Category: Statistics

Int J Methods Psychiatr Res. 2021 Dec 24:e1903. doi: 10.1002/mpr.1903. Online ahead of print.

ABSTRACT

OBJECTIVES: To estimate the prevalence of ADHD, and related comorbidities, mortality, and type of health service use among children and young adults, using different case definitions.

METHODS: We conducted a population-based retrospective cohort study between 2000 and 2018, using the Quebec Integrated Chronic Disease Surveillance System (QICDSS) database. All residents aged less than 25 years eligible for health insurance coverage were included. We compared outcomes of three indicators (morbidity, services use and mortality) according two different algorithms of ADHD definitions, to the general population.

RESULTS: The cumulative prevalence of ADHD has risen steadily over the past decade, reaching 12.6% in 2017-2018. People with ADHD have a higher prevalence of psychiatric comorbidities, make greater use of medical, mental health services, and are hospitalized more often. The comparison of prevalence between the two algorithms and the general population for the three indicators showed that the cohort having one claim was very close to that with two or more, and statistically significant higher to that of people without ADHD.

CONCLUSION: This finding support that a single claim algorithm for ADHD can be used for case definition. More research is needed on the impact of potentially effective treatments in improving consequences of ADHD.

PMID:34952999 | DOI:10.1002/mpr.1903

Clin Cardiol. 2021 Dec 24. doi: 10.1002/clc.23760. Online ahead of print.

ABSTRACT

BACKGROUND: NT Pro-BNP is a blood marker secreted by cardiomyocytes. Myocardial stretch is the main factor to stimulate NT Pro-BNP secretion in cardiomyocytes. NT Pro-BNP is an important risk factor for cardiac dysfunction, stroke, and pulmonary embolism. So does atrial myocyte stretching occur when patients have atrial fibrillation (AF)? Whether atrial muscle stretch induced by AF leads to increased NT Pro-BNP remains unclear. The purpose of this study is to investigate the relationship between NT Pro-BNP and AF.

HYPOTHESIS: AF can cause changes in myocardial tension. Changes in myocardial tension may lead to increased secretion of NT Pro-BNP. We hypothesize that NT Pro-BNP may increase in AF with or without LAD enlargement.

METHODS: This clinical study is an observational study and has been approved by the Ethics Committee of the First Affiliated Hospital of Xi’an Jiaotong University. Ethical approval documents is attached. The study retrospectively reviewed 1345 patients with and without AF. After excluding 102 patients who were not eligible, the final total sample size was 1243 cases: AF group 679 patients (378, 55.7% males) and non-AF group 564 patients (287, 50.8% males). NT Pro-BNP was observed in AF group and non-AF group with or without LAD. After adjusting for age, gender, BMI, left atrial diameter, hypertension, diabetes, coronary heart disease, and cerebral infarction, NT Pro-BNP remains statistically significant with AF.

CONCLUSION: NT Pro-BNP can be used as a risk predictor of AF with or without left atrial enlargement.

PMID:34952980 | DOI:10.1002/clc.23760

Sci Rep. 2021 Dec 24;11(1):24412. doi: 10.1038/s41598-021-02723-z.

ABSTRACT

Evaluation of appropriate physics parameterization schemes for the Weather Research and Forecasting (WRF) model is vital for accurately forecasting tropical cyclones. Three cyclones Nargis, Titli and Fani have been chosen to investigate the combination of five cloud microphysics (MP), three cumulus convection (CC), and two planetary boundary layer (PBL) schemes of the WRF model (ver. 4.0) with ARW core with respect to track and intensity to determine an optimal combination of these physical schemes. The initial and boundary conditions for sensitivity experiments are drawn from the National Centers for Environmental Prediction (NCEP) global forecasting system (GFS) data. Simulated track and intensity of three cyclonic cases are compared with the India Meteorological Department (IMD) observations. One-way analysis of variance (ANOVA) is applied to check the significance of the data obtained from the model. Further, Tukey’s test is applied for post-hoc analysis in order to identify the cluster of treatments close to IMD observations for all three cyclones. Results are obtained through the statistical analysis; average root means square error (RMSE) of intensity throughout the cyclone period and time error at landfall with the step-by-step elimination method. Through the elimination method, the optimal scheme combination is obtained. The YSU planetary boundary layer with Kain-Fritsch cumulus convection and Ferrier microphysics scheme combination is identified as an optimal combination in this study for the forecasting of tropical cyclones over the Bay of Bengal.

PMID:34952900 | DOI:10.1038/s41598-021-02723-z

BMJ Open. 2021 Dec 24;11(12):e053825. doi: 10.1136/bmjopen-2021-053825.

ABSTRACT

OBJECTIVE: The study was designed to assess the burden and significant risk factors among male commercial drivers in sub-Saharan Africa (SSA).

DESIGN: Systematic review and meta-analysis.

DATA SOURCES: Medline via PubMed, Google Scholar, Cochrane databases and Africa Journal Online were searched from January 2010 to December 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The authors included observational studies reporting on the burden and/or risk factors for hypertension among commercial drivers in SSA. Male adult population ≥18 years working as a commercial driver in SSA as well articles published in English.

DATA EXTRACTION AND SYNTHESIS: Two independent coauthors used a prepared data extraction form to extract data from the eligible published papers and assessed the risk of bias. DerSimonian and Laird random effects model was used to pool the burden of hypertension and significant risk factors among male commercial drivers in SSA. The presence of heterogeneity among studies was quantified by estimating variance using both Cochrane’s Q statistics and the I² statistics. A subgroup and sensitivity analyses were performed.

RESULTS: Overall, 14 articles met the inclusion criteria involving a total of 4285 male commercial drivers in SSA. The estimated pooled burden of hypertension among the male commercial drivers in SSA was 32% (95% CI 24% to 39%). The risk factors identified were age OR=1.10 (95% CI 1.06 to 1.15), overweight/obese OR=3.38 (95% CI 2.46 to 4.29), alcohol consumption OR=3.00 (95% CI 2.05 to 3.95) and duration of driving (≥5 years) OR=1.83 (95% CI 1.03 to 2.63). Funnel plot inspection and Egger’s regression test of small effect (0.5838) showed no evidence of publication bias.

CONCLUSIONS: Our review showed that nearly one-third of male commercial drivers in SSA have hypertension. Reduction of modifiable risk factors such as overweight/obesity, alcohol consumption and long-term driving through multifaceted implementation strategies are recommended for prevention and control of hypertension among male commercial drivers in SSA.

TRIAL REGISTRATION NUMBER: CRD42021250910.

PMID:34952880 | DOI:10.1136/bmjopen-2021-053825

Med Sci Monit. 2021 Dec 25;27:e932036. doi: 10.12659/MSM.932036.

ABSTRACT

BACKGROUND Myocardial injury after noncardiac surgery (MINS) is common and associated with postoperative mortality. We assessed MINS occurrence and association with 30-day and long-term mortality in older adult patients undergoing orthopedic surgery in China. MATERIAL AND METHODS This was a retrospective study of consecutive patients who underwent orthopedic surgery between January 1, 2009, and December 31, 2017, at Beijing Jishuitan Hospital. MINS was defined as postoperative troponin I peak elevation above the 99th percentile upper reference limit (>0.034 µg/L) within 30 days after surgery. Outcomes were 30-day postoperative mortality and long-term all-cause mortality. RESULTS From 34 901 patients, 5897 (16.9%) had serial troponin I measurements, and 266 (4.5%) had MINS after surgery. Mean patient age was 71.1±9.2 years; 32.9% were male. Among patients with MINS, 180 had myocardial infarction (MI) (3.2%). Patients with MI had higher 30-day and long-term mortality than those without MI (8.9% vs 1.2%; P<0.016 and 18.9% vs 3.5%; P=0.001). Male sex (OR 5.87, 95% CI 1.75-19.67; P=0.004), RCRI ≥2 (OR 5.05, 95% CI 1.67-15.31; P=0.004), and MI (OR 9.13, 95% CI 1.13-73.63; P=0.011) were independently associated with 30-day mortality. Age (HR 1.07, 95% CI 1.03-1.11; P=0.001), male sex (HR 2.96, 95% CI 1.51-5.80; P=0.002), RCRI ≥2 (HR 2.01, 95% CI 1.03-3.94; P=0.041), orthopedic trauma (HR 3.40, 95% CI 1.00-11.44; P=0.049), and MI (HR 7.33, 95% CI 2.22-24.20; P=0.001) were predictors of 2-year mortality. CONCLUSIONS Perioperative MI was independently associated with 30-day and long-term mortality after orthopedic surgery, providing a potential indicator of high risk of mortality in patients who could benefit from targeted prevention and intervention.

PMID:34952895 | DOI:10.12659/MSM.932036

BMJ Open. 2021 Dec 24;11(12):e050711. doi: 10.1136/bmjopen-2021-050711.

ABSTRACT

PURPOSE: To evaluate published evidence on the Modified Tardieu Scale (MTS) as a tool to assess spasticity in the upper limbs of adults with neurological conditions.

DATA SOURCES: A systematic search of six electronic databases (PubMed/MEDLINE, CINAHL, EMBASE, the Cochrane Library, Web of Science and Physiotherapy Evidence Database) from inception to 31 December 2020. A search strategy was developed using key elements of the research question: population, intervention (action), outcome.

STUDY ELIGIBILITY CRITERIA: Inclusion criteria: (1) adult participants with neurological conditions; (2) upper limb muscles/joints as tested elements; (3) studies testing the MTS and (4) reliability or validity reported.

EXCLUSION CRITERIA: (1) non-English articles; (2) non-empirical articles and (3) studies testing the Tardieu Scale.

STUDY APPRAISAL: Evidence quality was evaluated using the US National Heart, Lung, Blood Institute quality assessment tool for observational cohort and cross-sectional studies.

RESULTS: Six reliability studies met the inclusion criteria. Overall, most articles reported good-to-excellent levels of inter-rater, intrarater and test-retest reliability. However, limitations, such as study design weaknesses, statistical misuses and reporting biases, undermine confidence in reported conclusions. The validity of the MTS also remained questionable based on the results of one study.

CONCLUSIONS AND IMPLICATIONS: This review did not find sufficient evidence to either support or reject the use of the MTS in assessing spasticity in the upper limbs of adults with neurological conditions. Despite the paucity of research evidence, the MTS may still remain a clinically useful tool to measure the motor aspect of spasticity. Future research would benefit from a focus on test standardisation, while the wider field would require the development of a consensual definition of spasticity.

PMID:34952873 | DOI:10.1136/bmjopen-2021-050711

BMJ Open. 2021 Dec 24;11(12):e051622. doi: 10.1136/bmjopen-2021-051622.

ABSTRACT

BACKGROUND: Nephron-sparing surgery (NSS) is widely applied for small renal masses. However, the indication of NSS in patients with localised renal cell carcinoma (RCC) with high anatomical complexity is controversial. Thus, we compare functional and oncological outcomes, and safety of NSS versus radical nephrectomy (RN) in patients with localised RCC with high anatomical complexity Radius, Exophytic/endophytic, Nearness, Anterior/posterior, Location. (R.E.N.A.L.) score ≥10.

METHODS: We evaluated 575 patients with localised RCC that underwent NSS or RN at our centre between January 2013 and December 2018. Demographic characteristics, comorbidities, tumour data, surgery procedure, perioperative data and survival data were recorded. After propensity score matching, the variables were compared by binary paired logistic regression. The change in estimated glomerular filtration rate (eGFR) was compared with covariance analysis adjusted for baseline value. Recurrence and survival were calculated using Kaplan-Meier curves with log-rank tests. P<0.05 was considered to be statistically significant.

RESULTS: In the matched group, NSS showed lower eGFR loss compared with the RN group (17.81 mL/min/1.73 m² vs 28.28 mL/min/1.73 m², p<0.001). Moreover, the recurrence-free survival (p=0.002), cardiocerebrovascular disease-specific survival (p=0.015) and overall survival (p=0.017) of patients with NSS were better than those that underwent RN. Cancer-specific survival in both groups showed no difference (p=0.323). The incidence of minor and major complications in the two groups showed no difference (p=0.144, p=0.108).

CONCLUSION: NSS resulted in better preservation of renal function and oncological outcomes compared with RN, with acceptable complications. These findings could help improve clinical decision making for patients with localised RCC with high anatomical complexity.

TRIAL REGISTRATION NUMBER: ChiCTR2000040652.

PMID:34952876 | DOI:10.1136/bmjopen-2021-051622

BMJ Open. 2021 Dec 24;11(12):e050317. doi: 10.1136/bmjopen-2021-050317.

ABSTRACT

OBJECTIVES: Metabolic syndrome (MS) comprises a constellation of symptoms that include abdominal obesity, hypertension, hyperglycaemia and dyslipidaemia. Dietary intake is a crucial environmental risk factor for MS, but the exact association between MS and egg consumption, which accounts for more than half of the daily total cholesterol intake in Chinese population, has not been previously studied. The aim of this study was to examine the correlation between dietary egg consumption and the prevalence of MS in the context of a large population.

DESIGN: A cross-sectional study.

SETTINGS: Our study was conducted in a health examination centre in China.

PARTICIPANTS: Participants who aged ≥40 years and received routine physical examinations were included for analyses.

MAIN OUTCOME MEASURES: MS was diagnosed in accordance with the clinical diagnosis criteria specified in the American Heart Association Guidelines. Egg consumption was assessed by a validated semi-quantitative food frequency questionnaire.

RESULTS: A total of 11 529 participants (46.2% women) were included in the present study. On the basis of multivariable logistic regression analysis, egg consumption was negatively associated with the prevalence of MS after adjusting for dietary energy intake (OR=0.84, 95% CI 0.76 to 0.93, p value for trend=0.001). The above findings did not change with further adjustment for other potential confounders: model 2 was further adjusted for age, body mass index and sex (based on model 1) and model 3 was further adjusted for education level, physical activity level, smoking status, alcohol use status, dietary fat intake, dietary fibre intake and nutritional supplementation (based on model 2). Consistent results were obtained from the analysis in the female subgroup but not in male subjects.

CONCLUSIONS: A higher level of egg consumption was associated with a lower prevalence of MS in our study participants, and particularly in female subjects.

PMID:34952872 | DOI:10.1136/bmjopen-2021-050317

BMJ Open. 2021 Dec 24;11(12):e049575. doi: 10.1136/bmjopen-2021-049575.

ABSTRACT

INTRODUCTION: Phase I/II clinical trials suggested that the hepatocyte growth factor (HGF)/mesenchymal-epithelial transition (MET) pathway-targeted agents were active in suppression of gastric cancer (GC). Randomised controlled trials (RCTs) were undertaken assessing whether the addition of anti-HGF/MET agent (rilotumumab or onartuzumab) to chemotherapy improves survival outcomes of advanced GC, but conflict conclusions were reached. Therefore, we plan to perform this systematic review and meta-analysis to synthesise evidence concerning efficacy and safety of anti-HGF/MET agents combined with chemotherapy as the first-line treatment to advanced GC.

METHODS AND ANALYSIS: Systematic searches of the PubMed, Embase and the Cochrane Central Register of Controlled Trials will be performed with no language restriction from inception to 31 January 2022 to identify RCTs exploring the comparative efficacy and safety of anti-HGF/MET agents plus chemotherapy as first-line treatment in advanced GC. The primary outcome will be the time-to-event progression-free survival and overall survival, and the secondary outcomes will be disease control rate, overall adverse events rate and grade 3-5 adverse events rate. Statistical heterogeneity will be assessed by visual inspection of forest plots and measured using the I² statistics. A fixed-effect model will be used when heterogeneity is low otherwise, a random-effect model will be chosen. Publication bias will be assessed by funnel plots; subgroup analysis and sensitivity analysis will be performed in the right context. For each outcome, we will perform data synthesis using Rev Man V.5.3 software, and compile ‘summary of findings’ tables using GRADEpro software.

ETHICS AND DISSEMINATION: There is no requirement for ethics approval because no individual data will be collected in this research. It is anticipated that the dissemination of results will take place at conferences and through publication in a peer-review journal, any adjustments from the protocol will be clearly documented and explained in its final report.

PROSPERO REGISTRATION NUMBER: CRD42020177404.

PMID:34952869 | DOI:10.1136/bmjopen-2021-049575

BMJ Open. 2021 Dec 24;11(12):e050146. doi: 10.1136/bmjopen-2021-050146.

ABSTRACT

OBJECTIVE: The internal validation of prediction models aims to quantify the generalisability of a model. We aim to determine the impact, if any, that the choice of development and internal validation design has on the internal performance bias and model generalisability in big data (n~500 000).

DESIGN: Retrospective cohort.

SETTING: Primary and secondary care; three US claims databases.

PARTICIPANTS: 1 200 769 patients pharmaceutically treated for their first occurrence of depression.

METHODS: We investigated the impact of the development/validation design across 21 real-world prediction questions. Model discrimination and calibration were assessed. We trained LASSO logistic regression models using US claims data and internally validated the models using eight different designs: ‘no test/validation set’, ‘test/validation set’ and cross validation with 3-fold, 5-fold or 10-fold with and without a test set. We then externally validated each model in two new US claims databases. We estimated the internal validation bias per design by empirically comparing the differences between the estimated internal performance and external performance.

RESULTS: The differences between the models’ internal estimated performances and external performances were largest for the ‘no test/validation set’ design. This indicates even with large data the ‘no test/validation set’ design causes models to overfit. The seven alternative designs included some validation process to select the hyperparameters and a fair testing process to estimate internal performance. These designs had similar internal performance estimates and performed similarly when externally validated in the two external databases.

CONCLUSIONS: Even with big data, it is important to use some validation process to select the optimal hyperparameters and fairly assess internal validation using a test set or cross-validation.

PMID:34952871 | DOI:10.1136/bmjopen-2021-050146