Category: Statistics

Fam Med. 2021 Apr;53(4):295-299. doi: 10.22454/FamMed.2021.399314.

ABSTRACT

BACKGROUND AND OBJECTIVES: Substance use disorders (SUD) remain a public health crisis and training has been insufficient to provide the skills necessary to combat this crisis. We aimed to create and study an interactive, destigmatizing, skills-based workshop for medical students to evaluate if this changes students’ self-reported knowledge, skills, and attitudes toward patients with SUD.

METHODS: We surveyed students on a required family medicine outpatient rotation at a Pacific Northwest medical school during clerkship orientation on their views regarding SUDs utilizing the validated Drug and Drug Problems Perceptions Questionnaire containing a 7-point Likert scale. After attending a substance use disorder workshop, they repeated the survey. We calculated differences between the paired pre- to postsurveys.

RESULTS: We collected the pre- and postdata for 118 students who attended the workshop and showed statistically significant positive differences on all items.

CONCLUSIONS: The positive change in the medical students’ reported attitudes suggests both necessity and feasibility in teaching SUD skills in a destigmatizing way in medical training. Positive changes also suggest a role of exposing students to family medicine and/or primary care as a strategy to learn competent care for patients with substance use disorders.

PMID:33887053 | DOI:10.22454/FamMed.2021.399314

Int J Clin Pract. 2021 Apr 22:e14256. doi: 10.1111/ijcp.14256. Online ahead of print.

ABSTRACT

AIM: This study aimed to investigate hemogram parameters and CRP that can be used in clinical practice to predict mortality in hospitalized patients with a diagnosis of COVID-19.

METHODS: This cohort study was conducted at University Hospital, which is a designated hospital for COVID-19 patients. Adult patients who were admitted to our hospital emergency department with suspected COVID-19 and who were hospitalized in our institution with a COVID-19 diagnosis were analysed.

RESULTS: There were 148 patients hospitalized with COVID-19. All-cause mortality of follow-up was 12.8%. There were statistically significant results between the 2 groups (survivors and non-survivors), which were classified based on hospital mortality rates, in terms of the lymphocyte to C-reactive protein ratio (LCRP), Systemic immune inflammation index (SII), , neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), CRP concentration and comorbid disease. In a Receiver operating characteristic (ROC)”. curve analysis, LCRP, NLR, PLR, and SII area under the curve (AUC) for in-hospital mortality were 0.817, 0.816, 0.733 and, 0,742 respectively. Based on an LCRP value of 1 for in-hospital mortality, the sensitivity, and specificity rates were 100%, 86.8% respectively. Based on the average SII of 2699 for in-hospital mortality, the sensitivity, specificity, and accuracy rates were 68,4%, 77,5%, and 76,3%, respectively A total of 19 patients died during hospitalization. All of these patients had an LCRP level ≤ 1; 14 had an NLR level ≤ 10.8; 13 had a SII ≥ 2699 (Fisher’s exact test, p = 0.000). Independent predictors of in-hospital mortality rates were LCRP < 1, PLR, SII ≥ 2699, white blood cell count, CRP, age, comorbidities, and ICU stay.

CONCLUSIONS: We concluded that inflammatory parameters, such as LRCP, SII and NLR, were associated with disease severity and could be used as potentially important risk factors for COVID-19 progression.

PMID:33887100 | DOI:10.1111/ijcp.14256

Rev Saude Publica. 2021 Apr 14;55:10. doi: 10.11606/s1518-8787.2021055002685. eCollection 2021.

ABSTRACT

OBJECTIVE: To analyze the effect of matrix support on health for older adults in primary care according to the dimensions of frailty measured with the Clinical-Functional Vulnerability Index-20 (IVCF-20).

METHODS: This is a randomized controlled community trial, developed in the Northern Minas Gerais state, Brazil, in 2018. Initially, the stratification of clinical and functional vulnerability of older adults supported by six Family Health Strategy teams occurred with the IVCF-20. Subsequently, three teams were drawn to receive matrix support for six months, and the others for control. In this intervention, face-to-face educational activities were developed for health teams. Descriptive statistics were performed, followed by bivariate analysis by Pearson’s chi-square test, to compare the variables of the IVCF-20 between the two moments (before and after the intervention), with a 5% significance level. Relative risks and respective 95% confidence intervals (95%CI) were estimated.

RESULTS: The groups were similar before intervention, and the effect of matrix actions was positive for most dimensions measured by IVCF-20 (instrumental daily living activity, cognition, mood, mobility, communication, and multiple comorbidities). At the end of the research, the percentage of frailty in the group assisted by professionals participating in matrix support was lower than that of the control group.

CONCLUSIONS: Matrix support actions, such as pedagogical attribution and horizontal care for health teams, have the potential to contribute to the articulation of models of care for older adults.

REBEC: registro BR-7b9xff.

PMID:33886949 | DOI:10.11606/s1518-8787.2021055002685

J Burn Care Res. 2021 Apr 22:irab070. doi: 10.1093/jbcr/irab070. Online ahead of print.

ABSTRACT

Electrical burn injuries can cause devastating and debilitating morbidities and impairments for patients. This cross-sectional descriptive study was performed on electrical burn patients hospitalized from 2014 to 2019 to evaluate electrical burn injuries’ epidemiology and characteristics. A total number of 726 patients with the mean age of 31.17 years were evaluated for electrical burn injuries. Mean total burn surface area (TBSA) was 16.61 ± 12.56. Most victims were male (696 cases, 95.7%); and most patients did not have a constant job (n = 458, 63%). Most affected burn sites were hands (28.6%) and upper limbs (27.8%). A total number of 89 (12.2%) patients suffered amputations with the hand fingers (64 cases) as the most common site. Low voltage injuries were more common (n = 649 , 89%). Most incidents happened at the workplace (n =459 , 63%). Comparison of patients with high voltage and low voltage injuries showed significant correlations and statistical difference between these 2 groups regarding TBSA, mean hospital stays, escharectomy, fasciotomy, amputations, debridement, fracture and mortality rate (P = 0.001). Our observation revealed that electrical burn injuries are still significant causes of morbidity and mortality among trauma patients. In contrast to previous studies, low voltage injuries were more common than high voltage ones. We propose improvements in the manufacturing of electrical appliances; paying attention to safety measures will reduce thenumber of incidents. Moreover, training and education play important roles in reducing the number of incidents and mortality rates.

PMID:33886962 | DOI:10.1093/jbcr/irab070

Fam Med. 2021 Apr;53(4):256-266. doi: 10.22454/FamMed.2021.406778.

ABSTRACT

BACKGROUND AND OBJECTIVES: The feasibility of funding an additional year of residency training is unknown, as are perspectives of residents regarding related financial considerations. We examined these issues in the Family Medicine Length of Training Pilot.

METHODS: Between 2013 and 2019, we collected data on matched 3-year and 4-year programs using annual surveys, focus groups, and in-person and telephone interviews. We analyzed survey quantitative data using descriptive statistics, independent samples t test, Fisher’s Exact Test and χ2. Qualitative analyses involved identifying emergent themes, defining them and presenting exemplars.

RESULTS: Postgraduate year (PGY)-4 residents in 4-year programs were more likely to moonlight to supplement their resident salaries compared to PGY-3 residents in three-year programs (41.6% vs 23.0%; P=.002), though their student debt load was similar. We found no differences in enrollment in loan repayment programs or pretax income. Programs’ descriptions of financing a fourth year as reported by the program director were limited and budget numbers could not be obtained. However, programs that required a fourth year typically reported extensive planning to determine how to fund the additional year. Programs with an optional fourth year were budget neutral because few residents chose to undertake an additional year of training. Resources needed for a required fourth year included resident salaries for the fourth year, one additional faculty, and one staff member to assist with more complex scheduling. Residents’ concerns about financial issues varied widely.

CONCLUSIONS: Adding a fourth year of training was financially feasible but details are local and programs could not be compared directly. For programs that had a required rather than optional fourth year much more financial planning was needed.

PMID:33887047 | DOI:10.22454/FamMed.2021.406778

Epidemiol Serv Saude. 2021 Apr 16;30(1):e2020835. doi: 10.1590/S1679-49742021000100030. eCollection 2021.

ABSTRACT

OBJECTIVE: To define the list of priority congenital anomalies for improving their recording on the Brazilian Live Birth Information System (Sinasc).

METHODS: Based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), international protocols and meetings with specialists, the list of priority anomalies was built considering two main criteria: being diagnosable at birth and having intervention available at different levels. The list was submitted for consideration by the Brazilian Medical Genetics and Genomics Society.

RESULTS: The list comprised eight groups of congenital anomalies distributed according to the type of related anomaly, as well as the affected part of the body and its corresponding code in ICD-10 Chapter XVII.

CONCLUSION: The list of priority congenital anomalies for notification provides a basis for improving case recording on Sinasc.

PMID:33886939 | DOI:10.1590/S1679-49742021000100030

J Appl Oral Sci. 2021 Apr 19;29:e20200799. doi: 10.1590/1678-7757-2020-0799. eCollection 2021.

ABSTRACT

OBJECTIVES: This study aimed to investigate patterns and risk factors related to the feasibility of achieving technical quality and periapical healing in root canal non-surgical retreatment, using regression and data mining methods.

METHODOLOGY: This retrospective observational study included 321 consecutive patients presenting for root canal retreatment. Patients were treated by graduate students, following standard protocols. Data on medical history, diagnosis, treatment, and follow-up visits variables were collected from physical records and periapical radiographs and transferred to an electronic chart database. Basic statistics were tabulated, and univariate and multivariate analytical methods were used to identify risk factors for technical quality and periapical healing. Decision trees were generated to predict technical quality and periapical healing patterns using the J48 algorithm in the Weka software.

RESULTS: Technical outcome was satisfactory in 65.20%, and we observed periapical healing in 80.50% of the cases. Several factors were related to technical quality, including severity of root curvature and altered root canal morphology (p<0.05). Follow-up periods had a mean of 4.05 years. Periapical lesion area, tooth type, and apical resorption proved to be significantly associated with retreatment failure (p<0.05). Data mining analysis suggested that apical root resorption might prevent satisfactory technical outcomes even in teeth with straight root canals. Also, large periapical lesions and poor root filling quality in primary endodontic treatment might be related to healing failure.

CONCLUSION: Frequent patterns and factors affecting technical outcomes of endodontic retreatment included root canal morphological features and its alterations resulting from primary endodontic treatment. Healing outcomes were mainly associated with the extent of apical periodontitis pathological damages in dental and periapical tissues. To determine treatment predictability, we suggest patterns including clinical and radiographic features of apical periodontitis and technical quality of primary endodontic treatment.

PMID:33886941 | DOI:10.1590/1678-7757-2020-0799

J Appl Oral Sci. 2021 Apr 14;29:e20200978. doi: 10.1590/1678-7757-2020-0978. eCollection 2021.

ABSTRACT

Mucopolysaccharidosis (MPS) is a group of rare and inherited metabolic disorders caused by the accumulation of macromolecule glycosaminoglycans inside lysosomes. Affected individuals may have dental and craniofacial tissue alterations, facilitating the development of several oral diseases.

OBJECTIVES: To assess, with panoramic radiographic images, the frequency of dental and maxillomandibular incidental findings among MPS individuals and compare them with non-MPS individuals.

METHODOLOGY: A cross-sectional study evaluating a sample of 14 MPS individuals and 28 non-MPS individuals aged from 5 to 26 years was carried out. They were matched for sex and age on a 2:1 proportion. Panoramic radiographs were assessed for the presence/absence of the following dental and maxillomandibular alterations: dental anomalies of number (hypodontia/dental agenesis, supernumerary teeth); anomalies of form (microdontia, macrodontia, conoid teeth, taurodontism, and root dilaceration); anomalies of position (impacted tooth, inverted tooth, tooth migration, partially bony teeth, complete bony teeth); periapical alterations (furcation lesion, circumscribed bone rarefaction); other alterations (radiolucent bone lesions, radiopaque bone lesions, radiopacity in the maxillary sinus, condylar hypoplasia). Differences between groups were tested by the Fisher’s exact test and chi-square test (p<0.05).

RESULTS: For intrarater agreement, Kappa values were 0.76 to 0.85. The presence of supernumerary teeth (p=0.003); conoid teeth (p=0.009); taurodontism (p<0.001); impacted teeth (p<0.001); partial bony teeth (p=0.040); complete bony teeth (p=0.013); and root dilaceration (p=0.047) were statistically more frequent in MPS individuals compared to non-MPS individuals. Bone rarefaction/furcation lesions (p=0.032), condylar hypoplasia (p<0.001), radiolucent bone lesions (p=0.001), and dentigerous cysts (p=0.002) were also more frequent in MPS individuals.

CONCLUSION: The presence of specific oral manifestations is more common in MPS individuals than non-MPS individuals.

PMID:33886944 | DOI:10.1590/1678-7757-2020-0978

Rev Gaucha Enferm. 2021 Mar 12;42:e20200088. doi: 10.1590/1983-1447.2021.20200088. eCollection 2021.

ABSTRACT

OBJECTIVE: To identify the attitudes of nurses working in Primary Health Care towards the person with mental disorder and the variables related to health care provided.

METHODOLOGY: Descriptive, correlational study with 250 nurses from 69 Basic Health Units in the city of São Paulo. Data collection took place between April and August 2019 using the “Opinions about Mental Illness” scale. The data were analyzed using the KrusKal-Wallis test, with a 95% confidence level and statistical significance of p <0.05.

RESULTS: The global mean of the scale was 197, which shows negative attitudes especially in the dimensions of Authoritarianism (44.6), Social Restriction (42.0), and positive in the dimension of Benevolence (51.7).

CONCLUSION: Nurses tend to have a stigmatizing attitudinal profile. It is necessary formative and permanent intervention so that it is possible to reduce stigma and improve community-based care recommended in the guidelines of the Psychosocial Care Network.

PMID:33886923 | DOI:10.1590/1983-1447.2021.20200088

Rev Bras Enferm. 2021 Apr 9;74(1):e20200731. doi: 10.1590/0034-7167-2020-0731. eCollection 2021.

ABSTRACT

OBJECTIVES: to identify and map the invasive procedures performed by nursing that can cause Healthcare-Associated Infections in patients in Intensive Care Units.

METHODS: this is a scoping review carried out in the first half of 2018, based on search for studies in national and international databases, in which 2,209 studies were found, of which 35 constituted the final sample. The data were analyzed and organized by simple descriptive statistics.

RESULTS: among the invasive procedures performed by nursing that provide Healthcare-Associated Infections, delayed bladder catheter was indicated in 34 (66.67%) studies, the nasogastric catheter in 10 (19.61%) and the nasoenteral catheter in two (03.92%).

CONCLUSIONS: in the face of such problems, better nursing planning and guidance for care in these invasive techniques becomes relevant and thus minimizes the incidence of infections.

PMID:33886931 | DOI:10.1590/0034-7167-2020-0731