Category: Statistics

Crit Care Med. 2021 Apr 26. doi: 10.1097/CCM.0000000000005051. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the association of socioeconomic status as measured by the average socioeconomic status of the area where a person resides on short-term mortality in adults admitted to an ICU in Queensland, Australia.

DESIGN: Secondary data analysis using de-identified data from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation linked to the publicly available area-level Index of Relative Socioeconomic Advantage and Disadvantage from the Australian Bureau of Statistics.

SETTING: Adult ICUs from 35 hospitals in Queensland, Australia, from 2006 to 2015.

PATIENTS: A total of 218,462 patient admissions.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: The outcome measure was inhospital mortality. The main study variable was decile of Index of Relative Socioeconomic Advantage and Disadvantage. The overall crude inhospital mortality was 7.8%; 9% in the most disadvantaged decile and 6.9% in the most advantaged decile (p < 0.001). Increasing socioeconomic disadvantage was associated with increasing severity of illness as measured by Acute Physiology and Chronic Health Evaluation III score, admission with a diagnosis of sepsis or trauma, cardiac, respiratory, renal, and hepatic comorbidities, and remote location. Increasing socioeconomic advantage was associated with elective surgical admission, hematological and oncology comorbidities, and admission to a private hospital (all p < 0.001). After excluding patients admitted after elective surgery, in the remaining 106,843 patients, the inhospital mortality was 13.6%, 13.3% in the most disadvantaged, and 14.1% in the most advantaged. There was no trend in mortality across deciles of socioeconomic status after excluding elective surgery patients. In the logistic regression model adjusting for severity of illness and diagnosis, there was no statistically significant difference in the odds ratio of inhospital mortality for the most disadvantaged decile compared with other deciles. This suggests variables used for risk adjustment may lie on the causal pathway between socioeconomic status and outcome in ICU patients.

CONCLUSIONS: Socioeconomic status as defined as Index of Relative Socioeconomic Advantage and Disadvantage of the area in which a patient lives was associated with ICU admission diagnosis, comorbidities, severity of illness, and crude inhospital mortality in this study. Socioeconomic status was not associated with inhospital mortality after excluding elective surgical patients or when adjusted for severity of illness and admission diagnosis. Commonly used measures for risk adjustment in intensive care improve understanding of the pathway between socioeconomic status and outcomes.

PMID:34259436 | DOI:10.1097/CCM.0000000000005051

Crit Care Med. 2021 Jul 2. doi: 10.1097/CCM.0000000000005189. Online ahead of print.

ABSTRACT

OBJECTIVES: Patients suffering from spontaneous subarachnoid hemorrhage frequently require mechanical ventilation. Here, we aimed to identify factors associated with prolonged mechanical ventilation in subarachnoid hemorrhage patients and to create a new predictive score for prolonged mechanical ventilation.

DESIGN: Prospective cohort study with retrospective data analysis.

SETTING: Neurocritical care unit at a tertiary academic medical center.

PATIENTS: Two hundred ninety-seven consecutive nontraumatic adult subarachnoid hemorrhage patients.

METHODS: In patients with mechanical ventilation, we identified factors associated with mechanical ventilation greater than 48 hours, greater than 7 days, and greater than 14 days compared with mechanical ventilation less than or equal to 48 hours, less than or equal to 7 days, or less than or equal to 14 days in multivariable generalized linear models. Ventilated patients who died before 48 hours, 7 days, or 14 days and those never ventilated were excluded from the respective analysis. We incorporated those factors into a new prognostic score (the RAISE score) to predict prolonged mechanical ventilation greater than 7 days. The calculation was based on a random dataset of 60% of subarachnoid hemorrhage patients and was internally validated.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Patients were 57 years old (interquartile range, 47-68 yr) and presented with a median Hunt and Hess grade of 3 (1-5). Two hundred forty-two patients (82%) required mechanical ventilation for 9 days (2-20 d). In multivariable analysis, a higher Acute Physiology Score was associated with mechanical ventilation greater than 48 hours, greater than 7 days, and greater than 14 days, a higher Hunt and Hess grade with greater than 7 days and greater than 14 days. Early neuroimaging findings were associated with mechanical ventilation greater than 48 hours (hydrocephalus; high-grade Subarachnoid Hemorrhage Early Brain Edema Score), greater than 7 days (high-grade Subarachnoid Hemorrhage Early Brain Edema Score, co-occurrence of intracerebral bleeding) but not with prolonged mechanical ventilation greater than 14 days. The RAISE score, including age, Acute Physiology Score, Hunt and Hess grade, Subarachnoid Hemorrhage Early Brain Edema Score, and the co-occurrence of intracerebral hemorrhage accurately stratified patients by prolonged mechanical ventilation greater than 7 days (C-statistic 0.932). A RAISE score of 12 predicted 60% likelihood of mechanical ventilation greater than 7 days.

CONCLUSIONS: Initial disease severity and neuroimaging findings detected within 24 hours after ICU admission were associated with the need for prolonged mechanical ventilation in patients with subarachnoid hemorrhage. These results may be helpful for patient families and caregivers to better anticipate the course of therapy.

PMID:34259444 | DOI:10.1097/CCM.0000000000005189

Oral Health Prev Dent. 2021 Jan 7;19(1):383-389. doi: 10.3290/j.ohpd.b1749707.

ABSTRACT

PURPOSE: To investigate the practices, knowledge and opinions of French dental students (FDSs) in various domains of minimal intervention (MI) in cariology.

MATERIALS AND METHODS: A cross-sectional, questionnaire-based study was conducted in spring 2018 among all fifth-year French dental students (FDSs) from the 16 French dental schools. The present article focuses on restorative management. Statistical analyses (descriptive, chi-squared) were performed.

RESULTS: The response rate was 84.5%. Overall, 97.4% of respondents would have operatively intervened for proximal and 83% for occlusal carious lesions, respectively, while non-or micro-invasive intervention would have been possible. Interestingly, 15% would completely open the occlusal fissures. For both occlusal and proximal lesions requiring a restoration, composite resin was indicated by over 95% of the respondents. In a clinical case, 51.6% of FDSs who rightly diagnosed an enamel carious lesion would operatively intervene. When FDSs could not diagnose the type of carious lesions, a high proportion of invasive actions were also reported (40%). FDSs who read scientific articles were more likely to consider the high importance of not filling sound teeth unnecessarily (p = 0.033).

CONCLUSION: FDSs do not have sufficient awareness of MI guidelines regarding occlusal and proximal restorative thresholds. Efforts are required in dental schools to teach FDSs to postpone invasive/restorative strategies to later stages of carious progression. There is a need to strengthen prevention techniques and non-invasive options in the teaching of MI in cariology.

PMID:34259431 | DOI:10.3290/j.ohpd.b1749707

Oral Health Prev Dent. 2021 Jan 7;19(1):405-409. doi: 10.3290/j.ohpd.b1749761.

ABSTRACT

PURPOSE: Tongue coating is one of the primary causes of halitosis and some diseases such as aspiration pneumonia. However, to date, an effective method for reducing the bacterial count of tongue coating has not been established. We conducted a randomised-controlled study to compare the efficacy of three types of disinfectants approved for oral use in Japan in reducing the bacterial count of tongue coating.

MATERIALS AND METHODS: Thirty-two participants were randomly assigned to the following four groups according to the solution used: 1. benzethonium chloride; 2. povidone iodine; 3. hydrogen peroxide; 4. tap water (control group). Tongue cleaning with the three test disinfectants and water was performed using a toothbrush, and the bacterial count on the tongue dorsum before and after tongue cleaning was measured using the Rapid Oral Bacteria Quantification System.

RESULTS: The bacterial count decreased statistically significantly after tongue brushing using povidone iodine and hydrogen peroxide solutions (both p = 0.012), but not after brushing using 0.2% benzethonium chloride and tap water.

CONCLUSION: Tongue brushing with povidone iodine or hydrogen peroxide was the most effective method for reducing the bacterial count of tongue coating.

PMID:34259433 | DOI:10.3290/j.ohpd.b1749761

Oral Health Prev Dent. 2021 Jan 7;19(1):353-363. doi: 10.3290/j.ohpd.b1693873.

ABSTRACT

PURPOSE: To assess the knowledge, attitude and perception of dentists (dental students, dental school graduates/interns, postgraduate dentists) of the role of robotics (R) and artificial intelligence (AI) in oral health and preventive dentistry. The null hypothesis was that dentists would not be aware of R and AI use in dentistry and would not be ready to accept them in oral health and preventive dentistry for dental care management and training.

MATERIALS AND METHODS: This was an observational cross-sectional study in which data was collected from a representative population in Saudi Arabia. 570 participants answered 26 closed-ended questions. The questionnaire’s validity and reliability were evaluated for vetting and remarks. The questionnaire collected demographic data of participants and their knowledge, perception and attitude about R and AI. Questions were to be answered with ‘yes’, ‘no’ and ‘I don’t know’. Descriptive statistical analysis was performed using the control chart technique and the chi-squared test, with statistical significance set at p < 0.05.

RESULTS: The majority of the participants (n = 313; 54.6%) were males. Dental students, dentist school graduates/interns, and postgraduate dentists comprised of 58.8%, 18.2%, and 23.0% respectively. Most of the respondents gave affirmative answers for knowledge, attitude and perception of R and AI (58.3%, 67.4%, and 60.3%, respectively). Participants agreed that R and AI is beneficial in dentistry and would provide better results. Most (83.3%) would be willing to be treated using R/AI and would recommend (84.5%) treatment with R/AI, as shown in the control chart by affirmative answers. These were significantly above the overall affirmative answers, as the corresponding point lies above 95% UCL (upper confidence limit).

CONCLUSION: Most dentists were unacquainted with R and AI. Dentists had a positive attitude towards R/AI, but due to inadequate knowledge and understanding, its use and applications were very limited. There is significant need in the near future to increase awareness of this concept, as it may increase treatment efficiency and effectiveness.

PMID:34259428 | DOI:10.3290/j.ohpd.b1693873

Oral Health Prev Dent. 2021 Jan 7;19(1):365-371. doi: 10.3290/j.ohpd.b1693857.

ABSTRACT

PURPOSE: It is hypothesised that systemic calcitonin delivery with adjunct local platelet-rich fibrin (PRF) therapy is more effective in augmenting osseointegration than calcitonin delivery alone under experimental osteoporosis conditions. The primary objective of the present experiment was to assess the effect of systemic calcitonin delivery with and without adjunct local PRF therapy on osseointegration in ovariectomised osteoporotic rabbits.

MATERIALS AND METHODS: Thirty female bilaterally ovariectomized rabbits were used. The animals were fed a low-calcium diet to establish a model for osteoporosis. In each animal, 2 implants were bilaterally placed in tibia. The animals were randomly divided equally into 3 groups. In group 1, no treatment was offered (control group). In groups 2 and 3, the animals received intramuscular injections of calcitonin without and with local PRF delivery prior to implant placement, respectively. All animals were euthanised at 12 weeks, and osseointegration was assessed as the gap widths between the bone and implant surface in the cervical, middle and apical third using scanning electron microscopy and energy-dispersive x-ray spectroscopy. The bone-to-implant contact (BIC) was also measured. p < 0.05 was defined as statistically significant.

RESULTS: Gap widths in the cervical (p < 0.001), middle (p < 0.001) and apical third (p < 0.001) were statistically significantly higher in group 1 than groups 2 and 3. Gap widths in the cervical (p < 0.001), middle (p < 0.001) and apical third (p < 0.001) were significantly higher in group 3 than group 2. The mean BIC was statistically significantly higher in the cervical (p < 0.001), middle (p < 0.001) and apical third (p < 0.001) in group 3 compared with groups 2 and 3.

CONCLUSIONS: When used as an adjunct to calcitonin, PRF enhanced osseointegration in an experimental osteoporosis model. However, further well-designed studies with inclusion of additional groups (treatment with PRF alone) are needed.

PMID:34259429 | DOI:10.3290/j.ohpd.b1693857

Oral Health Prev Dent. 2021 Jan 7;19(1):373-381. doi: 10.3290/j.ohpd.b1694115.

ABSTRACT

PURPOSE: To assess factors related to the prevalence of dental caries among adolescent schoolchildren attending marginalised schools in the West Bank area of Palestine.

MATERIALS AND METHODS: A cross-sectional study was conducted in schools participating in the School Support Program (SSP). Fifty schools identified as marginalised by the SSP were stratified by district, student gender and grade level to select a random sample of 20 schools. Students in the 6th and 9th grades were screened by senior dental students to collect data about their weight, height, gingival health and caries experience. In addition, a structured in-person questionnaire was used to collect data about students’ oral hygiene practices, dietary habits, mother’s education and father’s employment.

RESULTS: In total, 1282 students completed interviews and clinical screenings. The mean number of Decayed, Missing and Filled Teeth (DMFT) was 6.4 ± 4.4. Sixty-four percent had moderate gingivitis and 73% had fair oral hygiene. ‘Recent visit to the dentist’ was associated with mother’s level of education (X2 = 22.06, p < 0.001) and father’s employment (X2 = 24.02, p < 0.001). The final regression model showed that grade (β = 0.31, p < 0.001), gender (β = 0.06, p < 0.03), recent visit to the dentist (β = -0.06, p < 0.03) and drinking fresh juices (β = -0.05, p < 0.05) were statistically significant in explaining the high level of caries in this sample.

CONCLUSIONS: This study indicates that Palestinian adolescents in marginalised governmental schools suffer the highest burden of dental disease and are disproportionally impacted when compared to other same-age students in the region. A high burden of disease was directly associated with unfavourable dietary habits, poor oral hygiene practices and challenges to accessing dental care services, and was indirectly associated with father’s employment and mother’s level of education.

PMID:34259430 | DOI:10.3290/j.ohpd.b1694115

Oral Health Prev Dent. 2021 Jan 7;19(1):327-337. doi: 10.3290/j.ohpd.b1749661.

ABSTRACT

PURPOSE: To study the practices of general dentists, periodontists and dental hygienists who are members of the European Federation of Periodontology, regarding oral hygiene education, plaque control assessment, recommended dental and interdental hygiene tools, and antimicrobial agents.

MATERIALS AND METHODS: A web-based survey was sent to 13,622 members of the European Federation of Periodontology (EFP) through its 29 national member societies. It targeted general dentists (GD), specialists in periodontology (DSP) and dental hygienists (DH). Data were collected between 24 April and 17 May 2015. A data-driven statistical analysis was conducted and differences between professions were explored.

RESULTS: A total of 2076 answers were collected. Only the 2009 answers originating from GD, DSP and DH were analysed (67 answers originated from other professions and were excluded). Among those 2009 respondents, 43.2% were DSP and 37.2% were GD. Overall, DH, DSP and GD reported spending 17.1 minutes for the initial teaching of OH, with differences between professions (p < 0.0001). DH, GD and DSP exhibited differences in the type of toothbrushes they recommend (p < 0.0001). DSP recommended electric and manual toothbrushes (TB) equally. DH predominantly recommended electric TB (56.8%). Overall, 95% of DH, DSP and GD recommended interdental brushes, with no statistically significant differences between professions. Low concentration chlorhexidine was considered the most relevant antimicrobial agent for daily oral care of periodontitis patients. Half of GD prescribed antimicrobial mouthrinses for long-term use in 70%-100% of their patients with periodontitis.

CONCLUSION: EFP-affiliated practitioners allocate a significant amount of time to educating patients on oral health. Their practices are mostly in line with the current scientific evidence. Some discrepancies were found between the different professions. Similar surveys could be conducted over time to monitor the evolution of practices.

PMID:34259425 | DOI:10.3290/j.ohpd.b1749661

Oral Health Prev Dent. 2021 Jan 7;19(1):345-351. doi: 10.3290/j.ohpd.b1694095.

ABSTRACT

PURPOSE: To determine the impact of the brushing protocol on dentin wear by comparing continuous to intermittent brushing, with the same total time of brushing.

MATERIALS AND METHODS: Dentin specimens (n = 120) were evently distributed into six groups (A-F). The samples were brushed with slurries of different relative dentin abrasivity (RDA): Groups A+B (Sident 2480-1; RDA 85), groups C+D (Zeodent 113; RDA 67), and groups E+F (Zeodent 103; RDA 174). Groups A+C+E were brushed continuously (25 min) with one slurry preparation, while groups B+D+F were brushed intermittently (25 x 1 min) with a renewal of the slurry after each sequence. Dentin wear was determined using surface profilometry and statistically analysed with ANOVA and post-hoc tests.

RESULTS: Neither the mode of brushing (p = 0.72) nor the interaction (p = 0.18) of the brushing mode with the type of abrasive particles had a significant influence on the abrasive dentin wear. Only the type of abrasive particles had a statistically significant influence on abrasive dentin wear (p < 0.001).

CONCLUSION: The mode of brushing (continuously or intermittently) has no influence on abrasive dentin wear.

PMID:34259427 | DOI:10.3290/j.ohpd.b1694095

Zhongguo Zhen Jiu. 2021 Jul 12;41(7):762-6. doi: 10.13703/j.0255-2930.20200907-0004.

ABSTRACT

OBJECTIVE: To observe the short-term and long-term effects of moxibustion on plaque psoriasis of blood stasis, and to compare the curative effect between moxibustion and calcipotriol ointment.

METHODS: A total of 80 patients with plaque psoriasis of blood stasis were randomly divided into an observation group (40 cases, 2 cases dropped off) and a control group (40 cases, 4 cases dropped off). Both groups were given routine medical vaseline topical emollient basic treatment. In the observation group, moxibustion was applied to ashi point (target skin lesions), Zusanli (ST 36), Xuehai (SP 10) and Qihai (CV 6) for 30 min each time, 3 times a week. The control group was treated with calcipotriol ointment (0.25 g each time, once in the morning and evening) on the target skin lesions. Both groups were treated for 8 weeks. The psoriasis area and severity index (PASI) score before and after treatment, main clinical symptoms of TCM score and dermatology life quality index (DLQI) score before and after treatment and 3 and 6 moths follow-up were observed in the two groups; the clinical efficacy after treatment was evaluated and the recurrence rates of the two groups were followed up for 3 and 6 months after treatment.

RESULTS: After treatment, the PASI scores in the both groups were lower than before treatment (P<0.01). After treatment and 3 and 6 months follow-up, the main clinical symptoms of TCM scores and DLQI scores of the two groups were lower than those before treatment (P<0.05), and at 3 and 6 months follow-up, those in the observation group were lower than the control group (P<0.01). There was no statistically significant difference between the observation group and the control group in overall effective rate and target skin lesion effective rate (P>0.05). At 3 and 6 months follow-up, the overall recurrence rate and target skin lesion recurrence rate in the observation group were lower than those in the control group (P<0.05).

CONCLUSION: Both moxibustion and calcipotriol ointment have good short-term effects on plaque psoriasis of blood stasis. Moxibustion has more advantages in reducing the recurrence rate of psoriasis, improving the main clinical symptoms of TCM and quality of life.

PMID:34259409 | DOI:10.13703/j.0255-2930.20200907-0004