Tag: statistics

Resuscitation. 2023 Aug 8:109933. doi: 10.1016/j.resuscitation.2023.109933. Online ahead of print.

ABSTRACT

BACKGROUND: The efficacy of empiric calcium for patients with undifferentiated cardiac arrest has come under increased scrutiny, including a randomized controlled trial that was stopped early due to a trend towards harm with calcium administration. However, small sample sizes and non-significant findings have hindered precise effect estimates. In this analysis we evaluate the association of calcium administration with survival in a large retrospective cohort of patients with cardiac arrest treated in the emergency department (ED).

METHODS: We conducted a retrospective review of medical records from two academic hospitals (one quaternary care center, one county trauma center) in San Francisco between 2011-2019. Inclusion criteria were patients aged greater than or equal to 18 years old who received treatment for cardiac arrest during their ED course. Our primary exposure was the administration of calcium while in the ED and the main outcome was survival to hospital admission. The association between calcium and survival to admission was estimated using a multivariable log-binomial regression, and also with two propensity score models.

RESULTS: We examined 781 patients with cardiac arrest treated in San Francisco EDs between 2011-2019 and found that calcium administration was associated with decreased survival to hospital admission (RR 0.74; 95% CI 0.66 – 0.82). These findings remained significant after adjustment for patient age, sex, whether the cardiac arrest was witnessed, and including an interaction term for shockable cardiac rhythms (RR 0.60; 95% CI 0.50 – 0.72) and non-shockable cardiac rhythms (RR 0.87; 95% CI 0.76 – 0.99). Risk ratios for the association between calcium and survival to hospital admission were also similar between two propensity score-based models: nearest neighbor propensity matching model (RR 0.79; 95% CI 0.68 – 0.89) and inverse propensity weighted regression adjustment model (RR 0.75; 95% CI 0.67 – 0.84).

CONCLUSIONS: Calcium administration as part of ED-directed treatment for cardiac arrest was associated with lower survival to hospital admission. Given the lack of statistically significant outcomes from smaller, more methodologically robust evaluations on this topic, we believe these findings have an important role to serve in confirming previous results and allowing for more precise effect estimates. Our data adds to the growing body evidence against the empiric use of calcium in cardiac arrest.

PMID:37562663 | DOI:10.1016/j.resuscitation.2023.109933

Braz J Anesthesiol. 2023 Aug 8:S0104-0014(23)00082-9. doi: 10.1016/j.bjane.2023.08.001. Online ahead of print.

ABSTRACT

BACKGROUND: There are few studies related to Coronavirus Disease 2019 (COVID-19) on the prevalence and nature of pain symptoms after hospital discharge, especially in individuals who develop moderate to severe disease forms. Therefore, this study aimed to evaluate the presence of chronic pain in patients discharged after hospitalization for COVID-19, and the relationship between the presence of chronic pain and intensive care stay, demographics, and risk factors for the worst Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outcome.

METHODS: A cross-sectional observational study was carried out on patients with COVID-19 who recovered after hospitalization. Patients were recruited at the least 3-months after discharge and their hospital’s health files were prospected. The variables evaluated were demographics, the severity of SARS-CoV-2 infection (considering the need for intensive care), and the presence of chronic pain. The results were shown in a descriptive manner, and multivariate analysis expressed as Odds Ratios (ORs) and respective Confidence Intervals (CIs) for the outcomes studied. Statistical significance was set at p < 0.05.

RESULTS: Of 242 individuals included, 77 (31.8%) reported chronic pain related to COVID-19, with no correlation with the severity of infection. Female sex and obesity were associated with a higher risk for chronic pain with ORs of 2.69 (Confidence Interval [95% CI 1.4 to 5.0]) and 3.02 (95% CI 1.5 to 5.9). The limbs were the most affected areas of the body.

CONCLUSION: Chronic pain is common among COVID-19 survivors treated in hospital environments. Female sex and obesity are risk factors for its occurrence.

PMID:37562649 | DOI:10.1016/j.bjane.2023.08.001

Sci Total Environ. 2023 Aug 8:166178. doi: 10.1016/j.scitotenv.2023.166178. Online ahead of print.

ABSTRACT

Traditional air quality analysis and prediction methods depend on the statistical and numerical analyses of historical air quality data with more information related to a specific region; therefore, the results are unsatisfactory. In particular, fine particulate matter (PM_2.5, PM₁₀) in the atmosphere is a major concern for human health. The modelling (analysis and prediction) of particulate matter concentrations remains unsatisfactory owing to the rapid increase in urbanization and industrialization. In the present study, we reconstructed a prediction model for both PM_2.5 and PM₁₀ with varying meteorological conditions (windspeed, temperature, precipitation, specific humidity, and air pressure) in a specific region. In this study, a prediction model was developed for the two observation stations in the study region. The analysis of particulate matter shows that seasonal variation is a primary factor that highly influences air pollutant concentrations in urban regions. Based on historical data, the maximum number of days (92 days in 2019) during the winter season exceeded the maximum permissible level of particulate matter (PM_2.5 = 15 μg/m³) concentration in air. The prediction results showed better performance of the Gaussian process regression model, with comparatively larger R² values and smaller errors than the other models. Based on the analysis and prediction, these novel methods may enhance the accuracy of particulate matter prediction and influence policy- and decision-makers among pollution control authorities to protect air quality.

PMID:37562623 | DOI:10.1016/j.scitotenv.2023.166178

Am J Emerg Med. 2023 Jul 24;73:1-6. doi: 10.1016/j.ajem.2023.07.042. Online ahead of print.

ABSTRACT

BACKGROUND: Andexanet alfa (AA) is approved for reversal of factor Xa inhibitor (FXaI) bleeds; however, there are limited reports of its use for gastrointestinal bleeding (GIB) in real-world populations. The objective of this study was to report real-world utilization and evaluation of the effectiveness of AA for FXaI-associated GIB.

METHODS: This retrospective cohort study including consecutive patients receiving AA for FXaI-associated GIB (7/2018-2/2021). Demographics, blood product administration, hemostatic efficacy, rebleeding, thrombosis, and mortality rates were collected. Hemostatic efficacy (HE), based on corrected hemoglobin at 12 h compared to baseline, was categorized as excellent (<10% decrease), good (≤ 20% decrease), or poor (>20% decrease, > 2 units of additional coagulation intervention or death prior to repeat hemoglobin). Comparative transfusion requirements between efficacy groups was assessed by Wilcoxon-Rank test.

RESULTS: Twenty-two patients were included (64% male, median (IQR) age 76 years (67, 80). Most patients (59%, n = 13) were on apixaban, and the primary anticoagulation indication was atrial fibrillation (64%, n = 14). Median initial hemoglobin was 7.5 g/dL (IQR 6.4, 8.8) and 50% (n = 11) were upper GIB. Hemostatic efficacy was excellent in 46% (n = 10), good in 23% (n = 5), and poor in 32% (n = 7). There was no statistically significant difference in red blood cells (RBCs) received between those with excellent/good hemostasis (median 2, IQR 1 to 2) and those with poor hemostasis (median 4, IQR 1.5 to 4.5). Two patients (9%) had arterial thrombotic events within 30 days of reversal.

CONCLUSION: In this multicenter, single arm, real-world observational analysis of patients with factor Xa inhibitor associated GIB most patients achieved good hemostasis following administration of AA. There was a 9% 30-day thrombotic event rate. The lack of a control group limits the strength of the conclusions that can be drawn from this study.

PMID:37562071 | DOI:10.1016/j.ajem.2023.07.042

J Can Dent Assoc. 2023 Jul;89:n6.

ABSTRACT

INTRODUCTION: Human papillomavirus (HPV), as the most common form of sexually transmitted infection, has been implicated in almost one-third of oropharyngeal cancers. One way to prevent HPV infections is through vaccination. This study aimed to investigate whether dentists in British Columbia (BC) were willing to discuss, refer and administer the vaccine in a dental practice setting.

METHODS: Our cross-sectional study used a survey consisting of 14 questions pertaining to demographics, scope of practice, barriers to discussing the HPV vaccine and willingness to engage in HPV vaccination. On 1 April 2021, the survey was distributed to all practising dentists in BC via a URL link; the link remained active for 30 days. Descriptive and inferential statistics were used to analyze results, and statistical significance was set at p < 0.05.

RESULTS: Of the 201 respondent who completed a survey, 168 (84%) agreed that discussing the link between HPV and oropharyngeal cancer falls within their scope of practice. Fewer agreed that recommending (74%) and administering (39%) the HPV vaccine were within their scope of practice. Barriers that may contribute to this unwillingness included lack of professional policies and guidelines. Although a significant proportion of respondents were willing to educate patients on HPV, they were unwilling to discuss sexual history in a dental setting (p = 0.02).

CONCLUSIONS: Despite a willingness to discuss and refer patients for HPV vaccination, most respondents were unwilling to administer the vaccine in a dental setting, as they perceived the act to fall outside their scope of practice. There remains a reluctance to engage in vaccination activities in dental settings in BC.

PMID:37562039

J Can Dent Assoc. 2023 Jun;89:n4.

ABSTRACT

BACKGROUND: Studies show concerning rates of occupational violence against oral health care workers, but few studies of this nature have been conducted on dental students in university clinics.

METHODS: We surveyed 3rd-, 4th- and 5th-year dental students in the 2020-2021 academic year at the dental teaching clinic of the University of Montreal, using a 17-item self-report questionnaire exploring 4 types of aggression: physical, verbal, reputational and sexual.

RESULTS: Of 239 students, 45 (19%) responded to the online questionnaire, and 28 (62% of respondents) reported some form of aggression in the previous year. Verbal aggression and sexual aggression were each reported by 21 (47%) students. No differences were found between rates of aggression based on ethnicity. Women (74%) reported higher rates of aggression than men (47%), although this difference did not reach statistical significance. Of the 6 students who said they speak a language other than French (the workplace language) at home, 5 (83%) reported experiencing sexual aggression.

CONCLUSION: Most students surveyed reported experiencing some form of patient aggression in the past year. The most common forms of aggression were verbal and sexual. Women and students who speak a language other than French at home may be particularly vulnerable to patient aggression in the clinical setting. This study has implications for dental education and points to the need for training and new solutions to prevent and respond to patient aggression at university dental clinics.

PMID:37562037

Int J Gynecol Pathol. 2023 Jul 18. doi: 10.1097/PGP.0000000000000975. Online ahead of print.

ABSTRACT

Cervical cancer is one of the most common gynecological malignancies. Upregulation of programmed death ligand-1 (PD-L1), an immunoregulatory protein, is associated with an adverse outcomes in several malignancies. Most studies evaluating PD-L1 expression in cervical squamous cell carcinoma (CSCC) lack data on outcomes. In this study, we correlate PD-L1 expression with clinicopathologic factors and clinical outcomes in invasive CSCC. Seventy-three cases of CSCC from 2010 to 2018 were immunostained for PD-L1. A combined positive score (CPS) of ≥1 and ≥10 was correlated with age, stage, and survival outcomes. Kaplan-Meier curves for progression-free survival and overall survival were plotted and compared using the log-rank test. Cox regression analysis was performed to identify significant prognostic factors (2-tailed P<0.05 was considered statistically significant). With CPS ≥1 or ≥10 as the cut-off, PD-L1 was positive in 52/73 (71.2%) and 23/73 (31.5%) of cases, respectively. PD-L1 positive patients present at a higher stage of disease, especially those with CPS ≥10. With CPS of ≥10 as the cut-off, the 5-yr progression-free survival and 5-yr overall survival were significantly lower (P = 0.034 and 0.012, respectively). Only stage was statistically significant for worse overall survival on multivariate analysis. PD-L1 positive patients present at a higher stage of disease, and stage is an independent prognostic indicator for adverse outcomes in CSCC. This study highlights the potential of PD-L1 targeted therapy in patients with CSCC.

PMID:37562018 | DOI:10.1097/PGP.0000000000000975

Plast Reconstr Surg. 2023 Aug 10. doi: 10.1097/PRS.0000000000010979. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients with micrognathia undergoing mandibular distraction osteogenesis (MDO) for functional and aesthetic improvement are at significant risk for dental complications. This study investigates association of two osteotomy patterns-oblique and inverted-L-with risk to developing dentition.

METHODS: Our senior orthodontist performed a retrospective review of dental radiographs of patients undergoing MDO with confirmed oblique or inverted-L osteotomies between 2012 and 2022. Images were assessed for evidence of missing, damaged, or displaced teeth, and proportion of affected hemimandibles by injury type and median number of affected teeth per hemimandible were compared between groups using appropriate statistical methodology.

RESULTS: Analysis included 44 patients (23 oblique, 21 inverted-L) and 85 hemimandibles (45 and 40). Mean age at surgery was 3.1±4.6 years, and mean time to imaging was 4.9±4.1 years; there was no difference between groups (p=0.23, p=0.34, respectively). Oblique osteotomy was associated with greater odds of missing teeth (OR 13.3, p<0.001), damaged teeth (OR 3.2, p=0.02), and any dental injury (OR 39.9, p<0.001) compared to inverted-L, as well as greater number of missing teeth (β=0.6, p<0.01), damaged teeth (β=0.3, p=0.02), and total number of affected teeth (β=0.9, p<0.001). There was no difference in incidence (p=0.5) or number (p=0.4) of displaced teeth between groups.

CONCLUSION: Inverted-L osteotomies were associated with fewer dental complications as compared to oblique osteotomy at all ages studied. While longer-term follow up and prospective data are needed prior to making definitive recommendations, this data is helpful to surgeons as they plan MDO.

PMID:37562015 | DOI:10.1097/PRS.0000000000010979

J Infect Dis. 2023 Aug 10:jiad330. doi: 10.1093/infdis/jiad330. Online ahead of print.

ABSTRACT

BACKGROUND: The knowledge on vertical human papillomavirus (HPV) transmission is limited. We aimed to determine whether HPV transmission from parents to their offspring occur before or during birth.

METHODS: Altogether, 321 mothers, 134 fathers and their 321 newborn offspring from the Finnish Family HPV study cohort were included. Parents’ genital and oral brush samples and semen samples were collected for HPV testing at baseline (36 weeks of pregnancy). Oral, genital and umbilical samples from the newborn and placenta samples were collected for HPV testing immediately after delivery. HPV risk for the newborn was calculated from mother’s and father’s HPV status by using logistic regression analyses.

RESULTS: Concordances between mothers’ and their newborns’ HPV genotype at any site were statistically significant with HPV6, HPV16, HPV18, HPV31 and HPV56; Odds Ratios (OR) ranged from OR 3.41 (95% CI: 1.80-6.48) for HPV16 to OR 634 (95% CI: 28.5-14087) for HPV31. Father-newborn HPV concordances were statistically significant with HPV6 and HPV31; OR 4.89 (95% CI: 1.09-21.9) and OR 65.0 (95% CI: 2.92-1448), respectively.ConclusionsThe genotype-specific HPV concordance between parents and their newborn is suggestive for vertical HPV transmission. However, transmission from the father to the newborn remains more uncertain.

PMID:37562006 | DOI:10.1093/infdis/jiad330

PLoS One. 2023 Aug 10;18(8):e0287002. doi: 10.1371/journal.pone.0287002. eCollection 2023.

ABSTRACT

This paper extends the existing literature by examining an important channel through which bank competition could drive the real economy by comprehensively influencing bank lending in three components-price, volume, and quality. For the measurement of bank competition, we build a series of different structural (concentration indicators) and non-structural (Lerner, Boone, and Panzar-Rose H-statistic indexes) measures, given that the reliance on solely one individual measure could lead to a misleading conclusion. Through a sample of commercial banks during 2007-2021 in a single Vietnamese banking market, we find a decline in bank loan growth and a rise in credit risk under the pressure of high competition. With respect to the association between bank competition and the price of credit, our empirical evidence is mixed based on different measures to analyze the banking market structure. Our findings support the view that greater competition results in a less proliferated banking sector with riskier assets. We also confirm that these findings are robust to additional tests, including employing alternative measures of bank lending dimensions and market structure, removing the periods of the financial crisis and the COVID-19 pandemic, and changing the empirical estimation technique. In addition, our deeper analysis reveals that the adverse impact of bank competition on lending, shown by reduced credit supply and increased credit risk, is less pronounced for banks with a higher degree of income diversification. This result suggests that bank diversification may protect the quantity and quality of bank lending from the detrimental competition effect.

PMID:37561996 | DOI:10.1371/journal.pone.0287002