Category: Statistics

Med Lav. 2021 Dec 23;112(6):496-505. doi: 10.23749/mdl.v112i6.12285.

ABSTRACT

OBJECTIVE: To evaluate the psychological state of healthcare workers (HCWs) in the field of rehabilitation during the COVID-19 pandemic.

METHODS: Cross-sectional observational study. Sample of 334 HCWs including: nurses, medical doctors, therapists, scientists, and clerical workers working at the IRCCS San Raffaele Roma rehabilitation hospital during the second wave of the COVID-19 pandemic. Anonymous web-based questionnaire included 14-item Resilience Scale, Brief-COPE, Hospital Anxiety Depression Scale, Fear of COVID-19 Scale. Occupational and sociodemographic characteristics.

RESULTS: High levels of resilience, low levels of anxiety, depression, and fear were observed in the study population; the most frequently used coping strategies in the Brief-COPE were acceptance, planning, and active coping. Specifically, 87% of the participants reported a moderate to high level of resilience, with the highest level observed in nurses while physicians show the lowest level. HCWs showed symptoms of anxiety (29%), depressive symptoms (10%), and fear caused by the COVID-19 pandemic (44%). Statistically significant differences were observed between different occupations for fear (p <0.05) and resilience (p <0.01). Levels of anxiety and fear appeared to be higher in female and younger workers. The latter group – who also reported higher levels of depression – showed lower levels of resilience.

CONCLUSIONS: In our study hospital and non-hospital workers show different emotional, cognitive, and behavioural resources when facing stressful situations, like in the case of the SARS-CoV-2 pandemics. Our results support the role of resilience and the proper use of problem-focused and emotion-focused coping strategies as protective factors from psychological distress.

PMID:34939618 | DOI:10.23749/mdl.v112i6.12285

Histol Histopathol. 2021 Dec 23:18414. doi: 10.14670/HH-18-414. Online ahead of print.

ABSTRACT

BACKGROUND: Fetal vascular malperfusion (FVM) can be diagnosed on placental examination based on histology of distal placental villi and large muscular placental vessels. While histology of both those placental compartments can be low grade or high grade, it is not known if these are clinically equivalent. This retrospective study aimed to compare the impact of placental distal villous and large vessel FVM lesions on clinical and placental phenotypes.

METHODS: Clinical and placental phenotypes of 479 consecutive ≥20 weeks of gestation at delivery cases of placental FVM were analyzed among 3 groups: Group 1: 86 cases with distal FVM (clusters of sclerotic distal villi and/or those with stromal vascular karyorrhexis and/or mineralization, and/or endothelial fragmentation by CD34 immunostain) without large vessel lesions; Group 2: 186 cases with large vessel lesions (fetal vascular ectasia, vascular thrombi, stem vessel obliteration, intramural fibrin deposition) without distal villous lesions; and Group 3: 207 cases showing both distal villous lesions and large fetal vessel lesions.

RESULTS: Statistically significant differences (Bonferroni correction) were observed in: average gestational age at delivery 31, 35, 34 weeks, fetal growth restriction 24, 9, 25%, average placental weight 318, 413, 366 g, postuterine pattern of chronic hypoxic placental injury 12, 2, 6%, luminal vascular abnormalities in stem vessels 16, 3, 11%, and high grade FVM 33, 16, 39%, among Groups 1-3, respectively.

CONCLUSION: Because of longer time needed for its development, distal FVM portends poorer prognosis for the fetus than large vessel FVM.

PMID:34939657 | DOI:10.14670/HH-18-414

Psychiatr Hung. 2021;36(4):504-517.

ABSTRACT

The “Act on the Development of the Health Care System, CXXXII/2006” ordered a general reduction in the number of hospital beds, which sensitively affected the care of psychiatric inpatients, too. In this wave of downsizing, the National Institute of Psychiatry and Neurology, an institute with the traditions of one and a half centuries, also ceased to exist. Based on statistical data, the article examined the effect of the law on inpatient and outpatient psychiatric/ addictological care. The reduction in the number of beds had a long-term effect only upon the reduction in the capacity of acute inpatient care; while the number of acute patients treated decreased, the number of involuntary hospital admissions increased and oddly enough, bed occupancy also decreased. This last phenomenon can in part be attributed to a reduction in nursing time. The patient care decreased in both adult and pediatric psychiatric out – patient care, as did similarly the turnover of outpatient clinics for addicts. However, the changes observed in outpatient care were not related to the bed number reduction, but rather meant the continuation of previously started decline in psychiatric/addictological care. There were no detectable changes in the trends for other examined characteristics, such as homelessness and involuntary treatment. A temporary increase was observed only in the number of completed suicides, but the previously seen decreasing trend was restored in this respect after 2011. All in all, the reduction in the number of beds forced by law caused only temporary care disruptions and had no significant effect, either positive or negative, on the negative trends in psychiatric/addictological care that started earlier. However, the reasons for these negative trends observed in Hungarian psychiatric/addictological care, and which still persist to this day, are unclear.

PMID:34939569

J Public Health Manag Pract. 2021 Dec 21. doi: 10.1097/PHH.0000000000001469. Online ahead of print.

ABSTRACT

CONTEXT: Sexually transmitted infections (STIs) continue to increase in the United States. Publicly funded sexually transmitted disease (STD) clinics provide important safety net services for communities at greater risk for STIs. However, creating financially sustainable models of STI care remains a challenge.

OBJECTIVE: Characterization of clinic insurance billing practices and patient willingness to use insurance.

DESIGN: Cross-sectional survey assessment of clinic administrators and patients.

SETTING: Twenty-six STD clinics and 4138 patients attending these clinics in high STD morbidity metropolitan statistical areas in the United States.

PARTICIPANTS: Clinic administrators and patients of these clinics.

INTERVENTION: Survey assessment.

MAIN OUTCOME MEASURE: Insurance billing practices of STD clinics and patient insurance status and willingness to use their insurance.

RESULTS: Fifteen percent of clinics (4/26) indicated that they billed only Medicaid, 58% (15/26) billed both Medicaid and private insurance, 27% (7/26) did not bill for any health insurance, and none (0%) billed only private health insurance companies. Of 4138 patients surveyed, just more than one-half of patients (52.6%) were covered by some form of health insurance. More than one-half (57.2%) of all patients covered by health insurance indicated that they would be willing to use their health insurance for that visit. After adjusting for patient demographics and clinic characteristics, the patients covered by government insurance were 3 times as likely (odds ratio: 3.16; 95% confidence interval, 2.44-4.10) than patients covered by private insurance to be willing to use their insurance for their visit.

CONCLUSION: Opportunities exist for sustainable STI services through the enhancement of billing practices in STD clinics. The STD clinics provide care to large numbers of individuals who are both insured and who are willing to use their insurance for their care. As Medicaid expansion continues across the country, efforts focused on improving reimbursement rates for Medicaid may improve financial sustainability of STD clinics.

PMID:34939604 | DOI:10.1097/PHH.0000000000001469

JMIR Form Res. 2021 Dec 17. doi: 10.2196/32302. Online ahead of print.

ABSTRACT

BACKGROUND: The ongoing rumors and fake news regarding food fraud, adulteration, and contamination are highly visible. Health risk information circulating through media and interpersonal communication channels has made health crisis an important research agenda.

OBJECTIVE: This study explores the issue of food fraud and the effect of rumors, incidents, and misinformation. Further, it studies whether and how these issues have provided evidence-based interventions for food handlers and regulators to mitigate food fraud misinformation.

METHODS: The Health Information National Trends Survey (HINTS) was adopted for collaborative study in China, after which a cross-sectional survey with door-to-door interviews was performed. Participants from Beijing and Hefei were selected using multistage sampling of adults during May, 2017. Based on four government surveillance reports on food rumors and safety incidents, a descriptive, correlation, and multivariate variance analysis was applied to the data.

RESULTS: A total of 3,090 results were gathered and analyzed. An average of 83.6% (n = 2,584) respondents heard at least one food rumor. Learning about food fraud is correlated with interpersonal connections (e.g., doctors or health specialists) for accessing food health information. Overall, Chinese citizens with a higher level of interpersonal connection were more likely to be concerned about food incidents with the statistical difference (P< .001). The Interpersonal connection was the highest frequency of communication sources (n = 698, 55.7%), followed by traditional media (n = 325, 25.9%) and Internet portal (n = 144, 11.5%). There was a significant relationship between media use and media category in Beijing (P<.001) and in Hefei (P<.001). Overall, Beijing’s responses to the food fraud and incidents risks were lower than in Hefei (P < .01). The respondents in Beijing were confronted more frequently by food rumors (range 346-1253) than those in Hefei (range 155-946). The urban dwellers in Beijing and their rural counterparts in Hefei also differ in terms of perceiving different levels of food risk from different media sources. The food rumor narratives examined the conspiracy belie finds that social media play a more important role in influencing attitude against misinformation for users in Hefei, rather than in Beijing.

CONCLUSIONS: A media complementarity and food fraud information acquisition examined food fraud rumors and incidents with intent to harm, mainly done for economic gain. The HINTS China reports that around 73.6% out of 2,584 Chinese respondents prefer to go to their physicians for quarrying food health information first; however, when asked where they actually went and got access to food rumors, up to 36.6% of out of 1,462 Beijing respondents and 55.6% out of 1,122 Hefei respondents reported going online first. This study extends beyond local food products to foreign countries that import conspiracy beliefs with fake food. Nonetheless, consumers have to be on guard not just against fake food, but also spreading fake information and rumors about food. The aim of this study is to focus on characterizing media sources, types of food fraud misinformation, and risk perception of food safety, which mixes urgency and suspicions, and to provide evidence-based interventions for risk management guidance, with the hypotheses of the significant correlations between media types and sources and consumers’ exposing and perceiving levels of food rumors and risks.

PMID:34939565 | DOI:10.2196/32302

Br J Neurosurg. 2021 Dec 23:1-8. doi: 10.1080/02688697.2021.2019677. Online ahead of print.

ABSTRACT

PURPOSE: Due to brain shift during bilateral deep brain stimulation (DBS) surgery, placement of the second electrode may be subjected to more error than that of the first electrode. The authors aimed to investigate the accuracy of second electrode placement in this setting.

MATERIALS AND METHODS: Fifty-five patients with Parkinson’s disease who underwent bilateral DBS surgery (110 electrodes) were retrospectively evaluated. The targets were subthalamic nucleus (STN) and globus pallidus interna (GPi) in 40 and 15 cases, respectively. Preoperative planning and postoperative electrode images were co-registered to compare the error margin between the two sides.

RESULTS: There is a statistically significant difference in the directional axis error along the y axis only when comparing each laterality (posterior 0.04 ± 1.21 mm vs anterior 0.41 ± 1.07 mm, p = 0.006). There is no significant difference of other error parameters, final track location, and number of microelectrode recording passes between the two sides. In a subgroup analysis, there is a significant difference in directional axis error along the y axis only in the STN subgroup (posterior 0.40 ± 1.05 mm vs anterior 0.18 ± 1.04 mm, p = 0.003).

CONCLUSION: Although a statistically significant difference in directional axis error along the y axis was found between first and second electrode placements in the STN group but not in the GPi group, its magnitude is well below the clinically significant threshold.

PMID:34939521 | DOI:10.1080/02688697.2021.2019677

Orbit. 2021 Dec 23:1-7. doi: 10.1080/01676830.2021.2002368. Online ahead of print.

ABSTRACT

PURPOSE: To report the microbiologic profile and antibiotic susceptibility trends in orbital cellulitis.

METHODS: Retrospective review of microbiology records of orbital cellulitis between 2005 and 2019. Orbital pus or conjunctival swab underwent culture for bacteria and fungi and antibiotic susceptibility testing for bacterial isolates. The microbiological profile and trends in antibiotic susceptibility were analyzed over the three study periods: 2005-2009, 2010-2014, and 2015-2019.

RESULTS: Of the 203 patient samples, 189 (93%) were orbital pus samples, and 146 (72%) were culture positive. Organisms included bacteria (167/203, 82.3%), fungi (13/203, 6.4%), and mixed infection (25/203, 10.3%). Among bacteria, 79% were gram positive, with Staphylococcus aureus and Streptococcus species being commonest, and 21% were gram negative, with Pseudomonas aeruginosa and Enterobacteriaceae group being the commonest. Aspergillus flavus was the most common fungus isolated. Trend analysis revealed no change in the number of sterile cases and fungal cellulitis. Increase in gram positive bacteria was statistically significant (p = .0002) between 2005-2009 and 2015-2019. The increase in gram negative bacteria was statistically significant (p = .047) between all three time periods. Susceptibility patterns showed increasing trend of resistance to fluoroquinolones, that reached statistical significance for Ciprofloxacin, Moxifloxacin and Gatifloxacin (p < .05). Sterile sample was not found in any of the pediatric (0-16 years) cases (n = 55), compared to 28% in adults.

CONCLUSION: There was a significant rise in gram positive and negative orbital infections over the 15 year period, with increased resistance to fluoroquinolones. Fungal cellulitis and sterile samples showed a steady trend. Orbital aspirate provides accurate detection of the causative organism.

PMID:34939530 | DOI:10.1080/01676830.2021.2002368

J Intensive Care Med. 2021 Dec 23:8850666211067509. doi: 10.1177/08850666211067509. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether surge conditions were associated with increased mortality.

DESIGN: Multicenter cohort study.

SETTING: U.S. ICUs participating in STOP-COVID.

PATIENTS: Consecutive adults with COVID-19 admitted to participating ICUs between March 4 and July 1, 2020.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: The main outcome was 28-day in-hospital mortality. To assess the association between admission to an ICU during a surge period and mortality, we used two different strategies: (1) an inverse probability weighted difference-in-differences model limited to appropriately matched surge and non-surge patients and (2) a meta-regression of 50 multivariable difference-in-differences models (each based on sets of randomly matched surge- and non-surge hospitals). In the first analysis, we considered a single surge period for the cohort (March 23 – May 6). In the second, each surge hospital had its own surge period (which was compared to the same time periods in matched non-surge hospitals).Our cohort consisted of 4342 ICU patients (average age 60.8 [sd 14.8], 63.5% men) in 53 U.S. hospitals. Of these, 13 hospitals encountered surge conditions. In analysis 1, the increase in mortality seen during surge was not statistically significant (odds ratio [95% CI]: 1.30 [0.47-3.58], p = .6). In analysis 2, surge was associated with an increased odds of death (odds ratio 1.39 [95% CI, 1.34-1.43], p < .001).

CONCLUSIONS: Admission to an ICU with COVID-19 in a hospital that is experiencing surge conditions may be associated with an increased odds of death. Given the high incidence of COVID-19, such increases would translate into substantial excess mortality.

PMID:34939474 | DOI:10.1177/08850666211067509

Perfusion. 2021 Dec 23:2676591211063830. doi: 10.1177/02676591211063830. Online ahead of print.

ABSTRACT

PURPOSE: The primary aim of this study was to examine the effects of two oxygenator systems on major adverse events and mortality.

METHODS: A total of 181 consecutive patients undergoing coronary artery bypass grafting in our clinic were retrospectively analyzed. The patients were divided into two groups according to the oxygenator used: Group M, in which a Medtronic Affinity (Medtronic Operational Headquarters, Minneapolis, MN, USA) oxygenator was used, and Group S, in which a Sorin Inspire (Sorin Group Italia, Mirandola, Italy) oxygenator was used.

RESULTS: Group S consisted of 89 patients, whereas Group M included 92 patients. No statistically significant differences were found between the two groups in terms of age (p = .112), weight (p = .465), body surface area (p = .956), or gender (p = .484). There was no statistically significant difference in hemorrhage on the first or second postoperative day (p = .318 and p = .455, respectively). No statistically significant differences were observed in terms of red blood cell (p = .468), fresh frozen plasma (p = .116), or platelet concentrate transfusion (p = .212). Infections, wound complications, and delayed sternal closure were significantly more common in Group M (p = .006, p = .023, and p = .019, respectively). Extracorporeal membrane oxygenators and intra-aortic balloon pumps were required significantly more frequently in Group S (p = .025 and p = .013, respectively). Major adverse events occurred in 16 (18%) patients in Group S and 14 (15.2%) patients in Group M (p = .382). Mortality was observed in six (6.7%) patients in Group S and three (3.3%) patients in Group M (p = .232). No statistically significant difference was found between the two groups in terms of length of hospital stay (p = .451).

CONCLUSION: The clinical outcomes of the two oxygenator systems, including mortality, major adverse events, hemorrhage, erythrocyte and platelet transfusions, and length of hospital stay, were similar.

PMID:34939512 | DOI:10.1177/02676591211063830

Sci Prog. 2021 Oct;104(4):368504211059976. doi: 10.1177/00368504211059976.

ABSTRACT

BACKGROUND: This study aims to compare the diagnostic accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) for the articular-sided partial-thickness rotator cuff tear (PTRCT).

METHODS: Three electronic databases, PubMed/Medline, Embase and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting articular-sided PTRCTs. The pooled statistical indexes included sensitivity, specificity, positive/negative predictive value, diagnostic odds ratio (DOR) and the area under the receiver operating characteristic curve (AUC).

RESULTS: Eleven studies involving 1703 patients and 1704 shoulders were included. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRA to diagnose articular-sided PTRCTs were 0.81 (95% CI, 0.65-0.90), 0.96 (95% CI, 0.91-0.98), 68.14 (95% CI, 33.20-139.84) and 0.96 (95% CI, 0.94-0.97), respectively. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRI were 0.78 (95% CI, 0.65-0.87) and 0.97 (95% CI, 0.84-0.99), 47.82 (95% CI, 8.29-275.89) and 0.89 (95% CI, 0.86-0.92), respectively.

CONCLUSIONS: This meta-analysis reveals that MRA has a better diagnostic value than that of MRI for the diagnosis of articular-sided partial-thickness rotator cuff tears because of an improvement of sensitivity.

PMID:34939473 | DOI:10.1177/00368504211059976