Tag: statistics

Am Surg. 2023 May 5:31348231174007. doi: 10.1177/00031348231174007. Online ahead of print.

ABSTRACT

CT imaging with rectal contrast historically has been a useful tool to help identify potential colon/rectal injuries; however, recent trends have shown less utilization of rectal contrast, in favor of IV contrast CT imaging alone. A retrospective review of patients with abdominal gunshot wounds was carried out to compare the two CT imaging techniques. An analysis of patients with colorectal injuries was conducted. Patients with IV contrast had a sensitivity of 84% and specificity of 96.8%. The PPV was 87.5% and NPV was 95.8%. In the IV and rectal contrast group, the sensitivity was 88.9% and specificity was 90.5%. The PPV was 80% and NPV was 95%. The proportion of missed injuries between the two was not statistically significant, p=0.18. The study suggests that while CT imaging with rectal contrast confidently identifies colon/rectal injuries, there are often secondary findings that will correctly prompt surgical exploration.

PMID:37144405 | DOI:10.1177/00031348231174007

Food Funct. 2023 May 5. doi: 10.1039/d3fo00325f. Online ahead of print.

ABSTRACT

The impact of betaine on the development of hypertension remains unclear, and prospective data are sparse. We aimed to investigate the association of serum betaine with repeated measurements of blood pressure (BP) and hypertension incidence. This study was based on the Guangzhou Nutrition and Health Study (GNHS), a community-based prospective cohort study in China. Baseline serum betaine was measured by high-performance liquid chromatography-tandem mass spectrometry. BP and hypertension status were assessed at the baseline and 3-year intervals. Linear mixed-effects models (LMEMs) were used to analyze the longitudinal association of serum betaine with BP (n = 1996). Cox proportional hazard models were used to evaluate the association of baseline serum betaine with hypertension incidence (n = 1339). LMEMs showed that compared with the lowest quartile group, the higher quartile groups had lower systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (all P-trend < 0.05). Each standard deviation (16.3 μmol L^-1) increase in serum betaine was associated with -0.92 (-1.52, -0.32) mmHg of SBP, -0.49 (-0.84, -0.13) mmHg of DBP and -0.43 (-0.81, -0.05) mmHg of pulse pressure. During a median follow-up of 9.2 years, 371 incident cases of hypertension were identified. Serum betaine was associated with lower risk of hypertension only when comparing the third quartile level with the lowest quartile (HR, 0.74; 95% CI, 0.56-0.99). A nonlinear association between serum betaine and the risk of hypertension was found (P-nonlinear = 0.040). A higher serum betaine level was associated with lower risk of hypertension below 54.5 μmol L^-1. Our findings suggested that higher serum betaine was associated with favorable blood pressure in middle-aged and older Chinese adults. Higher concentrations of serum betaine were related to lower hypertension risk in people with relatively low serum betaine concentrations.

PMID:37144398 | DOI:10.1039/d3fo00325f

Folia Med (Plovdiv). 2023 Apr 30;65(2):283-294. doi: 10.3897/folmed.65.e78138.

ABSTRACT

AIM: The study queries a sample of dentists and dental assistants in Bulgaria about their understanding and perceptions of Expanded Function Dental Auxiliaries (EFDA). The study considers whether expanding the skillset of dental assistants to function in specific scenarios without personal supervision by the dentist may be a viable strategy to address various oral health inequities in the country.

MATERIALS AND METHODS: An anonymous survey was conducted among 103 practicing dentists and 100 dental assistants throughout the country. The questionnaire consisted of 20 questions that probed respondents’ understanding about the duties performed by EFDAs and their potential to increase productivity and efficiency of the dental workforce. Sociological (poll) and statistical (alternative analysis) methods were used in the survey.

RESULTS: The majority of respondents were female. Most worked in the larger cities. One worked in a village. Most were ethnic Bulgarians and none were Roma, reflecting the racial imbalance in the national workforce. Two-thirds (67%) believed that dental assistants with appropriate training are capable of doing expanded dental procedures without personal supervision by a dentist. The majority (83.7%) believed that EFDAs could improve efficiency of a dental practice, while 58.1% indicated that with appropriate training, they could perform expanded duties as well as the dentist. However, only one third believed that EFDAs could increase practice output (38.9%); enhance the quality of the dentist’s work (37.4%); or decrease patient anxiety (31.5%). Though most respondents (78.3%) believed that a patient would not be receptive to an EFDA placing a restoration without personal supervision by the dentist, two thirds of respondents (66.5%) would like to see dental assistants trained to perform expanded duties otherwise reserved for dentists. Most respondents felt that EFDAs could help to build a well-functioning dental team.

CONCLUSIONS: Most respondents believed that EFDAs can benefit the efficiency of a practice, suggesting that Bulgarian dental professionals would respond favorably to enhancing the skillset of assistants with expanded functions. The study suggests they are skeptical about “general” versus “personal” supervision. EFDAs may potentially provide improved access by underserved communities, while building a more inclusive oral healthcare workforce reflective of the population.

PMID:37144314 | DOI:10.3897/folmed.65.e78138

Folia Med (Plovdiv). 2023 Apr 30;65(2):269-276. doi: 10.3897/folmed.65.e74030.

ABSTRACT

INTRODUCTION: Successful periapical surgery requires appropriate root resection, preparation, and adequate sealing.

AIM: The aim of the present study was to assess the marginal adaptation of MTA and Biodentine after apical resection with an Er:YAG laser and a diamond turbine bur using a scanning electron microscope (SEM).

MATERIALS AND METHODS: The crown part of forty-eight extracted single-root human teeth was removed, and the root canal length of 15 mm was standardized. The root canals were prepared using rotary Ni-Ti Revo-S files up to an apical stop – AS40 and filled with MTA Fillapex and gutta-percha points (cold lateral condensation). The teeth are divided into 2 main groups: group 1 (n=24) after apical resection with a turbine bur, ultrasonic preparation of the retrograde cavity at 3 mm depth and retrograde obturation with Biodentine and MTA; group 2 (n=24) after apical resection with an Er:YAG laser, ultrasonic preparation of the retrograde cavity at a depth of 3 mm and retrograde obturation with MTA and Biodentine. A SEM was used for assessment of the marginal adaptation of the material to the root dentin. The data was entered into and analyzed with IBM SPSS Statistics 22.0.

RESULTS: In the group with apical resection with a turbine bur, a statistically significant difference in the gap size between the material and dentin was found in both materials we studied (MTA and Biodentine). The higher mean value was in MTA (1.72 µm), in Biodentine it was 1.08 µm. In the group with apical resection with Er:YAG laser, no statistically significant difference in the gap size between the material and dentin was found in both studied materials: MTA – 1.88 µm, Biodentine – 1.32 µm.

CONCLUSIONS: In the present study, MTA and Biodentine showed good sealing capabilities after apical resection. Biodentine displayed better marginal adaptation when resecting the root tip using a turbine bur. The Er:YAG laser-assisted apical resection shows sealing of the open dentinal tubules around the resected root surface.

PMID:37144312 | DOI:10.3897/folmed.65.e74030

Folia Med (Plovdiv). 2023 Apr 30;65(2):260-268. doi: 10.3897/folmed.65.e75621.

ABSTRACT

INTRODUCTION: Developments in dental materials, CAD/CAM technologies and adhesive dentistry have improved the application of conservative restorations such as endocrowns and onlays. Among ceramics, zirconia has properties such as high strength, transformation toughening, chemical and structural durability, and biocompatibility, which enable zirconia to be used in the posterior area.

AIM: This study is a comparative evaluation of fracture resistance and failure modes in endodontically treated molars restored with zirconia endocrown and onlays.

MATERIALS AND METHODS: This study was performed on 20 human mandibular first molars with similar dimensions. After root canal treatment, the samples were divided into two groups: endocrowns and onlays (n=10). Restorations were made using a CAD-CAM milling machine with zirconia CAD blocks and, after cementation, subjected to 10,000 thermocycling and 500,000 fatigue cycle procedures, respectively. Each specimen was placed on a Universal Testing Machine and subjected to axial compressive force applied at a crosshead speed of 0.5 mm/min. The mean loads of failure of each group were statistically compared using the Student t-test. Chi-square tests were used to compare frequencies of failure modes among groups.

RESULTS: Fracture resistance showed a statistically significant difference between endocrown (5374.6810±670.03445 N) and onlay (3312.5000±804.01428 N) (p<0.001). No statistically significant difference was detected in the distribution of failure types among the groups (p>0.05).

CONCLUSIONS: The fracture resistance of endocrown is substantially higher than that of onlay, and failure type does not differ in both restorations. Zirconia is a reliable material to use in conservative restorations.

PMID:37144311 | DOI:10.3897/folmed.65.e75621

Folia Med (Plovdiv). 2023 Apr 30;65(2):251-259. doi: 10.3897/folmed.65.e77442.

ABSTRACT

INTRODUCTION: Masticatory pressure increases in the distal areas of the dentition. This should be considered when restoring partially edentulous patients with a metal-free fixed partial denture (FPD). An alternative abutment preparation design can be used in order to increase the materials’ volume in the most fracture-prone “connector area” of an FPD. The increased size of the connection might positively influence the constructions’ mechanical durability, thereby increasing its success and survivability.

AIM: The aim of the present study was to investigate the influence of two preparation designs of the distal abutment on the fracture resistance of three-unit, monolithic, ZrO2 FPDs.

MATERIALS AND METHODS: 3D printed replicas of a partially edentulous mandibular segment and a ZrO2, milled in full-contour, three-unit FPDs were used for this investigation. Two experimental groups (n=10 ) were defined based on the preparation design of the distal abutment tooth – classical shoulder preparation 0.8 mm deep, and endocrown preparation with a 2-mm retention cavity. The bridge – mandibular segment replica assembly was done with relyXU200(3M ESPE, USA), light-cured for 10 seconds per side with D-light Duo (GC, Europe). After cementation the test specimens were subjected to loading in a universal testing machine Zwick (Zwick-Roell Group, Germany). Statistical analysis was performed using R and includes descriptive statistics, t-test for quantitative and chi-squared test for qualitative variables.

RESULTS: The results showed no difference between the two studied groups in the maximum force required to fracture the test specimens [t=-1.8088 (17.39), p-value=0.087; P>0.05]. 95% of the fracture lines were located in the distal connector.

CONCLUSIONS: Within the limitations of this study, it can be concluded that both tested preparation designs show similar results in terms of the load required to fracture the test specimens. Furthermore, it is confirmed that the distal connector is the weakest area of an all-ceramic 3-unit FPD in the posterior area.

PMID:37144310 | DOI:10.3897/folmed.65.e77442

Folia Med (Plovdiv). 2023 Apr 30;65(2):235-242. doi: 10.3897/folmed.65.e79717.

ABSTRACT

INTRODUCTION: Good medical care depends both on the access to specialists and awareness of patients and healthcare professionals.

AIM: The purpose of this study was to assess the accessibility to rheumatology outpatient care and the awareness of patients with inflammatory joint diseases with regard to the types of sources and preferences of sources for obtaining information related to their disease and treatment, as well as to establish the extent to which this information is useful to patients.

MATERIALS AND METHODS: A pilot, cross-sectional, single center, anonymous study was conducted among adult patients with inflammatory joint diseases who were monitored in an outpatient rheumatology room at St George Diagnostic and Consultative Center in Plovdiv. A total of 56 patients were monitored. The questionnaire contained 56 questions, divided into 5 main groups: 1. questions about the disease, 2. questions about the sociodemographic profile of the patients, 3. questions about accessibility to specialized healthcare, 4. questions about the role of the nurse in the training of patients with inflammatory joint disease, and 5. questions evaluating the attitude to the monitoring medical team. The data were analyzed with IBM SPSS V.26, at a statistical significance level of p<0.05 for all analyses.

RESULTS: Women predominated among the patients under observation (37, 66%), as well as patients in the age group of 50-79 years (46, 82%). Twenty-four (42.9%) were the patients attending the consulting room twice a year. On-the-spot booking in the consulting room was preferred mainly among patients who lived within 50 km (3/16, 19%), while the rest of the patients preferred booking appointments by phone. Forty-five (80%) patients of the total number of patients used subcutaneous biological agents. Among them, the patients whose first application was performed by a nurse in a rheumatology room predominated (44 patients, 96%). All respondents (56, 100%) indicated that they had received self-injection training from a healthcare professional.

CONCLUSION: Patients with inflammatory joint diseases need information to help them manage issues related to their disease and treatment, as well as cope with their physical and psychological needs. Our study shows that patients most commonly use a combination of information sources – they get information from a doctor or from a healthcare professional, i.e. a nurse. We highlighted in the study the crucial role of nurses in improving the access of patients to specialized rheumatology care and satisfying patients’ information needs.

PMID:37144308 | DOI:10.3897/folmed.65.e79717

Psychogeriatrics. 2023 May 5. doi: 10.1111/psyg.12970. Online ahead of print.

ABSTRACT

BACKGROUND: Reduced physical activity and having a migration background are both associated with higher loneliness; however, the moderating role of migration background in the association between loneliness and physical activity remains largely unknown.

METHODS: We used cross-sectional data from the sixth wave (year 2017) of the German Ageing Survey (DEAS). Loneliness was measured using the De Jong Gierveld tool and physical activity was dichotomised into either of the following (i.e., at least 150 min of moderate physical activity per week) or not following physical activity recommendations of the World Health Organization (WHO). For evaluation of the associations we applied adjusted linear regression models with robust standard errors.

RESULTS: We included 6257 (average age = 67 years, 50% female) and 285 (average age = 63 years, 51% female) participants without and with migration background, respectively. In multiple linear regressions both migration background (ß = 0.13, P = 0.001), as well as not following the WHO physical activity recommendations (ß = 0.06, P < 0.001) were associated with increased loneliness. Moreover, the respective interaction term reached statistical significance (ß = -0.27, P = 0.013). Participants with migration background have a more pronounced association between following the WHO physical activity recommendations and reduced loneliness compared to participants without migration background.

CONCLUSION: Among middle-aged and older individuals, those with migration background benefit to a larger extent from following physical activity recommendations than the population without migration background regarding loneliness. Thus, motivating individuals with migration background to follow the WHO physical activity guidelines could particularly assist in reducing loneliness.

PMID:37144296 | DOI:10.1111/psyg.12970

Am Surg. 2023 May 5:31348231174005. doi: 10.1177/00031348231174005. Online ahead of print.

ABSTRACT

In this study, we evaluated the effects of the pandemic on our trauma population. We performed a retrospective review of the trauma registry in the 2 years prior, and then 2 years during the pandemic. We evaluated age, race, gender, injury severity score (ISS), mechanism of trauma, rate of self-inflicted injury, rate of gunshot wounds (GSW), presence of EtOH, drug screen results, mortality, rate of burn traumas, and zip code of residence. Our query captured 5 054 patients before, and 5 731 during the pandemic. We found no statistical difference in age, gender, mechanism of trauma, rate of self-inflicted injuries, and mortality during the pandemic when compared to before. There were statistically significant differences in race, ISS, rate of GSWs, EtOH use, drug screen results, and burn traumas. Geospatial mapping found a rise in GSWs for zip code 36606. Gun violence and substance use rose in our trauma population during COVID-19.

PMID:37144279 | DOI:10.1177/00031348231174005

Turk Arch Pediatr. 2023 May;58(3):282-288. doi: 10.5152/TurkArchPediatr.2023.22189.

ABSTRACT

OBJECTIVE: Carbon monoxide poisoning is an important cause of morbidity and mortality all over the world. In our study, it was aimed to determine the clinical and laboratory parameters that may be effective in deciding the need for hyperbaric oxygen therapy in the management of cases.

MATERIALS AND METHODS: From January 2012 to the end of December 2019, 83 patients who applied to a university hospital pediatric emergency department in İstanbul with the diagnosis of carbon monoxide poisoning were included. Demographic characteristics, carbon monoxide source, exposure duration, treatment approach, physical examination findings, Glasgow Coma Score, laboratory results, electrocardiogram, cranial imaging, and chest x-ray were evaluated from the records.

RESULTS: The median age of the patients was 56 (37.0-100.0) months and 48 (57.8%) of them were male. The median time of exposure to carbon monoxide was 5.0 (0.5-3.0) hours in those who received hyperbaric oxygen therapy and was significantly higher than those who received normobaric oxygen therapy (P < .001). Myocardial ischemia, chest pain, pulmonary edema, and renal failure were not detected in any of the cases. The median lactate level was detected as 1.5 (1.0-2.15) mmol/L in those who received normobaric oxygen therapy and 3.7 (3.17-4.62) mmol/L in those who received hyperbaric oxygen therapy, and the difference between them was statistically significant (P < .001).

CONCLUSIONS: A guideline containing precise clinical and laboratory parameters for hyperbaric oxygen therapy in children has not been developed yet. In our study, carbon monoxide exposure duration, carboxyhemoglobin levels, neurological symptoms, and lactate levels were found to be guiding parameters in determining the need for hyperbaric oxygen therapy.

PMID:37144261 | DOI:10.5152/TurkArchPediatr.2023.22189