Category: Statistics

Cancer Cytopathol. 2021 Mar 31. doi: 10.1002/cncy.22427. Online ahead of print.

ABSTRACT

BACKGROUND: The salivary gland neoplasm of unknown malignant potential (SUMP) category reflects the cytomorphologic overlap and complexity of reporting salivary gland cytology in the Milan system. It includes neoplasms for which a diagnosis of a specific entity cannot be made and, more importantly, for which a carcinoma cannot be entirely excluded. For risk stratification, the subcategorization of SUMP based on the predominant cell type is recommended. This study was aimed at evaluating the risk of neoplasm (RON) and the risk of malignancy (ROM) of the basaloid and oncocytic subtypes of the SUMP category.

METHODS: A retrospective analysis of 482 salivary gland fine-needle aspirations from 2012 to 2019 resulted in 48 SUMP cases. The cytology of these cases was reviewed and reclassified as the basaloid or oncocytic subtype. Surgical follow-up was available for 36 cases. The RON and ROM for each subtype were calculated.

RESULTS: The RON and ROM were 100% and 23%, respectively, for monomorphic basaloid tumors and 88% and 58.8%, respectively, for monomorphic oncocytic tumors. The ROM for basaloid tumors was 8.3% without matrix/with minimal matrix and 60% with an nonfibrillary matrix. The ROM for oncocytic tumors was 50% without a cystic background and 60% with a cystic or mucinous background. The difference was not statistically significant for either of the subgroups.

CONCLUSIONS: Even though statistically not significant in our study, the differential ROMs within the oncocytic and basaloid subgroups help in the risk stratification of SUMP cases. Further subcategorization based on the stroma and background helps in limiting the differential diagnosis but does not necessarily add to the value of the risk stratification.

PMID:33788998 | DOI:10.1002/cncy.22427

Dent Med Probl. 2021 Mar 31. doi: 10.17219/dmp/130088. Online ahead of print.

ABSTRACT

BACKGROUND: In the past 20 years, several studies and clinical trials have reported similar results for transmucosal implants as compared to submerged implants. Several advantages of immediate loading have been pointed out, such as the reduction of treatment time, trauma reduction, and immediate esthetic and functional improvements.

OBJECTIVES: The main objective of this study was to clinically evaluate the implant survival rate in patients with total rehabilitation via implants that underwent immediate loading in the past 5 years.

MATERIAL AND METHODS: A cross-sectional, descriptive, observational analysis was conducted. The implant survival rate for an edentulous maxilla or mandible was assessed with regard to the loading protocol by means of a questionnaire and clinical observation. The study included 103 patients with edentulous jaws rehabilitated with fixed prostheses on implants. Each patient received 4-6 implants. In total, 474 implants were placed. Factors such as the implant survival rate as well as biological and prosthetic complications were evaluated and analyzed statistically.

RESULTS: Of the 474 implants initially placed, 458 were considered osteointegrated and 16 were considered lost, which corresponds to a 96.62% implant survival rate. The most common types of failure were prosthetic fractures (46.2%), peri-implantitis (23.1%) and unscrewing (11.5%) in the first 5 years.

CONCLUSIONS: The rate of osseointegration for implants placed under immediate loading was extremely high, in accordance with the previously published studies, which led us to conclude that currently, this is a surgical procedure with a high rate of success and high predictability.

PMID:33789002 | DOI:10.17219/dmp/130088

PLoS One. 2021 Mar 31;16(3):e0249391. doi: 10.1371/journal.pone.0249391. eCollection 2021.

ABSTRACT

BACKGROUND: Households are important sites for transmission of SARS-CoV-2 and preventive measures are recommended. This study aimed to 1) investigate the impact of living with a person infected with SARS-CoV-2; 2) understand how household members implemented infection control recommendations in their home; and 3) identify the information and support needs of household members.

METHODS: For this observational mixed-methods study, households with a person with confirmed SARS-CoV-2 infection were recruited via drive-through testing sites of Municipal Health Services, healthcare worker screening or hospital emergency visits in the University Medical Centre Utrecht, the Netherlands and via primary care physicians, hospital emergency visits or preoperative screening in the University Hospital of Antwerp, Belgium. We recorded household characteristics, including characteristics of all household members, together with their views on prevention measures. In a subset of households one adult household member was asked to participate in an interview investigating their views on preventive measures. Survey data were analysed using descriptive statistics and interview data by rapid framework analysis. A triangulation protocol was used to integrate findings.

RESULTS: Thirty-four households (120 household members) were included in the quantitative survey. Twenty-two households were invited to be interviewed, of which 18 completed an interview (response 81.8%). Survey data showed that almost all households implemented some preventive measures, the use of face masks being least frequently reported. Measures taken depended on what was physically possible, the perceived severity of illness of the index patient and to what extent household members were willing to limit social interaction. Respondents did not believe in the effectiveness of wearing face masks within the house, and from the interviews this was explained by media coverage of face masks, impracticality and the stigma associated with wearing masks. Interviewees reported that quarantine had a high emotional burden and wished to have more information about the exact duration of quarantine, their own COVID-19 status, symptoms and when to seek medical help.

CONCLUSION: People were willing to implement prevention measures, however actual adherence depended on perceived severity of illness and the perceived risk of becoming infected. Homes are social environments and recommendations for infection prevention should account for this context. Incorporating our findings into policy making could provide households with more relevant and actionable advice.

PMID:33788890 | DOI:10.1371/journal.pone.0249391

PLoS One. 2021 Mar 31;16(3):e0248755. doi: 10.1371/journal.pone.0248755. eCollection 2021.

ABSTRACT

Early palliative/supportive care (ePSC) is a medical intervention focused on patient’s needs, that integrates standard oncological treatment, shortly after a diagnosis of advanced/metastatic cancer. ePSC improves the appropriate management of cancer pain. Understanding the semantic and emotional impact of the words used by patients to describe their pain may further improve its assessment in the ePSC setting. Psycholinguistics assumes that the semantic and affective properties of words affect the ease by which they are processed and comprehended. Therefore, in this cross-sectional survey study we collected normative data about the semantic and affective properties of words associated to physical and social pain, in order to investigate how patients with cancer pain on ePSC process them compared to healthy, pain-free individuals. One hundred ninety patients and 124 matched controls rated the Familiarity, Valence, Arousal, Pain-relatedness, Intensity, and Unpleasantness of 94 words expressing physical and social pain. Descriptive and inferential statistics were performed on ratings in order to unveil patients’ semantic and affective representation of pain and compare it with those from controls. Possible effects of variables associated to the illness experience were also tested. Both groups perceived the words conveying social pain as more negative and pain-related than those expressing physical pain, confirming previous evidence of social pain described as worse than physical pain. Patients rated pain words as less negative, less pain-related, and conveying a lower intense and unpleasant pain than controls, suggesting either an adaptation to the pain experience or the role played by ePSC in improving patients’ ability to cope with it. This exploratory study suggests that a chronic pain experience as the one experienced by cancer patients on ePSC affects the semantic and affective representation of pain words.

PMID:33788893 | DOI:10.1371/journal.pone.0248755

PLoS One. 2021 Mar 31;16(3):e0248752. doi: 10.1371/journal.pone.0248752. eCollection 2021.

ABSTRACT

BACKGROUND: Despite a free access to public health services policy in most sub-Saharan African countries, households still contribute to total health expenditures through out-of-pocket expenditures. This reliance on out-of-pocket expenditures places households at a risk of catastrophic health expenditures and impoverishment. This study examined the incidence of catastrophic health expenditures, impoverishing effects of out-of-pocket expenditures on households and factors associated with catastrophic expenditures in Malawi.

METHODS: We conducted a secondary analysis of the most recent nationally representative integrated household survey conducted by the National Statistical Office between April 2016 to 2017 in Malawi with a sample size of 12447 households. Catastrophic health expenditures were estimated based on household annual nonfood expenditures and total household annual expenditures. We estimated incidence of catastrophic health expenditures as the proportion of households whose out-of-pocket expenditures exceed 40% threshold level of non-food expenditures and 10% of total annual expenditures. Impoverishing effect of out-of-pocket health expenditures on households was estimated as the difference between poverty head count before and after accounting for household health payments. We used a multilevel binary logistic regression model to assess factors associated with catastrophic health expenditures.

RESULTS: A total of 167 households (1.37%) incurred catastrophic health expenditures. These households on average spend over 52% of household nonfood expenditures on health care. 1.6% of Malawians are impoverished due to out-of-pocket health expenditures. Visiting a religious health facility (AOR = 2.27,95% CI:1.24-4.15), hospitalization (AOR = 6.03,95% CI:4.08-8.90), larger household size (AOR = 1.20,95% CI:1.24-1.34), higher socioeconomic status (AOR = 2.94,95% CI:1.39-6.19), living in central region (AOR = 3.54,95% CI:1.79-6.97) and rural areas (AOR = 5.13,95% CI:2.14-12.29) increased the odds of incurring catastrophic expenditures.

CONCLUSION: The risk of catastrophic health expenditures and impoverishment persists in Malawi. This calls for government to improve the challenges faced by the free public health services and design better prepayment mechanisms to protect more vulnerable groups of the population from the burden of out-of-pocket payments.

PMID:33788900 | DOI:10.1371/journal.pone.0248752

PLoS One. 2021 Mar 31;16(3):e0249040. doi: 10.1371/journal.pone.0249040. eCollection 2021.

ABSTRACT

BACKGROUND: GPRC5A is associated with various cancer initiation and progression. Controversial findings have been reported about GPRC5A prognostic characteristics, and no meta-analysis has been conducted to assess the relationship between GPRC5A and cancer prognosis. Therefore, the objective of this meta-analysis is to evaluate the overall prognostic effectiveness of GPRC5A.

METHODS: We first conducted a systematic search in the PubMed, Embase, Web of Science, CNKI, Cochrane, and WangFang databases. The hazard ratio (HR) and odds ratios (OR) with 95% CI were then pooled to assess the associations between GPRC5A expression and overall survival (OS), disease-free survival (DFS), event-free survival (EFS), and clinicopathological characteristics. Chi-squared test and I2 statistics were completed to evaluate the heterogeneity in our study. A random-effects model was used when significant heterogeneity existed (I2>50% and p<0.05); otherwise, we chose the fixed-effect model. Subgroup analysis was stratified by tumor type, region, HR obtained measurements, and sample capacity to explore the source of heterogeneity.

RESULTS: In total, 15 studies with 624 patients met inclusion criteria of this study. Our results showed that higher expression of GPRC5A is associated with worse OS (HR:1.69 95%CI: 1.20-2.38 I2 = 75.6% p = 0.000), as well as worse EFS (HR:1.45 95%CI: 1.02-1.95 I2 = 0.0% p = 0.354). Subgroup analysis indicated that tumor type might be the source of high heterogeneity. Additionally, cancer patients with enhanced GPRC5A expression were more likely to lymph node metastasis (OR:1.95, 95%CI 1.33-2.86, I2 = 43.9%, p = 0.129) and advanced tumor stage (OR: 1.83, 95%CI 1.15-2.92, I2 = 61.3%, p = 0.035), but not associated with age, sex, differentiation, and distant metastasis.

CONCLUSION: GPRC5A can be a promising candidate for predicting medical outcomes and used for accurate diagnosis, prognosis prediction for patients with cancer; however, the predictive value of GPRC5A varies significantly according to cancer type. Further studies for this mechanism will be necessary to reveal novel insights into application of GPRC5A in cancers.

PMID:33788883 | DOI:10.1371/journal.pone.0249040

PLoS One. 2021 Mar 31;16(3):e0249121. doi: 10.1371/journal.pone.0249121. eCollection 2021.

ABSTRACT

Pandemics have historically had a significant impact on economic inequality. However, official inequality statistics are only available at low frequency and with considerable delay, which challenges policymakers in their objective to mitigate inequality and fine-tune public policies. We show that using data from bank records it is possible to measure economic inequality at high frequency. The approach proposed in this paper allows measuring, timely and accurately, the impact on inequality of fast-unfolding crises, like the COVID-19 pandemic. Applying this approach to data from a representative sample of over three million residents of Spain we find that, absent government intervention, inequality would have increased by almost 30% in just one month. The granularity of the data allows analyzing with great detail the sources of the increases in inequality. In the Spanish case we find that it is primarily driven by job losses and wage cuts experienced by low-wage earners. Government support, in particular extended unemployment insurance and benefits for furloughed workers, were generally effective at mitigating the increase in inequality, though less so among young people and foreign-born workers. Therefore, our approach provides knowledge on the evolution of inequality at high frequency, the effectiveness of public policies in mitigating the increase of inequality and the subgroups of the population most affected by the changes in inequality. This information is fundamental to fine-tune public policies on the wake of a fast-moving pandemic like the COVID-19.

PMID:33788886 | DOI:10.1371/journal.pone.0249121

PLoS One. 2021 Mar 31;16(3):e0249329. doi: 10.1371/journal.pone.0249329. eCollection 2021.

ABSTRACT

Uranium, perhaps the most strategically important component of heavy minerals, finds particular significance in the nuclear industry. In prospecting trenches, the radioactivity of 238U and 232Th provides a good signature of the presence of heavy minerals. In the work herein, the activity concentrations of several key primordial radionuclides (238U, 232Th, and 40K) were measured in prospecting trenches (each of the latter being of approximately the same geometry and physical situation). All of these are located in the Seila area of the South Eastern desert of Egypt. A recently introduced industry standard, the portable hand-held RS-230 BGO gamma-ray spectrometer (1024 channels) was employed in the study. Based on the measured data, the trenches were classified as either non-regulated (U activity less than 1000 Bq kg-1) or regulated (with 238U activity more than 1000 Bq kg-1). Several radiological hazard parameters were calculated, statistical analysis also being performed to examine correlations between the origins of the radionuclides and their influence on the calculated values. While the radioactivity and hazard parameters exceed United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) guided limits, the mean annual effective doses of 0.49 and 1.4 mSv y-1 in non-regulated and regulated trenches respectively remain well below the International Commission on Radiological Protection (ICRP) recommended 20 mSv/y maximum occupational limit. This investigation reveals that the studied area contains high uranium content, suitable for extraction of U-minerals for use in the nuclear fuel cycle.

PMID:33788889 | DOI:10.1371/journal.pone.0249329

PLoS One. 2021 Mar 31;16(3):e0248518. doi: 10.1371/journal.pone.0248518. eCollection 2021.

ABSTRACT

BACKGROUND: Protecting people from financial hardship and impoverishment due to health care costs is one of the fundamental purposes of the Mongolian health system. However, the inefficient, oversized hospital sector is considered one of the main shortcomings of the system. The aim of this study is to contribute to policy discussions by estimating the extent of catastrophic health expenditure and impoverishment due to inpatient care at secondary-level and tertiary-level public hospitals and private hospitals.

METHODS: Data were derived from a nationally representative survey, the Household Socio-Economic Survey 2012, conducted by the National Statistical Office of Mongolia. A total of 12,685 households were involved in the study. “Catastrophic health expenditure” is defined as out-of-pocket payments for inpatient care that exceed a threshold of 40% of households’ non-discretionary expenditure. The “impoverishment” effect of out-of-pocket payments for inpatient care was estimated as the difference between the poverty level before health care payments and the poverty level after these payments.

RESULTS: At the threshold of 40% of capacity to pay, 0.31%, 0.07%, and 0.02% of Mongolian households suffered financially as a result of their member(s) staying in tertiary-level and secondary-level public hospitals and private hospitals respectively. About 0.13% of the total Mongolian population was impoverished owing to out-of-pocket payments for inpatient care at tertiary-level hospitals. Out-of-pocket payments for inpatient care at secondary-level hospitals and private hospitals were responsible for 0.10% and 0.09% respectively of the total population being pushed into poverty.

CONCLUSIONS: Although most inpatient care at public hospitals is covered by the social health insurance benefit package, patients who utilized inpatient care at tertiary-level public hospitals were more likely to push their households into financial hardship and poverty than the inpatients at private hospitals. Improving the hospital sector’s efficiency and financial protection for inpatients would be a crucial means of attaining universal health coverage in Mongolia.

PMID:33788865 | DOI:10.1371/journal.pone.0248518

PLoS Negl Trop Dis. 2021 Mar 31;15(3):e0009193. doi: 10.1371/journal.pntd.0009193. Online ahead of print.

ABSTRACT

Single brain enhancing lesions (SEL) are the most common presentation of neurocysticercosis (NCC) observed on neuroimaging in people presenting with epileptic seizures not only on the Indian sub-continent and in travelers returning from cysticercosis-endemic regions, but also globally. The aim of this study, which consisted of a systematic review (CRD42019087665), a meta-analysis and an expert group consultation, was to reach consensus on the best anti-seizure medication and anti-inflammatory treatment for individuals with SEL NCC. Standard literature review methods were used, including the Cochrane risk of bias random effects model, meta-analyses were performed and the quality of the body of evidence was rated using GRADE tables. The expert committee included 12 gender and geographically balanced members and recommendations were reached by applying the GRADE framework for guideline development. The 1-1.5-year cumulative incidence of seizure recurrence, cyst resolution or calcification following anti-seizure medication (ASM) withdrawal was not statistically different between ASM of 6, 12 or 24 months. In contrast, in persons whose cyst calcified post treatment, longer ASM decreased seizure recurrence. The cumulative incidence ratio (CIR) 1-1.5 years after stopping ASM was 1.79 95% CI: (1.00, 3.20) for patients given 6 versus 24 months treatment. Duration of treatment had no effect on seizure recurrence in patients whose cyst did not calcify. Anti-inflammatory treatment with corticosteroids in patients treated with ASM compared to patients treated with ASM only showed a statistically significant beneficial effect on seizure reduction (CIR 0.44, 95% CI 0.23, 0.85) and cyst resolution (CIR 1.37, 95%CI: 1.07, 1.75). Our results indicate that ASM in patients with SEL NCC whose cysts resolved can be withdrawn, while patients whose cysts calcified seem to benefit from prolonged anti-seizure medication. Additional corticosteroid treatment was found to have a beneficial effect both on seizure reduction and cyst resolution.

PMID:33788843 | DOI:10.1371/journal.pntd.0009193