Category: Statistics

PLoS One. 2022 Apr 6;17(4):e0266479. doi: 10.1371/journal.pone.0266479. eCollection 2022.

ABSTRACT

INTRODUCTION: Worldwide, the estimated prevalence of urinary incontinence is 8.7%. Urinary incontinence is more frequent in women than in men. Posing the right questions is crucial, when diagnosing urinary incontinence, but also to evaluate the need of treatment and treatment effect. Therefore, reliable and validated questionnaires within this area are needed. Even though the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) has been used on a daily basis in the Danish Urogynaecological Database since 2006, it has not yet been validated in a Danish population of both men and women.

OBJECTIVE: To test the reliability and validity of the Danish version of the ICIQ-UI SF in a Danish speaking population of men and women among municipal employees.

METHODS: Content validity was evaluated with semi-structured interviews. A quantitative field test was performed, in which the questionnaire was distributed electronically to municipal workers by E-mail. Statistical methods included item characteristics (missings, kurtosis and skewness), internal consistency (Chronbach’s alfa), test-retest (ICC), construct validity (known group validation), and floor and ceiling effect.

RESULTS: A number of 1814 Danish municipal workers completed the questionnaire. Of the total number of responders, 426 were invited to complete the questionnaire twice (for test-retest) and 215 (50.5%) of these completed the questions again two weeks later. Statistical analyses of the ICIQ-UI SF demonstrated no floor and ceiling effects, skewness was zero and kurtosis 0.00-0.49. Cronbach’s alfa was 0.87 and intraclass correlation coefficient 0.73. Two out of three hypotheses were accepted in the known-groups validation.

CONCLUSION: This study offers an adaptation of the ICIQ-UI SF to a Danish setting. The Danish ICIQ-UI SF demonstrated acceptable reliability and validity. However, clinicians should consider the relatively high measurement error.

PMID:35385519 | DOI:10.1371/journal.pone.0266479

PLoS One. 2022 Apr 6;17(4):e0265497. doi: 10.1371/journal.pone.0265497. eCollection 2022.

ABSTRACT

BACKGROUND: Blood pressure (BP) elevations are commonly treated in hospitalized patients; however, treatment is not guideline directed. Our objective was to assess BP response to commonly prescribed antihypertensives after the development of severe inpatient hypertension (HTN).

METHODS: This is a cohort study of adults, excluding intensive care unit patients, within a single healthcare system admitted for reasons other than HTN who developed severe HTN (systolic BP>180 or diastolic BP >110 mmHg at least 1 hour after admission). We identified the most commonly administered antihypertensives given within 6 hours of severe HTN (given to >10% of treated patients). We studied the association of treatment with each antihypertensive vs. no treatment on BP change in the 6 hours following severe HTN development using mixed-effects model after adjusting for demographics and clinical characteristics.

RESULTS: Among 23,147 patients who developed severe HTN, 9,166 received antihypertensive treatment. The most common antihypertensives given were oral metoprolol (n = 1991), oral amlodipine (n = 1812), oral carvedilol (n = 1116), IV hydralazine (n = 1069) and oral hydralazine (n = 953). In the fully adjusted model, treatment with IV hydralazine led to 13 [-15.9, -10.1], 18 [-22.2, -14] and 11 [-14.1, -8.3] mmHg lower MAP, SBP, and DBP in the 6 hours following severe HTN development compared to no treatment. Treatment with oral hydralazine and oral carvedilol also resulted in significantly lower BPs in the 6 hours following severe HTN development (6 [-9.1, -2.1 and -7 [-9.1, -4.2] lower MAP, respectively) compared to no treatment. Receiving metoprolol and amlodipine did not result in a drop in BP compared to no treatment.

CONCLUSION: Among commonly used antihypertensives, IV hydralazine resulted in the most significant drop in BP following severe HTN, while metoprolol and amlodipine did not lower BP. Further research to assess the effect of treatment on clinical outcomes and if needed which antihypertensives to administer are necessary.

PMID:35385506 | DOI:10.1371/journal.pone.0265497

PLoS One. 2022 Apr 6;17(4):e0265153. doi: 10.1371/journal.pone.0265153. eCollection 2022.

ABSTRACT

BACKGROUND AND AIMS: Stigmatization is a well-documented problem of some diseases. Perceived stigma is common in alcohol-related liver disease and hepatitis C, but little information exists on stigma in patients with non-alcoholic fatty liver disease (NAFLD). Aim of the study was to investigate frequency and characteristics of perceived stigma among patients with NAFLD.

METHODS: One-hundred and ninety-seven patients seen at the liver clinic were included: a study group of 144 patients with NAFLD, 50 with cirrhosis (34 compensated, 16 decompensated), and a control group of 53 patients with alcohol-related cirrhosis. Demographic, clinical, and laboratory data were collected. Quality-of-life was assessed by chronic liver disease questionnaire (CLDQ). Perceived stigma was assessed using a specific questionnaire for patients with liver diseases categorized in 4 domains: stereotypes, discrimination, shame, and social isolation.

RESULTS: Perceived stigma was common in patients with NAFLD (99 patients, 69%) and affected all 4 domains assessed. The frequency was slightly higher, yet not significant, in patients with NAFLD cirrhosis vs those without (72% vs 67%, respectively; p = 0.576). In patients without cirrhosis perceived stigma was unrelated to stage of disease, since frequency was similar in patients with no or mild fibrosis compared to those with moderate/severe fibrosis (66% vs 68%, respectively). There were no differences in perceived stigma between patients with compensated cirrhosis and these with decompensated cirrhosis. Among patients with cirrhosis, stigmatization was more common in alcohol-related vs NAFLD-cirrhosis, yet differences were only significant in two domains. In patients with NAFLD, perceived stigma correlated with poor quality-of-life, but not with demographic or clinical variables.

CONCLUSIONS: Perceived stigmatization is common among patients with NAFLD independently of disease stage, is associated with impaired quality-of-life, and may be responsible for stereotypes, discrimination, shame, and social isolation, which may affect human and social rights of affected patients.

PMID:35385510 | DOI:10.1371/journal.pone.0265153

PLoS One. 2022 Apr 6;17(4):e0265673. doi: 10.1371/journal.pone.0265673. eCollection 2022.

ABSTRACT

PURPOSE: Research on the novel coronavirus diseases 2019 (COVID-19) mainly relies on cross-sectional data, but this approach fails to consider the temporal dimension of the pandemic. This study assesses three temporal dimensions of the COVID-19 infection risk in US counties, namely probability of occurrence, duration of the pandemic, and intensity of transmission, and investigate local patterns of the factors associated with these risks.

METHODS: Analyzing daily data between January 22 and September 11, 2020, we categorize the contiguous US counties into four risk groups-High-Risk, Moderate-Risk, Mild-Risk, and Low-Risk-and then apply both conventional (i.e., non-spatial) and geographically weighted (i.e., spatial) ordinal logistic regression model to understand the county-level factors raising the COVID-19 infection risk. The comparisons of various model fit diagnostics indicate that the spatial models better capture the associations between COVID-19 risk and other factors.

RESULTS: The key findings include (1) High- and Moderate-Risk counties are clustered in the Black Belt, the coastal areas, and Great Lakes regions. (2) Fragile labor markets (e.g., high percentages of unemployed and essential workers) and high housing inequality are associated with higher risks. (3) The Monte Carlo tests suggest that the associations between covariates and COVID-19 risk are spatially non-stationary. For example, counties in the northeastern region and Mississippi Valley experience a stronger impact of essential workers on COVID-19 risk than those in other regions, whereas the association between income ratio and COVID-19 risk is stronger in Texas and Louisiana.

CONCLUSIONS: The COVID-19 infection risk levels differ greatly across the US and their associations with structural inequality and sociodemographic composition are spatially non-stationary, suggesting that the same stimulus may not lead to the same change in COVID-19 risk. Potential interventions to lower COVID-19 risk should adopt a place-based perspective.

PMID:35385491 | DOI:10.1371/journal.pone.0265673

Pediatr Phys Ther. 2022 Apr 1;34(2):212-219. doi: 10.1097/PEP.0000000000000881.

ABSTRACT

PURPOSE: This pilot study assesses the feasibility of using PedBotHome to promote adherence to a home exercise program, the ability of the device to withstand frequent use, and changes in participant ankle mobility.PedBotHome is a robotic ankle device with integrated video game software designed to improve ankle mobility in children with cerebral palsy.

METHODS: Eight participants enrolled in a 28-day trial of PedBotHome. Ankle strength, range of motion, and plantar flexor spasticity were measured pre- and posttrial. Performance was monitored remotely, and game settings were modified weekly by physical therapists.

RESULTS: Four participants met the study goal of 20 days of use. There were statistically significant improvements in ankle strength, spasticity, and range of motion.

CONCLUSIONS: PedBotHome is a feasible device to engage children with static neurological injuries in ankle home exercise. This pilot study expands the paradigm for future innovative home-based robotic rehabilitation.

PMID:35385456 | DOI:10.1097/PEP.0000000000000881

PLoS One. 2022 Apr 6;17(4):e0265506. doi: 10.1371/journal.pone.0265506. eCollection 2022.

ABSTRACT

Review, promotion, and tenure (RPT) processes at universities typically assess candidates along three dimensions: research, teaching, and service. In recent years, some have argued for the inclusion of a controversial fourth criterion: collegiality. While collegiality plays a role in the morale and effectiveness of academic departments, it is amorphic and difficult to assess, and could be misused to stifle dissent or enforce homogeneity. Despite this, some institutions have opted to include this additional element in their RPT documents and processes, but it is unknown the extent of this practice and how it varies across institution type and disciplinary units. This study is based on two sets of data: survey data collected as part of a project that explored the publishing decisions of faculty and how these related to perceived importance in RPT processes, and 864 RPT documents collected from 129 universities from the United States and Canada. We analysed these RPT documents to determine the degree to which collegiality and related terms are mentioned, if they are defined, and if and how they may be assessed during the RPT process. Results show that when collegiality and related terms appear in these documents they are most often just briefly mentioned. It is less common for collegiality and related terms to be defined or assessed in RPT documents. Although the terms are mentioned across all types of institutions, there is a statistically significant difference in how prevalent they are at each. Collegiality is more commonly mentioned in the documents of doctoral research-focused universities (60%), than of master’s universities and colleges (31%) or baccalaureate colleges (15%). Results from the accompanying survey of faculty also support this finding: individuals from R-Types were more likely to perceive collegiality to be a factor in their RPT processes. We conclude that collegiality likely plays an important role in RPT processes, whether it is explicitly acknowledged in policies and guidelines or not, and point to several strategies in how it might be best incorporated in the assessment of academic careers.

PMID:35385489 | DOI:10.1371/journal.pone.0265506

J Clin Lab Anal. 2022 Apr 6:e24403. doi: 10.1002/jcla.24403. Online ahead of print.

ABSTRACT

INTRODUCTION: The intensification of coronavirus disease 2019 (COVID-19) complications, severe symptoms, and high mortality rate has led researchers to focus on this significant issue. While respiratory and cardiac complications have been described as high-risk manifestations in patients with COVID-19, neurological complications can also enhance mortality. This study aimed to evaluate the prevalence of neurological complications arises from SARS-CoV-2 and assess the mortality rate from neurological complications.

MATERIAL AND METHODS: Literature review was conducted by searching in PubMed/Medline, Web of Sciences, and Embase. After performing search strategies with relevant terms, a number of articles were excluded, including review articles, systematic review or meta-analysis, duplicate publication of same researchers, congress abstracts, animal studies, case reports, case series, and articles reporting a history of neurological features prior to COVID-19 infection. After retrieving the data, statistical analysis was performed using the STATA Version 14 software.

RESULTS: From 4455 retrieved publications, 20 articles were selected for further analysis. Among 18,258 included patients, 2791 showed neurological symptoms, which were classified into different groups. Headache, confusion, and fatigue were reported as the most non-specific neurological features in confirmed COVID-19 patients. Psychiatric symptoms, CNS disorders, cerebrovascular disorders, CNS inflammatory disorders, PNS disorders, neuromuscular disorders, etc., were defined as specific neurological manifestations. The pooled prevalence of neurological manifestations and mortality rate of COVID-19 patients with neurological features were estimated to be 23.0% (95% CI: 17.8-29.2) and 29.1% (95% CI: 20.3-39.8), respectively.

CONCLUSION: Neurological manifestations may commonly happen in patients with COVID-19. This study reported a high prevalence of neurological complications and mortality rates in COVID-19 patients. Therefore, patients with COVID-19 who indicated neurological symptoms should be taken seriously and should receive early treatment to prevent undesirable events.

PMID:35385200 | DOI:10.1002/jcla.24403

J Eval Clin Pract. 2022 Apr 6. doi: 10.1111/jep.13685. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: Clinical guidelines produced by cardiology societies (henceforth referred to simply as ‘clinical guidelines’) recommend thromboprophylaxis with oral anticoagulants (OACs) in patients with atrial fibrillation (AF) who have moderate-to-high stroke risk. However, deviations from these recommendations are observed, especially in the primary healthcare setting. The primary aims of this study were to evaluate the self-reported use of AF clinical guidelines and risk stratification tools among Australian general practitioners (GPs), and their perceptions regarding the available resources.

METHOD: We conducted an online survey of Australian GPs. Descriptive statistics were used to summarise the findings.

RESULTS: Responses from 115 GPs were included for analysis. Respondents reported various ways of accessing thromboprophylaxis-related information (n = 113), including clinical guidelines (13.3%), ‘Therapeutic Guidelines^© ‘ (37.2%) and Royal Australian College of General Practitioners websites (16.8%). Of those who reported reasons against accessing information from clinical guidelines (n = 97), the most frequent issues were: too many AF guidelines to choose from (34.0%; 33/97), different guidelines for different diseases (32.0%; 31/97), time-consuming to read guidelines (21.6%; 21/97), disagreements between different guideline recommendations (20.0%; 19/97), conflict with criteria for government subsidy (17.5%; 17/97) and GPs’ busy schedules (15.5%; 15/97). When assessing patients’ risk of stroke (n = 112) and bleeding (n = 111), the majority of the respondents reported primarily relying on a formal stroke risk (67.0%) and bleeding risk (55.0%) assessment tools, respectively. Respondents reported using formal stroke and bleeding risk assessment tools mainly when newly initiating patients on therapy (72.4%; 76/105 and 65.3%; 65/101, respectively).

CONCLUSION: Among our small sample of Australian GPs, most did not access thromboprophylaxis-related information directly from AF-specific clinical guidelines developed by cardiology societies. Although the majority reported using formal stroke and bleeding assessment tools, these were typically used on OAC initiation only. More focus is needed on formal risk reassessment as clinically indicated and at regular review.

PMID:35385183 | DOI:10.1111/jep.13685

J Obstet Gynaecol Res. 2022 Apr 6. doi: 10.1111/jog.15247. Online ahead of print.

ABSTRACT

INTRODUCTION: To assess the rate of disease control and survival after adjuvant treatment in patients with uterine papillary serous (PSC) and clear cell carcinoma (CCC) and compare the results between these two subtypes.

METHODS: The medical charts of 199 patients with de novo uterine PSC or CCC who underwent radiotherapy (RT) following surgery between 2001 and 2019 in three radiation oncology departments were retrospectively evaluated. Adjuvant treatment was decided by a multidisciplinary tumor board. All patients were planned to undergo adjuvant 4-6 cycles of chemotherapy with external beam RT (EBRT) and/or vaginal brachytherapy (VBT).

RESULTS: Median age was 63 years for all, 64 years for PSC, and 59 years for CCC, respectively. Complete surgical staging was applied in 98% of patients. Histopathologic subtype was PSC in 142 (71%) and pure CCC in 57 (29%) patients, respectively. FIGO stage was I in 107 (54%), II in 35 (18%), and III in 57 (28%) patients, respectively. Lympho-vascular space invasion and positive peritoneal cytology (PPC) were present in 42% and 10% of patients, respectively. All patients but 23 (12%) underwent adjuvant chemotherapy. Median follow-up was 49.5 months for all patients, 43.9 months for patients with PSC, and 90.4 months for patients with CCC, respectively. During follow-up, 20 (10%) patients developed pelvic recurrence (PR) and 37 (19%) developed distant metastasis (DM). PSC subtype increased the PR and DM rates, although the latter not statistically significant. The 5-year overall survival and disease-free survival rate was 73% and 69% for all patients, 71% and 66% for patients with PSC, and 77% and 75% for patients with CCC, respectively. The difference was more prominent in patients with stage ≥ IB disease. In multivariate analysis, advanced age and PPC significantly decreased all survival rates.

CONCLUSION: PSC has a worse prognosis than CCC with regard to pelvic and distant recurrence with a trend for decreased survival rates. Therefore, a more aggressive therapy is needed for patients with uterine PSC, particularly in patients with stage ≥ IB disease.

PMID:35385171 | DOI:10.1111/jog.15247

Cytopathology. 2022 Apr 6. doi: 10.1111/cyt.13124. Online ahead of print.

ABSTRACT

CONTEXT: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a standardized six tier-reporting format aimed at ensuring better communication and improved patient management.

AIMS: The main objectives of our study were to classify salivary gland fine needle aspirates into 6 categories of the MSRSGC and assess Risk of malignancy (ROM), specificity, sensitivity, Positive Predictive Value and Negative Predictive Value.

SETTINGS AND DESIGN: It was a retrospective study done over a period of three years from January 2017 to December 2020.

MATERIALS AND METHODS: All salivary gland FNAs performed in the above period were retrieved and classified into six categories based on the Milan system. Histopathological diagnosis was also retrieved wherever available.

STATISTICAL ANALYSIS: Using histopathological diagnosis as gold standard, ROM was calculated. Specificity, sensitivity, PPV, NPV and diagnostic accuracy were also assessed.

RESULTS: Out of the 202 salivary gland FNAs, histopathological diagnosis was available in 102 cases. ROM for Non Diagnostic, Non Neoplastic, Atypia of Undetermined Significance (AUS), Benign, Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP), Suspicious for Malignancy (SM) and Malignant categories was 30%, 8.3%, 25%, 3.9%, 33.3%, 71.4% and 93.3% respectively. Highest specificity and diagnostic accuracy were achieved when only malignant and SM were considered as positive results. Maximum sensitivity was observed when AUS, SUMP, SM and malignant were included in positive test results.

CONCLUSION: The MSRSGC is an excellent system for accurately classifying salivary gland FNAs with better reproducibility of reports and enhanced communication between pathologist and surgeon.

PMID:35385174 | DOI:10.1111/cyt.13124