Category: Statistics

PLoS One. 2022 Aug 5;17(8):e0268712. doi: 10.1371/journal.pone.0268712. eCollection 2022.

ABSTRACT

PURPOSE: Available but insufficient evidence shows that changes may occur in the immune system following coronavirus disease 2019 (COVID-19). The present study aimed at evaluating immunological changes in patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia compared with the control group.

METHOD: The present study was performed on 95 patients with COVID-19 (32 severe and 63 moderate cases) and 22 healthy controls. Relationship between immune cells, disease severity and lung involvement was assessed. Binary logistic regression and ROC curve tests were used for statistical analysis.

RESULTS: A significant decrease was observed in CD20+ cell counts of the patients. To differentiate patients from healthy individuals, the cutoff point for the CD4+ cell count was 688 /μL, sensitivity 0.96, and specificity 0.84. An increase in CD4+ cells reduces the odds of severe disease (odds ratio = 0.82, P = 0.047) and death (odds ratio = 0.74, P = 0.029). CD4+ cells play a pivotal role in the severity of lung involvement (P = 0.03). In addition to CD4+ cells, Fc gamma receptor III (FcγRIII) (CD16) also played a significant prognosis (odds ratio = 0.55, P = 0.047). In severe cases, C-reactive protein, Blood urea nitrogen, and Creatine phosphokinase levels, as well as neutrophil counts, were significantly higher than those of moderate ones whereas lymphocyte count in severe cases was lower than that of moderate ones.

CONCLUSION: The number of total T-cells and B-cells in patients with COVID-19 was lower than that of controls; however, their NK cells increased. FcγRIII and CD4+ cells are of great importance due to their association with COVID-19 prognosis.

PMID:35930526 | DOI:10.1371/journal.pone.0268712

Nutr Cancer. 2022 Aug 5:1-9. doi: 10.1080/01635581.2022.2104878. Online ahead of print.

ABSTRACT

Dietary factors show different effects on genetically diverse populations. Scientific research uses gene-environment interaction models to study the effects of dietary factors on genetically diverse populations for lung cancer risk. However, previous study designs have not investigated the degree of type I error inflation and, in some instances, have not corrected for multiple testing. Using a motivating investigation of diet-gene interaction and lung cancer risk, we propose a training and testing strategy and perform real-world simulations to select the appropriate statistical methods to reduce false-positive discoveries. The simulation results show that the unconstrained maximum likelihood (UML) method controls the type I error better than the constrained maximum likelihood (CML). The empirical Bayesian (EB) method can compete with the UML method in achieving statistical power and controlling type I error. We observed a significant interaction between SNP rs7175421 with dietary whole grain in lung cancer prevention, with an effect size (standard error) of -0.312 (0.112) for EB estimate. SNP rs7175421 may interact with dietary whole grains in modulating lung cancer risk. Evaluating statistical methods for gene-diet interaction analysis can help balance the statistical power and type I error.

PMID:35930377 | DOI:10.1080/01635581.2022.2104878

Hum Vaccin Immunother. 2022 Aug 5:2099163. doi: 10.1080/21645515.2022.2099163. Online ahead of print.

NO ABSTRACT

PMID:35930374 | DOI:10.1080/21645515.2022.2099163

Head Neck. 2022 Aug 5. doi: 10.1002/hed.27162. Online ahead of print.

ABSTRACT

BACKGROUND: Survival outcomes in recurrent head and neck squamous cell carcinoma (HNSCC) are poor. This study aimed to compare survival outcomes between salvage surgery and immunotherapy in patients with recurrent advanced HNSCC.

METHODS: Patients with advanced stage (stage III or IV) recurrent HNSCC following treatment with platinum-based chemotherapy were included. Survival was estimated using the Kaplan-Meier method, and Cox regression was used for multivariate logistic regression.

RESULTS: Two-year overall survival after salvage surgery was 68.6% and after immunotherapy patients was 24.6%. Multivariate logistic regression showed that salvage surgery was associated with improved survival without statistical significance (hazard ratio [HR] 0.12, p = 0.25). Subgroup analysis of patients with oral cavity/oropharyngeal cancer noted improved survival with salvage surgery over immunotherapy (HR 0.006, p = 0.01) and decreased survival with neutrophil-to-lymphocyte ratio (NLR) > 5 (HR 6.4, p = 0.02).

CONCLUSION: Our retrospective single-institutional data suggest that resectable advanced stage recurrent HNSCC may have improved survival with salvage surgery in appropriately selected patients, but larger prospective studies are required.

PMID:35930296 | DOI:10.1002/hed.27162

JAMA Netw Open. 2022 Aug 1;5(8):e2225805. doi: 10.1001/jamanetworkopen.2022.25805.

ABSTRACT

IMPORTANCE: Limited access to appropriate specialists and testing may be associated with delayed diagnosis and symptom management for patients with early-onset Alzheimer disease and related dementias (ADRDs).

OBJECTIVES: To examine rural vs urban differences in diagnostic and symptom management service use among patients with early-onset ADRDs.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted using commercial claims from 2012 to 2017. Included patients were those with early-onset ADRDs aged 40 to 64 years, including new patients, defined as those with no claims of ADRDs for 36 months before the first ADRD diagnosis. The likelihood of receiving diagnostic and symptom management services was estimated, with adjustment for individual-level variables associated with health care use. Data were analyzed from February 2021 to March 2022.

EXPOSURES: Rural residence.

MAIN OUTCOMES AND MEASURES: Among patients with new, early-onset ADRDs, use of psychological assessment and neuropsychological testing performed at the initial diagnosis (index date) or 90 days or less after the index date and use of brain imaging during the 180 days before the index date were collected. Access to different clinicians on the index date or 90 days or less after the index date was also collected, including visits to primary care physicians and nurse practitioners (PCPs) and specialty visits to psychologists, neurologists, and psychiatrists.

RESULTS: Among 71 799 patients with early-onset ADRD (mean [SD] age, 56.34 [6.05] years; 39 231 women [54.64%]), 8430 individuals had new early-onset ADRDs (mean [SD] age, 55.94 [6.30] years; 16 512 women [56.65%]). There were no statistically significant differences between new patients with early-onset ADRDs in rural vs urban areas in the use of psychological assessments, imaging studies, or visits to neurologists or psychiatrists. However, new patients in rural areas were less likely to receive neuropsychological testing (odds ratio [OR], 0.83; 95% CI, 0.70-0.98) or visit a psychologist (OR, 0.72; 95% CI, 0.60-0.85) compared with patients in urban areas. However, new patients in rural areas with early-onset ADRDs were more likely to have only PCP visits for diagnosis and symptom management compared with those in urban areas (OR, 1.40; 95% CI, 1.19-1.66).

CONCLUSIONS AND RELEVANCE: This study found that new patients with early-onset ADRDs in rural areas were less likely to receive neuropsychological testing or visit psychologists but more likely to be diagnosed and treated exclusively by PCPs compared with those in urban areas. These findings suggest that efforts, such as clinician education or teleconsultative guidance to PCPs, may be needed to enhance access to specialist services in rural areas.

PMID:35930281 | DOI:10.1001/jamanetworkopen.2022.25805

Hemoglobin. 2022 Aug 5:1-8. doi: 10.1080/03630269.2022.2083969. Online ahead of print.

ABSTRACT

Hepcidin (HEPC) hormone production is expected to be elevated in cases accompanying iron overload, but the opposite impact of ineffective erythropoiesis in β-thalassemia major (β-TM) patients overrides this effect. The role of the HEPC-to-ferritin (FER) ratio and its components in iron metabolism along with their diagnostic cutoff values, sensitivity, specificity, and accuracy in β-TM patients with iron overload, were examined in this study. This was a 1:1 case-control study with 120 participants, ages ranging from 2 to 30 years of both sexes, who were assigned into two groups: 60 β-TM patients with iron overload, and a control group, comprising 60 healthy individuals matched by gender and age. In the present study, we found slightly elevated serum HEPC concentration (21.9 ng/mL) compared to the controls (9.9 ng/mL), which was not statistically significant (p =0.1), and the median HEPC-to-FER ratio of the cases was significantly lower than the controls, with the median case-control difference of (-0.366; p < 0.001). Our results revealed a statistically significant impact (p < 0.001) of mean age on the serum HEPC level with the inverse linear correlation of (-0.487, p < 0.001). The area under the curve of the HEPC-to-FER ratio was 0.999 and the optimum cutoff value was 0.046 ng/mL (p < 0.001) with 100.0% sensitivity and 98.3% specificity. In conclusion, we found that serum HEPC-to-FER ratio, with an accuracy of 99.2%, may serve as an excellent index for the diagnosis of iron overload in β-TM patients differentiating them from nonthalassemic controls.

PMID:35930276 | DOI:10.1080/03630269.2022.2083969

Microsurgery. 2022 Aug 5. doi: 10.1002/micr.30946. Online ahead of print.

ABSTRACT

BACKGROUND: Free flap surgeries are useful procedures for lower-extremity reconstruction. Recipient vein selection for anastomosis is important to avoid venous congestion and thrombosis. Although deep or superficial venous system can be used as a recipient vein site, there is a lack of consensus on which system would be superior to avoid postoperative complications. This systematic review and meta-analysis aimed to assess the differences in outcomes between deep and superficial vein anastomosis for lower-extremity free flap reconstruction.

METHODS: The PubMed, Scopus, Web of Science, and Cochrane Library medical databases were systematically searched from inception to April 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A comparative meta-analysis was conducted on studies of deep and superficial venous system anastomosis outcomes, comprising vascular thrombosis, reoperation, complete flap necrosis, and any flap necrosis. The fixed-effects meta-analysis model was used when low heterogeneity (I² < 50%) was present.

RESULTS: Six studies with 789 flaps were included in the analysis and qualitative and quantitative syntheses. The rate of vascular thrombosis (8.2% vs. 15.1%; p = .005) was significantly lower for flaps involving deep vein anastomosis than for those involving superficial vein anastomosis. The rate of reoperation after deep vein anastomosis was lower than that after superficial vein anastomosis, with no statistically significant difference (9.0% vs. 14.7%; p = .06). There were no significant differences in the rates of complete (2.5% vs. 2.0%; p = .90) or any flap necrosis (7.0% vs. 9.8%; p = .20).

CONCLUSION: Deep vein anastomosis might be recommended for avoiding vascular thrombosis.

PMID:35930261 | DOI:10.1002/micr.30946

Int J Occup Saf Ergon. 2022 Aug 5:1-19. doi: 10.1080/10803548.2022.2110359. Online ahead of print.

ABSTRACT

BACKGROUND: Workplace inspection supports improving working environment and workers’ conditions. Changes in workplaces following inspections are construed as the inspection’s outcome. Inspectors need to be flexible, which affects their performance. This study aimed to design and develop a tool for inspection performance assessment based on identified inspection prerequisites and evaluate the tool’s appropriateness for performance assessment.

METHODS: Occupational safety and health experts were tasked to rank identified prerequisite for effective inspection performance, based on their experiences and perception of importance of the prerequisites. The outcome of the ranking exercise formed the basis for weighting and assignment of values to the prerequisites subgoals. A code was written creating an inspection performance assessment tool interface, which inspectors can assess their workplace inspection performance.Inspectors from different national authorities tested and evaluated the tool, providing feedback appropriateness for measuring inspection performance.

RESULTS: Statistical analysis of the data collected showed much agreement between the subject matter experts. A five-level performance consideration depending on the inspection performance index attained was implemented. On testing and evaluation of the tool, high average rating for the test criteria were obtained, with data from inspectors from different authorities showing higher interrater consistency, and thus reliability.

CONCLUSION: TIPA provides a systematic inspection performance quantification supporting inspectors’ self-actualisation, improving performance. Furthermore, the tool’s generality allows for use irrespective of the inspection area without affecting inspection areas specificity adjustments. In addition, the ease of use adds to its utility, and with agreement on the tool’s appropriateness for inspection performance assessment.

PMID:35930255 | DOI:10.1080/10803548.2022.2110359

J Palliat Med. 2022 Aug 5. doi: 10.1089/jpm.2022.0266. Online ahead of print.

ABSTRACT

Background: The opioid rotation ratios (ORRs) and conversion ratios (CRs) used worldwide among palliative care (PC) professionals to perform opioid rotations (ORs) and route conversions may have a wide variation. Methods: We surveyed PC professionals on opioid ratios used through email to the Multinational Association of Supportive Care in Cancer’s PC study group and Twitter and Facebook posts between September and November 2020. Results: We received 370 responses from respondents from 53 countries: 276 (76%) were physicians, 46 (13%) advanced practice providers, 39 (11%), and 9 respondents did not report their profession. There were statistically significant variations in median CR from intravenous (IV) to oral morphine (2-3), IV to oral hydromorphone (2-4.5), ORR from IV hydromorphone to oral morphine (10-20), and ORR from transdermal fentanyl mcg/hour to oral morphine (2-3.5) across various groups. Conclusion: This survey highlights the wide variation in ORRs and CRs among PC clinicians worldwide and the need for further research to standardize practice.

PMID:35930252 | DOI:10.1089/jpm.2022.0266

Int J Occup Saf Ergon. 2022 Aug 5:1-33. doi: 10.1080/10803548.2022.2108653. Online ahead of print.

ABSTRACT

OBJECTIVE: Investigate the prevalence, risk factors and impacts of neck and back pain among supermarkets cashiers in Botswana.

MATERIALS AND METHODS: A cross-sectional study was conducted among supermarkets cashiers using self-administered. Data were analysed using χ² and logistic regression models. Statistical significance was assumed at p<0.05.

RESULTS: A total of 174 supermarkets cashiers participated in this study majority of whom were females (72%). The prevalence of lower back pain was 69%, upper back pain 53% and neck pain 37%. Increasing age was associated with neck 95% CI [1.43-5.15] and upper back 95% CI [1.43-3.60] pain. Cashiers working at low work surface and overreaching for items were 19 and 11 times more likely to report neck 95% CI [1.7-255.9] and lower back 95% CI [1.84-62.1] pain, respectively. Almost 6% of cashiers who reported lower back pain reported considering changing jobs due to pain.

CONCLUSIONS: More than two-thirds, half and about two-fifths of supermarket cashiers reported lower back, upper back and neck pain, respectively. Individual and work-related factors were associated with neck and/or back pain. Back and neck pain workers’ health and wellbeing, their families, workplace productivity and the health care system. To reduce their prevalence and progression, supermarkets should introduce occupational health and safety talks.

PMID:35930246 | DOI:10.1080/10803548.2022.2108653