Tag: statistics

Ann Surg. 2025 Feb 12. doi: 10.1097/SLA.0000000000006664. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the association between glycemic control, measured by glycated hemoglobin (HbA1c) levels, and post-operative complications across various procedures, identify the prevalence of patients with undiagnosed prediabetes or diabetes undergoing surgery, and explore whether better glycemic management is associated with reduced short-term postoperative complications.

BACKGROUND: The presence of diabetes and the level of long-term glycemic control, as measured using HbA1c, can influence perioperative morbidity and mortality. Current evidence is largely based on small, single-center studies, with heterogeneous analysis strategies.

METHODS: Data from the 2021-2022 multi-institutional American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were utilized. Adult patients with recorded HbA1c were selected and categorized into eight groups based on the presence of a diabetes diagnosis and their HbA1c values. Various preoperative, surgical, and postoperative variables were extracted and analyzed using multivariate regression models.

RESULTS: The study included 502,478 patients with recorded HbA1c. Among those diagnosed with diabetes (n=179,697; 35.8%), HbA1c levels were distributed as follows: 27,516 (5.5%) had HbA1c <6% (<42 mmol/mol), 63,644 (12.7%) had HbA1c 6-6.9% (42-52 mmol/mol), 45,534 (9.1%) had HbA1c 7-7.9% (53-63 mmol/mol), 19,985 (4.0%) had HbA1c 8-8.9% (64-74 mmol/mol), and 23,018 (4.6%) had HbA1c ≥9% (≥75 mmol/mol). Of the patients without a diabetes diagnosis (n=322,781; 64.2%), 91,097 (18.1% of total) had HbA1c in the prediabetes range (5.7-6.4%, 39-46 mmol/mol) and 25,818 (5.1% of total) in the diabetes range (>6.4%, ≥47 mmol/mol). Multivariate logistic analysis revealed that, compared to patients without prediabetes or diabetes, patients with undiagnosed prediabetes had a lower risk of surgical complications, while patients with undiagnosed diabetes had a higher risk of medical complications. Patients with diagnosed diabetes with near-normal glycemia and those with very poor glycemic control had higher odds of any complication. Patients with undiagnosed prediabetes and undiagnosed diabetes had significantly lower chances of transfusion. Patients with undiagnosed diabetes and patients with diagnosed diabetes with near-normal glycemia, suboptimal glycemic control, or very poor glycemic control had significantly longer hospital stays compared to patients without prediabetes or diabetes.

CONCLUSIONS AND RELEVANCE: Glycemic control significantly impacts morbidity and mortality in surgical patients. A total of 23% of patients were patients with undiagnosed prediabetes or diabetes, underscoring the importance of preoperative HbA1c screening for all patients. Both very low and very high HbA1c levels should be preoperatively addressed, with moderate control (HbA1c 7-8%, 53-64 mmol/mol) identified as optimal. Overall, these findings emphasize the need for personalized diabetes management plans tailored to each patient’s needs and should inform clinical guidelines.

PMID:39936298 | DOI:10.1097/SLA.0000000000006664

Hypertension. 2025 Feb 12. doi: 10.1161/HYPERTENSIONAHA.124.24542. Online ahead of print.

ABSTRACT

BACKGROUND: The mediating role of inflammatory biomarkers in the causal relationship between body composition and hypertension remains unclear and requires further investigation.

METHODS: This study used a combination of retrospective observational analysis and Mendelian randomization approaches. Observational data were derived from 4717 Chinese children and adolescents aged 6 to 18 years who underwent dual-energy X-ray absorptiometry to assess body composition. Mendelian randomization analyses utilized summary statistics from large-scale data sets, including UK Biobank, deCODE2021, International Consortium of Blood Pressure, FinnGen, and other consortia. The inflammatory biomarkers included leptin, insulin, adiponectin, osteocalcin, FGF23 (fibroblast growth factor 23), and PTH (parathyroid hormone).

RESULTS: The observational analysis revealed that increased fat mass positively influenced diastolic blood pressure through osteocalcin, while fat-free mass had an inverse effect. Insulin mediated the association between fat mass and systolic blood pressure, diastolic blood pressure, and hypertension, with additional indirect effects observed for PTH (all P<0.05). The Mendelian randomization analyses demonstrated a causal relationship between childhood body mass index and hypertension mediated by insulin (indirect effect: odds ratio, 0.87 [95% CI, 0.78-0.97]) and adiponectin (odds ratio, 1.13 [95% CI, 1.04-1.23]). Adiponectin mediated the effects of fat-free mass (odds ratio, 0.81 [95% CI, 0.71-0.93]) and fat mass (odds ratio, 1.30 [95% CI, 1.11-1.51]) on hypertension. Leptin, adiponectin, and insulin also mediated the causal effects of body composition on systolic blood pressure, diastolic blood pressure, and hypertension.

CONCLUSIONS: These findings indicate that body composition influences blood pressure through distinct inflammatory biomarkers. Targeting inflammatory biomarkers may provide tailored strategies for managing body composition and hypertension.

PMID:39936290 | DOI:10.1161/HYPERTENSIONAHA.124.24542

Dan Med J. 2024 Dec 19;72(1):A01240067. doi: 10.61409/A01240067.

ABSTRACT

INTRODUCTION: Blunt cerebrovascular injuries (BCVI) associated with cervical spine injuries (CSI) carry a high risk of morbidity and mortality. This nationwide Danish study, covering the years 2017-2023, aimed to identify key BCVI predictors in patients with CSI to support improved early detection and management strategies.

METHODS: The study analysed data from four level-1 trauma centres using the Abbreviated Injury Scale to classify BCVI cases. Factors assessed included age, sex, type of cervical injury and the Injury Severity Score (ISS).

RESULTS: Age and sex were not significant predictors of BCVI (p = 0.12, p = 0.65). However, any form of CSI was a strong predictor (p less-than 0.001; odds ratios (OR) = 26.3; confidence intervals (95% CI): 16.84-41.12), as were cervical spine ligamentous injuries (p = 0.0007; OR = 5.4; 95% CI: 2.3-12.89). An increase in ISS score significantly correlated with BCVI risk (p = 0.001; OR = 1.03 per unit increase; 95% CI: 1.01-1.05). Specific cervical fractures were not independent predictors of BCVI.

CONCLUSIONS: From a Danish cohort of patients admitted to a level 1 trauma centre, we found a BCVI incidence of three per thousand. In case of verified injury to the cervical region, the incidence rose to 6.25%. Our findings underscore the need for increased vigilance and a standardised nationwide algorithm to prevent disability, loss of health-related quality of life, and mortality in CSI patients at risk of BCVI.

FUNDING: The study was funded by Offerfonden, Dagmar Marshall Fonden, and Torben and Alice Frimodt Fonden.

TRIAL REGISTRATION: The data collection was approved by the local ethical committee and the Central Denmark Region Office for Research: 1-45-70-19-23.

PMID:39936272 | DOI:10.61409/A01240067

Dan Med J. 2024 Dec 11;72(1):A06240378. doi: 10.61409/A06240378.

ABSTRACT

INTRODUCTION: Ankyloglossia in breastfeeding infants has been proposed to cause maternal nipple pain. Lingual frenotomy has been cited to reduce maternal nipple pain. The aim of this systematic review was to investigate if frenotomy in infants with ankyloglossia and breastfeeding problems reduces maternal nipple pain.

METHODS: We conducted a systematic literature search for RCTs comparing frenotomy to a sham procedure or usual care in mother-infant dyads with ankyloglossia and maternal nipple pain. Maternal nipple pain was registered as the main outcome. We conducted a meta-analysis and assessed the risk of bias using Rob 2.0 and the quality of evidence, adopting the GRADE approach.

RESULTS: Five RCTs were included in the review. Three RCTs were used for the meta-analysis. The meta-analysis showed a significant pre-post intervention reduction in maternal nipple pain in the frenotomy group compared with the comparison group: mean difference = -1.23; 95% confidence interval: -1.88 to -0.57. The overall bias was assessed to range from “some concerns” to “high”. The quality of evidence for the assessed outcome, maternal nipple pain, was classified as “low” to “very low”.

CONCLUSIONS: We found that frenotomy reduced maternal nipple pain in the short term. Despite being statistically significant, the clinical relevance of a 1.2-point reduction on a ten-point VAS must be questioned. Due to a considerable risk of bias along with a low study quality, the definitive benefit of frenotomy on maternal nipple pain remains unproven. Hence, quality large-scale RCTs are warranted.

PMID:39936271 | DOI:10.61409/A06240378

Dan Med J. 2024 Dec 11;72(1):A06240407. doi: 10.61409/A06240407.

ABSTRACT

INTRODUCTION: Acid-base disturbances are common in the emergency department, with acidosis and alkalosis being associated with an elevated risk of mortality and morbidity. Understanding the relationship between pH and mortality may serve to optimise patient outcomes. The primary objective was to describe the association between arterial blood pH and 0-2-day mortality in adult non-traumatic acute visits. The secondary objective was to describe this association for 3-7-day mortality.

METHODS: This population-based, multicentre cohort study included all adult non-traumatic acute visits in the Region of Southern Denmark between 2016 and 2018 who had an arterial blood gas (ABG) drawn within four hours of arrival. We described 0-2- and 3-7-day mortality stratified by pH level, controlled for confounding factors and reported as hazard ratio (HR) compared to normal pH.

RESULTS: A total of 64,725 acute visits in 31,650 individuals with an ABG were included. The overall mortality rate for index visits was 2.4% on days 0-2 and 2.1% on days 3-7. Patients with severe acidosis (pH less-than 7.20) had 20.8% and 8.9% mortality rates (HR = 9.6 and 5.2), whereas patients with acidosis (pH 7.20-7.34) had mortality rates of 7.4% and 5.2% (HR = 4.1 and 2.7) on day 0-2 and 3-7, respectively. Our secondary analysis found a 0-2-day mortality rate of nearly 60% in patients with a pH less-than 6.90.

CONCLUSION: The short-term mortality rates increased with the severity of acidosis. The highest mortality rate was found in patients with a pH less-than 6.90.

FUNDING: None.

TRIAL REGISTRATION: Not relevant.

PMID:39936269 | DOI:10.61409/A06240407

Dan Med J. 2024 Dec 11;72(1):A05240301. doi: 10.61409/A05240301.

ABSTRACT

INTRODUCTION: This study aimed to report the components of optometrist-facilitated eye health checks in optician chain stores in Denmark.

METHODS: In this survey-based cross-sectional study, we screened the 600 optician stores listed on the website of Fight for Sight Denmark and included optician store chains with more than 50 stores nationwide. The websites of each chain were reviewed to identify current trends in eye health checks, from which an interview guide was developed. Survey data were collected by conducting in-person interviews in three different optician stores from each chain.

RESULTS: Five optician store chains were eligible for inclusion in this study. All but one chain included at least non-contact air-puff tonometry and non-mydriatic colour fundus photography in their eye health check. In two of the chains, telemedical evaluation was mandatory for all abnormal results found by the in-store optometrists, whereas telemedical services were optional in the remaining optician chains.

CONCLUSIONS: This study reported the contents and organisation of optometrist-facilitated eye health checks across the five largest optician store chains in Denmark. We found that the content of eye health checks differs between chains and that their results are evaluated differently. Standardisation of the area and development of guidelines may be necessary if optometrists are to play a role in eye health screening.

FUNDING: None.

TRIAL REGISTRATION: Not relevant.

PMID:39936268 | DOI:10.61409/A05240301

JMIR Med Educ. 2025 Feb 10;11:e57634. doi: 10.2196/57634.

ABSTRACT

BACKGROUND: Forensic medicine requires background medical knowledge and the ability to apply it to legal cases. Medical students have different levels of medical knowledge and are therefore likely to perform differently when learning forensic medicine. However, different medical curricula in Thailand deliver forensic medicine courses at different stages of medical study; most curricula deliver these courses in the clinical years, while others offer them in the preclinical years. This raises questions about the differences in learning effectiveness.

OBJECTIVE: We aimed to compare the learning outcomes of medical students in curricula that either teach forensic medicine at the clinical level or teach it at the preclinical level.

METHODS: This was a 5-year retrospective study that compared multiple-choice question (MCQ) scores in a forensic medicine course for fifth- and third-year medical students. The fifth-year students’ program was different from that of the third-year students, but both programs were offered by Mahidol University. The students were taught forensic medicine by the same instructors, used similar content, and were evaluated via examinations of similar difficulty. Of the 1063 medical students included in this study, 782 were fifth-year clinical students, and 281 were third-year preclinical students.

RESULTS: The average scores of the fifth- and third-year medical students were 76.09% (SD 6.75%) and 62.94% (SD 8.33%), respectively. The difference was statistically significant (Kruskal-Wallis test: P<.001). Additionally, the average score of fifth-year medical students was significantly higher than that of third-year students in every academic year (all P values were <.001).

CONCLUSIONS: Teaching forensic medicine during the preclinical years may be too early, and preclinical students may not understand the clinical content sufficiently. Attention should be paid to ensuring that students have the adequate clinical background before teaching subjects that require clinical applications, especially in forensic medicine.

PMID:39936265 | DOI:10.2196/57634

Alzheimers Dement. 2025 Feb;21(2):e14568. doi: 10.1002/alz.14568.

ABSTRACT

INTRODUCTION: Alzheimer’s disease (AD) diagnosis centers on cognitive impairment despite other early indicators like neuropsychiatric symptoms (NPSs) and amyloid beta (Aβ) accumulation. This study examined how cognition, NPS, and Aβ changes are interrelated over time in individuals without dementia.

METHODS: Participants were 1247 individuals from the Alzheimer’s Disease Neuroimaging Initiative (ADNI)-2 and -3 cohorts with at least 48 months of follow-up. Cognitive domains were assessed via ADNI composite measures, NPS via the neuropsychiatric inventory, and Aβ via standardized uptake value ratio (SUVR) composite scores. Co-occurring changes were evaluated with parallel process models.

RESULTS: NPS was longitudinally associated with performance in each cognitive domain. Negative baseline Aβ-cognition associations were observed in three cognitive domains. No Aβ-NPS associations were observed.

DISCUSSION: This study demonstrated strong longitudinal relationships between NPS and cognition in preclinical and prodromal stages of AD. Future studies should incorporate NPS into models of disease trajectories to improve early detection and prediction of disease progression.

HIGHLIGHTS: Co-occurring changes in Aβ, cognition, and neuropsychiatric symptoms are understudied. We found relationships between neuropsychiatric symptoms and cognition. We found baseline, but not longitudinal, Aβ and cognition associations. Changes in neuropsychiatric symptoms should be included in early detection models of ADRD.

PMID:39936256 | DOI:10.1002/alz.14568

Neurol Res Pract. 2025 Feb 12;7(1):12. doi: 10.1186/s42466-024-00358-9.

ABSTRACT

BACKGROUND: The impact of direct oral anticoagulants (DOAC) on haematoma size after intracerebral haemorrhage (ICH) compared to no-anticoagulation is controversial and prospective data are lacking.

METHODS: The investigator-initiated, multicentre, prospective RASUNOA-prime study enrolled patients with non-traumatic ICH and atrial fibrillation while on a DOAC, vitamin K antagonist (VKA) or no anticoagulation (non-OAC). Neuroimaging was reviewed centrally blinded to group allocation. Primary endpoint was haematoma expansion (≥ 6.5 ml or ≥ 33%, any new intraventricular blood or an increase in modified Graeb score by ≥ 2 points) between baseline and follow-up scan within 72 h after symptom onset.

RESULTS: Of 1,440 patients screened, 951 patients with ICH symptom onset less than 24 h before admission were enrolled. Baseline scans were performed at a median of 2 h (IQR 1-6) after symptom onset. Neurological deficit and median baseline haematoma volumes (11 ml; IQR 4-39) did not differ among 577 DOAC, 251 VKA and 123 non-OAC patients. Haematoma expansion was observed in DOAC patients in 142/356 (39.9, 95%-CI 34.8-45.0%), VKA in 47/155 (30.3, 95-CI 23.1%-37.6%), versus non-OAC in 22/74 (29.7, 19.3-40.1%). Unspecific reversal agents in DOAC-ICH (212/356, 59.6%) did not affect the haematoma expansion rate compared to no-antagonization.

CONCLUSION: Baseline haematoma volume and risk of haematoma expansion did not differ statistically significantly in patients with and without DOAC.

PMID:39934933 | DOI:10.1186/s42466-024-00358-9

J Health Popul Nutr. 2025 Feb 11;44(1):37. doi: 10.1186/s41043-024-00722-0.

ABSTRACT

BACKGROUND: This study aims to determine the factors affecting the poverty rate among the households in question by region, the western, central, and eastern regions underwent research separately.

METHODS: This study uses the ordered discrete choice models: the heteroskedastic ordered logistic regression, generalized ordered probit, and partial proportional odds models.

RESULTS: Based on the findings of the data, statistically significant relationships between the variables; age, gender, levels of education, marital status, the number of equivalent individuals within the household, the existence of individuals under the age of 5 within the household, the presence of individuals over the age of 65 within the household, working status, the number of working individuals within the household, financial difficulty, the presence of income generated through real estate (rent) or securities, residential homeownership, chronic diseases, and the year of data collection were spotted.

CONCLUSIONS: Poverty is a multidimensional concept that can emerge due to several economic and social factors. Therefore, the policies that can be developed to reduce poverty can vary. To solve the problem of poverty, countries identify the factors that cause poverty and develop policies accordingly. Factors influencing household poverty levels across regions in Türkiye were identified, and several policy recommendations aimed to alleviate poverty were offered, considering the results achieved in this study. Given the results, Non-Governmental Organizations (NGOs) must implement practical projects that provide in-kind and cash assistance to those in need, offer employment opportunities, and improve the productivity of the impoverished. Continuous aid to the poor without expecting anything in return encourages them to be lazy, which may have a negative effect by increasing their dependency on getting help. In our country, an institutional monitoring mechanism should be established to measure the effectiveness of the in-kind and cash aids provided by central government institutions, local governments, and various non-governmental organizations in the fight against poverty.

PMID:39934907 | DOI:10.1186/s41043-024-00722-0