Category: Statistics

Psychother Psychosom Med Psychol. 2022 Mar 8. doi: 10.1055/a-1749-6379. Online ahead of print.

ABSTRACT

This study examined the implementation of a behavioral medicine oriented rehabilitation concept in a cardiological rehabilitation clinic. Psychotherapeutic interventions were based on an Acceptance and Commitment Therapy framework. Participants were treated in a behavioral cardiac rehabilitation program (BCR; n=149), or in a conventional cardiac rehabilitation program (CCR, n=100). We tested and compared the reach of the targeted group, the fidelity of the concept implementation in the BCR, as well as the completeness of the intervention (dose delivered) and the patient-reported behavioral medical treatment dose (dose received). Changes from beginning of rehabilitation until discharge with regard to mental and physical performance were assessed in both groups. BCR-patients were more impaired than CCR-patients, and they confirmed more behavioral medical content, a higher consistency of the behavioral medical strategy and a stronger gain of competence. Adherence ratings indicated a largely accurate implementation of the intervention. In both groups, depression, somatization, anxiety, heart anxiety, exercise self-efficacy expectation, and maximum power in bicycle ergometry improved statistically significant from admission to discharge. Large or nearly large effect sizes were found for avoidance behavior (d=0.78), somatization (d=0.82), depression (d=0.76), anxiety (d=0.72) and performance in bicycle ergometry (d=0.86) in the BCR. A further evaluation by means of a randomized controlled trial should follow this implementation study.

PMID:35259767 | DOI:10.1055/a-1749-6379

ORL J Otorhinolaryngol Relat Spec. 2022 Mar 8:1-8. doi: 10.1159/000521789. Online ahead of print.

ABSTRACT

INTRODUCTION: Bell’s palsy is acute facial paralysis with unclear etiology that results in weakness of facial muscles or paralysis on one side of the face.

METHODS: This prospective, randomized, single-blind, controlled study was conducted on 45 patients with Bell’s palsy who were randomly divided into three equal groups. Two groups received either low-level laser therapy (LLLT) or electrical stimulation (E.S.) both in conjunction to medications, massage, and facial exercise treatment. The third group (control) was treated with medication, massage, and facial exercise.

RESULTS: The primary outcome was the improvement of nerve conduction velocity of facial nerve while the secondary outcome was the change of Sunnybrook facial grading system (SBGS). The outcome measures were evaluated pre- and posttreatment. There was statistically significant difference between the three groups in favor of the LLLT group regarding the nerve action potential amplitude and latency, in addition to signs of nerve regeneration and improved SBGS.

CONCLUSION: This short-term investigation revealed that LLLT proved to be more efficient than E.S. in facial nerve regeneration for patients with Bell’s palsy.

PMID:35259753 | DOI:10.1159/000521789

Gerontology. 2022 Mar 8:1-9. doi: 10.1159/000521146. Online ahead of print.

ABSTRACT

INTRODUCTION: The first cases of COVID-19 in Israel were reported in February 2020. Family visits were prohibited from March 10, 2020, and then allowed on a limited basis on April 20, 2020. This article examines how COVID-19 impacted long-term care residents and their family members from the perspective of long-term care facility (LTCF) administrative staff.

METHODS: An online survey was sent to Israeli LTCF administrators between mid-July and mid-October 2020, resulting in 52 completed questionnaires. Quantitative analysis involved descriptive statistics using SPSS, with differences compared via t tests, ANOVA, and χ2 tests. Qualitative analysis involved thematic analysis of responses to open-ended questions.

RESULTS: COVID-19 was reported to have multiple types of negative impact on residents, including direct effects on morbidity and mortality as well as indirect effects manifested as negative reactions to measures aimed at limiting infection, including isolation from relatives, decreased activities for residents, and COVID-19 testing. The impact of isolation on LTCF residents was reported as negative or very negative by over three-quarters of the respondents. Behavioral problems among residents increased in 32% of the facilities. The qualitative results suggested that adverse effects on residents and family members were partially mitigated by the use of communication technologies.

DISCUSSION/CONCLUSION: The interplay of multiple factors affected LTCF residents against the backdrop of COVID-19 restrictions. The emergence of mitigating factors which provide solutions to some of the challenges has the potential of improving quality of care for LTCF residents as the pandemic continues and thereafter.

PMID:35259746 | DOI:10.1159/000521146

Phys Ther Sport. 2022 Feb 19;55:55-60. doi: 10.1016/j.ptsp.2022.02.004. Online ahead of print.

ABSTRACT

CONTEXT: Strength ratios are important because imbalances in opposing muscle groups can cause articular instability and subsequently increase the risk of musculoskeletal injury (MSKI). Therefore, the purpose of this study was to evaluate the association between lower extremity (LE) musculoskeletal isometric strength ratios and the history of LE MSKI.

PARTICIPANTS: One hundred eighty-two NCAA Division 1 soccer, football, volleyball, and basketball athletes.

INTERVENTIONS: All isometric strength assessments were measured bilaterally using a handheld dynamometer. Strength assessments included: ankle inversion/eversion, ankle dorsiflexion/plantarflexion, knee flexion/extension, hip abduction/adduction, and hip external/internal rotation. LE MSKI history was collected through self-report; a report of the LE MSKI sustained in the one year prior to testing were collected.

RESULTS: The hip external/internal rotation ratio was statistically significant for side to side differences in the non-injured (NINJ) group (p = 0.001). The dominant leg of the NINJ group had a mean external/internal rotation ratio of 1.109 ± 0.221, and the non-dominant leg had a mean ratio of 1.177 ± 0.208.

CONCLUSIONS: There were no statistically significant differences between the injured (INJ) and NINJ groups. This could indicate that injury history does not play a role in current strength ratios and could suggest that the athletes in the INJ group are performing successful rehabilitation for their injuries.

PMID:35259716 | DOI:10.1016/j.ptsp.2022.02.004

Int J Hyg Environ Health. 2022 Mar 5;241:113949. doi: 10.1016/j.ijheh.2022.113949. Online ahead of print.

ABSTRACT

Household air pollution from solid fuel combustion was estimated to cause 2.31 million deaths worldwide in 2019; cardiovascular disease is a substantial contributor to the global burden. We evaluated the cross-sectional association between household air pollution (24-h gravimetric kitchen and personal particulate matter (PM_2.5) and black carbon (BC)) and C-reactive protein (CRP) measured in dried blood spots among 107 women in rural Honduras using wood-burning traditional or Justa (an engineered combustion chamber) stoves. A suite of 6 additional markers of systemic injury and inflammation were considered in secondary analyses. We adjusted for potential confounders and assessed effect modification of several cardiovascular-disease risk factors. The median (25th, 75th percentiles) 24-h-average personal PM_2.5 concentration was 115 μg/m³ (65,154 μg/m³) for traditional stove users and 52 μg/m³ (39, 81 μg/m³) for Justa stove users; kitchen PM_2.5 and BC had similar patterns. Higher concentrations of PM_2.5 and BC were associated with higher levels of CRP (e.g., a 25% increase in personal PM_2.5 was associated with a 10.5% increase in CRP [95% CI: 1.2-20.6]). In secondary analyses, results were generally consistent with a null association. Evidence for effect modification between pollutant measures and four different cardiovascular risk factors (e.g., high blood pressure) was inconsistent. These results support the growing evidence linking household air pollution and cardiovascular disease.

PMID:35259686 | DOI:10.1016/j.ijheh.2022.113949

Eur J Radiol. 2022 Mar 2;150:110232. doi: 10.1016/j.ejrad.2022.110232. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the feasibility of simultaneous multi-slice readout-segmented diffusion-weighted echo-planar imaging (SMS rs-EPI DWI) in predicting invasive breast cancer molecular subtypes using whole-tumor histogram and texture analyses.

METHODS: In our retrospective study, 125 patients (mean age, 52.81 ± 12.01 years; range, 24-84 years) with single invasive breast cancer who underwent preoperative MRI with SMS rs-EPI DWI and surgery at our institution were included. Two radiologists independently performed whole-tumor histogram and texture analyses on the apparentdiffusioncoefficient (ADC) map of SMS rs-EPI DWI (TR, 3800.0 ms; TE 90.0 ms; field of view, 340 mm × 206 mm; in-plane matrix, 244 × 148; section thickness, 5 mm; readout segments, 5, b = 0, 800 s/mm²; scan time, 3 mins; slice acceleration factor, 2). The Mann-Whitney U test or Kruskal-Wallis test were used to compare histogram and texture parameters to assess their potential in differentiating molecular subtypes of breast cancer and predicting axillary lymph node status. Receiver operating characteristic (ROC) curves were generated for parameters with significant differences, and the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

RESULTS: Compared to luminal A breast cancer, the HER2-positive breast cancer subtype showed higher ADC_{_95th percentile} values (p = 0.016). In addition, HER2-positive breast cancer yielded significantly higher ADC_{_mean} (p = 0.025), ADC_{_median} (p = 0.025), and ADC_{_5th percentile} (p = 0.041) values than luminal B breast cancer. The ADC_{_skewness} value was higher for triple-negative breast cancer (TNBC) than Luminal A breast cancer (p = 0.021). The difference in ADC_{_mean}, ADC_{_median}, ADC_{_5th percentile} and ADC_{_95th percentile} values between the HER2-positive breast cancer and luminal types was statistically significant, with a combined AUC for these parameters of 0.762 (sensitivity 72.41%, specificity 75.00%, PPV 27.27 %, and NPV 95.45 %). The ADC_{_skewness} value for TNBC was higher than for luminal types (p = 0.012) and yielded an AUC value of 0.688 (sensitivity 96.15%, specificity 36.78%, PPV 31.25%, and NPV 96.97 %). Additionally, significantly higher ADC_{_skewness} and ADC_{_95th percentile} values (p = 0.003, 0.002, respectively) were reported for non-luminal types than luminal types yielding a combined AUC value of 0.712 (sensitivity 92.11%, and specificity 50.23%, PPV 41.18%, and NPV 92.50%). The AUC value for ADC_{_5th percentile} for axillary lymph node status prediction was 0.659 (sensitivity 65.38%, specificity of 64.86%).

CONCLUSIONS: The whole-tumor histogram and texture analyses parameters based on SMS rs-EPI DWI may provide biological information on aggressive molecular subtypes of breast cancer. In addition, ADC_{_5th percentile} values were significantly different between lymph node-positive and lymph node-negative breast cancer.

PMID:35259708 | DOI:10.1016/j.ejrad.2022.110232

Drug Alcohol Depend. 2022 Feb 26;233:109381. doi: 10.1016/j.drugalcdep.2022.109381. Online ahead of print.

ABSTRACT

BACKGROUND: Opioid-related overdoses are a major cause of mortality in the US. Medicaid Expansion is posited to reduce opioid overdose-related mortality (OORM), and may have a particularly strong effect among people of lower socioeconomic status. This study assessed the association between state Medicaid Expansion and county-level OORM rates among individuals with low educational attainment.

METHODS: This quasi-experimental study used lagged multilevel difference-in-difference models to test the relationship of state Medicaid Expansion to county-level OORM rates among people with a high-school diploma or less. Longitudinal (2008-2018) OORM data on 2978 counties nested in 48 states and the District of Columbia (DC) were drawn from the National Center for Health Statistics. The state-level exposure was a time-varying binary-coded variable capturing pre- and post-Medicaid Expansion under the Affordable Care Act (an “on switch”-type variable). The main outcome was annual county-level OORM rates among low-education adults adjusted for potential underreporting of OORM.

FINDINGS: The adjusted county-level OORM rates per 100,000 among the study population rose on average from 10.26 (SD = 13.56) in 2008-14.51 (SD = 18.20) in 2018. In the 1-year lagged multivariable model that controlled for policy and sociodemographic covariates, the association between state Medicaid Expansion and county-level OORM rates was statistically insignificant.

CONCLUSIONS: We found no evidence that expanding Medicaid eligibility reduced OORM rates among adults with lower educational attainment. Future work should seek to corroborate our findings and also identify – and repair – breakdowns in mechanisms that should link Medicaid Expansion to reduced overdoses.

PMID:35259679 | DOI:10.1016/j.drugalcdep.2022.109381

Schizophr Res. 2022 Mar 5;243:112-117. doi: 10.1016/j.schres.2022.02.038. Online ahead of print.

ABSTRACT

Incarceration of individuals with mental disorders is an important public health topic. While incarceration appears to be associated with schizophrenia and related psychotic disorders, to the best of our knowledge, no study has examined the association between incarceration and psychotic experiences (PEs). The present study aimed to examine whether individuals with PEs had higher odds of incarceration among a general population sample using data from Baltimore and New York City (N = 974). We fitted three regression models to examine the association between incarceration and PEs, using hierarchical adjustments for sociodemographic factors, adverse childhood experiences, and neighborhood disruption. The odds ratio (OR) for incarceration was attenuated with inclusion of more covariates in the model but remained statistically significant even at the highest level of adjustment (OR = 2.12, 95% CI = 1.30 to 3.46). Findings were similar when individually examining delusional mood, delusions of reference and persecution, and hallucination. For delusions of control, a significant association was not found in the highest level of adjustment. The present study provides novel information on the association between incarceration and PEs, adjusted for sociodemographic and psychosocial confounders. Taken in the context of prior studies, these data further support the need to address the high prevalence of psychosis across all aspects of the criminal justice system. Future studies should employ longitudinal data and objective outcome measurements.

PMID:35259671 | DOI:10.1016/j.schres.2022.02.038

Comput Methods Programs Biomed. 2022 Feb 17;218:106701. doi: 10.1016/j.cmpb.2022.106701. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Revealing the complexity behind subject-specific ankle joint mechanics requires simultaneous analysis of three-dimensional bony and soft-tissue structures. 3D musculoskeletal models have become pivotal in orthopedic treatment planning and biomechanical research. Since manual segmentation of these models is time-consuming and subject to manual errors, (semi-) automatic methods could improve the accuracy and enlarge the sample size of personalised ‘in silico’ biomechanical experiments and computer-assisted treatment planning. Therefore, our aim was to automatically predict ligament paths, cartilage topography and thickness in the ankle joint based on statistical shape modelling.

METHODS: A personalised cartilage and ligamentous prediction algorithm was established using geometric morphometrics, based on an ‘in-house’ generated lower limb skeletal model (N = 542), tibiotalar cartilage (N = 60) and ankle ligament segmentations (N = 10). For cartilage, a population-averaged thickness map was determined by use of partial least-squares regression. Ligaments were wrapped around bony contours based on iterative shortest path calculation. Accuracy of ligament path and cartilage thickness prediction was quantified using leave-one-out experiments. The novel personalised thickness prediction was compared with a constant cartilage thickness of 1.50 mm by use of a paired sample T-test.

RESULTS: Mean distance error of cartilage and ligament prediction was 0.12 mm (SD 0.04 mm) and 0.54 mm (SD 0.05 mm), respectively. No significant differences were found between the personalised thickness cartilage and segmented cartilage of the tibia (p = 0.73, CI [-1.60 .10^-17, 1.13 .10^-17]) and talus (p = 0.95, CI[ -1.35 .10^-17, 1.28 .10^-17]). For the constant thickness cartilage, a statistically significant difference was found in 89% and 92% of the tibial (p < 0.001, CI [0.51, 0.58]) and talar (p < 0.001, CI [0.33, 0.40]) cartilage area.

CONCLUSIONS: In this study, we described a personalised prediction algorithm of cartilage and ligaments in the ankle joint. We were able to predict cartilage and main ankle ligaments with submillimeter accuracy. The proposed method has a high potential for generating large (virtual) sample sizes in biomechanical research and mitigates technological advances in computer-assisted orthopaedic surgery.

PMID:35259673 | DOI:10.1016/j.cmpb.2022.106701

Sex Med. 2022 Mar 5;10(2):100500. doi: 10.1016/j.esxm.2022.100500. Online ahead of print.

ABSTRACT

INTRODUCTION: Carbohydrate restriction in diet is becoming a popular means of losing weight nowadays, although it has been reported that excessive intake of low-carbohydrate and high-protein (LCHP) diet causes an adverse effect on cardiovascular function.

AIM: To investigate the influence of LCHP on erectile function in rats.

METHODS: A total of 48, 12-week-old rats were divided into 2 groups and either fed a LCHP diet (LCHP group) or a normal diet (Control group). Hematological examination, blood pressure evaluation, erectile function assessments as well as evaluations of the relaxation and contractile responses of corpus cavernosum were carried out in these rats by using standardized methods. Statistical analysis using 2-way ANOVA and Welch’s t-test was conducted to examine the obtained data.

MAIN OUTCOME MEASURE: At the end of the study period, the evaluated outcomes to assess erectile function were intracavernosal pressure , mean arterial pressure , endothelial functions, nitric oxide (NO)-operated nerve functions and the expressions of endothelial nitric oxide synthase (eNOS), neuronal nitric oxide synthase (nNOS), and sphingosine-1-phosphate receptor 1 (S1P1).

RESULTS: The intracavernosal pressure / mean arterial pressure ratio was significantly lower in the LCHP group (P < .05) at 4 weeks. Compared to the Control group, the LCHP group exhibited significantly lower responses to ACh and EFS and a decreased nNOS mRNA expression. The results based on this animal model indicate that extreme carbohydrate restricted diet may affect erectile function. Our study identified that LCHP decreased erectile function in rats. A major limitation of this study is, due to the extreme condition of completely replacing carbohydrates with protein, that carbohydrate intake will be gradually increased in the future.

CONCLUSION: Extreme carbohydrate restriction and high protein in diet may cause ED with vascular endothelial dysfunction and a decrease in the relaxation response of the corpus cavernosum smooth muscle via NO-operated nerves. Kataoka T, Hidaka J, Suzuki J, et al. Evaluating the Effects of Low Carbohydrate and High Protein Diet on Erectile Function in Rats. Sex Med 2021;10:100500.

PMID:35259652 | DOI:10.1016/j.esxm.2022.100500