Category: Statistics

Gait Posture. 2021 Nov 6;91:290-296. doi: 10.1016/j.gaitpost.2021.10.030. Online ahead of print.

ABSTRACT

BACKGROUND: Stair climbing is a complex and demanding daily activity with increased physical loads. Therefore, analyzing stair climbing abilities is a frequently used diagnostic tool. Leg length inequalities (LLIs) are a common condition in the population, with individual consequences like lower back pain, scoliosis, and osteoarthritis. Despite its high prevalence, the necessary treatment, for mild LLIs, is still controversial. Previously, the focus was to analyze the effects of LLIs during static standing and walking. To create a holistic view on the dynamic effects of LLIs, and since climbing stairs produces a similar biomechanical imbalance as LLIs, the compensation mechanics during stair climbing are of special interest.

RESEARCH QUESTION: What are the biomechanical compensation mechanisms of (simulated) LLIs during ascending and descending stairs?

METHODS: Thirty-five healthy participants were measured with the inertial measurement system MyoMotion during stair climbing with simulated LLIs of 0-3 cm. The maximum estimated lower limb joint angles of the long and short leg were analyzed with statistically repeated measurement models.

RESULTS: The long leg showed significantly increased hip and knee flexion, while the short leg showed decreased hip and knee flexion, decreased dorsiflexion, and significantly increased plantarflexion. Different mechanisms were found in the case of 1 cm LLI when compared to greater LLIs. In the former, increased hip and knee flexion in the short leg accompanied by increased dorsiflexion in the long leg was observed. In the latter, the dorsiflexion of the long leg was reduced.

SIGNIFICANCE: Except for the reduced dorsiflexion of the long leg (LLI >1 cm), during stair climbing compared compensation mechanisms as during walking were presented, with the long leg functionally shortened and the short leg lengthened. Although the feet were already on different levels, during stair climbing with the step-over-step technique, significant compensation mechanisms were found as a consequence of LLIs.

PMID:34798420 | DOI:10.1016/j.gaitpost.2021.10.030

J Stroke Cerebrovasc Dis. 2021 Oct 14;31(1):106177. doi: 10.1016/j.jstrokecerebrovasdis.2021.106177. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: During the coronavirus disease 2019 (COVID-19) pandemic, we instituted virtual inpatient stroke rounds and acute stroke evaluations via telemedicine in the emergency department. We sought to explore trainees’ and experienced providers’ views on stroke care and education.

METHODS: The implementation and the survey took place at a single academic comprehensive stroke center in northeast Ohio in the United States. “Virtual rounding” consisted of patient presentation and discussion in the morning in on-line virtual team format followed by in-person patient rounds in small groups. Acute stroke evaluations in the emergency department included direct in-person evaluation by neurology residents with supervision over telemedicine.The neurology residents, stroke fellows, stroke nurse practitioners, and stroke staff physicians were surveyed 2 months after implementation. Quantitative data was analyzed using descriptive statistical analysis, written responses in comment sections were analyzed using content analysis.

RESULTS: Thirty-two of 42 (73%) surveys were completed. Nine (45%) residents and 5 (42%) experienced providers responded that virtual rounds did not compromise learning and education on stroke service. Fifteen (75%) residents and all experienced providers agreed that virtual rounds protected caregivers from exposure to the virus. While more than a third of residents (37%) did not feel comfortable utilizing telemedicine in ED, the majority of experienced providers (89%) were at ease with it. A total of 58% of residents and 67% of experienced providers felt that they were spending less time at the bedside, and 42% of residents and 58% of experienced providers felt less connected to patients during the pandemic.

CONCLUSION: Majority of neurology residents’ experience was not positive utilising telemedicine as compared to other staff providers. This is likely attributed to lack of prior exposure and unpreparedness. Incorporation of telemedicine curricula in medical school and residency training could prepare the next generation physicians to effectively use these technologies and meet the growing need for telehealth services for current and future pandemics.

PMID:34798435 | DOI:10.1016/j.jstrokecerebrovasdis.2021.106177

Aten Primaria. 2021 Nov 16;54(2):102171. doi: 10.1016/j.aprim.2021.102171. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the incidence of hip fracture in patients with antipsychotic treatment, comparing it with that of individuals who have not been treated with antipsychotics.

DESIGN: Retrospective cohort study of patients treated with antipsychotic drugs (TAP) and patients without known treatment (non-TAP). The observation period was 2006-2014. SITE: All primary care teams in Catalonia of the Catalan Health Institute (ICS).

PARTICIPANTS: Patients older than 44 years with TAP lasting at least 3 months. Control cohort: random selection of non-TAP patients matching for baseline comorbidities and other variables. A total of 22,010 are analyzed. Main measurements Incidence rate (1000× person-years: PY) of hip fracture in each group (TAP and non-TAP). Cox regression models to estimate adjusted risks (hazard ratio: HR).

RESULTS: The hip fracture incidence rate was higher in TAP patients (5.83 vs 3.58 fractures per 1000 PY), and is higher in all strata according to sex, age and type of diagnosis. The risk of suffering a hip fracture was 60% higher (HR: 1.60 95% CI: 1.34-1.92) in the TAP group than in the non-TAP group. The risk was higher in the group with schizophrenia (HR: 3.57 95% CI: 1.75-7.30), followed by bipolar disorder (HR: 2.61; 95% CI: 1.39-4.92) and depression (HR: 1.51; 95% CI: 1.21-1.88).

CONCLUSIONS: Patients with antipsychotic treatment have a higher risk of hip fracture than those who have not been treated with antipsychotics.

PMID:34798403 | DOI:10.1016/j.aprim.2021.102171

Aten Primaria. 2021 Nov 16;54(2):102194. doi: 10.1016/j.aprim.2021.102194. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop a valid and reliable scale to measure the role of the nursing professional in the community (REFCO).

DESIGN: Observational with cross-sectional and instrumental design. SITE: Populated centers and communities of the coast, highlands and jungle from Peru.

PARTICIPANTS: The validation phase of the questionnaire had the voluntary participation of 402 Peruvian adults (50.7% from the coast, 40.5% from the highlands and 8.8% from the jungle).

INTERVENTIONS: The elaborated questionnaire that measures perceptions about the role of the nursing professional in the community was applied.

MAIN MEASUREMENTS: The psychometric properties of the REFCO scale were analyzed, such as content validation and internal consistency through the calculation of Aiken’s V, exploratory factor analysis (EFA) and later confirmatory factor analysis (CFA), respectively. Finally, the reliability of the scale was calculated.

RESULTS: Overall, all values were statistically significant when evaluated with the V-Aiken coefficient. Likewise, the skewness and kurtosis values of all the items of the instrument did not exceed the range >±1.5. The correlations between factors 1 and 2 were significant (p < .05). The reliability of the scale presents a Cronbach’s α coefficient = 0.865.

CONCLUSIONS: The REFCO scale has 9 items and 2 dimensions; outreach and education; with content and construct validity that provide evidence for community nursing categories, which is useful for measuring nursing work in the community field.

PMID:34798404 | DOI:10.1016/j.aprim.2021.102194

Asian J Psychiatr. 2021 Nov 6;67:102918. doi: 10.1016/j.ajp.2021.102918. Online ahead of print.

ABSTRACT

Although many screening tools for delirium are available, delirium is still occasionally overlooked or misdiagnosed. One of the reasons for this is the lack of brief screening tools that do not require specialized training to use. The 4 ‘A’s test (the 4AT) is a validated screening tool for delirium that can be administered in a very short time without specialized training. Herein, we evaluated the reliability and validity of the Japanese version of the 4AT (the 4AT-J). A total of 150 patients aged ≥ 65 years were enrolled. Their demographics and clinical characteristics were obtained within 24 hr of their hospitalization. On each patient’s high-risk day of developing delirium, the 4AT-J was administered by a nurse, and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-Ⅴ) and the Japanese version of Delirium Rating Scale-Revised-98 (DRS-98-J) were administered by a psychiatrist. Our analyses revealed that when a cut-off score of 4, the 4AT-J showed high sensitivity and specificity. The Cronbach’s α-coefficient was similar to that of the original version. A receiver operating curve analysis showed sufficient power of the 4AT-J to discriminate delirium. The 4AT-J showed adequate reliability and validity for delirium screening in elderly patients.

PMID:34798384 | DOI:10.1016/j.ajp.2021.102918

J Crit Care. 2021 Nov 16;67:149-156. doi: 10.1016/j.jcrc.2021.11.005. Online ahead of print.

ABSTRACT

BACKGROUND: New-onset atrial fibrillation (NOAF) is common in patients on an intensive care unit (ICU). Evidence guiding treatments is limited, though recent reports suggest beta blocker (BB) therapy is associated with reduced mortality.

METHODS: We conducted a multicentre cohort study of adult patients admitted to 3 ICUs in the UK and 5 ICUs in the USA. We analysed the haemodynamic changes associated with NOAF. We analysed rate control, rhythm control, and hospital mortality associated with common NOAF treatments. We balanced admission and post-NOAF, pre-treatment covariates across treatment groups.

RESULTS: NOAF was followed by a systolic blood pressure reduction of 5 mmHg (p < 0.001). After adjustment, digoxin therapy was associated with inferior rate control versus amiodarone (adjusted hazard ratio (aHR) 0.56, [95% CI 0.34-0.92]). Calcium channel blocker (CCB) therapy was associated with inferior rhythm control versus amiodarone (aHR 0.59 (0.37-0.92). No difference was detected between BBs and amiodarone in rate control (aHR 1.15 [0.91-1.46]), rhythm control (aHR 0.85, [0.69-1.05]), or hospital mortality (aHR 1.03 [0.53-2.03]).

CONCLUSIONS: NOAF in ICU patients is followed by decreases in blood pressure. BBs and amiodarone are associated with similar cardiovascular control and appear superior to digoxin and CCBs. Accounting for key confounders removes previously reported mortality benefits associated with BB treatment.

PMID:34798373 | DOI:10.1016/j.jcrc.2021.11.005

J Crit Care. 2021 Nov 16;67:157-165. doi: 10.1016/j.jcrc.2021.10.022. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to provide an extended analysis of the physiological handling of of the sodium burden induced by maintenance fluids.

MATERIALS AND METHODS: We revisited two studies that demonstrated, in healthy volunteers and in surgical patients, that maintenance fluids with 154 mmol/L of sodium lead to a more positive fluid balance than a regimen containing 54 mmol/L. We report different unpublished data on the renal handling of the imposed sodium burdens with specific attention to the resulting fluid and sodium balances.

RESULTS: The kidneys adapt to the sodium-rich fluids not only by altering sodium excretion, but also by retaining extra free water by concentrating urine. Realigning urinary sodium excretion with an increased administration takes around one day in health and much longer in the clinical setting. This difference may be explained by the presence of hypovolemia-induced aldosterone secretion in the latter group. Non-osmotic storage of sodium limits an unrestrained fluid retention even when very high amounts of sodium are administered but fluid accumulation will inevitably be further prolonged.

CONCLUSIONS: Sodium administration induced by sodium-rich maintenance fluids leads, especially in the clinical setting, to prolonged fluid retention when compared with a regimen that resembles a healthy dietary sodium intake, even when kidney function is normal.

PMID:34798374 | DOI:10.1016/j.jcrc.2021.10.022

Oral Dis. 2021 Nov 19. doi: 10.1111/odi.14081. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate psychological (anxiety, depression, and stress) and salivary (flow and concentration of α-amylase) profile associated with oral lichen planus.

MATERIALS AND METHODS: A case-control preliminary study with oral lichen planus patients and age-gender matched controls was conducted. The participants underwent psychological tests (Beck depression and anxiety inventories and perceived stress scale) and saliva collection to determine the unstimulated salivary flow and α-amylase levels at three moments along the day. The data were analyzed statistically using Mann-Whitney, McNemar χ2 and Friedman tests, and the Spearman correlation coefficient. The significance level adopted was 5%.

RESULTS: A total of 46 case-control pairs were recruited. There was a significant correlation between anxiety, depression, stress, and oral lichen planus, as well as the stress and decline of salivary α-amylase levels. Higher concentrations of this biomarker were found in the case group thirty minutes post-awakening.

CONCLUSION: The applied psychological tests indicated that factors such as anxiety, depression and stress were associated to oral lichen planus. Salivary analyses demonstrated a higher concentration of α-amylase thirty minutes post-awakening on individuals with the disease and its decline correlated with stress, suggesting the role of α-amylase as a promising biomarker for future studies.

PMID:34797946 | DOI:10.1111/odi.14081

Ecology. 2021 Nov 19:e03588. doi: 10.1002/ecy.3588. Online ahead of print.

ABSTRACT

Growth in individual size or biomass is a key demographic component in population models, with wide-ranging applications from quantifying species performance across abiotic or biotic conditions to assessing landscape-level dynamics under global change. In forest ecology, the responses of tree growth to biotic interactions are widely held to be crucial for understanding forest diversity, function, and structure. To date, most studies on plant-plant interactions only examine the additive competitive or facilitative interactions between species pairs; however, there is increasing evidence of non-additive, higher-order interactions (HOIs) impacting species demographic rates. When HOIs are present, the dynamics of a multi-species community cannot be fully understood or accurately predicted solely from pairwise outcomes because of how additional species `interfere’ with the direct, pairwise interactions. Such HOIs should be particularly prevalent where species show nonlinear functional responses to resource availability and resource-acquisition traits themselves are density dependent. With this in mind, we used data from a tropical secondary forest-a system that fulfills both of these conditions-to build a ontogenetic diameter-growth model for individuals across ten woody-plant species. We allowed both direct and indirect interactions within communities to influence the species-specific growth parameters in a generalized Lotka-Volterra model. Specifically, indirect interactions entered the model as higher-order quadratic terms, i.e. non-additive effects of conspecific and heterospecific neighbour size on the focal individual’s growth. For the whole community and for four out of ten focal species, the model that included HOIs had more statistical support than the model that included only direct interactions, despite the former containing a far greater number of parameters. HOIs had comparable effect sizes to direct interactions, and tended to further reduce the diameter growth rates of most species beyond what direct interactions had already reduced. In a simulation of successional stand dynamics, the inclusion of HOIs lead to rank swaps in species’ diameter hierarchies, even when community-level size distributions remained qualitatively similar. Our study highlights the implications, and discusses possible mechanisms, of non-additive density dependence in highly diverse and light-competitive tropical forests.

PMID:34797924 | DOI:10.1002/ecy.3588

BJOG. 2021 Nov 19. doi: 10.1111/1471-0528.17021. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the performance of estimated fetal weight (EFW) charts at the third-trimester ultrasound for detecting small and large for gestational age (SGA/LGA) newborns with adverse outcomes DESIGN: Nationally representative observational study.

SETTING: French maternity units in 2016.

POPULATION: 9940 singleton live births with an ultrasound between 30 and 35 weeks of gestation.

METHODS: We compared three prescriptive charts (INTERGROWTH-21^st , World Health Organization (WHO), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)), four descriptive charts (Hadlock, Fetal Medicine Foundation, two French charts) and a French customised growth model (Epopé).

MAIN OUTCOMES MEASURES: SGA and LGA (birthweights <10^th and >90^th percentiles) associated with adverse outcomes (low Apgar score, delivery-room resuscitation, neonatal unit admission).

RESULTS: 2.1% and 1.1% of infants had SGA and LGA and adverse outcomes, respectively. The sensitivity and specificity for detecting these infants with an EFW <10^th and >90^th percentile varied from 29%-65% and 84%-96% for descriptive charts versus 27%-60% and 83%-96% for prescriptive charts. WHO and French charts were closest to the EFW distribution, yielding a balance between sensitivity and specificity for SGA and LGA births. INTERGROWTH-21^st and Epopé had low sensitivity for SGA with high sensitivity for LGA. Areas under the receiving operator characteristics curve ranged from 0.62 to 0.74, showing low to moderate predictive ability, whereas diagnostic odds ratios varied from 7 to 16.

CONCLUSION: Marked differences in the performance of descriptive as well as prescriptive EFW charts highlight the importance of evaluating them for their ability to detect high-risk fetuses.

PMID:34797926 | DOI:10.1111/1471-0528.17021