Category: Statistics

Child Abuse Negl. 2021 Apr 17;117:105067. doi: 10.1016/j.chiabu.2021.105067. Online ahead of print.

ABSTRACT

BACKGROUND: Adverse childhood experiences (ACEs) are widespread and are associated with adverse outcomes in later life, yet few studies have explored their prevalence and consequences in New Zealand.

OBJECTIVES: To provide prevalence estimates of ACEs in New Zealand using a large sample of adults, and to explore the associations between ACEs and experience of violence by intimate partners and non-partners in adulthood.

PARTICIPANTS AND SETTING: 2,887 participants (1464 female, 1423 male) from the 2019 New Zealand Family Violence Survey, a population based study conducted in New Zealand between March 2017-March 2019.

METHODS: Descriptive statistics for prevalence of each of the eight ACE types, and cumulative ACE scores were estimated across sociodemographic groups. Multivariate logistic regression models were developed to assess association between ACEs and five IPV and two non-partner violence variables.

RESULTS: ACEs were prevalent and co-occurring, with 55 % (95 % CI 53.2 %-56.8 %) of respondents reporting having experienced at least one ACE and 11.6 % (95 % CI 10.4 %-12.8 %) reporting at least four ACEs before the age of 18. Those who were younger, had lower socioeconomic status, and who identified as Māori reported higher prevalence of ACEs. Exposure to any ACE was significantly associated with later exposure to IPV and non-partner violence.

CONCLUSIONS: The findings provide the first comprehensive assessment of the prevalence of ACEs in the New Zealand population. They suggest that prevention of childhood trauma, maltreatment, and family dysfunction remain important and interconnected public health goals that need to be addressed to support the wellbeing of children and adults.

PMID:33878644 | DOI:10.1016/j.chiabu.2021.105067

Eur J Oncol Nurs. 2021 Apr 17;52:101958. doi: 10.1016/j.ejon.2021.101958. Online ahead of print.

ABSTRACT

PURPOSE: This study investigated experiences and levels of distress and resilience of Danish cancer patients during the second wave of the COVID-19 pandemic.

METHODS: The mixed methods design included a subset of cancer patients who responded to a cross-sectional survey in May 2020. Data were collected through telephone interviews. The National Comprehensive Cancer Network Distress Thermometer (NCCN DT), and Connor-Davidson-Resilience Scale (CD-RISC2) were used to measure distress and resilience. Data were analysed by thematic analysis and descriptive statistics.

RESULTS: Forty patients with lung, breast, colorectal and skin (melanoma) cancer were included; 65% were women. Mean age was 62.2 years (standard deviation [SD], 13.2). Most patients had curable disease (65%); 50% were in treatment and 50% in post-treatment follow up. The interviews revealed four themes: 1) the cost of living with cancer during COVID-19, 2) changes in cancer care delivery, 3) particularly vulnerable, and 4) importance of family support. Mean NCCN DT score was 2.3 (SD, 2.6) while the mean CD-RISC2 score was 7.25 (SD, 1.1).

CONCLUSION: Despite drastic changes in daily life imposed by COVID-19 restrictions, Danish cancer patients had remarkably low levels of distress and high levels of resilience. Patients in active treatment, with comorbidities or elderly felt vulnerable. Family support was invaluable in critical times.

PMID:33878634 | DOI:10.1016/j.ejon.2021.101958

JMIR Ment Health. 2021 Apr 20;8(4):e25097. doi: 10.2196/25097.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has affected the health, economic, and social fabric of many nations worldwide. Identification of individual-level susceptibility factors may help people in identifying and managing their emotional, psychological, and social well-being.

OBJECTIVE: This study is focused on learning a ranked list of factors that could indicate a predisposition to a mental disorder during the COVID-19 pandemic.

METHODS: In this study, we have used a survey of 17,764 adults in the United States from different age groups, genders, and socioeconomic statuses. Through initial statistical analysis and Bayesian network inference, we have identified key factors affecting mental health during the COVID-19 pandemic. Integrating Bayesian networks with classical machine learning approaches led to effective modeling of the level of mental health prevalence.

RESULTS: Overall, females were more stressed than males, and people in the age group 18-29 years were more vulnerable to anxiety than other age groups. Using the Bayesian network model, we found that people with a chronic mental illness were more prone to mental disorders during the COVID-19 pandemic. The new realities of working from home; homeschooling; and lack of communication with family, friends, and neighbors induces mental pressure. Financial assistance from social security helps in reducing mental stress during the COVID-19-generated economic crises. Finally, using supervised machine learning models, we predicted the most mentally vulnerable people with ~80% accuracy.

CONCLUSIONS: Multiple factors such as social isolation, digital communication, and working and schooling from home were identified as factors of mental illness during the COVID-19 pandemic. Regular in-person communication with friends and family, a healthy social life, and social security were key factors, and taking care of people with a history of mental disease appears to be even more important during this time.

PMID:33877051 | DOI:10.2196/25097

J Bone Joint Surg Am. 2021 Mar 11. doi: 10.2106/JBJS.20.01640. Online ahead of print.

ABSTRACT

BACKGROUND: Despite previous reports of improvements for athletes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS), many do not achieve clinically relevant outcomes. The purpose of this study was to develop machine learning algorithms capable of providing patient-specific predictions of which athletes will derive clinically relevant improvement in sports-specific function after undergoing hip arthroscopy for FAIS.

METHODS: A registry was queried for patients who had participated in a formal sports program or athletic activities before undergoing primary hip arthroscopy between January 2012 and February 2018. The primary outcome was achieving the minimal clinically important difference (MCID) in the Hip Outcome Score-Sports Subscale (HOS-SS) at a minimum of 2 years postoperatively. Recursive feature selection was used to identify the combination of variables, from an initial pool of 26 features, that optimized model performance. Six machine learning algorithms (stochastic gradient boosting, random forest, adaptive gradient boosting, neural network, support vector machine, and elastic-net penalized logistic regression [ENPLR]) were trained using 10-fold cross-validation 3 times and applied to an independent testing set of patients. Models were evaluated using discrimination, decision-curve analysis, calibration, and the Brier score.

RESULTS: A total of 1,118 athletes were included, and 76.9% of them achieved the MCID for the HOS-SS. A combination of 6 variables optimized algorithm performance, and specific cutoffs were found to decrease the likelihood of achieving the MCID: preoperative HOS-SS score of ≥58.3, Tönnis grade of 1, alpha angle of ≥67.1°, body mass index (BMI) of >26.6 kg/m2, Tönnis angle of >9.7°, and age of >40 years. The ENPLR model demonstrated the best performance (c-statistic: 0.77, calibration intercept: 0.07, calibration slope: 1.22, and Brier score: 0.14). This model was transformed into an online application as an educational tool to demonstrate machine learning capabilities.

CONCLUSIONS: The ENPLR machine learning algorithm demonstrated the best performance for predicting clinically relevant sports-specific improvement in athletes who underwent hip arthroscopy for FAIS. In our population, older athletes with more degenerative changes, high preoperative HOS-SS scores, abnormal acetabular inclination, and an alpha angle of ≥67.1° achieved the MCID less frequently. Following external validation, the online application of this model may allow enhanced shared decision-making.

PMID:33877058 | DOI:10.2106/JBJS.20.01640

Plast Reconstr Surg. 2021 Apr 20. doi: 10.1097/PRS.0000000000008194. Online ahead of print.

ABSTRACT

BACKGROUND: Implant-based breast reconstruction accounts for the vast majority of breast reconstruction procedures and is commonly performed with human acellular dermal matrix. There is no consensus as to the optimal human acellular dermal matrix preparation, and high-quality evidence concerning comparative effectiveness is lacking. This study is the first prospective, multicenter, randomized controlled clinical trial to compare human acellular dermal matrix-related complications of the two most commonly used human acellular dermal matrices in implant-based breast reconstruction. The authors hypothesize that there will be no difference in infection, seroma, and reconstructive failure between FlexHD Pliable and AlloDerm RTU.

METHODS: The authors conducted a Level 1 prospective, randomized, controlled, multicenter clinical trial to assess complications associated with the use of two human acellular dermal matrices in immediate postmastectomy implant-based breast reconstruction across seven clinical sites. Group A patients received FlexHD Pliable (113 patients with 187 breast reconstructions), and group B patients received AlloDerm RTU (117 patients with 197 breast reconstructions).

RESULTS: There was no significant difference with respect to patient demographics, indications, comorbidities, and reconstruction approach between groups. Mean follow-up time was 10.7 ± 3.2 months. There was no statistical difference in the overall matrix-related complications between groups A and B (4.3 percent versus 7.1 percent, p = 0.233). Obesity (OR, 1.14; 95 percent CI, 1.05 to 1.24; p = 0.001) and prepectoral placement of matrix (OR, 4.53; 95 percent CI, 1.82 to 11.3; p = 0.001) were independently associated with greater risks of overall matrix-related complications.

CONCLUSION: This work supports the use of human acellular dermal matrices in implant-based breast reconstruction and demonstrates no significant difference in matrix-related complication rates between FlexHD Pliable and AlloDerm RTU.

PMID:33877063 | DOI:10.1097/PRS.0000000000008194

Int J Stroke. 2021 Apr 20:17474930211013285. doi: 10.1177/17474930211013285. Online ahead of print.

ABSTRACT

Introduction There is controversy if direct to comprehensive center âmothershipâ (MS) orstopping at primary center for thrombolysis before transfer to comprehensive center âdrip-and-shipâ (DS) are best models of treatment of acute stroke. In this study, we compare MS and DS models to evaluate the best option of functional outcome. Methods Studies between 1990 and 2020 were extracted from online electronic databases. We compared the clinical outcomes, critical time measurements, functional independence and mortality were then compared.Results A total of 7,824 patientsâ data were retrieved from 13 publications (3 randomized control trials and 10 retrospective ones). 4,639 (59.3%) patients were treated under MS model and 3,185 (40.7%) followed the DS model with mean age of 70.01±3.58 vs. 69.03±3.36; p< 0 .001, respectively. The National Institute Health Stroke Scale was 15.57±3.83 for the MS and 15.72±2.99 for the DS model (p=<0.001). The mean symptoms onset-to-puncture time was significantly shorter in the MS group compared to the DS (159.69 min vs. 223.89 min; p=<0.001, respectively). Moreover, the collected data indicated no significant difference between symptomâs onset to intravenous (IV) thrombolysis time and stroke onset-to-successful recanalization time (p=0.205 and p=<0.001, respectively). Patients had significantly worse functional outcome [modified rankin score (mRS)] (3-6) at 90-days in the DS model [Odds Ratio (OR): 1.47, 95% Confidence Interval (CI): 1.13-1.92, p<0.004] and 1.49-folds higher likelihood of symptomatic intracerebral hemorrhage (OR: 1.49, 95%CI: 1.22-1.81, p<0.0001) compared to MS. However, there were no statistically significant difference in terms of mortality (OR: 1.16, 95%CI: 0.87-1.55, p=0.32) and successful recanalization (OR: 1.12, 95%CI: 0.76-1.65, p=0.56) between the two models of care.Conclusion Patients in the MS model have significantly improved functional independence and recovery. Further studies are needed as the data from prospectively randomized studies is not of sufficient quality to make definite recommendations.

PMID:33877018 | DOI:10.1177/17474930211013285

Eur Urol Focus. 2020 Oct 23:S2405-4569(20)30274-1. doi: 10.1016/j.euf.2020.09.015. Online ahead of print.

ABSTRACT

BACKGROUND: Focal therapy (FT) with its favorable side-effect profile represents an option between active surveillance and traditional whole-gland treatment in localized prostate cancer (PCa). Consensus statements recommend eligibility criteria based on magnetic resonance imaging (MRI)-targeted and systematic combination biopsy.

OBJECTIVE: To estimate the future potential of FT by analyzing the number of men eligible for FT among all men with biopsy-proven PCa and to judge the potential of different energy sources.

DESIGN, SETTING, AND PARTICIPANTS: Consensus criteria on FT were analyzed. Patients with biopsy-proven PCa from six tertiary referral hospitals and one outpatient practice in Germany had received a software-based combination biopsy. Men with Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesions based on PI-RADS v2 were included.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Patients were analyzed for potential treatment by FT and hemiablation. MRI lesions were mapped according to prostatic zones.

RESULTS AND LIMITATIONS: In total, 2371 patients were analyzed. According to consensus criteria (biopsy-proven unifocal lesion of International Society of Urological Pathology [ISUP] grade group ≤2, prostate-specific antigen [PSA] ≤15ng/mL, and life expectancy >10yr), 303 patients (12.8%; ISUP 1: n=148 [6.2%]; ISUP 2: n=155 [6.5%]) were potential candidates for FT. A maximum PSA level of <10ng/mL would exclude further 60 (2.5%) of these men. The eligibility for hemiablation is slightly higher (16.2%). Unifocal lesions (n=288) were equally distributed within the prostate (anteriorly [31%], apically [29%], and dorsally [36%]).

CONCLUSIONS: With adherence to consensus statements, only a minority of PCa patients present as potential candidates for FT. Distribution of tumor localization suggests the need for different energy modalities to warrant an optimal FT treatment.

PATIENT SUMMARY: We analyzed how many men who receive a magnetic resonance imaging-targeted and systematic prostate biopsy are candidates for the experimental focal therapy of the prostate. When following expert recommendations, only a small number of men are potential candidates for this alternative treatment.

PMID:33877047 | DOI:10.1016/j.euf.2020.09.015

Tumori. 2021 Apr 20:3008916211009301. doi: 10.1177/03008916211009301. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe smoking behaviours of patients with incident cancer attending an Italian cancer centre and to examine changes in their smoking habits within 12 months from cancer diagnosis, evaluating determinants of smoking cessation.

METHODS: A hospital-based prospective cohort included patients hospitalized in an Italian cancer centre (2016-2018). Patients were mostly female (74%) and included a limited proportion of aerodigestive cancers (7%). Face-to-face interviews were performed during hospital stay to gather information on patient characteristics and smoking history. Changes in smoking habits were assessed through telephone interviews at 3, at 6, and at 12 months after cancer diagnosis.

RESULTS: Among 1011 enrolled patients, 222 (22%) were current smokers at cancer diagnosis. Smoking prevalence was high in male patients (30%), in patients <50 years old (28%), in those with aerodigestive cancers (50%), and in those diagnosed at advanced stages (26%). Among current smokers at cancer diagnosis, 38% quit smoking after 12 months, 26% reduced intensity, and 36% did not modify smoking habits. Smoking cessation was associated with chemotherapy and, although not statistically significant, with female sex, older age, and advanced cancer stage. Patients with gastrointestinal, breast, or genitourinary cancer and those treated with surgery were less likely to quit smoking.

CONCLUSIONS: Our results highlighted that 62% of smoking patients with cancer did not quit the habit. Smoking cessation programs targeted to patients with cancer need intensification, particularly for those who may underestimate smoking effects after diagnosis.

PMID:33876985 | DOI:10.1177/03008916211009301

Ophthalmic Epidemiol. 2021 Apr 20:1-9. doi: 10.1080/09286586.2021.1910317. Online ahead of print.

ABSTRACT

PURPOSE: The optic nerve head (ONH) is a part of the brain that can be easily studied through the transparent medium of the eye. We explored the relationship between the properties of the optic nerve head, the retinal nerve fiber layer (RNFL) and cognitive function.

METHODS: Participants of the Northern Finland Birth Cohort (NFBC) 1966 underwent an ophthalmic and cognitive assessment after randomization at age 46. The ophthalmological parameters obtained were the disc area and the neuroretinal rim volume of the ONH and the average RNFL thickness. The surrogates used for cognitive function were the paired associates learning test (PAL), level of education, grade point average (GPA) and Humphrey 24-2 perimetric test time (HFA). We did exploratory research between the ophthalmological parameters and the surrogates for cognition and the correlations between the surrogates for cognition.

RESULTS: We found that a larger disc area was associated with a higher level of education, faster accomplishment of the HFA (R = -0.065) but a lower GPA (R = -0.084). An increase in neuroretinal rim volume was associated with fewer errors in the PAL test (R = -0.056), higher level of education, higher GPA (R = 0.072) and faster accomplishment of the HFA (R = -0.047). A thicker RNFL was associated with faster accomplishment of the HFA (R = -0.047).

CONCLUSION: We were able to find statistically significant associations between the parameters of the optic nerve head, the RNFL and cognition in the NFBC Eye study. However, the correlations were negligible at best and of limited predictive value.

PMID:33877002 | DOI:10.1080/09286586.2021.1910317

Clin Exp Hypertens. 2021 Apr 20:1-7. doi: 10.1080/10641963.2021.1901107. Online ahead of print.

ABSTRACT

Objective: To investigate the correlation between transient receptor potential channel 1 (TRPC1) gene polymorphism and microalbuminuria in patients with primary hypertension. Methods: A total of 468 patients with primary hypertension were admitted to the Department of Hypertension of the First Affiliated Hospital of Xinjiang Medical University from April 2015 to November 2017. According to microalbuminuria, the patients were divided into two groups: high urinary albumin group (EH+mALB group, n = 71) and normal urinary microalbuminuria group (EH group, n = 397). The Sequenom detection technology was used for genotyping the single nucleotide polymorphism (SNP) sites of the TRPC1 gene, such as rs1382688, rs3821647, rs7638459, rs953239, and rs7621642.Results: (1) No significant differences were detected in gender, smoking history, drinking history, family history, course of hypertension, fasting blood glucose, urea, creatinine, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, glycosylated hemoglobin, vitamin D, homocysteine, and cystatin C between the two groups (P > .05). However, age, body mass index (BMI), 24-h mean systolic and diastolic blood pressure, and 24-h average pulse pressure were statistically significant (P < .05). (2) No significant difference was detected in the distribution frequency of the polymorphisms of the TRPC1 gene between the two groups (P > .05), while the genotype, allele, and recessive model of rs7638459 differed significantly difference (P < .05). (3) Logistic regression analysis showed that BMI and rs7638459 CC genotype were the risk factors of increased microalbuminuria in patients with primary hypertension. Conclusion: TRPC1 gene polymorphism is associated with increased microalbuminuria in patients with primary hypertension. The CC genotype of rs7638459 may increase the risk of microalbuminuria in patients with essential hypertension, while BMI and rs7638459 CC genotype may be the risk factors of increased microalbuminuria in patients with primary hypertension.

PMID:33877007 | DOI:10.1080/10641963.2021.1901107