Category: Statistics

J Cosmet Dermatol. 2022 Feb 13. doi: 10.1111/jocd.14844. Online ahead of print.

ABSTRACT

BACKGROUND: Alopecia areata (AA) is a common non-scarring, inflammatory type of hair loss that affects people of all ages and genders.

AIMS: To evaluate the safety and efficacy of Intralesional vitamin D3 injection in the treatment of alopecia areata.

PATIENTS AND METHODS: A randomized- control clinical trial included a total of 60 adult patients with localized alopecia areata were randomly assigned into two groups . Group I consisted of thirty patients who received 1ml of intralesional injection of vitamin D3 every 4 weeks for a maximum of 3 sessions. Group II consisted of thirty patients who received intralesional injection of normal saline 0.9% every 4 weeks for 3 sessions as a control group. All patients had their serum levels of 25-hydroxy vitamin D, TSH, antithyroglobulin, and thyroid peroxidase antibodies estimated before starting treatment. The 5-point semiquantitative regrowth score (RGS) and dermoscopy were used to evaluate the therapeutic response.

RESULTS: There was statistically significant difference with p-value < 0.001 between two study groups regarding to degree of improvement. Dermoscopic findings that explain signs of activity were decreased, and signs of improvement were appeared after the 3rd months of treatment being better in intralesional vitamin D group.The adverse effects were negligible and transient, and there were no recurrence of lesions.

CONCLUSION: Intralesional vitamin D3 is an effective treatment option for localized patchy (not more than 40% of scalp distribution) alopecia areata .There is no relation between serum vitamin D3 and efficacy of treatment, so measuring vitamin D3 before starting treatment is not advised.

PMID:35152536 | DOI:10.1111/jocd.14844

Early Interv Psychiatry. 2022 Feb 13. doi: 10.1111/eip.13270. Online ahead of print.

ABSTRACT

AIM: Individuals at clinical high risk (CHR) for psychosis have been shown to experience more trauma than the general population. However, although the effects of trauma appear to impact some symptoms it does not seem to increase the risk of transition to psychosis. The aim of this article was to examine the prevalence of trauma, and its association with longitudinal clinical and functional outcomes in a large sample of CHR individuals.

METHODS: From the North American Prodrome Longitudinal Study-3 (NAPLS-3) 690 CHR individuals and 91 healthy controls from nine study sites between 2015 and 2018 were assessed. Historical trauma experiences were captured at baseline. Participants completed longitudinal assessments measuring clinical outcomes including positive and negative symptoms, depression, social and role functioning and assessing transition to psychosis.

RESULTS: From the 690 CHR participants and 96 healthy controls, 343 (49.6%) and 15 (15.6%), respectively, reported a history of trauma (p < .001). Emotional neglect (70.3%) was the most commonly reported type of trauma, followed by psychological abuse (57.4%). Among CHR participants, time to transition to psychosis was not associated with trauma. Baseline depression and suspiciousness/persecutory ideas were statistically significantly different between CHR individuals who did or did not experience trauma. However, when examining clinical and functional outcomes over 12-months of follow-up, there were no differences between those who experienced trauma and those who did not.

CONCLUSION: Overall, trauma is a significantly prevalent among CHR individuals. The effects of trauma on transition and longitudinal clinical and functional outcomes were not significant.

PMID:35152553 | DOI:10.1111/eip.13270

Glob Chang Biol. 2022 Feb 13. doi: 10.1111/gcb.16127. Online ahead of print.

ABSTRACT

Soils are important carbon (C) reservoirs and play a critical role in regulating the global C cycle. Soil water potential (SWP) measures the energy with which water is retained in the soil and is one of the most vital factors that constrain the decomposition of soil organic C (SOC). The measurements for soil water retention curve (SWRC), on which the estimation of SWP depends, are usually carried out above -1.5 MPa (i.e., the wilting point for many plants). However, the average moisture threshold at which soil microbial activity ceases is usually below -10 MPa in mineral soils. Beyond the measurement range, the SWP estimation has to be derived from extrapolating the SWRC, which violates the statistical principle, resulting in possibly inaccurate SWP estimations. To date, it is unclear to what extent the extrapolated SWP estimation deviates from the “true value” and how it impacts the modeling of SOC decomposition. This study combined SWRC measurements down to -43.7 MPa, a 72-day soil incubation experiment with four moisture levels, and a SOC decomposition model. In addition to the complete SWRC (SWRC_all ), we fitted two more SWRCs by using measurements above -0.5 MPa (SWRC_0.5 ) and -1.7 MPa (SWRC_1.7 ), respectively, to quantify the deviations of extrapolated SWPs from the complete SWRC. Results showed that extrapolating the SWRC beyond its measurement range significantly underestimated the SWP. Incorporating the extrapolated SWP in the model significantly underestimated the SOC decomposition under relatively dry conditions. With the extrapolated SWP, the model predicted no SOC decomposition in the driest treatment, while the experiment observed a significant CO₂ emission. The results emphasize that accurate SWP estimations beyond the wilting point are critically needed to improve the modeling of SOC decomposition.

PMID:35152535 | DOI:10.1111/gcb.16127

Haemophilia. 2022 Feb 13. doi: 10.1111/hae.14508. Online ahead of print.

ABSTRACT

INTRODUCTION: Hemarthrosis causes chronic haemophilic synovitis (CHS). Although neutrophils are major immune cells infiltrating joints after bleeding, their role on the pathogenesis of CHS is unknown. Neutrophils release extracellular DNA traps (ETs), structures of DNA with bound granular enzymes that were associated with tissue damage.

AIMS: To evaluate the presence of ETs as pathogenic biomarker and the protective effect of intraarticular injection of platelet-rich plasma (PRP) in patients with CHS.

METHODS: Haemophilia Joint Health Score (HJHS) and bleeding episodes (BE) were measured and correlated with ETs indicators (DNA/DNA-Elastase) in synovial fluids (SF), PRP and plasma of 21 patients.

RESULTS: Soluble DNA and DNA-Elastase were detected in SF and plasma of patients. The synovial and plasma levels of DNA-Elastase positively correlated with worse HJHS/BE. Interestingly, remaining ETs-inducer factors were present in SF that induced the in vitro release of ETs from blood-isolated neutrophils. This phenomenon was impaired by adding plasma or PRP. Finally, preliminary data obtained from five patients indicate that levels of DNA-Elastase and HJHS/BE decreased after receiving intraarticular injection of PRP.

CONCLUSIONS: The synovial and plasma levels of DNA-Elastase correlated with worse HJHS/BE suggesting that ETs formation could be a biomarker and potential therapeutic target for CHS. The intraarticular injection of PRP underlined a new potential alternative therapy, decreasing ETs formation in synovia of patients with CHS. However, our hypotheses must be confirmed in the future with better designed and more statistical power studies. Meanwhile, the use of intraarticular injections of PRP for the treatment of CHS remains controversial.

PMID:35152513 | DOI:10.1111/hae.14508

J Viral Hepat. 2022 Feb 13. doi: 10.1111/jvh.13656. Online ahead of print.

ABSTRACT

Renal safety is a critical issue in chronic hepatitis B (CHB) patients receiving long-term entecavir (ETV) or tenofovir disofuroxil fumarate (TDF) therapy. We investigated their effects on estimated glomerular filtration rate (eGFR). Treatment-naïve CHB patients receiving ETV or TDF for ≥1 year were recruited. The eGFR was assessed using the Chronic Kidney Disease Epidemiology Collaboration equation. We calculated average annual percent change (AAPC) in eGFR using Joinpoint regression. At the beginning of the observation, the ETV group had more unfavorable conditions than the TDF group: lower eGFR and higher FIB-4 and APRI than the TDF group (all P<0.001). After 6 years of antiviral therapy, the mean eGFR in the ETV group (n=1,793) was maintained (96.0 at first year to 95.6 mL/min/1.73 m² at sixth year; AAPC -0.09%; P=0.322), whereas that in the TDF group (n=1,240) significantly decreased annually (101.9 at first year to 96.9 mL/min/1.73 m² at sixth year; AAPC -0.88%; P<0.001). Notably, in the TDF group, even patients without diabetes (AAPC -0.80%; P=0.001) or hypertension (AAPC -0.87%; P=0.001) experienced significant decrease in eGFR. Expectably, accompanying diabetes (AAPC -1.59%; p=0.011) or hypertension (AAPC -1.00%; p=0.002) tended to accelerate eGFR decrease. TDF treatment (odds ratio 1.66, P<0.001), along with eGFR<60 mL/min/1.73 m² , serum albumin<3.5 mg/dL, and hypertension, were independently associated with ongoing renal dysfunction, defined as a negative slope of the mean eGFR change. In conclusion, compared to ETV, long-term TDF treatment induced slow, but progressive renal dysfunction. Although the annual eGFR change by TDF was small, careful monitoring is necessary, especially in patients requiring life-long therapy.

PMID:35152517 | DOI:10.1111/jvh.13656

J Occup Health. 2022 Jan;64(1):e12318. doi: 10.1002/1348-9585.12318.

ABSTRACT

OBJECTIVE: Exposure to ultraviolet (UV) radiation from sunlight induces the production of essential vitamin D, whereas overexposure to sunlight leads to skin cancer. Sunlight exposure has been measured using questionnaires, dosimeters, and vitamin D levels. Several studies have measured vitamin D in the working population; however, these studies were limited to certain occupations such as farmers and construction workers. In the present study, we evaluated sunlight exposure using blood vitamin D as an exposure surrogate across industries and occupations.

METHODS: The Korea National Health and Nutrition Examination Survey (KNHANES) is a nationwide study representing the Korean population. We analyzed data from KNHANES between 2008 and 2009. We examined the association between vitamin D levels and pertinent personal, seasonal, residential, and occupational factors. Furthermore, we developed a multiple regression model with factors other than occupational factors (industry and occupation) and obtained residual values. We computed the third quartile (Q3) of the residuals and then calculated the fractions exceeding the Q3 level for each combination of industry and occupation.

RESULTS: Age, sex, body mass index, year, season, latitude, living area, living in an apartment, industry, and occupation were significantly associated with vitamin D levels. Based on the exceeding fraction, the armed forces showed the highest exceeding fraction level of 0.71.

CONCLUSIONS: Our results present the high exposure groups to sunlight across industries and occupations. Our results may provide a source for prioritizing occupational groups with a high risk of adverse health effects from sunlight exposure.

PMID:35152501 | DOI:10.1002/1348-9585.12318

J Card Surg. 2022 Feb 13. doi: 10.1111/jocs.16306. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the impact of left ventricle outflow tract calcification (LVOT) on the outcomes of transcatheter aortic valve implantation (TAVI).

METHODS: Meta-analysis including studies published by October 2021. Primary endpoints were operative and 1-year mortality. The secondary endpoints were stroke, myocardial infarction, paravalvular leakage (PVL), new permanent pacemaker implantation (PPI), aortic annulus/root rupture.

RESULTS: Nine studies met our eligibility criteria, including a total of 4459 patients (1330 patients with significant LVOT calcification and 3129 patients without significant LVOT calcification). Pooled risk of operative death was higher in the group with significant LVOT calcification (odds ratio [OR]: 2.28; 95% confidence interval [CI]: 1.33-3.91; p < .001). Worse 1-year survival was observed in the group with LVOT calcification (hazard ratio 1.53, 95% CI: 1.26-1.87, p < .001). Patients with significant LVOT calcification had higher risk of stroke (OR: 1.83; 95% CI: 1.08-3.09; p = .032), myocardial infarction (OR: 1.74; 95% CI: 1.08-2.80; p = .034), PVL (OR: 1.88; 95% CI: 1.09-3.22; p = .028) and aortic annulus/root rupture (OR: 7.48; 95% CI: 3.58-15.65; p = .002). We did not observe a statistically significant difference in the pooled results for new PPI between the groups (OR: 1.19; 95% CI: 0.79-1.80; p = .337).

CONCLUSION: The presence of significant LVOT calcification increases the risk of periprocedural and 1-year mortality, stroke, myocardial infarction, PVL and aortic annulus/root rupture after TAVI. Self-expandable valves may be a preferrable option in this scenario. Structural heart surgeons and interventional cardiologists should consider this factor when referring patients for TAVI and technical aspects (such as the type of transcatheter heart valve to be deployed or the use of pre-/post-dilatation) should be factored in.

PMID:35152472 | DOI:10.1111/jocs.16306

Nurs Forum. 2022 Feb 13. doi: 10.1111/nuf.12705. Online ahead of print.

ABSTRACT

BACKGROUND: Nurses play a critical role in providing care to patients, in particular, they work in the frontlines in caring for patients with complicated COVID-19 requiring hospitalization. Evaluation of the caregiving roles and attitudes of nurses is critical in the current crisis. Therefore, this study aimed to determine the caregiving roles and attitudes of nurses during the COVID-19 pandemic.

METHODS: A quantitative descriptive study was performed with 130 nurses in Turkey. The attitude scale for the caregiving roles of nurses (ASCRNs) was used to collect data. We conducted an online survey between May and November 2020.

RESULTS: The mean total score of the participants on the ASCRN was 62.20 ± 18.42. All nurses stated that they were affected by the COVID-19 pandemic. The ASCRN scores of nurses who received training about the COVID-19 pandemic and who thought that the personal protective equipment they used was sufficient had statistically higher scores on the ASCRN (p < .05).

CONCLUSION: The results of this study suggested that the COVID-19 pandemic had a negative effect on the caregiving roles and attitudes of the nurses.

PMID:35152449 | DOI:10.1111/nuf.12705

Biom J. 2022 Feb;64(2):198-224. doi: 10.1002/bimj.202000202. Epub 2021 Jun 4.

ABSTRACT

Targeted therapies tend to have biomarker defined subgroups that derive differential efficacy from treatments. This article corrects three prevailing oversights in stratified analyses comparing treatments in randomized controlled trials (RCTs) with binary and time-to-event outcomes: 1.Using efficacy measures such as odds ratio (OR) and hazard ratio (HR) can make a prognostic biomarker appear predictive, targeting wrong patients, because the inference is affected by a confounding/covert factor even with ignorable treatment assignment in an RCT. As shown analytically and with real immunotherapy patient level data, OR and HR cannot meet the causal Estimand requirement of ICH E9R1. 2.Mixing efficacy in subgroups by prevalence, the prevailing practice, can give misleading results also, for any efficacy measured as a ratio. However, mixing relative response (RR) and ratio of median (RoM) survival times by the prognostic effect, the confounding/covert factor hiding in plain sight, will give causal inference in an RCT. 3.Effects in subgroups should not be mixed on the logarithmic scale, because it creates an artificial Estimand for the whole population which changes depending on how the population is divided into subgroups. Current computer package implementations contain all these oversights. Probabilities, including survival curve probabilities, naturally average within each treatment arm by prevalence. The subgroup mixable estimation (SME) principle fixes the oversights by first averaging probabilities (not their logarithms) within each treatment arm, then computing simultaneous confidence intervals for ratio efficacy in subgroups and their mixtures based on rigorous mathematical derivation, to finally provide causal inference in the form of apps.

PMID:35152457 | DOI:10.1002/bimj.202000202

Perspect Psychiatr Care. 2022 Feb 13. doi: 10.1111/ppc.13050. Online ahead of print.

ABSTRACT

PURPOSE: Anorexia nervosa (AN) may be treated with intravenous hyperalimentation (IVH) that may be associated with catheter-related bloodstream infection (CRBSI).

DESIGN AND METHODS: Retrospective chart review was conducted to compare those who developed CRBSI were compared with those who did not.

FINDINGS: Of 34 patients, 17 episodes of AN treated with IVH were identified, of which five resulted in CRBSI. The average body mass index at admission was low at 12.2. Patients who needed physical restraint during IVH had a higher (albeit statistically nonsignificant) risk. Also, those with purging had numerically lower risk.

PRACTICE IMPLICATIONS: CRBSI complicated IVH in 29.4% instances of severe life-threatening AN in our sample. Whether physical restraints and no purging constitute a risk factor of CRBSI needs to be further investigated.

PMID:35152427 | DOI:10.1111/ppc.13050