Category: Statistics

Domest Anim Endocrinol. 2021 Sep 4;78:106677. doi: 10.1016/j.domaniend.2021.106677. Online ahead of print.

ABSTRACT

Caseous Lymphadenitis (CLA) is an infectious disease that affects small ruminants, and the bacterium Corynebacterium pseudotuberculosis is its etiologic agent. This disease presents a high morbidity and a great economic impact on goat farming, leading to reduced milk and meat production and reproductive losses. The available data about the influence of C. pseudotuberculosis on the reproductive system were obtained after experimental inoculations. In this way, this study aimed to evaluate the influence of the natural infection by C. pseudotuberculosis on the luteal function and serum progesterone (P₄) levels in goats. Sixteen female goats were diagnosed for the presence of C. pseudotuberculosis specific antibodies and divided into 2 groups: CLA positive and negative animals. They were submitted to estrous synchronization, followed by controlled mating. Corpus luteum and serum levels of P₄ were evaluated on the 7th and 20th days after mating (D7 and D20). The ultrasonographic results were not statistically different between the 2 groups, as well as serum P₄ levels on D7. However, a significant increase in serum P₄ levels on the CLA positive group was identified on D20, along with a significant correlation between C. pseudotuberculosis specific antibody production, and P₄ serum levels. The result of this study indicates that the infection by C. pseudotuberculosis may influence the reproductive status of female goats through an enhanced production of progesterone.

PMID:34644669 | DOI:10.1016/j.domaniend.2021.106677

Health Soc Care Community. 2021 Oct 13. doi: 10.1111/hsc.13605. Online ahead of print.

ABSTRACT

Home-care professionals need competences to ensure that they evaluate their older peoples’ health conditions, especially in acute care situations. This study aims to investigate the effectiveness of combined web-based and simulation-based continuing education on home-care professionals’ competence regarding evaluating older people’s needs for acute care. A quasi-experimental pre-test-post-test study was conducted with home-care professionals who were working in older people’s care in Finland. Home-care professionals (N = 254) had participated in combined web-based and simulation-based continuing education in 2017-2019. Data were collected using a questionnaire developed for this study before (n = 171) and after (n = 83) the education. The data were analysed statistically. The mean competence score was 3.22 ± 0.51 before the education and 3.92 ± 0.57 after the education. Improvements were detected in overall competence and in all eight subscales. Improvements were highest in health assessment and consultation and the lowest in type 2 diabetes, but this was already the highest level of self-assessed competence in the pre-test assessment. The combined web-based and simulation-based continuing education was effective in increasing the home-care professionals’ competence in evaluating older people’s needs for acute care. Evaluating older people’s needs for acute care should be embedded in curricula and continuing education programmes.

PMID:34644436 | DOI:10.1111/hsc.13605

Acad Emerg Med. 2021 Oct 13. doi: 10.1111/acem.14399. Online ahead of print.

ABSTRACT

INTRODUCTION: Transthoracic echocardiography (TTE) is a standard procedure for emergency physicians (EPs). Transesophageal echocardiography (TEE) is known to have great utility in patients who are critically ill or in cardiac arrest, and has been used by some EPs with specialized ultrasound training, but it is generally considered outside the reach of the majority of EPs. We surmised that all of our EPs could learn to perform focused TEE (F-TEE), so we trained and credentialed all of the physicians in our group.

METHODS: We trained 52 EPs to perform and interpret F-TEEs using a 4-hour simulator-based course. We kept a database of all F-TEE exams for quality assurance and continuous quality feedback. Data is reported using descriptive statistics.

RESULTS: EPs attempted 557 total F-TEE exams (median 10, IQR 5, 15) during the 42-month period following training. Clinically relevant images were obtained in 99% of patients. EPs without fellowship or other advanced ultrasound training performed the majority of F-TEEs (417, 74.9%) and 94.3% (95% CI 91.4-96.3%) had interpretable images recorded. When TTE and TEE were both performed (n =410), image quality of TEE was superior in 378 (93.3%; 95% CI 89.7-95%). Indications for F-TEE included peri-arrest states (55.7%), cardiac arrest (32.1%), and shock (12.2%). There was one case of endotracheal tube dislodgement during TEE placement, but this was immediately identified and replaced without complication.

CONCLUSION: After initiating a mandatory group F-TEE training and credentialing program, we report the largest series to date of EP-performed resuscitative F-TEE. The majority of F-TEE exams (75%) were performed by EPs without advanced ultrasound training beyond residency.

PMID:34644420 | DOI:10.1111/acem.14399

Scand J Med Sci Sports. 2021 Oct 13. doi: 10.1111/sms.14081. Online ahead of print.

ABSTRACT

This study aimed to examine 1) adherence to 24-hour movement guidelines over a 2-year follow-up in children aged 6-8 years and 2) association of this adherence with cardiometabolic risk factors. Physical activity and sleep were assessed by a monitor combining heart rate and accelerometry measurements. Screen time was reported by the parents. Body fat percentage, waist circumference, blood glucose, serum insulin, plasma lipids and blood pressure were assessed, and a cardiometabolic risk score was calculated using z-scores. Children were classified as meeting the guidelines if they had on average ≥60min/day of moderate-to-vigorous physical activity during the valid days; ≤120min/day of screen time; and 9-11h/day of sleep. In total, 485 children had valid data at baseline or at 2-year follow-up. Analyses were conducted using adjusted logistic and linear regression models. Most children adhered to the 24-hour movement guidelines at baseline, but the adherence decreased over the 2-year follow-up. Meeting physical activity guidelines individually, or in combination with screen time and/or sleep, was longitudinally associated with a lower cardiometabolic risk score, insulin and waist circumference, and cross-sectionally additionally with lower diastolic blood pressure and higher high-density lipoprotein cholesterol. However, these associations became statistically non-significant after adjustment for body fat. In conclusion, meeting 24-hour movement guidelines at baseline increases the odds of meeting them at 2-year follow-up in school-aged children. Furthermore, meeting 24-hour movement guidelines is associated with lower levels of cardiometabolic risk factors, but these associations are partly explained by lower body fat. Thus, promoting movement behaviors, especially physical activity, and healthy weight in early childhood is important in supporting cardiometabolic health in children.

PMID:34644434 | DOI:10.1111/sms.14081

Radiat Res. 2021 Oct 13. doi: 10.1667/RADE-20-00244.1. Online ahead of print.

ABSTRACT

To investigate the optimal pre- and post-adaptive statistical iterative reconstruction-V (ASiR-V) levels in pediatric abdominal computed tomography (CT) to minimize radiation exposure and maintain image quality using an animal model. A total of 10 standard piglets were selected and scanned to obtain unenhanced and enhanced images under different pre-ASiR-V conditions. The corresponding images were obtained using ASiR-V algorithm at different post-ASiR-V levels. CT value, signal-to-noise ratio (SNR), contrast noise ratio (CNR) of abdominal tissues, subjective image score, and radiation dose of unenhanced and enhanced scans were analyzed. With the increase of pre-ASiR-V level, the radiation dose in piglets gradually decreased (P < 0.05). Within the same group of pre-ASiR-V, the image noise was decreased (P < 0.05) by increasing post-ASiR-V level. There was no statistical difference between SNR and CNR values. In unenhanced CT, the subjective score of the images with the combination of 40% pre- and 60% post-ASiR-V levels had no statistical difference compared to the combination of 0% pre- and 60% post-ASiR-V levels, while the radiation dose decreased by 31.6%. In the enhanced CT, the subjective image score with the 60% pre- and 60% post-ASiR-V combination had no statistical difference compared to the 0% pre- and 60% post-ASiR-V combination, while the radiation dose was reduced by 48.9%. The combined use of pre- and post-ASiR-V maintains image quality at the reduced radiation dose. The optimal level for unenhanced CT is 40% pre-combined with 60% post-ASiR-V, while that for enhanced CT is 60% pre- combined with 60% post-ASiR-V in pediatric abdominal CT.

PMID:34644380 | DOI:10.1667/RADE-20-00244.1

Fam Pract. 2021 Oct 13:cmab129. doi: 10.1093/fampra/cmab129. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiometabolic multimorbidity (CM) is the diagnosis of 2 or more cardiometabolic conditions. Multimorbidity and individual cardiometabolic conditions have been associated with activity limitation, a common form of disability, but few studies have investigated the association between CM and activity limitation.

OBJECTIVES: To estimate the prevalence of activity limitation among Canadians with CM and to quantify the association between CM and activity limitation.

METHODS: Using data from the Canadian Longitudinal Study on Aging, we conducted a cross-sectional analysis of activity limitation among Canadians aged 45-85 (n = 50,777; weighted n = 13,118,474). CM was defined as the diagnosis of 2 or more of diabetes/prediabetes, myocardial infarction, and stroke, and activity limitation was evaluated using the Older Americans Resources and Services scale. Descriptive statistics and logistic and multinomial logistic regression analyses were conducted to determine the association between CM and activity limitation.

RESULTS: The estimated prevalence of activity limitation among participants living with CM was 27.4% compared with 7.5% with no cardiometabolic conditions. Activity limitation increased in prevalence and severity with the number of cardiometabolic conditions. People with CM had increased odds of activity limitation compared with those without any cardiometabolic conditions (adjusted relative risk ratio = 3.99, 95% confidence interval [3.35-4.75]), and the odds increased with each additional condition. Stroke survivors had greater odds of activity limitation than those without a history of stroke and the same number of cardiometabolic conditions.

CONCLUSION: Activity limitation is common among Canadians living with CM. Odds of activity limitation increase with each additional cardiometabolic condition, especially for stroke survivors.

PMID:34644392 | DOI:10.1093/fampra/cmab129

PLoS One. 2021 Oct 13;16(10):e0258509. doi: 10.1371/journal.pone.0258509. eCollection 2021.

ABSTRACT

BACKGROUND: Variable, and typically inadequate, delivery of skills training following manual wheelchair (MWC) provision has a detrimental impact on user mobility and participation. Traditional in-person delivery of training by rehabilitation therapists has diminished due to cost, travel time, and most recently social distancing restrictions due to COVID-19. Effective alternative training approaches include eHealth home training applications and interactive peer-led training using experienced and proficient MWC users. An innovative TEAM Wheels program integrates app-based self-training and teleconference peer-led training using a computer tablet platform.

OBJECTIVE: This protocol outlines implementation and evaluation of the TEAM Wheels training program in a randomized control trial using a wait-list control group.

SETTING: The study will be implemented in a community setting in three Canadian cities.

PARTICIPANTS: Individuals ≥ 18 years of age within one year of transitioning to use of a MWC.

INTERVENTION: Using a computer tablet, participants engage in three peer-led teleconference training sessions and 75-150 minutes of weekly practice using a video-based training application over 4 weeks. Peer trainers individualize the participants’ training plans and monitor their tablet-based training activity online. Control group participants also receive the intervention following a 1-month wait-list period and data collection.

MEASUREMENTS: Outcomes assessing participation; skill capacity and performance; self-efficacy; mobility; and quality of life will be measured at baseline and post-treatment, and at 6-month follow-up for the treatment group.

IMPACT STATEMENT: We anticipate that TEAM Wheels will be successfully carried out at all sites and participants will demonstrate statistically significant improvement in the outcome measures compared with the control group.

PMID:34644350 | DOI:10.1371/journal.pone.0258509

PLoS One. 2021 Oct 13;16(10):e0258446. doi: 10.1371/journal.pone.0258446. eCollection 2021.

ABSTRACT

OBJECTIVE: Surge capacity refers to preparedness of health systems to face sudden patient inflows, such as mass-casualty incidents (MCI). To strengthen surge capacity, it is essential to understand MCI epidemiology, which is poorly studied in low- and middle-income countries lacking trauma databases. We propose a novel approach, the “systematic media review”, to analyze mass-trauma epidemiology; here piloted in Rwanda.

METHODS: A systematic media review of non-academic publications of MCIs in Rwanda between January 1st, 2010, and September 1st, 2020 was conducted using NexisUni, an academic database for news, business, and legal sources previously used in sociolegal research. All articles identified by the search strategy were screened using eligibility criteria. Data were extracted in a RedCap form and analyzed using descriptive statistics.

FINDINGS: Of 3187 articles identified, 247 met inclusion criteria. In total, 117 MCIs were described, of which 73 (62.4%) were road-traffic accidents, 23 (19.7%) natural hazards, 20 (17.1%) acts of violence/terrorism, and 1 (0.09%) boat collision. Of Rwanda’s 30 Districts, 29 were affected by mass-trauma, with the rural Western province most frequently affected. Road-traffic accidents was the leading MCI until 2017 when natural hazards became most common. The median number of injured persons per event was 11 (IQR 5-18), and median on-site deaths was 2 (IQR 1-6); with natural hazards having the highest median deaths (6 [IQR 2-18]).

CONCLUSION: In Rwanda, MCIs have decreased, although landslides/floods are increasing, preventing a decrease in trauma-related mortality. By training journalists in “mass-casualty reporting”, the potential of the “systematic media review” could be further enhanced, as a way to collect MCI data in settings without databases.

PMID:34644363 | DOI:10.1371/journal.pone.0258446

PLoS One. 2021 Oct 13;16(10):e0258556. doi: 10.1371/journal.pone.0258556. eCollection 2021.

ABSTRACT

BACKGROUND: Trichomonas vaginalis infection is underreported due to nonspecific clinical presentation and the nonavailability of sensitive laboratory diagnostic tests at the clinical setup. Hence, this study was designed to compare the sensitivity and specificity of microscopy and culture methods with polymerase chain reaction (PCR). The socio-demographic factors associated with the infection were explored.

METHODS: The study was carried out at the National Sexually Transmitted Diseases and Acquired Immuno Deficiency Syndrome Control Programme in Colombo and Sexually Transmitted Diseases and Acquired Immuno Deficiency Syndrome Control Programme in Kandy. Samples were collected from a total of 385 patients including, 272 females (70.7%) and 113 males (29.3%), and tested using microscopy (wet mount and Giemsa staining), culture, and PCR. Genus-specific primer set (TFR1/TFR2) that amplifies 5.8S rRNA and species-specific primer sets (TV16Sf-2/TV16Sr-2 and TVK3/7) that amplifies 18S rRNA and repetitive DNA, respectively, were used. Patient’s socio-demographic and sexual behaviour data were obtained using a standard interviewer-administered questionnaire. Data were analyzed with R statistical software Version 3.6.3.

RESULTS: The overall prevalence of trichomoniasis was 4.4% (17/385). Of these, six (1.6%) were positive for microscopic examination, 7 (1.8%) were positive for culture, and 13 (3.4%) for TVK3/7, 15 (3.9%) for TV16Sf/r, and TFR1/2 17 (4.4%) were positive for PCR. Sensitivities of PCR using TFR1/2, TV16Sf/r, and TVK3/7 primer sets were 100%, 88.20%, and 76.50%, respectively, against the expanded gold standard. Trichomoniasis was associated with age above 36 (p = 0.033), not using condoms in last three months (p = 0.016), multiple sex partners (p = 0.001), reason for attendance (p = 0.027), symptomatic nature (p = 0.015), and the presence of other sexually transmitted diseases (p = 0.001).

CONCLUSIONS: The study highlighted that age over 36 years, multiple sex partners, not using condoms, reason for attendance, symptomatic nature, and having other sexually transmitted diseases can increase the risk of acquiring trichomoniasis. Furthermore, this study confirmed PCR as highly sensitive and specific diagnostic test for the diagnosis of trichomoniasis in comparison to microscopy and culture methods.

PMID:34644344 | DOI:10.1371/journal.pone.0258556

PLoS One. 2021 Oct 13;16(10):e0258537. doi: 10.1371/journal.pone.0258537. eCollection 2021.

ABSTRACT

BACKGROUND: Real-world big data studies using health insurance claims databases require extraction algorithms to accurately identify target population and outcome. However, no algorithm for Crohn’s disease (CD) has yet been validated. In this study we aim to develop an algorithm for identifying CD using the claims data of the insurance system.

METHODS: A single-center retrospective study to develop a CD extraction algorithm from insurance claims data was conducted. Patients visiting the Kitasato University Kitasato Institute Hospital between January 2015-February 2019 were enrolled, and data were extracted according to inclusion criteria combining the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) diagnosis codes with or without prescription or surgical codes. Hundred cases that met each inclusion criterion were randomly sampled and positive predictive values (PPVs) were calculated according to the diagnosis in the medical chart. Of all cases, 20% were reviewed in duplicate, and the inter-observer agreement (Kappa) was also calculated.

RESULTS: From the 82,898 enrolled, 255 cases were extracted by diagnosis code alone, 197 by the combination of diagnosis and prescription codes, and 197 by the combination of diagnosis codes and prescription or surgical codes. The PPV for confirmed CD cases was 83% by diagnosis codes alone, but improved to 97% by combining with prescription codes. The inter-observer agreement was 0.9903.

CONCLUSIONS: Single ICD-code alone was insufficient to define CD; however, the algorithm that combined diagnosis codes with prescription codes indicated a sufficiently high PPV and will enable outcome-based research on CD using the Japanese claims database.

PMID:34644342 | DOI:10.1371/journal.pone.0258537