Mov Disord. 2022 Jan 24. doi: 10.1002/mds.28935. Online ahead of print.
NO ABSTRACT
PMID:35075696 | DOI:10.1002/mds.28935
Stat Med. 2022 Jan 25. doi: 10.1002/sim.9308. Online ahead of print.
ABSTRACT
Major advances have been made regarding the utilization of machine learning techniques for disease diagnosis and prognosis based on complex and high-dimensional data. Despite all justified enthusiasm, overoptimistic assessments of predictive performance are still common in this area. However, predictive models and medical devices based on such models should undergo a throughout evaluation before being implemented into clinical practice. In this work, we propose a multiple testing framework for (comparative) phase III diagnostic accuracy studies with sensitivity and specificity as co-primary endpoints. Our approach challenges the frequent recommendation to strictly separate model selection and evaluation, that is, to only assess a single diagnostic model in the evaluation study. We show that our parametric simultaneous test procedure asymptotically allows strong control of the family-wise error rate. A multiplicity correction is also available for point and interval estimates. Moreover, we demonstrate in an extensive simulation study that our multiple testing strategy on average leads to a better final diagnostic model and increased statistical power. To plan such studies, we propose a Bayesian approach to determine the optimal number of models to evaluate simultaneously. For this purpose, our algorithm optimizes the expected final model performance given previous (hold-out) data from the model development phase. We conclude that an assessment of multiple promising diagnostic models in the same evaluation study has several advantages when suitable adjustments for multiple comparisons are employed.
PMID:35075684 | DOI:10.1002/sim.9308
J Sch Health. 2022 Jan 24. doi: 10.1111/josh.13136. Online ahead of print.
ABSTRACT
BACKGROUND: School settings offer an opportunity to impact student health and wellness. Quality wellness policies are important in establishing strong wellness environments, but current resources to support policy development, maintenance, and dissemination are lacking. The Building Healthy Schools Program aimed to develop capacity of school districts to improve the strength and comprehensiveness of wellness policies and sustain these activities.
METHODS: Fifteen school districts in Pennsylvania participated in a program to facilitate the improvement of district wellness policies and practices. Program staff provided technical assistance to evaluate wellness policies before and after program implementation. Professional development and tailored training was provided for school personnel to create sustainability. Statistical analysis was performed to evaluate policy improvement.
RESULTS: Thirteen of the 15 participating districts completed a policy revision. Median strength (p = .001) and comprehensiveness (p = .002) scores improved from baseline to post-program and there were significant improvements in most assessment sub-sections. Some districts were hesitant to make strong language improvements due to their limited capacity (ie, staff) for implementation. Champions (n = 13; 87%) reported confidence to revise wellness policy language independently in the future.
CONCLUSIONS: Technical assistance provided to districts facilitated significant improvements to wellness policy language, especially in the implementation, evaluation, and communication; critical components for policy impact on school wellness environments. In addition, participant feedback suggested an ability to sustain activities in the future. Both external (ie, technical assistance) and internal resources are needed to facilitate school districts’ ongoing wellness policy improvement and implementation, including improved model wellness policy language and enforcement within schools, respectively.
PMID:35075644 | DOI:10.1111/josh.13136
Fam Process. 2022 Jan 24:e12755. doi: 10.1111/famp.12755. Online ahead of print.
ABSTRACT
OBJECTIVE: Child asthma disparities are prevalent in socio-economically stressed single-parent families. Stress impacts childhood asthma mediated by immune and autonomic pathways, but specific family stress pathways are not well established. This study tests the hypothesis, derived from a version of the Biobehavioral Family Model, that single parent maternal depression impacts child asthma mediated by insecure attachment and child depression.
METHODS: In a cross-sectional study, children with asthma (age 7-17 years old) from a socio-economically disadvantaged population and their single parent mothers (N = 202) were assessed for depression and attachment security. Child asthma disease activity was assessed by symptom report and lung function tests. Structural equation modeling (SEM) was used to test a model in which caregiver depression impacts child asthma disease activity mediated by insecure attachment and child depression.
RESULTS: SEM results indicated that maternal depression statistically predicted child depression (β = 0.21, p < 0.01) and insecure mother-child attachment (β = 0.17, p < 0.05). In addition, insecure attachment statistically predicted child depression (β = 0.50, p < 0.001). Child depression mediated the adverse effects of maternal depression and insecure attachment on child asthma disease activity (β = 0.43, p < 0.01). There was no direct effect of insecure attachment on child asthma.
CONCLUSION: In single-parent families, maternal depression may impact child asthma disease activity, mediated serially by insecure attachment and child depression. Longitudinal and/or intervention studies are needed to establish a causal effect. These findings suggest that caregiver depression and parent-child relationships may be important targets for family intervention. These interventions may help improve child asthma outcomes and reduce health disparities.
PMID:35075639 | DOI:10.1111/famp.12755
J Child Psychol Psychiatry. 2022 Jan 24. doi: 10.1111/jcpp.13572. Online ahead of print.
ABSTRACT
BACKGROUND: While transactional models suggest that parent and child mental health reciprocally influence one another over development, research has largely focused on parent-to-child effects. Additionally, it is not known whether observed associations hold when appropriate statistical tools are used to operationalise within-family dynamics.
METHODS: We investigated within-family mental health dynamics using autoregressive latent trajectory models with structured residuals, stratified by child gender. Parental psychological distress was assessed using the Kessler (K6) scale, and children’s internalising and externalising problems were assessed using the Strengths and Difficulties Questionnaire. Both measures were administered at the age 3, 5, 7, 11, 14 and 17 waves of the Millennium Cohort Study (N = 10,746, ~50% female).
RESULTS: Maternal psychological distress was positively associated with subsequent internalising and externalising problems for girls but only with internalising problems for boys. Paternal psychological distress was associated with boys’ later internalising and externalising problems during early adolescence. Among boys, internalising problems were associated with later maternal psychological distress, while externalising problems were associated with later paternal psychological distress. Among girls, internalising problems were associated with subsequent paternal psychological distress, while externalising problems were associated with later maternal psychological distress. Finally, maternal and paternal psychological distress showed negative bidirectional associations in early childhood but positive associations in middle childhood and early adolescence.
CONCLUSIONS: Findings support a transactional model of family mental health, with both child-to-parent and parent-to-child effects playing a role in the development of mental health difficulties. Mental health intervention efforts should, therefore, target the whole family system.
PMID:35075634 | DOI:10.1111/jcpp.13572
Int J Gynaecol Obstet. 2022 Jan 25. doi: 10.1002/ijgo.14113. Online ahead of print.
ABSTRACT
OBJECTIVE: This study aims to determine the factors that affect the women’s willingness of childbearing age to detect/screen for cervical cancer.
METHODS: A cross-sectional study was carried out on sexually active women, aged 30-50 years residing in Banyumas and Gunung Kidul Districts, Indonesia. There were 600 respondents identified. This study focused on the impact of knowledge, access to health information, and the support of their husband to the willingness to perform early detection of cervical cancer.
RESULTS: This study revealed that there was a statistically significant difference (p-value 0.000) between the women who were willing and unwilling to do the screening in terms of higher knowledge (64.67% and 36.21%), obtained access to the information (80.43% and 54.74%), and also supported by their husband (63.59% and 29.31%). This study also discovered that the willingness to be screened was significantly affected by spouse support (OR 4.19, CI 95% 2.81-6.27). Other factors such as education level (OR 2.94, CI 95% 1.20-6.63), Knowledge (OR 2.29, CI 95% 1.52-3.44), and access to information (OR 2.08, CI 95% 1.34-3.24) were also important drivers.
CONCLUSION: To improve the coverage of cervical screening, several aspects could be treated, including education, knowledge, access to information, and husband support.
PMID:35075629 | DOI:10.1002/ijgo.14113
Urol J. 2022 Jan 25. doi: 10.22037/uj.v19i.6946. Online ahead of print.
ABSTRACT
PURPOSE: Although extracorporeal shockwave lithotripsy (SWL) has been confirmed to be effective in treating ureteral stone, a definitive conclusion which patient’s position is optimal option during SWL treatment remains unclear. We therefore performed this updated meta-analysis to further clarify it.
MATERIALS AND METHODS: PubMed, Embase and Cochrane library were performed to capture all potentially eligible studies from their inception to October 2020. After screening eligible studies, extracting essential data, and assessing the risk of bias, we used STATA 14.0 to complete all statistical analyses.
RESULTS: We included 7 studies involving 8 cohorts in the final analysis. Our meta-analysis suggested that the prone position was inferior to supine position in terms of stone fragmentation and stone clearance rate after completing first treatment (95% CI: 0.30-0.63; OR = 0.44;), however subgroup analysis indicated that the difference between supine and prone positions for stone fragmentation and stone clearance rate was only getting statistical significance for distal ureteral stone (95% CI: 0.23-0.53; OR = 0.35). Moreover, subgroup analysis of two eligible randomized controlled trials suggested that the mean number of sessions per patient in the supine group was less than that in the prone group (95% CI: 0.11-0.48; WMD = 0.294). No major and severe complication was detected to be done with the association with positions.
CONCLUSION: SWL of the supine position may be the preferred option because this strategy can increase the distal ureteral stone-free rate compared to the prone position.
PMID:35075627 | DOI:10.22037/uj.v19i.6946
Urol J. 2022 Jan 25. doi: 10.22037/uj.v19i.6919. Online ahead of print.
ABSTRACT
PURPOSE: The aim of this study was to introduce an advanced surgical technique for laparoscopic radical cystectomy (LRC), evaluate the perioperative outcome and compare it to that of conventional LRC (CLRC).
MATERIALS AND METHODS: Between March 2018 and March 2020, sixty patients were divided into the “two-zone and three-segment” laparoscopic radical cystectomy (TTLRC) group or the CLRC group. Patient baseline characteristics, preoperative characteristics and postoperative complications were collected. Data were evaluated using Pearson’s chi square test, Fisher’s exact test, Student’s t-test and Mann-Whitney test. Two-sided p values of less than 0.05 were considered statistically significant.
RESULTS: The TTLRC technique was developed based on the pelvic anatomy of six formalin fixed male cadavers. None of the patient baseline characteristics, including ECOG-PS score, comorbidity, ASA score and Hb, were significantly different between the two groups (p>0.05). There were significant differences in the operating time and estimated blood loss (total time: 3±0.2 vs 3.8±0.4, p<0.001; time to cystectomy and lymph node dissection: 1.7±0.2 vs 2.2±0.3, p<0.001; estimated blood loss 182.1±18.8 vs 264.3±27.4, p<0.001). Although there were no differences in late complications, early complications were significantly different between the two groups (p = 0.033). No statistically significant differences were found between the two groups in other outcomes (p>0.05).
CONCLUSION: The TTLRC technique achieves a clearer surgical field, has a shorter operating time and produces less blood loss than CLRC. It is safe and feasible for urologists to perform this improved LRC procedure.
PMID:35075626 | DOI:10.22037/uj.v19i.6919
Langenbecks Arch Surg. 2022 Jan 24. doi: 10.1007/s00423-022-02446-3. Online ahead of print.
ABSTRACT
INTRODUCTION: The spleen provides a unique immune function in its production of opsins directed against encapsulated bacteria. Splenectomy, therefore, increases the risk of infections in patients as well as post-operative complications. This study aims to assess the risk of post-operative complications within 5 years of splenectomy by indication for splenectomy: trauma, disease, or in association with a distal pancreatectomy for pancreatic disease. The relationship between vaccination and infectious outcomes was also investigated.
METHODS: This study is a review of splenectomy cases between June 2005 and June 2015 at a single institution. Infection, splenectomy indication, and vaccination history were identified from electronic medical records and lab test confirmations. Data was analyzed using Student’s t test for continuous variables, the Mann-Whitney U test for ordinal variables, and a Chi-square/Fisher exact test for categorical variables.
RESULTS: A total of 106 splenectomy patients were included: 35 traumatic (74% male) and 71 non-traumatic causes (42% male) with no significant difference in age. There were no statistical differences in complications during splenectomy and vaccination administration between the splenectomy indication groups: trauma, disease, and with distal pancreatectomy. There was a statistically significant higher infection rate within 5 years post-splenectomy in the non-traumatic vs traumatic group (42% vs 14.0%, p = 0.0040) with majority gastrointestinal (7/38) and respiratory (5/38) and surgical wound infections (3/38) observed in non-traumatic versus traumatic, respectively.
CONCLUSION: Results from data analysis show a statistically significant difference in rates of infection within 5 years post-operatively between traumatic versus non-traumatic indications for splenectomies, with the non-traumatic group experiencing a higher rate of infectious outcomes. The non-traumatic group included patients with disease and distal pancreatectomy indications. This suggests that patients who have non-traumatic causes may be at a higher risk of developing infections following splenectomy procedure. Additionally, vaccinations did not appear to have a protective effect.
PMID:35075620 | DOI:10.1007/s00423-022-02446-3
Daru. 2022 Jan 24. doi: 10.1007/s40199-021-00431-7. Online ahead of print.
ABSTRACT
PURPOSE: To examine the impact of the COVID-19 pandemic on calcineurin inhibitors and related prescriptions for community patients in England.
METHODS: Data from all primary-care patients who had calcineurin inhibitors prescriptions, dispensed in the community in England were included. Descriptive statistics and interrupted time series analysis over 27 months (15 months before and 12 months after 1st lockdown) was evaluated.
RESULTS: Descriptive statistics show that mean values have declined since the pandemic’s onset. Over the 27 months: mean Tacrolimus 865,045 doses, standard deviation (SD) 76,147 doses, with 95% CI 834,923, 895,168, (min 567,508, max 1,010,900), ciclosporin 315,496 doses, SD 40,094, 95% CI 299,635, 331,356 (min 191,281, max 382,253) and sirolimus 21,384 doses, SD 2,610, 95% CI 20,352, 22,417 (min 13,022, max 26,156). Analysis of variance between the pre- and post- periods show significant variations in quantities of tacrolimus F 7.432, p = 0.012, ciclosporin F 33.147, p < 0.001 and sirolimus F 18.596, p < 0.001 (1df), mirrored in price analysis. The Interrupted Time Series (ARIMA Modelling) shows declining trends. After the pandemic’s onset, a statistically significant downward trend in quantity for tacrolimus p = 0.008 is observed, with an estimated monthly decline of 14,524 doses, ciclosporin p = 0.185, with an estimated decline of 2,161 doses and sirolimus p = 0.002 with an estimated decline of 485 doses, along with declining prices.
CONCLUSION: A decrease in prescription medicines use raises concerns for the care of (renal) transplant patients. Patients are encouraged to discuss their planned care with their doctor, secure supplies and remain adherent to their medication.
PMID:35075618 | DOI:10.1007/s40199-021-00431-7