Category: Statistics

Clin Nutr. 2022 Feb 24;41(4):937-947. doi: 10.1016/j.clnu.2022.02.014. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Biofortification of staple crops with higher levels of micronutrients via traditional breeding methods is a sustainable strategy and can possibly complement fortification and other interventions to target micronutrient deficiencies in low resource settings, particularly among vulnerable populations such as children. We aimed to determine if iron- and zinc-biofortified pearl millet (FeZnPM, Dhanashakti, ICTP-8203Fe)-based complementary feeding improves nutritional status, including iron biomarkers and growth, in children living in urban slums of Mumbai.

METHODS: We conducted a randomized controlled trial of FeZnPM among 223 children aged 12-18 months who were not severely anemic at baseline (hemoglobin ≥9.0 g/dL). Children were randomized to receive either FeZnPM or conventional non-biofortified pearl millet (CPM) daily for 9 months. Iron status (hemoglobin, serum ferritin), plasma zinc, and anthropometric indicators (length, weight, mid-upper arm circumference, triceps and subscapular skinfolds) were evaluated at enrollment and throughout the trial. World Health Organization (WHO) anthropometric z-scores were calculated using WHO growth standards. Primary outcomes were hemoglobin and serum ferritin concentrations, and growth, defined as WHO z-scores. An intent to treat approach was used for analyses. We used the Hodges-Lehmann-Sen test to assess the change in primary outcomes between baseline and the last visit and report corresponding 95% confidence intervals.

RESULTS: At baseline, 67.7% of children were anemic (hemoglobin <11.0 g/dL) and 59.6% were iron deficient (serum ferritin <12.0 μg/L). FeZnPM did not significantly increase iron biomarkers or improve growth, compared to CPM. In subgroup analyses, FeZnPM improved hemoglobin concentrations in male children, and in children with iron deficiency or iron depletion (serum ferritin <25.0 μg/L) at baseline, relative to CPM.

CONCLUSIONS: Daily consumption of FeZnPM-based complementary foods did not significantly impact iron and zinc status or growth in children living in Mumbai’s urban slums. However, the intervention significantly improved hemoglobin concentrations among male children and among individuals who were iron-deficient or iron-depleted at baseline.

TRIAL REGISTRATION: This trial is registered with Clinicaltrials.gov (ID: NCT02233764), and Clinical Trials Registry of India (ID: REF/2014/10/007731).

PMID:35299084 | DOI:10.1016/j.clnu.2022.02.014

J Infect Public Health. 2022 Feb 15;15(4):389-394. doi: 10.1016/j.jiph.2022.01.013. Online ahead of print.

ABSTRACT

BACKGROUND: Prior to the availability of the current COVID-19 vaccine, the need to control the pandemic worldwide was focused on management of the disease using previously approved antivirals, including Favipiravir which inhibits viral replication through the RNA dependent RNA polymerase enzyme. Favipiravir’s efficacy against different viral infections has made it a potential treatment for COVID-19. We are aiming in this study to assess the therapeutic efficacy and safety of Favipiravir in treating critically ill patients admitted with COVID-19 to Intensive Care Units (ICUs).

METHODS: This is a retrospective cohort study was conducted in five tertiary hospitals in Riyadh, Kingdom of Saudi Arabia (KSA). The studied sample was randomized from a huge pool of data collected primarily for critically ill COVID-19 patients admitted to (ICUs) during the period between April 2020 to March 2021. Two groups of patients matched 1: 1 for age and body mass index (BMI) was enrolled in the study; one group received Favipiravir and another comparison group received other antimicrobial medications, not including Favipiravir.

RESULTS: A total data of 538 COVID-19 patients were analyzed, 269 (50.%) received Favipiravir and 269 (50%) the control group received different treatments. More than two-thirds 201 (74.7%) were Saudi citizens, the majority 177 (65.8%) were males and the mean age and (BMI) were; (57.23 ± 15.16) years and (31.61 ± 7.33) kg/m2 respectively. The most frequent symptoms of presentation were shortness of breath (SOB), fever, and cough, and the most frequent comorbidity was diabetes mellitus, hypertension, and ischemic heart disease. In the supplemental therapy, corticosteroid, tocilizumab and chloroquine were statistically significant (P = 0.001) when combined in the FVP group more than in the comparison group. Severe acute respiratory distress syndrome (ARDS) was more frequent among Favipiravir group, while the overall mortality rate among the Favipiravir group was not statistically significant (p-value 0.4).

CONCLUSION: According to the study’s results revealing FVP is not superior to other antivirals, patients who received Favipiravir presented with more severe symptoms, more comorbidities, more complications, and is not effective in controlling the cytokine storm which negatively impact the efficacy of Favipiravir. FVP therapy had no influence on ICU and hospital length of stay in comparison with the control group as well as in the overall mortality rate among the FVP group was not statistically significant. further research is needed to understand how FVP along with other treatments can improve the length of stay among COVID-19 patients admitted to the ICU.

PMID:35299062 | DOI:10.1016/j.jiph.2022.01.013

Int J Food Microbiol. 2022 Mar 3;369:109609. doi: 10.1016/j.ijfoodmicro.2022.109609. Online ahead of print.

ABSTRACT

Frozen reformulated (FR) breaded chicken products have previously been implicated in causing human salmonellosis. A multi-country Salmonella enterica serovar Enteritidis outbreak involving several strains with >400 reported human cases in the UK occurred in 2020. Initially S. Infantis was detected in one sample from a case home but S. Enteritidis was then also isolated using a S. Enteritidis specific PCR in combination with isolation via a Craigie-tube. This prompted a survey to examine the presence and levels of Salmonella and E. coli in ready-to-cook FR poultry products in England in 2020. From a total of 483 samples, including two from cases’ homes, Salmonella was detected in 42 chicken samples, these originated from six out of 53 production plants recorded. Salmonella detection was associated with elevated levels of generic E. coli (OR = 6.63). S. Enteritidis was detected in 17 samples, S. Infantis in 25, S. Newport in four and S. Java, S. Livingstone and S. Senftenberg in one each. The highest levels of Salmonella were 54 MPN/g for S. Infantis and 28 MPN/g for S. Enteritidis; 60% of the Salmonella-positive samples had <1.0 MPN/g. S. Enteritidis was detected together with S. Infantis in five samples and with S. Livingstone in one. Where S. Enteritidis was detected with other Salmonella, the former was present at between 2 and 100-fold lower concentrations. The Salmonella contamination was homogeneously distributed amongst chicken pieces from a single pack and present in both the outer coating and inner content. The S. Enteritidis were all outbreak strains and detected in six products that were linked to four production plants which implicated a Polish origin of contamination. Despite S. Infantis being most prevalent in these products, S. Infantis from only two contemporaneous human cases in the UK fell into the same cluster as isolates detected in one product. Except for one human case falling into the same cluster as one of the S. Newport strains from the chicken, no further isolates from human cases fell into clusters with any of the other serovars detected in the chicken samples. This study found that higher E. coli levels indicated a higher probability of Salmonella contamination in FR chicken products. The results also highlight the importance of recognising co-contamination of foods with multiple Salmonella types and has provided essential information for detecting and understanding outbreaks where multiple strains are involved.

PMID:35299050 | DOI:10.1016/j.ijfoodmicro.2022.109609

Int J Nurs Stud. 2022 Jan 10;129:104173. doi: 10.1016/j.ijnurstu.2022.104173. Online ahead of print.

ABSTRACT

BACKGROUND: Both globally and nationally, determinants of end-of-life care practices in nursing homes, such as laws and workforce, vary widely, resulting in a huge disparity in the quality of such practices. Despite the rapid growth in the number of nursing homes and increasing social attention being paid to end-of-life care in South Korea, little is known about these practices and how they differ because of nursing home-related regulations and nurse staffing.

OBJECTIVES: To examine end-of-life care practices in nursing homes and compare them between nursing homes with 30 beds or more and those with fewer than 30 beds (the cut-point where nursing home-related regulations differ) and between nursing homes with and without registered nurses.

DESIGN: A cross-sectional exploratory study using data from a national survey conducted by the National Health Insurance Service.

SETTINGS: Nursing homes certified by the national long-term care insurance in South Korea.

PARTICIPANTS: Nursing representatives from 836 nursing homes.

METHODS: Measures of end-of-life care practices included the identification of residents’ (or families’) preferences for the place of death and a do-not-resuscitate order, the provision of end-of-life care on-site, and the presence of end-of-life care protocols. Descriptive statistics and logistic regression were used to compare end-of-life care practices by bed size and registered-nurse staffing.

RESULTS: Of the 836 nursing homes, 85% and 84.1% identified the preference for the place of death and a do-not-resuscitate order mostly from surrogates, respectively. The most preferred places of death were nursing homes (53.3%) and hospitals (46.0%). Approximately, 72% responded that on-site end-of-life care protocols were present, and 50.8% reported providing end-of-life care on-site. Compared to nursing homes with 10-29 beds, those with 30 beds or more were more likely to identify the preference for a do-not-resuscitate order (OR 2.392, 95% CI 1.643-3.482); have in place end-of-life care protocols (OR 1.829, 95% CI 1.341-2.496); and provide end-of-life care on-site (OR 1.556, 95% CI 1.169-2.072). Compared to nursing homes without registered nurses, those with registered nurses were also more likely to identify the preference for a do-not-resuscitate order (OR 1.717, 95% CI 1.142-2.583) and provide end-of-life care on-site (OR 1.663, 95% CI 1.254-2.206).

CONCLUSIONS: The findings indicate a huge disparity in end-of-life care practices in nursing homes across South Korea by bed size-based nursing-home regulations and registered-nurse staffing. Law/regulation- and policy-level changes are needed to promote robust end-of-life care in nursing homes.

STUDY REGISTRATION: Not registered.

PMID:35299051 | DOI:10.1016/j.ijnurstu.2022.104173

Breast. 2022 Feb 21;63:37-45. doi: 10.1016/j.breast.2022.02.012. Online ahead of print.

ABSTRACT

INTRODUCTION: Factors influencing breast reconstruction rates in Canada are complex and multi-factorial, ranging from patient-related to systemic considerations. For plastic surgeons, rates of immediate breast reconstruction (IBR) hinge on referral patterns from general surgeons performing breast cancer surgery and informed discussions with patients about their goals and risk tolerance. We seek to understand the reasons Alberta patients are not receiving IBR as reported by general surgeons.

METHODS: The Synoptec™ database is a synoptic operative report designed by Cancer Surgery Alberta™ and utilized by 95% of Alberta breast cancer surgeons. Within this report are mandatory questions regarding if a patient is receiving IBR and, if not, why. A retrospective review of this database was performed for all patients undergoing surgical treatment of breast cancer over two years. All statistical comparisons were made using chi-squared test for categorical variables with a p-value of 0.05 considered significant.

RESULTS: Of 6253 patients undergoing breast cancer surgery, 2649 underwent mastectomy and 615 mastectomy patients received IBR. The most commonly reported reasons patients did not undergo IBR were patient preference (55%), high likelihood of postoperative radiation therapy (20%), and high risk due to patient co-morbidities (12%). Resource limitations (2%) and a lack of an IBR discussion (3%) was rarely cited as reasons for no IBR.

CONCLUSIONS: There are many reconstructive options following mastectomy in breast cancer survivors. This study provides a unique look into general surgeon reported reasons patients are not receiving IBR and demonstrates the need for further probing into the thought-process behind these reported reasons from both a surgeon and patient perspective.

PMID:35299033 | DOI:10.1016/j.breast.2022.02.012

Int J Obstet Anesth. 2022 Feb 17;50:103271. doi: 10.1016/j.ijoa.2022.103271. Online ahead of print.

ABSTRACT

BACKGROUND: Uterine positioning during hysterotomy repair is controversial, with both in situ and externalized approaches commonly performed. Despite many published trials, clinical equipoise remains. This meta-analysis and trial sequential analysis (TSA) summarizes studies comparing both techniques.

METHODS: A systemic search for randomized controlled trials comparing in situ with externalized hysterotomy repair during cesarean delivery was performed. The primary outcomes were estimated blood loss (EBL) and surgical duration. Secondary outcomes were need for blood transfusion, incidence of endometritis, hospital length of stay, intra-operative hypotension, return of bowel function, intra-operative vomiting, intra-operative pain, and need for postoperative analgesia. Cochrane methodology was used to assess risk of bias. Data are presented as mean difference/standardized mean difference or odds ratio/risk difference with 95% confidence intervals (CI).

RESULTS: Nineteen studies enrolling 20 739 patients were included. Estimated blood loss and surgical duration were equivalent between methods, with TSA confirming adequate information size for surgical duration but not EBL. In situ repair was associated with faster return of bowel function (MD, -0.76 days; 95% CI, -1.36 to -0.15; P=0.01) and a reduction in need for breakthrough postoperative analgesia (OR, 0.44; 95% CI, 0.28 to 0.68; P <0.01).

CONCLUSIONS: This analysis revealed equivalence between methods for EBL and surgical duration. While the small reduction in EBL with externalized repair was not clinically or statistically significant, TSA analysis revealed an unmet information size, suggesting a potentially inconclusive result. In situ repair may be associated with less breakthrough postoperative analgesia requirement and faster return of bowel function.

PMID:35299027 | DOI:10.1016/j.ijoa.2022.103271

Breast. 2022 Mar 12;63:29-36. doi: 10.1016/j.breast.2022.03.006. Online ahead of print.

ABSTRACT

PURPOSE: Young age is associated with poor prognosis in ductal carcinoma in situ (DCIS) of female breast and controversy exists regarding the optimal treatment modality for young patients. We aimed to compare treatment outcomes among breast conserving surgery (BCS), BCS with adjuvant radiotherapy (BCS + RT), and total mastectomy (MT) for young DCIS women.

METHODS: PubMed, Cochrane, and Embase were searched for studies reporting comparative results among BCS, BCS + RT, or MT in ≤50 years old (y/o) DCIS females. Study quality was assessed and meta-analysis with subgroup analysis was performed to pool the effect sizes of the outcomes-of-interest.

RESULTS: We included 3 randomized control trials and 18 observational studies. For DCIS women ≤50 y/o, RT following BCS significantly reduced the risk for ipsilateral breast tumor recurrence (IBTR) (HR = 0.66, 95% CI 0.50-0.87). However, the benefit was less robust in extremely young patients and with long follow-ups. RT revealed no statistically significant preventive effect on ipsilateral invasive recurrence (HR = 1.38, 95% CI 0.98-1.94). On the other hand, MT yielded the lowest IBTR (BCS + RT vs MT: HR = 4.4, 95% CI 2.06-9.40), both in ipsilateral DCIS recurrence and ipsilateral invasive recurrence. There was great heterogeneity and could not reach an evident conclusion concerning survival outcomes.

CONCLUSION: This study highlighted the varying effect of RT for young DCIS females. The local control benefit of MT was definite without survival differences observed. Our study provided a moderate certainty of evidence to guide the treatment for young DCIS women. Further age-specific prospective trial is warranted.

PMID:35299032 | DOI:10.1016/j.breast.2022.03.006

J Biomech. 2022 Mar 10;135:111035. doi: 10.1016/j.jbiomech.2022.111035. Online ahead of print.

ABSTRACT

Exercise encourages active and healthy aging, maintaining functional and physical capabilities. This study aimed to assess the effects of a long-term moderate aerobic exercise protocol on bone microarchitecture and fragility associated with chronic inflammation and oxidative stress in aging. Male BALB/c mice (n = 10 per group) underwent a moderate exercise protocol from 13 weeks to 27 (adulthood age) or 108 weeks of age (elderly age) and were then sacrificed. Age-match sedentary mice were included as a control group. Serum cortisol concentrations were determined by chemiluminescent immunoassay, C-reactive protein (CRP) by a turbidimetric assay, advanced glycation end-products (AGEs) and malondialdehyde (MDA) by fluorescent spectroscopy, and total glutathione (GSH) by colorimetric method. The right femur was dissected formorphometric and densitometricanalysis bycomputerized microtomography (µCT),and biomechanical properties were assessed usinga three-point bending device. Musclefrom the same extremitywas obtained to determine relative mRNA expression ofpro-inflammatory cytokines (TNF-α and IL-6) by RT-qPCR.Statistical differences were evaluated by two-way ANOVA and Holm-Sidak method post hoc with P < 0.05. In elderly mice, moderate exercise increased glutathione levels and microarchitecture complexity but decreased bone fragility and oxidative stress markers, cortisol, and pro-inflammatory cytokines. In conclusion, these results suggest a strong link between a pro-inflammatory state and age-conditioned oxidative stress on bone quality. Thus, on a human scale, moderate aerobic exercise may improve bone quality during aging.

PMID:35298960 | DOI:10.1016/j.jbiomech.2022.111035

Water Res. 2022 Mar 8;215:118272. doi: 10.1016/j.watres.2022.118272. Online ahead of print.

ABSTRACT

Water governing systems are twisted with complex interplays among levels and scales which embody their structures. Typically, the mismatch between human-generated and natural systems produces externalities and inefficiencies reflectable in spatial scales. The largely known problem of fit in water governance is investigated to detect the issues of fit between administrative/institutional scales and the hydrological one in a lake basin. To implement the idea, constraining the level of analysis interlinked to the concentrated levels of administration in spatial scales, the fit of the governing system was analyzed by means of statistical mechanics. Modeling the structure of water demand/supply governing system in a given region through the Curie-Weiss Mean Field approximation, the system cost in relation to its structure and fit was appraised and compared with two other conceptual structures in the Urmia Lake Basin in Iran. The methodology articulated an analysis framework for exploring the effectiveness of the formulated water demand/supply governing system and its fit to the relevant hydrological system. The findings of this study may help developing strategies to encourage adaptations, rescaling/reforms for effective watershed management.

PMID:35298993 | DOI:10.1016/j.watres.2022.118272

Res Dev Disabil. 2022 Mar 14;124:104215. doi: 10.1016/j.ridd.2022.104215. Online ahead of print.

ABSTRACT

BACKGROUND: Children with Developmental Language Disorder (DLD) have been found to demonstrate low performance in Executive Functions (EFs). However, the evidence-based data is so far scarce, especially for 4-5-year-old children. Most of the existing research involves English-speaking populations, while very few studies have been carried out with non-English-speaking populations. Nevertheless, it is documented that possible differences in the language-cognition relations may exist due to the specific characteristics of each language, and studies across different languages could contribute to the above.

AIMS: The present study aimed to systematically investigate the profile of oral language and EF skills (verbal and nonverbal) and the way these skills are related with each other in 4-5-year-old Greek-speaking children with and without DLD.

METHODS AND PROCEDURES: Fifty-three 4-5-year-old children (age range: 51- 57 months) with DLD, and 62 Typically Developing (TD) peers (age range: 51- 57 months) were assessed on a standardized psychometric battery for oral language skills (phonological and morphological awareness, oral language comprehension, vocabulary knowledge, narrative speech and pragmatics) and on a series of verbal (v) and nonverbal (nv) tasks tapping EFs skills (updating-accuracy, inhibition -accuracy and reaction time-, and cognitive flexibility).

OUTCOMES AND RESULTS: Children with DLD demonstrated statistically significant lower performance across all oral language measures in comparison to their TD peers. Additionally, they performed significantly lower in the updating (nv) task, as well as in cognitive flexibility (v & nv) in comparison to the TD group. Further regression analyses demonstrated that updating (nv), inhibition (nv) and cognitive flexibility (v) predicted oral language comprehension in children with DLD while updating (v & nv), inhibition-reaction time (nv) and cognitive flexibility (v & nv) predicted phonological and morphological awareness, oral language comprehension, narrative speech as well as total language score in TD children.

CONCLUSIONS AND IMPLICATIONS: These results provide important information about the profile of oral language and EF skills in children with DLD compared to their TD peers as well as on the relationship of these skills in both groups. The findings also suggest that improving EFs skills may be a possible way for improving oral language skills in young children with DLD. Our findings are discussed in terms of their theoretical as well as practical implications regarding the diagnostic and intervention procedures for children with DLD.

PMID:35298958 | DOI:10.1016/j.ridd.2022.104215