Nevin Manimala

Stat Methods Med Res. 2022 Aug 1:9622802221115876. doi: 10.1177/09622802221115876. Online ahead of print.

ABSTRACT

Evidence from observational studies has become increasingly important for supporting healthcare policy making via cost-effectiveness analyses. Similar as in comparative effectiveness studies, health economic evaluations that consider subject-level heterogeneity produce individualized treatment rules that are often more cost-effective than one-size-fits-all treatment. Thus, it is of great interest to develop statistical tools for learning such a cost-effective individualized treatment rule under the causal inference framework that allows proper handling of potential confounding and can be applied to both trials and observational studies. In this paper, we use the concept of net-monetary-benefit to assess the trade-off between health benefits and related costs. We estimate cost-effective individualized treatment rule as a function of patients’ characteristics that, when implemented, optimizes the allocation of limited healthcare resources by maximizing health gains while minimizing treatment-related costs. We employ the conditional random forest approach and identify the optimal cost-effective individualized treatment rule using net-monetary-benefit-based classification algorithms, where two partitioned estimators are proposed for the subject-specific weights to effectively incorporate information from censored individuals. We conduct simulation studies to evaluate the performance of our proposals. We apply our top-performing algorithm to the NIH-funded Systolic Blood Pressure Intervention Trial to illustrate the cost-effectiveness gains of assigning customized intensive blood pressure therapy.

PMID:35912490 | DOI:10.1177/09622802221115876

Cleft Palate Craniofac J. 2022 Aug 1:10556656221117732. doi: 10.1177/10556656221117732. Online ahead of print.

ABSTRACT

OBJECTIVE: The development of the maxillary sinus is different in patients with cleft lip and palate (CLP) compared to non-CLP individuals. To investigate the prevalence and features of maxillary sinus septa (MSS) in patients with CLP in comparison with the non-CLP population.

DESIGN: Retrospective study.

INTERVENTION: Cone beam computed tomography (CBCT) evaluation.

SETTING: CLP center in Shiraz faculty of dentistry, Iran.

PATIENTS: A total 306 sinuses (88 cleft and 218 noncleft) on 153 images (CLP group: n = 66; control group: n = 87) were examined to determine the prevalence of septa and characterize them.

MAIN OUTCOME MEASURES: Sinus septa were characterized according to height, orientation, angle, origin, and location. The chi-square test, Mann-Whitney U test, and Fisher’s exact test were used for statistical analysis.

RESULTS: The prevalence of septa was 28.9% and 32.1% in the CLP and control groups, respectively. No significant difference was found between the study groups in terms of prevalence, location, and orientation of MSS. The average height and angle of septa were significantly higher in the control group compared to the CLP group. Inferior origin was significantly more prevalent in the control group than in the CLP group (P = .004).

CONCLUSION: There was no difference in the prevalence of MSS between patients with CLP and non-CLP individuals. However, certain features of the septa were different in patients with CLP.

PMID:35912448 | DOI:10.1177/10556656221117732

Eur J Hybrid Imaging. 2022 Aug 1;6(1):15. doi: 10.1186/s41824-022-00125-6.

ABSTRACT

BACKGROUND: Magnetic resonance imaging (MRI) and 2-[¹⁸F]-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) Positron Emission Tomography, paired with Computed Tomography (PET/CT) are commonly used modalities in the complicated diagnostic work-up of osteomyelitis. PET/MRI is a relatively novel hybrid modality with suggested applications in bone infection imaging, based on expert opinion and previous qualitative research. ¹⁸F-FDG PET/MRI has the advantages of reduced radiation dose, more soft tissue information, and is deemed more valuable for surgical planning compared to ¹⁸F-FDG PET/CT. The goal of this study is to quantitatively assess the diagnostic value of hybrid ¹⁸F-FDG PET/MRI for chronic osteomyelitis.

METHODS: A retrospective analysis was performed by a nuclear medicine physician and radiologist on 36 patients with ¹⁸F-FDG PET/MRI scans for suspected osteomyelitis. Sensitivity, specificity, and accuracy were determined with the clinical assessment by the orthopaedic surgeon (based on subsequent intraoperative microbiology or long-term follow-up) as the ground truth. Standardized uptake values (SUV) were measured and analysed by means of receiver operating characteristics (ROC).

RESULTS: This first study to quantitatively report the diagnostic value of ¹⁸F-FDG PET/MRI yielded a sensitivity, specificity, and accuracy of 78%, 100%, and 86% respectively. Area under the ROC curve was .736, .755, and .769 for the SUVmax, target to background ratio, and SUVmax_ratio respectively. These results are in the same range and not statistically different compared to diagnostic value for ¹⁸F-FDG PET/CT imaging of osteomyelitis in literature.

CONCLUSIONS: Based on the aforementioned advantages of ¹⁸F-FDG PET/MRI and the diagnostic value reported here, the authors propose ¹⁸F-FDG PET/MRI as an alternative to ¹⁸F-FDG PET/CT in osteomyelitis diagnosis, if available.

PMID:35909200 | DOI:10.1186/s41824-022-00125-6

BMC Med. 2022 Aug 1;20(1):246. doi: 10.1186/s12916-022-02437-7.

ABSTRACT

BACKGROUND: Although sexually transmitted infections are regarded as the main cause of tubal infertility, the association between the common vaginal microbiome and female fecundability has yet to be determined. The objective of this study was to find convincing evidence relating to the impact of the vaginal bacterial structure on the fecundability of women planning pregnancy.

METHODS: We recruited women who took part in the Free Pre-pregnancy Health Examination Project from 13 June 2018 to 31 October 2018 (n = 89, phase I) and from 1 November 2018 to 30 May 2020 (n = 389, phase II). We collected pre-pregnancy vaginal swabs from each subject; then, we followed up each subject to acquire the pregnancy-planning outcome in 1 year. In phase I, 16S rRNA gene sequencing was performed to investigate the vaginal bacterial content between the pregnancy and non-pregnancy groups. These findings were verified in phase II by applying a quantitative real-time polymerase chain reaction for the measurement of the absolute abundance of specific species. Cox models were used to estimate fecundability ratios (FR) for each vaginal microbiome type.

RESULTS: In phase I, 59.6% (53/89) of women became pregnant within 1 year. The principal coordinate analysis showed that the pre-pregnancy vaginal microbial community structures of the pregnant and non-pregnant groups were significantly different (PERMANOVA test, R² = 0.025, P = 0.049). The abundance of the genus Lactobacillus in the pregnancy group was higher than that of the non-pregnant group (linear discriminant analysis effect size (LDA) > 4.0). The abundance of the genus Gardnerella in the non-pregnant group was higher than those in the pregnant group (LDA > 4.0). In phase II, female fecundability increased with higher absolute loads of Lactobacillus gasseri (quartile Q4 vs Q1, FR = 1.71, 95%CI 1.02-2.87) but decreased with higher absolute loads of Fannyhessea vaginae (Q4 vs Q1, FR = 0.62, 95%CI 0.38-1.00). Clustering analysis showed that the vaginal microbiome of type D (characterized by a higher abundance of Lactobacillus iners, a lower abundance of Lactobacillus crispatus and Lactobacillus gassri) was associated with a 55% reduction of fecundability (FR = 0.45, 95%CI 0.26-0.76) compared with type A (featuring three Lactobacillus species, low Gardnerella vaginalis and Fannyhessea vaginae abundance).

CONCLUSIONS: This cohort study demonstrated an association between the pre-pregnancy vaginal microbiome and female fecundability. A vaginal microbiome characterized by a higher abundance of L. iners and lower abundances of L. crispatus and L. gasseri appeared to be associated with a lower fecundability. Further research now needs to confirm whether manipulation of the vaginal microenvironment might improve human fecundability.

PMID:35909180 | DOI:10.1186/s12916-022-02437-7

Crit Care. 2022 Jul 31;26(1):232. doi: 10.1186/s13054-022-04110-0.

ABSTRACT

BACKGROUND: The optimal level of positive end-expiratory pressure (PEEP) during mechanical ventilation for COVID-19 pneumonia remains debated and should ideally be guided by responses in both lung volume and perfusion. Capnodynamic monitoring allows both end-expiratory lung volume ([Formula: see text]) and effective pulmonary blood flow (EPBF) to be determined at the bedside with ongoing ventilation.

METHODS: Patients with COVID-19-related moderate to severe respiratory failure underwent capnodynamic monitoring of [Formula: see text] and EPBF during a step increase in PEEP by 50% above the baseline (PEEP_low to PEEP_high). The primary outcome was a > 20 mm Hg increase in arterial oxygen tension to inspired fraction of oxygen (P/F) ratio to define responders versus non-responders. Secondary outcomes included changes in physiological dead space and correlations with independently determined recruited lung volume and the recruitment-to-inflation ratio at an instantaneous, single breath decrease in PEEP. Mixed factor ANOVA for group mean differences and correlations by Pearson’s correlation coefficient are reported including their 95% confidence intervals.

RESULTS: Of 27 patients studied, 15 responders increased the P/F ratio by 55 [24-86] mm Hg compared to 12 non-responders (p < 0.01) as PEEP_low (11 ± 2.7 cm H₂O) was increased to PEEP_high (18 ± 3.0 cm H₂O). The [Formula: see text] was 461 [82-839] ml less in responders at PEEP_low (p = 0.02) but not statistically different between groups at PEEP_high. Responders increased both [Formula: see text] and EPBF at PEEP_high (r = 0.56 [0.18-0.83], p = 0.03). In contrast, non-responders demonstrated a negative correlation (r = – 0.65 [- 0.12 to – 0.89], p = 0.02) with increased lung volume associated with decreased pulmonary perfusion. Decreased (- 0.06 [- 0.02 to – 0.09] %, p < 0.01) dead space was observed in responders. The change in [Formula: see text] correlated with both the recruited lung volume (r = 0.85 [0.69-0.93], p < 0.01) and the recruitment-to-inflation ratio (r = 0.87 [0.74-0.94], p < 0.01).

CONCLUSIONS: In mechanically ventilated patients with moderate to severe COVID-19 respiratory failure, improved oxygenation in response to increased PEEP was associated with increased end-expiratory lung volume and pulmonary perfusion. The change in end-expiratory lung volume was positively correlated with the lung volume recruited and the recruitment-to-inflation ratio. This study demonstrates the feasibility of capnodynamic monitoring to assess physiological responses to PEEP at the bedside to facilitate an individualised setting of PEEP.

TRIAL REGISTRATION: NCT05082168 (18th October 2021).

PMID:35909174 | DOI:10.1186/s13054-022-04110-0

Pediatrics. 2022 Aug 1:e2021055291. doi: 10.1542/peds.2021-055291. Online ahead of print.

ABSTRACT

OBJECTIVES: To use a nationally representative sample to compare children in grandparent-led versus parent-led households with regard to diagnosed child health conditions, receipt of timely health care, and burden of caregiving responsibilities.

METHODS: We used 4 years of pooled data from the National Survey of Children’s Health, representative of United States children ages 0 to 17 years, and applied bivariate analyses and logistic regressions adjusted for sociodemographic confounders to compare grandparent- and parent-led households on key measures of interest.

RESULTS: Compared with children in parent-led households, those in grandparent-led households had increased physical health conditions (oral health problems: 18.9% vs 13.1%, P = .0006; overweight/obesity: 40.3% vs 29.7%, P = .0002); emotional, mental, and developmental health conditions (attention deficit hyperactivity disorder: 16.3% vs 8.0%; behavioral/conduct problems: 13.9% vs 6.1%; depression: 6.6% vs 3.1%; learning disability: 13.9% vs 6.2%, P < .0001 for all); and special health care needs (28.2% vs 17.8%, P < .0001). They also had decreased prevalence of health care utilization (usual source of sick care: 65.7% vs 79.5%, preventive checkups: 64.6% vs 77.1%; preventive dental visits: 73.8% vs 80.6%; specialty care: 78.6% vs 90.2%, P ≤ .0001 for all) and increased prevalence of forgone care (5.9% vs 2.8%, P = .0020). After adjustment, the associations with caregiver type remained statistically significant for all emotional, mental, and developmental conditions listed; special health care needs; usual source of sick care and preventive checkups.

CONCLUSIONS: Grandparent caregivers may benefit from additional support to ensure that grandchildren receive timely health care services.

PMID:35909145 | DOI:10.1542/peds.2021-055291

BMC Pediatr. 2022 Aug 1;22(1):460. doi: 10.1186/s12887-022-03521-w.

ABSTRACT

BACKGROUND: Constipation is one of the common symptoms in childhood. The prevalence of FC is about 0.5% to 32% and still on the rise according to global statistics. The aim of this study is to explore the associations between family-related factors (e.g., parental conflict, parenting style, and parent-child relationship) and functional constipation of preschool children based on family system theory.

METHODS: The study is a case-control survey of preschoolers in China. In total, 108 preschoolers with functional constipation diagnosed with pediatric Rome IV criteria and 324 healthy examination preschoolers without functional constipation were enrolled in the study. Parents completed the following 5 instruments: General information questionnaire, the Parental Conflict Scale, the Parenting Style Questionnaire, the Child-parent Relationship Scale and the Children’s Emotional Adjustment Scale-Preschool Version.

RESULTS: Nine categories of factors which significantly predicted functional constipation in preschoolers were retained in the final logistic regression model: Second child in birth order (OR = 0.456; 95% CI, 0.229 to 0.910), children picky eating (OR = 2.936; 95% CI, 1.133 to 7.611), bad bowel habits (OR = 2.896; 95% CI, 1.391 to 6.028), parental history of constipation (OR = 3.259; 95% CI, 1.600 to 6.639), parents blaming the child for having a bad bowel movement (OR = 3.788; 95% CI, 1.391 to 10.318), more than 3 h of fathers-child interaction time per day (OR = 0.137; 95% CI, 0.024 to 0.778), parental conflict (OR = 1.981; 95% CI, 0.950 to 3.831), doting or authoritarian parenting style (OR = 1.644; 95% CI, 1.067 to 2.534, OR = 2.481; 95% CI, 1.362 to 4.519), and anxiety control or temper control in children (OR = 0.492; 95% CI, 0.303 to 0.799, OR = 0.189; 95% CI, 0.103 to 0.348).

CONCLUSIONS: This study identified the significant associations between family-related factors and functional constipation in preschool children, which provide implications for healthcare professionals to address functional constipation in early childhood using a preventive lens.

PMID:35909122 | DOI:10.1186/s12887-022-03521-w

BMC Womens Health. 2022 Jul 31;22(1):321. doi: 10.1186/s12905-022-01905-9.

ABSTRACT

INTRODUCTION: Violence against women is a significant health and legal problem and has been declared as a health priority by the World Health Organization. The most common type of violence against women is domestic violence, more prevalent against women with disabilities than other women. Multiple sclerosis (MS) is a debilitating neurological disease and has experienced sudden growth in Iran. This study aimed to investigate the prevalence of domestic violence and its various types (psychological, economic, physical, and sexual) experienced by women with MS.

METHODS: In this cross-sectional study, 275 married women with MS were selected using convenience sampling. After obtaining informed consent and reviewing the inclusion and exclusion criteria, the Domestic Violence against Women Questionnaire developed by Mohseni Tabrizi et al. was completed by the participants on a self-report basis. The results were analyzed using SPSS software version 16. To analyze data, statistical tests including chi-square and Fisher exact tests for univariate analysis and logistic regression, were employed.

RESULTS: The mean age of participants was 37.12 ± 8.48 years. Domestic violence in different forms of psychological, economic, physical, and sexual violence was present in 53.1%, 63%, 33.6%, and 20.4% of participants, respectively. Economic violence (33.8%) was the highest, and sexual violence (5.1%) was the lowest rate of severe violence among participants. There was a significant relationship between the overall rate of domestic violence and the variables including income (P = 0.013), spouse’s income (P = 0.001), participant’s job (P = 0.036) and participant’s education (P = 0.001). In logistic regression, the overall rate of domestic violence was higher in participants with education less than a diploma than in participants with a diploma (P = 0.014) and participants with a university education (P = 0.016).

CONCLUSION: According to the results, providing opportunities such as promoting the social status of women, fulfilling the rights of women with disabilities and debilitating diseases such as MS in society is recommended. Additionally, educating men about the negative impact of domestic violence on the current and future status of the family seems necessary. Providing counseling facilities on various forms of violence, especially domestic violence, for women with MS, is also recommended.

PMID:35909119 | DOI:10.1186/s12905-022-01905-9

Contracept Reprod Med. 2022 Aug 1;7(1):13. doi: 10.1186/s40834-022-00178-9.

ABSTRACT

BACKGROUND: Unmet need for family planning has been remaining high in developing countries than developed countries, notably in sub-Saharan Africa. Data on unmet needs can help countries set service priorities. This study aimed to explore the geographical disparities of unmet need among reproductive-age women in Ethiopia using a 2016 national population-based survey.

METHODS: This study was based on the nationally representative 2016 Ethiopian Demographic and Health Survey data. We used a total weighted sample of 15,683 reproductive-aged women. A multi-level logistic regression analysis was used to account for the Demographic Health Survey data’s hierarchal nature. In the multivariable multi-level analysis, those variables with a p-value < 0.05 were significantly associated with unmet needs. Spatial autocorrelation techniques were used to explore the clustering tendencies of unmet needss using Getis-Ord Gi* statistics.

RESULTS: Overall, 15.2% (95% Confidence Interval (CI): 14.63, 15.76) of women of the reproductive age group in Ethiopia had an unmet need for family planning in 2016. In multivariable multilevel logistic regression analysis; individual-level variables such as being married (Adjusted odds ratio (AOR) = 25.7,95% CI: 11.50,60.42), lowest wealth status (AOR = 1.43,95% CI:1.14,1.79), having five or more children (AOR = 1.98, 95% CI:1.62,2.41), being a follower of Muslim religion (AOR = 1.35,95% CI:1.03,1.76) and protestant religion (AOR = 0.73,95% CI: 0.53,0.99) than orthodox Christian followers were statistically associated factors with unmet need. Among community-level variables; being in rural residency (AOR = 1.37, 95% CI: 1.01, 1.93), belong to the Oromia region (AOR = 1.53, 95%CI: 1.10, 2.11) and Somali region (AOR = 0.37, 95% CI: 0.22, 0.61) were significantly associated unmet need. The spatial analysis of unmet need among all women revealed that Oromia, Southern Nations, and Nationality of People and Gambela regions had high hotspots than other parts of the country.

CONCLUSIONS: In this study, the prevalence of unmet needs was high. Significant regional unmet need variation was indicated among reproductive-age women in Ethiopia, specifically in western parts of the country. Wealth status, number of children, marital status, residence, and religion were the most important associated factors with unmet needs. Addressing unmet needs targeted rural residents with low socioeconomic status, and western regions should be given top priority.

PMID:35909115 | DOI:10.1186/s40834-022-00178-9

Ann Hepatobiliary Pancreat Surg. 2022 Jul 29. doi: 10.14701/ahbps.22-041. Online ahead of print.

ABSTRACT

BACKGROUNDS/AIMS: In Korea, pancreatic cancer and “gallbladder and extrahepatic bile duct cancer” were ranked the 8th and 9th most frequent cancers in 2019 and the 4th and 6th most common causes of cancer deaths in 2020, respectively.

METHODS: This review provides national cancer statistics and secular trends of 207,521 patients with gallbladder (n = 44,178), extrahepatic bile duct (n = 61,856), and pancreatic cancer (n = 101,487) between 1999 and 2019 in Korea.

RESULTS: The crude incidence rate in both sexes increased in the gallbladder (2.8 to 5.4 per 100,000), extrahepatic bile duct (3.6 to 9.0), and pancreatic cancer (5.5 to 15.8). The age-standardized incidence rate in both sexes significantly increased in the extrahepatic bile duct (3.7 to 4.1) and pancreatic (5.6 to 7.6) cancers but decreased in gallbladder cancer (2.9 to 2.4). The overall 5-year relative survival rate increased in the gallbladder (21.8% to 30.6%), extrahepatic bile duct (23.1% to 27.5%), and pancreatic (8.5% to 13.3%) cancers. Between 2006 and 2019, the proportion of localized or regional stages remained stable. The proportion of surgical treatment within the first 4 months after diagnosis was relatively higher in the gallbladder (42.2%) and extrahepatic bile duct (45.9%) cancers than in pancreatic cancer (22.2%).

CONCLUSIONS: The crude incidence and mortality rates of the gallbladder, extrahepatic bile duct, and pancreatic cancer are steadily increasing in Korea, and the prognosis remains poor. Early detection, active application of surgical treatment, and minimization of the proportion of untreated patients are required to improve the survival rates of these cancers.

PMID:35909086 | DOI:10.14701/ahbps.22-041