Category: Statistics

Psychol Med. 2021 Sep 13:1-11. doi: 10.1017/S0033291721003433. Online ahead of print.

ABSTRACT

BACKGROUND: The relationship between schizophrenia and violence is complex. The aim of this multicentre case-control study was to examine and compare the characteristics of a group of forensic psychiatric patients with a schizophrenia spectrum disorders and a history of significant interpersonal violence to a group of patients with the same diagnosis but no lifetime history of interpersonal violence.

METHOD: Overall, 398 patients (221 forensic and 177 non-forensic patients) were recruited across five European Countries (Italy, Germany, Poland, Austria and the United Kingdom) and assessed using a multidimensional standardised process.

RESULTS: The most common primary diagnosis in both groups was schizophrenia (76.4%), but forensic patients more often met criteria for a comorbid personality disorder, almost always antisocial personality disorder (49.1 v. 0%). The forensic patients reported lower levels of disability and better social functioning. Forensic patients were more likely to have been exposed to severe violence in childhood. Education was a protective factor against future violence as well as higher levels of disability, lower social functioning and poorer performances in cognitive processing speed tasks, perhaps as proxy markers of the negative syndrome of schizophrenia. Forensic patients were typically already known to services and in treatment at the time of their index offence, but often poorly compliant.

CONCLUSIONS: This study highlights the need for general services to stratify patients under their care for established violence risk factors, to monitor patients for poor compliance and to intervene promptly in order to prevent severe violent incidents in the most clinically vulnerable.

PMID:34511148 | DOI:10.1017/S0033291721003433

Adv Clin Exp Med. 2021 Sep 9. doi: 10.17219/acem/140196. Online ahead of print.

ABSTRACT

BACKGROUND: The non-stress test (NST) is a simple non-invasive procedure commonly used in obstetrics clinics to assess fetal health. It is important that mothers feel comfortable during the NST and that the test results are obtained quickly.

OBJECTIVES: To determine the effects of maternal position on NST results and participants’ satisfaction during the procedure.

MATERIAL AND METHODS: This was a randomized controlled experimental study conducted at the Department of Obstetrics and Gynecology Polyclinic of Erciyes University Hospital (Kayseri, Turkey) between October 2017 and March 2018. During the NST, either the supine, semi-Fowler or left lateral position was utilized. Questionnaire forms and NST tracings were collected from 275 participating mothers and analyzed. The χ2 test was used to determine whether the distribution of categorical variables differed between groups. The Kruskal-Wallis test was used to determine whether median scores differed between groups. A p-value <0.05 was considered statistically significant.

RESULTS: Most participants in the left lateral (78.9%) and semi-Fowler positions (88.4%) reported feeling satisfied compared to only 24.2% of participants in the supine position (p < 0.001). Participants also felt more comfortable in the left lateral (92.2%) and semi-Fowler positions (87.2%). In the supine position, most participants (68.7%) reported experiencing back pain (p < 0.001). There were no significant differences among groups in terms of basal heart rate (p = 0.497), reactivity time (p = 0.421) or percentage of reactivity (p = 0.676). The number of accelerations was 5.0 in the left lateral position, 4.5 in the semi-Fowler position and 4.0 in the supine position (p = 0.051).

CONCLUSIONS: Our findings support the use of the semi-Fowler and left lateral positions during the NST. Participants reported high satisfaction in these positions and felt more comfortable, and no procedure-related problems occurred.

PMID:34510846 | DOI:10.17219/acem/140196

Hepatol Commun. 2021 Sep;5(9):1518-1526. doi: 10.1002/hep4.1738. Epub 2021 May 13.

ABSTRACT

Minimal hepatic encephalopathy (MHE) adversely affects the clinical outcomes of patients with liver cirrhosis. This prospective study aimed to evaluate the utility of the Stroop test in the diagnosis of MHE and prediction of overt hepatic encephalopathy (OHE) in Japanese patients with cirrhosis. We enrolled 152 patients who underwent the Stroop test between November 2018 and February 2020. MHE was diagnosed using a combination of neuropsychological tests as the gold standard. The enrolled patients were followed up prospectively until the occurrence of OHE or August 2020. The optimal cutoff value of the Stroop test measurements was determined by receiver operating characteristic (ROC) curve analysis, and its predictive ability was assessed using the area under the ROC curve (AUC). Among the 139 eligible patients, 50 (36%) were diagnosed with MHE. The OffTime+OnTime cutoff value of 218.3 seconds had the best discriminative ability for MHE diagnosis, with an AUC of 0.77, a sensitivity of 74%, and a specificity of 75%. During a median follow-up of 10.8 months, 6 (4%) patients developed OHE. The OffTime+OnTime cutoff value of 305.6 seconds had the highest predictive ability for OHE, with an AUC of 0.79, a sensitivity of 67%, and a specificity of 92%. This value predicted OHE occurrence independent of liver functional reserve and prior OHE (hazard ratio, 19.8; P = 0.003). These two cutoff values remained statistically significant even when patients with prior OHE were excluded from the analysis. Conclusion: The Stroop test was useful for diagnosing patients with MHE and predicting OHE in Japanese patients with cirrhosis.

PMID:34510827 | DOI:10.1002/hep4.1738

Adv Clin Exp Med. 2021 Sep 9. doi: 10.17219/acem/137383. Online ahead of print.

ABSTRACT

BACKGROUND: Endometrial cancers (EC) are a heterogeneous group of malignant neoplasms differing in etiology, clinical-pathological features and prognosis.

OBJECTIVES: The aim of our study is to determine differences between the expression of selected molecular factors and find connections between them in order to isolate possible biomarkers influencing treatment options.

MATERIAL AND METHODS: The investigated data involved archival histological preparations obtained from uterine EC samples taken from 137 patients, treated surgically between 2007 and 2014. The immunohistochemical Dako EnVisionTM Flex+ method was applied.

RESULTS: The expression of ERβ, MLH1 and BRCA1 was lower in ECI than in ECII patients. ERα expression was higher in early Fédération internationale de gynécologie et d’obstétrique (FIGO) (IA) stages than in advanced (IB-IV) stages, while ERβ expression was significantly higher in advanced stages compared to stage IA and increased with grading. BRCA1 expression also increased with grading. In both type I and type II EC patients, ERα expression correlated with MYH9 and BRCA1, while ERβ expression correlated with BAP expression. High expression of BRCA1 correlated with several proteins: BAP, MYH9 and FAK. High BAP expression also correlated with high MYH9 expression. A correlation in the expression of these proteins was also demonstrated in the group consisting only of patients with ECI. A significant correlation was found between BAP expression and MYH9 among patients diagnosed with ECI. In the ECII group, no correlation was found between the tested proteins.

CONCLUSIONS: The ECI and ECII patients differed in the studied molecular factors, mainly in terms of ER and BRCA1 expression. Changes in BRCA1 expression were linked to alterations in BAP expression, but were also associated with the proteins MYH9 and FAK.

PMID:34510841 | DOI:10.17219/acem/137383

Brain Behav. 2021 Sep 12. doi: 10.1002/brb3.2281. Online ahead of print.

ABSTRACT

Minor physical abnormalities (MPA) are subtle dysmorphic features of bodily structures that have little or no impact on function. Most MPA develop during the first gestational trimester and are considered as important indicators of neuroectodermal deficiencies emerging during early brain development. A higher frequency of MPA was confirmed in schizophrenia patients and their relatives, when compared to controls. These findings are consistent with the neurodevelopmental model of schizophrenia. A neurodevelopmental component amongst other risk factors has also been recently proposed for anorexia nervosa (AN). The current study aimed to assess MPA frequency in adolescent inpatients with either schizophrenia spectrum disorders (SSD) or AN as compared to healthy controls (HC). The Waldrop Scale was used for assessing MPA. The mean MPA total score and mean head subscore was significantly higher in both test groups than in HC. There were no statistically significant differences between SSD and AN groups. The MPA profile (not frequency) was similar in all three groups. This finding is consistent both with widely acknowledged neurodevelopmental schizophrenia hypothesis as well as with more recent neurodevelopmental model of AN. Nevertheless, the findings should not be overgeneralized and further studies are warranted.

PMID:34510800 | DOI:10.1002/brb3.2281

Epilepsia Open. 2021 Sep 12. doi: 10.1002/epi4.12538. Online ahead of print.

ABSTRACT

OBJECTIVE: The World Health Organization, International League Against Epilepsy (ILAE), and International Bureau for Epilepsy have called epilepsy a public health imperative, with appropriate emphasis on low-to-middle income countries (LMIC). Although Canada is a high-income country (HIC), income is not distributed uniformly. Furthermore, epilepsy data from the national statistical agency explicitly overlooks the Arctic by excluding these territories. A common neurologic emergency, status epilepticus (SE) is a life-threatening manifestation of epilepsy that demands prompt treatment to avoid death and long-term sequelae. Therefore, we examined the rate of SE in a well-defined Canadian Arctic region.

METHODS: This study takes epidemiologic advantage of the Kivalliq Region’s geographical isolation, which is accessible only by air. All SE patients requiring emergency care are consistently flown 1,200-1,900 kilometres to a single designated hospital in a distinct southern part of Canada for further management and electroencephalography (EEG). We conducted a retrospective database and chart review at this “bottleneck” hospital to identify patients with seizure(s) severe enough to justify emergency airborne medical evacuation over a 11.25 year period from 2009-2020.

RESULTS: We screened 40,392 EEGs to yield 117 distinct medical evacuations for “operational SE” from 99 patients to derive estimated SE incidences of 99.9 evacuations per 100,000/year, and 84.5 patients per 100,000/year. The average time from seizure onset to EEG was 3.2 days. Only 16.2% of SE patients had known epilepsy. For “confirmed SE” cases meeting ILAE criteria, or cases with persistently epileptiform EEG despite days of empiric treatment, estimated incidence was 77.7 evacuations per 100,000/year, and 64.9 patients per 100,000/year.

SIGNIFICANCE: High SE and epilepsy rates in the Canadian Arctic are consistent with LMIC rather than HIC. Our findings demonstrate the paradox of LMIC-equivalent epilepsy populations camouflaged within HIC. Our findings also highlight the longstanding plight of these under-served and overlooked populations hidden in plain sight.

PMID:34510825 | DOI:10.1002/epi4.12538

Int Forum Allergy Rhinol. 2021 Sep 12. doi: 10.1002/alr.22887. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic rhinosinusitis (CRS) causes a great deal of morbidity. There are a multitude of causal factors, though their precise contribution to symptom severity has yet to be defined. We hypothesized that exposure to both primary and secondhand tobacco smoke would correlate with more severe symptoms of CRS.

METHODS: This is a prospective cross-sectional study performed at an academic tertiary care medical center from 2010 to 2013. A total of 85 consecutive patients with chronic sinusitis were screened; 70 with medically refractory CRS requiring functional Endoscopic sinus surgery (FESS) were enrolled. Recent tobacco exposure was assessed using serum cotinine levels. Sinonasal mucosa was biopsied to assess ciliary architecture. Demographics, medical history, tobacco and environmental exposures, and computed tomography (CT) imaging were also collected. Two quality of life (QOL) surveys were administered: one disease specific, Sinonasal Outcomes Test-20 (SNOT-20), and one general, Short Form-12 (SF-12). Results were correlated with the aforementioned exposures.

RESULTS: The 70 patients had an average age of 46 years, and 42% were male. Variables that correlated with worse SNOT-20 scores included serum cotinine (r = 0.43, p = 0.002), number of cigarettes smoked daily (r = 0.27, p = 0.03), and number of secondhand cigarettes exposed to per day (r = 0.29, p = 0.04). There were no significant correlations between SNOT-20 scores and Lund-MacKay or axonemal ultrastructural abnormalities (AUA)-ciliary scores. The two five-variable models best predicted disease-specific QOL.

CONCLUSIONS: Increased amounts of serum cotinine and primary and secondhand smoke exposure were associated with worse sinonasal QOL. This study establishes an objective relationship between smoke exposure and patient-perceived severity of CRS, emphasizing the importance of tobacco cessation counseling as part of management.

PMID:34510792 | DOI:10.1002/alr.22887

J Biophotonics. 2021 Sep 12:e202100175. doi: 10.1002/jbio.202100175. Online ahead of print.

ABSTRACT

We aim to develop a quantitative viability method that distinguishes individual quiescent from dead cells and is measured in time (ns) as a referenceable, comparable quantity. We demonstrate that fluorescence lifetime imaging of an anionic, fluorescent membrane voltage probe fulfills these requirements for Streptococcus mutans. A random forest machine learning model assesses whether individual S. mutans can be correctly classified into their original populations: stationary phase (quiescent) (SP), heat killed (HK), and inactivated via chemical fixation. We compare the results to intensity using three models: lifetime variables (τ₁ , τ₂ , p₁ ), phasor variables (G, S) or all five variables, with the 5 variable model having the most accurate classification. This initial work affirms the potential for using fluorescence lifetime of a membrane voltage probe as a viability marker for quiescent bacteria, and future efforts on other bacterial species and fluorophores will help refine this approach. This article is protected by copyright. All rights reserved.

PMID:34510771 | DOI:10.1002/jbio.202100175

Int J Clin Pract. 2021 Sep 12:e14831. doi: 10.1111/ijcp.14831. Online ahead of print.

ABSTRACT

AIM: To examine the incidence and treatment of acute myocardial infarction (AMI) as well as 30-day and 1-year prognoses of patients in different regions of Hungary. According to the statistical system of the European Union, Hungary can be divided into three major socio-economic regions-west Hungary, central Hungary and east Hungary.

METHODS AND RESULTS: The Hungarian Myocardial Infarction Registry (HUMIR) is a prospective comprehensive and mandatory disease registry for patients with AMI. The total population of Hungary is currently 9.8 million: 39% live in the eastern region (ER), 31% in the Central region (CR) and 30% in the western region (WR). Population over 30 years, the age-standardised incidence of AMI was 177.5 (175.7-179.3) per 100,000 person-year. During hospital treatment, 82.5%-84.6% of patients with ST-elevation (STEMI) and 54.8%-58.8% without ST-elevation (NSTEMI) myocardial infarction underwent PCI. The total ischaemic time of patients with STEMI was shortest in WR (221 minutes) compared to two other regions (CR:225, ER:262 minutes). In the STEMI group, the 30-day mortality rates of males were lowest in the WR (p = 0.03). If PCI was performed, mortality rates for both sexes were lowest in the WR (p < 0.01; p = 0.04). The 1-year mortality rate in the male population who received PCI was lowest in the WR. In the NSTEMI group, the 30-day mortality rate exhibited no differences. Regarding 1-year mortality, those who underwent PCI in the WR showed the lowest mortality.

CONCLUSION: The major regions of Hungary revealed significant differences regarding the incidence, prehospital delay, treatment and mortality of AMI. Logistic regression analysis confirmed the independent prognostic significance of the region on the 30-day mortality of patients with STEMI (Hazard ratio = 0.88, p = 0.0114; CI:0.80-0.97).

PMID:34510670 | DOI:10.1111/ijcp.14831

Pain Pract. 2021 Sep 12. doi: 10.1111/papr.13075. Online ahead of print.

ABSTRACT

OBJECTIVES: Insomnia is a highly prevalent problem among patients with chronic pain. Interdisciplinary pain rehabilitation programs (IPRPs) are a leading treatment option for chronic pain; however, research is limited and existing findings are mixed on the impact of insomnia symptoms on IPRP outcomes and the extent to which insomnia symptoms improve as a result of IPRP treatment.

METHODS: In this study, insomnia and pain-related outcomes following a 10-week IPRP were examined from a relatively large sample (N = 393) of adult patients with varying chronic pain conditions who completed the Insomnia Severity Index (ISI) at program admission and discharge. Both group- and individual-level changes in insomnia severity were examined to evaluate statistically and clinically significant changes in insomnia symptoms, along with the impact of insomnia symptoms on measures of pain, emotional distress, and functioning. Participants were categorized as having no clinically significant insomnia symptoms (NCSI), mild, moderate, or severe insomnia based on ISI scores.

RESULTS: Higher levels of insomnia severity were associated with worse pain, functioning, and emotional distress. Most patients reporting mild, moderate, or severe insomnia symptoms at program admission moved to a lower insomnia symptom category at the time of discharge (62%); however, only 33% of these patients reported a meaningful score reduction (i.e., ISI change ≥ 8 points). In addition, insomnia symptoms had a negative impact on treatment gains related to pain interference and physical health-related quality of life.

DISCUSSION: These findings suggest that usual IPRP care confers overall treatment benefit for individuals with chronic pain and insomnia. However, insomnia symptoms may negatively impact pain treatment outcomes and usual care appears insufficient to address elevated insomnia patients for many patients. Additional insomnia-specific treatment may be warranted for patients with comorbid chronic pain.

PMID:34510698 | DOI:10.1111/papr.13075