations changed statistically significantly both on the basis of environment and species, and the species with the highest Al accumulation potential was difenbahya.

PMID:36219289 | DOI:10.1007/s11356-022-23434-6

Insights Imaging. 2022 Oct 11;13(1):165. doi: 10.1186/s13244-022-01302-8.

ABSTRACT

OBJECTIVES: To evaluate the association between adipose tissue distribution and early allograft dysfunction (EAD) in liver transplantation (LT) recipients.

METHODS: A total of 175 patients who received LT from April 2015 to September 2020 were enrolled in this retrospective study. The areas of abdominal adipose tissue and skeletal muscle of all patients were measured based on the preoperative CT images. The appropriate statistical methods including the propensity score-matched (PSM) analysis were performed to identify the association between adipose tissue distribution and EAD.

RESULTS: Of 175 LT recipients, 55 patients (31.4%) finally developed EAD. The multivariate logistic analysis revealed that preoperative serum albumin (odds ratio (OR) 0.34, 95% confidence interval (CI) 0.17-0.70), platelet-lymphocyte ratio (OR 2.35, 95% CI 1.18-4.79), and visceral adipose tissue (VAT) area (OR 3.17, 95% CI 1.56-6.43) were independent associated with EAD. After PSM analysis, VAT area was still significantly associated with EAD (OR 3.95, 95% CI 1.16-13.51). In survival analysis, no significant difference was identified in one-year graft failure (log-rank: p = 0.487), and conversely result was identified in overall survival (OS) (log-rank: p = 0.012; hazard ratio (HR) 4.10, 95% CI 1.27-13.16).

CONCLUSIONS: LT recipients with high VAT area have higher risk for the occurrence of EAD, and high VAT area might have certain clinical value for predicting the poor OS of patients. For LT candidates with large amount of VAT, the clinicians can take clinical interventions by suggesting physical and nutritional treatments to improve outcomes after LT.

PMID:36219263 | DOI:10.1186/s13244-022-01302-8

Langenbecks Arch Surg. 2022 Oct 11. doi: 10.1007/s00423-022-02701-7. Online ahead of print.

ABSTRACT

BACKGROUND: The choice for an ideal site of specimen extraction following laparoscopic colorectal surgery remains debatable. However, midline incision (MI) is usually employed for right and left-sided colonic resections while left iliac fossa or suprapubic transverse incision (STI) were reserved for sigmoid and rectal cancer resections.

OBJECTIVE: To compare the incidence of surgical site infection (SSI) and incisional hernia (IH) in elective laparoscopic colorectal surgery for cancer and specimen extraction via MI or STI.

METHOD: Prospectively collected data of elective laparoscopic colorectal cancer resections between January 2017 and December 2019 were retrospectively reviewed. MI was employed for right and left-sided colonic resections while STI was used for sigmoid and rectal resections. SSI is defined according to the US CDC criteria. IH was diagnosed clinically and confirmed by CT scan at 1 year.

RESULTS: A total of 168 patients underwent elective laparoscopic colorectal resections. MI was used in 90 patients while 78 patients had STI as an extraction site. Demographic and preoperative data is similar for two groups. The rate of IH was 13.3% for MI and 0% in the STI (p = 0.001). SSI was seen in 16.7% of MI vs 11.5% of STI (p = 0.34). Univariate and multivariate analysis showed that the choice of extraction site is associated with statistically significant higher incisional hernia rate.

CONCLUSION: MI for specimen extraction is associated with higher incidence of both SSI and IH. The choice of incision for extraction site is an independent predicative factor for significantly higher IH and increased SSI rates.

PMID:36219253 | DOI:10.1007/s00423-022-02701-7

Neuroradiology. 2022 Oct 11. doi: 10.1007/s00234-022-03061-1. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the alterations of topological organization of the whole brain functional networks in hypertension patients with cognitive impairment (HTN-CI) and characterize its relationship with cognitive scores.

METHODS: Fifty-seven hypertension patients with cognitive impairment and 59 hypertension patients with normal cognition (HTN-NC), and 49 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging. Graph theoretical analysis was used to investigate the altered topological organization of the functional brain networks. The global topological properties and nodal metrics were compared among the three groups. Network-based statistic (NBS) analysis was used to determine the connected subnetwork. The relationships between network metrics and cognitive scores were also characterized.

RESULTS: HTN-CI patients exhibited significantly decreased global efficiency, lambda, and increased shortest path length when compared with HCs. In addition, both HTN-CI and HTN-NC groups exhibited altered nodal degree centrality and nodal efficiency in the right precentral gyrus. The disruptions of global network metrics (lambda, Lp) and the nodal metrics (degree centrality and nodal efficiency) in the right precentral gyrus were positively correlated with the MoCA scores in HTN-CI. NBS analysis demonstrated that decreased subnetwork connectivity was present both in the HTN-CI and HTN-NC groups, which were mainly involved in the default mode network, frontoparietal network, and cingulo-opercular network.

CONCLUSION: This study demonstrated the alterations of topographical organization and subnetwork connectivity of functional brain networks in HTN-CI. In addition, the global and nodal network properties were correlated with cognitive scores, which may provide useful insights for the understanding of neuropsychological mechanisms underlying HTN-CI.

PMID:36219250 | DOI:10.1007/s00234-022-03061-1

World J Urol. 2022 Oct 11. doi: 10.1007/s00345-022-04181-2. Online ahead of print.

ABSTRACT

PURPOSE: A prospective case-control study was conducted to evaluate glycogen deposition within the detrusor and its correlation with the urodynamic findings in patients with bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH).

MATERIAL AND METHODS: Data from 50 patients with BPH (Study Group) and 20 controls (Control Group) were analyzed. BOO was confirmed by pressure-flow studies. The main outcome was glycogen deposition within the bladder wall. Bladder tissue biopsies were obtained from all patients, and histological assessment of the detrusor glycogen content was performed using Periodate Acid Schiff’s (PAS) stain. The obtained glycogen score ranged from 0 (no staining of glycogen granules) to 3 (staining of glycogen granules within the detrusor adjacent to the urothelium).

RESULTS: Fifty patients and 20 controls were included. Increased glycogen deposition was observed in 37 (74%) and 2 (10%) patients in the Study and Control Group, respectively (p < 0.01, OR 25.6, 95% CI 5.2-125.8). In the subgroup analysis, no statistically significant difference was found between glycogen deposition score and IPSS, maximum detrusor pressure at maximum flow (PdetQmax) and duration of LUTS. In multivariate logistic regression, history of retention was the only variable which could predict high glycogen deposition (p = 0.019).

CONCLUSIONS: Our results demonstrate increased detrusor glycogen deposition in patients with BOO due to BPH, but the amount of deposition did not seem to correlate with symptom severity and duration or urodynamic findings.

PMID:36219231 | DOI:10.1007/s00345-022-04181-2

Autism Res. 2022 Oct;15(10):1941-1960. doi: 10.1002/aur.2788. Epub 2022 Aug 8.

ABSTRACT

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous pollutants that are associated with altered neurodevelopment and various neurodevelopmental disorders. However, studies evaluating internal biomarkers of PAH exposure in reference to the severity of autism spectrum disorder (ASD) symptomology and autistic behaviors are scarce. Hence, we conducted a case-control study evaluating 12 urinary hydroxylated PAH metabolites (i.e., hydroxy-PAHs) in 101 children with autism and 101 neurotypical children, matching according to sex and age in a 1:1 ratio. In children with ASD, the severity of symptomology and autistic behaviors were assessed using the child autism rating scale (CARS) and the autism behavior checklist (ABC). We found that urinary levels of nine of the hydroxy-PAHs were statistically significantly higher in the ASD group, with the exception of 2-hydroxynaphthalene (2-OHNap) and 4-hydroxyphenanthrene (4-OHPhe). Moreover, urinary hydroxy-PAH levels were associated with ASD risk, with odds ratios ranging from 1.86 to 17.19. Exposures to 1-hydroxynaphthalene (1-OHNap, β = 3.32), hydroxyphenanthrenes (1/2/3 + 9-OHPhes, β = 3.41-5.12), 1-hydroxypyrene (1-OH-Pyr; β = 3.91), 2-hydroxybenzofuran (2-OHDBF; β = 3.93), and ∑OH-PAHs (β = 4.67) were positively associated with CARS scores after adjusting for covariates (all p < 0.05). When applying the ABC scale, 1-OHPyr levels were positively associated with ABC total scores (β = 18.54), with the strongest associations evidenced in regard to the social relatedness (β = 6.51) and language domains (β = 6.51) (all p < 0.05). Bayesian kernel machine regression (BKMR) showed consistent positive exposure responses for 1-OHNap, 1-OHPhe, and 3 + 9-OHPhe levels in regard to CARS scores, and for 1-OHPyr levels in regard to ABC total scores. Our findings suggest that children with ASD may have higher urinary levels of hydroxy-PAHs, and that these biomarker levels are associated with an increased odds of ASD, an increased severity of autism symptomology, and increased autistic behaviors in children with autism. LAY SUMMARY: We conducted an epidemiologic study evaluating the associations of urinary hydroxy-PAH levels with autism spectrum disorder (ASD), autism symptomology, and autistic behaviors. We found that urinary hydroxy-PAHs were statistically significantly associated with ASD. We note strong statistically significant associations between 1-OHNap, 1-OHPhe, and 3 + 9-OHPhe levels and increased severity of autism symptomology, as well as a strong statistically significant association between 1-OHPyr levels and behavioral characteristics within the social and linguistic domains. This work, if confirmed, will contribute to the future development of diagnostics for children with mild autism, as well as to environmental measures to promote the health and wellbeing of children with autism spectrum disorders.

PMID:36218012 | DOI:10.1002/aur.2788