Category: Statistics

Cureus. 2023 Sep 29;15(9):e46217. doi: 10.7759/cureus.46217. eCollection 2023 Sep.

ABSTRACT

BACKGROUND: Patients with unilateral peripheral vestibular deficit (UPVD) experience vertigo, dizziness, disability, negative influences on their quality of life, anxiety, and depression. In vestibular rehabilitation, virtual reality (VR) has proven to be effective. This investigation sought to evaluate the efficacy of the Balance Rehabilitation Unit (BRU^TM) (Medicaa^TM Montevideo, Uruguay, Balance Suite, version BRU 415) in patients with UPVD.

METHODS: A prospective, randomized, controlled study involved 38 patients from the Otoneurologic Service at the National Institute of Rehabilitation “Luis Guillermo Ibarra Ibarra” in Mexico. A physician specialist diagnosed the patients with UPVD and assigned them randomly to one of two groups. Group 1 (n = 19) received traditional vestibular rehabilitation, whereas Group 2 (n = 19) received BRU^TM-supported vestibular rehabilitation. Both groups were monitored by medical professionals. Patients were evaluated with the Dizziness Handicap Inventory, static and dynamic balance assessments, the dynamic gait index, and the sensory organization test. The statistical analysis was conducted using the Student’s t-test, with p 0.05 considered statistically significant.

RESULTS: The difference in mean age between the conventional therapy and BRU^TM groups was not statistically significant. Both conventional vestibular rehabilitation and the BRU^TM led to statistically significant improvements in all assessed parameters, with no statistically significant differences between the two groups.

CONCLUSION: Balance, mobility, and quality of life were enhanced similarly in UPVD patients by BRU^TM-supported vestibular rehabilitation and conventional vestibular rehabilitation. In addition, BRU^TM facilitated patient motivation, exercise feedback, and confidence enhancement.

PMID:37905268 | PMC:PMC10613477 | DOI:10.7759/cureus.46217

J Med Internet Res. 2023 Oct 30;25:e46890. doi: 10.2196/46890.

ABSTRACT

BACKGROUND: Despite great efforts in HIV prevention worldwide, HIV testing uptake among men who have sex with men (MSM) remains suboptimal. The effectiveness of digital, crowdsourced, multilevel interventions in improving HIV testing is still unclear.

OBJECTIVE: The aim of this study was to evaluate the effect of a digital, crowdsourced, multilevel intervention in improving HIV testing uptake among MSM in China.

METHODS: We conducted a 2-arm cluster randomized controlled trial among MSM in 11 cities in Shandong province, China, from August 2019 to April 2020. Participants were men who were HIV seronegative or had unknown serum status, had anal sex with a man in the past 12 months, and had not been tested for HIV in the past 3 months. Participants were recruited through a gay dating app and community-based organizations from preselected cities; these cities were matched into 5 blocks (2 clusters per block) and further randomly assigned (1:1) to receive a digital, crowdsourced, multilevel intervention (intervention arm) or routine intervention (control arm). The digital multilevel intervention was developed through crowdsourced open calls tailored for MSM, consisting of digital intervention images and videos, the strategy of providing HIV self-testing services through digital tools, and peer-moderated discussion within WeChat groups. The primary outcome was self-reported HIV testing uptake in the previous 3 months. An intention-to-treat approach was used to examine the cluster-level effect of the intervention in the 12-month study period using generalized linear mixed models and the individual-level effect using linear mixed models.

RESULTS: A total of 935 MSM were enrolled (404 intervention participants and 531 controls); 751 participants (80.3%) completed at least one follow-up survey. Most participants were younger than 30 years (n=601, 64.3%), single (n=681, 72.8%), had a college degree or higher (n=629, 67.3%), and had an HIV testing history (n=785, 84%). Overall, the proportion of testing for HIV in the past 3 months at the 3-, 6-, 9-, and 12-month follow-ups was higher in the intervention arm (139/279, 49.8%; 148/266, 55.6%; 189/263, 71.9%; and 171/266, 64.3%, respectively) than the control arm (183/418, 43.8%; 178/408, 43.6%; 206/403, 51.1%; and 182/397, 48.4%, respectively), with statistically significant differences at the 6-, 9-, and 12-month follow-ups. At the cluster level, the proportion of participants who had tested for HIV increased 11.62% (95% CI 0.74%-22.5%; P=.04) with the intervention. At the individual level, participants in the intervention arm had 69% higher odds for testing for HIV in the past 3 months compared with control participants, but the result was not statistically significant (risk ratio 1.69, 95% CI 0.87-3.27; P=.11).

CONCLUSIONS: The intervention effectively improved HIV testing uptake among Chinese MSM. Our findings highlight that digital, crowdsourced, multilevel interventions should be made more widely available for HIV prevention and other public health issues.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900024350; http://www.chictr.org.cn/showproj.aspx?proj=36718.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-020-04860-8.

PMID:37902831 | DOI:10.2196/46890

JMIR Form Res. 2023 Oct 30;7:e47167. doi: 10.2196/47167.

ABSTRACT

BACKGROUND: Functional limitations are associated with poor clinical outcomes, higher mortality, and disability rates, especially in older adults. Continuous assessment of patients’ functionality is important for clinical practice; however, traditional questionnaire-based assessment methods are very time-consuming and infrequently used. Mobile sensing offers a great range of sources that can assess function and disability daily.

OBJECTIVE: This work aims to prove the feasibility of an interpretable machine learning pipeline for predicting function and disability based on the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 outcomes of clinical outpatients, using passively collected digital biomarkers.

METHODS: One-month-long behavioral time-series data consisting of physical and digital activity descriptor variables were summarized using statistical measures (minimum, maximum, mean, median, SD, and IQR), creating 64 features that were used for prediction. We then applied a sequential feature selection to each WHODAS 2.0 domain (cognition, mobility, self-care, getting along, life activities, and participation) in order to find the most descriptive features for each domain. Finally, we predicted the WHODAS 2.0 functional domain scores using linear regression using the best feature subsets. We reported the mean absolute errors and the mean absolute percentage errors over 4 folds as goodness-of-fit statistics to evaluate the model and allow for between-domain performance comparison.

RESULTS: Our machine learning-based models for predicting patients’ WHODAS functionality scores per domain achieved an average (across the 6 domains) mean absolute percentage error of 19.5%, varying between 14.86% (self-care domain) and 27.21% (life activities domain). We found that 5-19 features were sufficient for each domain, and the most relevant being the distance traveled, time spent at home, time spent walking, exercise time, and vehicle time.

CONCLUSIONS: Our findings show the feasibility of using machine learning-based methods to assess functional health solely from passively sensed mobile data. The feature selection step provides a set of interpretable features for each domain, ensuring better explainability to the models’ decisions-an important aspect in clinical practice.

PMID:37902823 | DOI:10.2196/47167

J Sports Med Phys Fitness. 2023 Oct 30. doi: 10.23736/S0022-4707.23.14966-8. Online ahead of print.

ABSTRACT

BACKGROUND: In air pistol shooters, the number of studies evaluating the physical characteristics is very few. The purpose of this study was to examine the relationship of core, scapula, and shoulder girdle muscles endurance on performance in air pistol shooters and to determine the importance of the endurance parameters.

METHODS: Twenty-eight male air pistol shooters were included. The Closed Kinetic Chain Upper Extremity Stability Test, Upper Quarter Y Balance Test, Prone Bridge Test, Side Bridge Endurance Test, and The Scapular Muscle Endurance Test were used to evaluate the endurance of shoulder girdle, core, and scapular muscles. The relationships between endurance and shooting performance parameters were investigated.

RESULTS: A positive moderate correlation was found between the scapular muscle endurance test and the shooting performance (P=0.002 r=0.638). A significant regression equation was found for shooting scores (F<inf>(1.26)</inf>=11.975, P=0.02, R2=0.315). It was observed that the shooting score increased by 0.375 points for each unit increase of the Scapular Muscle Endurance Test. No statistically significant relationship was observed in other parameters (P>0.05).

CONCLUSIONS: In this study, core and shoulder girdle muscle endurances were not associated with shooting performance. Scapular muscle endurance may contribute positively to shooting performance. An exercise program to increase scapular muscles endurance can be beneficial for the performance of shooters.

PMID:37902793 | DOI:10.23736/S0022-4707.23.14966-8

Ultrasound Obstet Gynecol. 2023 Oct 30. doi: 10.1002/uog.27522. Online ahead of print.

ABSTRACT

OBJECTIVE: To construct a prediction model for fetal growth restriction (FGR) during the first trimester (11-13⁺⁶ weeks) and evaluate its screening performance.

METHODS: Single pregnancies who underwent the first trimester (11-13⁺⁶ weeks) ultrasound screening at the Affiliated Suzhou Hospital of Nanjing Medical University from January 2019 to April 2022 were selected as prospective study subjects. Basic clinical information, ultrasound indicators, and serum indicators of pregnant women were collected. Fetal weight assessment was based on the fetal growth curve of the Southern Chinese population, and the definition of FGR was based on standards developed through the Delphi process. The least absolute shrinkage and selection operator (LASSO) regression method was used to select optimal features and analyze the predictive value of each indicator in the model. Finally, the model was constructed, and its discrimination, effectiveness, and clinical usefulness were evaluated.

RESULTS: A total of 1188 pregnant women were included in the final statistical analysis, of whom 108 had FGR. LASSO regression identified 7 predictive features, including a history of maternal hypertension, maternal smoking or passive smoking history, number of pregnancies, uterine artery pulsatility index (UtA PI), ductus venosus pulsatility index (DV PIV), placental growth factor multiples of the median (PlGF MOM), and soluble fms-like tyrosine kinase-1 (sFlt-1) MOM. The nomogram prediction model constructed based on the above predictors predicted FGR more accurately, and the area under the curve (AUC) in the validation cohort was 0.82 (95%CI: 0.74-0.90). The calibration curve and Hosmer-Lemeshow test demonstrated good calibration of the model, while the clinical decision curve and clinical impact curve conclusively support its practical value in the clinical setting.

CONCLUSION: The multi-index prediction model constructed during the first trimester is feasible and has good predictive value. This article is protected by copyright. All rights reserved.

PMID:37902789 | DOI:10.1002/uog.27522

Ultrasound Obstet Gynecol. 2023 Oct 30. doi: 10.1002/uog.27523. Online ahead of print.

ABSTRACT

OBJECTIVE: To confirm the identity and assess the prevalence and evolution of the fluid-filled interhemispheric midline structure, potentially the cavum veli interpositi (CVI), in fetuses from 11 to 14 weeks gestation.

METHODS: A retrospective review of first trimester ultrasounds was performed over three months. Criteria included singleton pregnancies at a gestational age of 11-14 weeks gestation with known outcomes. Five experts reviewed the images. Mixed-effects logistic regression and generalized estimating equations (GEE) were conducted to analyze the associations between the first appearance of the structure and variables like scan route, maternal BMI, gestational age, CRL, and BPD. Second trimester evaluation of CNS, at 18-24 weeks gestation, for those in whom the structure was identified in the first trimester were then evaluated for its persistence.

RESULTS: Of 104 qualifying patients from the 223 reviewed, the CVI was found in 25 (24%). There was no statistically significant difference in its visualization between transabdominal and transvaginal ultrasound examinations. GEE revealed significant associations between the first appearance of the fetal structure and CRL and BPD: odds ratios of 1.32 (p < 0.0001) and 1.88 (p = 0.0011) per 10-unit increase, respectively. Maternal BMI and gestational age showed no significant effect on the first appearance of the CVI. In second trimester follow-ups, 44% still showed a CVI, 32% had a cavum vergae, 4% had both, 20% had none.

CONCLUSIONS: Based on its anatomical location and the separate visualization of the third ventricle in some fetuses, the interhemispheric midline structure visualized in the suprathalamic region of the fetal brain between 11-14 weeks of gestation is the CVI. It remained present in 80% of initially identified fetuses in the second trimester. Its presence is not linked to pathology, offering reassurance to practitioners and parents. This article is protected by copyright. All rights reserved.

PMID:37902788 | DOI:10.1002/uog.27523

J Womens Health (Larchmt). 2023 Oct 30. doi: 10.1089/jwh.2023.0044. Online ahead of print.

ABSTRACT

Objective: At the onset of the COVID-19 pandemic, in addition to increased use of telemedicine visits and a temporary suspension of interval tubal ligations, providers at the University of Maryland Medical Center were encouraged to counsel patients interested in long-acting reversible contraception (LARC) about immediate postpartum placement. We assessed immediate postpartum contraception uptake following these policy changes. Materials and Methods: In this retrospective cohort study, we compared patients who delivered a live born infant(s) before the pandemic (“pre-COVID cohort,” December 16, 2019-March 1, 2020) and at the beginning of the pandemic (“during-COVID cohort,” March 16-May 31, 2020). We collected electronic medical record data, including sociodemographic characteristics and contraception choices antenatally and through 1 year postpartum for 631 patients (321 pre-COVID, 310 during-COVID). Results: Odds of immediate postpartum LARC use in the during-COVID cohort were 33% higher than in the pre-COVID cohort, but this was not statistically significant (adjusted odds ratio 1.33, 95% confidence interval: 0.81-2.19). We found no difference in numbers of patients who received immediate postpartum tubal ligation (10% pre-COVID vs. 11% during-COVID). No patients in the during-COVID cohort obtained interval tubal ligations within 6 months of delivery. Contraceptive choices differed at postpartum visits (p = 0.03), with a decrease in delayed postpartum LARC placement in the during-COVID cohort (15% pre-COVID vs. 8% during-COVID). Conclusions: When COVID-19-related hospital policies prompted increased counseling on immediate postpartum LARC and suspension of interval tubal ligations, patients tended to be more likely to choose immediate postpartum LARC. Situational resource restrictions and targeted counseling may influence patient choices and access to desired contraceptive methods.

PMID:37902780 | DOI:10.1089/jwh.2023.0044

JAMA Netw Open. 2023 Oct 2;6(10):e2340307. doi: 10.1001/jamanetworkopen.2023.40307.

NO ABSTRACT

PMID:37902758 | DOI:10.1001/jamanetworkopen.2023.40307

JAMA Netw Open. 2023 Oct 2;6(10):e2340256. doi: 10.1001/jamanetworkopen.2023.40256.

ABSTRACT

IMPORTANCE: Oncologic outcomes among patients with rectal cancer after developing local recurrence and/or distant metastases remain poorly studied.

OBJECTIVE: To analyze the trend of overall survival after treatment failure for patients with rectal cancer within three consecutive phase 2 or 3 trials of the German Rectal Cancer Study Group.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study is a post hoc analysis of 3 randomized phase 2 or 3 trials (CAO/ARO/AIO-94, -04, and -12 trials, conducted in Germany) that included 1948 patients with locally advanced rectal adenocarcinoma. The CAO/ARO/AIO-94 trial recruited patients between February 1995 and September 2002, the CAO/ARO/AIO-04 trial recruited patients between July 2006 and February 2010, and the CAO/ARO/AIO-12 trial recruited patients between June 2015 and January 2018. Statistical analysis was conducted between September 2022 and March 2023.

EXPOSURES: A total of 119 of 391 patients in the CAO/ARO/AIO-94 trial group A, 295 of 1236 patients in the CAO/ARO/AIO-04 trial, and 69 of 306 in the CAO/ARO/AIO-12 trial experienced treatment failure (R2 resection or local recurrence or distant metastases) and were included in further analyses.

MAIN OUTCOMES AND MEASURES: Characteristics of treatment failure and overall survival were assessed in all 3 trial cohorts.

RESULTS: Of the 1948 patients treated in the 3 trials, 15 were excluded because of missing data. Of the remaining 1933 patients (median age, 62.5 years [range, 19-84 years]; 1363 men [71%] and 570 women [29%]) with locally advanced rectal adenocarcinoma (cT3 or 4 or cN+) treated within 3 consecutive clinical trials, 483 experienced treatment failure and were analyzed. After a median follow-up of 36 months (IQR, 24-51 months) for all patients, overall survival after treatment failure was significantly improved in the CAO/ARO/AIO-04 trial (at 3 years, 44% [IQR, 37%-51%]; hazard ratio [HR], 0.61 [95% CI, 0.47-0.79]) and further improved in the CAO/ARO/AIO-12 trial (at 3 years, 73% [IQR, 60%-87%]; HR, 0.32 [95% CI, 0.18-0.54]) compared with the CAO/ARO/AIO-94 trial (at 3 years, 30% [IQR, 22%-39%]) (both P < .001). Distant metastasis was the main reason for treatment failure throughout a 5-year follow-up (range, 67%-87%), and the relative risk for treatment failure was highest in the first 18 months in all 3 trials. ypTNM stage was significantly associated with the risk and time interval to treatment failure. Improvement in overall survival after treatment failure was independent of sex.

CONCLUSIONS AND RELEVANCE: This cohort study suggests that advancements in salvage strategies during the past decades have likely improved overall survival among patients with rectal cancer who experienced treatment failure.

PMID:37902752 | DOI:10.1001/jamanetworkopen.2023.40256

Invest Ophthalmol Vis Sci. 2023 Oct 3;64(13):46. doi: 10.1167/iovs.64.13.46.

ABSTRACT

PURPOSE: The purpose of this study was to explore the cortical deficits of patients with acquired concomitant esotropia (AACE) using the resting-state functional magnetic resonance imaging (rs-fMRI) technique.

METHODS: Rs-fMRI signals from 25 patients with AACE and 25 matched controls were collected. The repeated-measures analysis of variance (RM-ANOVA) test and two-sample t-test were used to investigate statistical differences of the amplitudes of low-frequency fluctuation (ALFF) signals and correlation analysis was performed to validate the relationship of signal change and clinical features.

RESULTS: The AACE group showed decreased ALFF in both hemispheres symmetrically (t = 0.38, P = 0.71), with peak t in both middle occipital gyrus. The ALFF signal from the upper left inferior frontal gyrus was negatively correlated with the age of onset (r = 0.62, P = 0.0008), and the ALFF signal from the right superior temporal gyrus was negatively correlated with the near work hours (r = 0.63, P = 0.0008). The ALFF signal in the left fusiform gyrus was positively correlated with both near (r = 0.48, P = 0.01) and far (r = 0.44, P = 0.03) deviation, whereas it was only positively correlated with far deviation (r = 0.44, P = 0.03) in the right. Besides, the age of onset and the near work hour were independent factors of signal changes.

CONCLUSIONS: Using the ALFF signal of rs-fMRI, we found functional deficits in the primary visual cortex and dorsal pathway in patients with AACE. There were functional changes in the fusiform gyrus, and the greater the deviation angle, the higher the changing level. These findings reveal the association of AACE and the visual center, giving us more clues about the treatment of AACE.

PMID:37902746 | DOI:10.1167/iovs.64.13.46