Tag: statistics

JAMA Oncol. 2023 May 25. doi: 10.1001/jamaoncol.2023.0998. Online ahead of print.

ABSTRACT

IMPORTANCE: The use of second-generation antiandrogens (AAs) in the treatment of prostate cancer is increasing. Retrospective evidence suggests an association between second-generation AAs and adverse cognitive and functional outcomes, but further data from prospective trials are needed.

OBJECTIVE: To examine whether evidence from randomized clinical trials (RCTs) in prostate cancer supports an association between second-generation AAs and cognitive or functional toxic effects.

DATA SOURCES: PubMed, EMBASE, and Scopus (inception to September 12, 2022).

STUDY SELECTION: Randomized clinical trials of second-generation AAs (abiraterone, apalutamide, darolutamide, or enzalutamide) among individuals with prostate cancer that reported cognitive toxic effects, asthenic toxic effects (eg, fatigue, weakness), or falls were evaluated.

DATA EXTRACTION AND SYNTHESIS: Study screening, data abstraction, and bias assessment were completed independently by 2 reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-analyses and Enhancing the Quality and Transparency of Health Research reporting guidelines. Tabular counts for all-grade toxic effects were determined to test the hypothesis formulated before data collection.

MAIN OUTCOMES AND MEASURES: Risk ratios (RRs) and SEs were calculated for cognitive toxic effects, asthenic toxic effects, and falls. Because fatigue was the asthenic toxic effect extracted from all studies, data on fatigue are specified in the results. Meta-analysis and meta-regression were used to generate summary statistics.

RESULTS: The systematic review included 12 studies comprising 13 524 participants. Included studies had a low risk of bias. An increased risk of cognitive toxic effects (RR, 2.10; 95% CI, 1.30-3.38; P = .002) and fatigue (RR, 1.34; 95% CI, 1.16-1.54; P < .001) was noted among individuals treated with second-generation AAs vs those in the control arms. The findings were consistent in studies that included traditional hormone therapy in both treatment arms for cognitive toxic effects (RR, 1.77; 95% CI, 1.12-2.79; P = .01) and fatigue (RR, 1.32; 95% CI, 1.10-1.58; P = .003). Meta-regression supported that, across studies, increased age was associated with a greater risk of fatigue with second-generation AAs (coefficient, 0.75; 95% CI, 0.04-0.12; P < .001). In addition, the use of second-generation AAs was associated with an increased risk of falls (RR, 1.87; 95% CI, 1.27-2.75; P = .001).

CONCLUSIONS AND RELEVANCE: The findings of this systematic review and meta-analysis suggest that second-generation AAs carry an increased risk of cognitive and functional toxic effects, including when added to traditional forms of hormone therapy.

PMID:37227736 | DOI:10.1001/jamaoncol.2023.0998

JAMA Netw Open. 2023 May 1;6(5):e2315306. doi: 10.1001/jamanetworkopen.2023.15306.

ABSTRACT

IMPORTANCE: Appreciation for the effects of neighborhood conditions and community factors on perinatal health is increasing. However, community-level indices specific to maternal health and associations with preterm birth (PTB) have not been assessed.

OBJECTIVE: To examine the association of the Maternal Vulnerability Index (MVI), a novel county-level index designed to quantify maternal vulnerability to adverse health outcomes, with PTB.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used US Vital Statistics data from January 1 to December 31, 2018. Participants included 3 659 099 singleton births at 22 plus 0/7 to 44 plus 6/7 weeks of gestation born in the US. Analyses were conducted from December 1, 2021, through March 31, 2023.

EXPOSURE: The MVI, a composite measure of 43 area-level indicators, categorized into 6 themes reflecting physical, social, and health care landscapes. Overall MVI and theme were stratified by quintile (very low to very high) by maternal county of residence.

MAIN OUTCOMES AND MEASURES: The primary outcome was PTB (gestational age <37 weeks). Secondary outcomes were PTB categories: extreme (gestational age ≤28 weeks), very (gestational age 29-31 weeks), moderate (gestational age 32-33 weeks), and late (gestational age 34-36 weeks). Multivariable logistic regression quantified associations of MVI, overall and by theme, with PTB, overall and by PTB category.

RESULTS: Among 3 659 099 births, 298 847 (8.2%) were preterm (male, 51.1%; female, 48.9%). Maternal race and ethnicity included 0.8% American Indian or Alaska Native, 6.8% Asian or Pacific Islander, 23.6% Hispanic, 14.5% non-Hispanic Black, 52.1% non-Hispanic White, and 2.2% with more than 1 race. Compared with full-term births, MVI was higher for PTBs across all themes. Very high MVI was associated with increased PTB in unadjusted (odds ratio [OR], 1.50 [95% CI, 1.45-1.56]) and adjusted (OR, 1.07 [95% CI, 1.01-1.13]) analyses. In adjusted analyses of PTB categories, MVI had the largest association with extreme PTB (adjusted OR, 1.18 [95% CI, 1.07-1.29]). Higher MVI in the themes of physical health, mental health and substance abuse, and general health care remained associated with PTB overall in adjusted models. While the physical health and socioeconomic determinant themes were associated with extreme PTB, physical health, mental health and substance abuse, and general health care themes were associated with late PTB.

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that MVI was associated with PTB even after adjustment for individual-level confounders. The MVI is a useful measure for county-level PTB risk that may have policy implications for counties working to lower preterm rates and improve perinatal outcomes.

PMID:37227724 | DOI:10.1001/jamanetworkopen.2023.15306

J Vis. 2023 May 2;23(5):19. doi: 10.1167/jov.23.5.19.

ABSTRACT

Dual-task studies have demonstrated that goal-directed actions are typically preceded by a premotor shift of visual attention toward the movement goal location. This finding is often taken as evidence for an obligatory coupling between attention and motor preparation. Here, we examined whether this coupling entails a habitual component relating to an expectation of spatial congruence between visual and motor targets. In two experiments, participants had to identify a visual discrimination target (DT) while preparing variably delayed pointing movements to a motor target (MT). To induce distinct expectations regarding the DT position, different groups of participants performed a training phase in which the DT either always appeared at MT, opposite to MT, or at an unpredictable position. In a subsequent test phase, the DT position was randomized to assess the impact of learned expectancy on premotor attention allocation. Although we applied individually determined DT presentation times in the test phase of Experiment 1, a fixed DT presentation time was used in Experiment 2. Both experiments yielded evidence for attentional enhancement at the expected DT position. Although interpretability of this effect was limited in Experiment 1 because of between-group differences in DT presentation time, results of Experiment 2 were much clearer. Specifically, a marked discrimination benefit was observed at the position opposite to MT in participants anticipating the DT at this position, whereas no statistically significant benefit was found at MT. Crucially, this was observed at short movement delays, demonstrating that expectation of spatial incongruence between visual and motor targets allows for decoupling of attentional resources from ongoing motor preparation. Based on our findings, we suggest that premotor attention shifts entail a considerable habitual component rather than being the sole result of motor programming.

PMID:37227715 | DOI:10.1167/jov.23.5.19

JAMA Ophthalmol. 2023 May 25. doi: 10.1001/jamaophthalmol.2023.1892. Online ahead of print.

NO ABSTRACT

PMID:37227711 | DOI:10.1001/jamaophthalmol.2023.1892

Psychiatr Q. 2023 May 25. doi: 10.1007/s11126-023-10027-w. Online ahead of print.

ABSTRACT

Although personality disorders (PDs) are more common among persons experiencing homelessness than the general population, few studies have investigated the risk of experiencing homelessness among persons with PDs. This study seeks to identify the demographic, socioeconomic, and behavioral health correlates of past-year homelessness among persons with antisocial, borderline, and schizotypal PDs. Nationally representative data of the civilian, noninstitutionalized population of the United States was used to identify correlates of homelessness. Descriptive statistics and bivariate associations between variables and homeless status were summarized prior to conducting several multivariate logistic regression models to identify correlates of homelessness. Main findings revealed positive associations between poverty, relationship dysfunction, and lifetime suicide attempt with homelessness. In the antisocial PD (ASPD) and borderline PD (BPD) models, comorbid BPD and ASPD, respectively, were associated with higher odds of past-year homelessness. Findings underscore the importance of poverty, interpersonal difficulties, and behavioral health comorbidities on homelessness among persons with ASPD, BPD, and schizotypal PD. Strategies to promote economic security, stable relationships, and interpersonal functioning may buffer against the effects of economic volatility and other systemic factors that could contribute to homelessness and persons with PD.

PMID:37227676 | DOI:10.1007/s11126-023-10027-w

Musculoskelet Surg. 2023 May 25. doi: 10.1007/s12306-023-00787-w. Online ahead of print.

ABSTRACT

PURPOSE: Injuries of the scapholunate ligament (SL) and of the triangular fibrocartilage complex (TFCC) represent the main ligament injuries of the traumatic wrist. A double injury of the SL and TFCC ligaments is quite common in the trauma setting, and clinical examination is fundamental. MRI allows to detection of a TFCC and SL ligament injury, but wrist arthroscopy is still the gold standard for diagnosis. We present the clinical results of the combined reconstruction of chronic scapholunate ligament and TFCC injury.

MATERIALS AND METHODS: Fourteen patients were treated at our hospital with a combined scapholunate ligament and TFCC complex repair. All patients were surgically treated by the same senior author, after a diagnostic arthroscopy that revealed a lesion of both structures. A comparison between the pre-operative and post-operative pain and function was carried out using VAS, Disability of Arm, Shoulder and Hand score (DASH) and Patient-Related Wrist/Hand Evaluation score (PRWHE). Wrist range of motion and strength were also compared following surgery.

RESULTS: All patients had a mean follow-up of 54 months. A statistically significant improvement was observed both with the reduction in pain (VAS from 8.9 to 5) and with the improvement of functionality scores (DASH from 63 to 40 and PRWHE from 70 to 57) and with the increase in ROM and strength. In only one patient (7%), because of pain and instability, a supplement operation was needed (Sauve-Kapandji procedure) 3 months after the initial surgery.

CONCLUSIONS: The simultaneous repair of the SL and TFCC complex has shown a good success rate in both decreasing pain and regaining functionality.

PMID:37227663 | DOI:10.1007/s12306-023-00787-w

J Gen Intern Med. 2023 May 25. doi: 10.1007/s11606-023-08235-y. Online ahead of print.

ABSTRACT

BACKGROUND: Although many studies assess predictors of provider burnout, few analyses provide high-quality, consistent evidence on the impact of provider burnout on patient outcomes exist, particularly among behavioral health providers (BHPs).

OBJECTIVE: To assess the impact of burnout among psychiatrists, psychologists, and social workers on access-related quality measures in the Veterans Health Administration (VHA).

DESIGN: This study used burnout in VA All Employee Survey (AES) and Mental Health Provider Survey (MHPS) data to predict metrics assessed by the Strategic Analytics for Improvement and Learning Value, Mental Health Domain (MH-SAIL), VHA’s quality monitoring system. The study used prior year (2014-2018) facility-level burnout proportion among BHPs to predict subsequent year (2015-2019) facility-level MH-SAIL domain scores. Analyses used multiple regression models, adjusting for facility characteristics, including BHP staffing and productivity.

PARTICIPANTS: Psychologists, psychiatrists, and social workers who responded to the AES and MHPS at 127 VHA facilities.

MAIN MEASURES: Four compositive outcomes included two objective measures (population coverage, continuity of care), one subjective measure (experience of care), and one composite measure of the former three measures (mental health domain quality).

KEY RESULTS: Adjusted analyses showed prior year burnout generally had no impact on population coverage, continuity of care, and patient experiences of care but had a negative impact on provider experiences of care consistently across 5 years (p < 0.001). Pooled across years, a 5% higher facility-level burnout in AES and MHPS had a 0.05 and 0.09 standard deviation worse facility experiences of care from the prior year, respectively.

CONCLUSIONS: Burnout had a significant negative impact on provider-reported experiential outcome measures. This analysis showed that burnout had a negative effect on subjective but not on objective quality measures of Veteran access to care, which could inform future policies and interventions regarding provider burnout.

PMID:37227659 | DOI:10.1007/s11606-023-08235-y

Matern Child Health J. 2023 May 25. doi: 10.1007/s10995-023-03677-6. Online ahead of print.

ABSTRACT

BACKGROUND: In Spain, allowing women to be accompanied by their partners during cesarean deliveries is a poorly consolidated practice. Going through this experience alone, not only deprives women from the opportunity of sharing the birth with their partners, but also, forces them to face, on their own, one of the most stressful experiences during pregnancy.

OBJECTIVE: To analyze whether significant differences exist in levels of anxiety of women who receive an elective cesarean delivery, according to whether they are allowed to be accompanied by their partners.

DESIGN: Quasi-experimental, longitudinal, prospective study, comparing a group of 31 women receiving elective cesarean deliveries, without the presence of their partners, with a group of 33 women with elective cesarean deliveries who were accompanied by their partners. Anxiety levels were assessed using the STAI-State/Trait scale. Participants were given a questionnaire to assess their level of satisfaction with the care received.

RESULTS: Anxiety measured via total scores on the STAI-S scale was significantly lower (p < 0.004) among the women who were accompanied by their partners during the elective cesarean delivery (median = 25), compared to the group who were not (median = 50). The differences were also significant (p < 0.003) considering the impact of accompaniment upon the group with high scores in the STAI-S (> 31) and continue to be significant when using the cut-off point of very high scores on the STAI-S (> 45).

CONCLUSIONS: Presence of partners during elective cesareans is a key factor for decreasing the anxiety caused by the surgery and for improving the overall experience of cesarean deliveries.

PMID:37227622 | DOI:10.1007/s10995-023-03677-6

Child Psychiatry Hum Dev. 2023 May 25. doi: 10.1007/s10578-023-01545-6. Online ahead of print.

ABSTRACT

Inpatient psychiatric care may be required to manage adolescents with severe mental health problems. As the ward can be a challenging environment, this study explored the influence of clown doctors on adolescents. Seventy-seven adolescents (13-18 years) and 22 staff from the Monash Health Stepping Stones Adolescent Unit, and 11 clown doctors from The Humour Foundation participated in the study. Bespoke surveys were developed by the research team to collect quantitative self-report data and qualitative responses. Descriptive statistics and thematic analysis suggested that adolescents experienced high levels of fun as well as positive mood during a clown doctor session. Clown doctor programs show promise within an inpatient unit with opportunities for further development being identified. With considerations of the findings, future clown doctor training could include tailoring sessions to the developmental needs of adolescents and developing strategies on how to interact with adolescents who have a mental health disorder.

PMID:37227620 | DOI:10.1007/s10578-023-01545-6

Indian J Pediatr. 2023 May 25. doi: 10.1007/s12098-023-04604-x. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether red blood cell glucose-6-phosphate dehydrogenase (G6PD) activity is associated with retinopathy of prematurity (ROP).

METHODS: This case-control study was conducted in a Level-3 neonatal unit. Subjects were inborn boys with birth weight <2000 g. “Cases” were consecutive subjects with ROP of any severity. “Controls” were consecutive unrelated subjects without ROP. Recipients of blood or exchange transfusions were excluded. Sixty cases (out of 98 screened) and 60 controls (out of 93 screened) were enrolled. G6PD activity (quantitative assay) as the candidate risk factor was evaluated.

RESULTS: Sixty cases with 60 controls [mean (SD) gestation 28.80 (2.2) and 30.60 (2.2) wk respectively] were compared. “Cases” had a higher median (1st, 3rd quartile) G6PD activity compared to “controls” [7.39 (4.7, 11.5) vs. 6.28 (4.2, 8.8) U/g Hb, p = 0.084]. G6PD activity was highest among ROP requiring treatment [8.68 (4.7, 12.3)] followed by ROP not requiring treatment [6.91 (4.4, 11.0)], followed by controls (p_{linear trend} = 0.06). Gestation, birth weight, duration of oxygen, breastmilk feeding, and clinical sepsis were other variables associated with ROP on univariable analysis. On multivariable logistic regression, G6PD activity [Adjusted OR 1.14 (1.03, 1.25), p = 0.01] and gestation [Adjusted OR 0.74 (0.56, 0.97), p = 0.03] independently predicted ROP. C-statistic of the model was 0.76 (95% CI 0.67, 0.85).

CONCLUSIONS: Higher G6PD activity was independently associated with ROP after adjusting for confounders. Each 1 U/g Hb increase in G6PD increased the odds of ROP by 14%. Severer forms of ROP were associated with higher levels of G6PD activity.

PMID:37227582 | DOI:10.1007/s12098-023-04604-x