Category: Statistics

Soc Sci Med. 2021 Apr 3;277:113893. doi: 10.1016/j.socscimed.2021.113893. Online ahead of print.

ABSTRACT

INTRODUCTION: Lolland-Falster is a rural area in south-eastern Denmark that scores unfavourable in health surveys and has the lowest life expectancy in the country. To determine the origin of poor health in Lolland-Falster, we investigated impact on mortality of long-term population movements.

METHODS: We used data from the Danish Central Population Register 1968-2017 to track movements in and out of Lolland-Falster. This enabled us to calculate mortality based on tenure of residence. Poisson regression adjusted for sex, 5-year age-groups, and calendar year; separately for men and women; and ages <30, 30-64 and ≥ 65 years; was reported as mortality rate ratios (MRR) with 95% confidence intervals (95% CI).

RESULTS: Until 1988, mortality in Lolland-Falster was fairly similar to that in the rest of Denmark. Hereafter, mortality rates drifted apart. In 2008-2017, MRR of the total Lolland-Falster population was 1.21 (95% CI: 1.19-1.23). In each 10-year calendar period, people recently in-migrating constituted about one fourth of the population. MRRs of the in-migrating population increased over time from 1.17 (95% CI: 1.08-1.26) in 1968-1977, to 1.82 (95% CI: 1.75-1.89) in 2008-2017. Persons aged 30-64 constituted the largest in-migrating group and had highest excess mortality, MRR 2.34 (95% CI: 2.19-2.50) in 2008-2017.

CONCLUSION: Long-term selective in-migration of vulnerable persons was behind the gradual build-up of the currently high mortality in Lolland-Falster compared to the rest of Denmark. In particular, people of working age in-migrating to Lolland-Falster contributed to this disparity.

PMID:33838450 | DOI:10.1016/j.socscimed.2021.113893

Cancer Epidemiol. 2021 Apr 7;72:101935. doi: 10.1016/j.canep.2021.101935. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate forecasts of cancer incidence, with appropriate estimates of uncertainty, are crucial for planners and policy makers to ensure resource availability and prioritize interventions. We used Bayesian age-period-cohort (APC) models to project the future incidence of cancer in Australia.

METHODS: Bayesian APC models were fitted to counts of cancer diagnoses in Australia from 1982 to 2016 and projected to 2031 for seven key cancer types: breast, colorectal, liver, lung, non-Hodgkin lymphoma, melanoma and stomach. Aggregate cancer data from population-based cancer registries were sourced from the Australian Institute of Health and Welfare.

RESULTS: Over the projection period, total counts for these cancer types increased on average by 3 % annually to 100 385 diagnoses in 2031, which is a 50 % increase over 2016 numbers, although there is considerable uncertainty in this estimate. Counts for each cancer type and sex increased over the projection period, whereas decreases in the age-standardized incidence rates (ASRs) were projected for stomach, colorectal and male lung cancers. Large increases in ASRs were projected for liver and female lung cancer. Increases in the percentage of colorectal cancer diagnoses among younger age groups were projected. Retrospective one-step-ahead projections indicated both the incidence and its uncertainty were successfully forecast.

CONCLUSIONS: Increases in the projected incidence counts of key cancer types are in part attributable to the increasing and ageing population. The projected increases in ASRs for some cancer types should increase motivation to reduce sedentary behaviour, poor diet, overweight and undermanagement of infections. The Bayesian paradigm provides useful measures of the uncertainty associated with these projections.

PMID:33838461 | DOI:10.1016/j.canep.2021.101935

Am J Emerg Med. 2021 Apr 5;48:33-37. doi: 10.1016/j.ajem.2021.03.090. Online ahead of print.

ABSTRACT

INTRODUCTION: Due to the high mortality and spread rates of coronavirus disease 2019 (COVID-19), there are currently serious challenges in emergency department management. As such, we investigated whether the blood urea nitrogen (BUN)/albumin ratio (BAR) predicts mortality in the COVID-19 patients in the emergency department.

METHODS: A total of 602 COVID-19 patients who were brought to the emergency department within the period from March to September 2020 were included in the study. The BUN level, albumin level, BAR, age, gender, and in-hospital mortality status of the patients were recorded. The patients were grouped by in-hospital mortality. Statistical comparison was conducted between the groups.

RESULTS: Of the patients who were included in the study, 312(51.8%) were male, and their median age was 63 years (49-73). There was in-hospital mortality in 96(15.9%) patients. The median BUN and BAR values of the patients in the non-survivor group were significantly higher than those in the survivor group (BUN: 24.76 [17.38-38.31] and 14.43 [10.84-20.42], respectively [p < 0.001]; BAR: 6.7 [4.7-10.1] and 3.4 [2.5-5.2], respectively [p < 0.001]). The mean albumin value in the non-survivor group was significantly lower than that in the survivor group (3.60 ± 0.58 and 4.13 ± 0.51, respectively; p < 0.001). The area-under-the-curve (AUC) and odds ratio values obtained by BAR to predict in-hospital COVID-19 mortality were higher than the values obtained by BUN and albumin (AUC of BAR, BUN, and albumin: 0.809, 0.771, and 0.765, respectively; odds ratio of BAR>3.9, BUN>16.05, and albumin<4.01: 10.448, 7.048, and 6.482, respectively).

CONCLUSION: The BUN, albumin, and BAR levels were found to be reliable predictors of in-hospital mortality in COVID-19 patients, but BAR was found to be a more reliable predictor than the BUN and albumin levels.

PMID:33838471 | DOI:10.1016/j.ajem.2021.03.090

J Surg Res. 2021 Apr 7;264:230-235. doi: 10.1016/j.jss.2021.02.035. Online ahead of print.

ABSTRACT

BACKGROUND: Central neck dissection (CND) remains a controversial intervention for papillary thyroid carcinoma (PTC) patients with clinically negative nodes (cN0) in the central compartment. Proponents state that CND in cN0 patients prevents locoregional recurrence, while opponents deem that the risks of complications outweigh any potential benefit. Thus, there remains conflicting results amongst studies assessing oncologic and surgical outcomes in cN0 PTC patients who undergo CND. To provide clarity to this controversy, we sought to evaluate the efficacy, safety, and oncologic impact of CND in cN0 PTC patients at our institution.

MATERIALS AND METHODS: Six hundred and ninety-five patients with PTC who underwent thyroidectomy at our institution between 1998 and 2018 were identified using an institutional cancer registry and supplemental electronic medical record queries. Patients were stratified by whether or not they underwent CND; identified as CND(+) or CND(-), respectively. Patients were also stratified by whether or not they received adjuvant radioactive iodine (RAI) therapy. Patient demographics, pathologic results, as well as surgical and oncologic outcomes were reviewed. Standard statistical analyses were performed using ANOVA and/or t-test and chi-squared tests as appropriate.

RESULTS: Among the 695 patients with PTC, 492 (70.8%) had clinically and radiographically node negative disease (cN0). The mean age was 50 ± 1 years old and 368 (74.8%) were female. Of those with cN0 PTC, 61 patients (12.4%) underwent CND. CND(+) patients were found to have higher preoperative thyroid stimulating hormone (TSH) values, 2.8 ± 0.8 versus 1.5 ± 0.2 mU/L (P = 0.028) compared to CND(-) patients. CND did not significantly decrease disease recurrence, development of distant metastatic disease (P = 0.105) or persistence of disease (P = 0.069) at time of mean follow-up of 38 ± 3 months compared to CND(-) patients. However, surgical morbidity rates were significantly higher in CND(+) patients; including transient hypocalcemia (36.1% versus 14.4%; P < 0.001), transient recurrent laryngeal nerve (RLN) injury (19.7% vers us 7.0%; P < 0.001), and permanent RLN injury (3.3% versus 0.7%; P < 0.001).

CONCLUSIONS: The majority of patients at our institution with cN0 PTC did not undergo CND. This data suggests that CND was not associated with improvements in oncologic outcomes during the short-term follow-up period and led to increased postoperative morbidity. Therefore, we conclude that CND should not be routinely performed for patients with cN0 PTC.

PMID:33838407 | DOI:10.1016/j.jss.2021.02.035

Chemosphere. 2021 Apr 3;278:130484. doi: 10.1016/j.chemosphere.2021.130484. Online ahead of print.

ABSTRACT

Aluminium (Al), not essential for biological activities, accumulates in the tissues. It exerts toxic effects on the nervous system, inducing in humans’ irreversible cognitive impairment. In this study, a cluster sampling method was used to observe the cognitive function of long-term occupational Al-exposed workers in a large Al factory, and determine the expression of peripheral blood tumour necrosis factor receptor 1 (TNFR1), receptor-interacting protein 1 (RIP1), and RIP3. TNF-alpha, expressed in blood macrophages and microglia, with its receptors TNFR1, TR1 and TR3, enhances the necroptosis of neurons. Additionally, the relationship between the expression of TNFR1, RIP1, and RIP3 in the peripheral blood of long-term occupational Al-exposed workers and changes in their cognitive function was explored. The differences in the distributions of clock drawing test (CDT) scores among the three groups were statistically significant (P < 0.05). The results of correlation analysis showed that RIP1 and RIP3 protein contents were negatively correlated with mini-mental state examination (MMSE) and CDT scores (P < 0.05). Plasma Al content was positively correlated with other biological indicators (P < 0.05), and negatively correlated with MMSE and CDT scores (P < 0.05). Results showed that RIP3 protein had an incomplete mediation effect between plasma Al content and cognitive function. This suggests that Al may affect cognitive function by influencing the expression of TNFR1, RIP1, and RIP3 in the nervous system.

PMID:33838418 | DOI:10.1016/j.chemosphere.2021.130484

Clin Imaging. 2021 Mar 31;78:171-178. doi: 10.1016/j.clinimag.2021.03.026. Online ahead of print.

ABSTRACT

OBJECTIVE: To review MRI findings of pure lobular neoplasia (LN) on MRI guided biopsy, evaluate surgical and clinical outcomes, and assess imaging findings predictive of upgrade to malignancy.

METHODS: HIPAA compliant, IRB-approved retrospective review of our MRI-guided breast biopsy database from October 2008-January 2015. Biopsies yielding atypical lobular hyperplasia or lobular carcinoma in situ were included in the analysis; all biopsy slides were reviewed by a dedicated breast pathologist. Imaging indications, MRI findings, and histopathology were reviewed. Statistical analysis was performed using the two-tailed Fisher exact-test and the t-test, and 95% CIs were determined. A p < 0.05 was considered statistically significant.

RESULTS: Database search yielded 943 biopsies in 785 patients of which 65/943 (6.9%) reported LN as the highest risk pathologic lesion. Of 65 cases, 32 were found to have LN as the dominant finding on pathology and constituted the study population. All 32 findings were mammographically and sonographically occult. Three of 32 (9.3%) cases of lobular neoplasia were upgraded to malignancy, all LCIS (one pleomorphic and two classical). The most common MRI finding was focal, heterogenous non-mass enhancement with low T2 signal. No clinical features or imaging findings were predictive of upgrade to malignancy.

CONCLUSION: Incidence of pure lobular neoplasia on MRI guided biopsy is low, with comparatively low incidence of upgrade to malignancy. No imaging or clinical features are predictive of upgrade on surgical excision, therefore, prudent radiologic-pathologic correlation is necessary.

PMID:33838434 | DOI:10.1016/j.clinimag.2021.03.026

Sci Total Environ. 2021 Mar 20;782:146654. doi: 10.1016/j.scitotenv.2021.146654. Online ahead of print.

ABSTRACT

Effects of mercury on maturing immune system have been reported, however the association with respiratory and allergy problems during infancy remains unclear. The aim of this study is to evaluate the association between pre and postnatal mercury exposure and respiratory and allergy problems among preschool children and to examine the role of potential modifying factors. Study subjects were children participant in Spanish Childhood and Environment Project (INMA, 2003-2008). We measured total mercury levels in cord blood (n = 1868) and hair at 4 years of age (n = 1347). Respiratory outcomes (wheezing, severe wheezing, chestiness, persistent cough, eczema and otitis) were obtained by questionnaires administered to parents. Associations were investigated by logistic regression adjusted for socio-demographic and lifestyle-related variables in each cohort and subsequent meta-analysis. We tested effect modification by factors related to individual susceptibility, diet and co-exposure with other pollutants. The geometric mean of cord blood and hair total mercury was 8.20 μg/L and 0.97 μg/g, respectively. No statistically significant association between pre or postnatal mercury exposure and respiratory and allergy outcomes was found. Notwithstanding, lower maternal intake of fruits and vegetables increased the risk of some respiratory outcomes due to the prenatal exposure to mercury (p_int < 0.05). Moreover, an inverse association between prenatal mercury exposure and some respiratory outcomes was observed among children with higher maternal exposure to organocholorine compounds or smoking (p_int < 0.05). Also, sex and postnatal smoking exposure modulated mercury postnatal effects on persistent cough (p_int < 0.05). In conclusion, no association between pre and postnatal mercury exposure and respiratory and allergy problems among the whole population at study was found. However, diet and other toxicants could modulate this relation, especially during prenatal period. More research on this topic is warranted due to the limited evidence.

PMID:33838378 | DOI:10.1016/j.scitotenv.2021.146654

Waste Manag. 2021 Apr 7;126:454-465. doi: 10.1016/j.wasman.2021.03.037. Online ahead of print.

ABSTRACT

The absence of sound sampling procedures and statistical analyses to estimate solid waste generation in many developing countries has resulted in incomplete historical records of waste quantity and composition. Data is often arbitrarily aggregated or disaggregated as a function of waste generators to obtain results at the desired spatial level of analysis. Inference fallacies arising from the generalization or individualization of results are almost never considered. In this paper, Panama, one of the fastest-growing developing countries, was used as a case-study to review the main methodological approaches to estimate solid waste generation per capita per day, and at different hierarchical levels (from households to the country). The solid waste generation intensity indicator is used by the Panamanian waste management authority to run the waste management system. It was also the main parameter employed by local and foreign companies to estimate solid waste generation in Panama between 2001 and 2008. The methodological approaches used by these companies were mathematically formalized and classified as per the expressions suggested by Subramanian et al. (2009). Seven inference fallacies (ecological, individualistic, stage, floating population, linear forecasting, average population and mixed spatial levels) were identified and allocated to the studies. Foreign companies committed three of the seven inference fallacies, while one was committed by the local entity. Endogenous knowledge played an important role in these studies to avoid spatial levels mismatch and multilevel measurements appear to produce more reliable information than studies obtained via other means.

PMID:33838385 | DOI:10.1016/j.wasman.2021.03.037

Clin Gastroenterol Hepatol. 2021 Apr 7:S1542-3565(21)00393-1. doi: 10.1016/j.cgh.2021.04.005. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: Pediatric functional constipation (PFC) is a common problem in children that causes distress and presents treatment challenges to healthcare professionals. We conducted a randomized, placebo-controlled trial (Study 1) in patients with PFC (aged 6-17 years) to evaluate the efficacy and safety of lubiprostone, followed by an open-label extension for those who completed the placebo-controlled phase (Study 2).

METHODS: Study 1 (NCT02042183) was a phase 3, multicenter, randomized, double-blind, placebo-controlled, 12-week study evaluating the efficacy and safety of lubiprostone 12 mcg twice-daily (BID) and 24 mcg BID. Study 2 (NCT02138136) was a phase 3, long-term, open-label extension of Study 1. In both studies, lubiprostone doses were based on patients’ weight. Efficacy was assessed solely based on Study 1, with a primary endpoint of overall spontaneous bowel movement (SBM) response (increase of ≥1 SBM/week vs baseline and ≥3 SBMs/week for ≥9 weeks, including 3 of the final 4 weeks).

RESULTS: 606 patients were randomized to treatment (placebo: n=202; lubiprostone: n=404) in Study 1. No statistically significant difference in overall SBM response rate was observed between the lubiprostone and placebo groups (18.5% vs 14.4%; P=.2245). Both the 12-mcg BID and 24-mcg BID doses of lubiprostone were well tolerated in the double-blind and extension phases, with a safety profile consistent with that seen in adult studies.

CONCLUSIONS: Lubiprostone did not demonstrate statistically significant effectiveness over placebo in children and adolescents with PFC, but did demonstrate a safety profile similar to that in adults.

PMID:33838349 | DOI:10.1016/j.cgh.2021.04.005

Am J Otolaryngol. 2021 Mar 26;42(5):102999. doi: 10.1016/j.amjoto.2021.102999. Online ahead of print.

ABSTRACT

INTRODUCTION: The COVID-19 disease emerged in Wuhan province of China in November 2019 and spread across the world in a short time, resulting in a pandemic. The first case in Turkey was detected on March 11, 2020. The aim of the current study was to reveal the effects of COVID-19 on cranial nerves by monitoring people infected with the disease based on repeated examinations and surveys.

MATERIAL AND METHOD: The data of 356 patients with a positive COVID-19 polymerase chain reaction (PCR) test who received treatment between June 2020 and August 2020 in our hospital were prospectively evaluated after the study was approved by the relevant ethics committee.

RESULTS: Of the 356 patients included in the study, 47 under the age of 18 years were excluded due to their unreliable examination and anamnesis findings. In addition, seven patients that died while in hospital were excluded from the study due to the lack of examination and survey records during their hospitalization. The data of the remaining 302 patients were statistically analyzed. Symptoms of cranial nerve involvement were observed in 135 patients.

CONCLUSION: The COVID-19 disease caused by the SARS-CoV2 virus commonly results in cranial nerve symptoms. The fact that these findings are more common and severe in COVID-19 than previous SARS and MERS outbreaks suggests that it has a more neurotrophic and more aggressive neuroinvasion. While the negative effects of the virus on sensory functions resulting from cranial nerve involvement are evident, motor functions are rarely affected.

PMID:33838359 | DOI:10.1016/j.amjoto.2021.102999