Category: Statistics

Turk Arch Pediatr. 2022 Jul;57(4):459-466. doi: 10.5152/TurkArchPediatr.2022.21359.

ABSTRACT

OBJECTIVE: In recent years, young children from all socioeconomic conditions found an oppor- tunity to own or access video game devices. The precisely defined effects of video gaming on young children’s behaviors and mental health are unknown. This study aimed to investigate the relationship between the psychosocial well-being and video gaming in preschool children.

MATERIALS AND METHODS: The video gamer (n = 70) and non-gamer (n = 140) children between 2 and 6 years old and their mothers were included in the study. Psychosocial well-being was assessed using the Strengths and Difficulties Questionnaire parent version. Multivariable logis- tic regressions were used.

RESULTS: 30% of the video gamers played video games for more than 1 hour per day. Factors associated with video gaming included sex, birth order, age of first screen exposure, daily screen time, and parent(s) video gaming. Being a boy, having a daily screen time of more than 1 hour and parent(s) video gaming increased the probability of video gaming [Odds (95% CI) = 3.00 (1.42-6.31), P = .004; 6.28 (2.86-13.80), P < .001; 6.49 (2.77-15.23), P < .001, respec- tively]. Not being the first child and having an age of first screen exposure older than 12 months old decreased the probability of video gaming [Odds (95% CI) = 0.29 (0.11-0.76), P = .012; 0.34 (0.13-0.89), P = .027, respectively]. Video gamers and non-gamers had statistically similar Strengths and Difficulties Questionnaire scores. There was no association between video gam- ing and being borderline or abnormal in emotional symptoms, conduct problems, hyperactiv ity/inattention, peer relationship problems, prosocial behavior, and total difficulties.

CONCLUSION: This study investigating the relationship between psychosocial well-being and video gaming revealed that video gaming is not associated with psychosocial well-being in preschool age.

PMID:35822480 | DOI:10.5152/TurkArchPediatr.2022.21359

Turk Arch Pediatr. 2022 Jul;57(4):441-447. doi: 10.5152/TurkArchPediatr.2022.21201.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the knowledge, attitude, and practices of parents about breastfeeding, complementary food, and infant nutrition who have healthy infants born at term and under 2 years of age.

MATERIALS AND METHODS: This is a cross-sectional study conducted among the parents of infants who came for well-child visits to pediatric clinics of 4 hospitals. Healthy infants under 2 years of age and who had been born at term were interviewed. The questionnaire included 35 questions to evaluate parents’ knowledge, attitude, and practices about breastfeeding and infant nutri- tion in addition to sociodemographic data. Data were obtained via questionnaire and were analyzed using Statistical Package for the Social Sciences 20.0 package program.

RESULTS: The study group consisted of 679 infants and their parents. The median durations of exclusive breastfeeding and total breastfeeding time were found to be 4 months and 10 months. Although 75% of the participants stated that infants must be exclusively breastfed for 6 months, the rate of exclusive breastfeeding for the first 6 months was 44%. The 393 (58%) participants used formula for infant nutrition and 47 (12%) of those started with complementary feeding. 90% of the participants stated that formula advertisements did not affect their decision on starting formula but the rate of thinking that other people may be affected by the advertisements was 80%.

CONCLUSION: The knowledge of parents on human milk is not insufficient but they need to be supported especially to continue exclusive breastfeeding during the first 6 months and appro- priate complementary food during the weaning period.

PMID:35822477 | DOI:10.5152/TurkArchPediatr.2022.21201

Turk Arch Pediatr. 2022 Jul;57(4):453-458. doi: 10.5152/TurkArchPediatr.2022.22032.

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 pandemic affected the healthcare systems worldwide. In this study, we aimed to examine the impact of the coronavirus disease 2019 pandemic on injury-related visits.

MATERIALS AND METHODS: We conducted a retrospective analysis of 7648 injury-related pediatric emergency department visits between March 11 and June 30, 2018, 2019, and 2020, and com- pared the total number of visits, triage levels, distributions of injury mechanisms, and admission rates during the pandemic in 2020 to the same period in 2018 and 2019.

RESULTS: In the first 4 months of the pandemic, there was a 69.5% drop in all pediatric emer- gency department visits compared to the previous 2 years. Despite this decrease, the propor- tion of injury-related pediatric emergency department visits increased from 14% to 20.9% in 2020 (P < .001). There was a 3.8% increase in the frequencies of patients with high triage acuity levels (T1, T2, and T3) and a 3.8% decrease in patients with low triage acuity levels (P < .001). The domestic injury rate increased from 40% to 60% during the pandemic period (P < .001). Hospitalization rates increased from 6% to 11.5% and admission to intensive care units increased from 0.9% to 3.3%. The differences were statistically significant (P < .001). Visits due to burn increased from 2.7% to 5.2% (P < .001), poisoning from 3.4% to 5.5% (P < .001), bicycle accidents from 3.3% to 6.8% (P < .001), while injuries due to motor vehicle accidents decreased from 2.6% to 1.3% (P = .004) and sports injuries decreased from 8% to 2.1% (P < .001).

CONCLUSION: This study revealed that despite the significant decrease in total pediatric emer- gency department visits, percentages of injury-related visits increased during the pandemic.

PMID:35822479 | DOI:10.5152/TurkArchPediatr.2022.22032

Turk Arch Pediatr. 2022 Jul;57(4):413-420. doi: 10.5152/TurkArchPediatr.2022.22011.

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 is a major health problem in all age groups. Although most clinical symptoms are respiratory, gastrointestinal symptoms are often reported. This is a major concern for children and has limited research coverage. In this study, we evaluated the frequencies of gastrointestinal symptoms and liver biochemical findings in children with coronavirus disease 2019 and their relationship with clinical course and length of hospital stay.

MATERIALS AND METHODS: Demographic data, clinical, and laboratory findings of children with Coronavirus disease 2019 who were followed up by the Department of Pediatric Infectious Diseases between March 2020 and August 2020 were recorded. They were classified accord- ing to age groups as <5 years, 5-10 years, and >10 years. Laboratory findings were analyzed according to age groups. Demographic, clinical, and laboratory findings were compared in both situations, the presence of gastrointestinal symptoms and the presence of elevated liver enzymes. It was considered statistically significant if it was <.05.

RESULTS: A total of 294 patients (median age 10 years [14 days to 18 years]) were enrolled in this study. Although fever is the most common symptom of coronavirus disease 2019, 15.6% of patients presented with acute gastroenteritis. Most patients with liver involvement (n = 130, 44.2%) were under 5 years of age (n = 74, 56.9%, P <.001). The patterns of abnormal liver test results were cholestatic (71.5%), hepatocellular (18.4%), and mixed (10%) types. Severe or mas- sive elevation of aminotransferase or liver failure was not observed. No statistically significant difference was noted in outcomes, including length of stay, for patients with gastrointestinal symptoms (P = .178) or liver involvement (P = .146).

CONCLUSION: The presence of gastrointestinal symptoms or elevated liver enzymes does not affect the course of the disease in children with coronavirus disease 2019.

PMID:35822473 | DOI:10.5152/TurkArchPediatr.2022.22011

Aging Ment Health. 2022 Jul 13:1-10. doi: 10.1080/13607863.2022.2098912. Online ahead of print.

ABSTRACT

OBJECTIVES: Understanding longitudinal patterns of rural-urban mental health disparities is vital for effective intervention and policy development in China. However, few studies have estimated separate effects of birth-cohort and ageing and examined the role of community resources on health inequalities.

METHODS: Drawing data from the China Health and Retirement Longitudinal Study (2011-2018), this study employed multilevel modelling to identify the mental health trajectories of rural, peri-urban, urban older adults by cohort and the community effects.

RESULTS: The changes in the mental health gap between rural, peri-urban and urban older adults over time varied by birth cohorts. Among younger cohorts aged under 65, the mental health disparities between rural, peri-urban and urban residents increased as they got older. Underdeveloped community infrastructure greatly explained the rural health disadvantage.

CONCLUSION: The study indicates increasing rural-urban health disparities at the onset of later life. Improving community infrastructure in rural and peri-urban areas is vital to minimise rural-urban health gaps.

PMID:35822456 | DOI:10.1080/13607863.2022.2098912

Turk Arch Pediatr. 2022 Jul;57(4):406-412. doi: 10.5152/TurkArchPediatr.2022.21307.

ABSTRACT

OBJECTIVE: Atrial septal defect is a congenital heart disease usually diagnosed in childhood. This study aimed to evaluate the mid-term follow-up results of patients who underwent trans- catheter closure of atrial septal defect by comparing the devices and methods used in the procedure and investigating the complications of this procedure in children.

MATERIALS AND METHODS: This study evaluated 232 patient files retrospectively. Of the 232 patients, 24 were excluded from the study due to missing files or data. Also, patients with multi-fenestrated atrial septal defect and aneurismatic septal tissue were excluded from the study. The following data were evaluated: follow-up time, patient complaints, symptoms, trans- thoracic echocardiography, and transesophageal echocardiography findings (if performed), the size of the defect as measured by balloon-sizing, the size of the device used in the proce- dure, and major and minor complications.

RESULTS: The study included 208 children who were diagnosed with atrial septal defect. The mean age of the patients was 88.0 ± 56.5 months. Of the patients, 170 (81.7%) had no com- plaints. The success rate of the procedure was found to be 95.7%. While device embolization was the most common major complication, arrhythmia was the most common minor complica- tion. The complication rate was statistically different according to the device type used in the procedure.

CONCLUSION: Transcatheter closure of atrial septal defect is a safe method for atrial septal defect closure in pediatric patients. The study found that defect diameters measured by differ- ent methods were not correlated with each other. The procedure complication rates differed according to device type.

PMID:35822472 | DOI:10.5152/TurkArchPediatr.2022.21307

J Chest Surg. 2022 Jul 13. doi: 10.5090/jcs.21.146. Online ahead of print.

ABSTRACT

BACKGROUND: Atrial fibrillation (Afib) is a marker of increased cardiovascular morbidity and mortality. Owing to the increased prevalence of Afib in patients undergoing cardiac surgery, assessing the effect of Afib on postsurgical outcomes is important. We aimed to analyze the effect of preoperative Afib on clinical outcomes in patients undergoing cardiac surgery using a large surgical database.

METHODS: This retrospective cohort study was based on the national health claims database established by the National Health Insurance Service of the Republic of Korea from 2009 to 2015. Diagnosis and procedure codes were used to identify diseases according to the International Statistical Classification of Diseases, 10th revision.

RESULTS: We included 1,037 patients (0.1%) who had undergone cardiac surgery from a randomized 1,000,000-patient cohort, and 15 patients (1.5%) treated with isolated surgical Afib ablation were excluded. Of these 1,022 patients, 412 (39.7%), 303 (29.2%), and 92 (9.0%) underwent coronary artery bypass, heart valve surgery, and Cox-maze surgery, respectively. Preoperative Afib was associated with higher patient mortality (p=0.028), regardless of the surgical procedure. Patients with preoperative Afib (n=190, 18.6%) experienced a higher cumulative risk of overall mortality (hazard ratio [HR], 1.435; 95% confidence interval [CI], 1.263-2.107; p=0.034). Subgroup analysis revealed a reduced risk of overall mortality with Cox-maze surgery in Afib patients (HR, 0.500; 95% CI, 0.266-0.938; p=0.031). Postoperative cerebral ischemia or hemorrhage events were not related to Afib.

CONCLUSION: Preoperative Afib was independently associated with worse long-term postoperative outcomes after cardiac surgery. Concomitant Cox-maze surgery may improve the survival rate.

PMID:35822442 | DOI:10.5090/jcs.21.146

Am J Transplant. 2022 Jul 13. doi: 10.1111/ajt.17149. Online ahead of print.

ABSTRACT

Uterus transplantation (UTx) is an effective treatment option for uterine factor infertility. However, the need for immunosuppression and congenital renal anomalies that coexist with uterine agenesis in about 30% of women with Mayer-Rokitansky-Kuster-Hauser syndrome create a risk for renal dysfunction. We therefore examined renal function trajectory and related pregnancy complications in an international cohort of 18 UTx recipients from 9/2016-2/2020 who had at least one live birth. All UTx recipients had a diminution in their renal function that was apparent starting at 30 days posttransplant and in half the reduction in eGFR was at least 20%; the decrease in eGFR persisted into the early post-partum period. Half met criteria for Stage 1 acute kidney injury (AKI) as defined by the AKI Network criteria during their pregnancy. Overall, 28% of UTx recipients developed pre-eclampsia. eGFR was lower at embryo transfer and throughout pregnancy among those who developed pre-eclampsia, reaching statistical significance at week 16 of pregnancy. This effect was independent of tacrolimus levels. Mean eGFR remained significantly lower in the first 1-3 months after delivery. In the subgroup who reached 12 months of postpartum follow up and had a graft hysterectomy (n=4) there was no longer a statistical difference in eGFR (pretransplant 106.7ml/m ± 17.7 vs. 12 mos postpartum 92.6 ml/m ± 21.7, p=0.13) but the number was small. Further study is required to delineate long term renal risks for UTx recipients, improve patient selection and make decisions regarding a second pregnancy.

PMID:35822437 | DOI:10.1111/ajt.17149

Physiol Rep. 2022 Jul;10(13):e15380. doi: 10.14814/phy2.15380.

ABSTRACT

Abnormal postprandial suppression of glucagon in Type 2 diabetes (T2DM) has been attributed to impaired insulin secretion. Prior work suggests that insulin and glucagon show an inverse coordinated relationship. However, dysregulation of α-cell function in prediabetes occurs early and independently of changes in β-cells, which suggests insulin having a less significant role on glucagon control. We therefore, sought to examine whether hepatic vein hormone concentrations provide evidence to further support the modulation of glucagon secretion by insulin. As part of a series of experiments to measure the effect of diabetes-associated genetic variation in TCF7L2 on islet cell function, hepatic vein insulin and glucagon concentrations were measured at 2-minute intervals during fasting and a hyperglycemic clamp. The experiment was performed on 29 nondiabetic subjects (age = 46 ± 2 years, BMI 28 ± 1 Kg/m² ) and enabled post-hoc analysis, using Cross-Correlation and Cross-Approximate Entropy (Cross-ApEn) to evaluate the interaction of insulin and glucose. Mean insulin concentrations rose from fasting (33 ± 4 vs. 146 ± 12 pmol/L, p < 0.01) while glucagon was suppressed (96 ± 8 vs. 62 ± 5 ng/L, p < 0.01) during the clamp. Cross-ApEn was used to measure pattern reproducibility in the two hormones using glucagon as control mechanism (0.78 ± 0.03 vs. 0.76 ± 0.03, fasting vs. hyperglycemia) and using insulin as a control mechanism (0.78 ± 0.02 vs. 0.76 ± 0.03, fasting vs. hyperglycemia). Values did not differ between the two scenarios. Cross-correlation analysis demonstrated a small in-phase coordination between insulin and glucagon concentrations during fasting, which inverted during hyperglycemia. This data suggests that the interaction between the two hormones is not driven by either. On a minute-to-minute basis, direct control and secretion of glucagon is not mediated (or restrained) by insulin.

PMID:35822422 | DOI:10.14814/phy2.15380

Health Serv Res. 2022 Jul 13. doi: 10.1111/1475-6773.14027. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine factors associated with racial inequities in discharge location, skilled nursing facility (SNF) utilization, and readmissions.

DATA SOURCES: A 20% sample of longitudinal Medicare claims from 2016 to 2018.

STUDY DESIGN: We present layered target matching, a method for studying sources of inequities. Layered target matching examines a fixed target population profile representing any race, ethnicity, or vulnerable population, sequentially adjusting for sets of characteristics that may contribute to inequities these groups endure. We use the method to study racial inequities in post-acute care use and readmissions.

DATA COLLECTION/EXTRACTION METHODS: We studied Black and Non-Hispanic White fee-for-service Medicare beneficiaries aged 66+ admitted to short-term acute-care hospitals for qualifying diagnoses or procedures between 1/1/2016 and 11/30/2018.

PRINCIPAL FINDINGS: Admitted Black patients tended to be younger, had significantly higher rates of risk factors such as diabetes, stroke, or renal disease, and were much more frequently admitted to large or academic hospitals. Relative to demographically similar White patients, Black patients were significantly more likely to be discharged to SNFs (21.8% vs. 19.3%, difference=2.5%, P<0.0001) and to receive any SNF care within 30 days of discharge (25.3% vs. 22.4%, difference=2.9%, P<0.0001). Black patients were also significantly more likely to experience 30-day readmission (18.7% vs. 14.5%, difference=4.2%, P<0.0001). Differences in reasons for hospitalization and risk factors explained most of the differences in discharge location, post-acute care use, and readmission rates, while additional adjustment for differences in hospital characteristics and complications made little difference for any of the measures studied.

CONCLUSIONS: We found significant Black-White differences in discharge to SNFs, SNF utilization, and readmission rates. Using layered target matching, we found that differences in risk factors and reasons for hospitalization explained most of these differences, while differences in hospitals did not materially impact the differences.

PMID:35822418 | DOI:10.1111/1475-6773.14027