Tag: statistics

Clin Epigenetics. 2022 Nov 30;14(1):157. doi: 10.1186/s13148-022-01377-6.

ABSTRACT

BACKGROUND: High caloric diet and lack of physical activity are considered main causes of NAFLD, and a change in the diet is still the only effective treatment of this disease. However, molecular mechanism of the effectiveness of diet change in treatment of NAFLD is poorly understood. We aimed to assess the involvement of epigenetic mechanisms of gene expression regulation in treatment of NAFLD. Eighteen participants with medium- to high-grade steatosis were recruited and trained to follow the Mediterranean diet modified to include fibre supplements. At three timepoints (baseline, after 30 and 60 days), we evaluated adherence to the diet and measured a number of physiological parameters such as anthropometry, blood and stool biochemistry, liver steatosis and stiffness. We also collected whole blood samples for genome-wide methylation profiling and histone acetylation assessment.

RESULTS: The diet change resulted in a decrease in liver steatosis along with statistically significant, but a minor change in BMI and weight of our study participants. The epigenetic profiling of blood cells identified significant genome-wide changes of methylation and acetylation with the former not involving regions directly regulating gene expression. Most importantly, we were able to show that identified blood methylation changes occur also in liver cells of NAFLD patients and the machine learning-based classifier that we build on those methylation changes was able to predict the stage of liver fibrosis with ROC AUC = 0.9834.

CONCLUSION: Methylomes of blood cells from NAFLD patients display a number of changes that are most likely a consequence of unhealthy diet, and the diet change appears to reverse those epigenetic changes. Moreover, the methylation status at CpG sites undergoing diet-related methylation change in blood cells stratifies liver biopsies from NAFLD patients according to fibrosis grade.

PMID:36447285 | DOI:10.1186/s13148-022-01377-6

Environ Health. 2022 Nov 29;21(1):118. doi: 10.1186/s12940-022-00924-1.

ABSTRACT

BACKGROUND: Studies of effects of hurricanes on perinatal outcomes often rely on approximate measures of exposure. This study aims to use observed damage from aerial imagery to refine residential building damage estimates, evaluate the population changes post landfall, and assess the associations between the extent of residential building damage and adverse perinatal outcomes and access to prenatal care (PNC) services. METHODS: Vital statistics data from the Florida Department of Health’s Office of Vital Statistics were used to align maternal geocoded address data to high-resolution imagery (0.5-foot resolution, true color with red, blue, and green bands) aerial photographs. Machine learning (support vector machines) classified residential roof damage across the study area. Perinatal outcomes were compared with the presence or absence of damage to the mother’s home. Log-binomial regression models were used to compare the populations living in and outside of high-risk/damage areas, to assess the population changes after Hurricane Michael, and to estimate the associations between damage after Hurricane Michael and adverse perinatal outcomes/access to PNC services. A semi-parametric linear model was used to model time of first PNC visit and increase in damage.

RESULTS: We included 8,965 women in analysis. Women with lower education and/or of Black or other non-White race/ethnicity were more likely to live in areas that would see high damage than other groups. Moreover, there was a greater proportion of births delivered by women living in the high-risk/damage area (> 25% damaged parcels after Michael) in the year before Michael than the year after Michael. Lastly, living in the area with relatively high damage increased the risk of having intermediate or inadequate PNC (adjusted Risk Ratio = 1.21, 95% CI: 1.03, 1.43), but not other adverse perinatal outcomes.

CONCLUSIONS: Aerially observed damage data enable us to evaluate the impact of natural disasters on perinatal outcomes and access to PNC services based on residential building damage immediately surrounding a household. The association between the extent of damage and adverse perinatal outcomes should be further investigated in future studies.

PMID:36447282 | DOI:10.1186/s12940-022-00924-1

BMC Health Serv Res. 2022 Nov 29;22(1):1445. doi: 10.1186/s12913-022-08756-y.

ABSTRACT

BACKGROUND: Credible evidence has established a link between the level of patient safety culture in healthcare environments and patient outcomes. Patient safety culture in the operating room has received scant attention despite the burden of adverse events among surgical patients. We aimed to evaluate the safety culture in our operating rooms and compare with existing data from other operating room settings.

METHODS: We investigated the patient safety culture in the operating rooms of our hospital as perceived by the surgeons, nurse anaesthetists and perioperative nurses using the Hospital Survey on Patient Safety Culture (HSOPSC) instrument. IBM Statistical Package for Social Science software, version 25, was used for data entry and analysis. Differences were considered significant when p < 0.05.

RESULTS: Only 122 completed surveys were returned out of a survey population of 132 frontline staff, yielding a response rate of 92.4%. The overall average composite score was 47%. The average composite scores ranged from 17-79.6% across the 12 dimensions of the HSOPSC, with teamwork within units being the only dimension with demonstrable strength. Non-punitive response to error, communication openness, feedback and communication about error”, frequency of events reported”, handoffs and transition and staffing need improvement. The perceived safety culture varied according to work areas and professional roles with nurse anaesthetists having the highest perception and the surgeons the least.

CONCLUSION: Patient safety culture in our operating rooms is adjudged to be weak, with only one of the twelve dimensions of HSOPSC demonstrating strength. This is notwithstanding its comparative strengths relative to other operating room settings.

PMID:36447277 | DOI:10.1186/s12913-022-08756-y

BMC Health Serv Res. 2022 Nov 29;22(1):1440. doi: 10.1186/s12913-022-08813-6.

ABSTRACT

BACKGROUND: Older adults with serious mental illness (SMI) often have multiple comorbidities and complex medication schedules. Shortages of behavioral health specialists (BHSs), especially in rural areas, frequently make primary care providers (PCPs) the only clinician managing this complex population. The aim of this study was to describe rural/urban psychiatric medication prescribing in older adults with SMI by PCPs and BHSs, and by clinician type.

METHODS: This retrospective descriptive analysis used 2018 Medicare data to identify individuals with a bipolar, major depression, schizophrenia, or psychosis diagnosis and examined medication claims for antianxiety, antidepressants, antipsychotics, hypnotics, and anticonvulsants. Descriptive statistics summarized percentage of medications provided by PCPs and BHSs stratified by rural and urban areas and by drug class. Additional analyses compared psychiatric prescribing patterns by physicians, advanced practice registered nurses (APRNs), and physician assistants (PAs).

RESULTS: In urban areas, PCPs prescribed at least 50% of each psychiatric medication class, except antipsychotics, which was 45.2%. BHSs prescribed 40.7% of antipsychotics and less than 25% of all other classes. In rural areas, percentages of psychiatric medications from PCPs were over 70% for each medication class, except antipsychotics, which was 60.1%. Primary care physicians provided most psychiatric medications, between 36%-57% in urban areas and 47%-65% in rural areas. Primary care APRNs provided up to 13% of prescriptions in rural areas, which was more than the amount prescribed by BHS physicians, expect for antipsychotics. Psychiatric mental health APRNs provided up to 7.5% of antipsychotics in rural areas, but their prescribing contribution among other classes ranged between 1.1%-3.6%. PAs provided 2.5%-3.4% of medications in urban areas and this increased to 3.9%-5.1% in rural areas.

CONCLUSIONS: Results highlight the extensive roles of PCPs, including APRNs, in managing psychiatric medications for older adults with SMI.

PMID:36447260 | DOI:10.1186/s12913-022-08813-6

BMC Pharmacol Toxicol. 2022 Nov 30;23(1):88. doi: 10.1186/s40360-022-00630-1.

ABSTRACT

BACKGROUND: Prescribing medications without potential drug-drug interactions (pDDIs) is one of the components of the rational use of medications. However, taking combined medications has resulted in life-threatening pDDIs, which are causing severe clinical outcomes for patients. This study was aimed at assessing the prevalence of pDDIs and associated factors in admitted patients with psychiatric disorders.

METHODS: An institution-based multicenter cross-sectional study was conducted among patients with psychiatric disorders admitted to a selected hospital in Northwest Ethiopia. Samples were approached through a systematic sampling method. The Statistical Package for the Social Sciences (SPSS) version 26 was used to analyze the data. Logistic regression was applied to determine the association of variables with pDDIs. A p-value of < 0.05 was statistically significant.

RESULTS: Out of 325 study participants, more than half (52.9%) were females, with a median age of 61 years. Overall, more than two-thirds (68.9%) were exposed to at least one clinically significant, either significant or serious level of pDDIs. Nearly one-fourth (23.2%) of participants had at least one serious level of pDDIs. Older patients were found more likely to have pDDIs compared to younger patients (p = 0.043). Similarly, patients with a higher number of prescribed medications (p = 0.035) and patients with longer hospital admissions (p = 0.004) were found more likely to be exposed to pDDIs than their counterparts.

CONCLUSION: In this study, a significant number of admitted patients with psychiatric problems encountered clinically significant pDDIs. As a result, healthcare providers could assess and follow patients with a combination of medications that potentially have a drug-drug interaction outcome.

PMID:36447276 | DOI:10.1186/s40360-022-00630-1

BMC Med. 2022 Nov 30;20(1):465. doi: 10.1186/s12916-022-02664-y.

ABSTRACT

BACKGROUND: To update and internally validate a model to predict children and young people (CYP) most likely to experience long COVID (i.e. at least one impairing symptom) 3 months after SARS-CoV-2 PCR testing and to determine whether the impact of predictors differed by SARS-CoV-2 status.

METHODS: Data from a nationally matched cohort of SARS-CoV-2 test-positive and test-negative CYP aged 11-17 years was used. The main outcome measure, long COVID, was defined as one or more impairing symptoms 3 months after PCR testing. Potential pre-specified predictors included SARS-CoV-2 status, sex, age, ethnicity, deprivation, quality of life/functioning (five EQ-5D-Y items), physical and mental health and loneliness (prior to testing) and number of symptoms at testing. The model was developed using logistic regression; performance was assessed using calibration and discrimination measures; internal validation was performed via bootstrapping and the final model was adjusted for overfitting.

RESULTS: A total of 7139 (3246 test-positives, 3893 test-negatives) completing a questionnaire 3 months post-test were included. 25.2% (817/3246) of SARS-CoV-2 PCR-positives and 18.5% (719/3893) of SARS-CoV-2 PCR-negatives had one or more impairing symptoms 3 months post-test. The final model contained SARS-CoV-2 status, number of symptoms at testing, sex, age, ethnicity, physical and mental health, loneliness and four EQ-5D-Y items before testing. Internal validation showed minimal overfitting with excellent calibration and discrimination measures (optimism-adjusted calibration slope: 0.96575; C-statistic: 0.83130).

CONCLUSIONS: We updated a risk prediction equation to identify those most at risk of long COVID 3 months after a SARS-CoV-2 PCR test which could serve as a useful triage and management tool for CYP during the ongoing pandemic. External validation is required before large-scale implementation.

PMID:36447237 | DOI:10.1186/s12916-022-02664-y

BMC Med. 2022 Nov 30;20(1):463. doi: 10.1186/s12916-022-02665-x.

ABSTRACT

BACKGROUND: Compared with patients who require fewer antihypertensive agents, those with apparent treatment-resistant hypertension (aTRH) are at increased risk for cardiovascular and all-cause mortality, independent of blood pressure control. However, the etiopathogenesis of aTRH is still poorly elucidated.

METHODS: We performed a genome-wide association study (GWAS) in first cohort including 586 aTRHs and 871 healthy controls. Next, expression quantitative trait locus (eQTL) analysis was used to identify genes that are regulated by single nucleotide polymorphisms (SNPs) derived from the GWAS. Then, we verified the genes obtained from the eQTL analysis in the validation cohort including 65 aTRHs, 96 hypertensives, and 100 healthy controls through gene expression profiling analysis and real-time quantitative polymerase chain reaction (RT-qPCR) assay.

RESULTS: The GWAS in first cohort revealed four suggestive loci (1p35, 4q13.2-21.1, 5q22-23.2, and 15q11.1-q12) represented by 23 SNPs. The 23 significant SNPs were in or near LAPTM5, SDC3, UGT2A1, FTMT, and NIPA1. eQTL analysis uncovered 14 SNPs in 1p35 locus all had same regulation directions for SDC3 and LAPTM5. The disease susceptible alleles of SNPs in 1p35 locus were associated with lower gene expression for SDC3 and higher gene expression for LAPTM5. The disease susceptible alleles of SNPs in 4q13.2-21.1 were associated with higher gene expression for UGT2B4. GTEx database did not show any statistically significant eQTLs between the SNPs in 5q22-23.2 and 15q11.1-q12 loci and their influenced genes. Then, gene expression profiling analysis in the validation cohort confirmed lower expression of SDC3 in aTRH but no significant differences on LAPTM5 and UGT2B4, when compared with controls and hypertensives, respectively. RT-qPCR assay further verified the lower expression of SDC3 in aTRH.

CONCLUSIONS: Our study identified a novel association of SDC3 with aTRH, which contributes to the elucidation of its etiopathogenesis and provides a promising therapeutic target.

PMID:36447229 | DOI:10.1186/s12916-022-02665-x

BMC Med Educ. 2022 Nov 29;22(1):821. doi: 10.1186/s12909-022-03908-4.

ABSTRACT

BACKGROUND: Students with developed self-regulated learning (SRL) skills demonstrate an ability to set individualized educational goals, select optimal learning strategies for reaching these goals, and reflect on overall progress. The primary aims of this study were to investigate first-year medical students’ perceived utility of a self-regulated learning-informed intervention and to assess the impact of its implementation on students’ intended use of SRL throughout medical school.

METHODS: A two-part educational intervention focused on SRL skill development was carried out at Harvard Medical School during the start of the 2021 academic year. For the first component of the intervention, 169 first-year medical students engaged in an interactive class session structured around SRL concept videos, a brief lecture, small group discussions and individual reflection. Students completed pre- and post-intervention surveys which inquired about learners’ current and anticipated application of SRL skills. During the second component of the intervention, 15 first-year medical students participated in a set of one-on-one academic SRL coaching sessions. All coaching participants completed follow-up semi-structured interviews.

RESULTS: A statistically significant increase was observed between students’ use of skills in all domains of self-regulated learning prior to the intervention and their anticipated use of these skills following the intervention. Prior to the intervention, 60.1% (n = 92) of students reported utilizing evidence-based learning strategies, compared to 92.8% (n = 142) of students (p < 0.001) who anticipated applying this SRL skills at the completion of the classroom session. Six core themes emerged from qualitative analysis of the post-intervention survey including learning plan development, accountability and progress tracking, goals for growth, engagement through active learning, routine reflection, and adapting to the curriculum.

CONCLUSIONS: Both classroom-based learning sessions and one-on-one academic coaching programs are feasible approaches for encouraging the use of self-regulated learning techniques in the preclinical setting.

PMID:36447223 | DOI:10.1186/s12909-022-03908-4

Malar J. 2022 Nov 29;21(1):358. doi: 10.1186/s12936-022-04381-6.

ABSTRACT

BACKGROUND: Endemic malaria is present in all 15 municipalities of Roraima state, Brazilian Amazonia. Knowledge of epidemiological data of specific populations can guide health policies to formulate effective strategies for integrated control of health-disease care. This study aims to ascertain when, where and who fell ill with malaria in Roraima state from 2010 to 2020.

METHODS: This descriptive study was based on statistical secondary surveillance data through the analysis of relationships underlying numbers of cases, hospitalizations and deaths using the Malaria Epidemiological Surveillance Information System, Mortality Information System and Hospitalization Information System.

RESULTS: From 2010 to 2020, there were 138,504 autochthonous cases, 26,158 Venezuelan imported cases, 3765 hospitalizations, and 77 deaths from malaria reported in Roraima. Annual parasitic incidence and the number of hospitalizations showed impressive changes over the period, but without significantly correlating with number of deaths. The proportion of Plasmodium falciparum infections had significant shifts throughout this study. Malaria prevalence in indigenous and mining areas has been increasing since 2014.

CONCLUSION: The presence of miners in indigenous areas is a reality that has been contributing to the increase of malaria cases in Roraima. The need to implement health policies that also meet this contingent is reinforced.

PMID:36447220 | DOI:10.1186/s12936-022-04381-6

BMC Nurs. 2022 Nov 29;21(1):332. doi: 10.1186/s12912-022-01109-4.

ABSTRACT

BACKGROUND: An accurate and reliable patient classification system (PCS) can help inform decisions regarding adequate assignments for nurse staffing. This study aimed to evaluate the criterion validity of the Asan Patient Classification System (APCS), a new tertiary hospital-specific PCS, by comparing its rating and total scores with those of KPCS-1 and KPCS-GW for measuring patient activity and nursing needs.

METHODS: We performed a retrospective analysis of the medical records of 50,314 inpatients admitted to the general wards of a tertiary teaching hospital in Seoul, South Korea in March, June, September, and December 2019. Spearman’s correlation and Kappa statistics according to quartiles were calculated to examine the criterion validity of the APCS compared with the KPCS-1 and KPCS-GW.

RESULTS: The average patient classification score was 28.3 points for APCS, 25.7 points for KPCS-1, and 21.6 points for KPCS-GW. The kappa value between APCS and KPCS-1 was 0.91 (95% CI:0.9072, 0.9119) and that between APCS and KPCS-GW was 0.88 (95% CI:0.8757, 0.8810). Additionally, Spearman’s correlation coefficients among APCS, KPCS-1, and KPCS-GW showed a very strong correlation. However, 10.8% of the participants’ results were inconsistent, and KPCS-1 tended to classify patients into groups with lower nursing needs compared to APCS.

CONCLUSION: This study showed that electronic health record-generated APCS can provide useful information on patients’ severity and nursing activities to measure workload estimation. Additional research is needed to develop and implement a real-world EHR-based PCS system to accommodate for direct and indirect nursing care while considering diverse population and dynamic healthcare system.

PMID:36447217 | DOI:10.1186/s12912-022-01109-4