Category: Statistics

Surg Oncol. 2021 Mar 31;37:101557. doi: 10.1016/j.suronc.2021.101557. Online ahead of print.

ABSTRACT

INTRODUCTION: Ductal carcinoma in situ with microinvasion (DCISM); arguably a more aggressive subtype of DCIS, currently has variable recommendations governing its staging and management in the UK. As a result, there is ongoing controversy surrounding the most appropriate management of DCISM, in particular the need of axillary staging.

METHOD: A search was conducted on the databases MEDLINE and Embase using the keywords: breast, DCISM, microinvasion, “ductal carcinoma in situ with microinvasion”, sentinel lymph node biopsy, SLNB, axillary staging was performed. 23 studies were selected for analysis. Primary outcome was the positivity of metastasis of lymph node; secondary outcome looked at characteristics of DCISM that may affect node positivity.

RESULTS: A total of 2959 patients were included. Significant heterogeneity was observed amongst the studies with regards to metastases (I² = 61%; P < 0.01). Lymph node macrometastases was estimated to be 2%. Significant subgroup difference was not observed between SLNB technique and lymph node macrometastases (Q = 0.74; p = 0.69). Statistical significance was observed between the focality of the DCISM and lymph node macrometastases (Q = 8.71; p = 0.033).

CONCLUSION: Although histologically more advanced than DCIS, DCISM is not linked with higher rates of clinically significant metastasis to axillary lymph nodes. Survival rates are very similar to those seen in cases of DCIS. Current evidence suggests that axillary staging in cases of DCISM will not change their overall management, thus may only be an unnecessary and inconvenient additional intervention considering the majority of DCISM diagnoses are made from post-operative pathology samples. A multidisciplinary team approach evaluating pre-operative clinical and histological information to tailor the management specific to individual cases of DCISM would be a preferred approach than routine axillary staging.

PMID:33819852 | DOI:10.1016/j.suronc.2021.101557

Placenta. 2021 Mar 22;108:47-54. doi: 10.1016/j.placenta.2021.03.011. Online ahead of print.

ABSTRACT

The objective of this study was to investigate the accuracy of universal third trimester umbilical artery (UA) Doppler to predict adverse pregnancy outcome at term. We searched Medline, EMBASE, the Cochrane library and ClinicalTrials.gov from inception to October 2020 and we also analyzed previously unpublished data from a prospective cohort study of nulliparous women, the Pregnancy Outcome Prediction (POP) study. We included studies that performed a third-trimester ultrasound scan in unselected, low or mixed risk populations, excluding studies which only included high risk pregnancies. Meta-analysis was performed using the hierarchal summary receiver operating characteristic curve (HSROC) analysis and bivariate logit-normal models. We identified 13 studies (including the POP study) involving 67,764 pregnancies which met our inclusion criteria. The overall quality was variable and only six studies (N = 5777 patients) blinded clinicians to the UA Doppler result. The summary sensitivity and positive likelihood ratio (LR) for small for gestational age (SGA; birthweight <10th centile) were 21.7% (95% CI 13.2-33.6%) and 2.65 (95% CI 1.89-3.72) respectively. The summary positive LR for NICU admission and metabolic acidosis were 1.35 (95% CI 0.93-1.97) and 1.34 (95% CI 0.86-2.08) respectively. The results were similar in the POP study: associations with SGA (positive LR 2.66 [95% CI 2.11-3.36]) and severe SGA (birthweight <3rd centile; positive LR 3.27 [95% CI 2.29-4.68]) but no statistically significant association with neonatal morbidity. We conclude that third trimester UA Doppler has moderate predictive accuracy for small for gestational age but not for indicators of neonatal morbidity in unselected and low risk pregnancies.

PMID:33819861 | DOI:10.1016/j.placenta.2021.03.011

Int J Pediatr Otorhinolaryngol. 2021 Mar 21;144:110685. doi: 10.1016/j.ijporl.2021.110685. Online ahead of print.

ABSTRACT

BACKGROUND: Choking injuries are a significant cause of morbidity and mortality in children and represent a significant public health concern. Evaluating trends and the impact of interventions are essential to highlight whether progress has been made and to target public health efforts.

OBJECTIVE: To investigate how rates of nonfatal and fatal choking injuries have changed before and after 2010 when policy recommendations were made by the American Academy of Pediatrics.

METHODS: A descriptive study investigating unintentional nonfatal and fatal choking injuries in children aged 0-19 years using national data from 2001 to 2016 through the Centers for Disease Control and Prevention’s WISQARS™ and WONDER databases, focusing on the 6 years prior and 6 years after release of the AAP’s recommendations. The data was categorized by age, gender, year, and race/ethnicity for descriptive and statistical analyses.

RESULTS: From 2001 to 2016, there were a total of 305,814 nonfatal injuries and 2347 choking deaths in children from 0 to 19 years. Children under five years of age accounted for 73% of nonfatal injuries and 75% of choking fatalities. There was a statistically significant increase in the nonfatal injuries rate when comparing 2005-2010 and 2011-2016 (19/100,000 versus 26/100,000, respectively). There was a decrease in the choking fatalities rate in all children (0.18/100,000 versus 0.16/100,000, respectively) but no change in fatalities rate for children under five. White and Black children experience nonfatal choking injuries at a higher rate than Hispanics. Black children had highest rates of choking fatalities over Hispanic, White, Asian, and Alaskan or American Indian ethnicities. The lowest rates of death occurred in Asians.

CONCLUSIONS: Overall rate of nonfatal choking injuries increased, while rate of choking fatalities in children decreased after 2010. However, the choking fatalities rate in 0-4 years olds, the highest risk group, did not change. Racial gaps exist with highest rates of injury in Black children. We must continue to educate and raise awareness of choking injuries, with targeted efforts to address racial disparities.

PMID:33819896 | DOI:10.1016/j.ijporl.2021.110685

J Med Internet Res. 2021 Apr 2. doi: 10.2196/26296. Online ahead of print.

ABSTRACT

BACKGROUND: In the United States, racial and ethnic minorities are disproportionately affected by COVID-19, with persistent social and structural factors contributing to these disparities. At the intersection of race/ethnicity and gender, women of color may be disadvantaged in terms of COVID-19 outcomes due to their role as essential workers, higher prevalence of pre-existing conditions, increased stress and anxiety from loss of wages and caregiving, and domestic violence.

OBJECTIVE: The purpose of this study was to examine racial and ethnic differences in the prevalence of COVID-19 outcomes, stressors, fear, and prevention behaviors among adult women residing in the United States.

METHODS: Between May and June 2020, women were recruited into The COPE Study, a web-based cross-sectional study, using advertisements on Facebook; 491 eligible women completed a self-administered internet-based cross-sectional survey. Descriptive statistics were used to examine racial and ethnic differences (White; Asian; Native Hawaiian or other Pacific Islander; Black; Hispanic, Latina or Spanish Origin; American Indian or Alaskan Native; Multiracial or some other race, ethnicity, or origin) on COVID-19 outcomes, stressors, fear, and prevention behaviors.

RESULTS: Among our sample of women, 16% (73/470) reported COVID-19 symptoms, 22% (18/82) were concerned about possible exposure from the people they knew who tested positive for COVID-19, and 51.4% (227/442) knew where to get tested; yet only 5.8% (27/469) had been tested. Racial/ethnic differences were observed, with racial/ethnic minority women being less likely to know where to get tested. Significant differences in race/ethnicity were observed for select stressors (food insecurity, not enough money, homeschooling children, unable to have a doctor/telemedicine appointment) and prevention behaviors (handwashing with soap, self-isolation if sick, public glove use, not leaving home for any activities). Although no racial/ethnic differences emerged for the fear of COVID-19 scale, significant racial/ethnic differences were observed for some of the individual scale items (e.g., being afraid of getting COVID-19, sleep loss and heart racing due to worrying about COVID-19).

CONCLUSIONS: Low prevalence of COVID-19 testing and knowledge of where to get tested indicate a critical need to expand testing for women in the U.S., particularly among racial/ethnic minority women. Although overall prevalence of engagement in prevention behaviors was high, targeted education and promotion of prevention activities is warranted in communities of color, particularly with consideration for stressors and adverse mental health.

PMID:33819909 | DOI:10.2196/26296

Eur J Radiol. 2021 Mar 26;139:109681. doi: 10.1016/j.ejrad.2021.109681. Online ahead of print.

ABSTRACT

PURPOSE: To determine the diagnostic performance of virtual noncalcium (VNCa) dual-energy computed tomography (DECT) in the detection of bone marrow edema (BME) in participants with osteonecrosis of the femoral head (ONFH).

METHODS: In this prospective study, 24 consecutive participants (15 men, 9 women; mean age, 44 years, range, 21-72 years) diagnosed with ONFH who underwent DECT and magnetic resonance imaging (MRI) between September 2019 and January 2020 were involved. Two independent readers visually evaluated color-coded VNCa images using a binary classification (0 = normal bone marrow, 1 = BME). MRI served as the reference standard for the presence of BME. Interobserver agreement for the visual evaluation of VNCa DECT images was calculated with κ statistics. We determined computed tomography (CT) numbers on VNCa images and weighted-average CT sets using region-of-interest-based quantitative analysis. The t-test was used to compare the differences of CT values between BME areas and normal bone marrow areas. Receiver operating characteristic (ROC) curve was used to select an optimal CT values of VNCa images for detecting BME. A p value of <0.05 was considered as statistically significant.

RESULTS: The sensitivity, specificity, and accuracy of Reader 1 and Reader 2, respectively, in the identification of BME at DECT were 95 % and 89 % (18 and 17 of 19), 96 % and 96 % (25 and 25 of 26), and 93 % (43 and 42 of 45). Interobserver agreement was excellent (κ = 0.86). The VNCa CT numbers of the BME area and the normal bone marrow area were -28.6 (-17.9–39.4) HU and -97.9 (-91.3–104.4) HU, respectively, with statistical significance (t = -10.6, p < 0.001). The weighted-average CT numbers of the BME area and the normal bone marrow area were 152.4(122.2-182.7) HU and 121.1(103.6-183.6) HU, respectively, with no statistical significance (t = -2.0, p > 0.05). The area under the receiver operating characteristic curve was 0.99 in differentiation of the BME from normal bone marrow. A cut-off value of -57.2 HU yielded overall sensitivity, specificity, and accuracy, respectively, of 95 % (18 of 19), 100 % (26 of 26), and 98 % (44 of 45) detection of BME in participants with ONFH.

CONCLUSION: Visual and quantitative analyses of VNCa images shows excellent diagnostic performance for assessing BME in participants with ONFH.

PMID:33819804 | DOI:10.1016/j.ejrad.2021.109681

Cancer Epidemiol. 2021 Apr 2;72:101929. doi: 10.1016/j.canep.2021.101929. Online ahead of print.

ABSTRACT

BACKGROUND: Numbers of patients who develop subsequent primary tumours have markedly increased recently. This study aimed to carry out a comprehensive analysis documenting the risk of incidence of subsequent haematological malignancies.

METHODS: The Czech National Cancer Registry was the main data source, containing records of 126,822 haematological malignancies diagnosed in the period 1977-2016. Subsequent haematological malignancies were identified according to IACR rules. Joinpoint regression was employed to assess the time trends. The risk of development of subsequent haematological malignancy was evaluated by the standardised incidence ratio. The Kaplan-Meier curves were used to assess the differences in survival.

RESULTS: Age-standardised incidence of subsequent haematological malignancies increased from 0.5 in 1977 to 9.1 in 2016. In 1992, there was a significant change in the trend: a sharp increase by 7.7 % annually was revealed thereafter. The risk of development of a haematological malignancy was approximately 1.5 times higher in persons with history of any cancer than in the general Czech population. Patients with haematological malignancies – mainly myelodysplastic syndromes, polycythaemia vera and non-Hodgkin lymphoma – were shown to be at the highest risk of developing a subsequent haematological malignancy. While the median survival following a first haematological malignancy was 2.3 years, it was only 1.1 years for subsequent haematological malignancies (p < 0.001).

CONCLUSIONS: Our study identified the highest-risk diagnoses in terms of development of subsequent haematological malignancy. The results might be useful to set up correctly follow-up procedures from which cancer patients could benefit.

PMID:33819838 | DOI:10.1016/j.canep.2021.101929

Comp Immunol Microbiol Infect Dis. 2021 Mar 27;76:101643. doi: 10.1016/j.cimid.2021.101643. Online ahead of print.

ABSTRACT

The World Health Organization has categorized toxocarosis as a neglected tropical disease despite its significant impact on high-risk groups such as children. This study aimed to investigate the seroprevalence, risk factors, and clinical symptoms of Toxocara spp. infection among children 3-15 years old in northern Iran. A total of 386 children were enrolled in the study. All serum samples were tested for the presence of IgG antibodies against Toxocara spp. infection using an enzyme-linked immunosorbent assay. Moreover, relevant risk factors and clinical symptom data were obtained using questionnaires. Data analysis was performed using the SPSS software version 24. The overall seroprevalence of Toxocara spp. infection was found 2.85 % (11/386). However, Toxocara spp. infection was high for some risk factors, including eating soil (14.3 %), contacting cats (6.7 %), and consuming raw vegetables (3.7 %). However, there were no statistically significant differences regarding the risk factors and socio-demographic characteristics. Considering the clinical symptoms, Toxocara spp. infection was different in children with eosinophilia (20 %), ocular disorders (8.3 %), skin disorders (7.7 %), liver disorders (4.5 %), and stomach ache (4.2 %), although not statistically significant. The results revealed that the seroprevalence of Toxocara spp. infection was relatively low in children in northern Iran. It is suggested to conduct more studies in different parts of Iran to gain a deeper understanding of the toxocarosis seroprevalence and its status in high-risk groups such as children with asthma, hypereosinophilic syndrome, allergic skin disorders, and epilepsy.

PMID:33819773 | DOI:10.1016/j.cimid.2021.101643

Int J Hyg Environ Health. 2021 Apr 2;234:113746. doi: 10.1016/j.ijheh.2021.113746. Online ahead of print.

ABSTRACT

Natural window ventilation is frequently employed in schools in Europe and often leads to inadequate levels of human bioeffluents. However, intervention studies that verify whether recommended ventilation targets can be achieved in practice with reasonable ventilation regimes and that are also suitable for countries with cold winters are practically non-existent. To explore the initial situation in Switzerland we carried out carbon dioxide (CO₂) measurements during the winter in 100 classrooms, most of which (94%) had natural window ventilation. In more than two thirds of those, the hygienic limit value of 2000 ppm specified for CO₂ in the Swiss Standard SN 520180 (2014) was exceeded. To improve ventilation behavior, an intervention was implemented in 23 classrooms during the heating season. Ventilation was performed exclusively during breaks (to avoid discomfort from cold and drafts), efficiently, and only for as long as was necessary to achieve the ventilation objective of compliance with the hygienic limit value (strategic ventilation). The intervention included verbal and written instructions, awareness-raising via a school lesson and an interactive tool for students, which was also used to estimate the required duration of ventilation. CO₂ exposure was significantly reduced in pilot classes (Wilcoxon signed-rank test, p = 3.815e^-06). Median CO₂ levels decreased from 1600 ppm (control group) to 1097 ppm (intervention group), and the average proportion of teaching time at 400-1400 ppm CO₂ increased from 40% to 70%. The duration of ventilation was similar to spontaneous natural window ventilation (+5.8%). Stricter ventilation targets are possible. The concept of the intervention is suitable for immediate adoption in schools with natural window ventilation for a limited period, pending the installation of a mechanical ventilation system. The easy integration of this intervention into everyday school life promotes compliance, which is particularly important during the COVID-19 pandemic.

PMID:33819800 | DOI:10.1016/j.ijheh.2021.113746

Res Vet Sci. 2021 Mar 29;136:464-471. doi: 10.1016/j.rvsc.2021.03.018. Online ahead of print.

ABSTRACT

Diarrhea is the most common cause of mortality and morbidity in dairy calves during the first weeks of life. It is responsible for the majority of costs related to animal death and treatments, as well as lower productivity due to reduced weight gain. Therefore, studies that focus on strategies to reduce diarrhea incidence and to improve animal welfare are very important for the dairy industry. For that reason, the beneficial effects of red propolis on the health status of preweaned dairy calves was studied. Animal disease data usually present incomplete observations of interest time, so-called censored observations and one of the statistical techniques for this modeling type is the survival analysis, hence it is a set of methods for analyzing data where the response variable is the time until the occurrence of an event of interest. We propose among some methods of survival data analysis, the long-term models. The motivation to study these models is the fact that part of the population is not susceptible to the event of interest during the period of the study, considered as immune or cured. In this paper, we studied the Weibull distribution in a structure of long-term model, including the covariates in the proportion of cured through the logistic link function. Besides, we used the residual analysis to check the assumptions of the model. The reason for the choice of the Weibull distribution was that this model is very flexibility to model a variety of data sets, among them animal science and long-term survival data. We illustrate its application with a case study from an animal experiment, which examined the time till the occurrence of diarrhea in Holstein calves, where a proportion of the animals were not susceptible to this health condition. This experiment aimed to verify the efficiency of red propolis in disease prevention and the influence of that on the proportion of animals that are not susceptible to diarrhea.

PMID:33819754 | DOI:10.1016/j.rvsc.2021.03.018

Spectrochim Acta A Mol Biomol Spectrosc. 2021 Mar 22;256:119731. doi: 10.1016/j.saa.2021.119731. Online ahead of print.

ABSTRACT

Diabetes has become a major public health problem worldwide, and the incidence of diabetes has been increasing progressively. Diabetes is prone to cause various complications, among which diabetic keratopathy (DK) emphasizes the significant impact on the cornea. The current diagnosis of DK lacks biochemical markers that can be used for early and non-invasive screening and detection. In contrast, in this study, Raman spectroscopy, which demonstrates non-destructive, label-free features, especially the unique advantage of providing molecular fingerprint information for target substances, were utilized to interrogate the intrinsic information of the corneal tissues from normal and diabetic mouse models, respectively. Visually, the Raman spectral response derived from the biochemical components and biochemical differences between the two groups were compared. Moreover, multivariate analysis methods such as principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) were carried out for advanced statistical analysis. PCA yields a diagnostic results of 57.4% sensitivity, 89.2% specificity, 74.8% accuracy between the diabetic group and control group; Moreover, PLS-DA was employed to enhance the diagnostic ability, showing 76.1% sensitivity, 86.1% specificity, and 87.6% accuracy between the diabetic group and control group. Our proof-of-concept results show the potential of Raman spectroscopy-based techniques to help explore the underlying pathogenesis of DK disease and thus be further expanded for potential applications in the early screening of diabetic diseases.

PMID:33819764 | DOI:10.1016/j.saa.2021.119731