Category: Statistics

Eur J Orthod. 2021 May 5:cjab017. doi: 10.1093/ejo/cjab017. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the long-term skeletal stability following maxillary advancement using Rigid External Distraction (RED) in growing and non-growing patients with Cleft Lip and Palate (CLP).

METHODS: Data sources: A systematic literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from database inception till August 2020 in MEDLINE-PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, Google Scholar and a manual search in the institutional library. Study eligibility criteria, participants and intervention: All available literature published in English, with a minimum of six human subjects with well-defined age range either 7-14.9 years or 15-30 years, follow up period of a minimum of 12 months assessing the skeletal stability as horizontal change at Point A (Subspinale) following maxillary advancement using a RED device, without the use of rigid internal fixation or bone grafts were included in the study. Study appraisal and synthesis method: The quality assessment of selected articles was done using the Newcastle-Ottawa scale. The meta-analysis was carried out with Q statistic method, I-squared statistics, fixed-effect model to estimate pooled mean and Begg-Mazumdar bias indicator.

RESULTS: Selected nine articles that were qualitatively assessed for relapse rate following maxillary advancement using a RED device, showed consistent and stable results. The meta-analysis found no significant difference in long-term skeletal stability of maxillary advancement by RED device in growing and non-growing patients with CLP [(growing group: Pooled proportion = 0.2927; 95% CI = 0.1534 to 0.4319) (non-growing group: Pooled proportion = 0.23077; 95% CI = 0.09854 to 0.36300)].

LIMITATIONS: No study, as revealed by the search, was available that compared the two groups as defined by the inclusion criteria. Data for the two groups were retrieved from different studies and meta-analysed.

CONCLUSION: RED is an effective modality for correction of maxillary hypoplasia secondary to CLP, requiring large maxillary advancement. The technique can be used in young and adult patients with similar long-term results.

PROSPERO REGISTRATION NUMBER: CRD42020205513.

PMID:33950171 | DOI:10.1093/ejo/cjab017

Codas. 2021 May 3;33(1):e20190026. doi: 10.1590/2317-1782/20202019026. eCollection 2021.

ABSTRACT

PURPOSE: evaluate the influence of frenotomy on the breastfeeding of newborns diagnosed with ankyloglossia.

METHODS: this is an intervention study performed with 50 newborns diagnosed with ankyloglossia. It was conducted in three stages: diagnosis, intervention and reassessment. In the diagnostic phase, the Protocol for the Assessment of Speech Language with Scores for Babies was applied to diagnose ankyloglossia and a questionnaire assessing the symptoms and coordination of sucking, swallowing and breathing during breastfeeding. In the intervention, frenotomy was performed, and at reassessment, the diagnostic protocol and questionnaire in order to compare the post-surgical effects.

RESULTS: of the 50 babies participating in the study, 35 (70%) were boys and 15 (30%) girls. A total of 68% of ankyloglossia cases were reported in the family, a majority (38%) involving cousins. There was a statistically significant reduction in the average protocol score in the reassessment stage, from 8.38 (7-12 points) to 0.86 (0-5 points), as well as a statistically significant improvement in all variables related to the symptoms of breastfeeding.

CONCLUSION: surgical intervention, known as frenotomy, made it possible to improve the negative symptoms of breastfeeding in newborns diagnosed with ankyloglossia.

PMID:33950144 | DOI:10.1590/2317-1782/20202019026

JAMA Psychiatry. 2021 May 5. doi: 10.1001/jamapsychiatry.2021.0480. Online ahead of print.

ABSTRACT

IMPORTANCE: Racial/ethnic and sex disparities in suicide ideation and attempts are well established, with higher risk of suicide ideation and attempt among US racial/ethnic minority school-aged youths (than their White peers) and girls and women (than boys and men). The suicide-related risk of racial/ethnic minority young adults, especially young women, may be strongly influenced by adverse childhood experiences, known early determinants of suicide ideation and attempts.

OBJECTIVES: To assess lifetime and past-year prevalence estimates of suicide ideation and suicide attempt and to examine sex differences in the role of adverse childhood experiences as a prospective risk factor for Puerto Rican young adults from 2 sociocultural contexts.

DESIGN, SETTING, AND PARTICIPANTS: Data in this longitudinal cohort study are from 4 waves of the Boricua Youth Study, a population-based cohort study of Puerto Rican children from San Juan and Caguas, Puerto Rico, and the South Bronx, New York, 5 to 17 years of age (N = 2491; waves 1-3: 2000-2004) and 15 to 29 years of age (wave 4: 2013-2017). Data analysis was performed from February 26, 2019, to October 16, 2020.

EXPOSURES: Adverse childhood experiences were assessed by interview in childhood and early adolescence (waves 1-3) and included child maltreatment (physical, sexual, and emotional abuse and neglect), exposure to violence, parental loss (separation, divorce, and death), and parental maladjustment (mental health problems, substance or alcohol abuse, intimate partner violence, and incarceration).

MAIN OUTCOMES AND MEASURES: Lifetime and past-year suicide ideation and attempt were assessed in young adulthood (wave 4) using the World Health Organization Composite International Diagnostic Interview.

RESULTS: Among 2004 Puerto Rican young adults (80.4% of the original cohort; mean [SD] age, 22.9 [2.8] years; 1019 [50.8%] male), young women compared with young men had a higher prevalence of lifetime suicide attempt (9.5% vs 3.6%) and lifetime suicide ideation (16.4% vs 11.5%), whereas past-year suicide ideation (4.4% vs 2.4%) was not statistically different. Logistic regression models, adjusting for demographics and lifetime psychiatric disorders, found that young women but not young men with more adverse childhood experiences had higher odds of suicide ideation (lifetime; odds ratio [OR], 2.44; 95% CI, 1.54-3.87; past year: OR, 2.56; 95% CI, 1.18-5.55). More adverse childhood experiences were also prospectively associated with lifetime suicide attempt (OR, 1.16; 95% CI, 1.04-1.29), irrespective of sex.

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that, among Puerto Rican young adults from 2 different sociocultural contexts, adverse childhood experiences were relevant to understanding suicide attempt and suicide ideation, the latter specifically among young women. The prevention of cumulative adverse childhood experiences could reduce later risk of suicide attempts and, among young women, for suicide ideation.

PMID:33950163 | DOI:10.1001/jamapsychiatry.2021.0480

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