BMJ. 2024 Jun 24;385:q1353. doi: 10.1136/bmj.q1353.
NO ABSTRACT
PMID:38914429 | DOI:10.1136/bmj.q1353
Tag: statistics
Clin Exp Optom. 2024 Jun 24:1-5. doi: 10.1080/08164622.2024.2371360. Online ahead of print.
ABSTRACT
CLINICAL RELEVANCE: Isotretinoin has been the best treatment option for moderate and severe acne vulgaris since the 1980s. Some studies have shown evidence of subclinical anterior segment involvement of the eye in patients treated with isotretinoin.
BACKGROUND: This study aimed to evaluate lens clarity with the densitometry software of Scheimpflug tomography in patients treated with isotretinoin and to compare with healthy control subjects.
METHODS: Thirty-seven acnepatients treated with isotretinoin who met the inclusion criteria (24 males and 13 females, mean age 22.94 ± 4.21 years) and 39 healthy control subjects were included in the study. Clinical characteristics of the isotretinoin and control subjects were recorded. Lens density was evaluated with the densitometry software of the Scheimpflug tomography device (PentacamHR, Oculus, Wetzlar, Germany).
RESULTS: There was no statistically significant difference between the groups in age, gender distribution, spherical equivalent, or anterior segment parameters measured by the Pentacam system (p > 0.05 for all). Lens density values in zones 2 and 3 were significantly higher in the isotretinoin group (p = 0.042, p < 0.001) and positively correlated with cumulative isotretinoin dose (zone 2: r = 0.384, p = 0.032; zone 3: r = 0.384, p = 0.005).
CONCLUSION: Zone 2 and zone 3 lens density are higher in patients treated with isotretinoin when compared to healthy controls.
PMID:38914426 | DOI:10.1080/08164622.2024.2371360
J Dermatolog Treat. 2024 Dec;35(1):2365820. doi: 10.1080/09546634.2024.2365820. Epub 2024 Jun 24.
ABSTRACT
PURPOSE: Providers who treat patients with psoriasis are unevenly distributed across the United States, with more in urban than rural areas. This retrospective claims analysis characterized disparities in access to care for US patients with psoriasis using data from the STATinMED database.
MATERIALS AND METHODS: Patients (≥18 years) had ≥1 claim with a psoriasis diagnosis and ≥1 claim for advanced psoriasis therapy (apremilast or biologics) between January 2015 and December 2019. Access to psoriasis care was determined using the proportion of patients with 0, 1-2, 3-4, or ≥5 providers in their local area.
RESULTS: Overall, 179,688 patients were included in the analysis, 80.0% in urban areas. The access ratio was highest for internal medicine physicians (97.1 per 1000 patients) and lowest for dermatologists (4.4 per 1000 patients) and family practice physicians (3.9 per 1000 patients). In urban areas, 41% of patients had access to ≥5 dermatologists versus 7% in rural areas. Whereas 2% of patients in urban areas sought care outside of their local area, 75% in rural areas did so. Use of advanced therapies was low in all states (<17%).
CONCLUSION: Access to psoriasis-treating providers varied widely. Regardless of access, utilization of advanced treatments was low, suggesting the need for effective, easy-to-administer therapy.
PMID:38914420 | DOI:10.1080/09546634.2024.2365820
J Stroke Cerebrovasc Dis. 2024 Jun 22:107832. doi: 10.1016/j.jstrokecerebrovasdis.2024.107832. Online ahead of print.
ABSTRACT
BACKGROUND: Stroke is a leading cause of death and disability in Nigeria. Effective stroke management is essential to reduce morbidity and mortality. Few trained neurologists in Nigeria are mostly concentrated in the cities, making non-specialists the backbone of acute stroke management in Nigeria. Physicians-related factors have been identified as one of the factors leading to sub-optimal stroke care. This study aimed to describe the knowledge of medical doctors in acute stroke care and the factors responsible for the disparity in their skills.
METHODS: A descriptive cross-sectional survey was conducted among 404 medical doctors across all the six geo-political zones in Nigeria using the Acute Stroke Management Questionnaire (ASMaQ). Data were analysed using descriptive statistics and simple logistics regression to predict the relationship between independent variables and the outcome variable (good knowledge vs poor knowledge).
RESULTS: 67% (95% CI =63% – 72%) of respondents had good overall knowledge of stroke management. Most respondents [88.6%, 95% CI =85% – 92%] had good knowledge of General Stroke Knowledge (GSK) followed by Hyperacute Stroke Management (HSM) [52.5%, 95% CI=47.3% – 57.7%] and Advanced Stroke Management (ASM) [49.5%, 95%CI= 49.5% -54.4%]. Working in a primary healthcare center (PHCs) and government hospital were significant predictor of overall poor knowledge of stroke. Physicians at PHCs had 2.29 times the odds of poor knowledge compared to those in tertiary hospital CONCLUSIONS: It is essential to retrain doctors on stroke management regularly, as part of their professional development.
PMID:38914357 | DOI:10.1016/j.jstrokecerebrovasdis.2024.107832
Sci Total Environ. 2024 Jun 22:174209. doi: 10.1016/j.scitotenv.2024.174209. Online ahead of print.
ABSTRACT
The coming decades are likely to see of extreme weather events becoming more intense and frequent across Europe as a whole and around the Mediterranean in particular. The reproduction rate of some microorganisms, including the bacteria that cause foodborne diseases, will also be affected by these events. The aim of this study was thus to ascertain whether there might be a statistically significant relationship between emergency hospital admissions due to the principal bacterial foodborne diseases (BFDs) and the various meteorological variables, including heatwaves. We conducted a time-series study, with daily observations of both the dependent variable (emergency hospital admissions due to BFDs) and the independent variables (meteorological variables and control variables of chemical air pollution) across the period 2013-2018 in the Madrid Region (Spain), using Generalised Linear Models with Poisson regression, in which control and lag variables were included for the purpose of fitting the models. We calculated the threshold value of the maximum daily temperature above which such admissions increased statistically significantly, analysed data for the whole year and for the summer months alone, and estimated the relative and attributable risks. The estimated attributable risk was 3.6 % for every one-degree rise in the maximum daily temperature above 12 °C throughout the year, and 12.21 % for every one degree rise in temperature above the threshold heatwave definition temperature (34 °C) in summer. Furthermore, different meteorological variables displayed a statistically significant association. Whereas hours of sunlight and mean wind speed proved significant in the analyses of both the whole year and summer, the variables “rain” and “relative humidity”, only showed a significant relationship in the analysis for the whole year. High ambient temperature is a risk factor that favours the increase in emergency hospitalisations attributable to the principal BFDs, with a greater impact being observed on days coinciding with heatwave periods. The results yielded by this study could serve as a basis for implementing BFD prevention strategies, especially on heatwave days.
PMID:38914322 | DOI:10.1016/j.scitotenv.2024.174209
Arthroscopy. 2024 Jun 22:S0749-8063(24)00459-6. doi: 10.1016/j.arthro.2024.06.024. Online ahead of print.
ABSTRACT
PURPOSE: This study aimed to investigate the efficacy of arthroscopic subacromial balloon placement for massive rotator cuff tear (MRCT), assessing patient satisfaction, outcomes, shoulder functionality, pain scores, and revision-free survivorship up to eight years post the initial surgery.
METHODS: In this retrospective study with prospective data collection, patients with MRCTs undergoing balloon placement from 2014 to 2017 were prospectively enrolled. Their outcomes were analyzed retrospectively over a minimum 5-year follow-up. Demographics, patient satisfaction, reoperations, and complications were documented. Minimal clinically important differences (MCIDs) were calculated for SF-12 scores and Constant-Murley score (CMS) sub-scores. Pre- and post-surgery measures statistically compared for anatomical and functional evaluations.
RESULTS: In a study with 61 participants initially, 10 were lost to follow-up over 3 years. Of the remaining 51, 9 were lost at the latest follow-up. The cohort (42 participants, mean age 63.17 ± 7.66 years) was monitored for 83.98 ± 9.50 months. Seven participants required revisions within two years, resulting in an 83.33% revision-free survival rate. Significant improvements were observed from preoperative to latest follow-up: acromiohumeral interval decreased (7.83 to 6.56, p = 0.004), critical shoulder angle increased (36.10 to 38.24, p = 0.001), osteoarthritis grade increased (1.45 to 2.81, p = 0.001), SF-12 physical score improved (27.40 to 37.69, p = 0.001), and Constant-Murley total scores increased (26.50 to 68.69, p = 0.001). MCID for total Constant-Murley scores was 11.78 points. Among those without revisions, satisfaction rates were 11.43% excellent, 57.14% satisfied, and 31.43% dissatisfied.
CONCLUSIONS: Employing a balloon spacer for MRCTs yielded moderate satisfaction at the 5-year follow-up, with stable revision rates within the first 2 years. Notably, low revision surgery rates, high revision-free survival, and significant shoulder functionality improvements were observed at a minimum 5-year follow-up with arthroscopic subacromial balloon placement in conjunction with biceps tenotomy and subacromial bursectomy for MRCT.
PMID:38914297 | DOI:10.1016/j.arthro.2024.06.024
J Am Pharm Assoc (2003). 2024 Jun 22:102148. doi: 10.1016/j.japh.2024.102148. Online ahead of print.
ABSTRACT
BACKGROUND: Fentanyl test strips (FTS) are used to detect the presence of fentanyl in other substances, but Alabama pharmacists’ opinions regarding FTS provision are unknown.
OBJECTIVE: The purpose of this study was to assess the knowledge and perceptions of Alabama pharmacists regarding FTS and factors influencing pharmacists’ FTS provision intentions across community pharmacy locations and types.
METHODS: An anonymous cross-sectional survey was distributed via email to Alabama pharmacists employed in community (retail) pharmacies. The survey consisted of multiple-choice questions and 5-point Likert-type scales (1=strongly disagree, 5=strongly agree) informed by the Theory of Planned Behavior. Primary outcome measures included: knowledge; general attitudes; perceived benefits; perceived barriers; self-efficacy; subjective norms; perceived behavioral control (PBC); and intention regarding FTS provision. Outcomes were characterized using descriptive statistics and differences in scales scores across pharmacy locations (rural versus urban) and types (corporately- versus independently-owned) were assessed using Mann-Whitney U tests. Predictors of FTS provision intentions were evaluated using multiple linear regression (alpha=0.05).
RESULTS: Respondents (N=131; 3.82% response rate) were mostly female (64%) and Caucasian (92%). No respondents stocked FTS at their pharmacy and knowledge about FTS was low (mean[SD] knowledge score: 58.7%[15.1]). Despite the existence of perceived barriers (mean[SD] scale score: 3.2[0.6]), pharmacists’ general attitudes (3.4[0.5]), perceived benefits (3.7[0.6]), self-efficacy (3.1[0.8]), and intentions (3.2[0.7]) were positive. While subjective norms were positive (3.5[0.6]), PBC over FTS decision-making was negative (2.7[0.8]). Subjective norms were higher (p=0.040) and PBC was lower (p<0.001) amongst corporately- versus independently-owned pharmacies, but no differences existed between rural and urban locations for any measures. Additionally, perceived benefits (β=0.342, p=0.002), PBC (β=0.133, p=0.045), and self-efficacy (β=0.142, p=0.034) were positive predictors and perceived barriers (β=-0.211, p=0.029) was a negative predictor of intention.
CONCLUSION: Alabama community pharmacists have positive attitudes regarding FTS, but future research should focus on strategies to increase PBC and overcome perceived barriers.
PMID:38914293 | DOI:10.1016/j.japh.2024.102148
Prev Med. 2024 Jun 22:108053. doi: 10.1016/j.ypmed.2024.108053. Online ahead of print.
ABSTRACT
OBJECTIVE: To assess the association between work location and movement behaviours (physical activity [PA], screen time, sleep) and adherence to the Canadian 24-Hour Movement Guidelines (24-H Guidelines) among Canadian workers during the Covid-19 pandemic.
METHODS: Using cross-sectional data from the 2021 Canadian Community Health Survey (n = 10,913 working adults 18-75 years), primary work location was categorized as: worked outside the home at a fixed location (fixed workplace), worked at home (telework), and worked outside the home at no fixed location (non-fixed workplace). Recreational, transportation and occupational/household PA, as well as leisure screen time and sleep duration were self-reported. Logistic regression assessed associations between work location and adherence to movement behaviour recommendations, adjusting for covariates.
RESULTS: Compared to a fixed workplace, those teleworking reported more recreational PA (21.1 vs 17.0 min/day, p < 0.0001) and sleep (7.2 vs 7.1 h/night, p = 0.026) and were more likely to meet sleep duration recommendations (adjusted odds ratio [aOR] = 1.28, 95%CI: 1.08-1.51) and the 24-H Guidelines (aOR = 1.25, 95%CI: 1.04-1.51). Compared to fixed workplaces, those at non-fixed workplaces reported more occupational PA (62.7 vs 32.8 min/day, p < 0.0001) and less leisure screen time (2.5 vs 2.7 h/day, p = 0.021), and were more likely to meet the PA recommendation (aOR = 1.46, 95%CI: 1.15-1.85) and the 24-H Guidelines (aOR = 1.38, 95%CI: 1.09-1.75).
CONCLUSIONS: Results suggest that adherence to the 24-H Guidelines varies by work location, and work location should be considered when developing strategies to promote healthy movement behaviours. Future studies could explore hybrid work arrangements, and longitudinal study designs.
PMID:38914269 | DOI:10.1016/j.ypmed.2024.108053
Bone. 2024 Jun 22:117138. doi: 10.1016/j.bone.2024.117138. Online ahead of print.
ABSTRACT
PURPOSE: Greater white matter hyperintensities (WMH) in older adults have been associated with reduced bone mineral density (BMD) and increased fractures and falls. However, it is unclear whether there is a causal relationship between BMD reduction and WMH. In this study, Mendelian randomization (MR) was used to find the causality between WMH and estimated BMD (eBMD).
METHODS: We performed a two-sample bidirectional MR analysis using statistical data obtained from publicly available genome-wide association studies (GWAS). The main method of MR analysis is the inverse-variance weighted (IVW) method. To identify and account for the impact of horizontal pleiotropy, we also employed MR-Egger regression, MR pleiotropy residual sum, and outlier (MR-PRESSO).
RESULTS: MR analysis found a causal relationship between eBMD and WMH (IVW OR = 0.938, 95 % CI: 0.889-0.990, p = 0.020). Our causal estimates are unlikely to be distorted by horizontal pleiotropy according to heterogeneity test (both p > 0.05) and MR-Egger regression (p > 0.05). However, in the reverse MR analysis, there was no evidence that WMH was causally correlated with eBMD (IVW OR = 0.979, 95 % CI: 0.954-1.005, p = 0.109).
CONCLUSION: Our results suggest that low eBMD increased the risk of WMH; conversely, no evidence that WMH causally affects eBMD was found.
PMID:38914213 | DOI:10.1016/j.bone.2024.117138
Arch Phys Med Rehabil. 2024 Jun 22:S0003-9993(24)01057-8. doi: 10.1016/j.apmr.2024.06.003. Online ahead of print.
ABSTRACT
OBJECTIVE: To examine the evidence regarding FES-cycling’s physiological and clinical effects.
DATA SOURCES: The study was conducted in accordance with PRISMA. PubMed, EMBASE, Cochrane Review, CINAHL, Scopus, Sport Discus, and Web of Science databases were used.
STUDY SELECTION: Randomized controlled trials involving FES-cycling were included. Studies that didn’t involve FES-cycling in the intervention group or without the control group were excluded. Two reviewers screened titles and abstracts and then conducted a blinded full-text evaluation. A third reviewer resolved discrepancies.
DATA EXTRACTION: Meta-analysis was performed using inverse variance for continuous data with effect measured by mean difference and random effects analysis model. A 95% confidence interval was adopted. The significance level was set at p<.05, and trends were declared at p=.05 to ≤ .10. The I2 method was used for heterogeneity analysis. The minimal clinically important difference was calculated. Methodological quality was assessed by the risk-of-bias tool for randomized trials. The GRADE method was used for the quality of the evidence analysis.
RESULTS: A total of 52 studies were included. Metabolic, cardiocirculatory, ventilatory, and peripheral muscle oxygen extraction variables presented statistical (p<.05) and clinically important differences favoring FES-cycling, with moderate to high certainty of evidence. It also presented statistical (p<.05) and clinically important improvement in cardiorespiratory fitness, leg and total body lean mass, power, physical fitness in intensive care (moderate to high certainty of evidence), and torque (low certainty of evidence). It presented a trend (p=.05 to ≤.10) of improvement in muscle volume, spasticity, and mobility (low to moderate certainty of evidence). It showed no difference (p>.10) in six-minute walking distance, muscle cross-sectional area, bone density, and length of ICU stay (low to moderate certainty of evidence).
CONCLUSIONS: FES-cycling exercise is a more intense stimulus modality than other comparative therapeutic modalities and presented clinically important improvement in several clinical outcomes.
PMID:38914190 | DOI:10.1016/j.apmr.2024.06.003