Category: Statistics

Pharmacol Res Perspect. 2022 Feb;10(1):e00915. doi: 10.1002/prp2.915.

ABSTRACT

Although relapse is an important outcome to measure the effectiveness of schizophrenia treatment, no standard definition exists. This review aimed at identifying definitions and measurements of schizophrenia relapse in observational studies of long-acting injectables (LAIs) versus oral antipsychotics (OAPs) and at determining their impact on heterogeneity of comparative effectiveness estimates. A systematic review was conducted using MEDLINE and Embase (01 January 2010-11 November 2019 [date last searched]). Pragmatic searches of gray literature and snowballing were also conducted. Search outputs were screened independently by two assessors at first stage, and full-text of potentially eligible sources at second stage. For each retained source, definition and measurement of relapse, study methods, and comparative effectiveness estimates were extracted. Heterogeneity of estimates was assessed using I² statistic with a threshold of 50% for substantial heterogeneity. Literature search yielded 543 sources and pragmatic searches, 21, of which 35 were eligible. Twelve definitions of relapse were found based on hospitalization/emergency department (ED) data (28 studies) or clinical assessment (5 studies). No definition was provided in five studies. According to quantitative analyses, in studies defining relapse as schizophrenia-related hospitalization and/or ED visits over 1-year follow-up, LAIs were significantly more effective than OAPs. For studies measuring relapse based on all-cause hospitalization, heterogeneity was too high for pooling; yet this definition is the most frequently found in pooled estimates published in the literature. Schizophrenia relapse definitions led to substantial heterogeneity of comparative effectiveness estimates of LAIs versus OAPs. Creating study subgroups based on relapse definition effectively reduces statistical heterogeneity.

PMID:35089656 | DOI:10.1002/prp2.915

J Eval Clin Pract. 2022 Jan 28. doi: 10.1111/jep.13657. Online ahead of print.

ABSTRACT

RATIONALE, AIMS, AND OBJECTIVES: It is generally believed that evidence from low quality of evidence generate inaccurate estimates about treatment effects more often than evidence from high (certainty) quality evidence (CoE). As a result, we would expect that (a) estimates of effects of health interventions initially based on high CoE change less frequently than the effects estimated by lower CoE (b) the estimates of magnitude of effect size differ between high and low CoE. Empirical assessment of these foundational principles of evidence-based medicine has been lacking.

METHODS: We reviewed the Cochrane Database of Systematic Reviews from January 2016 through May 2021 for pairs of original and updated reviews for change in CoE assessments based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. We assessed the difference in effect sizes between the original versus updated reviews as a function of change in CoE, which we report as a ratio of odds ratio (ROR). We compared ROR generated in the studies in which CoE changed from very low/low (VL/L) to moderate/high (M/H) versus M/H to VL/L. Heterogeneity and inconsistency were assessed using the tau and I² statistic. We also assessed the change in precision of effect estimates (by calculating the ratio of standard errors) (seR), and the absolute deviation in estimates of treatment effects (aROR).

RESULTS: Four hundred and nineteen pairs of reviews were included of which 414 (207 × 2) informed the CoE appraisal and 384 (192 × 2) the assessment of effect size. We found that CoE originally appraised as VL/L had 2.1 [95% confidence interval (CI): 1.19-4.12; p = 0.0091] times higher odds to be changed in the future studies than M/H CoE. However, the effect size was not different (p = 1) when CoE changed from VL/L → M/H [ROR = 1.02 (95% CI: 0.74-1.39)] compared with M/H → VL/L (ROR = 1.02 [95% CI: 0.44-2.37]). Similar overlap in aROR between the VL/L → M/H versus M/H → VL/L subgroups was observed [median (IQR): 1.12 (1.07-1.57) vs. 1.21 (1.12-2.43)]. We observed large inconsistency across ROR estimates (I² = 99%). There was larger imprecision in treatment effects when CoE changed from VL/L → M/H (seR = 1.46) than when it changed from M/H → VL/L (seR = 0.72).

CONCLUSIONS: We found that low-quality evidence changes more often than high CoE. However, the effect size did not systematically differ between the studies with low versus high CoE. The finding that the effect size did not differ between low and high CoE indicate urgent need to refine current EBM critical appraisal methods.

PMID:35089627 | DOI:10.1111/jep.13657

Int J Med Robot. 2022 Jan 28:e2370. doi: 10.1002/rcs.2370. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to compare the bone resection thickness, rate of minimal thickness insert usage, and postoperative range of motion (ROM) between robotic and navigated TKA.

METHODS: Fifty consecutive posterior-stabilized (PS) robotic TKA and 50 case-controlled PS navigated TKA were enrolled. Bone resection thickness, rate of minimal thickness insert usage, and postoperative flexion contracture over 5X00B0; were statistically compared.

RESULTS: The tibial bone resection thickness was significantly thinner in robotic TKA. The insert thickness was significantly lower, and the rate of minimal thickness insert usage was significantly higher in robotic TKA. The ROM at 3 months postoperatively and the rate of postoperative flexion contracture were comparable between the two groups.

CONCLUSION: Robotic TKA can reduce the tibial bone resection thickness and increase the rate of minimal thickness insert usage without increasing postoperative flexion contracture as compared with navigated TKA. This article is protected by copyright. All rights reserved.

PMID:35089642 | DOI:10.1002/rcs.2370

J Magn Reson Imaging. 2022 Jan 28. doi: 10.1002/jmri.28078. Online ahead of print.

ABSTRACT

BACKGROUND: Liver shear stiffness measurement using magnetic resonance elastography (MRE) aids in the noninvasive diagnosis and staging of liver fibrosis. Inadequate breath-holds can lead to inaccurate stiffness estimation and/or failed MRE exams.

PURPOSE: To prospectively evaluate the performance of compressed sensitivity encoding (C-SENSE) accelerated rapid MRE measurement of liver shear stiffness using displacement wave polarity-inversion motion encoding.

STUDY TYPE: Retrospective.

SUBJECTS: Eleven with liver disease and 10 asymptomatic subjects.

FIELD STRENGTH/SEQUENCE: 1.5 T; gradient-recalled-echo (GRE) MRE.

ASSESSMENT: All participants underwent: 1) two-dimensional (2D) GRE MRE with inflow saturation using SENSE acceleration factor (R) of 2 (standard of care [SC]); 2) 2D rapid MRE with (RwS); and 3) without (RnS) inflow saturation using C-SENSE R = 3; and 4) spatial three-dimensional (3D) rapid MRE with inflow saturation (R3D) using C-SENSE R = 4; with nominally identical spatial resolution and coverage. Image analyst (D.G., 2 years of experience) drew identical and maximal regions of interest (ROIs) in right hepatic lobe.

STATISTICAL TESTS: Linear regression, intra-class correlation coefficients (ICC), Bland-Altman analyses, and the Wilcoxon signed-rank test were used to assess consistency and agreement of liver stiffness measurements for manually drawn identical and maximal ROIs.

RESULTS: In 21 participants (37 ± 14 years) with liver stiffness (2.3 ± 0.7 kPa), body mass index (BMI 27 ± 7 kg/m² ), proton density fat fraction (PDFF 9 ± 9%), and T₂ * (27 ± 4 msec); rapid MRE sequences showed excellent agreement (ICC > 0.95) with SC MRE and no correlation (r² < 0.1) of the differences (mean difference <0.2 kPa, <6%; limits of agreement <0.4 kPa, <16%) with BMI, PDFF, and T₂ *. Breath-hold times were: 14 seconds (SC), 5 seconds (RnS), 7 seconds (RwS) per slice, and 16 seconds for the R3D acquisition.

DATA CONCLUSIONS: C-SENSE accelerated GRE MRE sequences, using displacement wave polarity-inversion motion encoding, produce equivalent measurements of liver stiffness and have potential clinical benefit in patients with limited breath-holding capacity.

LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 1.

PMID:35089614 | DOI:10.1002/jmri.28078

Med Vet Entomol. 2022 Jan 28. doi: 10.1111/mve.12564. Online ahead of print.

ABSTRACT

The study aimed to develop a multiplex qPCR to detect Leishmania infantum load in different sandfly sample settings using Leishmania kDNA and sandfly vacuolar ATPase (VATP) subunit C as internal control gene. The amplification of Lutzomyia longipalpis VATP gene was evaluated together with Leishmania infantum kDNA in a multiplex reaction. The concentration of VATP gene oligonucleotides was adjusted until no statistically significant difference was observed between all multiplex standard curves and singleplex curves, that is, only kDNA amplification. Limit of detection (LoD) was measured using a probit model and a cut-off defined by receiver operating characteristic analysis. Limit of quantification (LoQ) was assessed by a linear model using the coefficient of variation threshold of 25%. After assuring VATP gene amplification, its primer-probe concentrations were best at 100 nM/10 nM, respectively. The cut-off C_q value for L. infantum kDNA was defined as 35.46 with 100% of sensitivity and specificity. A total of 95% LoD was determined to be of 0.162 parasites while LoQ was 5.858. Our VATP/kDNA multiplex qPCR assay shows that it can be used to evaluate both DNA integrity and determine L. infantum load in L. longipalpis even for low yielded samples, that is, individual midguts.

PMID:35089617 | DOI:10.1111/mve.12564

Acta Neurol Scand. 2022 Jan 28. doi: 10.1111/ane.13584. Online ahead of print.

ABSTRACT

OBJECTIVE: Uncertainty exists for the absolute risk of ischemic and hemorrhagic stroke in users of oral contraceptives (OCs). Estimates greatly vary between countries. In Denmark, absolute risk of ischemic stroke (IS) is estimated to be 21 per 100,000 person-years. Risk of cerebral hemorrhage (CH) is unknown. Using the Danish Stroke Registry, we investigated absolute risk of IS and CH in users of OC.

MATERIAL AND METHODS: For the Danish female population aged 15-49 years during 2003-2011, we obtained information on hospital admission for IS and CH and current use of OC from Danish nationwide registries. We defined current use of OC as redeeming at least two OC prescriptions within the previous year.

RESULTS: The Danish female population years 2003-2011 consisted mean of 1,246,142 women per year. Of these, 29.6% were OC users. In the study period, OC users had 291 IS and 14 CH. Absolute risk of IS in OC users was 8.8 per 100,000 person-years and of CH it was 0.4 per 100,000 person-years.

CONCLUSIONS: In OC users, absolute risk of IS was 8.8 per 100,000 person-years. This is more than half that of the risk previously assumed in Denmark. Risk of CH in OC users was very low and 0.4 per 100,000 person-years.

PMID:35089604 | DOI:10.1111/ane.13584

Hum Psychopharmacol. 2022 Jan 28:e2833. doi: 10.1002/hup.2833. Online ahead of print.

ABSTRACT

OBJECTIVE: We examined the association of serotonin receptor transporter gene polymorphism in patients with MDD with the clinical efficacy of mirtazapine (MZ) and sertraline (ST).

METHOD: Newly diagnosed, treatment naïve, 80 MDD patients (aged 18-45) diagnosed using DSM-5 criteria and with Beck’s depression inventory score (BDI) score ≥21 were included and randomly divided into two groups of 40 participants and were administered MZ 15-45 mg/day or ST 25-200 mg/day respectively. Patients were followed up for 6 weeks for evaluation of BDI scores. Genotypic evaluation was done and three allele variants were identified based on the polymerase chain reaction fragment sizes: short (S; 486 bp), long (L; 529 bp), or extralong (XL; 612 or 654 bp) and classified into five genotypes: S/S,S/L, L/L, S/XL, and L/XL.

RESULT: We found that 32.5% patients belonged to the S/S genotype, suggesting that individuals with the SS genotype are at higher risk of developing MDD. No statistically significant association was seen with ST or MZ groups on the basis of genotypes. Clinically significant improvement was observed with a more than 50% reduction in BDI scores at 6 weeks of treatment with both drugs.

CONCLUSION: Identification of risk population can be carried out by genotype testing. Prior genotyping in MDD patients might help to predict a better clinical outcome with antidepressants.

PMID:35089613 | DOI:10.1002/hup.2833

J Racial Ethn Health Disparities. 2022 Jan 28. doi: 10.1007/s40615-022-01251-4. Online ahead of print.

ABSTRACT

BACKGROUND: Depression is an extremely common and widespread problem among university students. A better understanding of the magnitude and determinants of depressive symptoms is required to create appropriate interventions for those groups. This study aimed to assess the prevalence and predictors of depressive symptoms among Mizan-Tepi University students during the pandemic lockdown.

METHODS: From September 11th to September 25th, 2020, 779 Mizan-Tepi University students participated in this web-based cross-sectional study. The link was created with a Google Form, and the questionnaire was distributed to participants via e-mail, WhatsApp, Telegram, and other social media accounts. To determine the prevalence and determinants of depressive symptoms, both descriptive and inferential analyses were used. The chi-squared test of association and logistic regression were used to identify predictors of depressive symptoms among university students. We used (IBM) SPSS version 20 for all statistical analyses.

RESULTS: The prevalence of depressive symptoms among university students was 39.5%. According to results of multivariable binary logistic regression, being female (AOR = 0.339, 95%CI: 0.220-0.522), being an alcoholic (AOR = 2.101, 95%CI: 1.452-3.041), smoking (AOR = 2.088, 95%CI: 1.460-2.986), being quarantined for 14 days (AOR = 1.775, 95%CI: 1.231-2.560), frequently using social media (AOR = 1.510, 95%CI: 1.063-2.145), fearing COVID-19 (AOR = 5.058, 95%CI: 3.508-7.292), having sleeping problems (AOR = 1.703, 95%CI: 1.051-2.760), having a family member infected with COVID-19 (AOR = 1.829, 95%CI: 1.211-2.763), being exposed to COVID-19 (AOR = 1.748, 95%CI: 1.114-2.743), monthly disposable income ≥ 501 ETB (AOR = 0.531, 95%CI: 0.359-0.784), having a higher level of hope (AOR = 0.158, 95%CI:0.056-0.447), and having high social support (AOR = 0.546, 95%CI: 0.374-0.797) were significantly associated with depressive symptoms among students.

CONCLUSION: In this study, the prevalence of depressive symptoms was found to be high among university students. Being an alcoholic, smoking, quarantined for 14 days, frequently using social media, fearing COVID-19, having sleep problems, having a family member infected with COVID-19, and being exposed to COVID-19 were all associated with an increased risk of developing depressive symptoms, while being a female, having a high level of disposable monthly income, hope, and social support decreased the risk of depressive symptoms among university students. Interventions should be put in place to promote mental health among university students.

PMID:35089580 | DOI:10.1007/s40615-022-01251-4

Environ Sci Pollut Res Int. 2022 Jan 28. doi: 10.1007/s11356-021-18296-3. Online ahead of print.

ABSTRACT

Among alternative tillage practices, conservation tillage (CT) is a prominent greenhouse gas (GHG) mitigation strategy advocated in wheat cultivation, largely because of its low energy consumption and minimum soil disturbance during cultural operations. This paper examines the agricultural production and GHG emission trade-off of CT vis-à-vis traditional tillage (TT) on wheat farms of Bangladesh. Using a directional distance function approach, the maximum reduction in GHG emissions was searched for within all available tillage technology options, while increasing wheat production as much as possible. The underlying institutional, technical, and other socio-economic factors determining the efficient use of CT were analyzed using a fractional regression model. The average meta-efficiency score for permanent bed planting (PBP) and strip tillage (ST) was 0.89, while that achieved using power tiller operated seeders (PTOS) is 0.87. This indicates that with the given input sets, there is potential to reduce GHG emissions by about 11% for ST and PTOS; that potential is 13% for farmers using PTOS. The largest share of TT farmers cultivate wheat at lower meta-efficiency levels (0.65-0.70) compared to that observed with farmers practicing CT (0.75-0.80). Fractional regression model estimates indicate that an optimal, timely dose of fertilizers with a balanced dose of nutrients is required to reduce GHG emissions. To develop climate smart sustainable intensification strategies in wheat cultivation, it is important to educate farmers on efficient input management and CT together. Agricultural development programs should focus on addressing heterogeneities in nutrient management in addition to tillage options within CT.

PMID:35089510 | DOI:10.1007/s11356-021-18296-3

Environ Sci Pollut Res Int. 2022 Jan 28. doi: 10.1007/s11356-022-18816-9. Online ahead of print.

ABSTRACT

Reproduction plays an important role in fish population efficiency and its resiliency to fishing and environment changes. The present study described the comprehensive information on reproductive feature of stinging catfish, Heteropneustes fossilis (Bloch 1794), including size at sexual maturity, spawning season, and fecundity using 622 female individuals sampling by the use of gill net, cast net, and square lift net from January to December 2019 in the Ganges River. We calculated the influences of various environmental parameters which include temperature, dissolved oxygen, pH, and rainfall on the reproductive feature of H. fossilis in the Ganges River. For every specimen, total length (TL), standard length (SL), and body weight (BW) were estimated by measuring board and electronic weighing scale. With ventral dissection of fishes, female gonads were cautiously removed and measured to 0.01 g precision. The gonadosomatic index (GSI), modified gonadosomatic index (MGSI), and Dobriyal index (DI) were used to assess the size at sexual maturity (L_m) and spawning season. According to the results of these indices, L_m was obtained 15.5 cm in TL. Also, TL₅₀ was determined through logistic function as 15.5 cm in TL. Moreover, the highest GSI, MGSI, and DI values indicated the spawning season as of March-August, with peak in May-June. Total fecundity (F_T) varied from 2059 to 59,984 with a mean of 25,028 ± 15,048. Temperature and rainfall was statistically correlated with GSI. In addition, long climatic data series analysis denoted that yearly mean atmospheric temperature is rising in 0.028 °C/year and yearly mean rainfall is declining in 2.98 mm/year which may suggest a potential shift of the spawning period of the species in the future if this trend persists. The results of our study might be more useful in imposing particular management and conservation for H. fossilis in the Ganges River and the surroundings.

PMID:35089516 | DOI:10.1007/s11356-022-18816-9