Tag: nevin manimala

Psychol Methods. 2022 Oct 6. doi: 10.1037/met0000532. Online ahead of print.

ABSTRACT

Studies of interaction effects are of great interest because they identify crucial interplay between predictors in explaining outcomes. Previous work has considered several potential sources of statistical bias and substantive misinterpretation in the study of interactions, but less attention has been devoted to the role of the outcome variable in such research. Here, we consider bias and false discovery associated with estimates of interaction parameters as a function of the distributional and metric properties of the outcome variable. We begin by illustrating that, for a variety of noncontinuously distributed outcomes (i.e., binary and count outcomes), attempts to use the linear model for recovery leads to catastrophic levels of bias and false discovery. Next, focusing on transformations of normally distributed variables (i.e., censoring and noninterval scaling), we show that linear models again produce spurious interaction effects. We provide explanations offering geometric and algebraic intuition as to why interactions are a challenge for these incorrectly specified models. In light of these findings, we make two specific recommendations. First, a careful consideration of the outcome’s distributional properties should be a standard component of interaction studies. Second, researchers should approach research focusing on interactions with heightened levels of scrutiny. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:36201820 | DOI:10.1037/met0000532

Obstet Gynecol. 2022 Oct 6. doi: 10.1097/AOG.0000000000004939. Online ahead of print.

ABSTRACT

In this retrospective cohort study, we investigated the relationship between delayed presentation of first-trimester ultrasonographic landmarks of intrauterine pregnancy and perinatal outcomes. Patients presenting as pregnancies of unknown location who ultimately had intrauterine pregnancies were included and divided into two groups, determined by visualization of intrauterine landmarks at hCG <2000 or ≥ 2000. From 487 total patients, there was no significant difference in incidence of favorable perinatal outcome (73.3% vs 73.7%, RR=1.01, 95% CI 0.98-1.10). Of 439 live births, mean birthweight was statistically significantly lower by 115 g in the latter group. No significant difference was found for other neonatal or maternal outcomes. Our findings suggest no relationship between delayed presentation of intrauterine landmarks and poor perinatal outcomes, but a potential association with lower birthweight, though this may have limited clinical significance.

PMID:36201786 | DOI:10.1097/AOG.0000000000004939

Obstet Gynecol. 2022 Oct 6. doi: 10.1097/AOG.0000000000004965. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify rates of fetal autopsy in the United States as well as demographic and clinical characteristics related to consent to autopsy after stillbirth.

METHODS: This is a population-based retrospective cohort study using U.S. fetal death certificates for stillborn fetuses (20 weeks of gestation or more) delivered between January 2014 and December 2016. Multiple gestations were excluded. Fetal autopsy rates were calculated by gestational age, maternal age, self-reported race and ethnicity, education, and having at least one living child. Multivariate logistic regression to adjust for potential confounders was performed.

RESULTS: There were 60,328 stillbirths meeting inclusion criteria. Overall, fetal autopsy was performed in 20.9% of stillbirths. Non-Hispanic Black women had the highest rate of fetal autopsy (22.9%, 95% CI 22.3-23.6%), compared with non-Hispanic White women (20.4%, 95% CI 20.0-20.9%) and Hispanic women (19.6%, 95% CI 19.0-20.3%) (P<.001). After adjusting for potential confounders, maternal non-Hispanic Black race (adjusted odds ratio [aOR] 1.22, 95% CI 1.16-1.29), higher education (graduate degree: aOR 1.62, 95% CI 1.47-1.79), and higher gestational age (term: aOR 2.08, 95% CI 1.95-2.23) were associated with increased aORs for fetal autopsy. Maternal age 40 years or older (aOR 0.77 95% CI 0.63-0.92) and having at least one living child (aOR 0.74, 95% CI 0.71-0.78) were associated with a decreased aOR of having a fetal autopsy. Women of American Indian or Alaska Native decent had decreased uptake of fetal autopsy compared with non-Hispanic White women (aOR 0.72, 95% CI 0.58-0.90).

CONCLUSION: Fetal autopsy rates are low throughout the United States. The reasons for low autopsy rates warrant further exploration to inform strategies to increase availability and uptake.

PMID:36201780 | DOI:10.1097/AOG.0000000000004965

Obstet Gynecol. 2022 Oct 6. doi: 10.1097/AOG.0000000000004958. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe the testing rate, patient characteristics, temporal trends, timing, and results of germline and somatic BRCA testing in patients with ovarian cancer using real-world data.

METHODS: We included a cross-sectional subset of adult patients diagnosed with ovarian cancer between January 1, 2011, and November 30, 2018, who received frontline treatment and were followed for at least 1 year in a real-world database. The primary outcome was receipt of BRCA testing, classified by biosample source as germline (blood or saliva) or somatic (tissue). Lines of therapy (frontline, second line, third line) were derived based on dates of surgery and chemotherapy. Descriptive statistics were analyzed.

RESULTS: Among 2,557 patients, 72.2% (n=1,846) had at least one documented BRCA test. Among tested patients, 62.5% (n=1,154) had only germline testing, 10.6% (n=197) had only somatic testing, and 19.9% (n=368) had both. Most patients had testing before (9.7%, n=276) or during (48.6%, n=1,521) frontline therapy, with 17.6% (n=273) tested during second-line and 12.7% (n=129) tested during third-line therapy. Patients who received BRCA testing, compared with patients without testing, were younger (mean age 63 years vs 66 years, P<.001) and were more likely to be treated at an academic practice (10.4% vs 7.0%, P=.01), with differences by Eastern Cooperative Oncology Group performance score (P<.001), stage of disease (P<.001), histology (P<.001), geography (P<.001), and type of frontline therapy (P<.001), but no differences based on race or ethnicity. The proportion of patients who received BRCA testing within 1 year of diagnosis increased from 24.6% of patients in 2011 to 75.6% of patients in 2018.

CONCLUSION: In a large cohort of patients with ovarian cancer, significant practice disparities existed in testing for actionable BRCA mutations. Despite increased testing over time, many patients did not receive testing, suggesting missed opportunities to identify patients appropriate for targeted therapy and genetic counseling.

PMID:36201776 | DOI:10.1097/AOG.0000000000004958

Psychosom Med. 2022 Oct 1. doi: 10.1097/PSY.0000000000001146. Online ahead of print.

ABSTRACT

OBJECTIVE: Older adults may be at lower risk of common mental disorders than younger adults during the COVID-19 pandemic. Previous researchers have shown differences by age in psychosocial well-being during the pandemic and have highlighted the moderating effect of pre-pandemic mental disorders on that association. In this line, we examined the association of age with self-reported symptoms of loneliness, depression, anxiety, and posttraumatic stress, as well as potential roles of loneliness symptoms and pre-pandemic mental disorders on the association between age and mental disorder symptoms.

METHODS: Cross-sectional data of 2,000 Spanish adults interviewed by phone during the COVID-19 pandemic (February-March, 2021) were analyzed. Depression, anxiety, and posttraumatic stress were measured with the 8-item Patient Health Questionnaire, the 7-item GAD, and the 4-item checklist for Diagnostic and Statistical Manual of Mental Disorders (DSM-5), respectively. Loneliness was measured with the 3-item UCLA loneliness scale. Several regression models were constructed to assess factors related to loneliness and mental disorders.

RESULTS: According to cut-off points used, 12.4% of participants revealed depression, 11.9% anxiety, and 11.6% posttraumatic stress. Age was negatively related with mental disorder symptoms and loneliness. Loneliness was associated with higher levels of mental disorder symptoms. This association was stronger in younger adults without pre-pandemic mental disorders and in older adults without them. The association between age and loneliness was stronger in those with pre-pandemic mental disorders. Loneliness mediated the association of age with mental disorder symptoms.

CONCLUSIONS: Interventions focused on loneliness could alleviate the impact of the COVID-19 pandemic on mental health.

PMID:36201774 | DOI:10.1097/PSY.0000000000001146

Obstet Gynecol. 2022 Oct 6. doi: 10.1097/AOG.0000000000004953. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare trend of primary cesarean delivery rate and composite neonatal and maternal adverse outcomes in low-risk pregnancies among racial and ethnic groups: non-Hispanic White, non-Hispanic Black, and Hispanic.

METHODS: This population-based cohort study used U.S. vital statistics data (2015-2019) to evaluate low-risk, nulliparous patients with nonanomalous singletons who labored and delivered at 37-41 weeks of gestation. The primary outcome was the primary cesarean delivery rate. Secondary outcomes included composite neonatal adverse outcome (Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, seizure, or death), and composite maternal adverse outcome (intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy), as well as infant death. Multivariable Poisson regression models were used to estimate adjusted relative risks (aRR) and 95% CIs.

RESULTS: Among 4.3 million births, 60.6% identified as non-Hispanic White, 14.6% identified as non-Hispanic Black, and 24.8% identified as Hispanic. The rate of primary cesarean delivery was 18.5% (n=804,155). An increased risk for cesarean delivery was found in non-Hispanic Black (21.7%, aRR 1.24, 95% CI 1.23-1.25) and Hispanic (17.3%, aRR 1.09, 95% CI 1.09-1.10) individuals, compared with non-Hispanic White individuals (18.1%) after multivariable adjustment. There was an upward trend in the rate of primary cesarean delivery in all racial and ethnic groups (P for linear trend<0.001 for all groups). However, the racial and ethnic disparity in the rate of primary cesarean delivery remained stable during the study period. The composite neonatal adverse outcome was lower in Hispanic individuals in all newborns (10.7 vs 8.3 per 1,000 live births, aRR 0.74, 95% CI 0.72-0.75), and in newborns delivered by primary cesarean delivery (18.5 vs 15.0 per 1,000 live births, aRR 0.73, 95% CI 0.70-0.76), compared with non-Hispanic White individuals.

CONCLUSION: Using a nationally representative sample in the United States, we found racial and ethnic disparities in the primary cesarean delivery rate in low-risk nulliparous patients, which persisted throughout the study period.

PMID:36201767 | DOI:10.1097/AOG.0000000000004953

Retina. 2022 Oct 3. doi: 10.1097/IAE.0000000000003639. Online ahead of print.

ABSTRACT

PURPOSE: To describe characteristics of indocyanine green (ICG) angiographic plaques in the nonexudative fellow eye of Caucasian patients with unilateral treatment-naïve exudative neovascular age-related macular degeneration (nAMD) through optical coherence tomography (OCT) and OCT angiography (OCTA).

METHODS: In this retrospective cross-sectional study, nonexudative eyes with ICG angiographic plaques were analyzed by OCT B-scans for the sensitivity of a double-layer sign (DLS), a pigment epithelium detachment (PED), outer retinal atrophy (ORA), hyperreflective dots (HRD) and subretinal hyperreflective material (SRHM). The ICG angiographic plaque was matched with a macular neovascularization (MNV) in OCTA en-face scans and color-coded B-scans.

RESULTS: In total, 35 ICG angiographic plaques in 33 of 291 (11%) nonexudative eyes were diagnosed. OCT revealed: 27 DLS (78%), 8 PED (23%), 8 ORA (23%), 8 HRD (23%), 1 SRHM (3%). OCTA confirmed a MNV in 28 plaques (80%): 7 (20%) in en-face scans, 3 (9%) in color-coded B-scans and 18 (51%) in both. The area size in OCTA was significantly smaller as compared to ICG angiography (p=0,002).

CONCLUSION: The diagnosis of an ICG angiographic plaque in nonexudative fellow eyes of Caucasians with unilateral treatment-naïve exudative nAMD was highly suggestive of a typical MNV type 1 as characterized by OCT and OCTA.

PMID:36201752 | DOI:10.1097/IAE.0000000000003639

N Z Med J. 2022 Oct 7;135(1563):62-69.

ABSTRACT

AIMS: The aims of this study were to quantify the burden, and the cost of health loss, following hospitalisation for major trauma in New Zealand.

METHOD: Hospitalised major trauma patients injured between July 2017 and June 2020 were extracted from the New Zealand Trauma Registry. Case-mix of major trauma in each year was summarised using descriptive statistics. Disability-adjusted life years (DALYs) were calculated for the cohort. A cost per DALY was applied to estimate the cost of health loss.

RESULTS: A total of 6,629 major trauma cases were recorded, rising from 2,072 in 2017-2018 to 2,191 in 2019-2020. The patient case-mix remained relatively consistent over the timeframe while the in-hospital mortality rate declined from 9.2% to 7.3%. Hospitalised major trauma patients accrued 22,718 DALYs (average 7,573 DALYs per year) at an estimated health loss cost of $1.02 billion ($341 million per year). The cost of health loss per case declined from $162,747 in 2017-2018 to $143,577 in 2019-2020.

CONCLUSION: The burden of major trauma is high. As injury is a preventable condition, the findings highlight the need for dedicated investment in both primary prevention and trauma care in New Zealand to reduce these avoidable costs.

PMID:36201731

N Z Med J. 2022 Oct 7;135(1563):52-61.

ABSTRACT

AIM: The safety of dabigatran is poorly studied in patients with liver cirrhosis and has rarely been compared to warfarin in terms of bleeding risks.

METHOD: We undertook a retrospective cohort study across three tertiary centres in Auckland, New Zealand, between 2008 to 2020. Adults 18 years and over and those with a clinically confirmed diagnosis of cirrhosis were included. Data collected included demographic data and clinical characteristics, baseline medication and comorbidities. The primary outcome measure was the incidence of any bleeding event that resulted in hospital admission.

RESULTS: Overall, 100 patients were included in this study. A total of 52 patients took warfarin, and 48 took dabigatran. Baseline characteristics for both groups were generally similar. The incidence rate of bleeds for patients taking warfarin was 14.4 per 100 person-years (95% CI, 8.8-23.5) compared to 9.1 per 100 person-years (95% CI, 4.5-18.1) for patients taking dabigatran. The incidence rate ratio comparing dabigatran to warfarin was 0.63 (95% CI, 0.23-1.60), p=0.25.

CONCLUSION: Our study found that patients on dabigatran may have a lower bleeding risk than patients taking warfarin, but this was not statistically significant.

PMID:36201730

J Craniofac Surg. 2022 Oct 1;33(7):2272-2275. doi: 10.1097/SCS.0000000000008747. Epub 2022 Aug 1.

ABSTRACT

This study aimed to investigate the effects of systemic irisin hormone application on new bone formation in peri-implant bone defects. After surgically creating peri-implant bone defects in the metaphyseal part of the tibiae of rats, the rats were randomly divided into 2 equal groups: a control group and an irisin group. In the control group, the rats received no further treatment during the 4-week experimental period after the surgery. The rats in the irisin group, 100 ng/kg irisin was administered intraperitoneally 3 days a week during the 8 weeks experimental period after the surgery. At the end of the experimental period, the rats were euthanized. Implants and surrounding bone tissues were collected for histological new bone formation analysis. The Student t test was used for statistical analysis. There were no significant differences between the groups in the histological analysis, new bone formation and fibrosis (P>0.05). Also, in the irisin group, there was numerically but not statistically more new bone formation detected compared with the controls. Within the limitations of this study, irisin did not affect new bone formation in peri-implant defects, although the numerical values favored the irisin group.

PMID:36201689 | DOI:10.1097/SCS.0000000000008747