Tag: statistics

J Am Dent Assoc. 2023 Mar 30:S0002-8177(23)00071-5. doi: 10.1016/j.adaj.2023.02.005. Online ahead of print.

ABSTRACT

BACKGROUND: In the context of evolving dental materials and techniques and a national agenda to phasedown use of dental amalgam, estimates of dental amalgam placement are necessary for monitoring purposes.

METHODS: Numbers of amalgam and composite posterior restorations from 2017 through 2019 were calculated using retrospective dental claims analysis of privately insured patients. Kruskal-Wallis and multilevel, multivariable negative binomial regression models were used to test for differences in rates of amalgam and composite restoration placement by age group, sex, urban or rural area, and percentage race and ethnicity area distribution. Statistical significance was set at 0.05, with Benjamini-Hochberg correction for false discovery rate.

RESULTS: The rate of amalgam restorations declined over time from a mean of 6.29 per 100 patients in 2017 to 4.78 per 100 patients in 2019, whereas the composite restoration rate increased from 27.6 per 100 patients in 2017 to 28.8 per 100 in 2019. The mean number of amalgam restorations placed per person were lowest in females compared with males, in urban areas compared with rural areas, and in areas with more than 75% non-Hispanic White residents.

CONCLUSIONS: Amalgam restoration placements in privately insured people in the United States declined from 2017 through 2019. Amalgam restoration placements may be unevenly distributed by location.

PRACTICAL IMPLICATIONS: Achieving further declines of dental amalgam use may require changes to insurance coverage, incentives, and provider training as well as augmented disease prevention and health promotion efforts. These efforts should focus particularly on groups with high caries risk or higher rates of amalgam placement.

PMID:37003957 | DOI:10.1016/j.adaj.2023.02.005

Jt Comm J Qual Patient Saf. 2023 Feb 14:S1553-7250(23)00054-5. doi: 10.1016/j.jcjq.2023.02.001. Online ahead of print.

ABSTRACT

BACKGROUND: There is a current lack of research exploring the contextual factors of why and how quality improvement collaboratives (QICs) work. To this end, a mixed methods study was undertaken to improve our understanding of what works for whom and in what context among participants in a nationwide Canadian QIC.

METHODS: The authors used a mixed methods approach consisting of a written survey and 30-to-45-minute telephone interviews with collaborative team members, coaches, and senior leaders of participating safety improvement project (SIP) organizations to identify the essential elements of an integrated approach involving implementation science/knowledge translation, quality improvement (QI), patient safety, and collaborative learning/networked approach to enhancing safety and quality and building implementation capabilities. Survey data were analyzed using descriptive statistics. Interview data were analyzed by three team members using thematic analysis and development of an emergent coding schema.

RESULTS: Four themes emerged as the essential elements: (1) integrating implementation science into the QI/patient safety learning collaborative; (2) reinforcing of and opening eyes to implementation science by an expert implementation specialist; (3) valuing the sense making and strategies shared by coaches; and (4) experiencing challenges to implementation amplified by the COVID-19 pandemic. Teams also reported improvements in teamwork and patient outcomes as a result of participating in the QIC.

CONCLUSION: This study’s findings provide deeper insight into the “essential ingredients” (expert implementation specialist, coaches) grounded in an integrated approach that drew from QI, patient safety, and implementation science. Organizations can use the key learnings on how best to implement quality and safety projects by leveraging the sense making of the expert implementation specialist and coaches in an integrated networked learning approach.

PMID:37003945 | DOI:10.1016/j.jcjq.2023.02.001

J Prosthet Dent. 2023 Mar 30:S0022-3913(23)00171-3. doi: 10.1016/j.prosdent.2023.03.007. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Digital occlusal analyzers allow the recording of dental contact forces. Some authors assume a unique location for the center of contact forces at the position of maximum intercuspation, while others indicate variations in dental contact forces when recorded at different times of the day. Which approach is more appropriate is unclear.

PURPOSE: The purpose of this in vitro study was to analyze whether a change in the balance of masticatory forces influences the location of the center of contact forces and its magnitude.

MATERIAL AND METHODS: Three different dental casts, selected under dental criteria, were mounted in maximum intercuspation on a semiadjustable articulator equipped with a pattern indicating 9 different force application points (intersection point between 3 longitudinal rows and 3 transverse columns). A force of constant magnitude (169 N) was applied 10 times at each of the application points, and occlusal forces were recorded with a digital occlusal analyzer. Then, two variables were studied: the location of the center of contact forces and its magnitude. Each force application position (9 positions × 3 dental casts=27 in total) was repeated 10 times, and measured data were statistically analyzed with 2-way repeated measures ANOVA (α=.05) test.

RESULTS: The repeatability of the method indicated that the coefficient of variation mean was 0.37% in the location of the center of contact forces and that its magnitude was 3.70%. The 2-way repeated measures ANOVA test revealed statistically significant variations in the location of the center of contact forces and its magnitude, revealing that longitudinal changes of the application point of masticatory forces affected the magnitude of contact forces and that longitudinal and transverse changes of the application point of masticatory forces affected the location of the center of contact forces.

CONCLUSIONS: The location of the center of contact force and its magnitude provided by a digital occlusal analyzer at the position of maximum intercuspation are not necessarily unique to each articulated dental cast. Even if the intensity of the masticatory force remains unchanged, changes in its lateral or longitudinal balance also influence the result of the occlusion forces.

PMID:37003941 | DOI:10.1016/j.prosdent.2023.03.007

Prim Care Diabetes. 2023 Mar 30:S1751-9918(23)00067-0. doi: 10.1016/j.pcd.2023.03.006. Online ahead of print.

ABSTRACT

This review aims to identify the magnitude of the placebo effect in people with type 2 diabetes mellitus. Literature research was conducted Medline, Embase and Virtual Health Library for studies published between the date of inception and June 2021. The eligibility criteria included randomized controlled trials, showing comparison to placebo, having participants with type 2 diabetes mellitus, and having glycated hemoglobin (HbA1c) as the primary outcome. Meta-analysis was conducted with the effect of changing HbA1c in relation to the baseline. Exploration of heterogeneity was performed.The meta-analysis showed an increase in the average of HbA1c compared to the baseline of 0.14% (95% CI: 0.07-0.21). There was a significant difference between follow-up times (p = 0.03) and between administration routes (p = 0.01), with an increase in HbA1c in the oral route [0.15% (95% CI: 0.07-0.23)]. The meta-regression of the year of publication showed a significant downward trend (p = 0.01) of the increase in HbA1c compared to the baseline.In this study, the expected placebo effect of Hba1c reduction was not found; instead, higher Hba1c levels were observed in the control groups, although this effect was reduced over the years. Registration: PROSPERO ID CRD42020172797.

PMID:37003927 | DOI:10.1016/j.pcd.2023.03.006

Womens Health Issues. 2023 Mar 2:S1049-3867(23)00008-7. doi: 10.1016/j.whi.2023.02.001. Online ahead of print.

ABSTRACT

INTRODUCTION: Mental health symptoms and substance use increased during the COVID-19 pandemic, and women may be disproportionately affected. Women report substantial mental health consequences, and women veterans may experience additional risks associated with military service. However, rates and correlates of substance use and consequences among women veterans are largely unknown. This study aimed to 1) report rates of substance use and consequences among women veterans; 2) identify correlates of substance use and consequences; and 3) test COVID-specific anxiety as a moderator.

METHOD: Women veterans (n = 209) enrolled in Veterans Health Administration primary care completed measures of demographics, psychiatric and substance use disorder (SUD) diagnoses, current mental health symptoms, alcohol consumption, drug-related problems, and COVID-specific anxiety. Bivariate correlations evaluated demographics (age, race, employment, relationship status), psychiatric (depression/anxiety/posttraumatic stress disorder) and SUD diagnoses, and current mental health (depression/anxiety) symptoms as correlates of substance use outcomes. For any relationships between correlates and outcomes that were statistically significant, COVID-specific anxiety was tested as a moderator using the PROCESS macro in SPSS version 27. Any statistically significant moderation effects were further investigated using the PROCESS macro to estimate conditional effects. COVID-specific anxiety was mean-centered before analyses. Alpha was set to 0.05 for all statistical tests.

RESULTS: Thirty-six percent screened positive for hazardous (Alcohol Use Disorder Identification Test-Consumption [AUDIT-C] ≥ 3) alcohol consumption and 26% reported drug-related problems (18% low-level, 7% moderate-level, and 2% substantial per Drug Abuse Screening Test [DAST-10] scores). Drug-related problems were positively associated with COVID-specific anxiety, psychiatric diagnosis, SUD diagnosis, and depression symptoms. Alcohol consumption was significantly associated with SUD diagnosis. COVID-specific anxiety significantly moderated relationships between SUD diagnosis and both outcomes.

DISCUSSION: Results help identify women veterans with SUD diagnoses and high COVID-specific anxiety as at risk for increased substance use during COVID-19 and suggest a potential intervention target (COVID-specific anxiety).

PMID:37003919 | DOI:10.1016/j.whi.2023.02.001

Am J Orthod Dentofacial Orthop. 2023 Mar 30:S0889-5406(23)00136-1. doi: 10.1016/j.ajodo.2023.02.010. Online ahead of print.

ABSTRACT

INTRODUCTION: This study investigated the interrelationship between FMIA and soft-tissue profile changes in skeletal Class I and skeletal Class II white adolescents with 3 different vertical skeletal patterns.

METHODS: Two hundred seventy cephalometric images were constructed from pretreatment and posttreatment cone-beam computed tomography images of 135 white adolescents (69 females and 66 males with a mean age of 12.8 ± 1.4 years pretreatment and 15.0 ± 1.4 years posttreatment). SNA, SNB, ANB, Frankfort Mandibular Angle [FMA], Incisor Mandibular Plane Angle [IMPA], Frankfort-Mandibular Incisor Angle [FMIA], and Z angle were measured. A mixed-model analysis of variance was performed for patients with an increased posttreatment Z angle to evaluate within-subject and between-subject effects of variables in relation to horizontal and vertical skeletal patterns. Post-hoc tests were conducted to identify statistical significance among the 3 different divergent subgroups.

RESULTS: Patients with a skeletal Class I relationship had straighter facial profiles and a larger FMIA than patients with a skeletal Class II relationship before and after treatment. FMA, FMIA, IMPA, and Z angle treatment changes were similar between the skeletal Class I and II groups. The final FMIA means of the 3 divergent subgroups converged at 65° in the skeletal Class I group and 60° in the skeletal Class II group. The mandibular incisors were uprighted during treatment in the hyperdivergent patients whose Z angle values increased after treatment.

CONCLUSION: Horizontal skeletal relationships seem more suitable for determining the desired FMIA in Tweed’s total space analysis than vertical skeletal divergencies.

PMID:37003905 | DOI:10.1016/j.ajodo.2023.02.010

An Bras Dermatol. 2023 Mar 30:S0365-0596(23)00072-7. doi: 10.1016/j.abd.2022.10.007. Online ahead of print.

NO ABSTRACT

PMID:37003901 | DOI:10.1016/j.abd.2022.10.007

Rev Neurol (Paris). 2023 Mar 30:S0035-3787(23)00884-6. doi: 10.1016/j.neurol.2023.02.067. Online ahead of print.

ABSTRACT

Resective surgery is the treatment of choice for one-third of adult patients with focal, drug-resistant epilepsy. This procedure is associated with substantial clinical and cognitive risks. In clinical practice, there is no validated model for epilepsy surgery outcome prediction (ESOP). Meta-analyses on ESOP studies assessing prognostic factors report discrepancies in terms of study design. Our review aims to systematically investigate methodological and analytical aspects of studies predicting clinical and cognitive outcomes after temporal lobe epilepsy surgery. A systematic review of ESOP studies published between 2000 and 2022 from three databases (MEDLINE, Web of Science, and PsycINFO) was completed by following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. It yielded 4867 articles. Among them, 21 corresponded to our inclusion criteria and were therefore retained in the final review. The risk of bias was assessed using A Tool to Assess Risk of Bias and Applicability of Prediction Model Studies (PROBAST). Data extracted from the 21 studies were analyzed using narrative synthesis and descriptive statistics. Our findings show an increase in the use of multimodal datasets and machine learning analyses in recent ESOP studies, although regression remained the most frequently used approach. We also identified a more frequent use of network notions in recent ESOP studies. Nevertheless, several methodological issues were noted, such as small sample sizes, lack of information on the follow-up period, variability in seizure outcome, and the definition of neuropsychological postoperative change. Of 21 studies, only one provided a clinical tool to anticipate the cognitive outcome after epilepsy surgery. We conclude that methodological issues should be overcome before we move towards more complete models to better predict clinical and cognitive outcomes after epilepsy surgery. Recommendations for future studies to harness the possibilities of multimodal datasets and data fusion, are provided. A stronger bridge between fundamental and clinical research may result in developing accessible clinical tools.

PMID:37003897 | DOI:10.1016/j.neurol.2023.02.067

Transplant Proc. 2023 Mar 30:S0041-1345(23)00114-8. doi: 10.1016/j.transproceed.2023.02.051. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to investigate the expression and significance of interleukin (IL)-17 in acute rejection after renal transplantation.

METHODS: From September 2019 to December 2021, patients and healthy volunteers who underwent renal allograft transplantation and renal biopsy in our hospital were selected and divided into 4 groups: the stable group (stable) showed no obvious abnormality in renal transplantation pathology; the pathologic diagnosis of acute rejection was the rejection group; the pathologic diagnosis of renal transplantation was immunosuppressive poisoning in the drug group; and the normal group (control) was healthy volunteers. The expression of IL-17 was detected by reverse transcription-polymerase chain reaction, quantitative enzyme-linked immunosorbent assay, and immunohistochemistry. Analysis of the area under the curve and sensitivity and specificity of IL-17 for the diagnosis of acute rejection after raw transplantation was done using receiver operating characteristic curves.

RESULTS: Compared with those in the normal group and the stable group, the expression of IL-17 DNA in the blood, the value of IL-17 in the blood, and the integrated optical density value of IL-17 in the transplanted kidney were significantly higher in the rejection group (P < .05). There were no statistically significant differences in the expression of blood IL-17 DNA, the value of blood IL-17, or the integrated optical density value of transplanted kidney IL-17 between the normal group and the stable group (P > .05).

CONCLUSION: IL-17 is involved in acute rejection after renal transplantation. Increased expression of IL-17 is seen in the blood and kidneys of patients with acute rejection after renal transplantation. The detection of IL-17 may provide a theoretical basis for diagnosing and treating acute rejection in human kidney transplantation.

PMID:37003893 | DOI:10.1016/j.transproceed.2023.02.051

Acad Radiol. 2023 Mar 30:S1076-6332(23)00098-3. doi: 10.1016/j.acra.2023.02.026. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: This study assessed the role of second-look automated breast ultrasound (ABUS) adjunct to mammography (MAM) versus MAM alone in asymptomatic women and compared it with supplementing handheld ultrasound (HHUS).

MATERIALS AND METHODS: Women aged 45 to 64 underwent HHUS, ABUS, and MAM among six hospitals in China from 2018 to 2022. We compared the screening performance of three strategies (MAM alone, MAM plus HHUS, and MAM plus ABUS) stratified by age groups and breast density. McNemar’s test was used to assess differences in the cancer detection rate (CDR), the false-positive biopsy rate, sensitivity, and specificity of different strategies.

RESULTS: Of 19,171 women analyzed (mean [SD] age, 51.54 [4.61] years), 72 cases of breast cancer (3.76 per 1000) were detected. The detection rates for both HHUS and ABUS combined with MAM were statistically higher than those for MAM alone (all p < 0.001). There was no significant difference in cancer yields between the two integration strategies. The increase in CRD of the integrated strategies was higher in women aged 45-54 years with denser breasts compared with MAM alone (all p < 0.0167). In addition, the false-positive biopsy rate of MAM plus ABUS was lower than that of MAM plus HHUS (p = 0.025). Moreover, the retraction in ABUS was more frequent in cases detected among MAM-negative results.

CONCLUSION: Integrated ABUS or HHUS into MAM provided similar CDRs that were significantly higher than those for MAM alone in younger women (45-54 years) with denser breasts. ABUS has the potential to avoid unnecessary biopsies and provides specific image features to distinguish malignant tumors from HHUS.

PMID:37003874 | DOI:10.1016/j.acra.2023.02.026