Tag: statistics

Epidemiol Psychiatr Sci. 2024 May 23;33:e30. doi: 10.1017/S2045796024000325.

ABSTRACT

AIMS: While past research suggested that living arrangements are associated with suicide death, no study has examined the impact of sustained living arrangements and the change in living arrangements. Also, previous survival analysis studies only reported a single hazard ratio (HR), whereas the actual HR may change over time. We aimed to address these limitations using causal inference approaches.

METHODS: Multi-point data from a general Japanese population sample were used. Participants reported their living arrangements twice within a 5-year time interval. After that, suicide death, non-suicide death and all-cause mortality were evaluated over 14 years. We used inverse probability weighted pooled logistic regression and cumulative incidence curve, evaluating the association of time-varying living arrangements with suicide death. We also studied non-suicide death and all-cause mortality to contextualize the association. Missing data for covariates were handled using random forest imputation.

RESULTS: A total of 86,749 participants were analysed, with a mean age (standard deviation) of 51.7 (7.90) at baseline. Of these, 306 died by suicide during the 14-year follow-up. Persistently living alone was associated with an increased risk of suicide death (risk difference [RD]: 1.1%, 95% confidence interval [CI]: 0.3-2.5%; risk ratio [RR]: 4.00, 95% CI: 1.83-7.41), non-suicide death (RD: 7.8%, 95% CI: 5.2-10.5%; RR: 1.56, 95% CI: 1.38-1.74) and all-cause mortality (RD: 8.7%, 95% CI: 6.2-11.3%; RR: 1.60, 95% CI: 1.42-1.79) at the end of the follow-up. The cumulative incidence curve showed that these associations were consistent throughout the follow-up. Across all types of mortality, the increased risk was smaller for those who started to live with someone and those who transitioned to living alone. The results remained robust in sensitivity analyses.

CONCLUSIONS: Individuals who persistently live alone have an increased risk of suicide death as well as non-suicide death and all-cause mortality, whereas this impact is weaker for those who change their living arrangements.

PMID:38779822 | DOI:10.1017/S2045796024000325

Epidemiol Infect. 2024 May 23;152:e79. doi: 10.1017/S0950268824000621.

NO ABSTRACT

PMID:38779811 | DOI:10.1017/S0950268824000621

Multivariate Behav Res. 2024 May 23:1-17. doi: 10.1080/00273171.2024.2350236. Online ahead of print.

ABSTRACT

Linear mixed-effects models have been increasingly used to analyze dependent data in psychological research. Despite their many advantages over ANOVA, critical issues in their analyses remain. Due to increasing random effects and model complexity, estimation computation is demanding, and convergence becomes challenging. Applied users need help choosing appropriate methods to estimate random effects. The present Monte Carlo simulation study investigated the impacts when the restricted maximum likelihood (REML) and Bayesian estimation models were misspecified in the estimation. We also compared the performance of Akaike information criterion (AIC) and deviance information criterion (DIC) in model selection. Results showed that models neglecting the existing random effects had inflated Type I errors, unacceptable coverage, and inaccurate R-squared measures of fixed and random effects variation. Furthermore, models with redundant random effects had convergence problems, lower statistical power, and inaccurate R-squared measures for Bayesian estimation. The convergence problem is more severe for REML, while reduced power and inaccurate R-squared measures were more severe for Bayesian estimation. Notably, DIC was better than AIC in identifying the true models (especially for models including person random intercept only), improving convergence rates, and providing more accurate effect size estimates, despite AIC having higher power than DIC with 10 items and the most complicated true model.

PMID:38779786 | DOI:10.1080/00273171.2024.2350236

Am J Physiol Renal Physiol. 2024 May 23. doi: 10.1152/ajprenal.00043.2024. Online ahead of print.

ABSTRACT

Sepsis-associated acute kidney injury (SA-AKI) is a key contributor to the life threatening sequalae of sepsis. Mechanistically, SA-AKI is a consequence of unabated myeloid cell activation and oxidative stress that induces tubular injury. Iron mediates inflammatory pathways directly and through regulating the expression of ferritin, an iron storage protein comprised of ferritin light (FtL) and heavy chain (FtH). Previous work revealed myeloid FtH deletion leads to a compensatory increase in intracellular and circulating FtL and is associated with amelioration of SA-AKI. We designed this study to test the hypothesis that loss of myeloid FtL will exacerbate the sepsis-induced inflammatory response and worsen SA-AKI. We generated a novel myeloid-specific FtL knockout mouse and induced sepsis via cecal ligation and puncture or lipopolysaccharide endotoxemia. As expected, myeloid FtL and serum ferritin levels were significantly lower in the knockout mice. Interestingly, while sepsis led to production of pro- and anti-inflammatory cytokines, there was no statistical difference between the genotypes. There was a similar loss of kidney function and injury, identified by expression of kidney injury molecule-1 and neutrophil gelatinase associated lipocalin. RNA sequencing revealed upregulation of pathways for cell cycle arrest and autophagy post-sepsis, but no significant differences were observed between genotypes, including in key genes associated with ferroptosis, an iron-mediated form of cell death. FtL deletion did not impact activation of NFkB or HIF-1a signaling, key inflammatory pathways associated with dysregulated host response. Taken together, while FtL overexpression was shown to be protective, loss of FtL did not influence sepsis pathogenesis.

PMID:38779751 | DOI:10.1152/ajprenal.00043.2024

GMS J Med Educ. 2024 Apr 15;41(2):Doc16. doi: 10.3205/zma001671. eCollection 2024.

ABSTRACT

OBJECTIVES: The aim of this paper is to present the development of a longitudinal curriculum for medical students that is rooted in the particularity of the medical sciences and that aims to build and strengthen medical students’ scientific skills and use thereof in clinical practice.

METHODS: The curriculum development was initiated based on students’ feedback on the initial curriculum. To improve and expand the curriculum appropriately, a needs assessment, a literature review to define science specific to the medical sciences and practice, and an analysis of national and international curricula were performed. The curriculum development followed the PDCA cycle (Plan-Do-Check-Act).

RESULTS: The curriculum extends across the entire medical study programme from semesters 1 to 10. It consists of the seminar series on basic conduct and the epistemological groundings of science, scientific methods in medical research and health sciences, statistics and the scientific internship. Up to the sixth semester, the focus is on the acquisition of skills and abilities to work on and carry out a concrete research project; starting in semester seven, the critical evaluation and application of research results in everyday clinical practice are introduced. The curriculum is taught by epidemiologists, anthropologists, statisticians and public health scholars. Starting in semester seven, seminars are generally taught together with clinicians as tandem teaching. The curriculum is regularly assessed and adjusted.

CONCLUSIONS: The Brandenburg Scientific Curriculum can be seen as a model of a longitudinal curriculum to teach scientific thinking and acting. One that is at the same time highly integrated in the medical curriculum overall. A central coordination point seems to be necessary to coordinate the teaching content and to ensure that teachers are interconnected. Furthermore, a complex curriculum in scientific methodology requires a set of teachers from a range of disciplinary backgrounds. To ensure equally high-quality education, the variability of research projects and faculty must be taken into account by establishing generally applicable evaluation criteria and fostering faculty development, and providing all students supporting courses throughout the research project.

PMID:38779698 | PMC:PMC11106572 | DOI:10.3205/zma001671

GMS J Med Educ. 2024 Apr 15;41(2):Doc15. doi: 10.3205/zma001670. eCollection 2024.

ABSTRACT

AIM: This systematic review aims to investigate the level of empathy among medical students in Arabic speaking countries and analyze its determinants.

METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2022 (PRISMA), the authors conducted a systematic research of studies investigating the level and determinants of empathy among medical students in Arabic speaking countries. The databases PubMed, Scopus, web of science and google scholar were searched.

RESULTS: Ten studies from six countries were included. Nine of which had a cross-sectional study design. Level of empathy was assessed using the Jefferson scale in seven studies and using the Interpersonal Reactivity Index in two studies. The mean of empathy scale ranges between 97.65±14.10 to 106.55±19.16 in studies used the Jefferson scale of empathy. The associated factors with empathy were gender; high levels of empathy were reported in female students. Other factors are explored in relation with empathy such as specialty preference (surgery or medicine, “people-orientated” specialties or ”technology-oriented specialties”), family factors (marital status of parents, satisfactory relationship with parents, parents level of education and household income) and factors related to medical education (academic performance, year of study and type of curriculum) but the results are heterogeneous.

CONCLUSION: This is the first systematic review, which illustrated the determinants of empathy in Arabic medical students. Our results revealed varied results on empathy determinants. Further studies may guarantee a full exploration of this ability in order to improve the doctor-patient relationship and patient management in the Arab world.

PMID:38779697 | PMC:PMC11106575 | DOI:10.3205/zma001670

GMS J Med Educ. 2024 Apr 15;41(2):Doc21. doi: 10.3205/zma001676. eCollection 2024.

ABSTRACT

AIM: Training decisions are viewed as a problem by the majority of medical students.In the present study we compared sociodemographic and psychological characteristics of students who are interested in surgical training to those who preferred a non-surgical specialty. Furthermore, we examined whether students who wish to be trained as surgeons performed better than their non-surgical counterparts in a course designed to acquire skills in minimally invasive surgery.

METHOD: From October 2020 to January 2021 we performed a cross-sectional survey among 116 medical students prior to their year of practical training at Christian-Albrechts University in Kiel. Based on their intended field of specialization, the students were divided into a non-surgical and a surgical group. Sociodemographic and psychological characteristics such as self-efficacy expectations, resilience and stress perception were evaluated and compared between groups. Simultaneously, we compared their surgical performance in two laparoscopic exercises and their self-assessment as surgeons. Statistical differences between the training groups were determined by the Mann-Whitney U test or Pearson’s Chi square test.

RESULTS: Ninety-two students participated in the study, of whom 64.1% intended to train in a non-surgical specialty and 35.9% in a surgical specialty. Students who wished to be trained as surgeons had higher general self-efficacy expectations (p<0.001) and greater resilience (p=0.009). However, on comparison they had a lower stress level (p=0.047). The inter-group comparison of training results and self-assessment as surgeons revealed no unequivocal differences in surgical performance.

CONCLUSION: Interest in surgical specialties is correlated, among other factors, with the strength of psychological skills such as general self-efficacy expectations, resilience and stress perception. Early attention to these psychological resources in academic training might assist medical students in future career choices.

PMID:38779696 | PMC:PMC11106567 | DOI:10.3205/zma001676

Front Immunol. 2024 May 8;15:1386586. doi: 10.3389/fimmu.2024.1386586. eCollection 2024.

ABSTRACT

BACKGROUND: Sepsis, a life-threatening condition caused by the dysregulated host response to infection, is a major global health concern. Understanding the impact of viral or bacterial pathogens in sepsis is crucial for improving patient outcomes. This study aimed to investigate the human cytomegalovirus (HCMV) seropositivity as a risk factor for development of sepsis in patients with COVID-19.

METHODS: A multicenter observational study enrolled 95 intensive care patients with COVID-19-induced sepsis and 80 post-surgery individuals as controls. HCMV serostatus was determined using an ELISA test. Comprehensive clinical data, including demographics, comorbidities, and 30-day mortality, were collected. Statistical analyses evaluated the association between HCMV seropositivity and COVID-19 induced sepsis.

RESULTS: The prevalence of HCMV seropositivity did not significantly differ between COVID-19-induced sepsis patients (78%) and controls (71%, p = 0.382) in the entire cohort. However, among patients aged ≤60 years, HCMV seropositivity was significantly higher in COVID-19 sepsis patients compared to controls (86% vs 61%, respectively; p = 0.030). Nevertheless, HCMV serostatus did not affect 30-day survival.

DISCUSSION: These findings confirm the association between HCMV seropositivity and COVID-19 sepsis in non-geriatric patients. However, the lack of an independent effect on 30-day survival can be explained by the cross-reactivity of HCMV specific CD8⁺ T-cells towards SARS-CoV-2 peptides, which might confer some protection to HCMV seropositive patients. The inclusion of a post-surgery control group strengthens the generalizability of the findings. Further research is needed to elucidate the underlying mechanisms of this association, explore different patient populations, and identify interventions for optimizing patient management.

CONCLUSION: This study validates the association between HCMV seropositivity and severe COVID-19-induced sepsis in non-geriatric patients, contributing to the growing body of evidence on viral pathogens in sepsis. Although HCMV serostatus did not independently influence 30-day survival, future investigations should focus on unraveling the intricate interplay between HCMV, immune responses, and COVID-19. These insights will aid in risk stratification and the development of targeted interventions for viral sepsis.

PMID:38779663 | PMC:PMC11109369 | DOI:10.3389/fimmu.2024.1386586

Int J Gen Med. 2024 May 18;17:2253-2264. doi: 10.2147/IJGM.S465169. eCollection 2024.

ABSTRACT

BACKGROUND: Heart failure (HF) is a common final pathway of various insults to the heart, primarily from risk factors including diabetes mellitus (DM) type 2. This study analyzed the clinical characteristics of HF in a Jordanian population with a particular emphasis on the relationship between DM and HF.

METHODS: This prospective study used the Jordanian Heart Failure Registry (JoHFR) data. Patients with HF were characterized by DM status and HF type: HF with preserved ejection fraction (HFpEF) or HF with reduced ejection fraction (HFrEF). Demographics, clinical presentations, and treatment outcomes were collected. Statistical analyses and machine learning techniques were carried out for the prediction of mortality among HF patients: Recursive Feature Elimination with Cross-Validation (RFECV) and Synthetic Minority Over-sampling Technique with Edited Nearest Neighbors (SMOTEENN) were employed.

RESULTS: A total of 2007 patients with HF were included. Notable differences between diabetic and non-diabetic patients are apparent. Diabetic patients were predominantly male, older, and obese (p < 0.001 for all). A higher incidence of HFpEF was observed in the diabetes cohort (p = 0.006). Also, diabetic patients had significantly higher levels of cholesterol (p = 0.008) and LDL (p = 0.003), reduced hemoglobin levels (p < 0.001), and more severe renal impairment (eGFR; p = 0.006). Machine learning models, particularly the Random Forest Classifier, highlighted its superiority in mortality prediction, with an accuracy of 90.02% and AUC of 80.51%. Predictors of mortality included creatinine levels >115 µmol/L, length of hospital stay, and need for mechanical ventilation.

CONCLUSION: This study underscores notable differences in clinical characteristics and outcomes between diabetic and non-diabetic heart failure patients in Jordan. Diabetic patients had higher prevalence of HFpEF and poorer health indicators such as elevated cholesterol, LDL, and impaired kidney function. High creatinine levels, longer hospital stays, and the need for mechanical ventilation were key predictors of mortality.

PMID:38779652 | PMC:PMC11110810 | DOI:10.2147/IJGM.S465169

Int J Gen Med. 2024 May 18;17:2265-2278. doi: 10.2147/IJGM.S456643. eCollection 2024.

ABSTRACT

OBJECTIVE: This study aims to evaluate the association between socioeconomic conditions and the lung function of children below 18 years old.

DESIGN: Systematic review.

METHODS: PRISMA guidelines were followed to browse relevant studies from 2013 to 2023. Data from the included studies were extracted after the Newcastle-Ottawa risk of bias tool was applied.

MAIN OUTCOME: Forced expiratory volume in the first second (FEV₁) liters.

RESULTS: 20 papers with 89,619 participants were included. Logistic regression model for FEV₁ based on multiple SES indices, suggested a positive association between lower respiratory function and a lower SES, with an interquartile odds ratio (OR) of 1.67 (95% CI 1.03-1.34).

CONCLUSION: Children from a lower socioeconomic status (SES) do exhibit lower lung function and addressing the causes of this can contribute to developing preventive public health strategies.

LIMITATIONS: Lack of appropriate reference values and varied indicators of socioeconomic status in the studies contributed to significant statistical differences.

PROSPERO REGISTRATION NUMBER: CRD 42020197658.

PMID:38779651 | PMC:PMC11110818 | DOI:10.2147/IJGM.S456643