Category: Statistics

Epilepsy Behav. 2021 Nov 13;125:108399. doi: 10.1016/j.yebeh.2021.108399. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate Sexual Function Scores in women of childbearing age with epilepsy.

METHOD: Cross-sectional study and comparison of two groups, one with and the other without epilepsy. The instruments used were: semi-structured socioeconomic, demographic and clinical questionnaire; Beck Anxiety and Depression Inventories; Word Health Organization Quality of Life (WHOQOL-brief); Female Sexual Function Index (FSFI); and Female Genital Self Image Scale (FGSIS). Statistical analysis was performed using Fisher’s Exact Test, Chi-Square, Mann-Whitney, and Spearman’s Correlation, considering p < 0.05 as a measure of significance.

RESULTS: 110 women were included (55 with epilepsy and 55 without epilepsy) with a mean age of 32 years. Both groups had sexual dysfunction (with epilepsy: 19.28 vs. without epilepsy: 21.05; p = 0.416). There was no significant difference between groups in the analysis of self-image of the genitalia, Quality of Life, or Anxiety. However, there was a statistical difference in Depression Symptoms (with epilepsy: 11.44 vs. without epilepsy:13.82, p = 0.038). When evaluating the influence of epilepsy on sexual function score, women who used enzyme-inducing drugs had worse scores in desire domain (5.21 vs. 6.65; p = 0.020) and lubrication domain (9.48 vs. 12.95; p = 0.047) when compared to women who used non-enzyme-inducing drugs, respectively. In the correlation of Sexual Function with Anxiety, Depression, Quality of Life, and Self-Image of the genitalia, it was observed that when Depression levels increase, desire is impaired [-0.273(p = 0.043)]. In Quality of Life, the psychological [0.311(p = 0.021)] and environmental [0.268(p = 0.048)] domains positively influenced desire. The social relationships domain improved desire [0.504(p = 0.000)], excitement [0.461(p = 0.000)], lubrication [0.342(p = 0.011)], orgasm [0.425(p = 0.001)], satisfaction [0.449(p = 0.001)], and decreased pain [0.402(p = 0.002)]. Consequently, these influence appeared to improve sexual function [0.521(p = 0.000)].

CONCLUSION: Women of childbearing age with epilepsy have sexual dysfunction. The presence of signs of depression and the use of enzyme-inducing drugs must be carefully analyzed, as they can worsen the sexual function score. Health professionals need to be aware that sexual dysfunction must be investigated because this issue influences the quality of life of these women.

PMID:34785412 | DOI:10.1016/j.yebeh.2021.108399

Neural Netw. 2021 Nov 8;145:300-307. doi: 10.1016/j.neunet.2021.10.026. Online ahead of print.

ABSTRACT

Clipping on learning rates in Adam leads to an effective stochastic algorithm-AdaBound. In spite of its effectiveness in practice, convergence analysis of AdaBound has not been fully explored, especially for non-convex optimization. To this end, we address the convergence of the last individual output of AdaBound for non-convex stochastic optimization problems, which is called individual convergence. We prove that, with the iteration of the AdaBound, the cost function converges to a finite value and the corresponding gradient converges to zero. The novelty of this proof is that the convergence conditions on the bound functions and momentum factors are much more relaxed than the existing results, especially when we remove the monotonicity and convergence of the bound functions, and only keep their boundedness. The momentum factors can be fixed to be constant, without the restriction of monotonically decreasing. This provides a new perspective on understanding the bound functions and momentum factors of AdaBound. At last, numerical experiments are provided to corroborate our theory and show that the convergence of AdaBound extends to more general bound functions.

PMID:34785445 | DOI:10.1016/j.neunet.2021.10.026

Photodiagnosis Photodyn Ther. 2021 Nov 13:102626. doi: 10.1016/j.pdpdt.2021.102626. Online ahead of print.

ABSTRACT

AIM: To evaluate the effect of prematurity on choroidal structure in children born preterm with no history of retinopathy of prematurity (ROP) by comparing them with age-matched healthy children born at full term.

METHODS: Enhanced depth imaging optical coherence tomography (EDI-OCT) scans of children aged 5 to 9 years with a history of prematurity but no history of ROP, and age-matched full-term healthy children were evaluated, retrospectively. Choroidal thicknesses (CTs) were measured at subfoveal (SFCT), 1000 µm temporal and nasal from the fovea (T1, N1), and 2000 µm temporal and nasal (T2, N2) from the fovea. The EDI-OCT images were binarized to stromal (SA) and luminal areas (LA) using the ImageJ software. The choroidal vascularity index (CVI) was calculated by dividing LA by the total choroidal area (TCA).

RESULTS: Twenty-nine eyes of 15 preterm children and 41 eyes of 26 full-term children were included. Demographic characteristics including axial length (AL), eye side, age, and the sex of the children in the groups were similar (p>0.05). There was no statistically significant difference in the mean CVI, SFCT, N1, and T1 values between the groups (p>0.05); however, the mean T2 and N2 values were significantly higher in the full-term group than in the preterm group (p<0.05). There was a significant positive correlation between the birth week and the T1 (p<0.05) CONCLUSION: : Prematurity can affect CT even with no history of ROP. The decreases in CTs were significant at 2000 µm nasal and temporal from the fovea. The impairment of temporal choroidal region was more evident than nasal choroidal region. The mean CVI values were similar between the groups.

PMID:34785405 | DOI:10.1016/j.pdpdt.2021.102626

Ann Epidemiol. 2021 Nov 13:S1047-2797(21)00324-0. doi: 10.1016/j.annepidem.2021.11.006. Online ahead of print.

ABSTRACT

PURPOSE: The Veterans Health Administration (VA) is the largest single integrated healthcare system in the US and is likely the largest healthcare provider for people with minoritized sexual orientations (e.g., gay, lesbian, bisexual). The purpose of this study was to use electronic health record (EHR) data to replicate self-reported survey findings from the general US population and assess whether sexual orientation is associated with diagnosed physical health conditions that may elevate risk of COVID-19 severity among veterans who utilize the VA.

METHODS: A retrospective analysis of VA EHR data from 10/01/1999-07-01-2019 analyzed in 2021. Veterans with minoritized sexual orientations were included if they had documentation of a minoritized sexual orientation within clinical notes identified via natural language processing. Veterans without minoritized sexual orientation documentation comprised the comparison group. Adjusted prevalence and prevalence ratios (aPR) were calculated overall and by race/ethnicity while accounting for differences in distributions of sex assigned at birth, age, calendar year of first VA visit, volumes of healthcare utilization, and VA priority group.

RESULTS: Data from 108,401 veterans with minoritized sexual orientation and 6,511,698 controls were analyzed. After adjustment, veterans with minoritized sexual orientations had a statistically significant elevated prevalence of 10 of the 11 conditions. Amongst the highest disparities observed were COPD (aPR:1.24 [95% confidence interval:1.23-1.26]), asthma (1.22 [1.20-1.24]), and stroke (1.26 [1.24-1.28]).

CONCLUSIONS: Findings largely corroborated patterns among the general US population. Further research is needed to determine if these disparities translate to poorer COVID-19 outcomes for individuals with minoritized sexual orientation.

PMID:34785397 | DOI:10.1016/j.annepidem.2021.11.006

J Gynecol Obstet Hum Reprod. 2021 Nov 13:102271. doi: 10.1016/j.jogoh.2021.102271. Online ahead of print.

ABSTRACT

INTRODUCTION: Up to 30% of couples may face secondary infertility. The impact of ectopic pregnancy, spontaneous abortion, pregnancy termination or live birth with caesarean section may impair further fertility in different ways. However, secondary infertility after physiological vaginal life childbirth has been little studied. The aim of this study was to describe the population and the fertility issues and analyze the predictive factors of success in in vitro fertilization in women presenting secondary infertility after a physiological vaginal childbirth.

MATERIAL AND METHODS: This single-centre retrospective study included women aged 18-43 years consulting between 2013 and 2020 for secondary infertility in a couple having already had previous vaginal life childbirth. Couples’ characteristics, management decision after the first consultation and IVF outcomes were analyzed.

RESULTS: Secondary infertility was found in 286 couples, out of whom 138 had a history of vaginal life childbirth. Population was characterized by an advanced female age and overweight. After the first consultation, IVF was performed in only 40% of couples. No predictive factor of live birth was found.

CONCLUSION: Our study shows that in couples with secondary infertility after prior physiological delivery cigarette smoking is frequent in male partners, and ovarian reserve markers are altered. However, no statistically significant predictive factor of live birth after IVF treatment has been identified. Further large prospective studies are necessary.

PMID:34785399 | DOI:10.1016/j.jogoh.2021.102271

Ann Vasc Surg. 2021 Nov 13:S0890-5096(21)00883-9. doi: 10.1016/j.avsg.2021.10.047. Online ahead of print.

ABSTRACT

OBJECTIVE: to identify predictors of long-term aortic diameter change and disease progression in a population cohort of patients with newly diagnosed aortic dissection (AD), intramural hematoma (IMH), or penetrating aortic ulcer (PAU).

METHODS: We used the Rochester Epidemiology Project record linkage system to identify all Olmsted County, MN-USA, residents diagnosed with AD, IMH, and PAU (1995-2015). The endpoints were aortic diameter change, freedom from clinical disease progression (any related intervention, aortic aneurysm, new aortic syndrome, rupture or death) and disease resolution (complete spontaneous radiological disappear). Linear regression was used to assess aortic growth rate; predictors of disease progression were identified with Cox proportional hazards.

RESULTS: Of 133 incident cases, 46 ADs, 12 IMHs, and 28 PAUs with sufficient imaging data were included. Overall median follow-up was 8.1 years. Aortic diameter increase occurred in 40 ADs (87%, median 1.0 mm/year), 5 IMHs (42%, median 0.2 mm/year) and 14 PAUs (50%, median 0.4 mm/year). Symptomatic presentation (P=.045), connective tissue disorders (P=.005), and initial aortic diameter >42 mm (P=.013) were associated with AD growth rate. PAU depth >9 mm (P=.047) and female sex (P=.013) were associated with aortic growth rate in PAUs and IMHs. At 10 years, freedom from disease progression was 22% (95%CI 12-41) for ADs, 44% (95%CI 22-92) for IMHs, and 46% (95%CI 27-78) for PAUs. DeBakey I/IIIB AD (HR 3.09; P=.038), initial IMH aortic diameter (HR 1.4; P=.037) and PAU depth >10 mm (HR 3.92; P=.018) were associated with disease progression. No AD spontaneously resolved; resolution rate at 10 years was 22% (95%CI 0-45) for IMHs and 11% (95%CI 0-23) for PAUs.

CONCLUSIONS: Aortic growth and clinical disease progression are observed in most patients with aortic syndromes, while spontaneous resolution is uncommon. Predictors of aortic growth and disease progression may be used to tailor appropriate follow-up and eventual early intervention.

PMID:34785342 | DOI:10.1016/j.avsg.2021.10.047

J Allergy Clin Immunol Pract. 2021 Nov 13:S2213-2198(21)01259-9. doi: 10.1016/j.jaip.2021.10.068. Online ahead of print.

ABSTRACT

BACKGROUND: Autonomy is the ability of patients to make informed medical decisions. Autonomy is rooted in disease state understanding. Medical ethics, especially the principle of autonomy, plays an important role in healthcare delivery when caring for diverse populations.

OBJECTIVE: We sought to identify patient characteristics that influence autonomy.

METHODS: 295 adults with moderate to severe asthma completed two surveys at the beginning of a one year randomized clinical trial. The Navigating Ability and Inhaled Corticosteroids Knowledge questionnaires were combined to create a 21-question assessment of autonomy with possible scores ranging from 10-105. Linear regression was performed on the derived autonomy score predicted by patient baseline characteristics.

RESULTS: Comparison revealed statistically significant differences in baseline autonomy scores in patients who reported Spanish as their primary language (p=0.01), patients with diabetes (p=0.01), and those with depressive symptoms (p=0.03) at -11.4 (95% CI, -20.5, -2.3), -4.8 (95% CI, -8.3, -1.3), and -3.1 (95% CI, -5.9, -0.3) points respectively. Non-Hispanic White participants on average were found to have 8.2 (95% CI, 4.5, 12.0) points higher autonomy scores compared to non-Hispanic Black participants (Bonferroni adjusted p<0.01). Patients with higher functional health literacy had higher autonomy scores (coefficient=0.24, 95% CI, 0.1, 0.4, p<0.01) CONCLUSIONS: Autonomy is associated with comorbidities, demographics, and literacy. These results may reflect differences in social, educational, and economic opportunities encountered by patients. Further investigation is needed to assess and understand how socioeconomic and educational factors influence autonomy. By identifying differences in autonomy based on baseline patient characteristics, this project serves as an initial step in adjusting current and developing new treatment guidelines and interventions to improve patient autonomy.

PMID:34785390 | DOI:10.1016/j.jaip.2021.10.068

Ann Anat. 2021 Nov 13:151855. doi: 10.1016/j.aanat.2021.151855. Online ahead of print.

ABSTRACT

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is the gold standard method for bariatric surgery and leads to substantial improvements in Type 2 Diabetes mellitus. However, many patients experience relapses in diabetes five years after undergoing this aggressive surgical procedure. We focus on beta-cell population changes and absorptive intestinal consequences after RYGB in a healthy nonobese animal model after a long survival period.

METHODS: For our purpose, we use three groups of Wistar rats: RYGB-operated, surgical control (Sham) and fasting control. We measure alpha-, beta-cell mass; transcription (Arx, and Pdx-1) and proliferation (Ki67) factors; glucose tolerance and insulin release after oral glucose tests; histological adaptive changes in the jejunum; and intestinal glucose transporters.

RESULTS: Our results showed an early increase in insulin secretion after surgery, that decrease at the end of the study. The beta-cell mass reduces twenty-four weeks after RYGB, which coincides with decrease of Pdx-1 transcription promoter factor. These was coincident with an increase in alpha-mass and a high expression of Arx in RYGB group.

CONCLUSIONS: The analysis of all data showed beta-cell mass transdifferentiation into alpha-cell mass in RYGB rats. Due to long-term exhaustion of the beta-cell population by hyperinsulinism derived from digestive tract adaptation to surgery.

PMID:34785322 | DOI:10.1016/j.aanat.2021.151855

Ann Vasc Surg. 2021 Nov 13:S0890-5096(21)00873-6. doi: 10.1016/j.avsg.2021.10.039. Online ahead of print.

ABSTRACT

OBJECTIVES: Contrast induced nephropathy occurs in up to 7.5% of cases in endovascular aortic repair (EVAR). Carbon Dioxide (CO₂) has been proposed as an alternative agent to iodinated contrast medium (ICM); however, specific protocols are not universally adopted, and the visualization of the renal arteries may be suboptimal in some cases. The aim of this study was to analyze our CO₂-EVAR experience with automatic injections, in order to identify the anatomical characteristics associated with the best visualization of all the aortic vessels, with particular attention to the lowest renal artery (LoRA).

METHODS: From 2016 to 2019, all EVAR performed with either CO₂ or ICM were analyzed and compared. CO₂-EVAR was performed using an automated injector (600 mmHg pressure; 100 cc volume); a small amount of ICM was injected in case of difficulty in LoRA visualization or doubts at the completion angiogram. Clinical and CT-Scan preoperative characteristics were considered. The study endpoints were technical success, amount of ICM and radiation dose, postoperative renal function and possible CO₂-related adverse events. Statistical analysis was by Fisher’s exact, t-Student, Mann-Whitney tests and ROC curve.

RESULTS: In the considered period, 321 EVAR procedures, 72 (22.4%) with CO₂ and 249 (77.6%) with ICM, were performed. The two groups were similar for clinical characteristics and preoperative renal function. ICM was injected in a significantly lower amount in the CO₂-EVAR group (52.8 ± 6.1 vs. 88.1 ±9.2 cc, p<0.001), which received a significantly higher mean radiation dose (Total DAP: 500550.8 ± 377394.6 mGy/cm² CO₂-EVAR vs. 332301.8 ±230139.3 mGy/cm² ICM-EVAR, p=0.001). Postoperative eGFR decreased significantly less in the CO₂-EVAR (2.3 ± 1.1 ml/min) compared with the ICM-EVAR group (10.6 ±5.3 ml/min), p<0.001. LoRA was correctly visualized in 50/72 (69.4%) cases of CO₂-EVAR, which had a significantly longer proximal neck [Median (IQR): 30 (14) vs. 18 (15) mm, p=0.001]. At ROC curve, a proximal neck length >24.5 mm was predictive of LoRA visualization (72.1% sensitivity, 73.8% specificity). Three CO₂-EVAR cases had intraoperative transient hypotension with no consequences. Sixteen/72 (22.2%) CO₂-EVAR procedures were performed using 0 cc of ICM.

CONCLUSIONS: CO₂-EVAR by automated injections is safe and requires a lower amount of ICM if compared with ICM-EVAR, with a consequent significant benefit on postoperative renal function. If specific anatomical situations are present, ICM may be completely unnecessary. The radiation dose is however significantly higher, therefore procedural protocols need further refinements.

PMID:34785338 | DOI:10.1016/j.avsg.2021.10.039

Contemp Clin Trials. 2021 Nov 13:106620. doi: 10.1016/j.cct.2021.106620. Online ahead of print.

ABSTRACT

In the U.S., older adults hospitalized with acute episodes of chronic conditions often are rehospitalized within 30 days of discharge. Numerous studies reveal that poor management of the complex needs of this population remains the norm. METHODS: This prospective, intent-to-treat, randomized controlled trial (RCT) will assess the effects of replicating the rigorously studied Transitional Care Model (TCM) in four U.S. healthcare systems. The TCM is an advanced practice registered nurse led, team-based, care management intervention that supports older adults throughout vulnerable care episodes that span hospital to home. This RCT will compare health and economic outcomes demonstrated by at-risk older adults hospitalized with heart failure, chronic obstructive pulmonary disease or pneumonia randomized to receive usual discharge planning (control group, N = 800) to those observed by a similar group of older adults randomized to receive the TCM protocol (N = 800). The primary outcome is number of rehospitalizations at 12 months post-discharge, with secondary resource use outcomes measured at multiple intervals. Patient experience with care, health and quality of life outcomes will be assessed at 90 days post-discharge. DISCUSSION: Based on health and economic benefits demonstrated in multiple NIH funded RCTs, the study team hypothesizes that the intervention group, both within and across participating health systems, will have decreased acute care resource use and costs at 12 months and better ratings of the care experience and health and quality of life through 90 days post-discharge compared to the control group. The impact of COVID-19 on implementation of this study also is discussed.

PMID:34785306 | DOI:10.1016/j.cct.2021.106620