Tag: statistics

Biometals. 2024 Jan 8. doi: 10.1007/s10534-023-00563-0. Online ahead of print.

ABSTRACT

There is limited experimental evidence on the biochemical consequences of aluminium (Al) and cadmium (Cd) co-exposures during pregnancy and postnatal life.This study investigated the impacts of perinatal Al chloride (AlCl₃) and Cd chloride (CdCl₂) co-exposures on neuroendocrine functions in mice offspring during postnatal life. The study comprised of four pregnant experimental groups. Group 1 received AlCl₃ (10 mg/kg), group 2 were administered CdCl₂ (1.5 mg/kg), while group 3 received both AlCl₃ (10 mg/kg) and CdCl₂ (1.5 mg/kg) (AlCl₃+CdCl₂), and group 4 received saline (10 mL/kg) only and served as control group. All experimental animals were chemically exposed once daily from gestation days 7-20. Upon delivery, male pups were regrouped based on maternal chemical exposure on postnatal day 21 (PND 21) and allowed to grow to adulthood until PND 78, after which they were sacrificed for assessment of neuroendocrine markers and histological investigations. There was no statistical significance (p > 0.05) on follicle stimulating hormone, testosterone, estrogen and progesterone, thyroid stimulating hormone, thyroxine (T4) in all treatment groups relative to controls|. However, AlCl₃ and AlCl₃-CdCl₂ significantly (p < 0.05) reduced triiodothyronine (T3) levels, with a profound increase in T3:T4 ratio by AlCl₃, and AlCl₃+CdCl₂ compared to control. Furthermore, pups from pregnant mice treated with CdCl₂ and AlCl₃+CdCl₂ demonstrated increased testicular malondialdehyde concentration with increased catalase activity relative to controls, suggesting oxidative imbalance. In addition, AlCl₃, CdCl₂, and AlCl₃+CdCl₂ exposures induced testicular and hypothalamic architectural disruption compared to controls, with marked architectural derangement in the AlCl₃+CdCl₂ group. Our findings suggest that prenatal co-exposures to Alcl₃ and CdCl₂ induce testicular and hypothalamic alterations in offspring via a testicular oxidative stress and thyrotoxicosis-dependent mechanisms.

PMID:38190032 | DOI:10.1007/s10534-023-00563-0

Endocrine. 2024 Jan 8. doi: 10.1007/s12020-023-03669-0. Online ahead of print.

ABSTRACT

PURPOSE: The study aimed to investigate the potential effect of Antithrombin III (ATIII) between chronic renal insufficiency and chronic coronary artery disease (chronic CAD) in type 2 diabetes mellitus (T2DM) patients.

METHODS: T2DM patients hospitalized in ZhongDa Hospital from 2013 to 2018 were enrolled. Relationships between renal function, ATIII, and chronic CAD risk were explored using multivariate regression models. Multiplicative and additive interactions were investigated between ATIII and renal function for CAD risk, and the role of ATIII was determined by bootstrap mediation analysis in patients with chronic renal dysfunction.

RESULTS: A total of 4197 patients were included in the study, with a chronic CAD prevalence of 23.02%. Low ATIII level was statistically associated with chronic renal insufficiency and elevated CAD risk even after adjustments (P < 0.05). A positive correlation between renal function and ATIII was demonstrated, and each 1 SD increase in renal function, ATIII increased by 2.947% (2.406-3.488%, P < 0.001) and 0.969% (0.297-1.642%, P < 0.001) in crude and adjusted models respectively. Patients with decreased renal function and ATIII were at the highest chronic CAD risk (OR = 1.51, 95%CI:1.15-1.98, P < 0.05), while no multiplicative and additive interaction effects were significant. Bootstrap mediation analysis estimated that ATIII mediated approximately 4.27% of the effect of chronic renal insufficiency on chronic CAD risk.

CONCLUSION: ATIII may serve as a mediator between chronic renal insufficiency and chronic CAD, providing mechanistic clues for renal-heart association and new insight into clinical therapies.

PMID:38190026 | DOI:10.1007/s12020-023-03669-0

Psychometrika. 2024 Jan 8. doi: 10.1007/s11336-023-09945-2. Online ahead of print.

ABSTRACT

Most measures of agreement are chance-corrected. They differ in three dimensions: their definition of chance agreement, their choice of disagreement function, and how they handle multiple raters. Chance agreement is usually defined in a pairwise manner, following either Cohen’s kappa or Fleiss’s kappa. The disagreement function is usually a nominal, quadratic, or absolute value function. But how to handle multiple raters is contentious, with the main contenders being Fleiss’s kappa, Conger’s kappa, and Hubert’s kappa, the variant of Fleiss’s kappa where agreement is said to occur only if every rater agrees. More generally, multi-rater agreement coefficients can be defined in a g-wise way, where the disagreement weighting function uses g raters instead of two. This paper contains two main contributions. (a) We propose using Fréchet variances to handle the case of multiple raters. The Fréchet variances are intuitive disagreement measures and turn out to generalize the nominal, quadratic, and absolute value functions to the case of more than two raters. (b) We derive the limit theory of g-wise weighted agreement coefficients, with chance agreement of the Cohen-type or Fleiss-type, for the case where every item is rated by the same number of raters. Trying out three confidence interval constructions, we end up recommending calculating confidence intervals using the arcsine transform or the Fisher transform.

PMID:38190018 | DOI:10.1007/s11336-023-09945-2

Eur J Epidemiol. 2024 Jan 8. doi: 10.1007/s10654-023-01080-7. Online ahead of print.

ABSTRACT

To explore to which extent neurodegeneration and cerebral small vessel disease (SVD) could mediate the association between type-2 diabetes and higher dementia risk. The analytical sample consisted in 2228 participants, out of the Three-City study, aged 65 and older, free of dementia at baseline who underwent brain MRI. Diabetes was defined by medication intake or fasting or non-fasting elevated glucose levels. Dementia status was assessed every 2 to 3 years, during up to 12 years of follow-up. Brain parenchymal fraction (BPF) and white matter hyperintensities volume (WMHV) were selected as markers of neurodegeneration and cerebral SVD respectively. We performed a mediation analysis of the effect of baseline BPF and WMHV (mediators) on the association between diabetes and dementia risk using linear and Cox models adjusted for age, sex, education level, hypertension, hypercholesterolemia, BMI, smoking and alcohol drinking status, APOE-ε4 status, and study site. At baseline, 8.8% of the participants had diabetes. Diabetes (yes vs. no) was associated with higher WMHV (β_diab = 0.193, 95% CI 0.040; 0.346) and lower BPF (β_diab = -0.342, 95% CI -0.474; -0.210), as well as with an increased risk of dementia over 12 years of follow-up (HR_diab = 1.65, 95% CI 1.04; 2.60). The association between diabetes status and dementia risk was statistically mediated by higher WMHV (HRdiab=1.05, 95% CI 1.01; 1.11, mediated part = 10.8%) and lower BPF (HR_diab = 1.12, 95% CI 1.05; 1.20, mediated part = 22.9%). This study showed that both neurodegeneration and cerebral SVD statistically explained almost 30% of the association between diabetes and dementia.

PMID:38190014 | DOI:10.1007/s10654-023-01080-7

Sports Med Open. 2024 Jan 8;10(1):5. doi: 10.1186/s40798-023-00671-8.

ABSTRACT

BACKGROUND: Patellofemoral pain (PFP) is among the most common injuries in runners. While multiple risk factors for patellofemoral pain have been investigated, the interactions of variables contributing to this condition have not been explored. This study aimed to classify runners with patellofemoral pain using a combination of factors including biomechanical, anthropometric, and demographic factors through a Classification and Regression Tree analysis.

RESULTS: Thirty-eight runners with PFP and 38 healthy controls (CON) were selected with mean (standard deviation) age 33 (16) years old and body mass index 22.3 (2.6) kg/m². Each ran at self-selected speed, but no between-group difference was identified (PFP = 2.54 (0.2) m/s x CON = 2.55 (0.1) m/s, P = .660). Runners with patellofemoral pain had different patterns of interactions involving braking ground reaction force impulse, contact time, vertical average loading rate, and age. The classification and regression tree model classified 84.2% of runners with patellofemoral pain, and 78.9% of healthy controls. The prevalence ratios ranged from 0.06 (95% confidence interval: 0.02-0.23) to 9.86 (95% confidence interval: 1.16-83.34). The strongest model identified runners with patellofemoral pain as having higher braking ground reaction force impulse, lower contact times, higher vertical average loading rate, and older age. The receiver operating characteristic curve demonstrated high accuracy at 0.83 (95% confidence interval: 0.74-0.93; standard error: 0.04; P < .001).

CONCLUSIONS: The classification and regression tree model identified an influence of multiple factors associated with patellofemoral pain in runners. Future studies may clarify whether addressing modifiable biomechanical factors may address this form of injury.

PMID:38190013 | DOI:10.1186/s40798-023-00671-8

J Opioid Manag. 2023 Nov-Dec;19(6):533-541. doi: 10.5055/jom.0838.

ABSTRACT

OBJECTIVE: This study evaluated the opioid sparing and pain relief effect of erector spinae plane block (ESPB) for radiofrequency ablation (RFA) of hepatic focal lesions under conscious sedation.

DESIGN: A randomized controlled trial.

SETTING: Tanta University Hospitals.

PATIENTS: Fifty patients aged 30-60 years old and eligible for RFA of hepatic focal lesions were included.

INTERVENTIONS: Patients randomized to receive either local anesthetic infiltration (group I) or ESPB (group II). Both groups received sedation by propofol infusion.

MAIN OUTCOME MEASURE(S): The primary outcome was total fentanyl consumption. Secondary outcomes were nonverbal pain score (NVPS), time to first analgesic request post-procedure, radiologist’s satisfaction, and complications.

RESULTS: In group I, NVPS was significantly increased at 10, 15, 25, and 30 minutes during RFA compared to group II (p = 0.008, <0.001, 0.018, and 0.001, respectively) with no significant differences on arrival to post-anesthesia care unit (PACU) and after 1 hour. Total fentanyl consumption during the procedure was significantly increased in group I compared to group II (160.9 ± 38.2 and 76 ± 21 µg, respectively; p < 0.001) with prolonged time to first analgesia request post-procedure in group II compared to group I (392.7 ± 38.8 and 101.1 ± 13.6 minutes, respectively; p < 0.001). The level of radiologist’s satisfaction was significantly increased in the group II (p = 0.010). Three patients in group I and one patient in group II needed general anesthesia. Lower incidence of complications in group II occurred with statistical insignificance.

CONCLUSIONS: The ESPB provided adequate analgesia and reduced opioids consumption during the hepatic RFA, with high radiologist’s satisfaction.

PMID:38189195 | DOI:10.5055/jom.0838

J Opioid Manag. 2023 Nov-Dec;19(6):523-532. doi: 10.5055/jom.0837.

ABSTRACT

OBJECTIVE: The primary objective of this study is to assess factors that influence opioid prescribing by dentists and the role of these factors in the practice of dental pain control.

DESIGN: A 25-question survey instrument was distributed to the study population for anonymous responses, covering dentist and practice demographics and opioid prescribing characteristics.

SETTING: Private solo and group practice settings, including general practitioners and dental specialists.

PARTICIPANTS: Potential participants included all active members of a large state dental professional association.

MAIN OUTCOME MEASURES: They were practitioner and practice demographic traits, types of opioids prescribed, and statistical correlations. Outcome variables included practice type, practitioner gender, practice location, practice model, and years in practice. Categorical covariates were summarized statistically by frequencies and percentages, and continuous covariates were summarized by means, medians, ranges, and standard deviations.

RESULTS: Strongest correlations with opioid prescribing included general practitioner (vs specialist) and male gender. The coronavirus disease 2019 pandemic was confirmed as having exerted a significant impact on opioid prescribing among the survey respondents.

CONCLUSIONS: Further research is warranted to assess post-pandemic opioid prescribing patterns, and additional educational strategies regarding limitations of opioid prescriptions should be applied to general, rather than specialty, dental practitioners.

PMID:38189194 | DOI:10.5055/jom.0837

J Opioid Manag. 2023 Nov-Dec;19(6):515-521. doi: 10.5055/jom.0836.

ABSTRACT

BACKGROUND: The epidemic of opioid misuse and abuse is rampant in the United States. A large percentage of patients who go on to misuse or abuse opioids were initially legally prescribed an opioid medication by their physician. One of the most common reasons patients of reproductive age seek medical care is for pregnancy and delivery. These patients are frequently prescribed opioids. Greater than one in 10 Medicaid-enrolled women fill an opioid prescription after vaginal delivery.

OBJECTIVE: To assess the opioid prescribing patterns of obstetric providers following vaginal deliveries.

STUDY DESIGN: Obstetric physicians and certified nurse midwives (CNMs) from different practice backgrounds were administered a questionnaire regarding opioid prescribing practices for patients who undergo vaginal delivery. Providers were contacted via email and completed survey via REDCap.

RESULTS: Ninety-nine providers completed the survey between October 2018 and January 2019. Eight percent of all providers reported prescribing opioids at discharge after vaginal deliveries. There was a statistically significant difference in the proportion of physicians who provided opioid prescriptions at discharge compared to CNMs (16.7 percent vs 1.8 percent, respectively, p < .05). Common reasons for prescribing opioids at discharge included post-partum tubal ligation (56.4 percent), third- and fourth-degree lacerations (59.6 and 73.4 percent, respectively), and operative deliveries (26.6 percent). Physicians were significantly more likely to prescribe an opioid after a second-degree laceration than CNMs (19.1 percent vs 5.3 percent, p < 0.05).

CONCLUSIONS: Practice patterns for opioid prescription vary by provider type as well as by delivery characteristics. Further study is necessary to delineate the optimal care while minimizing unnecessary opioid prescriptions.

PMID:38189193 | DOI:10.5055/jom.0836

J Opioid Manag. 2023 Nov-Dec;19(6):507-513. doi: 10.5055/jom.0835.

ABSTRACT

OBJECTIVES: (1) To evaluate the effectiveness of a curriculum on physician assistant (PA) students’ knowledge about opioid use disorder (OUD) treatment and management and (2) present student satisfaction with the curriculum.

METHODS: Three cohorts of PA students completed pre- and post-intervention questionnaires about their knowledge of motivational interviewing (MI) for OUD. One cohort of students completed the 11-item questionnaire without exposure to the intervention (control group). Students’ satisfaction with the curriculum was assessed as was their pre- and post-intervention knowledge about using MI for OUD. Bivariate statistical tests were used to analyze the quantitative data.

RESULTS: Three hundred complete and usable responses were obtained from the four cohorts of PA students (n = 300, 87.7 percent response rate). The intervention groups answered a higher number of items correctly (median = 7) than the control group (median = 6, Wilcoxon sign test M = 31, p < 0.0001). Among the intervention group, there was not a statistically significant between cohort difference on: (1) the number of identical pre- and post-intervention questionnaire items answered correctly (Chi-square = 3.77, DF = 2, p = 0.15), and (2) the total number of items answered correctly on the post-intervention questionnaire (Chi-square = 0.32, DF = 2, p = 0.85). Student comments suggest students were supportive of the curriculum, with improvements noted on how to deliver the material.

CONCLUSIONS: An educational intervention using MI for PA students was found to be valuable, and students who completed the intervention had greater knowledge about using MI with OUD patients than those who did not complete the training. The size of the effect was small, and more research on the curriculum is necessary prior to widespread adoption.

PMID:38189192 | DOI:10.5055/jom.0835

J Opioid Manag. 2023 Nov-Dec;19(6):489-494. doi: 10.5055/jom.0833.

ABSTRACT

STUDY OBJECTIVE: Pain management is a widely discussed topic, especially in the setting of the current opioid epidemic. Previous studies have shown that the use of opioids increased in the adult population. We aimed to look at the use of narcotic and non-narcotic pain medications at a large pediatric hospital to discern if patterns of pediatric pain management changed over time.

METHODS: 58,402 analgesic prescriptions of patients 0-21 years of age were analyzed from May 2012 to November 2016. A logistic regression model was fitted to examine the association of age, sex, primary diagnosis, and the length of hospital stay with probability of opioid prescription.

RESULTS: 36,560 patients aged 0-21 years (mean: 10.5, median: 11.0, and standard deviation (SD): 7.42) received analgesic pain medications. 21,847 (59.8 percent) patients were prescribed more than one analgesic. There was a male predominance in patients <15 years of age; however, in adolescents >16 years, females constituted 57.1 percent of patients. Data also showed a statistically significant reduction of opioid prescriptions from 2012 to 2016 (p < 0.001). Age and length of hospital stay were directly associated with opioid prescription (p < 0.001).

CONCLUSION: Data show that there is a decrease in overall opioid prescriptions among pediatric patients, which may be secondary to new Food and Drug Administration regulations and increased awareness of morbidity associated with opioid use. Not surprisingly, increased hospital stay and increase in age lead to more analgesic prescriptions. Further investigation is needed to determine the differences within opioid prescription patterns.

PMID:38189190 | DOI:10.5055/jom.0833