Category: Statistics

BMC Pregnancy Childbirth. 2022 Aug 17;22(1):648. doi: 10.1186/s12884-022-04979-3.

ABSTRACT

BACKGROUND: Anxiety is a behavioral expression of tension and unpleasant emotion that arises from multifactorial dimensions that might increase the mortality of patients during anesthesia and surgery. This study aimed to verify the prevalence and associated factors of preoperative anxiety among women undergoing elective cesarean delivery.

METHOD: A cross-sectional study design was conducted on a total of 392 patients who underwent elective cesarean delivery in Debre Tabor Comprehensive Specialized Hospital, in North Central Ethiopia from October 15, 2020, to September 15, 2021. Data was collected using a validated Amsterdam questionnaire, after translating to the local language (Amharic). Descriptive statistics were expressed in percentages and presented in tables. Bivariable and multivariable logistic analyses were done to identify factors associated with preoperative anxiety. The statistical significance level was set at P < 0.05 with 95% CI.

RESULTS: The overall prevalence of preoperative anxiety in women undergoing elective cesarean delivery was 67.9 [95% CI = (63.0-72.7)]. Participants who came from rural areas [AOR = 2.65; 95%CI: 1.27-5.53], farmers [AOR = 2.35; 95%CI: 1.02-5.40], participants with no previous surgical and anesthesia history [AOR = 2.91; 95%CI: 1.69-5.01], and primiparous women [AOR = 1.69; 95%CI: 1.01-2.83] were more significantly associated with preoperative anxiety.

CONCLUSION: The prevalence of preoperative anxiety among elective cesarean deliveries was found to be high. So, preoperative maternal counseling and anxiety reduction services should therefore be given top priority, particularly for those women who came from rural areas, are farmers, have no prior surgical or anesthetic experience, and are primiparous.

PMID:35978308 | DOI:10.1186/s12884-022-04979-3

BMC Cardiovasc Disord. 2022 Aug 17;22(1):375. doi: 10.1186/s12872-022-02809-0.

ABSTRACT

BACKGROUND: Previous studies of left ventricular diastolic function (LVDF) have focused on the decrease in active and passive diastolic function due to ischemic factors but have not investigated if the decrease in compliance of the coronary arteries that bypass the surface of the heart and travel between the myocardium could cause a constricting effect on the ventricular wall like that caused by myocardial fibrosis.

METHODS AND RESULTS: 581 patients diagnosed with coronary heart disease (CHD) were divided into A group (patients are the control group), B group (patients with less than 50% coronary artery stenosis), C group (patients with coronary artery stenosis between 50 and 75%), D group (patients with coronary artery stenosis greater than 75%) according to the degree of coronary stenosis. The diastolic function of the ventricle is reflected by applying the relaxation time constant T value, which refers to the time between peak dp/dt and end-diastolic pressure in the left ventricle. It was concluded that there was a statistical difference in Gensini scores between patients in groups B, C and D (P < 0.001). And multiple linear regression analysis showed that T was correlated with Gensini score and C-dp/dtmax (R = 0.711, P < 0.001). Grouping according to the site of stent implantation and the number of stents implanted, it was found out that the changes in T values before and after left anterior descending artery (LAD) stent implantation were greater than left circumflex artery (LCX) and right coronary artery (RCA) (P < 0.001). And multiple linear regression revealed a correlation between T values and stent length, ventricular stiffness, and C-dp/dtmax (P = 0.001).

CONCLUSIONS: The decrease in compliance of the coronary arteries bypassing the surface of the heart and travelling between the myocardium would cause a constricting effect on the ventricular wall like that caused by myocardial fibrosis.

PMID:35978296 | DOI:10.1186/s12872-022-02809-0

J Med Internet Res. 2022 Aug 17;24(8):e38714. doi: 10.2196/38714.

ABSTRACT

BACKGROUND: In health care, the benefits of digitalization need to outweigh the risks, but there is limited knowledge about the factors affecting this balance in the work environment of physicians. To achieve the benefits of digitalization, a more comprehensive understanding of this complex phenomenon related to the digitalization of physicians’ work is needed.

OBJECTIVE: The aim of this study was to examine physicians’ perceptions of the effects of health care digitalization on their work and to analyze how these perceptions are associated with multiple factors related to work and digital health usage.

METHODS: A representative sample of 4630 (response rate 24.46%) Finnish physicians (2960/4617, 64.11% women) was used. Statements measuring the perceived effects of digitalization on work included the patients’ active role, preventive work, interprofessional cooperation, decision support, access to patient information, and faster consultations. Network analysis of the perceived effects of digitalization and factors related to work and digital health usage was conducted using mixed graphical modeling. Adjusted and standardized regression coefficients are denoted by b. Centrality statistics were examined to evaluate the relative influence of each variable in terms of node strength.

RESULTS: Nearly half of physicians considered that digitalization has promoted an active role for patients in their own care (2104/4537, 46.37%) and easier access to patient information (1986/4551, 43.64%), but only 1 in 10 (445/4529, 9.82%) felt that the impact has been positive on consultation times with patients. Almost half of the respondents estimated that digitalization has neither increased nor decreased the possibilities for preventive work (2036/4506, 45.18%) and supportiveness of clinical decision support systems (1941/4458, 43.54%). When all variables were integrated into the network, the most influential variables were purpose of using health information systems, employment sector, and specialization status. However, the grade given to the electronic health record (EHR) system that was primarily used had the strongest direct links to faster consultations (b=0.32) and facilitated access to patient information (b=0.28). At least 6 months of use of the main EHR was associated with facilitated access to patient information (b=0.18).

CONCLUSIONS: The results highlight the complex interdependence of multiple factors associated with the perceived effects of digitalization on physicians’ work. It seems that a high-quality EHR system is critical for promoting smooth clinical practice. In addition, work-related factors may influence other factors that affect digital health success. These factors should be considered when developing and implementing new digital health technologies or services for physicians’ work. The adoption of digital health is not just a technological project but a project that changes existing work practices.

PMID:35976692 | DOI:10.2196/38714

JAMA Dermatol. 2022 Aug 17. doi: 10.1001/jamadermatol.2022.3171. Online ahead of print.

ABSTRACT

IMPORTANCE: Identifying the optimal long-term biologic therapy for patients with psoriasis is often done through trial and error.

OBJECTIVE: To identify the optimal biologic therapy for individual patients with psoriasis using predictive statistical and machine learning models.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used data from Danish nationwide registries, primarily DERMBIO, and included adult patients treated for moderate-to-severe psoriasis with biologics. Data were processed and analyzed between spring 2021 and spring 2022.

MAIN OUTCOMES AND MEASURES: Patient clusters of clinical relevance were identified and their success rates estimated for each drug. Furthermore, predictive prognostic models to identify optimal biologic treatment at the individual level based on data from nationwide registries were evaluated.

RESULTS: Assuming a success criterion of 3 years of sustained treatment, this study included 2034 patients with a total of 3452 treatment series. Most treatment series involved male patients (2147 [62.2%]) originating from Denmark (3190 [92.4%]), and 2414 (69.9%) had finished an education longer than primary school. The average ages were 24.9 years at psoriasis diagnosis and 45.5 years at initiation of biologic therapy. Gradient-boosted decision trees and logistic regression were able to predict a specific cytokine target (eg, interleukin-17 inhibition) associated with a successful treatment with accuracies of 63.6% and 59.2%, and top 2 accuracies of 95.9% and 93.9%. When predicting specific drugs resulting in success, gradient boost and logistic regression had accuracies of 48.5% and 44.4%, top 2 accuracies of 77.6% and 75.9%, and top 3 accuracies of 89.9% and 89.0%.

CONCLUSIONS AND RELEVANCE: Of the treatment prediction models used in this cohort study of patients with psoriasis, gradient-boosted decision trees performed significantly better than logistic regression when predicting specific biologic therapy (by drug as well as target) leading to a treatment duration of at least 3 years without discontinuation. Predicting the optimal biologic could benefit patients and clinicians by minimizing the number of failed treatment attempts.

PMID:35976663 | DOI:10.1001/jamadermatol.2022.3171

JAMA Psychiatry. 2022 Aug 17. doi: 10.1001/jamapsychiatry.2022.2386. Online ahead of print.

ABSTRACT

IMPORTANCE: Improved understanding of the boundaries and connections between positive symptoms, negative symptoms, and role functioning in schizophrenia is critical, given limited empirical support for clear distinctions among these clinical areas. This study’s use of network psychometrics to investigate differential associations and structural overlap between positive symptoms, negative symptoms, and functional domains in schizophrenia may contribute to such understanding.

OBJECTIVE: To apply network analysis and community detection methods to examine the interplay and structure of positive symptoms, negative symptoms, and functional domains in individuals with schizophrenia.

DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study in 5 geographically distributed research centers in the US as part of the Consortium on the Genetics of Schizophrenia-2 from July 1, 2010, through January 31, 2014. Data were analyzed from November 2021 to June 2022. Clinically stable outpatients with schizophrenia or schizoaffective disorder were included. Participants were excluded if they had evidence of neurologic or additional Axis I psychiatric disorders. Other exclusion criteria included head injury, stroke, and substance abuse. Of 1415 patients approached, 979 were included in the final analysis.

MAIN OUTCOMES AND MEASURES: Measures included the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, and the Role Functioning Scale. Main outcomes were expected influence, which assesses the relative importance of items to the network and is defined as the association of an item with all others, and community detection and stability, defined as the presence of statistical clusters and their replicability.

RESULTS: Participants with complete data included 979 outpatients (mean [SD] age, 46 [11] years; 663 male [67.7%]; 390 participants [40%] self-identified as African American, 30 [3%] as Asian, 7 [0.7%] as Native American, 8 [0.8%] as Pacific Islander, 412 [42.1%] as White, 125 [12.8%] as more than 1 race, and 5 [0.5%] did not identify). Anhedonia had the highest expected influence in the most comprehensive network analysis, showing connections with negative and positive symptoms and functional domains. Positive symptoms had the lowest expected influence. Community detection analyses indicated the presence of 3 clusters corresponding to positive symptoms; negative symptoms and work functioning; functional domains, including independent living, family relationships, and social network; and avolition, anhedonia, and work functioning. Hallucinations and delusions replicated in 1000 bootstrapped samples (100%), while bizarre behavior and thought disorder replicated in 390 (39%) and 570 (57%), respectively. In contrast, negative symptoms and work functioning replicated between 730 (73%) and 770 (77%) samples, respectively, and the remaining functional domains in 940 samples (94%).

CONCLUSIONS AND RELEVANCE: The high centrality of anhedonia and its connections with multiple functional domains suggest that it could be a treatment target for global functioning. Interventions for work functioning may benefit from a specialized approach that focuses primarily on avolition.

PMID:35976655 | DOI:10.1001/jamapsychiatry.2022.2386

JAMA Netw Open. 2022 Aug 1;5(8):e2227211. doi: 10.1001/jamanetworkopen.2022.27211.

ABSTRACT

IMPORTANCE: Appropriate clinical decision-making relies on accurate data interpretation, which in turn relies on the use of suitable statistical models. Long tails and early crossover-2 features commonly observed in immune checkpoint inhibitor (ICI) survival curves-raise questions as to the suitability of Cox proportional hazards regression for ICI survival analysis. Cox proportional hazards-Taylor expansion adjustment for long-term survival data (Cox-TEL) adjustment may provide possible solutions in this setting.

OBJECTIVE: To estimate overall survival and progression-free survival benefits of ICI therapy vs chemotherapy using Cox-TEL adjustment.

DATA SOURCES: A PubMed search was performed for all cataloged publications through May 22, 2022.

STUDY SELECTION: The search was restricted to randomized clinical trials with search terms for ICIs and lung cancer, melanoma, or urothelial carcinoma. The publications identified were further reviewed for inclusion.

DATA EXTRACTION AND SYNTHESIS: Cox proportional hazards ratios (HRs) were transformed to Cox-TEL HRs for patients with short-term treatment response (ie, short-term survivor) (ST-HR) and difference in proportions for patients with long-term survival (LT-DP) by Cox-TEL. Meta-analyses were performed using a frequentist random-effects model.

MAIN OUTCOMES AND MEASURES: Outcomes of interest were pooled overall survival (primary outcome) and progression-free survival (secondary outcome) HRs, ST-HRs, and LT-DPs. Subgroup analyses stratified by cancer type also were performed.

RESULTS: A total of 1036 publications was identified. After 3 levels of review against inclusion criteria, 13 clinical trials (7 in non-small cell lung cancer, 3 in melanoma, and 3 in urothelial carcinoma) were selected for the meta-analysis. In the primary analysis, pooled findings were 0.75 (95% CI, 0.70-0.81) for HR, 0.86 (95% CI, 0.81-0.92) for ST-HR, and 0.08 (95% CI, 0.06-0.10) for LT-DP. In the secondary analysis, the pooled values for progression-free survival were 0.77 (95% CI, 0.64-0.91) for HR, 1.02 (95% CI, 0.84-1.24) for ST-HR, and 0.10 (95% CI, 0.06-0.14) for LT-DP.

CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis of ICI clinical trial results noted consistently larger ST-HRs vs Cox HRs for ICI therapy, with an LT-DP of approximately 10%. These results suggest that Cox HRs may not provide a full picture of survival outcomes when the risk reduction from treatment is not constant, which may aid in the decision-making process of oncologists and patients.

PMID:35976648 | DOI:10.1001/jamanetworkopen.2022.27211

J Ultrasound. 2022 Aug 17. doi: 10.1007/s40477-022-00709-9. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate and compare the mammographic and ultrasonographic features of TNBC with non-TNBC.

METHODS: A retrospective review of 193 invasive breast cancer patients (TNBC = 32 and non-TNBC = 161) was collected from January 2014 to June 2019. The imaging features were reviewed according to the 5th edition of the American College of Radiology Breast Imaging Reporting and Data System lexicon. We used the student t-test, Mann-Whitney U test, and Fisher’s exact test for statistical analyses.

RESULTS: Mass without calcifications was the most mammographic feature of TNBC (22 of 32, 68.8%) and more commonly found in TNBC than in non-TNBC (p = 0.007). The irregular shape (19 of 28, 67.9%) and indistinct margin (10 of 28, 35.7%) were the most common findings in the TNBC group. However, TNBC lesions appeared as round or oval shape and microlobulated margin more frequently than non-TNBC lesions (p < 0.001). Additionally, the tumor size and histological grade of TNBC were significantly higher than non-TNBC (p < 0.001).

CONCLUSION: TNBC has distinct imaging features compared to non-TNBC. The imaging features on mammography combined with ultrasonography can be used to detect and differentiate this subtype from other breast cancers.

PMID:35976611 | DOI:10.1007/s40477-022-00709-9

Qual Life Res. 2022 Aug 17. doi: 10.1007/s11136-022-03217-9. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to (1) describe the health-related quality of life (HRQoL) outcomes experienced by children born very preterm (28-31 weeks’ gestation) and extremely preterm (< 28 weeks’ gestation) at five years of age and (2) explore the mediation effects of bronchopulmonary dysplasia (BPD) and severe non-respiratory neonatal morbidity on those outcomes.

METHODS: This investigation was based on data for 3687 children born at < 32 weeks’ gestation that contributed to the EPICE and SHIPS studies conducted in 19 regions across 11 European countries. Descriptive statistics and multi-level ordinary linear squares (OLS) regression were used to explore the association between perinatal and sociodemographic characteristics and PedsQL^™ GCS scores. A mediation analysis that applied generalised structural equation modelling explored the association between potential mediators and PedsQL^™ GCS scores.

RESULTS: The multi-level OLS regression (fully adjusted model) revealed that birth at < 26 weeks’ gestation, BPD status and experience of severe non-respiratory morbidity were associated with mean decrements in the total PedsQL^™ GCS score of 0.35, 3.71 and 5.87, respectively. The mediation analysis revealed that the indirect effects of BPD and severe non-respiratory morbidity on the total PedsQL^™ GCS score translated into decrements of 1.73 and 17.56, respectively, at < 26 weeks’ gestation; 0.99 and 10.95, respectively, at 26-27 weeks’ gestation; and 0.34 and 4.80, respectively, at 28-29 weeks’ gestation (referent: birth at 30-31 weeks’ gestation).

CONCLUSION: The findings suggest that HRQoL is particularly impaired by extremely preterm birth and the concomitant complications of preterm birth such as BPD and severe non-respiratory morbidity.

PMID:35976599 | DOI:10.1007/s11136-022-03217-9

Environ Sci Pollut Res Int. 2022 Aug 17. doi: 10.1007/s11356-022-21962-9. Online ahead of print.

ABSTRACT

Few studies have evaluated the association between air pollutants and neural tube defects (NTDs). Moreover, the existing research ignores the lag effect of air pollution on health and provides inconsistent epidemiological evidence. We aim to estimate the association between air pollution and NTDs during the first trimester of pregnancy and identify specific susceptible windows. Birth data was collected from the Birth Defects Surveillance Network in Lanzhou from September 1, 2014, to December 31, 2019. Air quality and meteorological data were collected from ambient air monitoring stations and China Meteorological Data Network. The log connection function of the Poisson distribution function is used to establish a DLNM model to estimate the exposure-effect relationship and exposure-lag relationship association between air pollutants levels and NTDs. There were 320,787 perinatal infants in Lanzhou from September 1, 2014, to December 31, 2019, and 486 cases of NTDs (1.5‰). The result indicates that exposure to inhalable particles (PM₁₀) at lag 2-4 weeks was significantly associated with the risk of NTDs, with the most significant impact at the lag 2 week (RR=1.048, 95%CI, 1.015-1.084). Exposure to fine particulate matter (PM_2.5) at the lag 2 week was significantly associated with the risk of NTDs, with the most significant impact at the lag 2 week (RR=1.077, 95%CI, 1.004-1.155). Exposure to sulfur dioxide (SO₂) and nitrogen dioxide (NO₂) at lag 3-6weeks was significantly associated with the risk of NTDs, with the most significant impact at the lag 4 week (RR=1.220, 95%CI, 1.105-1.348; RR=1.143, 95%CI, 1.048-1.245). This study provides further evidence that exposure to air pollutants in the first trimester of pregnancy significantly increases the risk of neural tube defects.

PMID:35976594 | DOI:10.1007/s11356-022-21962-9

Environ Sci Pollut Res Int. 2022 Aug 17. doi: 10.1007/s11356-022-22431-z. Online ahead of print.

ABSTRACT

Many studies have detected a relationship between diarrhea morbidity rates with the changes in precipitation, temperature, floods, droughts, water shortage, etc. But, most of the authors were cautious in their studies, because of the lack of empirical climate-health data and there were large uncertainties in the future projections. The study aimed to refine the link between the morbidity rates of diarrhea in some Egyptian governorates representative of the three Egyptian geographical divisions with the meteorological changes that occurred in the 2006-2016 period for which the medical data are available, as a case study. Medical raw data was collected from the Information Centre Department of the Egyptian Ministry of Health and Population. The meteorological data of temperature and precipitation extremes were defined as data outside the 10th-90th percentile range of values of the period of study, and their analysis was done using a methodology similar to the one recommended by the WMO and integrated in the CLIMDEX software. Relationships between the morbidity rates of diarrhea in seven Egyptian governorates and the meteorological changes that occurred in the period 2006 to 2016 were analyzed using multiple linear regression analysis to identify the most effective meteorological factor that affects the trend of morbidity rate of diarrhea in each governorate. Statistical analysis revealed that some meteorological parameters can be used as predictors for morbidity rates of diarrhea in Cairo, Alexandria, and Gharbia, but not in Aswan, Behaira, and Dakahlia where the temporal evolution cannot be related with meteorology. In Red Sea, there was no temporal trend and no significant relationships between the diarrhea morbidity rate and meteorological parameters. The predictor meteorological parameters for morbidity rates of diarrhea were found to be depending on the geographic locations and infrastructures in these governorates. It was concluded that the meteorological data that can be used as predictors for the morbidity rate of diarrhea is depending on the geographical location and infrastructures of the target location. The socioeconomic levels as well as the infrastructures in the governorate must be considered confounders in future studies.

PMID:35976593 | DOI:10.1007/s11356-022-22431-z