Category: Statistics

J Thorac Imaging. 2022 Jun 22. doi: 10.1097/RTI.0000000000000664. Online ahead of print.

ABSTRACT

PURPOSE: Computed tomography pulmonary angiography (CT-PA) is frequently used in the diagnostic workup of pulmonary embolism (PE), even in highly radiosensitive patient populations. This study aims to assess CT-PA with reduced z-axis coverage (compared with a standard scan range covering the entire lung) for its sensitivity for detecting PE and its potential to reduce the radiation dose.

MATERIALS AND METHODS: We retrospectively analyzed 602 consecutive CT-PA scans with definite or possible PE reported. A reduced scan range was defined based on the topogram, where the cranial slice was set at the top of the aortic arch and the caudal slice at the top of the lower hemidiaphragm. Locations of emboli in relation to the reduced scan range were recorded.

RESULTS: We included 513 CT-PA scans with definite acute PE in statistical analysis. Patients’ median age was 66 (52 to 77) years, 46% were female. Median dose length product was 270.8 (111.3 to 503.9) mGy*cm. Comparing the original and reduced scan ranges, the mean scan length was significantly reduced by 48.0±8.6% (26.8±3.0 vs. 13.9±2.6 cm, P<0.001). Single emboli outside the reduced range in addition to emboli within were found in 15 scans (2.9%), while only 1 scan (0.2%) had an embolus outside the reduced range and none within it. The resulting sensitivity of CT-PA with reduced scan range was 99.81% (95% confidence interval: 98.74%-99.99%) for detecting any PE.

CONCLUSION: A reduced scan length in CT-PA, as defined above, would substantially decrease radiation dose while maintaining diagnostic accuracy for detecting PE.

PMID:35797627 | DOI:10.1097/RTI.0000000000000664

J Patient Saf. 2022 Jul 6. doi: 10.1097/PTS.0000000000001058. Online ahead of print.

ABSTRACT

BACKGROUND: Social distancing has been recommended by the Centers for Disease Control and Prevention to avoid exposure to SARS-CoV-2 (Epidemiol Prev 2020;44:353-362).Cancer patients on or after active therapy seem to be more prone to COVID being symptomatic and life-threatening. When evaluating cancer patients’ risk of acquiring COVID, it is essential to know the behavior of cancer patients that will affect their risk of exposure. However, it is not known to what degree social distancing is practiced by cancer patients compared with noncancer patients and what factors lead to the decision to distance oneself.

METHOD: After a pilot phase using patients’ MyChart messaging, links to the electronic questionnaires were texted to patients using Twillio. Responses were stored on REDCap (Vanderbilt University, Nashville, TN). Six questions about their social distancing behavior and mask wearing were posed and responses were compared between cancer and noncancer patients. Demographics, comorbidities, and a questionnaire about anxiety (Generalized Anxiety Disorder 7-item scale) were recorded. To assess differences between cancer and noncancer groups, Bonferroni-corrected χ2 tests and proportions confidence intervals were used.

RESULTS: The pilot survey was sent in mid-2020 and the full survey followed in January 2021 during a high community COVID incidence. Three hundred eighty-seven cancer patients (32.4% responded) and 503 noncancer patients (22.9% responded) completed the survey. Questions about leaving their houses, driving, shopping, friends, and family indicated that patients with cancer are more cautious (P < 0.001). Cancer patients were up to 20% more likely to distance themselves. No difference was seen in wearing a mask-both groups wore approximately 90% of the time. Most respondents were female (63% versus 71%). Cancer patients were older (>60 y, 69% versus 45%) and less likely to work (52% versus 31%) or less likely to be White collar workers (21% versus 38%). In both groups, 54% marked “not at all anxious.”

CONCLUSIONS: Cancer patients’ responses revealed a distancing behavior that would likely lower the risk exposure to SARS-CoV-2. It is unclear which of the demographic differences would account for this behavior, although remarkably anxiety was not a clear motivating factor. The high acceptance of masks is encouraging. Early publications during the pandemic and patient education suggesting a higher COVID risk for cancer patients may have reduced risk prone behavior. Considering COVID’s impact on the vulnerable cancer population and uncertainty in immunosuppressed patients about clearing the virus or adequately responding to a vaccine, further studies about health behavior and health promotion during the pandemic are needed.

PMID:35797588 | DOI:10.1097/PTS.0000000000001058

Psychosom Med. 2022 Jun 28. doi: 10.1097/PSY.0000000000001099. Online ahead of print.

ABSTRACT

OBJECTIVES: Prior studies have suggested reciprocal relationships between cognitive function and adiposity, but this has not been investigated with population representative datasets. The purpose of this study was to examine the association between cognitive function and adiposity in a large population-based sample of middle-aged and older adults. It was hypothesized that better scores on tests of cognitive function would be associated with lower adiposity and this association would be primarily mediated through lifestyle behavior and physical health status.

METHODS: Using data from the Canadian Longitudinal Study on Aging (N = 30,097), we tested our hypotheses using three indicators of cognitive function (animal fluency, Stroop interference, and men reaction time) and four indicators of adiposity (body mass index [BMI], total fat mass, waist circumference and waist-hip ratio). Hierarchical multivariable linear regression modeling was conducted followed by tests for moderation by socioeconomic status and mediation through diet, physical activity, hypertension and diabetes status.

RESULTS: All measures of cognitive indicators were significantly associated with adiposity after adjusting for confounders. In general, superior performance on animal fluency, Stroop and reaction time tasks were associated with lower adiposity by most metrics. Stroop interference was associated with lower adiposity across all metrics, including BMI (b = 0.04, 95% CI 0.06, 0.01), total fat mass (b = 19.35, 95% CI 8.57, 30.12), waist circumference (b = 33.83, 95% CI 10.08, 57.58), and waist-hip ratio (b = 0.13,95% CI 0.01, 0.24). These associations were more substantial for moderate- and high-income sub-populations. Mediational analyses suggested that the above effects were mediated through lifestyle behavior (e.g., diet and physical activity) and physical health conditions (e.g., diabetes and diet).

CONCLUSIONS: Reliable associations exist between cognitive function and adiposity in middle-aged and older adults. The associations appear to be mediated through lifestyle behavior and physical health conditions.

PMID:35797581 | DOI:10.1097/PSY.0000000000001099

J Pediatr Gastroenterol Nutr. 2022 Jul 6. doi: 10.1097/MPG.0000000000003552. Online ahead of print.

ABSTRACT

AIM: To compare presenting symptoms, comorbidities, disease, and treatment characteristics of a black pediatric eosinophilic esophagitis (EoE) group to a non-black pediatric EoE group.

METHODS: A retrospective chart review consisting of pediatric patients diagnosed with EoE between the years of 2010 and 2018 at a single urban pediatric hospital system comprising 143 black pediatric patients compared with 142 non-black pediatric patients with similar distribution of age and sex.

RESULTS: Both groups were majority male and the median age of diagnosis between the black and non-black group was 5.1 and 6.7 years-old, respectively. Comorbidities more commonly seen in the black group included food allergies, atopic dermatitis, asthma, and allergic rhinitis. Black patients were more likely to present with failure to thrive (FTT)/poor growth whereas non-black patients were more likely to present with abdominal pain. There was no statistically significant difference between the groups in achieving remission using current therapies. The black group had higher rates of non-adherence to medical therapies.

CONCLUSION: This is the largest study to date comparing a black versus non-black pediatric EoE population. The black population had more atopic comorbidities and failure to thrive at presentation and had significantly more issues with non-adherence. This new knowledge describing EoE in a minority population will hopefully improve awareness, diagnosis, and management of EoE in this population.

PMID:35797567 | DOI:10.1097/MPG.0000000000003552

Am J Public Health. 2022 Jul 7:e1-e4. doi: 10.2105/AJPH.2022.306937. Online ahead of print.

ABSTRACT

Objectives. To estimate the national pregnancy-associated homicide rate in 2020 and to characterize patterns of victimization. Methods. Using a retrospective analysis of the 2020 US national mortality file, I identified all homicides of women who were pregnant or within 1 year of the end of pregnancy. Descriptive statistics characterized these victims, and I calculated annual pregnancy-associated homicide rates (deaths per 100 000 live births) for comparisons with 2018 and 2019. I estimated the added risk conferred by pregnancy in 2020 by comparing the pregnancy-associated homicide rate to homicide in the nonpregnant, nonpostpartum population of females aged 10 to 44 years. Results. There were 5.23 pregnancy-associated homicides per 100 000 live births in 2020, a notable increase from previous years. Rates were highest among adolescents and non-Hispanic Black women. Eighty percent of incidents involved firearms. The risk of homicide was 35% greater for pregnant and postpartum women than for their nonpregnant, nonpostpartum counterparts, who did not experience as large an increase from previous years. Conclusions. Pregnancy-associated homicide substantially increased in 2020. Public Health Implications. Policies to address domestic and community violence against women are urgently needed. (Am J Public Health. Published online ahead of print July 7, 2022:e1-e4. https://doi.org/10.2105/AJPH.2022.306937).

PMID:35797500 | DOI:10.2105/AJPH.2022.306937

Wounds. 2022 Apr;34(4):E34-E36.

ABSTRACT

OBJECTIVE: This is the second of 3 planned articles reporting on a prospective, multicenter, randomized controlled trial assessing the efficacy of fish skin graft in the management of diabetic foot ulcers in comparison with the standard of care (collagen alginate dressing).

MATERIALS AND METHODS: The primary end point of this prospective randomized trial is the number of closed wounds at 12 weeks.

RESULTS: As of the time of this writing, 94 patients had completed the protocol. At 12-week follow-up, healing was achieved in 63.0% of index ulcers (29 of 46 patients) in the acellular fish skin graft group compared with 31.3% in the control group (15 of 48 patients) (P =.0036). In both groups, the mean time to healing was 7 weeks. The median number of applications of the fish skin graft to achieve healing was 6.

CONCLUSION: A clinically and statistically significant difference in healing was observed between patients treated with acellular fish skin graft and those treated with a collagen alginate dressing. The data support the completion of this prospective randomized trial.

PMID:35797557

Med Sci Sports Exerc. 2022 Jul 7. doi: 10.1249/MSS.0000000000002995. Online ahead of print.

ABSTRACT

INTRODUCTION: The influence of graft type on the restoration of quadriceps strength symmetry following ACL reconstruction (ACLR) has been widely studied. However, an important consideration when evaluating quadriceps symmetry is the fact that this measure can be influenced by numerous factors beyond graft type. This study sought to determine if graft type is predictive of quadriceps strength asymmetry during the first 12 months post ACLR taking into consideration potentially influential factors (i.e., age, sex, BMI, time post ACLR).

METHODS: We retrospectively reviewed quadriceps strength data from 434 patients (303 females and 131 males) who had previously undergone ACLR with an autograft (hamstring tendon (HT), quadriceps tendon (QT), patellar tendon (PT)) or allograft. Chi-squared Automatic Interaction Detection (CHAID) decision tree analysis was used to evaluate how graft type influenced quadriceps strength asymmetry during the first 12 months post ACLR taking into consideration age, sex, BMI, and time post ACLR.

RESULTS: The best predictor of quadriceps strength asymmetry was graft type. Specifically, 3 graft categories were identified (1) allograft and HT autograft, (2) PT autograft, and (3) QT autograft. The average quadriceps strength asymmetry for each of the 3 identified categories was 0.91, 0.87, and 0.81, respectively, and differed statistically from each other (p < 0.001). The second-best predictor of quadriceps strength asymmetry was sex, albeit only in the PT and QT groups (with females having increased asymmetry). Female patients post ACLR with a QT autograft were at highest risk for quadriceps strength asymmetry.

CONCLUSIONS: Graft type and sex are important predictors of quadriceps strength asymmetry following ACLR. Clinicians should take these factors into consideration when designing rehabilitation protocols to restore quadriceps strength symmetry during the post-operative period.

PMID:35797489 | DOI:10.1249/MSS.0000000000002995

J Patient Saf. 2022 Jul 6. doi: 10.1097/PTS.0000000000001055. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients leaving against medical advice (AMA) are commonly encountered in hospital medicine. The problem is prevalent worldwide and across all fields of medicine. A retrospective study of 47,583 patients reported a 3.3% AMA rate in 2015.

OBJECTIVES: In this retrospective study, we aimed (1) to study the demographic, clinical, and laboratory parameters of infective endocarditis (IE) patients leaving AMA. We also compared (2) the various risk factors and outcomes of these patients with IE patients who completed treatment.

RESULTS: A total of 111 patients diagnosed with IE were recruited for 36 months. Of the 74 patients with available details, 32 patients (29%) left AMA during their treatment. The mean age of patients leaving AMA was 39, and among those who left AMA, 66% were females. As compared with patients completing therapy, patients leaving AMA tend to have higher comorbidities, including injection drug use (68.1% versus 31.9%), prior IE (83.3% versus 16.7%), and chronic hepatitis C (72.4% versus 27.8%). Rates of consumption of substances of abuse were higher among those who left AMA. Patients leaving AMA also had higher psychiatric comorbidities (63% versus 37.5%), history of leaving AMA (70.5% versus 29.5%), and consumption of more than 2 substances of abuse. Morbidity was higher in patients leaving AMA. There was a statistically significant association between the development of distal embolus (P < 0.001), the need for recurrent admissions (P = 0.002), recurrent bacteremia (P < 0.001), developing new embolus (P < 0.001), and overall morbidity (P = 0.002) among IE patients leaving AMA.

CONCLUSIONS: Infective endocarditis patients leaving AMA tend to be younger females. These patients have prior comorbidities of injection drug use, prior IE, multiple psychiatric comorbidities, drug use, and multiple socioeconomic issues. Patients leaving AMA tend to develop further non-Central nervous system embolic events, recurrent bacteremia, and require frequent admissions. Morbidity in these patients was higher.

PMID:35797474 | DOI:10.1097/PTS.0000000000001055

Psychosom Med. 2022 Jun 30. doi: 10.1097/PSY.0000000000001104. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the associations between indices of family socioeconomic status and sleep during adolescence and to examine whether measures of hypothalamic-pituitary-adrenal (HPA) axis functioning mediate the observed associations.

METHODS: A total of 350 ethnically diverse adolescents (57% female; mean agewave1 = 16.4, SD = 0.7 years) completed a three-wave longitudinal study in which sleep and cortisol data were collected at two-year time intervals. Sleep duration, latency, and variability was assessed via actigraphy over a period of eight days per study wave. Salivary cortisol was collected across three days per study wave to assess cortisol diurnal slope, area under the curve and the cortisol awakening response. Adolescents’ caregivers reported their education levels, family income, and economic hardship.

RESULTS: A greater family income-to-needs ratio was associated with longer adolescent sleep duration (b = 2.90, p = .023), whereas greater parental education was associated with shorter sleep duration (b = -3.70, p = .030), less sleep latency (b = -0.74, p = .016), and less variability across days (b = -2.06, p = .010). Diurnal cortisol slope statistically mediated the association of parental education with sleep duration (b = -0.48, 95% CI [-1.099, -0.042]), but not the association of income-to-needs ratio with sleep duration.

CONCLUSION: Findings suggest parental education and family resources may have unique impacts upon sleep and HPA axis functioning during the period of adolescence. Future research is needed to examine family and behavioral factors that may underlie SES associations with adolescent sleep and HPA axis functioning.

PMID:35797448 | DOI:10.1097/PSY.0000000000001104

J Environ Qual. 2022 Jul 7. doi: 10.1002/jeq2.20387. Online ahead of print.

ABSTRACT

Swine manure management and storage have been implicated as a major source of increasing agricultural ammonia (NH₃ ) emissions resulting in increased ammonium (NH₄⁺ ) deposition in North Carolina. This study was conducted to establish how improvements in manure and animal management have affected lagoons’ nutrient loading and subsequent lagoon NH₃ emissions determined from measured lagoon chemistry and climate data. Archived lagoon chemistry analyses from 182 farm lagoons (106,000 sample analyses) were used to evaluate trends in lagoon chemical properties. Process and empirical (statistical) NH₃ volatilization models were used with the data to calculate changes in NH₃ emissions from 2001 through 2018. Lagoon nutrient trends for both finisher and sow farms showed that annual averages of nutrients had decreases ranging from 18% to 93% except for a 41% increase in copper for finisher primary lagoons. Because of reduced nitrogen and pH in the lagoons, a process model of NH₃ emissions suggested decreases from primary lagoons of 49% and 25% from both finisher and sow farm lagoons, respectively. Empirical (statistical) models predicted even larger relative NH₃ decreases (up to 54%). This article is protected by copyright. All rights reserved.

PMID:35797461 | DOI:10.1002/jeq2.20387