Category: Statistics

JAMA Surg. 2021 May 5. doi: 10.1001/jamasurg.2021.0954. Online ahead of print.

ABSTRACT

IMPORTANCE: Accurate preoperative prediction of hepatocellular carcinoma (HCC) recurrence after liver transplant is the mainstay of selection tools used by transplant-governing bodies to discern candidacy for patients with HCC. Although progress has been made, few tools incorporate objective measures of tumor biological characteristics, resulting in inclusion of patients with high recurrence rates and exclusion of others who could otherwise be cured.

OBJECTIVE: To externally validate the New York/California (NYCA) score, a recently published multi-institutional US HCC selection tool that was the first model incorporating a dynamic α-fetoprotein response (AFP-R) and compare the validated score with currently accepted HCC selection tools, namely, the Milan Criteria (MC), the French-AFP (F-AFP), and Metroticket 2.0 models.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective, multicenter prognostic analysis of prospectively collected databases of 2236 adults undergoing liver transplant for HCC was conducted at 3 US, 1 Canadian, and 4 European centers from January 1, 2001, to December 31, 2013. The AFP-R was measured as the difference between maximum and final pre-liver transplant AFP level. Cox proportional hazards regression and competing risk regression analyses examined recurrence-free and overall survival. Receiver operating characteristic analyses and net reclassification index were used to compare NYCA with MC, F-AFP, and Metroticket 2.0. Data analysis was performed from June 2019 to April 2020.

MAIN OUTCOMES AND MEASURES: The primary study outcome was 5-year recurrence-free survival; overall survival was the secondary outcome.

RESULTS: Of 2236 patients, 1808 (80.9%) were men; mean (SD) age was 58.3 (7.96) years. A total of 545 patients (24.4%) did not meet the MC. The NYCA score proved valid on competing risk regression analysis, accurately predicting recurrence-free and overall survival (5-year cumulative incidence of recurrence risk in NYCA risk categories was 9.5% for low-, 20.5%, for acceptable-, and 40.5% for high-risk categories; P < .001 for all). The NYCA also predicted recurrence-free survival on a center-specific level: 453 of 545 patients (83.1%) who did not meet MC, 213 of 308 (69.2%) who did not meet the French-AFP, 292 of 384 (76.1%) who did not meet Metroticket 2.0 would be recategorized into NYCA low- and acceptable-risk groups (>75% 5-year recurrence-free survival). The Harrell C statistic for the validated NYCA score was 0.66 compared with 0.59 for the MC and 0.57 for the F-AFP models (P < .001). The net reclassification index for NYCA was 8.1 vs MC, 12.9 vs F-AFP, and 10.1 vs Metroticket 2.0.

CONCLUSIONS AND RELEVANCE: This study appears to externally validate the importance of AFP-R in the selection of patients with HCC for liver transplant. The AFP-R represents one of the truly objective measures of biological characteristics available before transplantation. Incorporation of AFP-R into selection criteria allows safe expansion of MC and other models, offering liver transplant to patients with acceptable tumor biological characteristics who would otherwise be denied potential cure.

PMID:33950167 | DOI:10.1001/jamasurg.2021.0954

Rev Bras Enferm. 2021 May 3;74(2):e20200165. doi: 10.1590/0034-7167-2020-0165. eCollection 2021.

ABSTRACT

OBJECTIVE: to assess the implementation of actions for early detection of breast cancer in Primary Care and to verify the adequacy of these actions with the Ministry of Health recommendations.

METHOD: a cross-sectional study conducted from September 2017 to March 2018 with 736 women registered in Basic Health Units in two municipalities in Acre. For data collection, a validated questionnaire was used. In statistical analysis, the chi-square test or Fisher’s exact test was applied.

RESULTS: the frequency of mammography was 42%. Of the women at standard risk for breast cancer, only 5,8% underwent mammography properly.

CONCLUSION: there was a low compliance of early detection actions to the Ministry of Health recommendations; thus, the need to adopt measures to increase professionals’ adherence to government proposals is highlighted, as well as continuous actions assessments.

PMID:33950117 | DOI:10.1590/0034-7167-2020-0165

Rev Bras Enferm. 2021 May 3;74(2):e20200195. doi: 10.1590/0034-7167-2020-0195. eCollection 2021.

ABSTRACT

OBJECTIVES: to construct and assess bundle content for the prevention and management of complications in neutropenia in cancer patients.

METHODS: a methodological study developed in four stages: scoping review; bundle construction; material assessment by experts (developed according to Pasquali’s psychometry); pilot test in a High Complexity Assistance Unit in Oncology. For content assessment, the Delphi technique was applied in two rounds and those items with Content Validation Coefficient (CVC)> 0.78 and agreement> 80.0% were considered valid. Data were analyzed using descriptive and inferential statistics.

RESULTS: all bundle requirements reached agreement between judges above 80.0%, in addition to statistically significant levels of assessment. At the end of the Delphi technique, bundle was significantly valid with CVC = 0.92 and CVC = 0.93, respectively.

CONCLUSIONS: bundle content proved to be valid and highly credible.

PMID:33950119 | DOI:10.1590/0034-7167-2020-0195

Rev Bras Epidemiol. 2021 May 3;24:e210019. doi: 10.1590/1980-549720210019. eCollection 2021.

ABSTRACT

OBJECTIVE: To analyze the association between diet quality assessed with the Diet Quality Scale (ESQUADA) and the nutritional status and metabolic risk in adults.

METHODS: The data included 1,147 adults aged 20 to 59, from the population-based study with complex sampling. Weight, height, tricipital (TSF) and subscapular (SSF) skinfolds, and waist (WC) and mid-arm (MAC) circumferences were measured. Body mass index (BMI) and mid-arm muscle circumference (MAMC) were calculated. Nutritional status and metabolic risk were classified considering BMI and WC values, respectively. Diet quality was assessed with ESQUADA. Data were collected at household using the Epicollect5 application. Diet quality (in scores) was analyzed as continuous data and later categorized. The confidence interval was used for comparison between groups, Fisher’s exact test for an association study. Adjusted multiple linear regression models were also estimated. P < 0.05 was adopted for statistical significance.

RESULTS: Overweight prevailed in 60.33% of individuals, especially among women (60.73%). High or very high metabolic risk was more frequent among women with “very good or excellent” diet quality. Higher diet quality score was associated with a reduction in TSF (β = -0.07; 95%CI -0.13 – -0.01) and an increase in MAMC (β = 0.09; 95%CI 0.00 – 0,18) in men and the reduction in weight (β = -0.04; 95%CI -0.07 – -0.01), SSF (β = -0.07; 95%CI -0.13 – -0,00) and WC in women (β = -0.06; 95%CI -0.09 – -0.02).

CONCLUSION: A better diet quality is positively associated with lean mass in men, and negatively with fat mass in men and women.

PMID:33950140 | DOI:10.1590/1980-549720210019

Cad Saude Publica. 2021 Apr 30;37(3):e00182720. doi: 10.1590/0102-311X00182720. eCollection 2021.

ABSTRACT

This is a cross-sectional study investigating the factors affecting brazilians’ self-rated health during the COVID-19 pandemic, based on data from the web-based behavior survey. Carried out from April 24 to May 24, 2020, the survey recruited participants by a chain sampling procedure. Its outcome was the worsening of self-rated health during the pandemic. Statistical analysis was based on a hierarchical model of determination. Logistic regression models were used to test the associations between sociodemographic characteristics, pre-existing health conditions, lifestyle indicators and intensity of social restraint measures, and biological and psychological issues during the pandemic. From the total sample of 45,161 participants, 29.4% reported worsening of health state during this period. After adjusting for hierarchical distal factors, the health problems mostly associated with worsening health state were: bad self-rated health (adjusted OR = 4.35, p < 0.001), health care seeking for mental health problem (adjusted OR = 3.95, p < 0.001), and for COVID-19 (adjusted OR = 3.60, p < 0.001). People who experienced sleep problems, worsening of back pain, depression and at least one flu symptom during the pandemic were twice as likely to report worsening of health status. Sedentary and eating behaviors and adherence to social distancing measures showed significant correlation with the outcome. There exists a relation between social, biological, and psychological factors, mediated by lifestyles and variables pertaining to confinement. Altogether, these factors have negatively affected self-rated health during the COVID-19 pandemic in Brazil.

PMID:33950075 | DOI:10.1590/0102-311X00182720

Cad Saude Publica. 2021 Apr 30;37(3):e00221920. doi: 10.1590/0102-311X00221920. eCollection 2021.

ABSTRACT

This study analyzed changes in the prevalence of physical inactivity and sedentary behaviors according to correlates during the COVID-19 pandemic among Brazilian adults. A national retrospective online survey was conducted with 39,693 Brazilian adults. Physical activity (weekly frequency and daily duration; cut-off point of 150 minutes/week), TV-viewing time and computer/tablet use (daily duration; cut-off point of 4 hours/day) before and during the pandemic period were reported. Sex, age group, schooling level, skin color, per capita income, country region, working status during the quarantine, and adherence to the quarantine were the correlates. Descriptive statistics were used. The prevalence of physical inactivity, high TV-viewing time and computer/tablet use increased, respectively, 26%, 266%, and 38% during the pandemic. While increases in physical inactivity and computer/tablet were more widespread, higher increases in the prevalence of high TV viewing tiem were observed among younger adults (660%), with higher schooling level (437%) and those who were at home office (331%). The prevalence of physical inactivity and sedentary behaviors increased in all population sub-groups during the COVID-19 pandemic in Brazil.

PMID:33950077 | DOI:10.1590/0102-311X00221920

Rev Esc Enferm USP. 2021 Apr 30;55:e03741. doi: 10.1590/S1980-220X2020023903741. eCollection 2021.

ABSTRACT

OBJECTIVE: To evaluate the psychometric properties of the Jefferson Medical Empathy Scale, Spanish version (JSE-S), its factorial structure, reliability, and the presence of invariance between genders in the behavior of empathy levels among Chilean nursing students.

METHOD: Instrumental research design. The JSE-S was applied to 1,320 nursing students. A confirmatory factor analysis was used. An invariance study between genders was carried out. Descriptive statistics were estimated. Between genders, Student’s T distribution was applied alongside a homoscedasticity analysis. The level of significance was α ≤ 0.05.

RESULTS: The confirmatory factor analysis determined the existence of three dimensions in the matrix. The statistical results of the invariance tests were significant, and allowed comparison between genders. Differences were found between mean empathy values, as well as in some of its dimensions between genders.

CONCLUSION: The factor structure of empathy data and its dimensions is in correspondence with the underlying three-dimensional model. There are differences in empathy levels and their dimensions between genders, with the exception of the compassionate care dimension, which was distributed similarly. Women were more empathetic than men.

PMID:33950108 | DOI:10.1590/S1980-220X2020023903741

Menopause. 2021 May 3. doi: 10.1097/GME.0000000000001789. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the impact of vitamin D levels on early clinical function outcomes and the potential risk factors of moderate-to-severe pain prevalence in postmenopausal women after primary total knee arthroplasty (TKA).

METHODS: From April 2017 to December 2019, 226 women were retrospectively recruited. The women were divided into two groups based on their preoperative serum 25-hydroxyvitamin D levels: (1) vitamin D-sufficient group (≥30 ng/mL); (2) vitamin D-deficient group (<30 ng/mL). The visual analog scale, Western Ontario and McMaster Arthritis Index score, and Knee Society Score were used to evaluate clinical outcomes. Risk factors for developing postoperative moderate-to-severe knee pain were studied using multivariate binary logistic regression analyses.

RESULTS: There was no significant difference in preoperative clinical function assessment between the two groups. The difference in postoperative Western Ontario and McMaster Arthritis Index score between the two groups was statistically significant (15.3 ± 0.7 vs 15.6 ± 0.7: P = 0.02). However, the differences in postoperative visual analog scale and Knee Society Score scores between the two groups were not significant (P > 0.05). The incidence of postoperative moderate-to-severe pain was 16.4% (95% CI 11.8%-21.9%). Multivariate logistic regression analysis revealed that vitamin D deficiency, smoking, and high body mass index were potential risk factors for moderate-to-severe knee pain in postmenopausal women early after TKA (P < 0.05).

CONCLUSION: Preoperative vitamin D deficiency may adversely affect early functional outcomes in postmenopausal women after TKA. In addition, vitamin D deficiency, smoking, and high body mass index were independent risk factors for moderate-to-severe knee pain after surgery.

PMID:33950032 | DOI:10.1097/GME.0000000000001789

Rev Esp Salud Publica. 2021 May 5;95:e202105063.

ABSTRACT

OBJECTIVE: In college students, higher risk alcohol consumption (drunkenness and binge drinking-BD) has negative consequences on their development and and probably facilitates risk sexual behaviors. The objective was to study if risky sexual behaviors when consuming alcohol (RSBA) are associated with higher risk consumption.

METHODS: Cross-sectional multicenter study with UniHcos Project, 1^st year university students from 11 universities in Spain, academic years 2011-2012 to 2017-2018 data. This data were collected by self-administered questionnaire. A uni and bivariate analysis was performed, evaluated the statistical significance of the differences in prevalence with chi-square. Mean and standard deviation were used for quantitative variables and Student’s t test statistic was used.

RESULTS: 9,862 subjects (72.2% women). 90.3% reported having consumed alcohol and 60.9% had drunk the last year, 49% BD in last month. It was deteded in men, significantly higher consumption in the last month and drunkenness. Last month consumption and drunkenness were significantly higher in men and in <21 years. The RSBA were significantly higher among who were drunk (15.7% unprotected sex, 1.9% sexual abuse and 0.7% taking sexual advantage) and had BD (17.1%, 1.9% and 0.7 %). Women with both risk consumptions had more sexual abuse (2.2%), and men had greater behaviors of taking sexual advantage of someone (drunk: 1.2%; BD: 1.3%).

CONCLUSIONS: Alcohol consumption was above similar groups. BD consumption was similar by gender and age. Risk sexual behaviors appear mainly in problematic consumption. Gender differences are not detected in alcohol consumers in unprotected sex but deteded in the rest.

PMID:33950045

Cardiovasc J Afr. 2021 Apr 15;32:1-6. doi: 10.5830/CVJA-2021-011. Online ahead of print.

ABSTRACT

BACKGROUND: Hypertension has long been recognised as a major risk factor for coronary artery disease, stroke and kidney disease. Despite a multitude of new pharmacological agents, in the Sudan, a significant proportion of hypertensive patients’ blood pressure remains uncontrolled. An important, often underutilised treatment approach is therapeutic lifestyle changes (TLC). This study aimed to assess the knowledge, attitude and practice of patients with regard to TLC in the management of hypertension in a Khartoum locality in 2016.

METHODS: The study was cross sectional and descriptive. Data were collected via structured interviews using a questionnaire. Full coverage of patients attending Ahmed Gasim and Al-Shaab hospitals for follow up during August and September 2016 was carried out. Descriptive and inferential statistics were utilised for data analysis.

RESULTS: We identified 112 patients for participation in this study. There was a slight preponderance of females (54.5%) and older age, with 58% in the 55- to 70-year age group. When assessed for knowledge on lifestyle and habits that affect blood pressure, respondents were most familiar with the fact that salt consumption affects blood pressure, 93.8% answering correctly. After knowledge scores were calculated, only 31.3% of participants had above-average knowledge on blood pressure and TLC. The lifestyle change the respondents were least adherent to was regular exercise, with 59.8% of participants struggling with this. Participants’ most-cited obstacle was lack of motivation, the same answer being most frequent for each lifestyle change.

CONCLUSIONS: This study demonstrated that although the hypertensive patients were generally aware of the importance of TLC in its management, they struggled to implement this. The researcher believes that novel approaches are needed to help motivate patients who are diagnosed with hypertension in a third-world country such as Sudan, and apply their knowledge regarding TLC.

PMID:33950069 | DOI:10.5830/CVJA-2021-011