Category: Statistics

Sleep Breath. 2021 Apr 30. doi: 10.1007/s11325-021-02391-3. Online ahead of print.

ABSTRACT

PURPOSE: To examine the association of sleep duration and quality in early pregnancy with gestational diabetes mellitus (GDM), and explore their interaction effect on GDM.

METHODS: Participants from 2 hospitals were enrolled in this case-control study between April 2018 and November 2020. Sleep duration and quality were measured using the Pittsburg Sleep Quality Index (PSQI).

RESULTS: A total of 1300 participants (396 GDM and 904 controls) were included. After adjusting for potential confounders, higher global PSQI scores or poor sleep quality were associated with GDM with odds ratios of 1.13 (95% CI 1.07, 1.19, p < 0.001) and 1.75 (95% CI 1.29, 2.38, p < 0.001), respectively; sleep duration < 7 h, 9-9.9 h and ≥ 10 h were all associated with increased GDM with odds ratios of 4.28 (95% CI 2.51, 7.31, p < 0.001), 1.69 (95% CI 1.20, 2.39, p = 0.003), and 4.42 (95% CI 3.01, 6.50, p < 0.001), respectively. In the stratified analysis based on sleep duration, the effect of poor sleep quality on GDM in the < 7 h group (OR 5.47, 95% CI 2.57, 11.64, p < 0.001) was much stronger than that in the 7-8.9 h group (OR 1.24, 95% CI 0.81, 1.91, p = 0.327), and the p value of the interaction was 0.011.

CONCLUSIONS: Poor sleep quality and short or long sleep duration in early pregnancy were all associated with GDM, and an interaction effect between short sleep duration and poor sleep quality on GDM was noted.

PMID:33929688 | DOI:10.1007/s11325-021-02391-3

Appl Microsc. 2021 Apr 30;51(1):6. doi: 10.1186/s42649-021-00055-w.

ABSTRACT

Histopathology is a well-established standard diagnosis employed for the majority of malignancies, including breast cancer. Nevertheless, despite training and standardization, it is considered operator-dependent and errors are still a concern. Fractal dimension analysis is a computational image processing technique that allows assessing the degree of complexity in patterns. We aimed here at providing a robust and easily attainable method for introducing computer-assisted techniques to histopathology laboratories. Slides from two databases were used: A) Breast Cancer Histopathological; and B) Grand Challenge on Breast Cancer Histology. Set A contained 2480 images from 24 patients with benign alterations, and 5429 images from 58 patients with breast cancer. Set B comprised 100 images of each type: normal tissue, benign alterations, in situ carcinoma, and invasive carcinoma. All images were analyzed with the FracLac algorithm in the ImageJ computational environment to yield the box count fractal dimension (Db) results. Images on set A on 40x magnification were statistically different (p = 0.0003), whereas images on 400x did not present differences in their means. On set B, the mean Db values presented promissing statistical differences when comparing. Normal and/or benign images to in situ and/or invasive carcinoma (all p < 0.0001). Interestingly, there was no difference when comparing normal tissue to benign alterations. These data corroborate with previous work in which fractal analysis allowed differentiating malignancies. Computer-aided diagnosis algorithms may beneficiate from using Db data; specific Db cut-off values may yield ~ 99% specificity in diagnosing breast cancer. Furthermore, the fact that it allows assessing tissue complexity, this tool may be used to understand the progression of the histological alterations in cancer.

PMID:33929635 | DOI:10.1186/s42649-021-00055-w

Matern Child Health J. 2021 Apr 30. doi: 10.1007/s10995-021-03157-9. Online ahead of print.

ABSTRACT

INTRODUCTION: The impact on research findings that use pregnancy data from surveys with underreported abortions is not well-established. We estimate the percent of all pregnancies missing from women’s self-reported pregnancy histories because of abortion underreporting.

METHODS: We obtained abortion and fetal loss data from the 2006-2015 National Survey of Family Growth (NSFG), annual counts of births from US vital statistics, and external abortion counts from the Guttmacher Institute. We estimated the completeness of abortion reporting in the NSFG as compared to the external counts, the proportion of pregnancies resolving in abortion, and the proportion of pregnancies missing in the NSFG due to missing abortions. Each measure was examined overall and by age, race/ethnicity, union status, and survey period.

RESULTS: Fewer than half of abortions (40%, 95% CI 36-44) that occurred in the five calendar years preceding respondents’ interviews were reported in the NSFG. In 2006-2015, 18% of pregnancies resolved in abortion, with significant variation across demographic groups. Nearly 11% of pregnancies (95% CI 10-11) were missing from the 2006-2015 NSFG due to abortion underreporting. The extent of missing pregnancies varied across demographic groups and was highest among Black women and unmarried women (18% each); differences reflect both the patterns of abortion underreporting and the share of pregnancies ending in abortion.

DISCUSSION: Incomplete reporting of pregnancy remains a fundamental shortcoming to the study of US fertility-related experiences. Efforts to improve abortion reporting are needed to strengthen the quality of pregnancy data to support maternal, child, and reproductive health research.

PMID:33929651 | DOI:10.1007/s10995-021-03157-9

Matern Child Health J. 2021 Apr 30. doi: 10.1007/s10995-021-03135-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Significant and persistent racial and ethnic disparities exist related to infant mortality and other birth outcomes. Few models exist that aim to prepare organizations to implement essential features, such as community engagement or intervening on social determinants of health.

METHODS: Between 2013 and 2015, teams from seven local health departments participated in the Institute for Equity in Birth Outcomes (EI) with the goals of building capacity and implementing changes to address equity in birth outcomes. Four of the teams enrolled in the first cohort (2013-2015), and three enrolled in cohort two (2014-2015). To examine the EI effort and its impact on capacity and implementation of changes, two types of assessments were completed. Capacities of the teams in specific key areas were assessed using “Best Change Process” instruments at the completion of participation in the EI. Teams also documented on an ongoing basis implementation of interventions. The data were analyzed using descriptive statistics and Pearson Correlation tests.

RESULTS: Best Change Process capacity scores were higher in the first cohort than in the second and were highly correlated with implementation of changes (Pearson’s Correlation = 0.838, p = 0.037). Collectively, the teams implemented about 32 new programs, policies, practices, and systems changes aimed at addressing equity in birth outcomes. Most interventions were based on scientific recommendations and local epidemiologic data.

DISCUSSION: The results of the study suggest the EI is a promising approach that may result in strong capacity and ability to implement interventions aimed at addressing equity in birth outcomes.

PMID:33929652 | DOI:10.1007/s10995-021-03135-1

EJNMMI Res. 2021 Apr 30;11(1):41. doi: 10.1186/s13550-021-00783-w.

ABSTRACT

BACKGROUND: Detection of the site of recurrence using PSMA-PET/CT is important to guide treatment in patients with biochemical recurrence of prostate cancer (PCa). The aim of this study was to evaluate the positivity rate of [¹⁸F]PSMA-1007-PET/CT in patients with biochemically recurrent PCa and identify parameters that predict scan positivity as well as the type and number of detected lesions. This monocentric retrospective study included 137 PCa patients with biochemical recurrence who underwent one or more [¹⁸F]PSMA-1007-PET/CT scans between August 2018 and June 2019. PET-positive malignant lesions were classified as local recurrence, lymph node (LN), bone or soft tissue lesions. The association between biochemical/paraclinical parameters, as PSA value, PSA doubling time, PSA velocity, Gleason score (GS) and androgen deprivation therapy (ADT), and scan positivity as well as type and number of detected lesions was evaluated using logistic regression analysis (binary outcomes) and Poisson models (count-type outcomes).

RESULTS: We included 175 [¹⁸F]PSMA-1007-PET/CT scans after radical prostatectomy (78%), external beam radiation therapy (8.8%), ADT (7.3%), brachytherapy (5.1%) and high intensity focused ultrasound (0.7%) as primary treatment (median PSA value 1.6 ng/ml). Positivity rate was 80%. PSA value and PSA velocity were significant predictors of scan positivity as well as of the presence of bone and soft tissue lesions and number of bone, LN and soft tissue lesions, both in uni- and/or multivariable analysis. Multivariable analysis also showed prior ADT as predictor of bone and soft tissue lesions, GS as predictor of the number of bone lesions and ongoing ADT as predictor of the number of LN lesions.

CONCLUSION: [¹⁸F]PSMA-1007-PET/CT showed a high positivity rate in patients with biochemically recurrent PCa. PSA value and PSA velocity were significant predictors of scan positivity as well as of the presence and number of bone and soft tissue lesions and the number of LN lesions. Our findings can guide clinicians in optimal patient selection for [¹⁸F]PSMA-1007-PET/CT and support further research leading to the development of a prediction nomogram.

PMID:33929626 | DOI:10.1186/s13550-021-00783-w

Clin Oral Investig. 2021 Apr 30. doi: 10.1007/s00784-021-03918-4. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of the study was to find out whether and to what extent the performance of dentists regarding diagnostic evaluation of dental radiographs is influenced by symptoms of fatigue.

MATERIALS AND METHODS: Over a period of 40 minutes, 21 dentists evaluated a database of 96 randomly selected, infinitely repeating intraoral dental radiographs for the presence of periapical radiolucencies. Both before and after, participants were asked to assess their subjective fatigue using the Swedish Occupational Fatigue Inventory (SOFI), Visual Analogue Scale (VAS), and Numerical Rating Scale (NRS). Diagnostic accuracy was analyzed using the Receiver Operating Characteristics (ROC) method. Furthermore, the correlation between diagnostic accuracy and radiographic experience, image viewing time, and level of training was also evaluated.

RESULTS: The study showed that despite increasing fatigue, the diagnostic accuracy of the examiners remained consistent with an average AUC value of 0.768 ± 0.091. Within the 40-min reporting period, no statistically significant fluctuations were found. The diagnostic accuracy varied depending on the radiographic experience: with many years of radiographic experience, the diagnostic accuracy increased. At the same time, the older study participants with greater radiographic experience became less tired compared to younger study participants during the examination.

CONCLUSIONS: Although an increase in fatigue was observed during the 40-min examination, the diagnostic accuracy of the doctors remained constant.

CLINICAL RELEVANCE: Due to the high workload which needs to be handled in a limited time, medical and dental professionals have reached a certain level of exposition to stress that can lead to physical fatigue. However, the increasing fatigue should not negatively influence the work of the doctors. The study shows that the radiodiagnostic accuracy remained the same.

PMID:33929630 | DOI:10.1007/s00784-021-03918-4

Ophthalmic Plast Reconstr Surg. 2021 Apr 28. doi: 10.1097/IOP.0000000000001989. Online ahead of print.

ABSTRACT

PURPOSE: Autologous fat transfer is an effective tool for volume restoration to the aging face. Although numerous reports exist regarding injection site complications, there is limited data on donor-site morbidity in the cosmetic surgery literature.

METHODS: This study is a large-scale retrospective review to determine incidence of fat harvest-site complications, identify risk factors, and describe management strategies. Records of all patients who underwent autologous fat harvesting and facial grafting at a single oculofacial plastic surgery practice from 2010 to 2019 were reviewed. Patient demographics and clinical data were collected and assessed. A statistical analysis was performed using a two-tailed T-test with p values of <0.05 considered significant.

RESULTS: Four-hundred sixteen patients were followed for an average of 6.2 months postoperatively. There was an overall 5.5% harvest-site complication rate. There was no correlation of harvest-site complications with gender (p = 0.249) or age (p = 0.881). Harvest location did not significantly correlate with complication rate. The most common complications were contour irregularities, prolonged induration, and prolonged erythema. Low body mass index was associated with higher complication rate (p = 0.003), even when excluding those patients with contour irregularities (p = 0.001). Various treatment modalities were used to manage donor-site morbidity with consistent improvement.

CONCLUSIONS: Autologous fat transfer used for facial volume augmentation has low donor-site morbidity. Minor harvest-site complications occur more commonly in patients with low body mass index, irrespective of age, gender, or fat source.

PMID:33927171 | DOI:10.1097/IOP.0000000000001989

Rev Esp Salud Publica. 2021 Apr 30;95:e202104066.

ABSTRACT

OBJECTIVE: Highlighting gender inequalities during the pandemic and its relationship with other axes of social inequality will be decisive for its adequate monitoring. The aim of this study was to assess the differences between men and women in the main measures of infection and mortality by COVID-19, considering its temporal evolution, raising awareness about the weaknesses and contradictions between sources of information.

METHODS: Cross-sectional analysis based on the microdata on COVID cases notified by the National Epidemiological Surveillance Network (RENAVE), the Death Statistics of the National Statistical Institute (INE) and the estimates of excess mortality from the INE and the Daily Mortality Monitoring System (MoMo) microdata. Standardized rates, prevalences and and ratios by sex were calculated for each indicator. The percentage of excess mortality without COVID-19 diagnosis in each sex was calculated. Male/female ratios for symptoms and risk factors of COVID-19 were also calculated.

RESULTS: The rate of infection by COVID-19 was higher in women in the three waves of the pandemic, reaching 65% of infections during April and May 2020. Complications were between 1.5 and 2.5 times higher in men, especially in ICU admissions, which were 2.5 times more frequent than in women. Although mortality rates and excess mortality were also higher in men (around 1.8 times), the percentage of excess mortality without COVID-19 diagnosis was higher in women (44% in men vs. 52% in women the first wave). With regard to the symptoms of COVID-19, fever, cough, and dyspnoea were more frequent in men (20%, 10% and 19% more, respectively) compared to sore throat, vomiting or diarrhea that were more prevalent in women (90%, 40% and 10% more, respectively).

CONCLUSIONS: The analysis disaggregated by sex has made it possible to identify differences between men and women in the diagnosis, presentation and severity of the COVID-19 that can help a better clinical and epidemiological approach to the disease. However, official sources present important gaps when presenting information disaggregated by sex. It is therefore necessary to advance in the inclusion of a gender perspective in the statistics on COVID-19, starting with a necessary but not sufficient condition such as the disaggregation by sex of the data.

PMID:33927179

J Glaucoma. 2021 Apr 28. doi: 10.1097/IJG.0000000000001857. Online ahead of print.

ABSTRACT

PRCIS: The vessel density and perfusion density generated by optical microangiography is significantly affected by the signal strength. Gender, hypertension, diabetes and axial length did not have any statistically significant effect on these measurements.

PURPOSE: To assess the effect of subject-related factors (age, gender, systemic hypertension, diabetes and axial length) and machine related factor (signal strength) on vessel density (VD) and perfusion density (PD) generated by optical microangiography (OMAG) in peripapillary and macular regions.

METHODS: In an observational, cross-sectional study of 200 eyes of 100 healthy individuals (age: 18-80▒y), mean and sectoral VD and PD were calculated on disc and macular scans. Effect of subject-related and machine-related factors on VD and PD parameters were evaluated using multivariate mixed effect models.

RESULTS: Mean (±standard deviation) peripapillary and macular VD of the study population was 18.56±1.11▒mm-1 and 20.59±1.85▒mm-1 respectively. Mean peripapillary and macular PD was 46.43±3.22% and 37.61±3.26% respectively. Sex, hypertension, diabetes and axial length did not have any statistically significant effect on the OMAG measurements (P>0.05 for all associations). However, the signal strength (SS) had significant effect on the OMAG measurements. Mean peripapillary and macular VD on scans with SS of 10 was 1.4▒mm-1 and 3.79▒mm-1 greater respectively than that on scans with SS of 7. Mean peripapillary and macular PD on scans with SS of 10 was 4.43% and 7.85% greater respectively than that on scans with SS of 7.

CONCLUSION: Significant association exists between SS of the scan and the optical coherence tomography angiography (OCT-A) measurements generated by OMAG even when the scans had acceptable SS as recommended by the manufacturer (≥7). This needs to be considered while interpreting OCT-A measurements.

PMID:33927147 | DOI:10.1097/IJG.0000000000001857

Gastroenterol Nurs. 2021 Apr 26. doi: 10.1097/SGA.0000000000000542. Online ahead of print.

ABSTRACT

The aim of this research study was to evaluate the effectiveness of lidocaine versus lidocaine with sodium bicarbonate in reducing anxiety and pain, using visual analog scales, in subjects receiving local anesthetic during liver biopsies. The project included 199 subjects presenting for percutaneous liver biopsy using local anesthesia. Subjects were randomized into 2 groups: the control group, which received lidocaine alone, and the experimental group, which received lidocaine buffered with sodium bicarbonate. Immediately after they received the lidocaine injection, both groups were asked to rate their preprocedure anxiety and pain using a 0-10 visual analog scale. Mean postprocedure pain was statistically significantly different between the two arms with the intervention group reporting less pain (1.65 vs. 2.27, p = .037). Change in pain scores between the two groups were also statistically significantly different with the intervention group reporting a mean change in pain score of 0.93 compared to 1.63 in the control group (p = .021). However, no differences were found for reported anxiety. This study has shown that using sodium bicarbonate with lidocaine significantly decreased pain sensation at the injection site when used for deep visceral anesthesia during percutaneous liver biopsy.

PMID:33927155 | DOI:10.1097/SGA.0000000000000542