Category: Statistics

PLoS One. 2022 Feb 23;17(2):e0264332. doi: 10.1371/journal.pone.0264332. eCollection 2022.

ABSTRACT

BACKGROUND: Polypharmacy, defined as the concurrent use of ≥5 medications, increases the risk of drug-drug and drug-disease interactions as well as non-adherence to drug therapy. This may have negative health consequences particularly among older adults due to age-related pharmacokinetic and pharmacodynamic changes. This study aims to uncover the occurrence of polypharmacy among older adults in Denmark and investigate how polypharmacy relates to mortality.

METHOD: This nationwide register-based study included 1,338,058 adults aged 65+ years between January 2013 and December 2017 in Denmark. Polypharmacy prevalence was measured at time of inclusion while incidence and the association between polypharmacy and mortality were measured over the five-year follow-up using Cox regression. In an attempt to adjust for confounding by indication, propensity scores with overlap weighting were introduced to the regression model.

RESULTS: At time of inclusion, polypharmacy prevalence was 29% and over the five years follow-up, 47% of the remaining adults transitioned into polypharmacy. Identified risk factors included multimorbidity (2+ morbidities: HR = 3.51; 95% CI = 3.48-3.53), age (95+ years: HR = 2.85; 95% CI = 2.74-2.96), socioeconomic factors (Highest income quartile: HR = 0.81; 95% CI = 0.80-0.81), region of birth region (Non-western migrants: HR = 0.77; 95% CI = 0.75-0.79), marital status (Divorced: HR = 1.10; 95% CI = 1.10-1.12) and year of inclusion (2017: HR = 1.19; 95% CI = 1.19-1.22). Further analyses showed that polypharmacy involves many different drug cocktails with medication for the cardiovascular system (95%), blood and blood-forming organs (69%), alimentary tract and metabolism (61%) and nervous system (54%) contributing the most. After adjustment for propensity scores with OW, both polypharmacy (HR = 3.48, CI95% = 3.41-3.54) and excessive polypharmacy (HR = 3.48, CI95% = 3.43-3.53) increased the risk of death substantially.

CONCLUSION: A considerable proportion of older adults in Denmark were exposed to polypharmacy dependent on health status, socio-economic status, and societal factors. The associated three- to four-fold mortality risk indicate a need for further exploration of the appropriateness of polypharmacy among older adults.

PMID:35196345 | DOI:10.1371/journal.pone.0264332

PLoS One. 2022 Feb 23;17(2):e0264114. doi: 10.1371/journal.pone.0264114. eCollection 2022.

ABSTRACT

BACKGROUND: Balance impairment in Parkinson’s disease is multifactorial and its changes due to subthalamic stimulation vary in different studies.

OBJECTIVE: We aimed to analyze the combination of predictive clinical factors of balance impairment in patients with Parkinson’s disease treated with bilateral subthalamic stimulation for at least one year.

METHODS: We recruited 24 patients with Parkinson’s disease treated with bilateral subthalamic stimulation and 24 healthy controls. They wore an Opal monitor (APDM Inc.) consisting of three-dimensional gyroscopes and accelerometers in the lumbar region. We investigated four stimulation conditions (bilateral stimulation OFF, bilateral stimulation ON, and unilateral right- and left-sided stimulation ON) with four tests: stance on a plain ground with eyes open and closed, stance on a foam platform with eyes open and closed. Age, disease duration, the time elapsed after implantation, levodopa, and stimulation responsiveness were analyzed. The distance of stimulation location from the subthalamic motor center was calculated individually in each plane of the three dimensions. We analyzed the sway values in the four stimulation conditions in the patient group and compared them with the control values. We explored factor combinations (with age as confounder) in the patient group predictive for imbalance with cluster analysis and a machine-learning-based multiple regression method.

RESULTS: Sway combined from the four tasks did not differ in the patients and controls on a group level. The combination of the disease duration, the preoperative levodopa responsiveness, and the stimulation responsiveness predicted individual stimulation-induced static imbalance. The more affected patients had more severe motor symptoms; primarily, the proprioceptive followed by visual sensory feedback loss provoked imbalance in them when switching on the stimulation.

CONCLUSIONS: The duration of the disease, the severity of motor symptoms, the levodopa responsiveness, and additional sensory deficits should be carefully considered during preoperative evaluation to predict subthalamic stimulation-induced imbalance in Parkinson’s disease.

PMID:35196348 | DOI:10.1371/journal.pone.0264114

PLoS One. 2022 Feb 23;17(2):e0263935. doi: 10.1371/journal.pone.0263935. eCollection 2022.

ABSTRACT

OBJECTIVE: To examine the effectiveness and safety of non-pharmacological interventions to reduce bone loss among post-stroke adult patients.

DATA SOURCES: Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database for Systematic Reviews, MEDLINE, CINAHL, ScienceDirect, Scopus, PubMed and PeDRO databases were searched from inception up to 31st August 2021.

METHODS: A systematic review of randomized controlled trials, experimental studies without randomization and prospective cohort studies with concurrent control of non-pharmacological interventions for adult stroke patients compared with placebo or other stroke care. The review outcomes were bone loss, fall and fracture. The Cochrane Risk of Bias Tools were used to assess methodological quality, and Grading of Recommendations, Assessment, Development and Evaluations Framework to assess outcome quality. Synthesis Without Meta-Analysis (SWiM) was used for result synthesis.

RESULTS: Seven studies (n = 453) were included. The methodological and outcome qualities varied from low to moderate. There were statistically significant changes between the intervention and parallel/placebo group in bone mineral density, bone mineral content, cortical thickness and bone turnover markers with specific physical and vibration therapies (p<0.05). Falls were higher in the intervention group, but no fracture was reported.

CONCLUSION: There was low to moderate evidence that physical and vibration therapies significantly reduced bone loss in post-stroke patients at the expense of a higher falls rate. The sample size was small, and the interventions were highly heterogeneous with different duration, intensities and frequencies. Despite osteoporosis occurring with ageing and accelerated by stroke, there were no studies on vitamin D or protein supplementation to curb the ongoing loss. Effective, high-quality non-pharmacological intervention to improve post-stroke bone health is required.

PMID:35196338 | DOI:10.1371/journal.pone.0263935

PLoS One. 2022 Feb 23;17(2):e0264209. doi: 10.1371/journal.pone.0264209. eCollection 2022.

ABSTRACT

Lead is one of ten hazardous chemicals of public health concern and is used in more than 900 occupations, including the battery, smelting, and mining industries. Lead toxicity accounts for 1.5% (900,000) of deaths annually in the world. In Indonesia, reports of high Blood Lead Level (BLL) were associated with residency in Used Lead Acid Battery (ULAB) recycling sites. The present study aims to investigate the BLL and the evidence of lead toxicity of children living in an ULAB recycling site in Bogor Regency, Indonesia. A cross-sectional study involving 128 children aged 1-5 years was conducted in September-October 2019. The socio-economic factors, BLL, nutritional status, and hematological parameters, were evaluated. Data were analyzed by univariate and bivariate using the Chi-Square test. Socio-economic factors revealed only 2.3% children have pica and 10.9% children have hand-to-mouth habits. Majority of parents had low income, education, and have stayed in the village for years. Analysis on BLL revealed that 69.5% children had BLL of >10 μg/dL, 25% had abnormal BMI, 23.4% had underweight, 53.9% had stunting, 33.6% had anemia, and 22.6% had basophilic stippling. The average BLL and hemoglobin levels of respondents were 17.03 μg/dL and 11.48 g/dL, respectively. Bivariate analysis revealed that children with high BLL had double risk of having underweight and protected from stunting. Analysis on the association between BLL and BMI for age revealed a higher risk to have abnormal BMI. The high BLL also had 1.017 times risk of developing anemia, and almost doubled risk of having basophilic stippling, although they were not statistically significant. In conclusion, the high BLL of children living in the ULAB recycling indicates that lead exposure as well as lead toxicity are still occurring in Cinangka Village, and alerts to the need for a systematic action to mitigate the exposure.

PMID:35196330 | DOI:10.1371/journal.pone.0264209

PLoS One. 2022 Feb 23;17(2):e0264229. doi: 10.1371/journal.pone.0264229. eCollection 2022.

ABSTRACT

One of the most important applications of statistical analysis is in health research and applications. Cancer studies are mostly required special statistical considerations in order to find the appropriate model for fitting the survival data. Existing classical distributions rarely fit such data well and an increasing interest has been shown recently in developing more flexible distributions by introducing some additional parameters to the basic model. In this paper, a new five-parameters distribution referred as alpha power Kumaraswamy Weibull distribution is introduced and studied. Particularly, this distribution extends the Weibull distribution based on a novel technique that combines two well known generalisation methods, namely, alpha power and T-X transformations. Different characteristics of the proposed distribution, including moments, quantiles, Rényi entropy and order statistics are obtained. The method of maximum likelihood is applied in order to estimate the model parameters based on complete and censored data. The performance of these estimators are examined via conducting some simulation studies. The potential importance and applicability of the proposed distribution is illustrated empirically by means of six datasets that describe the survival of some cancer patients. The results of the analysis indicated to the promising performance of the alpha power Kumaraswamy Weibull distribution in practice comparing to some other competing distributions.

PMID:35196331 | DOI:10.1371/journal.pone.0264229

PLoS One. 2022 Feb 23;17(2):e0262734. doi: 10.1371/journal.pone.0262734. eCollection 2022.

ABSTRACT

BACKGROUND AND OBJECTIVE: Tuberculosis (Tuberculosis, TB) is a public health problem in China, which not only endangers the population’s health but also affects economic and social development. It requires an accurate prediction analysis to help to make policymakers with early warning and provide effective precautionary measures. In this study, ARIMA, GM(1,1), and LSTM models were constructed and compared, respectively. The results showed that the LSTM was the optimal model, which can be achieved satisfactory performance for TB cases predictions in mainland China.

METHODS: The data of tuberculosis cases in mainland China were extracted from the National Health Commission of the People’s Republic of China website. According to the TB data characteristics and the sample requirements, we created the ARIMA, GM(1,1), and LSTM models, which can make predictions for the prevalence trend of TB. The mean absolute error (MAE), root mean square error (RMSE), and mean absolute percentage error (MAPE) were applied to evaluate the effects of model fitting predicting accuracy.

RESULTS: There were 3,021,995 tuberculosis cases in mainland China from January 2018 to December 2020. And the overall TB cases in mainland China take on a downtrend trend. We established ARIMA, GM(1,1), and LSTM models, respectively. The optimal ARIMA model is the ARIMA (0,1,0) × (0,1,0)12. The equation for GM(1,1) model was X(k+1) = -10057053.55e(-0.01k) + 10153178.55 the Mean square deviation ratio C value was 0.49, and the Small probability of error P was 0.94. LSTM model consists of an input layer, a hidden layer and an output layer, the parameters of epochs, learning rating are 60, 0.01, respectively. The MAE, RMSE, and MAPE values of LSTM model were smaller than that of GM(1,1) and ARIMA models.

CONCLUSIONS: Our findings showed that the LSTM model was the optimal model, which has a higher accuracy performance than that of ARIMA and GM (1,1) models. Its prediction results can act as a predictive tool for TB prevention measures in mainland China.

PMID:35196309 | DOI:10.1371/journal.pone.0262734

J Am Acad Orthop Surg. 2022 Feb 22. doi: 10.5435/JAAOS-D-21-00657. Online ahead of print.

ABSTRACT

INTRODUCTION: Although intramedullary implants are commonly used to treat stable intertrochanteric (IT) fractures, there is a lack of evidence to demonstrate their superiority over extramedullary implants in treating these fractures. The purpose of this study was to compare short-term outcomes (<30 days) between intramedullary and extramedullary implants in patients with closed nondisplaced stable IT fractures.

METHODS: Patients with closed nondisplaced stable IT fractures were identified from the American College of Surgeons National Surgical Quality Improvement Program database between 2016 and 2019. Patients who either underwent extramedullary implant or intramedullary implant fixation were selected for this analysis. Postoperative outcomes included transfusion, surgical complications (stroke, myocardial infarction, venous thromboembolism, pneumonia, renal failure/insufficiency, surgical site infection, urinary tract infections, and sepsis), weight-bearing on postoperative day 1, discharge destination, place of residence at 30 days after the operation, days from operation to discharge, readmission related to the index procedure, any readmission, revision surgery, and mortality.

RESULTS: Of the 3,244 cases identified for the study, 2,521 (77.7%) underwent intramedullary nailing (IMN). Based on adjusted multivariable analysis, surgical complications between the two intervention groups were not statistically significantly (odds ratio [OR] 1.142; confidence interval [CI], 0.838 to 1.558; P = 0.4). However, patients who underwent IMN were associated with higher rates of blood transfusions (OR, 1.35, CI, 1.042 to 1.748, P = 0.023), more likely discharged to a place other than home (OR, 1.372, CI, 1.106 to 1.700, P = 0.004), and more likely to get readmitted (OR, 1.783, CI, 1.157 to 2.75, P = 0.009). Patients treated with IMN were associated with lower postoperative length of stay (OR 0.982, CI 0.967 to 0.998, P = 0.030).

DISCUSSION: Our study found that extramedullary implants were associated with lower transfusions rates, lower readmissions, and better patient disposition. We recommend surgeons to consider extramedullary implants when treating stable IT fractures, especially if the patient is anemic or at high risk for hospital readmission.

LEVEL OF EVIDENCE: Level III. Retrospective cohort study.

PMID:35196299 | DOI:10.5435/JAAOS-D-21-00657

J Vis Exp. 2022 Feb 23;(180). doi: 10.3791/6493.

ABSTRACT

An erratum was issued for: Drosophila Passive Avoidance Behavior as a New Paradigm to Study Associative Aversive Learning. The Representative Results and Discussion sections were updated. In the Representative Results, the legend for Figure 5 was updated from: Figure 5: Comparison of passive avoidance and grooming behavior in D. simulans males and females. (A) Average latency (s) per trial. The graph shows no statistically significant differences between males and females in the latencies. (B) An average number of received shocks per trial. The graph shows no statistically significant differences between males and females in the number of received shocks. (C) The total duration of grooming bouts in trials 1-3. While there were no statistically significant differences between males and females, the female flies showed a considerable increase in grooming behavior during trials 2 and 3 compared to trial 1. Abbreviations: *- P<0.05. One-way ANOVA with Tukey’s multiple comparisons test. to: Figure 5: Comparison of passive avoidance and grooming behavior in D. simulans males and females. (A) Average latency (s) per trial. The graph shows no statistically significant differences between males and females in the latencies. (B) An average number of received shocks per trial. The graph shows no statistically significant differences between males and females in the number of received shocks. (C) The total duration of grooming bouts in trials 1-3. While there were no statistically significant differences between males and females, the female flies showed a considerable decrease in grooming behavior during trials 2 and 3 compared to trial 1. Abbreviations: *- P<0.05. One-way ANOVA with Tukey’s multiple comparisons test. In the Discussion, the third paragraph was updated from: The assay worked equally well in D. melanogaster and D. simulans male and female flies, demonstrating that the paradigm could be adapted to different D. species. The changes in fly behavior characterized by increased latencies and decreased number of shocks were statistically significant in the second trial and would strengthen with subsequent trials. Interestingly, if naïve flies were habituated to the apparatus without electric shock, they would enter the upper compartment a little faster on the second and the third trials. However, the decrease in latencies was not statistically significant (data not shown). No statistically significant differences were observed between sexes, although female flies had somewhat longer latencies and received slightly more shocks. This difference could be due to a combination of factors, including females’ failure to associate the shock with the upper compartment, a stronger geotaxis, or possibly because females are slightly larger and slower than males. The total duration of grooming bouts was significantly higher in the second and third trials in female flies, which draws a parallel between D. and rodent anxiety-like behaviors²⁶. to: The assay worked equally well in D. melanogaster and D. simulans male and female flies, demonstrating that the paradigm could be adapted to different D. species. The changes in fly behavior characterized by increased latencies and decreased number of shocks were statistically significant in the second trial and would strengthen with subsequent trials. Interestingly, if naïve flies were habituated to the apparatus without electric shock, they would enter the upper compartment a little faster on the second and the third trials. However, the decrease in latencies was not statistically significant (data not shown). No statistically significant differences were observed between sexes, although female flies had somewhat longer latencies and received slightly more shocks. This difference could be due to a combination of factors, including females’ failure to associate the shock with the upper compartment, a stronger geotaxis, or possibly because females are slightly larger and slower than males. The total duration of grooming bouts was significantly lower in the second and third trials in female flies, which draws a parallel between D. and rodent anxiety-like behaviors²⁶.

PMID:35196308 | DOI:10.3791/6493

Plast Reconstr Surg. 2022 Feb 23. doi: 10.1097/PRS.0000000000008956. Online ahead of print.

ABSTRACT

BACKGROUND: Reproducible research-defined as the ability to replicate a study with its published materials and procedures-is integral to ensuring the validity of published studies and promoting scientific advancement. The primary aim of this study was to quantitatively evaluate the reproducibility and transparency of research in the plastic surgery literature.

METHODS: A cross-sectional study was performed. Articles published in 12 plastic surgery journals over a 5-year period were randomly selected. Reproducibility-related and transparency-related variables were blindly and independently collected by two reviewers using previously published methods. Descriptive statistics and univariate analysis were performed for outcomes of interest.

RESULTS: The initial search yielded 18,461 publications, from which 400 were randomly selected. A total of 397 publications met inclusion criteria, of which 203 were empirical studies eligible for analysis of reproducibility-related and transparency-related variables. Among the empirical studies, most did not have a data availability statement (97.0 percent; 95 percent CI, 93.7 to 98.9). Only seven (3.4 percent; 95 percent CI, 1.4 to 7.0) were linked to an accessible protocol, four (2.0 percent; 95 percent CI, 0.5 to 5.0) were preregistered, and no studies provided analysis scripts or claimed to replicate another study. Of the 202 studies evaluated for material availability, only 17 (8.4 percent; 95 percent CI, 5.0 to 13.1) had a material availability statement.

CONCLUSIONS: There is an evident lack of reproducible research practices in plastic surgery literature. The majority of plastic surgery publications do not provide information and raw materials necessary to reproduce empirical studies. Increasing awareness at the individual and institutional levels can improve research quality and transparency.

PMID:35196293 | DOI:10.1097/PRS.0000000000008956

J Homosex. 2022 Feb 23:1-21. doi: 10.1080/00918369.2022.2043132. Online ahead of print.

ABSTRACT

In light of recent studies on the changing views on masculinity, this quantitative study aimed to determine the attitudes of South African undergraduate students toward the display of the tenets associated with orthodox and inclusive masculinities in contact sport, and to determine to what extent these attitudes were predicted by students’ gender, race, religiosity, and attitudes toward the importance of primary gender-role sport socialization and homosexuality. Findings, which originated from the data collected through the use of 200 structured interviews, indicated that male and female students endorsed displays of a ‘softening’ in masculinities in sport, and were slightly opposed toward displays of ‘harder’ masculinities, a trend that was strongest among women. The more importance these students’ ascribed to primary gender-role sports socialization, the more likely they were to support the display of orthodox masculinities in sport, and the less likely they were to endorse inclusive masculinities, with the converse being true for those who were more accepting of homosexuality. The study contributes to current theorization in a twofold way: Firstly, by problematizing a simplistic differentiation between orthodox and inclusive masculine typologies in favor of ascribing to theorization that indicates how the attitudes among students of the said South African university campus arguably attest to the concurrent existence of ‘multiple dominant masculinities.’ In-keeping with this, the findings arguably echo the Andersonian emphasis on the co-existence of declining levels of homohysteria among younger persons and the continuing prevalence of homophobia among some students on university campuses.

PMID:35196212 | DOI:10.1080/00918369.2022.2043132