Category: Statistics

Cureus. 2021 Jan 31;13(1):e13032. doi: 10.7759/cureus.13032.

ABSTRACT

Background Although pancreatic cancer incidence is low at 13.1 per 100,000 people, this cancer is difficult to treat and carries a poor 5-year survival rate. Additionally, pancreatic cancer survival rates vary disproportionately based on age and race. The objective of this study was to evaluate the association between 5-year survival of pancreatic cancer and the basic demographic factors age, race, and sex. Methods Data were retrieved from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) 18 database, spanning from 2000-2017, using SEER*Stat. SPSS was used to calculate descriptive statistics for vital status, age, race, and sex. Odds ratios with confidence intervals were calculated using Epi Info. Case data were used to conduct survival analysis by age, race, and sex using OriginPro. Results Out of a total of 118,581 cases, 79.3% were White (n = 106,887), 12.5% were Black (n = 16,866), 7.4% were Asian or Pacific Islander (n = 9,960), 0.6% were American Indian/Alaskan Native (n = 792), and 0.2% were unknown race (n = 321). The odds ratio (OR) of dying before reaching 5+ survival was lowest for the Asian or Pacific Islander group (OR = 0.70, 95% CI: 0.66 – 0.74), followed by the group of Black patients (OR = 1.07, 95% CI: 1.02 – 1.13), the White patients group (OR = 1.12, 95% CI: 1.08 – 1.17), and the American Indian/Alaskan Native group (OR = 1.12, 95% CI: 0.89 – 1.40). The largest age group was 65-69 years old, comprising 14.7% (n = 19,866) of the dataset. Probability of 5+ year survival for pancreatic cancer patients was highest for the age group 15-19 years (n = 74). In general, 5+ year survival probability declined with age. Risk of death before reaching 5+ year pancreatic cancer survival was slightly higher in men (OR = 1.03, 95% CI: 1.00 – 1.07), who comprised 50.9% (n = 68,628) of the dataset. Discussion Findings from this study corroborate differences by age, race, and sex discussed in the literature. Differences in survival rates by race depart from some findings in literature documenting no significant differences in treatment outcome by race. Controlling for age in a future study in both race and sex survival probability analyses may be helpful. Further, stratifying by sex in survival probability analysis by race would be illuminating. In addition to survival analysis, regression modeling would be a useful next step.

PMID:33665053 | PMC:PMC7924966 | DOI:10.7759/cureus.13032

Southwest J Pulm Crit Care. 2021;22(2):58-68. doi: 10.13175/swjpcc015-20. Epub 2021 Feb 13.

ABSTRACT

BACKGROUND: Uranium workers are at risk of developing lung disease, characterized by low forced expiratory volume in one second (FEV1) and/or forced vital capacity (FVC). Previous studies have found an association between decreased lung function and depressive symptoms in patients with pulmonary pathologies, but this association has not been well examined in occupational cohorts, especially uranium workers.

METHODS: This cross-sectional study evaluated the association between spirometric measures and depressive symptoms in a sample of elderly former uranium workers screened by the New Mexico Radiation Exposure Screening & Education Program (NM-RESEP). Race- and ethnicity-specific reference equations were used to determine predicted spirometric indices (predictor variable). At least one depressive symptom [depressed mood and/or anhedonia, as determined by a modified Patient Health Questionnaire-2 (PHQ-2)], was the outcome variables. Chi-square tests and multivariable logistic regression models were used for statistical analyses.

RESULTS: At least one depressive symptom was self-reported by 7.6% of uranium workers. Depressed mood was reported over twice as much as anhedonia (7.2% versus 3.3%). Abnormal FVC was associated with at least one depressive symptom after adjustment for covariates. There was no significant interaction between race/ethnicity and spirometric indices on depressive symptoms.

CONCLUSIONS: Although depressive symptoms are uncommonly reported in uranium workers, they are an important comorbidity due to their overall clinical impact. Abnormal FVC was associated with depressive symptoms. Race/ethnicity was not found to be an effect modifier for the association between abnormal FVC and depressive symptoms. To better understand the mechanism underlying this association and determine if a causal relationship exists between spirometric indices and depressive symptoms in occupational populations at risk for developing lung disease, larger longitudinal studies are required. We recommend screening for depressive symptoms for current and former uranium workers as part of routine health surveillance of this occupational cohort. Such screening may help overcome workers’ reluctance to self-report and seek treatment for depression and may avoid negative consequences to health and safety from missed diagnoses.

PMID:33664988 | PMC:PMC7929482 | DOI:10.13175/swjpcc015-20

PeerJ. 2021 Feb 23;9:e10734. doi: 10.7717/peerj.10734. eCollection 2021.

ABSTRACT

BACKGROUND: The number of children with obesity has increased in Saudi Arabia, which is a significant public health concern. Early diagnosis of childhood obesity and screening of the prevalence is needed using a simple in situ method. This study aims to generate statistical equations to predict body fat percentage (BF%) for Saudi children by employing machine learning technology and to establish gender and age-specific body fat reference range.

METHODS: Data was combined from two cross-sectional studies conducted in Saudi Arabia for 1,292 boys and girls aged 8-12 years. Body fat was measured in both studies using bio-electrical impedance analysis devices. Height and weight were measured and body mass index was calculated and classified according to CDC 2,000 charts. A total of 603 girls and 374 boys were randomly selected for the learning phase, and 153 girls and 93 boys were employed in the validation set. Analyses of different machine learning methods showed that an accurate, sensitive model could be created. Two regression models were trained and fitted with the construction samples and validated. Gradient boosting algorithm was employed to achieve a better estimation and produce the equations, then the root means squared error (RMSE) equation was performed to decrease the error. Body fat reference ranges were derived for children aged 8-12 years.

RESULTS: For the gradient boosting models, the predicted fat percentage values were more aligned with the true value than those in regression models. Gradient boosting achieved better performance than the regression equation as it combined multiple simple models into a single composite model to take advantage of that weak classifier. The developed predictive model archived RMSE of 3.12 for girls and 2.48 boys. BF% and Fat mass index charts were presented in which cut-offs for 5th, 75th and 95th centiles are used to define ‘under-fat’, ‘normal’, ‘overfat’ and ‘subject with obesity’.

CONCLUSION: Machine learning models could represent a significant advancement for investigators studying adiposity-related issues in children. These models and newly developed centile charts could be useful tools for the estimation and classification of BF%.

PMID:33665006 | PMC:PMC7908871 | DOI:10.7717/peerj.10734

PeerJ. 2021 Feb 24;9:e10783. doi: 10.7717/peerj.10783. eCollection 2021.

ABSTRACT

BACKGROUND: Peer recovery coaches (PRCs) have become a critical tool in addiction treatment in many areas of the world. Despite this fact, no identified research has examined the process or impact of PRC training. Furthermore, no scales were identified to measure trainee confidence in various PRC techniques. The goal of this article is to analyze the process and immediate impact of PRC training of twelve American Indians (AIs) in a culturally-specific program. We focus most specifically on trainee confidence levels.

METHODS: No written consent was obtained and completion of the assessment was considered consent. Trainees completed self-assessments before and after the training. The self-assessment examined nine areas ranging from understanding the role of PRCs to knowledge of effective PRC techniques. Paired t-tests were used to assess for changes in individual trainee responses between the pre- and post-assessments.

RESULTS: Pre-training responses ranged from moderate to high. Questions with the lowest average confidence levels address PRC activities or specific techniques to facilitate recovery. All nine questions showed statistically significant mean improvements in the post-training self-assessments. Questions regarding specific PRC activities and techniques showed the greatest improvement. Questions relating to helping people more generally showed the smallest improvement. Average post-training responses fell within a very narrow range indicating relatively consistent confidence levels across skills. Analysis indicates participants were possibly over-confident in certain areas (i.e., maintaining boundaries). This small pilot represents an initial attempt to measure confidence levels of PRC trainees. The findings may inform future training by identifying certain areas where emphasis might be most helpful for trainees. In addition, it is hoped that this work will encourage more systematic analysis of the impact of PRC training on individuals.

PMID:33665010 | PMC:PMC7912601 | DOI:10.7717/peerj.10783

World J Mens Health. 2021 Feb 24. doi: 10.5534/wjmh.200155. Online ahead of print.

ABSTRACT

PURPOSE: Male infertility is a worldwide problem with limitations in the treatment. Phosphodiesterase-5 inhibitors (PDE5is) is the first choice for the treatment of erectile dysfunction, more and more studies show that it has a certain effect on male infertility in recent years. But there was currently no high quality of systematic review to evaluate the effects of PDE5is on semen quality.

MATERIALS AND METHODS: We retrieved the electronic databases of MEDLINE, PubMed, Web of Science, EMBASE, etc. Related randomized controlled trials (RCTs) were collected and selected up to May 20, 2020. We have searched literature with terms “male infertility”, “phosphodiesterase-5 inhibitors”, “PDE5i”, “Tadalafil”, “Sildenafil”, “Vardenafil”, “Udenafil”, “Avanafil”, “semen”, and “sperm”. Mean value and its standard deviation were used to perform quantitative analysis. All statistical analyses were conducted by RevMan 5.3 and Stata software.

RESULTS: There were a total of 1,121 participants in the nine included studies. There was a statistically significant improvement treated with PDE5is compared with sham therapy, which including sperm concentration (mean difference [MD]=1.96, 95% confidence interval [CI]=1.70-2.21, p<0.001; MD=3.22, 95% CI=1.96-4.48, p<0.001), straight progressive motility (%) Grade A (MD=3.71, 95% CI=2.21-5.20, p<0.001), sperm motility (MD=8.09, 95% CI=7.83-8.36, p<0.001), morphologically normal spermatozoa (%) (MD=0.67, 95% CI=0.20-1.15, p=0.005; MD=1.27, 95% CI=0.02-2.52, p=0.05), sperm abnormalities (%) (MD=-0.64, 95% CI=-0.81–0.47, p<0.001), and progressive motile sperm (MD=5.34, 95% CI=3.87-6.81, p<0.001).

CONCLUSIONS: In this meta-analysis of nine RCTs, treatment with PDE5is could improve some indicators of male sperm.

PMID:33663030 | DOI:10.5534/wjmh.200155

Eur J Pediatr Surg. 2021 Mar 4. doi: 10.1055/s-0041-1723994. Online ahead of print.

ABSTRACT

INTRODUCTION: The majority of pediatric surgeons and hepatologists recommend the centralization of biliary atresia (BA) treatment within experienced liver units. We aimed to investigate whether voluntary self-restriction and acceptance of the need for this change in practice changed the BA referral policy in Germany during the last decade.

MATERIALS AND METHODS: In cooperation with pediatric surgeons, gastroenterologists or hepatologists, and pediatric liver transplant units, the 2-year follow-up data of infants with BA born in Germany between 2010 and 2014 were collected using www.bard-online.com or pseudonymized data transfer. Results were compared with our previous analysis of the outcome data of infants with BA born between 2001 and 2005 in Germany.

RESULT: Overall, 173 infants with BA were identified, of whom 160 underwent Kasai portoenterostomy (KPE; 92.5%) and 13 (7.5%) underwent primary liver transplantation at 21 German centers. At 2-year follow-up, overall survival was 87.7% (vs. 81.9% in 2001-2005 [p = 0.19]), survival with native liver post-KPE was 29.2% (vs. 22.8% in 2001-2005 [p = 0.24]), and jaundice-free survival with native liver post-KPE was 24.0% (vs. 20.1% in 2001-2005 [p = 0.5]). Compared with the 2001-2005 analysis, all criteria showed improvement but the differences are statistically not significant.

CONCLUSION: Our observation shows that KPE management requires improvement in Germany. Centralization of BA patients to German reference liver units is not yet mandatory. However, European and national efforts with regard to the centralization of rare diseases support our common endeavor in this direction.

PMID:33663007 | DOI:10.1055/s-0041-1723994

Psychogeriatrics. 2021 Mar 4. doi: 10.1111/psyg.12673. Online ahead of print.

ABSTRACT

BACKGROUND: The changes that occur during the ageing process affect the mental health of individuals and their adaptation to old age. In this study, it was aimed to evaluate the effect of progressive muscle relaxation (PMR) exercises on the depression level of elderly women and their adaptation to old age.

METHODS: A randomised controlled trial design was used. The sample consisted of 49 elderly women (21 intervention and 28 controls) from a family health centre of a city in Turkey. The research data were collected using the introductory information form, Mini-Mental State Examination, Barthel index, Geriatric Depression-15 Scale, and Assessment Scale of Adaptation Difficulty for the Elderly. Two home visits were made to women in the first and eighth week of the application. PMR was applied by women in the intervention group in 28 min sessions three times a week for 8 weeks. During the 8 weeks the women were called by the researcher once a week and PMR was reminded.

RESULTS: As a result of the PMR exercises performed for 8 weeks, it was determined that there was a statistically significant difference in the mean Geriatric Depression-15 Scale and Assessment Scale of Adaptation Difficulty for the Elderly scores of the women in the intervention group compared to the control group (P < 0.05).

CONCLUSION: In this study, it was found that PMR exercises reduce the depression level of elderly women and increase their adaptation to old age.

PMID:33663021 | DOI:10.1111/psyg.12673

Homeopathy. 2021 Mar 4. doi: 10.1055/s-0040-1721062. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the increasing demand for complementary and integrative medicine, only a few studies have evaluated the effect of these types of treatments on the quality of life (QoL) of patients with chronic diseases. The objective of this study was to evaluate the QoL of women treated with homeopathy within the Public Health System of Belo Horizonte, Brazil.

METHODS: This is a prospective randomized controlled pragmatic trial. The patients were divided into two independent groups, one group underwent homeopathic treatment in the first 6-month period and the other did not receive any homeopathic treatment. In both randomized groups, patients maintained their conventional medical treatment when necessary. The World Health Organization Quality of Life abbreviated questionnaire (WHOQOL-BREF) was used for QoL analysis prior to treatment and 6 months later.

RESULTS: Randomization afforded similar baseline results in three domains of QoL analysis for both groups. After 6 months’ treatment, there was a statistically significant difference between groups in the physical domain of WHOQOL-BREF: the average score improved to 63.6 ± (SD) 15.8 in the homeopathy group, compared with 53.1 ± (SD) 16.7 in the control group.

CONCLUSIONS: Homeopathic treatment showed a positive impact at 6 months on the QoL of women with chronic diseases. Further studies should be performed to determine the long-term effects of homeopathic treatment on QoL and its determinant factors.

PMID:33662995 | DOI:10.1055/s-0040-1721062

Eur J Pediatr Surg. 2021 Mar 4. doi: 10.1055/s-0041-1723993. Online ahead of print.

ABSTRACT

INTRODUCTION: Placental insufficiency is one of the reasons for the reduction of hormone production. Thus, if one of the suspected causes of hypospadias is placental insufficiency, then the neurodevelopmental status of boys with hypospadias may be impaired. The aim of this study was to evaluate the neurodevelopmental status of boys with hypospadias and guide the parents of those who need support to related departments for early intervention.

MATERIALS AND METHODS: Boys were divided into two groups, those with hypospadias (group H) and healthy children undergoing traditional circumcision (group C). The parents of the boys completed the Ages and Stages Questionnaire (ASQ) and ASQ-Social Emotional (SE), both of which are screening instruments for the early identification of developmental and social-emotional problems, respectively.

RESULTS: Seventy-eight boys had hypospadias and 59 were admitted for traditional circumcision. The group H had statistically significant more impaired scores than group C in communication, gross motor, and personal-social skill sections. The multivariate logistic regression analysis revealed that hypospadias was the independent predictive factor for communication and personal-social skills.

CONCLUSION: Hypospadias and neurologic impairment may share common etiologic factors. Accordingly, physicians should keep in mind that if a boy presents with hypospadias, the possibility of having neurologic impairment is higher than normal population and early intervention has crucial importance. Every boy with hypospadias should be evaluated for neurodevelopmental status.

PMID:33663006 | DOI:10.1055/s-0041-1723993

Obes Facts. 2021 Mar 4:1-13. doi: 10.1159/000513042. Online ahead of print.

ABSTRACT

There is substantial evidence documenting the effects of behavioural interventions on weight loss (WL). However, behavioural approaches to initial WL are followed by some degree of longer-term weight regain, and large trials focusing on evidence-based approaches to weight loss maintenance (WLM) have generally only demonstrated small beneficial effects. The current state-of-the-art in behavioural interventions for WL and WLM raises questions of (i) how we define the relationship between WL and WLM, (ii) how energy balance (EB) systems respond to WL and influence behaviours that primarily drive weight regain, (iii) how intervention content, mode of delivery and intensity should be targeted to keep weight off, (iv) which mechanisms of action in complex interventions may prevent weight regain and (v) how to design studies and interventions to maximise effective longer-term weight management. In considering these issues a writing team within the NoHoW Consortium was convened to elaborate a position statement, and behaviour change and obesity experts were invited to discuss these positions and to refine them. At present the evidence suggests that developing the skills to self-manage EB behaviours leads to more effective WLM. However, the effects of behaviour change interventions for WL and WLM are still relatively modest and our understanding of the factors that disrupt and undermine self-management of eating and physical activity is limited. These factors include physiological resistance to weight loss, gradual compensatory changes in eating and physical activity and reactive processes related to stress, emotions, rewards and desires that meet psychological needs. Better matching of evidence-based intervention content to quantitatively tracked EB behaviours and the specific needs of individuals may improve outcomes. Improving objective longitudinal tracking of energy intake and energy expenditure over time would provide a quantitative framework in which to understand the dynamics of behaviour change, mechanisms of action of behaviour change interventions and user engagement with intervention components to potentially improve weight management intervention design and evaluation.

PMID:33662958 | DOI:10.1159/000513042