Category: Statistics

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

Health Care Women Int. 2022 Jul 7:1-16. doi: 10.1080/07399332.2022.2061971. Online ahead of print.

ABSTRACT

The researchers’ aim is to examine the postural stability and flexibility responses of yoga training in women. The authors conducted the yoga training program 2 days a week and they assessed flexibility using the sit and reach test, trunk hyperextension test and trunk lateral flexion test. The researchers measured static and dynamic balance employing the device and database system. Then, the authors repeated all assesments were at the end of the first, the fifth and the tenth sessions. As a result of this study, the researchers revealed that the male participants had significantly poorer results in a single parameter (longitudinal sway) when compared with the female group, but the groups were statistically equivalent in this parameter after the first yoga training session. The authors also revealed that yoga was effective in improving flexibility among healthy young adults of both sexes, although the males showed greater improvement than females in the flexibility results.

PMID:35797446 | DOI:10.1080/07399332.2022.2061971

Cancer. 2022 Jul 7. doi: 10.1002/cncr.34377. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate risk factors (treatment-related, comorbidities, and lifestyle) for breast cancer-related lymphedema (BCRL) within the context of a Prospective Surveillance and Early Intervention (PSEI) model of care for subclinical BCRL.

METHODS: The parent randomized clinical trial assigned patients newly diagnosed with breast cancer to PSEI with either bioimpedance spectroscopy (BIS) or tape measurement (TM). Surgical, systemic and radiation treatments, comorbidities, and lifestyle factors were recorded. Detection of subclinical BCRL (change from baseline of either BIS L-Dex ≥6.5 or tape volume ≥ 5% and < 10%) triggered an intervention with compression therapy. Volume change from baseline ≥10% indicated progression to chronic lymphedema and need for complex decongestive physiotherapy. In this secondary analysis, multinomial logistic regressions including main and interaction effects of the study group and risk factors were used to test for factor associations with outcomes (no lymphedema, subclinical lymphedema, progression to chronic lymphedema after intervention, progression to chronic lymphedema without intervention). Post hoc tests of significant interaction effects were conducted using Bonferroni-corrected alphas of .008; otherwise, an alpha of .05 was used for statistical significance.

RESULTS: The sample (n = 918; TM = 457; BIS = 461) was female with a median age of 58.4 years. Factors associated with BCRL risk included axillary lymph node dissection (ALND) (p < .001), taxane-based chemotherapy (p < .001), regional nodal irradiation (RNI) (p ≤ .001), body mass index >30 (p = .002), and rurality (p = .037). Mastectomy, age, hypertension, diabetes, seroma, smoking, and air travel were not associated with BCRL risk.

CONCLUSIONS: Within the context of 3 years of PSEI for subclinical lymphedema, variables of ALND, taxane-based chemotherapy, RNI, body mass index >30, and rurality increased risk.

PMID:35797441 | DOI:10.1002/cncr.34377