Category: Statistics

J Mother Child. 2022 Feb 8. doi: 10.34763/jmotherandchild.20212503SI.d-21-00013. Online ahead of print.

ABSTRACT

BACKGROUND: The paper focuses on Bulgarian adolescents’ behaviours that put their health at risk and their relationship to family-related characteristics: structure of family and material status, family support, communication with parents, parental monitoring and school-related parental support. It also discusses intervention programs with a focus on parent support gradient.

MATERIAL AND METHODS: The analysis is based on the Bulgarian sample of Health Behaviour in School-Aged Children survey, the 2018 round. Logistic regression models of current cigarette smoking, regular alcohol consumption, sexual debut and current cannabis use are applied. Main national programs on adolescent health and the parental involvement component in them are also discussed.

RESULTS: The statistical analyses reveal significant gender and age differences in Bulgarian adolescents’ health risk behaviours. Girls have significantly higher odds of smoking and are less likely to report an early start of sexual life. Odds of cigarette smoking and regular alcohol consumption increase with age. Children living with one parent have significantly higher odds of smoking, regular alcohol consumption and current cannabis use. Interactions between FAS and family support reveal that students who report low family support, regardless of the material status of the family, have significantly higher odds of health risk behaviours.

CONCLUSION: The main contribution of the analysis reveals the alleviating effect of family support on socio-economic inequalities between families. An evidence-based approach delineating a preventive potential of family support on Bulgarian adolescents’ health risk behaviours despite the level of family affluence provides solid arguments for increasing national family support programs.

PMID:35143718 | DOI:10.34763/jmotherandchild.20212503SI.d-21-00013

Clin Transplant. 2022 Feb 10:e14611. doi: 10.1111/ctr.14611. Online ahead of print.

ABSTRACT

Lay-caregivers in organ transplantation (to candidates, recipients, and donors) are essential to pre- and post-operative care, but report significant caregiving-related stressors. This review aims to summarize studies testing non-pharmacological interventions aimed at improving organ transplant caregiver-reported outcomes.

METHODS: In accordance with PRISMA, we conducted a systematic review (searched PubMed, Embase, Cochrane Central, PsycInfo, and CINAHL, no start-date restriction through 7/1/2021). Quality of comparative studies assessed by ROBS-2 or ROBINS.

RESULTS: Twelve studies met inclusion. Study designs, interventions, and outcomes varied. Sample sizes were small across caregivers to adult (nine studies, five with caregiver samples ns≤50) and pediatric patients (three studies, caregiver samples ns≤16). Study designs included seven single-arm interventions, two pre-post with comparison cohorts, and three randomized-controlled trials. Eight studies included transplant-specific education as the intervention, an interventional component, or as the comparison group. Outcomes included transplant specific knowledge, mental health, and intervention acceptability. Of the nine pre-post caregiver assessments and/or comparison groups, four studies demonstrated no statistically significant intervention effects.

CONCLUSION: Few interventions addressing the needs of organ transplant caregivers have been empirically evaluated. Existing interventions were well-received by caregivers. Given complexities of care in transplantation, research is needed evaluating interventions using rigorous trial methodology with adequate samples. This article is protected by copyright. All rights reserved.

PMID:35143701 | DOI:10.1111/ctr.14611

Fam Med. 2022 Feb;54(2):114-122. doi: 10.22454/FamMed.2022.189296.

ABSTRACT

BACKGROUND AND OBJECTIVES: Structural racism is a cause of health disparities. Graduate medical education is tasked with training physicians who understand and address disparities. Addressing health disparities includes education on racism, such as racial justice curricula (RJC). We surveyed program directors (PDs) about the prevalence and characteristics of RJC in family medicine residency programs (FMRPs).

METHODS: RJC questions were included in the 2020 Council of Academic Family Medicine Educational Research (CERA) survey of FMRP PDs. We calculated univariate and bivariate statistics to describe respondent characteristics and attitudes, program characteristics, curriculum characteristics, and barriers to implementation.

RESULTS: Of 624 PDs, 312 (50%) responded and 283/312 (90.7%) completed RJC questions. Less than one-third of FMRPs reported RJC, of which 98.9% focused on implicit/unconscious bias. Program characteristics associated with RJC included location, percent underrepresented minorities in medicine (URMM) residents and faculty, and percent patients identifying as Black, Latino/a, and Native American. FMRPs with RJC were more likely to have PDs who reported favorable attitudes toward including RJC and believed it is important for family physicians to understand structural racism. The greatest barrier to implementation of RJC was lack of faculty training.

CONCLUSIONS: In this national survey, most FMRPs reported no RJC. Most respondent PDs endorsed that it is important for family physicians to understand structural racism and that RJC should be included in residency. Lack of faculty training was the greatest barrier to implementation. Research is needed to evaluate existing RJC and explore strategies for overcoming barriers to implemention.

PMID:35143683 | DOI:10.22454/FamMed.2022.189296

Fam Med. 2022 Feb;54(2):123-128. doi: 10.22454/FamMed.2022.410546.

ABSTRACT

BACKGROUND AND OBJECTIVES: Contraception is a core component of family medicine residency curriculum. Institutional environments can influence residents’ access to contraceptive training and thus their ability to meet the reproductive health needs of their patients.

METHODS: Contraceptive training questions were included in the 2020 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors. The survey asked how many faculty and residents opt out of providing contraceptive methods for moral or religious reasons, and whether training sites have institutional restrictions on contraception. We performed descriptive statistics and regression to identify program characteristics associated with having a resident or faculty opt out of providing contraceptive care.

RESULTS: Of 626 program directors, 249 responded to the survey, and 237 answered the contraceptive questions. Percentages of program directors reporting any residents or faculty who opted out of contraceptive services are as follows: pill/patch/ring (residents 27%; faculty 17%), emergency contraception (residents 40%, faculty 33%), or intrauterine devices/implants (resident 29%; faculty 23%). Programs in the South (OR 2.78; 1.19-6.49) and those with Catholic affiliation (OR 2.35; 1.23-4.91) had higher adjusted odds of at least one opt-out faculty but were not associated with having opt-out residents. Eleven percent of programs had at least one training site with institutional restrictions on contraception.

CONCLUSIONS: To ensure that residents have access to adequate contraceptive training, residencies should proactively seek faculty and training environments that meet residents’ needs, and should make limitations on services clear to potential residents and patients.

PMID:35143684 | DOI:10.22454/FamMed.2022.410546

Mol Biol Evol. 2022 Feb 10:msac034. doi: 10.1093/molbev/msac034. Online ahead of print.

ABSTRACT

Bioinformatic research relies on large-scale computational infrastructures which have a non-zero carbon footprint but so far, no study has quantified the environmental costs of bioinformatic tools and commonly run analyses. In this work, we estimate the carbon footprint of bioinformatics (in kilograms of CO2 equivalent units, kgCO2e) using the freely available Green Algorithms calculator (www.green-algorithms.org). We assessed (i) bioinformatic approaches in genome-wide association studies (GWAS), RNA sequencing, genome assembly, metagenomics, phylogenetics and molecular simulations, as well as (ii) computation strategies, such as parallelisation, CPU (central processing unit) vs GPU (graphics processing unit), cloud vs. local computing infrastructure and geography. In particular, we found that biobank-scale GWAS emitted substantial kgCO2e and simple software upgrades could make it greener, e.g. upgrading from BOLT-LMM v1 to v2.3 reduced carbon footprint by 73%. Moreover, switching from the average data centre to a more efficient one can reduce carbon footprint by ∼34%. Memory over-allocation can also be a substantial contributor to an algorithm’s greenhouse gas (GHG) emissions. The use of faster processors or greater parallelisation reduces running time but can lead to greater carbon footprint. Finally, we provide guidance on how researchers can reduce power consumption and minimise kgCO2e. Overall, this work elucidates the carbon footprint of common analyses in bioinformatics and provides solutions which empower a move toward greener research.

PMID:35143670 | DOI:10.1093/molbev/msac034

Hum Reprod. 2022 Feb 10:deac020. doi: 10.1093/humrep/deac020. Online ahead of print.

ABSTRACT

STUDY QUESTION: Can use of a commercially available time-lapse algorithm for Day 5 blastocyst selection improve pregnancy rates compared with morphology alone?

SUMMARY ANSWER: The use of a time-lapse selection model to choose blastocysts for fresh single embryo transfer on Day 5 did not improve ongoing pregnancy rate compared to morphology alone.

WHAT IS KNOWN ALREADY: Evidence from time-lapse monitoring suggests correlations between timing of key developmental events and embryo viability. No good quality evidence exists to support improved pregnancy rates following time-lapse selection.

STUDY DESIGN, SIZE, DURATION: A prospective multicenter randomized controlled trial including 776 randomized patients was performed between 2018 and 2021. Patients with at least two good quality blastocysts on Day 5 were allocated by a computer randomization program in a proportion of 1:1 into either the control group, whereby single blastocysts were selected for transfer by morphology alone, or the intervention group whereby final selection was decided by a commercially available time-lapse model. The embryologists at the time of blastocyst morphological scoring were blinded to which study group the patients would be randomized, and the physician and patients were blind to which group they were allocated until after the primary outcome was known. The primary outcome was number of ongoing pregnancies in the two groups.

PARTICIPANTS/MATERIALS, SETTING, METHODS: From 10 Nordic IVF clinics, 776 patients with a minimum of two good quality blastocysts on Day 5 (D5) were randomized into one of the two study groups. A commercial time-lapse model decided the final selection of blastocysts for 387 patients in the intervention (time-lapse) group, and blastocysts with the highest morphological score were transferred for 389 patients in the control group. Only single embryo transfers in fresh cycles were performed.

MAIN RESULTS AND THE ROLE OF CHANCE: In the full analysis set, the ongoing pregnancy rate for the time-lapse group was 47.4% (175/369) and 48.1% (181/376) in the control group. No statistically significant difference was found between the two groups: mean difference -0.7% (95% CI -8.2, 6.7, P = 0.90). Pregnancy rate (60.2% versus 59.0%, mean difference 1.1%, 95% CI -6.2, 8.4, P = 0.81) and early pregnancy loss (21.2% versus 18.5%, mean difference 2.7%, 95% CI -5.2, 10.6, P = 0.55) were the same for the time-lapse and the control group. Subgroup analyses showed that patient and treatment characteristics did not significantly affect the commercial time-lapse model D5 performance. In the time-lapse group, the choice of best blastocyst changed on 42% of occasions (154/369, 95% CI 36.9, 47.2) after the algorithm was applied, and this rate was similar for most treatment clinics.

LIMITATIONS, REASONS FOR CAUTION: During 2020, the patient recruitment rate slowed down at participating clinics owing to coronavirus disease-19 restrictions, so the target sample size was not achieved as planned and it was decided to stop the trial prematurely. The study only investigated embryo selection at the blastocyst stage on D5 in fresh IVF transfer cycles. In addition, only blastocysts of good morphological quality were considered for transfer, limiting the number of embryos for selection in both groups: also, it could be argued that this manual preselection of blastocysts limits the theoretical selection power of time-lapse, as well as restricting the results mainly to a good prognosis patient group. Most patients were aimed for blastocyst stage transfer when a minimum of five zygotes were available for extended culture. Finally, the primary clinical outcome evaluated was pregnancy to only 6-8 weeks.

WIDER IMPLICATIONS OF THE FINDINGS: The study suggests that time-lapse selection with a commercially available time-lapse model does not increase chance of ongoing pregnancy after single blastocyst transfer on Day 5 compared to morphology alone.

STUDY FUNDING/COMPETING INTEREST(S): The study was financed by a grant from the Swedish state under the ALF-agreement between the Swedish government and the county councils (ALFGBG-723141). Vitrolife supported the study with embryo culture dishes and culture media. During the study period, T.H. changed his employment from Livio AB to Vitrolife AB. All other authors have no conflicts of interests to disclose.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov registration number NCT03445923.

TRIAL REGISTRATION DATE: 26 February 2018.

DATE OF FIRST PATIENT’S ENROLMENT: 11 June 2018.

PMID:35143661 | DOI:10.1093/humrep/deac020

Bioinformatics. 2022 Feb 10:btac076. doi: 10.1093/bioinformatics/btac076. Online ahead of print.

ABSTRACT

MOTIVATION: The identification of pathways and biological processes from differential gene expression is central for interpretation of data collected by transcriptomics assays. Gene-Set Enrichment Analysis (GSEA) is the most common used algorithm to calculate the significance of the relevancy of an annotated gene set with a differential expression signature. To compute significance, GSEA implements permutation tests which are slow and inaccurate for comparing many differential expression signatures to thousands of annotated gene sets.

RESULTS: Here we present blitzGSEA, an algorithm that is based on the same running sum statistic as GSEA, but instead of performing permutations, blitzGSEA approximates the enrichment score probabilities based on Gamma distributions. blitzGSEA achieves dramatic improvement in performance compared with prior GSEA implementations, while approximating small p-values more accurately.

AVAILABILITY: A python package, together with all source code, and a detailed user guide are available from GitHub at: https://github.com/MaayanLab/blitzgsea.

SUPPLEMENTARY INFORMATION: Supplementary text and figures are available at Bioinformatics online.

PMID:35143610 | DOI:10.1093/bioinformatics/btac076

Eur J Cardiothorac Surg. 2022 Feb 10:ezac068. doi: 10.1093/ejcts/ezac068. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to test if the current general practice of surgical revascularization is comparable to the setting of International Study of Comparative Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial and to evaluate the comparative risk of cardiovascular events or death after coronary artery bypass grafting.

METHODS: We selected patients undergoing surgical revascularization and matching ISCHEMIA inclusion criteria. Chronic coronary syndrome patients were included if diagnosis of myocardial ischaemia by functional testing and coronary artery disease at angiography were detected. The primary end point was a composite of cardiovascular death, myocardial infarction, rehospitalization for unstable angina, heart failure and resuscitated cardiac arrest. Secondary end points were death by any cause, cardiovascular death, myocardial infarction and rehospitalization.

RESULTS: Among 353 patients, the primary outcome occurred in 62 (17.6%) patients. At 6 months, cumulative event-free survival was 97%, at 1 year 96%, at 5 years 89% and at 10 years 80%. Cumulative risk of the primary composite outcome at 5 years was 11%, 18% in the conservative arm of ISCHEMIA and 16% in the revascularization arm of ISCHEMIA (P < 0.001). Risk of myocardial infarction at 5 years was 7% in surgical patients and 12% and 10% in the conservative and invasive arms of the trial, respectively (P < 0.001).

CONCLUSIONS: Long-term results in surgical patients treated for chronic coronary syndromes showed that ISCHEMIA trial findings are not transferable in a ‘real-world’ scenario and have not changed previous medical practice. A patient-tailored approach, especially with diabetes and reduced left ventricle function, offers the best results in patients with stable coronary artery disease.

PMID:35143617 | DOI:10.1093/ejcts/ezac068

Am J Occup Ther. 2022 Mar 1;76(2):7602205030. doi: 10.5014/ajot.2022.046912.

ABSTRACT

IMPORTANCE: Asian-Americans are more likely than other ethnic groups to care for older family members and less likely to seek mental health services. The research on caregiver burden among Asian-American intergenerational caregivers is limited.

OBJECTIVE: To investigate how spirituality and mental health help-seeking attitudes correlate with and predict perceived feelings of caregiver burden among Asian-American caregivers. Favorable mental health help-seeking attitudes were predicted to negatively correlate with caregiver burden, and spirituality was predicted to negatively correlate with and negatively predict caregiver burden.

DESIGN: Quantitative survey research.

SETTING: Community mental health.

PARTICIPANTS: One hundred one participants were recruited using the following inclusion criteria: Asian-Americans who currently or previously provided care to an Asian family member at least one generation older than the caregiver for at least 1 mo and in the past 3 yr. Outcomes and Measures: Items from the Burden Scale for Family Caregivers, Spirituality Scale, Expressions of Spirituality Inventory-Revised, Mental Help Seeking Attitudes Scale, and Self-Stigma of Seeking Psychological Help measured caregiver burden, spirituality, and mental health help-seeking attitudes.

RESULTS: A statistically significant negative correlation was found between caregiver burden and spirituality and between caregiver burden and mental health help-seeking attitudes. Spirituality and number of domains of care were statistically significant predictors of caregiver burden.

CONCLUSIONS AND RELEVANCE: Spirituality was found to negatively predict caregiver burden among Asian-American intergenerational caregivers. Mental health help-seeking attitudes were negatively correlated with caregiver burden. Occupational therapy practitioners have the opportunity to integrate spirituality and culturally sensitive mental health promotion into their services to Asian-Americans. What This Article Adds: Evidence that spirituality is a negative predictor of caregiver burden for Asian-American intergenerational caregivers offers a unique opportunity for occupational therapy practitioners to offer alternative methods of mental health promotion with this population. Understanding that spirituality and mental health help-seeking attitudes are culturally mediated allows practitioners to be informed about a dynamic in Asian-American culture.

PMID:35143608 | DOI:10.5014/ajot.2022.046912

JAMA. 2022 Feb 10. doi: 10.1001/jama.2022.1645. Online ahead of print.

ABSTRACT

IMPORTANCE: It is estimated that only 27% of patients with acute ischemic stroke and large vessel occlusion who undergo successful reperfusion after mechanical thrombectomy are disability free at 90 days. An incomplete microcirculatory reperfusion might contribute to these suboptimal clinical benefits.

OBJECTIVE: To investigate whether treatment with adjunct intra-arterial alteplase after thrombectomy improves outcomes following reperfusion.

DESIGN, SETTING, AND PARTICIPANTS: Phase 2b randomized, double-blind, placebo-controlled trial performed from December 2018 through May 2021 in 7 stroke centers in Catalonia, Spain. The study included 121 patients with large vessel occlusion acute ischemic stroke treated with thrombectomy within 24 hours after stroke onset and with an expanded Treatment in Cerebral Ischemia angiographic score of 2b50 to 3.

INTERVENTIONS: Participants were randomized to receive intra-arterial alteplase (0.225 mg/kg; maximum dose, 22.5 mg) infused over 15 to 30 minutes (n = 61) or placebo (n = 52).

MAIN OUTCOMES AND MEASURES: The primary outcome was the difference in proportion of patients achieving a score of 0 or 1 on the 90-day modified Rankin Scale (range, 0 [no symptoms] to 6 [death]) in all patients treated as randomized. Safety outcomes included rate of symptomatic intracranial hemorrhage and death.

RESULTS: The study was terminated early for inability to maintain placebo availability and enrollment rate because of the COVID-19 pandemic. Of 1825 patients with acute ischemic stroke treated with thrombectomy at the 7 study sites, 748 (41%) patients fulfilled the angiographic criteria, 121 (7%) patients were randomized (mean age, 70.6 [SD, 13.7] years; 57 women [47%]), and 113 (6%) were treated as randomized. The proportion of participants with a modified Rankin Scale score of 0 or 1 at 90 days was 59.0% (36/61) with alteplase and 40.4% (21/52) with placebo (adjusted risk difference, 18.4%; 95% CI, 0.3%-36.4%; P = .047). The proportion of patients with symptomatic intracranial hemorrhage within 24 hours was 0% with alteplase and 3.8% with placebo (risk difference, -3.8%; 95% CI, -13.2% to 2.5%). Ninety-day mortality was 8% with alteplase and 15% with placebo (risk difference, -7.2%; 95% CI, -19.2% to 4.8%).

CONCLUSIONS AND RELEVANCE: Among patients with large vessel occlusion acute ischemic stroke and successful reperfusion following thrombectomy, the use of adjunct intra-arterial alteplase compared with placebo resulted in a greater likelihood of excellent neurological outcome at 90 days. However, because of study limitations, these findings should be interpreted as preliminary and require replication.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03876119; EudraCT Number: 2018-002195-40.

PMID:35143603 | DOI:10.1001/jama.2022.1645