Tag: statistics

Nutr Metab Cardiovasc Dis. 2023 Jan 29:S0939-4753(23)00022-4. doi: 10.1016/j.numecd.2023.01.011. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The relationship between reproductive factors and type 2 diabetes (T2D) is controversial; therefore, we explored the causal relationship of age at menarche (AAM), age at natural menopause (ANM), with the risk of T2D and glycemic traits using two-sample Mendelian randomization.

METHODS AND RESULTS: We used publicly available data at the summary level of genome-wide association studies, where AAM (N = 329,345), ANM (N = 69,360), T2D (N = 464,389). The inverse variance weighting (IVW) method was employed as the primary method. To demonstrate the robustness of the results, we also conducted various sensitivity analysis methods including the MR-Egger regression, the weighted median (WM) and the MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO) test. After excluding IVs associated with confounders, we found a causal association between later AAM and reduced risk of T2D (OR 0.81 [95% CI 0.75, 0.87]; P = 2.20 × 10^-8), lower levels of FI (β -0.04 [95% CI -0.06, -0.01]; P = 2.19 × 10^-3), FPG (β -0.03 [95% CI -0.05, -0.007]; P = 9.67 × 10^-5) and HOMA-IR (β -0.04 [95% CI -0.06, -0.01]; P = 4,95 × 10^-3). As for ANM, we only found a causal effect with HOMA-IR (β -0.01 [95% CI -0.02, -0.005]; P = 1.77 × 10^-3), but not with T2D.

CONCLUSIONS: Our MR study showed a causal relationship between later AAM and lower risk of developing T2D, lower FI, FPG and HOMA-IR levels. This may provide new insights into the prevention of T2D in women.

PMID:36775707 | DOI:10.1016/j.numecd.2023.01.011

Clin Ther. 2023 Jan 16:S0149-2918(23)00023-1. doi: 10.1016/j.clinthera.2023.01.003. Online ahead of print.

ABSTRACT

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on everyday life, the environment, and health care services. A shift from in-person medical appointments to telemedicine was a main adjustment. Such changes can have repercussions on the control and management of chronic respiratory diseases, such as asthma. The available data suggest that there was an overall decrease in asthma-related morbidities during the first year of the pandemic. Therefore, the goal of this study was to quantify the effects of the pandemic on the prescribing of antiasthmatic treatments in outpatient care (public and private health care).

METHODS: This before-after study used a time series approach based on data from monthly prescriptions of antiasthmatic drugs (anti-inflammatory drugs and bronchodilators) dated between April 2018 and March 2021. An interrupted time series (ITS) design was used for assessing changes in antiasthmatic prescribing patterns in the short and long terms after COVID-19 was recognized as a pandemic. The results are complemented with seasonal autoregressive integrated moving average (sARIMA) models.

FINDINGS: The ITS analysis showed a non-significant increase in antiasthmatic prescribing in the short term. In the long term, after the pandemic was declared, a statistically significant decrease was observed in the prescribing of antiasthmatics (in anti-inflammatory drugs and, more pronounced, in bronchodilators). In the sARIMA model, the mean monthly volume of antiasthmatic prescriptions was 18.1% lower than predicted. The numbers of months outside of the 95% CIs were different between anti-inflammatory drugs (1 month) and bronchodilators (7 months).

IMPLICATIONS: The prescribing of antiasthmatic drugs in the long term was significantly decreased with the COVID-19 pandemic, with a greater effect in the case of bronchodilators.

PMID:36775690 | DOI:10.1016/j.clinthera.2023.01.003

Hepatobiliary Pancreat Dis Int. 2023 Feb 2:S1499-3872(23)00010-3. doi: 10.1016/j.hbpd.2023.01.010. Online ahead of print.

ABSTRACT

BACKGROUND: Grafts from older donors after circulatory death were associated with inferior outcome in liver transplants in the past. But it has seemed to remain controversial in the last decade, as a result of modified clinical protocols, selected recipients, and advanced technology of organ perfusion and preservation. The present study aimed to examine the impact of older donor age on complications and survival of liver transplant using grafts from donation after circulatory death (DCD).

METHOD: A total of 944 patients who received DCD liver transplantation from 2015 to 2020 were included and divided into two groups: using graft from older donor (aged ≥ 65 years, n = 87) and younger donor (age < 65 years, n = 857). Propensity score matching (PSM) was applied to eliminate selection bias.

RESULTS: A progressively increased proportion of liver transplants with grafts from older donors was observed from 1.68% to 15.44% during the study period. The well-balanced older donor (n = 79) and younger donor (n = 79) were 1:1 matched. There were significantly more episodes of biliary non-anastomotic stricture (NAS) in the older donor group than the younger donor group [15/79 (19.0%) vs. 6/79 (7.6%); P = 0.017]. The difference did not reach statistical significance regarding early allograft dysfunction (EAD) and primary non-function (PNF). Older livers had a trend toward inferior 1-, 2-, 3-year graft and overall survival compared with younger livers, but these differences were not statistically significant (63.1%, 57.6%, 57.6% vs. 76.9%, 70.2%, 67.7%, P = 0.112; 64.4%, 58.6%, 58.6% vs. 76.9%, 72.2%, 72.2%, P = 0.064). The only risk factor for poor survival was ABO incompatible transplant (P = 0.008) in the older donor group. In the subgroup of ABO incompatible cases, it demonstrated a significant difference in the rate of NAS between the older donor group and the younger donor group [6/8 (75.0%) vs. 3/14 (21.4%); P = 0.014].

CONCLUSIONS: Transplants with grafts from older donors (aged ≥ 65 years) after circulatory death are more frequently associated with inferior outcome compared to those from younger donors. Older grafts from DCD are more likely to develop NAS, especially in ABO incompatible cases.

PMID:36775686 | DOI:10.1016/j.hbpd.2023.01.010

J Med Imaging Radiat Sci. 2023 Jan 30:S1939-8654(23)00005-X. doi: 10.1016/j.jmir.2023.01.005. Online ahead of print.

ABSTRACT

BACKGROUND: Resilient health systems effectively respond to health crises and coordinate post-event recovery. Central to a resilient system is the willingness of its workforce to work in high-risk scenarios. This study explored traits that may affect Medical Radiation and Imaging Professionals (MRIPs) willingness to work during a pandemic. Specifically, intrapersonal traits of compassion, empathy, and resilience were examined. Understanding such relationships can inform interventions that enhance individuals’ willingness and health system resilience (HSR).

METHODS: In Fall 2020, a cross-sectional survey of Nova Scotian MRIPs was conducted. Witte’s Extended Parallel Process Model, Professional Quality of Life, Intrapersonal Reactivity Index and Adult Resilience Measures-17 tools were used to assess willingness, compassion, empathy, and resilience. Statistical tests included chi-square, binomial, and multinomial logistic regression.

RESULTS: MRIPs were willing to report to work during the SARS-CoV-2 pandemic if required (92%); asked but not required (89%); or regardless of severity (94%). Individuals with very high levels of willingness reported lower personal distress (a facet of empathy) compared to those with high (p=.018) or moderate levels (p=.005). MRIPs with < 10 years experience were more likely to report high personal distress (p≤.37). Job role was associated with willingness (p<.001). There were no significant associations between level of willingness, and gender, age, experience, education, or the intrapersonal traits resilience and compassion.

CONCLUSION: Willingness was associated with job role and levels of personal distress. Personal distress was higher in participants with less years of practice. Interventions to reduce personal distress in early career MRIPs may enhance willingness to work during crises and thereby support HSR.

PMID:36775684 | DOI:10.1016/j.jmir.2023.01.005

J Pediatr Surg. 2023 Jan 20:S0022-3468(23)00040-4. doi: 10.1016/j.jpedsurg.2023.01.021. Online ahead of print.

ABSTRACT

BACKGROUND: Global pandemics may limit access to specialized care, delaying diagnosis and treatment of common acute surgical diseases. We analyzed the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on acute appendicitis at an urban tertiary care center. We hypothesize that pandemics are associated with delayed presentation and worsened clinical sequelae, specifically, higher incidences of perforation in children.

METHODS: We retrospectively assessed patients admitted to our institution with acute appendicitis in pre-pandemic control (February 2018-June 2019) and COVID-19 (February 2020-June 2021) cohorts. Primary outcomes included complicated appendicitis rates (perforation/abscess/bowel obstruction), COVID-19 status, complications and travel distance to our institution. 1107 patients met inclusion criteria: 491 (44.4%) during the control period and 616 (55.6%) in the COVID-19 cohort. Statistical analysis involved t-tests, contingency tables and logistic regression modelling for key variables.

RESULTS: A larger proportion of complicated appendicitis occurred during COVID-19 compared to controls (28.3% vs 38.8%, p < 0.001). Symptom duration at presentation and length of stay were not significantly different. Duration of antibiotic treatment, surgery length, readmission rate and travel distances were significantly higher during COVID-19. The pre-pandemic cohort had a significantly younger age distribution.

CONCLUSION: Pediatric appendicitis was significantly impacted during COVID-19, demonstrated by increased rates of complicated appendicitis, surgery duration and antibiotic duration. This may be an unintended secondary consequence of patients avoiding healthcare facilities for non-pandemic related illnesses or lockdown policies. Government policies directing all provincial pediatric appendicitis cases to pediatric institutions increased travel distances for our patients and had unanticipated consequences and resource requirements on tertiary healthcare.

LEVEL OF EVIDENCE: Level III for “Treatment Studies”.

PMID:36775681 | DOI:10.1016/j.jpedsurg.2023.01.021

Aust Crit Care. 2023 Feb 10:S1036-7314(22)00258-2. doi: 10.1016/j.aucc.2022.12.012. Online ahead of print.

ABSTRACT

OBJECTIVES: We aim to ascertain whether the benefit of early tracheostomy can be found in patients with severe traumatic brain injury (TBI) and stroke and if the benefit will remain considering distinct pathologies.

DATA SOURCES: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, a search through Lilacs, PubMed, and Cochrane databases was conducted.

REVIEW METHODS: Included studies were those written in English, French, Spanish, or Portuguese, with a formulated question, which compared outcomes between early and late trach (minimum of two outcomes), such as intensive care unit (ICU) length of stay (LOS), duration of mechanical ventilation (MV), hospital LOS, mortality rates, or ventilator-associated pneumonia (VAP). Likewise, patients presented exclusively with head injury or stroke had minimum hospital stay follow-up, and as for severe TBI patients, they presented Glasgow Coma Scale ≤8 at admission. Evaluated outcomes were the risk ratio (RR) of VAP, risk difference (RD) of mortality, and mean difference (MD) of the duration of MV, ICU LOS, and hospital LOS.

RESULTS: The early and late tracheostomy cohorts were composed of 6211 and 8140 patients, respectively. The meta-analysis demonstrated that the early tracheostomy cohort had a lower risk for VAP (RR: 0.73 [95% confidence interval {CI}, 0.66, 0.81] p < 0.00001), shorter duration of MV (MD: -4.40 days [95% CI, -8.28, -0.53] p = 0.03), and shorter ICU (MD: -6.93 days [95% CI, -8.75, -5.11] p < 0.00001) and hospital LOS (MD: -7.05 days [95% CI, -8.27, -5.84] p < 0.00001). The mortality rate did not demonstrate a statistical difference.

CONCLUSION: Early tracheostomy could optimise patient outcomes by patients’ risk for VAP and decreasing MV durationand ICU and hospital LOS.

PMID:36775675 | DOI:10.1016/j.aucc.2022.12.012

Acad Radiol. 2023 Feb 10:S1076-6332(23)00027-2. doi: 10.1016/j.acra.2023.01.011. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: Work-life experience of physicians is a driver of work engagement vs. burnout. We aimed to determine individual and institutional factors affecting work-life experience of the clinical faculty at a large tertiary care academic medical center.

MATERIALS AND METHODS: The Department of Radiology clinical faculty (n = 62) were surveyed electronically in October 2022. Twenty-three questions, consisting of multiple choice, Yes/No, and Likert scale ratings were administered to obtain demographic information and data for life outside of work, life at work, and work-life integration for the prior 12 months. Work engagements in terms of clinical, research, administrative, and education; work practices including engagement in extra work and remote work; life responsibilities; and utilization of work-life balance strategies were analyzed for percentages and differences in seniority levels and genders. Ratings of faculty work engagement and life integration strategies were assessed utilizing a 1-5 Likert scale. Descriptive statistics were utilized to report mean, standard deviation, median, Q1 and Q3 for continuous measurements, while count and percentage for categories measurements. Comparisons between seniority and gender categories were conducted using independent t-test or Wilcoxon rank sum test depending on data normality assessed through histogram analysis. Chi-square test was used to make comparisons for categorical data. When encountered with small cell (category with <5 count), Fisher’s exact test was used for 2 × 2 table analysis and Freeman-Halton test was used for comparisons with more than two categories. SAS 9.4 was used for the data analysis.

RESULTS: Twenty-eight faculty (M:F = 17:11) responded to the survey (survey response rate 45%). The vast majority of faculty reported working extra hours, with 40% working at least 10 hours extra per week. Total of 42.9% reported performing clinical work in the extra hours worked. Total 70.4% of faculty had caregiver responsibilities and 64.3% reported other individual stresses (e.g., financial, family/social, health-related), which required consistent demand of time and effort. A total of 35.7% of faculty reported not being able to balance competing life and work demands. A total of 21.4% respondents reported not utilizing any individual healthy lifestyle choices on a consistent basis over the prior 12 months. Protected time off work and remote work were perceived as effective strategies to provide adequate work-life balance; however, remote work engagement was relatively minor and 35.7% bought back vacation. Total 53.6% respondents reported a level 4 (out of 5) rating for work being meaningful and being positively engaged in their work.

CONCLUSION: Institutions should invest in providing the infrastructure for physician work-life balance and in facilitating healthy lifestyle choices for physicians.

PMID:36775667 | DOI:10.1016/j.acra.2023.01.011

J Biomol Struct Dyn. 2023 Feb 12:1-22. doi: 10.1080/07391102.2023.2178510. Online ahead of print.

ABSTRACT

Currently, numerous potent chemotherapeutic agents are available in the market but most of them show poor pharmacokinetics, lethal effects and drug resistance during their enduring use. The increased cancer cases, deaths and need of better treatment stimulates us to give newer lifesaving anticancer drugs. The phthalimide derivatives are structurally diverse and exert potential anticancer activity. In this regard, the 3D QSAR Pharmacophore model was developed and validated using fifty-eight phthalimide derivatives. The validation parameters corroborated the reliability and statistical robustness of CEASER Hypo 1. Three databases-NCI Open, Drug Bank, and Asinex were submitted to ADMET and drug-like filtering; 117893 drug-like compounds were mapped on CEASER Hypo 1; and 362 hits with IC₅₀ <1 µM were discovered. These hits were docked on VEGFR2-TK, and in the form of results fifteen hits exhibited greater affinity than sorafenib. The top lead ASN 03206926 was subjected for MD simulation (100 ns) and RMSD, Rg, RMSF, number of hydrogen bonds, and SASA verified that the complex was stable, rigid and highly compact. Results demonstrated GLU885, PHE918, CYS919, LYS920, HIS1026, CYS1045, ASP1046 are the essential residues for favourable interactions. The binding free energy calculations support the affinity and stability revealed by docking and MD simulation. The DFT calculations, negative binding energy and lower HOMO-LUMO band gap revealed that the process is spontaneous and ASN 03206926 is very reactive. Following extensive analysis we suggest that the ASN 03206926 might be employed as a new VEGFR2-TK inhibitor for the treatment of breast and VEGFR2-TK associated cancers.Communicated by Ramaswamy H. Sarma.

PMID:36775656 | DOI:10.1080/07391102.2023.2178510

Huan Jing Ke Xue. 2023 Feb 8;44(2):807-815. doi: 10.13227/j.hjkx.202204212.

ABSTRACT

Polycyclic aromatic hydrocarbons (PAHs), as a highly toxic persistent organic pollutant, are commonly found in soil and water environments. In recent years, the pollution of PAHs in groundwater has attracted wide attention from scientists. To study the pollution characteristics and sources of polycyclic aromatic hydrocarbon in groundwater of the coking site, 16 PAHs priorly controlled by the US EPA were analyzed and discussed. In this study, we identified the contamination characteristics of PAHs in groundwater, analyzed the pollution sources of PAHs, and evaluated the ecological risk of PAHs in the coking site by combining statistical techniques, the positive matrix factorization (PMF) model, and risk quotient (RQ) methods. The results indicated that the total detection rate of PAHs in groundwater of the coking plant was 46.7%. The concentrations of PAHs in groundwater of the coking plant ranged from below the detection limit to 444.9 μg·L^-1, with the average value of 1.88 μg·L^-1. The concentration of PAHs in the groundwater of different production workshops was significantly different. The most polluted workshop was in the tar-refining area, and the concentration of 16 PAHs was 444.9 μg·L^-1. Based on the PMF model, we identified the two primary contamination sources of PAHs in groundwater of the coking plant:① oil combustion and ② coal and biomass combustion and oil leakage. The contribution ratios of the two sources to PAHs of groundwater were 38.6% and 61.4%, respectively. The results of the ecological risk assessment indicated that Σ₁₆PAHs in groundwater of the coking plant had high ecological risk, and the ecological risk of single PAHs in 53.4% of the groundwater sampling site was at a high ecological risk level. In conclusion, it is urgent to carry out the treatment and restoration of the groundwater environment in the coking plant site.

PMID:36775604 | DOI:10.13227/j.hjkx.202204212

Huan Jing Ke Xue. 2023 Feb 8;44(2):796-806. doi: 10.13227/j.hjkx.202203144.

ABSTRACT

In order to explore the sources of pollution and health risk profile of heavy metal elements in groundwater, 41 sets of representative groundwater samples from the southwest sub-basin of the Shiqi River were examined for 10 heavy metal elements (As, Cr, Cd, Al, Cu, Zn, Ni, Co, Mn, and Hg), and correlation analysis and principal component analysis were used to resolve the possible sources of heavy metal contamination in groundwater in the study area. The concentration characteristics and health risk levels of the 10 heavy metals were assessed using the single-factor contamination index (P_i), the Nemerow comprehensive contamination index (P_N), and the health risk model. The results showed that:① the average values of heavy metal elements of the groundwater in the study area all met the limit of the class Ⅲ water standard in the quality standard for groundwater (GB/T 14848-2017); only the maximum value of Al was exceeded, followed by a large variation in the concentrations of Al, Mn, and Cr. The heavy metal element with the largest average contribution was Al (65.74%). ② The results of the single-factor contamination index evaluation showed that only the heavy metal element Al exceeded the cleaning level, and the results of the Nemerow comprehensive contamination index evaluation showed that the study area was basically at low pollution levels, and the quality of groundwater was good. ③ The results of the multivariate statistical analysis showed that Zn, Co, and Mn were from mixed sources consisting of geological formation and domestic waste; Al, As, and Cu were from agricultural sources; Cd, Cr, and Ni were from industrial sources; and Hg came from long-range atmospheric transport. ④ The health risk values for all heavy metals in the study area were within acceptable limits, with higher health risk values for children than for adults from the drinking water route, lower health risk values than in adults from the dermal route, and higher health risk values for heavy metals from the drinking water route than those from the dermal route, indicating that the drinking water route was the main route of exposure to heavy metals.

PMID:36775603 | DOI:10.13227/j.hjkx.202203144