Tag: statistics

IEEE J Biomed Health Inform. 2023 Feb 9;PP. doi: 10.1109/JBHI.2023.3243698. Online ahead of print.

ABSTRACT

The present paper introduces a novel method to decode imagined movement from electroencephalographic (EEG) signals. Decoding the imagined movement with good accuracy is a challenging topic in motor imagery (MI) BCIs, poor accuracy may indeed hinder the application of such systems in practice. The present paper introduces an extension of the well-established Filter Bank Common Spatial Patterns (FBCSP) algorithm, named AutoEncoder(AE)-FBCSP, to benefit from the ability of AE to learn how to map data from the feature space onto a latent space where information relevant for classification are is embedded. The proposed method is based on a global (cross-subject) and subsequent transfer learning subject-specific (intra-subject) approach. A multi-way extension of AE-FBCSP is also introduced in this paper. The proposed methodology consists of recording high-density EEG (64 electrodes). Features are extracted by means of FBCSP and used to train a custom AE, in an unsupervised way, to project the features into a compressed latent space. Latent features then are used to train a supervised classifier (feed forward neural network) to decode the imagined movement. The algorithm was tested using a dataset of EEG extracted from a publicly available database of data collected from 109 subjects. AE-FBCSP was extensively tested in the 3-way (right-hand vs left-hand motor imagery vs resting) classification and also in the 2-way, 4-way and 5-way ones, both in cross- and intra-subject analysis. AE-FBCSP outperformed standard FBCSP in a statistically significant way (p 0.05) and outperformed also comparable methods in the literature applied to the same dataset. AE-FBCSP achieved an average accuracy of 89.09% in the 3-way subject-specific classification. With AE-FBCSP, 71.43% of subjects achieved a very high accuracy ( 87.68%) whereas no subject achieved an accuracy 87.68% with FBCSP. One of the most interesting outcomes is that AE-FBCSP remarkably increased the number of subjects that responded with a very high accuracy, which is a fundamental requirement for BCI systems to be applied in practice.

PMID:37022818 | DOI:10.1109/JBHI.2023.3243698

LGBT Health. 2023 Apr 5. doi: 10.1089/lgbt.2022.0249. Online ahead of print.

ABSTRACT

Purpose: The purpose of this study was to utilize a systematic review and meta-analysis to assess the existing body of literature to understand the mental health impacts of the coronavirus disease-19 (COVID-19) pandemic among sexual and gender minority (SGM) people. Methods: The search strategy was developed by an experienced librarian and used five bibliographical databases, specifically PubMed, Embase, APA PsycINFO (EBSCO), Web of Science, and LGBTQ+ Source (EBSCO), for studies (published 2020 to June, 2021) examining the psychological impact of the COVID-19 pandemic among SGM people. Articles were screened by two reviewers. The quality of the articles was assessed using the National Institutes of Health quality assessment tool for observational studies. A double extraction method was used for data abstraction. Heterogeneity among studies was assessed by I² statistic. The random-effects model was utilized to obtain the pooled prevalence. Publication bias was assessed by Funnel plot and Egger’s linear regression test. Results: Of a total of 37 studies, 15 studies were included in the meta-analysis with 17,973 SGM participants. Sixteen studies were U.S. based, seven studies were multinational studies, and the remaining studies were from Portugal, Brazil, Chile, Taiwan, the United Kingdom, France, Italy, Canada, and several other countries. A majority of studies used psychometric valid tools for the cross-sectional surveys. The pooled prevalence of anxiety, depression, psychological distress, and suicidal ideation was 58.6%, 57.6%, 52.7%, and 28.8%, respectively. Conclusions: Findings of this study serve as evidence to develop appropriate interventions to promote psychological wellbeing among vulnerable population subgroups, such as SGM individuals.

PMID:37022764 | DOI:10.1089/lgbt.2022.0249

J Clin Psychiatry. 2023 Apr 3;84(2):23f14874. doi: 10.4088/JCP.23f14874.

ABSTRACT

A small proportion of women with anxiety, insomnia, and other conditions may require benzodiazepines or z-hypnotics intermittently or daily sometime during pregnancy. This article provides an update on pregnancy outcomes associated with pre-gestational or gestational exposure to benzodiazepines and z-hypnotics based on results from 2 meta-analyses, 2 registry-based studies, and 2 large retrospective cohort studies. In summary, the meta-analyses found that exposure was associated with an increased risk of spontaneous abortion, induced abortion, preterm birth, low birth weight, small for gestational age, low Apgar scores at 5 min, and neonatal intensive care unit admission. Whereas meta-analyses and registry studies found that first trimester exposure to benzodiazepines and/or z-hypnotics was not associated with increased risk of congenital malformations, a nationwide observational study with 10 times as many exposed pregnancies as in all the previous studies combined found that first trimester exposure to benzodiazepines was associated with a small but statistically significantly increased risk of overall malformations as well as, specifically, cardiac malformations; in this study, analyses that examined the potential role of confounding by indication suggested that the adverse findings may not have been due to confounding. Finally, a large observational study found that exposure to benzodiazepines in the 90 days before conception was associated with an increased risk of ectopic pregnancy; in this study, as well, the findings were consistent in analyses that examined possible confounding by indication. In no reviewed study could residual confounding be ruled out. The take-home message is that benzodiazepine and z-drug exposure before and during pregnancy is associated with many adverse gestational outcomes, but it is unclear to what extent the findings are due to exposure to drugs vs exposure to the indication for treatment. Therefore, all treatment decisions need to be tailored to context and shared between health care professionals, patients, and their caregivers.

PMID:37022751 | DOI:10.4088/JCP.23f14874

LGBT Health. 2023 Apr 5. doi: 10.1089/lgbt.2021.0384. Online ahead of print.

ABSTRACT

Purpose: This study aimed to describe the gynecological care provided to Brazilian women who have sex with women (WSW). Methods: Respondent-driven sampling was used to recruit Brazilian WSW. The survey questions, concerning gynecological care, were designed in Portuguese by medical professionals, medical students, and LGBTQIA+ community members, including the authors. The statistical analyses were weighted to account for the likelihood of recruitment. Results: From January to August of 2018, 299 participants were recruited in 14 recruitment waves. The mean age of the WSW was 25.3 years. Most (54.9%) identified as lesbian and had been involved in past-year sexual intercourse mainly with cisgender women (86.1%). The WSW also reported having sex with cisgender men (22.2%), transgender men (5.3%), nonbinary people (2.3%), and transgender women (5.3%) in the last year. More than a quarter of the WSW did not have regular appointments with a gynecologist: 8.0% (95% confidence interval [CI] = 4.2-11.6) and 19% (95% CI = 12.8-25.2) stated that they had never gone to the gynecologist or they had only gone for emergencies, respectively. Almost one-third had never had cervical cancer screening (cervical cytology, Pap test or Pap smear). Most women justified avoiding the test because they felt healthy, thought it would hurt, or feared a health professional might mistreat them. Conclusion: Gynecologists should avoid heteronormative assumptions, inquire about sexual practices, orientation, and identity separately, and provide Pap tests as advised to WSW.

PMID:37022728 | DOI:10.1089/lgbt.2021.0384

Environ Health Perspect. 2023 Apr;131(4):45001. doi: 10.1289/EHP11899. Epub 2023 Apr 6.

ABSTRACT

BACKGROUND: Epidemiological studies are increasingly going beyond the evaluation of health effects of individual chemicals to consider chemical mixtures. To our knowledge, the advantages and disadvantages of addressing chemical mixtures for informing regulatory decisions-as opposed to obtaining a more comprehensive understanding of etiology-has not been carefully considered.

OBJECTIVES: We offer a framework for the study of chemical mixtures in epidemiological research intended to inform regulatory decisions. We identify a) the different ways mixtures originate (product source, pollution source, shared mode of action, or shared effect on health outcome), b) the use of indicator chemicals to address mixtures, and c) the requirements for epidemiological studies to be informative for regulatory purposes.

DISCUSSION: The principal advantage of considering mixtures is to obtain a more complete understanding of the role of the chemical environment as a determinant of health. Incorporating other exposures may improve the assessment of the net effect of the chemicals of interest. However, the increased complexity and potential loss of generalizability may limit the value of studies of mixtures, especially for mixtures based on mode of action or shared health outcomes. Our recommended strategy is to successively assess the marginal contribution of individual chemicals, joint effects with other specific chemicals, and hypothesis-driven evaluation of mixtures rather than applying hypothesis-free data exploration methods. Although more ambitious statistical approaches to mixtures may, in time, be helpful for guiding regulation, the authors believe conventional methods for assessing individual and combined effects of chemicals remain preferable. https://doi.org/10.1289/EHP11899.

PMID:37022726 | DOI:10.1289/EHP11899

Eur Thyroid J. 2023 Apr 1:ETJ-22-0219. doi: 10.1530/ETJ-22-0219. Online ahead of print.

ABSTRACT

BACKGROUND: Purpose To determine whether thyroid stimulating hormone level ≥30 mU/l is necessary for radioiodine (131I) remnant ablation (RRA) in patients with differentiated thyroid cancer (DTC), as well as its influencing factors and predictors.

METHODS: 487 DTC patients were retrospectively enrolled in this study. They were divided into two groups (TSH <30 and ≥30 mU/l) and further divided into eight subgroups (0-<30, 30-<40, 40-<50, 50-<60, 60-<70, 70-<80, 80-<90, 90-<100 mU/l). The simultaneous serum lipids level, successful rate of RRA and its influencing factors in different groups were analyzed. The receiver operating characteristic curves derived from pre-ablative thyroglobulin (pre-Tg) and pre-Tg/TSH ratio were compared for RRA success prediction performance.

RESULTS: There was no statistical difference in success rates of RRA between the two groups (p=0.247) and eight subgroups (p=0.685). Levels of total cholesterol (p<0.001), triglyceride (p=0.006), high-density lipoprotein cholesterol (p=0.024), low-density lipoprotein cholesterol (p=0.001), apolipoprotein B (p<0.001) and apolipoprotein E (p=0.002) were significantly higher while apoA/apoB ratio (p=0.024) were significantly lower at TSH ≥30 mU/l group. Pre-Tg level, gender and N stage were influencing factors for RRA. The area under the curve of pre-Tg level and pre-Tg/TSH ratio were 0.7611 (p<0.0001), 0.7340 (p<0.0001) for all enrolled patients and 0.7310 (p=0.0145), 0.6524 (p=0.1068) for TSH <30 mU/l respectively.

CONCLUSION: TSH ≥30 mU/l may not be necessary for the success of RRA. Patients with higher serum TSH level prior RRA will suffer from severer hyperlipidemia. Pre-Tg level could be used as a predictor for the success of RRA, especially when TSH <30 mU/l.

PMID:37022724 | DOI:10.1530/ETJ-22-0219

JAMA Otolaryngol Head Neck Surg. 2023 Apr 6. doi: 10.1001/jamaoto.2023.0309. Online ahead of print.

ABSTRACT

IMPORTANCE: Loneliness is suggested to negatively affect physical and mental health and influence the development of disability; however, a consensus on the relationship between loneliness and disability has not been reached. Age-related hearing impairment worsens the daily-life activities of older adults, and the association between loneliness and the incidence of disability may be influenced by hearing impairment.

OBJECTIVE: To examine the association between loneliness and the incidence of disability among older adults stratified by hearing impairment.

DESIGN, SETTING, AND PARTICIPANTS: This prospective observational cohort study included 5563 community-dwelling adults 65 years or older who participated in functional health examinations in Tokai City, Aichi Prefecture, Japan, between September 2017 and June 2018. Data analysis was conducted from August 2022 to February 2023.

MAIN OUTCOMES AND MEASURES: Cox proportional hazards regression models were used to examine the association between loneliness and the incidence of disability stratified by hearing impairment.

RESULTS: Among the 4739 participants who met the inclusion criteria (mean [SD] age, 73.8 [5.5] years; 2622 [55.3%] female), 3792 (80.0%) were without hearing impairment and 947 (20.0%) were with hearing impairment. Of those who reported experiencing loneliness, 1215 (32.0%) were without hearing impairment, and 441 (46.6%) were with hearing impairment. After 2 years, the number of individuals with disabilities was 172 (4.5%) without hearing impairment and 79 (8.3%) with hearing impairment. Cox proportional hazards regression analysis showed no statistically significant association between loneliness and the incidence of disability in a model adjusted for potential confounding factors among community-dwelling older adults without hearing impairment (hazard ratio, 1.10; 95% CI, 0.80-1.52). Among community-dwelling older adults with hearing impairment, a model adjusted for potential confounding factors showed a statistically significant association between loneliness and the incidence of disability (hazard ratio, 1.71; 95% CI, 1.04-2.81).

CONCLUSIONS AND RELEVANCE: This cohort study found that the association between loneliness and the incidence of disability was moderated by the presence or absence of hearing impairment. Hearing impairment is the most common symptom of geriatric syndromes, showing that among the various risk factors, loneliness may require special attention in the prevention of disability in people with hearing impairment.

PMID:37022721 | DOI:10.1001/jamaoto.2023.0309

Invest Ophthalmol Vis Sci. 2023 Apr 3;64(4):4. doi: 10.1167/iovs.64.4.4.

ABSTRACT

PURPOSE: This study aimed to assess the prevalence and characteristics of the peripapillary gamma zone in myopic, emmetropic, and hyperopic eyes of Chinese children.

METHODS: Overall, 1274 children aged 6 to 8 years from the Hong Kong Children Eye Study underwent ocular examinations, including measurements of cycloplegic auto-refraction and axial length (AL). The optic disc was imaged using a Spectralis optical coherence tomography (OCT) unit and a protocol involving 24 equally spaced radial B-scans. The Bruch’s membrane opening (BMO) was identified in over 48 meridians in each eye. The peripapillary gamma zone was defined as the region between the BMO and the border of the optic disc, identified by the OCT.

RESULTS: The prevalence of the peripapillary gamma zone was higher in myopic eyes (36.3%) than in emmetropic (16.1%) and hyperopic eyes (11.5%, P < 0.001). AL (per 1 mm; odds ratio [OR]) = 1.861, P < 0.001) and a more oval disc shape (OR = 3.144, P < 0.001) were associated with the presence of a peripapillary gamma zone after adjusting for demographic, systemic, and ocular variables. In the subgroup analysis, a longer AL was associated with the presence of a peripapillary gamma zone in myopic eyes (OR = 1.874, P < 0.001), but not in emmetropic (OR = 1.033, P = 0.913) or hyperopic eyes (OR = 1.044, P = 0.883). A peripapillary zone was not observed in the region nasal to the optic nerve in myopic eyes, in contrast to its presence in the same region in 1.9% of emmetropic eyes and 9.3% of hyperopic eyes; these intergroup differences were statistically significant (P < 0.001).

CONCLUSIONS: Although peripapillary gamma zones were observed in the eyes of both myopic and non-myopic children, their characteristics and distribution patterns were substantially different.

PMID:37022704 | DOI:10.1167/iovs.64.4.4

JAMA Netw Open. 2023 Apr 3;6(4):e235841. doi: 10.1001/jamanetworkopen.2023.5841.

ABSTRACT

IMPORTANCE: A better understanding of the psychosocial health of resettled child and adolescent refugees and associated premigration and postmigration factors may help this population integrate effectively.

OBJECTIVE: To estimate the associations of premigration and postmigration multidomain factors with psychosocial health after resettlement among young refugees of different ages.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used wave 3 data from the Building a New Life in Australia (BNLA) cohort study, as they represented the first time a BNLA study included a child module targeting children and adolescents in the migrating unit as a nested component of the broader study. The study population consisted of children aged 5 to 10 years and adolescents aged 11 to 17 years. The caregivers of the children, the adolescents themselves, and the adolescents’ caregivers were invited to complete the child module. Wave 3 data were collected from October 1, 2015, to February 29, 2016. Statistical analysis was performed from May 10 to September 21, 2022.

EXPOSURES: Premigration and postmigration multidomain factors, including individual (child and caregiver), family, school, and community levels, were measured.

MAIN OUTCOMES AND MEASURES: Social and emotional adjustment and posttraumatic stress disorder (PTSD) were the dependent variables measured by the Strengths and Difficulties Questionnaire (SDQ) and an 8-item PTSD scale. Weighted multilevel linear or logistic regression models were used.

RESULTS: Of the 220 children aged 5 to 10 years (mean [SD] age, 7.4 [2.0] years), 117 (53.2%) were boys; of the 412 adolescents aged 11 to 17 years (mean [SD] age, 14.1 [2.0] years), 215 (52.2%) were boys. Among the children, compared with no exposure, exposure to premigration traumatic events (β = 2.68 [95% CI, 0.51-4.85]) and having family conflicts after resettlement (β = 6.30 [95% CI, 2.97-9.64]) were positively associated with SDQ total difficulties score; school achievement was negatively associated with SDQ total difficulties score (β = -5.02 [95% CI, -9.17 to -0.87]). Among the adolescents, being treated unfairly (β = 3.32 [95% CI, 1.41-5.22]) and parenting harshness after resettlement (β = 0.25 [95% CI, 0.11-0.40]) were positively associated with SDQ total difficulties score; engagement in extracurricular activities (β = -3.67 [95% CI, -6.83 to -0.50]) was negatively associated with SDQ total difficulties score. Exposure to premigration traumatic events (adjusted odds ratio [aOR], 2.49 [95% CI, 1.10-5.63]), being treated unfairly (aOR, 3.77 [95% CI, 1.60-8.91]), and facing English language barriers (aOR, 6.41 [95% CI, 1.98-20.79]) after resettlement were positively associated with the presence of PTSD.

CONCLUSIONS AND RELEVANCE: In this study of refugee children and adolescents, apart from premigration traumatic experiences, several postmigration family- and school-related factors and social integration factors were associated with psychosocial health after resettlement. The findings suggest that family- and school-centered psychosocial care and social integration programs targeting related stressors merit increased attention for improving the psychosocial health of refugee children and adolescents after resettlement.

PMID:37022686 | DOI:10.1001/jamanetworkopen.2023.5841

JAMA Netw Open. 2023 Apr 3;6(4):e235870. doi: 10.1001/jamanetworkopen.2023.5870.

ABSTRACT

IMPORTANCE: International Classification of Diseases-coded hospital discharge data do not accurately reflect whether firearm injuries were caused by assault, unintentional injury, self-harm, legal intervention, or were of undetermined intent. Applying natural language processing (NLP) and machine learning (ML) techniques to electronic health record (EHR) narrative text could be associated with improved accuracy of firearm injury intent data.

OBJECTIVE: To assess the accuracy with which an ML model identified firearm injury intent.

DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional retrospective EHR review was conducted at 3 level I trauma centers, 2 from health care institutions in Boston, Massachusetts, and 1 from Seattle, Washington, between January 1, 2000, and December 31, 2019; data analysis was performed from January 18, 2021, to August 22, 2022. A total of 1915 incident cases of firearm injury in patients presenting to emergency departments at the model development institution and 769 from the external validation institution with a firearm injury code assigned according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM), in discharge data were included.

EXPOSURES: Classification of firearm injury intent.

MAIN OUTCOMES AND MEASURES: Intent classification accuracy by the NLP model was compared with ICD codes assigned by medical record coders in discharge data. The NLP model extracted intent-relevant features from narrative text that were then used by a gradient-boosting classifier to determine the intent of each firearm injury. Classification accuracy was evaluated against intent assigned by the research team. The model was further validated using an external data set.

RESULTS: The NLP model was evaluated in 381 patients presenting with firearm injury at the model development site (mean [SD] age, 39.2 [13.0] years; 348 [91.3%] men) and 304 patients at the external development site (mean [SD] age, 31.8 [14.8] years; 263 [86.5%] men). The model proved more accurate than medical record coders in assigning intent to firearm injuries at the model development site (accident F-score, 0.78 vs 0.40; assault F-score, 0.90 vs 0.78). The model maintained this improvement on an external validation set from a second institution (accident F-score, 0.64 vs 0.58; assault F-score, 0.88 vs 0.81). While the model showed some degradation between institutions, retraining the model using data from the second institution further improved performance on that site’s records (accident F-score, 0.75; assault F-score, 0.92).

CONCLUSIONS AND RELEVANCE: The findings of this study suggest that NLP ML can be used to improve the accuracy of firearm injury intent classification compared with ICD-coded discharge data, particularly for cases of accident and assault intents (the most prevalent and commonly misclassified intent types). Future research could refine this model using larger and more diverse data sets.

PMID:37022685 | DOI:10.1001/jamanetworkopen.2023.5870