Category: Statistics

Cancer. 2021 Jul 15. doi: 10.1002/cncr.33801. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer is the most common cancer among women in the United States. However, data on spatial disparities in survival for breast cancer are limited in the country. This study estimated 5-year relative survival (RS) of female breast cancer and examined the spatial variations across the contiguous United States.

METHODS: Women newly diagnosed with breast cancer in 2003-2010 in the United States were identified from the National Cancer Database and followed up through 2016. The crude 5-year RS at the county level was estimated and adjusted for patients’ key sociodemographic and clinical factors. To account for spatial effects, the RS estimates were smoothed using the Bayesian spatial survival model. A local spatial autocorrelation analysis with the Getis-Ord Gi* statistics was applied to identify geographic clusters of low or high RS.

RESULTS: Clusters of low RS were identified in more than 15 states covering 671 counties, mostly in the southeast and southwest regions, including Georgia, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, and Texas. Approximately 30% of these clusters can be explained by patients’ characteristics: Race, insurance, and stage at diagnosis appeared to be the major attributable factors.

CONCLUSIONS: Significant spatial disparity in female breast cancer survival was found, with low RS clusters identified in Georgia, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, and Texas. Policies and interventions that focus on serving Black women, improvements in insurance coverage, and early detection in these areas could potentially mitigate the spatial disparities.

PMID:34265081 | DOI:10.1002/cncr.33801

Br J Clin Pharmacol. 2021 Jul 15. doi: 10.1111/bcp.14985. Online ahead of print.

ABSTRACT

AIM: The Norwegian Association for Clinical Pharmacology in their National Guidelines decreased therapeutic range (TR) of topiramate (TPM) from 5-20 mg/L to 2-10 mg/L. The objective of this study is to ascertain which TR produces better clinical outcomes.

METHODS: Data source were request forms for routine therapeutic drug monitoring of TPM. Concentration dependent adverse drug reactions (ADRs) were evaluated in 1,721 samples taken pre-dose. Seizure frequency analysis was performed in 294 samples of monotherapy.

STATISTICS: Prism 5.0, GraphPad Instatt: One-way Anova with Bonferroni correction for median plasma level (PL). χ2-test with Bonferroni correction for seizure frequency and for distribution of PL according to TR 5-20 mg/L and intervals <2, 2-5, 5-10, 10-20, >20 mg/L.

RESULTS: Better seizure control was found in children both in whole cohort (without seizure 49% vs 37% adults), as well as in monotherapy (56% vs 44%), in children with PL 5-20 mg/L vs <5 mg/L (65% vs 44%) and in children with PL 5-10 mg/L vs <2 mg/L (63 vs 14%). PL in seizure-free patients did not differ from those with seizure. Seizure control was poorer in the period 2003-2005 compared to 2006-2011. ADRs reported in 38 samples (2.8%) were without relation to PL.

CONCLUSIONS: Change of TR is not recommended.

PMID:34265104 | DOI:10.1111/bcp.14985

J Clin Endocrinol Metab. 2021 Jul 15:dgab518. doi: 10.1210/clinem/dgab518. Online ahead of print.

ABSTRACT

CONTEXT: Craniopharyngioma is a sellar tumor associated with high rates of pituitary deficiencies (~98%) and hypothalamic obesity (~50%).

OBJECTIVE: To determine the efficacy regarding long-term weight loss after bariatric surgery in obese craniopharyngioma patients with hypothalamic dysfunction.

DESIGN: Retrospective case control study.

SETTING: Multicenter international study.

PATIENTS AND PARTICIPANTS: Obese craniopharyngioma patients (N = 16; of which 12 women) with a history of bariatric surgery [12 Roux-en-Y gastric bypass, 4 sleeve gastrectomy; median age of 21 years (range 15-52), median follow-up 5.2 years (range 2.0-11.3)] and age/sex/surgery/BMI-matched obese controls (N = 155).

MAIN OUTCOME MEASURES: Weight loss and obesity-related comorbidities up to 5 years after bariatric surgery were compared and changes in hormonal replacement therapy evaluated.

RESULTS: Mean weight loss at 5-year follow-up was 22.0% (95% CI 16.1, 27.8) in patients versus 29.5% (28.0, 30.9) in controls (P = 0.02), which was less after Roux-en-Y gastric bypass (22.7% [16.9, 28.5] vs. 32.0% [30.4, 33.6]; P = 0.003) but at a similar level after sleeve gastrectomy (21.7% [-1.8, 45.2] vs. 21.8% [18.2, 25.5]; P = 0.96). No major changes in endocrine replacement therapy were observed after surgery. One patient died (unknown cause). One patient had long-term absorptive problems.

CONCLUSIONS: Obese patients with craniopharyngioma had a substantial mean weight loss of 22% at 5-year follow-up after bariatric surgery, independent of type of bariatric surgery procedure. Weight loss was lower than in obese controls after Roux-en-Y gastric bypass. Bariatric surgery appears effective and relatively safe in the treatment of obese craniopharyngioma patients.

PMID:34265053 | DOI:10.1210/clinem/dgab518

J Food Prot. 2021 Jul 15. doi: 10.4315/JFP-21-028. Online ahead of print.

ABSTRACT

Based upon regulatory and food industry-driven food safety standards, there is a need for rapid, accurate methods for assessing sanitary conditions. A commonly utilized assay is based on the assessment of the biochemical molecule, adenosine triphosphate (ATP). A more recent assay (AXP) targets the cumulative presence of ATP and its dephosphorylated homologues, adenosine diphosphate (ADP) and adenosine monophosphate (AMP). Yet, there is little information that compares the practical performance of these two assays. This work examined these two assay types with a comparative study in a Grade A dairy foods processing plant and a licensed and inspected meat processing facility. A total of 1,920 concomitant analyses were conducted with main variables of assay type, processing facility type and hygiene zone category. Statistical process control methodology was used to calculate 95% confidence control limits (CL); data beyond those limits were considered contamination events. Results demonstrated that, overall, the AXP assay detected contamination events approximately two times more often than the ATP-only based assay. This increase in the rate of contamination event detection was especially more prevalent in the meat processing facility where, across all hygienic zones, there were 38 vs. 85 contaminations events detected for the ATP and AXP assays, respectively. Across hygiene zones, the AXP data displayed either an equal or increased incidence of soil detection compared to data from the ATP assay. This study provides applied evidence that assays solely dependent on ATP concentrations are less able to detect soil contaminants under conditions that favor ATP dephosphorylation reactions.

PMID:34265064 | DOI:10.4315/JFP-21-028

Swiss Med Wkly. 2021 Jul 7;151:w20525. doi: 10.4414/smw.2021.20525. eCollection 2021 Jul 5.

ABSTRACT

OBJECTIVE: The Swiss Diabetes Registry (SwissDiab) is a multicentre, longitudinal, observational study of outpatients with diabetes receiving treatment at tertiary care centres. The aim of this study was to evaluate the representativeness of the participants at the study centre in the Division of Endocrinology and Diabetes at the Cantonal Hospital of St Gallen by comparing diabetes-related characteristics of participating and nonparticipating patients.

METHODS: The study included 493 SwissDiab participants enrolled between 1 January 2010 and 31 December 2016 and 640 nonparticipating patients treated at the centre during the same time period. For participants and nonparticipating patients, demographic characteristics, clinical findings, blood chemistry and medication were retrieved from the SwissDiab baseline visit and the medical record &plusmn;6 months from the first available outpatient visit to the clinic for diabetes-related care within the study period. Nonparticipating patients were further divided into three subgroups: (i) excluded from SwissDiab, or having received (ii) &ge;6 months or (iii) &lt;6 months of prior diabetes treatment at the centre. Differences in diabetes-related clinical characteristics were determined using simple bivariate (nonparametric) statistical analyses stratified by diabetes mellitus type 1 and type 2.

RESULTS: Compared with nonparticipants, participants smoked less (diabetes mellitus type 1: 24% vs 45%; diabetes mellitus type 2: 21% vs 29%), had higher educational attainment (diabetes mellitus type 1: 39% vs 21%; and diabetes mellitus type 2: 25% vs 18%) and lower glycated haemoglobin levels (diabetes mellitus type 1: 7.2% vs 7.8%; diabetes mellitus type 2: 7.2% vs 8.1%). In diabetes mellitus type 2, the proportion of females (30% vs 38%) and a migration background (36% vs 49%) were lower among participants. (All p-values &lt;0.05.) In a stratified analysis SwissDiab participants had slightly better controlled diabetes than nonparticipating patients with &ge;6 months of prior treatment, whereas the diabetes of patients recently referred to the clinic (with &lt;6 months of prior treatment) and patients excluded from participation in SwissDiab were less well controlled.

CONCLUSION: The observed differences in clinical characteristics between study participants and nonparticipating patients indicate that SwissDiab is likely to overestimate the state of diabetes care and management. The results highlight the need to improve recruitment of females and patients with a migration background in diabetes mellitus type 2.

PMID:34265071 | DOI:10.4414/smw.2021.20525

PLoS One. 2021 Jul 15;16(7):e0254703. doi: 10.1371/journal.pone.0254703. eCollection 2021.

ABSTRACT

BACKGROUND: Urinary tract infection (UTI) is a common disease in childhood. A sterile collection of urine samples using suprapubic aspiration (SPA) and bladder catheterization (BC) is helpful for rapid and accurate diagnosis of UTI in infants. With the advent of point-of-care ultrasound (POCUS), the use of ultrasound by non-radiologists at the patient’s bedside, great advancement has been noticed in various medical fields. Considering the importance and advantages of using POCUS in the physical examination and guiding procedures, the authors aimed to compare urine sampling’s success rate by SPA, BC, and POCUS guided SPA (POCUS-SPA) in infants performed by three pediatricians.

MATERIALS AND METHODS: This study is a randomized clinical trial conducted on 114 neonates and infants with suspected UTI admitted to 17-Shahrivar children’s hospital from April 2017 to September 2019. Neonates and infants were randomly assigned to three groups of BC, SPA, and POCUS-SPA. The primary outcome was the success of sampling defined by obtaining 1cc of urine in each method. The secondary outcome was assessing the pain level.

RESULTS: Results showed that the POCUS-SPA had the highest success rate in urine sampling, and a statistically significant relation was noted among the three groups (P = 0.0001). From 38 patients in each group, 37 patients of POCUS-SPA (97.4%), 34 patients of BC (89.5%), and 23 patients of SPA (60.5%) had a successful sampling. Most of the patients in all three groups experienced severe pain.

CONCLUSIONS: In the current study, results showed that the POCUS-SPA significantly increased the success rate of urine sampling and most of the patients in all three groups had severe pain. Based on the shortage of access to radiologists in emergency setups, it seems that the POCUS-SPA by the pediatricians can be one of the most appropriate and applicable diagnostic methods in infants with UTI.

PMID:34265015 | DOI:10.1371/journal.pone.0254703

Clin Infect Dis. 2021 Jul 15:ciab603. doi: 10.1093/cid/ciab603. Online ahead of print.

ABSTRACT

BACKGROUND: In men, human papillomavirus (HPV)-related cancer incidence is rising, but data regarding male HPV infection and seroprevalence are available from only a few countries.

METHODS: This analysis of a global HPV vaccine trial evaluated baseline data from 1399 HIV-negative heterosexual men (HM) and men who have sex with men (MSM). Key objectives included assessment of HPV prevalence and risk factors for seropositivity to 9-valent HPV (9vHPV) vaccine types (6/11/16/18/31/33/45/52/58), and concordance between seropositivity and prevalent HPV type.

RESULTS: Overall, 455/3463 (13.1%) of HM and 228/602 (37.9%) of MSM were HPV DNA-positive for any 9vHPV vaccine type at baseline. Infection prevalence/seroprevalence (≥1 9vHPV vaccine types) was 13.2%/8.1% among 333 HM from Europe, and 37.9%/29.9% among 335 MSM from Europe/North America. Among men with baseline infection, MSM had higher seroprevalence for concordant HPV types (39.5% vs 10.8% in HM). Seropositivity risk (irrespective of baseline infection status) was higher among MSM vs HM (age-adjusted odds ratio=3.0, 95%CI=2.4-6.4). Among MSM, statistically significant seropositivity risk factors included younger age at sexual debut, higher number of receptive anal sex partners, and less frequent condom use. No factors assessed were associated with seropositivity in HM.

CONCLUSIONS: Higher proportions of MSM than HM were HPV DNA-positive and seropositive and concordance between HPV DNA positivity and seropositivity, a potential marker of true infection versus carriage, was higher in MSM. Most MSM and HM were seronegative for all 9vHPV vaccine types, suggesting the potential benefit of catch-up vaccination after sexual debut.

PMID:34265048 | DOI:10.1093/cid/ciab603

PLoS One. 2021 Jul 15;16(7):e0254538. doi: 10.1371/journal.pone.0254538. eCollection 2021.

ABSTRACT

AIM: The aim was to predict and understand variations in swimmer performance between individual and relay events, and develop a predictive model for the 4×200-m swimming freestyle relay event to help inform team selection and strategy.

DATA AND METHODS: Race data for 716 relay finals (4 x 200-m freestyle) from 14 international competitions between 2010-2018 were analysed. Individual 200-m freestyle season best time for the same year was located for each swimmer. Linear regression and machine learning was applied to 4 x 200-m swimming freestyle relay events.

RESULTS: Compared to the individual event, the lowest ranked swimmer in the team (-0.62 s, CI = [-0.94, -0.30]) and American swimmers (-0.48 s [-0.89, -0.08]) typically swam faster 200-m times in relay events. Random forest models predicted gold, silver, bronze and non-medal with 100%, up to 41%, up to 63%, and 93% sensitivity, respectively.

DISCUSSION: Team finishing position was strongly associated with the differential time to the fastest team (mean decrease in Gini (MDG) when this variable was omitted = 31.3), world rankings of team members (average ranking MDG of 18.9), and the order of swimmers (MDG = 6.9). Differential times are based on the sum of individual swimmer’s season’s best times, and along with world rankings, reflect team strength. In contrast, the order of swimmers reflects strategy. This type of analysis could assist coaches and support staff in selecting swimmers and team orders for relay events to enhance the likelihood of success.

PMID:34265006 | DOI:10.1371/journal.pone.0254538

PLoS One. 2021 Jul 15;16(7):e0254777. doi: 10.1371/journal.pone.0254777. eCollection 2021.

ABSTRACT

A growing trend in the caesarian section (CS) for delivery is a threat to child health as well as maternal health. This study was conducted to identify the potential socioeconomic and demographic factors associated with CS delivery in Bangladesh. Data obtained from the Bangladesh Demographic and Health Survey (BDHS) 2014 has been used for this study. The prevalence of CS delivery among Bangladeshi mothers was 24% (Urban: 36.9%, Rural: 17.9%). A two-level logistic regression showed that mothers having delivery in the private sector or private hospital (adjusted odds ratio [AOR] = 38.70, 95% confidence interval [CI] = 29.58 to 50.62), mother’s age 25-35 years (AOR = 1.73, 95% CI = 1.26 to 2.37), wealth index average (AOR = 1.61, 95% CI = 1.15 to 2.27) and rich (AOR = 1.80, 95% CI = 1.29 to 2.51), antenatal visit 1-2 (AOR = 2.31, 95% CI = 1.47 to 3.64) and ≥ 3 (AOR = 3.68, 95% CI = 2.35 to 5.76), overweight mothers (AOR = 1.44, 95% CI = 1.09 to 1.90), multiple births (AOR = 3.87, 95% CI = 1.15 to 12.58), husband’s occupation professional/technical/managerial (AOR = 1.68, 95% CI = 1.15 to 2.47) were significantly more prone to CS delivery. Also, place of residence, number of family members, birth order, child’s size during birth, and divisions of Bangladesh, were potentially associated with CS delivery. The current epidemiological findings and evidence suggest adopting and implementing some urgent clinical practices and strict guidelines in the healthcare system to avoid unnecessary CS delivery in Bangladesh.

PMID:34265013 | DOI:10.1371/journal.pone.0254777

PLoS One. 2021 Jul 15;16(7):e0254818. doi: 10.1371/journal.pone.0254818. eCollection 2021.

ABSTRACT

INTRODUCTION: Unsafe abortion is a leading cause of maternal mortality, and access to safe abortion services remains a public health priority in sub-Saharan Africa (SSA). A considerable amount of abortion research exists in the region; however, the spread of existing evidence is uneven such that some countries have an acute shortage of data with others over-researched. The imbalance reflects the complexities in prioritization among researchers, academics, and funders, and undeniably impedes effective policy and advocacy efforts. This scoping review aims to identify and map the landscape of abortion research in SSA, summarize existing knowledge, and pinpoint significant gaps, both substantive and geographic, requiring further investigation. This review will provide direction for future research, investments, and offer guidance for policy and programming on safe abortion.

MATERIALS AND METHODS: We utilize the Joanna Briggs Institute’s methodology for conducting scoping reviews. We will perform the search for articles in 8 electronic databases (i.e., PubMed, AJOL, Science Direct, SCOPUS, HINARI, Web of Knowledge, CINAHL, and WHO Regional Databases). We will include studies written in English or French language, produced or published between January 1, 2011, and July 31, 2021, and pertain directly to the subject of abortion in SSA. Using a tailored extraction frame, we will extract relevant information from publications that meet the inclusion criteria. Data will be analyzed using descriptive statistics and thematic analysis in response to key review questions.

ETHICS AND DISSEMINATION: Formal ethical approval is not required, as no primary data will be collected. The findings of this study will be disseminated through peer-reviewed publications and conference presentations.

PMID:34264992 | DOI:10.1371/journal.pone.0254818