Category: Statistics

Laryngoscope. 2021 Jun 18. doi: 10.1002/lary.29602. Online ahead of print.

ABSTRACT

OBJECTIVES/HYPOTHESIS: The prevalence of tympanostomy tube surgery (TTS) in patients with a cleft deformity was investigated, in relation to cleft width and cleft type.

STUDY DESIGN: Retrospective review of medical health records.

METHODS: Retrospective review of medical health records. Seventy-eight patients with non-syndromic cleft deformity of the palate and/or alveolus and lip between 2003 and 2017 were investigated. All available medical documents were analyzed. The study group was divided into subgroups: 1) patients with isolated cleft palate (CP) and patients with a cleft palate with cleft lip and alveolus (CLP). 2) According to Veau’s classification (I-IV), further subgroups were defined. Cleft width was measured using plaster cast models.

RESULTS: TTS was performed in 55% of the patients (n = 43). Considering Veau’s classification, TTS was conducted as follows: Veau I 65.2% (n = 15/23), Veau II 55.0% (n = 11/20), Veau III 47.6% (n = 10/21), and Veau IV 50.0% (n = 7/14). Cleft classifications, maxillary arch width, and absolute/relative cleft width had no statistical impact on TTS occurrence. Although no significant correlation could be found, patients in our study group with CP (Veau I and II) underwent TTS more often (60.5%, n = 26/43) than patients with CPL (Veau III and IV; 48.6%, n = 17/35) during a three-year follow-up.

CONCLUSION: None of the cleft characteristics examined had a significant impact on the proportion of patients who received TTS. Nevertheless, patients with lower Veau classification and CP received tympanostomy tubes more often. Therefore, otolaryngologists and pediatricians treating children with cleft palate should maintain a high level of suspicion for chronic middle ear effusion, even in patients with small clefts.

LEVEL OF EVIDENCE: 3 Laryngoscope, 2021.

PMID:34142721 | DOI:10.1002/lary.29602

Eur J Clin Invest. 2021 Jun 18:e13630. doi: 10.1111/eci.13630. Online ahead of print.

ABSTRACT

BACKGROUND: Several prognostic models for gestational diabetes mellitus (GDM) are provided in the literature; however, their clinical significance has not been thoroughly evaluated, especially with regard to application at early gestation and in accordance with the most recent diagnostic criteria. This external validation study aimed to assess the predictive accuracy of published risk estimation models for the later development of GDM at early pregnancy.

METHODS: In this cohort study, we prospectively included 1132 pregnant women. Risk evaluation was performed before 16 + 0 weeks of gestation including a routine laboratory examination. Study participants were followed-up until delivery to assess GDM status according to the IADPSG 2010 diagnostic criteria. Fifteen clinical prediction models were calculated according to the published literature.

RESULTS: Gestational diabetes mellitus was diagnosed in 239 women, that is 21.1% of the study participants. Discrimination was assessed by the area under the ROC curve and ranged between 60.7% and 76.9%, corresponding to an acceptable accuracy. With some exceptions, calibration performance was poor as most models were developed based on older diagnostic criteria with lower prevalence and therefore tended to underestimate the risk of GDM. The highest variable importance scores were observed for history of GDM and routine laboratory parameters.

CONCLUSIONS: Most prediction models showed acceptable accuracy in terms of discrimination but lacked in calibration, which was strongly dependent on study settings. Simple biochemical variables such as fasting glucose, HbA1c and triglycerides can improve risk prediction. One model consisting of clinical and laboratory parameters showed satisfactory accuracy and could be used for further investigations.

PMID:34142723 | DOI:10.1111/eci.13630

J Adv Nurs. 2021 Jun 18. doi: 10.1111/jan.14940. Online ahead of print.

ABSTRACT

AIMS: This study aimed to identify the predicting factors of quality of life (QoL) from a set of psychosocial, sociodemographic and clinical variables amongst older adults in a long-term care setting.

DESIGN: A cross-sectional, descriptive correlational study.

METHOD: The study was conducted in a nursing home and a day care centre from July to December 2019. Two hundred older adults were recruited. Guided by the salutogenic model, the sense of coherence (SOC) scale, Connor-Davidson resilience scale, de Jong Gierveld loneliness scale and World Health Organization quality of life instrument-older adults (WHOQOL-OLD) were used. The sociodemographic and clinical profiles of participants were collected. Descriptive statistics, Pearson product-moment correlation coefficient, independent-samples t test, one-way analysis of variance and stepwise regression were utilised in the analysis.

RESULTS: The mean score for WHOQOL-OLD was 94.42 ± 19.55. The highest mean score was observed in the “Death and Dying” facet, while the lowest mean scores were reflected in the “Autonomy” and “Intimacy” facets of QoL. Regardless of resident type, most QoL scores were similar across different variables. Based on the stepwise regression, higher manageability and meaningfulness in SOC, higher resilience, lower social loneliness, lower emotional loneliness and hearing impairments are significantly associated with higher QoL.

CONCLUSION: Manageability, meaningfulness and resilience should be enhanced while ameliorating feelings of loneliness to improve the QoL amongst older adults receiving long-term care. Age, marital status, educational level, care arrangement, body mass index, performance in activities of daily living, comorbidities and hearing and mobility impairments could influence QoL and thus warrant more attention.

IMPACT: Future interventions can be conducted in group sessions to facilitate social interaction and alleviate loneliness. More resources should be allocated to enhance older adults’ care arrangements and coping mechanisms to provide them with the support, as they face challenges in daily life due to mobility impairment and other restrictions.

PMID:34142732 | DOI:10.1111/jan.14940

Am J Epidemiol. 2021 Jun 18:kwab177. doi: 10.1093/aje/kwab177. Online ahead of print.

ABSTRACT

We examined the association between early-life participation in collision sports and later life cognitive health over a 28-year period in a population-based sample drawn from the longitudinal Swedish Adoption/Twin Study of Aging (1987-2014). Cognitive measures included the Mini-Mental State Examination and performance across multiple cognitive domains (e.g., global cognition, verbal ability, spatial ability, memory, processing speed). Among a sample of 660 adults (mean age at baseline 62.8 years [range: 50-88]; 58.2% female) who contributed 10,944 person-years of follow-up, there were 450 cases of cognitive impairment (crude rate: 41.1/1,000 person-years). Early-life participation in collision sports was not significantly associated with cognitive impairment at baseline nor its onset over a 28-year period in a time-to-event analysis which accounted for the semi-competing risk of death. Furthermore, growth curve models revealed no association between early-life participation in collision sports and the level of or change in trajectories of cognition across multiple domains overall nor in gender-stratified models. We discuss the long-term implications of adolescent participation in collision sports on cognitive health.

PMID:34142704 | DOI:10.1093/aje/kwab177

Mil Med. 2021 Jun 18:usab239. doi: 10.1093/milmed/usab239. Online ahead of print.

ABSTRACT

INTRODUCTION: The Military Health System (MHS) offers an example of a socialized healthcare model, operating within a larger “purchased care” civilian healthcare market. This arrangement has facilitated a trend wherein MHS clinicians often transfer moderate-to-complex patients to surrounding civilian hospitals, despite having the capability to care for such patients in-house. In an effort to stem this behavior, two initiatives were introduced at Carl R Darnall Army Medical Center (CRDAMC): A Transfer Policy Statement and Transfer Rounds. The Transfer Policy Statement emphasized that patients ought to be transferred only for capability gaps within the hospital. Transfer Rounds were then used to review the care received by each transferred patient and assess if that care could have been delivered internally. The purpose of this study is to assess the effect of these initiatives on reducing transfers from our hospital.

MATERIALS AND METHODS: We performed a retrospective chart review from July 2019 through June 2020 to identify the number of total emergency department (ED) transfers, subcategorized as either transfers we had the capability to care for or transfers we did not have the capability to care for. The Transfer Policy Statement was published in August 2019, and Transfer Rounds were instituted in November 2019. We hypothesized that the two interventions would decrease the number of monthly inappropriate transfers. This was assessed by analyzing the proportion of inappropriate to appropriate patient transfers via Cochran and Armitage using SAS 9.4 (SAS Institute, Cary, NC). The projected received an Exemption Determination from the CRDAMC’s Human Research Protections Office. The Defense Health Agency approved the data-sharing agreement.

RESULTS: Over the study period, a total of 706 transfers met the criteria for analysis. The monthly median for total ED transfers was 64.5 (Interquartile Range (IQR) 45-74); appropriate transfers averaged 29.5 (median, IQR 24.5-36) and inappropriate 25.5 (median, IQR 9-41.5). A statistically significant downward trend in the fraction of inappropriate transfers was demonstrated by Cochran and Armitage (P < .0001).

CONCLUSION: Our analysis supports the hypothesis that implementing a Transfer Policy and Transfer Rounds can significantly reduce the amount of MHS Leakage-that is the number of transferred patients that the MHS could have equally cared for. The effects of reduced patient transfers have many implications for the MHS: patients experience improved continuity of care by remaining in the same hospital system; clinicians maintain and extend their scope of practice by treating more complex patients; and patient flow and ED wait times are reduced by eliminating the transfer process. The financial implications of reduced MHS Leakage were not directly evaluated by our study, however may be assessed in future study.

PMID:34142706 | DOI:10.1093/milmed/usab239

Sci Rep. 2021 Jun 17;11(1):12765. doi: 10.1038/s41598-021-91917-6.

ABSTRACT

The onset and worsening of some diseases are related to the variation and instability of gut microbiota. However, studies examining the personal variation of gut microbiota in detail are limited. Here, we evaluated the yearly variation of individual gut microbiota in 218 Japanese subjects aged 66-91 years, using Jensen-Shannon distance (JSD) metrics. Approximately 9% of the subjects showed a substantial change, as their formerly predominant bacterial families were replaced over the year. These subjects consumed fermented milk products less frequently than their peers. The relationship between the intake frequencies of fermented milk products containing Lactocaseibacillus paracasei strain Shirota (LcS) and JSD values was also investigated. The intra-individual JSD of subjects ingesting LcS products ≥ 3 days/week over the past 10 years was statistically lower than the < 3 days/week group (P = 0.045). Focusing on subjects with substantial gut microbiota changes, only 1.7% of the subjects were included in the LcS intake ≥ 3 days/week group whereas 11.3% were found in the < 3 days/week group (P = 0.029). These results suggest that about one-tenth of the elderly Japanese could experience a substantial change in their gut microbiota during a 1-year period, and that the habitual intake of probiotics may stabilize their gut microbiota.

PMID:34140561 | DOI:10.1038/s41598-021-91917-6

Sci Rep. 2021 Jun 17;11(1):12825. doi: 10.1038/s41598-021-92152-9.

ABSTRACT

Since the collapse of the Soviet Union and transition to a new forest inventory system, Russia has reported almost no change in growing stock (+ 1.8%) and biomass (+ 0.6%). Yet remote sensing products indicate increased vegetation productivity, tree cover and above-ground biomass. Here, we challenge these statistics with a combination of recent National Forest Inventory and remote sensing data to provide an alternative estimate of the growing stock of Russian forests and to assess the relative changes in post-Soviet Russia. Our estimate for the year 2014 is 111 ± 1.3 × 10⁹ m³, or 39% higher than the value in the State Forest Register. Using the last Soviet Union report as a reference, Russian forests have accumulated 1163 × 10⁶ m³ yr^-1 of growing stock between 1988-2014, which balances the net forest stock losses in tropical countries. Our estimate of the growing stock of managed forests is 94.2 × 10⁹ m³, which corresponds to sequestration of 354 Tg C yr^-1 in live biomass over 1988-2014, or 47% higher than reported in the National Greenhouse Gases Inventory.

PMID:34140583 | DOI:10.1038/s41598-021-92152-9

Clin Transl Gastroenterol. 2021 Jun 18;12(6):e00376. doi: 10.14309/ctg.0000000000000376.

ABSTRACT

INTRODUCTION: Hepatic encephalopathy (HE) is a major complication of transjugular intrahepatic portosystemic shunt (TIPS) creation. This study was aimed to determine whether underdilated TIPS with 8-mm polytetrafluoroethylene-covered stents could reduce the risk of HE and liver damage yet maintain clinical and hemodynamic efficacy.

METHODS: This retrospective case-controlled study included 134 patients treated with TIPS from March 2017 to November 2019. All the TIPS procedures were created using 8-mm covered stents, and according to the diameter of expansion balloon catheters, the patients were divided into 2 groups, an underdilated group (6-mm balloon catheter, n = 73) and a control group (8-mm balloon catheter, n = 61).

RESULTS: The Kaplan-Meier analysis indicated that the cumulative incidence of overt HE in the underdilated group was significantly lower than that in the control group (11.0% vs 29.5%, log rank P = 0.007), but no statistical differences were found toward variceal rebleeding, shunt dysfunction, and survival between groups. In multivariate analysis, the independent risk factors for overt HE were identified as age (hazard ratio [HR] = 1.036, 95% confidence interval [CI] = 1.003-1.069, P = 0.032), Child-Pugh score (HR = 1.519, 95% CI = 1.212-1.905, P < 0.001), and group assignment (HR = 0.291, 95% CI = 0.125-0.674, P = 0.004).

DISCUSSION: Underdilated TIPS with 8-mm polytetrafluoroethylene-covered stents could reduce the risk of HE and liver function impairment compared with completely dilated TIPS, but not increase the risk of variceal rebleeding, shunt dysfunction, and death.

PMID:34140457 | DOI:10.14309/ctg.0000000000000376

BDJ Open. 2021 Jun 17;7(1):22. doi: 10.1038/s41405-021-00077-2.

ABSTRACT

INTRODUCTION: Lateral cephalometric analysis continues to be one of the gold standard diagnostic aids in orthodontics, with various software available to enhance this.

AIM: This study was done to evaluate the accuracy and reliability of linear and angular measurements obtained from OneCeph digital cephalometric tracing and manual tracings in lateral cephalometry.

METHODOLOGY: This is a cross-sectional study done on twenty pre-treatment lateral cephalometric radiographs of subjects who reported to the postgraduate orthodontic clinic for orthodontic treatment over one month. Cephalometric tracings were done using OneCeph digital software and manual tracing method to evaluate nine parameters of Steiner’s cephalometric analysis. An Independent T-sample test was done between the mean values of manual and OneCeph tracing. Intra operator reliability was evaluated by paired T-test after a week.

RESULTS: No significant statistical difference was observed as the p-value was greater than 0.05 for all the parameters in the two groups.

CONCLUSION: The reliability and accuracy of OneCeph software application was found to be at par with manual cephalometric tracing.

PMID:34140466 | DOI:10.1038/s41405-021-00077-2

Science. 2021 Jun 18;372(6548):eabf3736. doi: 10.1126/science.abf3736.

ABSTRACT

Brain regions communicate with each other through tracts of myelinated axons, commonly referred to as white matter. We identified common genetic variants influencing white matter microstructure using diffusion magnetic resonance imaging of 43,802 individuals. Genome-wide association analysis identified 109 associated loci, 30 of which were detected by tract-specific functional principal components analysis. A number of loci colocalized with brain diseases, such as glioma and stroke. Genetic correlations were observed between white matter microstructure and 57 complex traits and diseases. Common variants associated with white matter microstructure altered the function of regulatory elements in glial cells, particularly oligodendrocytes. This large-scale tract-specific study advances the understanding of the genetic architecture of white matter and its genetic links to a wide spectrum of clinical outcomes.

PMID:34140357 | DOI:10.1126/science.abf3736