Category: Statistics

J Neurosci. 2021 Apr 20:JN-RM-3238-20. doi: 10.1523/JNEUROSCI.3238-20.2021. Online ahead of print.

ABSTRACT

Animal studies suggest that cochlear nerve degeneration precedes sensory cell degeneration in both noise-induced hearing loss (NIHL) and age-related hearing loss (ARHL), producing a hearing impairment that is not reflected in audiometric thresholds. Here, we investigated the histopathology of human ARHL and NIHL by comparing loss of auditory nerve fibers (ANFs), cochlear hair cells and the stria vascularis in a group of 52 cases with noise-exposure history against an age-matched control group. Although strial atrophy increased with age, there was no effect of noise history. Outer hair cell (OHC) loss also increased with age throughout the cochlea but was unaffected by noise history in the low-frequency region (<2 kHz), while greatly exacerbated at high frequencies (≥2 kHz). Inner hair cell (IHC) loss was primarily seen at high frequencies but was unaffected by noise at either low or high frequencies. ANF loss was substantial at all cochlear frequencies and was exacerbated by noise throughout. According to a multivariable regression model, this loss of neural channels contributes to poor word discrimination among those with similar audiometric threshold losses. The histopathological patterns observed also suggest that, whereas the low-frequency OHC loss may be an unavoidable consequence of aging, the high-frequency loss, which produces the classic down-sloping audiogram of ARHL, may be partially because of avoidable ear abuse, even among those without a documented history of acoustic overexposure.Statement of SignificanceAs regenerative therapeutics in sensorineural hearing loss enter clinical trials, it becomes critical to infer which cochlear pathologies are present in addition to hair cell loss. Here, by analyzing human autopsy material, we show that acoustic injury accelerates age-related primary neural degeneration, but not strial degeneration, neither of which can be inferred from audiometric thresholds. It exacerbates outer hair cell (OHC) loss only in the high-frequency half of the cochlea, suggesting that the apical loss is age-related, whereas the basal loss is partially noise induced, and therefore avoidable. Statistical analysis suggests that neural loss helps explain differences in word-recognition ability among individuals with similar audiometric thresholds. The surprising correlation between neural loss and OHC loss in the cochlea’s speech region also implicates neural loss in the well-known decline in word scores as thresholds deteriorate with age.

PMID:33883202 | DOI:10.1523/JNEUROSCI.3238-20.2021

Sci Adv. 2021 Apr 21;7(17):eabg4755. doi: 10.1126/sciadv.abg4755. Print 2021 Apr.

ABSTRACT

Single-cell RNA sequencing (scRNA-seq) of tissues has revealed remarkable heterogeneity of cell types and states but does not provide information on the spatial organization of cells. To better understand how individual cells function within an anatomical space, we developed XYZeq, a workflow that encodes spatial metadata into scRNA-seq libraries. We used XYZeq to profile mouse tumor models to capture spatially barcoded transcriptomes from tens of thousands of cells. Analyses of these data revealed the spatial distribution of distinct cell types and a cell migration-associated transcriptomic program in tumor-associated mesenchymal stem cells (MSCs). Furthermore, we identify localized expression of tumor suppressor genes by MSCs that vary with proximity to the tumor core. We demonstrate that XYZeq can be used to map the transcriptome and spatial localization of individual cells in situ to reveal how cell composition and cell states can be affected by location within complex pathological tissue.

PMID:33883145 | DOI:10.1126/sciadv.abg4755

BMJ Open. 2021 Apr 21;11(4):e043944. doi: 10.1136/bmjopen-2020-043944.

ABSTRACT

OBJECTIVES: The objectives of this study were to estimate the direct and indirect excess costs of type 2 diabetes mellitus (T2D) using data representative for the German adult population and to investigate the association of sociodemographic and clinical determinants with these excess costs.

SETTING: We calculated mean annual costs for individuals with T2D and a control group without diabetes, using data on healthcare utilisation and productivity losses from the cross-sectional German Health Interview and Examination Survey for Adults. We adjusted for group differences using entropy balancing and estimated excess costs for total, direct, indirect costs and additional cost categories using generalised linear models. We performed subgroup analyses to investigate the association of sociodemographic (age, sex and education) and clinical determinants (diabetes duration, glycaemic index and complications) with excess costs.

PARTICIPANTS: The final study sample included n=325 individuals with T2D and n=4490 individuals without diabetes in the age between 18 and 79 years.

RESULTS: Total excess costs amounted to €927, of which €719 were attributable to direct and €209 to indirect excess costs. Total costs were significantly increased by 28% for T2D compared with controls. Group differences in direct, outpatient and medication costs were statistically significant. Medication costs were 88% higher for T2D and had the highest share in direct excess costs. With respect to specific determinants, direct excess costs ranged from €203 for 4-10 years diabetes duration to €1405 for diabetes complications. Indirect excess costs ranged from €-544 for >10 years diabetes duration to €995 for high education.

CONCLUSIONS: T2D was associated with high costs, mainly due to direct costs. As pointed out by our results, diabetes complications and comorbidities have a large impact on the costs, leaving medication costs as main contributor of T2D excess costs.

PMID:33883150 | DOI:10.1136/bmjopen-2020-043944

BMJ Open. 2021 Apr 21;11(4):e045890. doi: 10.1136/bmjopen-2020-045890.

ABSTRACT

Multimorbidity has become highly prevalent around the globe and been associated with adverse health outcomes and cost of care. The built environment has become an important dimension in response to obesity and associated chronic diseases by addressing population sedentariness and low physical activity.

OBJECTIVE: The aim of the following study was to examine whether there was an increased risk for multimorbidity for those living in less walkable neighbourhoods. It was hypothesised that participants residing in less walkable neighbourhoods would have a higher risk for multimorbidity.

SETTING: City of Toronto and 14 neighbouring regions/municipalities within Ontario, Canada.

PARTICIPANTS: Study participants who had completed the Canadian Community Health Survey between the year 2000 and 2012, between 20 and 64 and 65 and 95 years of age, residing within a neighbourhood captured in the Walkability Index, and who were not multimorbid at the time of interview, were selected.

INTERVENTION: The Walkability Index was the key exposure in the study, which is divided into quintiles (1-least, 5-most walkable neighbourhoods). Participants were retrospectively allocated to one of five quintiles based on their area of residency (at the time of interview) and followed for a maximum of 16 years.

PRIMARY OUTCOME MEASURE: Becoming multimorbid with two chronic conditions.

SECONDARY OUTCOME MEASURE: Becoming multimorbid with three chronic conditions.

RESULTS: Risk for multimorbidity (two chronic conditions) was highest in least compared with most walkable neighbourhoods with an HR of 1.14 (95% CI: 1.02 to 1.28, p=0.0230). While results showed an overall gradient response between decreased walkability and increased risk for multimorbidity, they were not statistically significant across all quintiles or in the older-adult cohort (65-95 years of age).

CONCLUSION: Study results seem to suggest that low neighbourhood walkability may be a risk factor for multimorbidity over time. More studies are needed to examine whether neighbourhood walkability is a potential solution for multimorbidity prevention at the population level.

PMID:33883154 | DOI:10.1136/bmjopen-2020-045890

Rocz Panstw Zakl Hig. 2021;72(1):95-101. doi: 10.32394/rpzh.2021.0150.

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a global pandemic with more than 53,973 people affected in West Bengal state of India.

OBJECTIVES: The aim of present study was to assess the Knowledge, Attitudes and Practices (KAP) of dental practitioners in Kolkata city, West Bengal, India regarding COVID-2019 pandemic.

MATERIALS AND METHOD: Online questionnaire was distributed among dentists across West Bengal city, using a combination of convenience and snowball sampling. The questionnaire had 17 questions: (1) Section A was ‘General section’ which comprised of socio-demographic and professional details of the subjects; and (2) Section B comprised of 14 questions depicting knowledge, awareness attitude and practice regarding COVID-19. The data collected was subjected to statistical analysis with level of significance at p=0.05. The descriptive statistical analysis was done to compute frequency and percentages. Intergroup comparison was determined by Chi-square statistical analysis to determine the level of significance for responses of each question.

RESULTS: Around 70.4% undergraduates participated in the study. Only 4.3% showed accurate knowledge with respect to the incubation period of coronavirus. Coughing and sneezing was considered to be the most common mode of transmission. 98.9% of dentists considered fever to be the characteristic symptom of the disease. Hand washing and alcohol rubs was advocated by 99.5% of the dentist. Emergency procedures were considered necessary by 90.8% dentists. 75.1% of dentists agree that their practice has been affected by the pandemic.

CONCLUSION: A constant update regarding COVID-19 should be made available to dental health care professionals through webinars, seminars, discussions and articles. Dentists should keep themselves updated and help to fight against this pandemic.

PMID:33883104 | DOI:10.32394/rpzh.2021.0150

Injury. 2021 Apr 9:S0020-1383(21)00336-3. doi: 10.1016/j.injury.2021.04.027. Online ahead of print.

ABSTRACT

BACKGROUND: Approximately 20,000 major trauma cases occur in England every year. However, the association with concomitant upper limb injuries is unknown. This study aims to determine the incidence, injury pattern and association of hand and wrist injuries with other body injuries and the Injury Severity Score (ISS) in multiply injured trauma patients.

METHODS: Single centre retrospective study was performed at a level-one UK Major Trauma Centre (MTC). Trauma Audit and Research Network (TARN) eligible multiply injured trauma patients that were admitted to the hospital between January 2014 and December 2018 were analysed. TARN is the national trauma registry. Eligible patients were: a trauma patient of any age who was admitted for 72 h or more, or was admitted to intensive care, or died at the hospital, was transferred into the hospital for specialist care, was transferred to another hospital for specialist care or for an intensive care bed and whose isolated injuries met a set of criteria. Data extracted included: age, gender, mode of arrival, location of injuries including: hand and/or wrist and mechanism of injury. We performed a logistic regression analysis to assess the association between hand/wrist injury to ISS score of 15 points or above/below and to the presentation of other injuries.

RESULTS: 107 patients were analysed. Hand and wrist injuries were the second most common injury (26.2%), after thoracic injuries. Distal radial injuries were found in 5.6%, carpal/carpometacarpal in 6.5%, concurrent distal radius and carpometacarpal in 0.9%, phalangeal injuries in 4.7%, tendon injuries in 0.9% and concurrent hand and wrist injuries in 7.5% cases. There was a significant association between hand or wrist injuries and lower limb injuries (Odds Ratio (OR): 3.84; 95% confidence intervals (CI): 1.09 to 13.50; p = 0.04) and pelvic injuries (OR: 4.78; 95% CI: 1.31 to 17.44; p = 0.02). There was no statistical association between hand and wrist injuries and ISS score (OR: 0.80; 95% CI: 0.11 to 5.79; p = 0.82).

CONCLUSIONS: Hand and wrist injuries are prevalent in trauma patients admitted to MTCs. They should not be under-estimated but routinely screened for in multiply injured patients particularly those with a pelvic or lower limb injury.

PMID:33883075 | DOI:10.1016/j.injury.2021.04.027

J Optom. 2021 Apr 18:S1888-4296(20)30120-5. doi: 10.1016/j.optom.2020.08.010. Online ahead of print.

ABSTRACT

BACKGROUND: Interpupillary distance (IPD) is important in developmental anatomy, genetics, design of optical instrumentation, ocular diagnostics, and optical prescribing. IPD frequently is measured on different days, and by either automatic pupillometers (physiological measurement) or manual ruler (anatomical measurement). Therefore, there is importance in the agreement and inter-session repeatability of manual and automatic IPD measurements.

METHODS: Monocular distance from the bridge of the nose and binocular distance and near binocular IPD were randomly measured, using a millimeter ruler and the Essilor Pupillon pupillometer. Gender effects were assessed using Wilcoxon and Mann-Whitney tests, respectively. Agreement was assessed using Spearman correlation and Bland-Altman (B&A) plots. Thirty additional participants were tested within 1-2 weeks to determine the inter-session repeatability.

RESULTS: The agreement study included 199 participants (mean age: 24.1 ± 5.0 range: 19-53, 58 male, 141 female) and the repeatability sub- study included 30 (mean age: 27.9 ± 4.5, range: 23-39, 6 male, 24 female). Males and females significantly differed in age (<2 year mean difference (md)) and IPD (monocular md: < 1 mm, binocular md: < 2 mm). Manual vs. automatic measurements were significantly different for all conditions (md: <1 mm for all) except for distance left eye male PD. There was no significant difference between the session for both methods.

CONCLUSIONS: Binocular and monocular manual and automatic measurements were significantly different statistically, but not clinically. Distance binocular IPD was approximately 3 mm wider than near IPD. Male binocular IPD was approximately 2 mm wider than the female IPD. Both methods had good inter-session repeatability.

PMID:33883087 | DOI:10.1016/j.optom.2020.08.010

J Laryngol Otol. 2021 Apr 22:1-5. doi: 10.1017/S0022215121000293. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to compare the necessary scutum defect for transmeatal visualisation of middle-ear landmarks between an endoscopic and microscopic approach.

METHOD: Human cadaveric heads were used. In group 1, middle-ear landmarks were visualised by endoscope (group 1 endoscopic approach) and subsequently by microscope (group 1 microscopic approach following endoscopy). In group 2, landmarks were visualised solely microscopically (group 2 microscopic approach). The amount of resected bone was evaluated via computed tomography scans.

RESULTS: In the group 1 endoscopic approach, a median of 6.84 mm3 bone was resected. No statistically significant difference (Mann-Whitney U test, p = 0.163, U = 49.000) was found between the group 1 microscopic approach following endoscopy (median 17.84 mm3) and the group 2 microscopic approach (median 20.08 mm3), so these were combined. The difference between the group 1 endoscopic approach and the group 1 microscopic approach following endoscopy plus group 2 microscopic approach (median 18.16 mm3) was statistically significant (Mann-Whitney U test, p < 0.001, U = 18.000).

CONCLUSION: This study showed that endoscopic transmeatal visualisation of middle-ear landmarks preserves more of the bony scutum than a microscopic transmeatal approach.

PMID:33883045 | DOI:10.1017/S0022215121000293

Rocz Panstw Zakl Hig. 2021;72(1):77-82. doi: 10.32394/rpzh.2021.0148.

ABSTRACT

BACKGROUND: Poor oral health among children is common finding in the rural regions of India. But if the existent structure of primary health care is used, favourable oral health habits and importance of oral health can be instilled in the children and their parents at a very early stage.

OBJECTIVE: To evaluate the effectiveness of Anganwadi workers (AWWs) in improving the oral hygiene of the preschool children through oral health education.

MATERIAL AND METHODS: 250 children in the age group of 2.5-6 years, were included in the study. The study was conducted in three phases over a period of 8 months which included a follow up of six months. Baseline oral health was determined using a questionnaire assessing the oral hygiene practices and DMFT Index, Plaque Index and Gingival Index. This was re-assessed after 6 months using the same questionnaire and indices. Statistical significance was fixed at p value Ł 0.05. Chi square and paired ‘t’ test were used to assess the difference in the variables after providing oral health education.

RESULTS: Out of 250 children, with mean age of 4.24 years, majority were girls (142, 56.8%). The use of fluoridated toothpaste among the study population significantly increased from 34.4% to 41.5% (p=0.001) with the intervention of oral health education (OHE). Decrease in consumption of sticky sugar, addition of sugar in the night-feeds and cleaning of teeth after night-feeds were also found to change significantly. Gingival index showed significant reduction after OHE (p=0.001).

CONCLUSION: The study revealed that training of Anganwadi workers (AWWs) could be used to improve the oral health of the Anganwadi children. They represent an untapped source for delivering oral care to rural communities that otherwise have limited access.

PMID:33883064 | DOI:10.32394/rpzh.2021.0148

Surg Today. 2021 Apr 21. doi: 10.1007/s00595-021-02286-6. Online ahead of print.

ABSTRACT

PURPOSE: The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for surgical staffs to minimize exposure to COVID-19 or save medical resources without harmful patient outcomes, in accordance with the statement of each surgical society. No research has empirically validated declines in surgical volume in Japan, based on the usage of surgical triage. We aimed to identify whether the announcement of surgical priorities by each Japanese surgical society may have affected the surgical volume decline during the 1st wave of this pandemic.

METHODS: We extracted 490,719 available cases of patients aged > 15 years who underwent elective major surgeries between July 1, 2018, and June 30, 2020. After the categorization of surgical specialities, we calculated descriptive statistics to compare the year-over-year trend and conducted an interrupted time series analysis to validate the decline of each surgical procedure.

RESULTS: Monthly surgical cases of eight surgical specialities, especially ophthalmology and ear/nose/throat surgeries, decreased from April 2020 and reached a minimum in May 2020. An interrupted time series analysis showed no significant trends in oncological and critical surgeries.

CONCLUSION: Non-critical surgeries showed obvious and statistically significant declines in case volume during the 1st wave of the COVID-19 pandemic according to the statement of each surgical society in Japan.

PMID:33881619 | DOI:10.1007/s00595-021-02286-6