Category: Statistics

Physiology (Bethesda). 2022 Jul 26. doi: 10.1152/physiol.00015.2022. Online ahead of print.

ABSTRACT

This review focuses on the physiology of glymphatic solute transport and waste clearance, using evidence from experimental animal models as well as from human studies. Specific topics we will address include the biophysical characteristics of fluid and solute transport in the central nervous system, glymphatic-lymphatic coupling as well as the role of cerebrospinal fluid movement for brain waste clearance. We also discuss the current understanding of mechanisms underlying increased clearance during sleep.

PMID:35881783 | DOI:10.1152/physiol.00015.2022

Dev Neurorehabil. 2022 Jul 26:1-12. doi: 10.1080/17518423.2022.2099994. Online ahead of print.

ABSTRACT

PURPOSE: Fatigue in patients with acquired brain injury (ABI) is common. However, to better target fatigue, clear ways to categorize/interpret fatigue-severity in individual patients are lacking. This study aims to determine/categorize fatigue severity among children, adolescents, and young adults with ABI.

METHODS: This cross-sectional study included young patients admitted to outpatient rehabilitation and their parents. To determine fatigue, the PedsQL™Multidimensional-Fatigue-Scale was used (MFS, scores 0-100, lower scores = higher fatigue, patient-/parent-reported). Based on scores from a reference population, four categories were formed: “1 = no/little fatigued” to “4 = severely-more fatigued.”

RESULTS: All scores were lower than those from the reference population, with comparisons in the adolescent and young adult groups reaching statistical significance (p < .05). The proportions of patients in category 4 were: 9%/50%/58% among children/adolescents/young adults, showing that many patients were “severely-more fatigued”-than the reference population.

CONCLUSIONS: Measuring fatigue and categorizing fatigue severity looks promising for clinical practice and could help to better target fatigue.

PMID:35881762 | DOI:10.1080/17518423.2022.2099994

J Orthop Sports Phys Ther. 2022 Jul 26:1-16. doi: 10.2519/jospt.2022.11220. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess whether prior analyses, where there was a relationship between altitude and concussion rates in American football, would replicate using a larger data set and altitude as a continuous variable.

DESIGN: Cohort study replication.

METHODS: We analyzed data from all NFL regular season games from 2012-19. Concussions were identified from public databases and NFL injury reports. The altitude of each stadium was identified using mapping software. Concussion rates were calculated for each stadium and plotted against continuous altitude. We calculated crude rate ratios for several categorical cutpoints and used logistic and Poisson regression models to assess associations with continuous altitudes.

RESULTS: We identified 867 players (1,103 player-seasons) who sustained 1,159 concussions during the time period 2012 to 2019. All continuous plots and models showed no evidence of any association between concussions and altitude. A Poisson model found an IRR of 1.00 (95% CI 0.99-1.01) for every 100 ft increase in altitude. A 644 ft cutpoint (used in previous studies) produced a significant difference (incidence rate ratio (IRR) 0.71, 95% CI: 0.54-0.94) in 2012-13, but this did not replicate in 2014-19 (0.99, 95% CI: 0.84-1.14).

CONCLUSIONS: We found no association between altitude and concussion rates in the NFL when altitude was analyzed continuously rather than inappropriately categorized. Our findings should increase skepticism of any effect of altitude on concussions at the elevations at which most American football is played as well as clinical interventions based on that theory. It also underscores the importance of keeping continuous variables continuous wherever possible.

PMID:35881704 | DOI:10.2519/jospt.2022.11220

NCHS Data Brief. 2022 Jul;(440):1-8.

ABSTRACT

Drug overdose death rates, which have been rising over the past decade, differ by urban and rural counties across the United States (1-4). A previous report demonstrated higher drug overdose death rates in urban counties by various demographic and geographic characteristics (4). This report uses the most recent final mortality data from the National Vital Statistics System (NVSS) to describe urban and rural differences in drug overdose death rates in 2020 by sex, race and Hispanic origin, and selected types of opioids and stimulants.

PMID:35881473

J Hypertens. 2022 Jul 26. doi: 10.1097/HJH.0000000000003215. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the study was to assess the use of antihypertensive combination treatment, both as the initial and as a subsequent therapeutic step, in a large Italian population.

METHODS: The residents of the Lombardy Region (Italy), aged 40 years or older, who were newly treated with antihypertensive drugs during 2012, 2015 and 2018 were identified and the drug treatment strategy (monotherapy and combination of two, three and more than three antihypertensive drugs) was assessed at treatment initiation, and after 6 months, 1, 2, and 3 years of treatment. Data were also analysed after stratification for demographic and clinical categories.

RESULTS: About 100 000 patients were identified for each cohort. Monotherapy was the most common initial treatment strategy (75%), followed by two-drug single-pill combination (16%), two-drug free combination (6%), and combination of at least three drugs (3%). Use of two and three or more antihypertensive drugs increased during follow-up and reached about 32% (two drugs) and 11% (>2 drugs) of the patients after 3 years from treatment initiation. Among patients prescribed a two-drug combination, the single-pill was the most common approach, whereas the use of the three-drug single-pill combination was extremely rare. There were no substantial differences in the use of combination treatment between the three cohorts and the results were similar in all demographic and clinical categories.

CONCLUSION: Our data show that in a real-life population use of antihypertensive drug combinations is low. They also show that, contrary to guideline recommendations, antihypertensive combination treatment did not show any noticeable increase in recent years.

PMID:35881457 | DOI:10.1097/HJH.0000000000003215

J Hypertens. 2022 Aug 1;40(8):1478-1486. doi: 10.1097/HJH.0000000000003165.

ABSTRACT

OBJECTIVE: This study aimed to investigate the possible influence of arterial stiffness assessed by the cardio-ankle vascular index (CAVI) on chronic-phase left ventricular dysfunction in patients with ST-segment elevation myocardial infarction (STEMI).

METHODS: A total of 208 consecutive patients with first STEMI (age, 64 ± 11 years; 86% men) who underwent reperfusion therapy within 12 h of onset were enrolled. We analysed arterial stiffness by measuring CAVI in a stable phase after admission and performed two-dimensional echocardiography at baseline and 7 months’ follow-up. Subsequently, we assessed left ventricular global longitudinal strain (LV-GLS) to evaluate left ventricular function. A total of 158 (75.9%) patients underwent baseline cardiac magnetic resonance (CMR). We estimated left ventricular infarct size by measuring peak levels of creatine kinase-myocardial band (CK-MB), and CMR-late gadolinium enhancement (LGE).

RESULTS: On the basis of the median CAVI value, the patients were allocated into high CAVI (CAVI ≥ 8.575) and low CAVI (CAVI < 8.575) groups. The groups showed no statistically significant differences in LV-GLS at baseline (-13.5% ± 3.1 vs. -13.9% ± 2.7%, P = 0.324). However, LV-GLS was significantly worse in the high CAVI group than in the low-CAVI group at 7 months (-14.0% ± 2.9 vs. -15.6% ± 3.0%, P < 0.001). Stratified by CAVI and peak CK-MB or LGE, the four groups showed significant differences in LV-GLS at 7 months after STEMI (both P < 0.001). Multivariate linear regression analysis with the forced inclusion model showed that CAVI was an independent predictor of LV-GLS at 7 months (P = 0.015).

CONCLUSION: CAVI early after STEMI onset was significantly associated with chronic-phase LV-GLS. In addition, combining CAVI with CK-MB or LGE improves its predictive ability for evaluation of chronic-phase LV-GLS. Thus, the arterial stiffness assessment by CAVI was an important factor related to chronic-phase left ventricular dysfunction after the first STEMI.

PMID:35881449 | DOI:10.1097/HJH.0000000000003165

J Med Internet Res. 2022 Jul 26;24(7):e38100. doi: 10.2196/38100.

ABSTRACT

BACKGROUND: More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions.

OBJECTIVE: This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success.

METHODS: From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool.

RESULTS: We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses.

CONCLUSIONS: Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages.

TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1177/20552076211035988.

PMID:35881432 | DOI:10.2196/38100

J Med Internet Res. 2022 Jul 26;24(7):e34030. doi: 10.2196/34030.

ABSTRACT

BACKGROUND: Popular web-based portals provide free and convenient access to user-generated hospital quality reviews. The Centers for Medicare & Medicaid Services (CMS) also publishes Hospital Compare Star Ratings (HCSR), a comprehensive expert rating of US hospital quality that aggregates multiple measures of quality. CMS revised the HCSR methods in 2021. It is important to analyze the degree to which web-based ratings reflect expert measures of hospital quality because easily accessible, crowdsourced hospital ratings influence consumers’ hospital choices.

OBJECTIVE: This study aims to assess the association between web-based, Google hospital quality ratings that reflect the opinions of the crowd and HCSR representing the wisdom of the experts, as well as the changes in these associations following the 2021 revision of the CMS rating system.

METHODS: We extracted Google star ratings using the Application Programming Interface in June 2020. The HCSR data of April 2020 (before the revision of HCSR methodology) and April 2021 (after the revision of HCSR methodology) were obtained from the CMS Hospital Compare website. We also extracted scores for the individual components of hospital quality for each of the hospitals in our sample using the code provided by Hospital Compare. Fractional response models were used to estimate the association between Google star ratings and HCSR as well as individual components of quality (n=2619).

RESULTS: The Google star ratings are statistically associated with HCSR (P<.001) after controlling for hospital-level effects; however, they are not associated with clinical components of HCSR that require medical expertise for evaluation such as safety of care (P=.30) or readmission (P=.52). The revised CMS rating system ameliorates previous partial inconsistencies in the association between Google star ratings and quality component scores of HCSR.

CONCLUSIONS: Crowdsourced Google star hospital ratings are informative regarding expert CMS overall hospital quality ratings and individual quality components that are easier for patients to evaluate. Improvements in hospital quality metrics that require expertise to assess, such as safety of care and readmission, may not lead to improved Google star ratings. Hospitals can benefit from using crowdsourced ratings as timely and easily available indicators of their quality performance while recognizing their limitations and biases.

PMID:35881418 | DOI:10.2196/34030

Int J Neurosci. 2022 Jul 26:1-9. doi: 10.1080/00207454.2022.2095272. Online ahead of print.

ABSTRACT

Objective: The objective of the study was to determine the effect of task-oriented training on the dexterous movements of hands in Hemiplegic post-stroke patients.Methods: This study has been registered on site ClinicalTrial.gov with clinical trial number NCT05201196. The study was Randomized controlled trial, 18 patients were recruited that meet the inclusion criteria, randomly allocated to task-oriented training Group A (n = 9) and Conventional Therapy Group B (n = 9). Both exercise trainings were applied for 45 min/session, 5 times/week for 6 weeks. Fugl-Meyer Assessment Scale Motor, sensory and coordination portion, Wolf Motor Function Scale and Barthel Index were used as outcome measures, assessed patients at Baseline, after 3 weeks and 6 weeks after training. Data were analyzed by SPSS version 23.Results: The results suggested the mean Age was 60.78 ± 9.08 and 61.33 ± 6.78 for Group A and Group B, respectively. Average BMI was 23.66 ± 2.66 for Task-oriented group and 21.36 ± 2.46 for Conventional group. Fugl-Meyer scale shows significant P-value 0.03 post treatment compare to pre-treatment which was .283, Wolf Motor Function test and Barthel Index also showed significant P-values as 0.023 and 0.007, respectively, indicating that Task-oriented training shows more significant improvements than conventional group.Conclusion: Task-based training produced statistically significant as well as clinically meaningful enhancement in the dexterous hand movements of acute and subacute stroke patients than conventional therapy and ultimately improves the functional independence in their daily activities such as feeding, bathing and hygiene.

PMID:35881414 | DOI:10.1080/00207454.2022.2095272

JAMA Netw Open. 2022 Jul 1;5(7):e2222106. doi: 10.1001/jamanetworkopen.2022.22106.

ABSTRACT

IMPORTANCE: People conceived using assisted reproductive technology (ART) make up an increasing proportion of the world’s population.

OBJECTIVE: To investigate the association of ART conception with offspring growth and adiposity from infancy to early adulthood in a large multicohort study.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a prespecified coordinated analysis across 26 European, Asia-Pacific, and North American population-based cohort studies that included people born between 1984 and 2018, with mean ages at assessment of growth and adiposity outcomes from 0.6 months to 27.4 years. Data were analyzed between November 2019 and February 2022.

EXPOSURES: Conception by ART (mostly in vitro fertilization, intracytoplasmic sperm injection, and embryo transfer) vs natural conception (NC; without any medically assisted reproduction).

MAIN OUTCOMES AND MEASURES: The main outcomes were length / height, weight, and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared). Each cohort was analyzed separately with adjustment for maternal BMI, age, smoking, education, parity, and ethnicity and offspring sex and age. Results were combined in random effects meta-analysis for 13 age groups.

RESULTS: Up to 158 066 offspring (4329 conceived by ART) were included in each age-group meta-analysis, with between 47.6% to 60.6% females in each cohort. Compared with offspring who were NC, offspring conceived via ART were shorter, lighter, and thinner from infancy to early adolescence, with differences largest at the youngest ages and attenuating with older child age. For example, adjusted mean differences in offspring weight were -0.27 (95% CI, -0.39 to -0.16) SD units at age younger than 3 months, -0.16 (95% CI, -0.22 to -0.09) SD units at age 17 to 23 months, -0.07 (95% CI, -0.10 to -0.04) SD units at age 6 to 9 years, and -0.02 (95% CI, -0.15 to 0.12) SD units at age 14 to 17 years. Smaller offspring size was limited to individuals conceived by fresh but not frozen embryo transfer compared with those who were NC (eg, difference in weight at age 4 to 5 years was -0.14 [95% CI, -0.20 to -0.07] SD units for fresh embryo transfer vs NC and 0.00 [95% CI, -0.15 to 0.15] SD units for frozen embryo transfer vs NC). More marked differences were seen for body fat measurements, and there was imprecise evidence that offspring conceived by ART developed greater adiposity by early adulthood (eg, ART vs NC difference in fat mass index at age older than 17 years: 0.23 [95% CI, -0.04 to 0.50] SD units).

CONCLUSIONS AND RELEVANCE: These findings suggest that people conceiving or conceived by ART can be reassured that differences in early growth and adiposity are small and no longer evident by late adolescence.

PMID:35881399 | DOI:10.1001/jamanetworkopen.2022.22106