Category: Statistics

J Indian Soc Pedod Prev Dent. 2021 Apr-Jun;39(2):196-201. doi: 10.4103/JISPPD.JISPPD_247_20.

ABSTRACT

BACKGROUND: Multiple factors can affect early childhood caries (ECC). Maternal stress and child’s temperament, as predictors of child behavior, are among factors that may be associated with ECC.

OBJECTIVES: The aim of this study was to evaluate the association between the salivary cortisol level of mothers as an indicator of maternal stress, child’s temperament, and ECC.

METHODS: Ninety preschool children, who were divided into three groups of ECC, severe ECC (S-ECC), and caries-free (CF), were included in this study, as well as their mothers with no history of anxiety disorders. The salivary cortisol levels of mothers were analyzed using ELISA assay. Children were examined for the evidence of caries, using the decayed-missing-filled teeth index, based on the World Health Organization standard criteria. Child temperament was also assessed, using Cloninger’s Preschool Temperament and Character Inventory, consisting of seven significant factors (cooperativeness, harm avoidance, novelty seeking, reward dependence, persistence, self-directing, and self-transcendence).

RESULTS: The association between the salivary cortisol level of mothers and temperament of children with S-ECC was positive although it was not statistically significant (P > 0.05). Of seven temperament factors, only harm avoidance was significantly different between the CF and S-ECC groups (P = 0.016).

CONCLUSION: Maternal stress and child’s temperament were not associated with ECC. Based on the present findings, children with less harm avoidance may be more prone to S-ECC.

PMID:34341241 | DOI:10.4103/JISPPD.JISPPD_247_20

J Indian Soc Pedod Prev Dent. 2021 Apr-Jun;39(2):202-207. doi: 10.4103/jisppd.jisppd_426_20.

ABSTRACT

BACKGROUND: Atraumatic restorative treatment (ART) and chemomechanical removal of dental caries have been shown to be safe and effective restorative procedures. However, current literature lacks well-design studies comparing the pain perceived by infants using ART and chemo-mechanical removal techniques.

AIMS: To compare pain perception of children of two techniques (ART vs. chemomechanical removal) of restorative treatments for dental caries removal.

SETTINGS AND DESIGN: A randomized clinical trial with two parallels arms (1:1) was conducted in the cities of Manaus (AM) and Uberlândia (MG), Brazil.

METHODS: Children between 4 and 9 years old were selected. In both groups – ART (n = 20) and chemomechanical caries removal (Papaya^® gel) (n = 20) – oximeter measurements (heart rate and blood oxygenation) were performed before the intervention and until the complete removal of the infected caries dentin. At the end of the treatment, a Wong-Baker scale was used to assess pain perception during the procedure. An independent researcher measured, in minutes, the duration of each technique.

STATISTICAL ANALYSIS: Poisson regression analysis was used to evaluate the association between the outcome and the explicative variables.

RESULTS: No statistical difference in pain perception between the two procedures of carious tissue removal was observed. By contrast, a lower heart rate was observed when chemomechanical removal was used (P = 0.013).

CONCLUSION: Children that underwent chemomechanical caries removal presented lower heart rate compared to those who underwent ART. However, both techniques showed minimal or absent perceived pain.

PMID:34341242 | DOI:10.4103/jisppd.jisppd_426_20

Psychiatry Investig. 2021 Jul;18(7):661-669. doi: 10.30773/pi.2020.0447. Epub 2021 Jul 22.

ABSTRACT

OBJECTIVE: Precarious workers have increased over the past two decades in South Korea. Employment instability, especially among young adults, is considered a serious social problem. The unstable employment status of precarious workers has negative impacts on their mental health, such as suicidal behavior. This study aims to identify the effect of the unstable employment conditions on the suicidal behavior of precarious workers.

METHODS: An online survey was conducted with a panel sample of South Korean adults (n=797) who were precarious workers aged between 25-34 years. We applied Model 6 of SPSS PROCESS MACRO 3.5 to examine the multiple mediation effects of depression and anger in the relationship between employment instability and suicide.

RESULTS: Unstable employment had no direct effect on suicidal behavior. The path of unstable employment to suicidal behavior via depression and anger had a significant indirect effect. However, employment and anger were negatively related. The indirect effect of depression and anger on the relation between unstable employment and suicidal behavior was statistically significant.

CONCLUSION: This study suggests an association between unstable employment and suicidal behavior, mediated by depression and anger. Specifically, a high level of unstable employment status increased depression. In contrast, a low level of unstable employment status increased anger, which ultimately led to an increase in suicidal behavior. These contrasting findings are likely to reflect the heterogeneity of precarious workers. Further longitudinal studies are necessary to identify the causality between precarious employment and suicidal behavior over time.

PMID:34340275 | DOI:10.30773/pi.2020.0447

Eur J Neurosci. 2021 Aug 2. doi: 10.1111/ejn.15407. Online ahead of print.

ABSTRACT

To relate individual differences in music perception ability with whole brain white matter connectivity, we scanned a group of twenty-seven individuals with varying degrees of musical training and assessed musical ability in sensory and sequential music perception domains using the Profile of Music Perception Skills-Short version (PROMS-S). Sequential processing ability was estimated by combining performance on tasks for Melody, Standard Rhythm, Embedded Rhythm, and Accent sub-scores while sensory processing ability was ascertained via tasks of Tempo, Pitch, Timbre and Tuning. Controlling for musical training, gender and years of training, Network Based Statistics revealed positive linear associations between total PROMS-S scores and increased inter-hemispheric fronto-temporal and parieto-frontal white matter connectivity, suggesting a distinct segregated structural network for music perception. Secondary analysis revealed two sub-networks for sequential processing ability, one comprising of ventral fronto-temporal and sub-cortical regions and the other comprising dorsal fronto-temporo-parietal regions. A graph-theoretic analysis to characterize the structural network revealed a positive association of modularity of the whole brain structural connectome with the d` total score. In addition, the nodal degree of the right posterior cingulate cortex also showed a significant positive correlation with the total d`score. Our results suggest that a distinct structural network of connectivity across fronto-temporal, cerebellar and cerebro-subcortical regions is associated with music processing abilities and the right posterior cingulate cortex mediates the connectivity of this network.

PMID:34340255 | DOI:10.1111/ejn.15407

Stat Med. 2021 Aug 2. doi: 10.1002/sim.9155. Online ahead of print.

ABSTRACT

Dynamic treatment regimes (DTRs), consisting of a sequence of tailored treatment decision rules that span multiple stages of care, present a unique opportunity in our drive toward personalized medicine. Given that estimation of optimal DTRs is often exploratory and communication with clinicians is vital, robust and flexible methods that yield interpretable results are needed. Tree-based methods utilizing a purity measure defined on the full set of covariates have enjoyed much success in meeting this goal. Often, however, it is necessary for clinical, practical, or ethical reasons to restrict certain covariates that should be used when making treatment decisions. Herein we present restricted sub-tree learning (ReST-L), a flexible and robust, sub-tree-based method to estimate an optimal multi-stage multi-treatment DTR that enables restrictions to the set of prespecified candidate tailoring variables. ReST-L employs a purity measure derived from an augmented inverse probability weighted estimator for the counterfactual mean outcome, using observational data to build multi-stage decision trees that are restricted in sub-tree spaces defined by the corresponding prescriptive covariates. We show that ReST-L is able to correctly estimate the optimal DTR searching over a large number of variables with relatively small sample sizes and improves upon competing estimation methods. We demonstrate the utility of ReST-L to estimate a two-stage fluid resuscitation strategy for patients admitted to an intensive care unit with acute emergent sepsis.

PMID:34340264 | DOI:10.1002/sim.9155

Nature. 2021 Aug 2. doi: 10.1038/s41586-021-03843-2. Online ahead of print.

ABSTRACT

Enhancing vaccine uptake is a critical public health challenge¹. Overcoming vaccine hesitancy^2,3 and failure to follow-through on vaccination intentions³ requires effective communication strategies^3,4. We present two sequential randomized controlled trials (RCTs) to test the impact of behavioral interventions on COVID-19 vaccine uptake. We designed text-based reminders that make vaccination salient and easy, and delivered them to patients of a healthcare system one day (first RCT; N=93,354, clinicaltrials #NCT04800965) and eight days (second RCT; N=67,092, NCT04801524) after they received notification of vaccine eligibility. The first reminder boosted appointments and vaccination rates within the healthcare system by 6.07 (84%) and 3.57 (26%) percentage points, respectively; the second reminder increased those outcomes by 1.65 and 1.06 percentage points, respectively. The first reminder was more impactful when it made patients feel the vaccine was already theirs. However, we find no evidence that combining it with an information intervention addressing vaccine hesitancy heightened its effect. Online studies (N=3,181) examining vaccination intentions reveal divergent patterns from the first RCT, underscoring the importance of pilot-testing interventions in the field. These findings inform the design of behavioral nudges for promoting health decisions⁵, highlighting the value of making vaccination easy and inducing feelings of ownership.

PMID:34340242 | DOI:10.1038/s41586-021-03843-2

Stat Med. 2021 Aug 2. doi: 10.1002/sim.9151. Online ahead of print.

ABSTRACT

In the statistical literature, a number of methods have been proposed to ensure valid inference about marginal effects of variables on a longitudinal outcome in settings with irregular monitoring times. However, the potential biases due to covariate-driven monitoring times and confounding have rarely been considered simultaneously, and never in a setting with an ordinal outcome and a continuous exposure. In this work, we propose and demonstrate a methodology for causal inference in such a setting, relying on a proportional odds model to study the effect of the exposure on the outcome. Irregular observation times are considered via a proportional rate model, and a generalization of inverse probability of treatment weights is used to account for the continuous exposure. We motivate our methodology by the estimation of the marginal (causal) effect of the time spent on video or computer games on suicide attempts in the Add Health study, a longitudinal study in the United States. Although in the Add Health data, observation times are prespecified, our proposed approach is applicable even in more general settings such as when analyzing data from electronic health records where observations are highly irregular. In simulation studies, we let observation times vary across individuals and demonstrate that not accounting for biasing imbalances due to the monitoring and the exposure schemes can bias the estimate for the marginal odds ratio of exposure.

PMID:34340246 | DOI:10.1002/sim.9151

Br J Haematol. 2021 Aug 2. doi: 10.1111/bjh.17691. Online ahead of print.

ABSTRACT

Patients with asymptomatic/smouldering Waldenström macroglobulinaemia (SWM) have a variable risk of progression to active WM. Our study evaluated 143 patients with SWM consecutively seen between January 1996 and December 2013. With a median [95% confidence interval (CI)] follow-up of 9·5 [8·1-11·5] years, the cumulative rate of progression was 11% at 1 year, 38% at 3 years and 55% at 5 years. On multivariate analysis, haemoglobin (Hb) ≤123 g/l [risk ratio (RR) 2·08; P = 0·009] and β₂ -microglobulin (β₂ M) ≥2·7 µg/ml (RR 2·0; P = 0·01) were independent predictors of a shorter time-to-progression (TTP) to active WM. Patients with myeloid differentiation factor 88 wild type (MYD88^WT ) genotype (n = 11) demonstrated a trend toward shorter TTP [median (95% CI) 1·7 (0·7-8·7) vs. 4·7 (2·4-7·7) years for the MYD88^L265P cohort, n = 42; P = 0·11]. The presence of C-X-C chemokine receptor type 4 (CXCR4) mutation (n = 29) did not impact the TTP (median: 3 years for CXCR4^WT vs. 5·6 years for CXCR4^MUT , P = 0·34). The overall survival (OS) for patients with SWM (median: 18·1 years) was comparable to an age-, sex- and calendar year-matched USA population (median: 20·3 years, P = 0·502). In conclusion, Hb and β₂ M at diagnosis represent independent predictors of progression to active WM. Comparable survival of SWM and a matched USA population argues against pre-emptive intervention in this patient population.

PMID:34340248 | DOI:10.1111/bjh.17691

Oncology. 2021 Aug 2:1-7. doi: 10.1159/000517738. Online ahead of print.

ABSTRACT

INTRODUCTION: Heterogeneous tumor response has been reported in cancer patients treated with immune checkpoint inhibitors (ICIs). This study investigated whether the tumor site is associated with the response to ICIs in patients with recurrent or metastatic esophageal squamous cell carcinoma (ESCC).

METHODS: Patients with ESCC who had measurable tumors in the liver, lung, or lymph node (LN) according to the response evaluation criteria in solid tumors (RECIST) 1.1 and received ICIs at 2 medical centers in Taiwan were enrolled. In addition to RECIST 1.1, tumor responses were determined per individual organ basis according to organ-specific criteria modified from RECIST 1.1. Fisher test or χ2 test was used for statistical analysis.

RESULTS: In total, 37 patients were enrolled. The overall response rate per RECIST 1.1 was 13.5%. Measurable tumors in the LN, lung, and liver were observed in 26, 17, and 13 patients, respectively. The organ-specific response rates were 26.9%, 29.4%, and 15.4% for the LN, lung, and liver tumors, respectively (p = 0.05). The organ-specific disease control rates were 69.2%, 52.9%, and 21.1% for the LN, lung, and liver tumors, respectively (p = 0.024). Five (27.8%) among 18 patients harboring at least 2 involved organs had heterogeneous tumor response.

CONCLUSION: The response and disease control to ICIs may differ in ESCC tumors located at different metastatic sites, with a lesser likelihood of response and disease control in metastatic liver tumors than in tumors located at the LNs and lung.

PMID:34340231 | DOI:10.1159/000517738

Gerontology. 2021 Aug 2:1-14. doi: 10.1159/000517659. Online ahead of print.

ABSTRACT

Youth, working age and the elderly: On a timeline, chronological age (CA) and biological age (BA) may dissociate; nosological entities manifest themselves at different BAs. In determining which disease corresponds to a given age decade, statistical registries of causes of death are unreliable and this does not change with SARS CoV-2 infection. Beyond adolescence, ageing metrics involve estimations of changes in fitness, including prediction models to estimate the number of remaining years left to live. A substantial disparity in biomarker levels and health status of ageing can be observed: the difference in CA and BA in the large cohorts under consideration is glaring. Here, we focus more closely on ageing and senescence metrics in order to make information available for risk analysis non the least with COVID-19, including the most recent risk factors of ABO blood type and 3p21.31 chromosome cluster impacting on C5a and SC5b-9 plasma levels. From the multitude of routine medical laboratory assays, a potentially meaningful set of assays aimed to best reflect the stage of individual senescence; hence risk factors the observational prospective SENIORLABOR study of 1,467 healthy elderly performed since 2009 and similar approaches since 1958 can be instantiated as a network to combine a set of elementary laboratory assays quantifying senescence.

PMID:34340235 | DOI:10.1159/000517659