Tag: statistics

BMC Musculoskelet Disord. 2023 Feb 2;24(1):90. doi: 10.1186/s12891-023-06198-z.

ABSTRACT

PURPOSE: Distal femoral torsion is a key factor for poor alignment of patellofemoral joint. This study aims to evaluate the correlation between distal femoral torsion and the severity of patellofemoral arthritis, and to analyze the correlation between distal femoral torsion and the morphology of femoral condyle.

METHODS: A retrospective analysis was performed on 125 patients awaiting surgical treatment for knee osteoarthritis from January 2021 to March 2022(79 females, 46 males, average age: 65.78 years, SD 6.61). All patients underwent knee joint radiography, lower-limb digital radiography, and knee joint CT scans. The ratio of length of each distal femoral condyle, TT-TG, patellar tilt, DFL-PCL, DFL-TEA, TEA-PCL and TEA-ACL were measured. The Pearson correlation coefficient was used to evaluate the correlation between distal femoral torsion and ratio of distal femoral condyle, TT-TG and patellar tilt. Logistic regression was used to evaluate the correlation between each parameter and the severity of PFOA.

RESULTS: With the increased severity of PFOA, TT-TG, patellar tilt, DFL-PCL, DFL-TEA and PCA all tended to increase. Patellar tilt was correlated with DFL-PCL (r = 0.243) and TEA-PCL(r = 0.201), but TT-TG had no evident correlation with distal femoral torsion. Compared with Grade I patients of PFOA, DFL-PCL, DFL-TEA, and TEA-PCL were risk factors for increased severity of patellofemoral arthritis in Grade III patients of PFOA, but there was no significant statistic difference in Grade II patients of PFOA.

CONCLUSIONS: Distal femoral torsion correlates with the severity of patellofemoral arthritis. Variation of the femoral transepicondylar axis caused by the change of ratio of the femoral condyle is particularly important in the distal femoral torsion. In patients with severe PFOA, abnormal variation of the femoral condyle axis should be not ignored.

PMID:36732733 | DOI:10.1186/s12891-023-06198-z

BMC Med Educ. 2023 Feb 2;23(1):82. doi: 10.1186/s12909-023-04052-3.

ABSTRACT

OBJECTIVES: Since 2020, with the entire world in crisis over the coronavirus pandemic (COVID-19), medical students have adapted to hybrid and distance learning. This study aims to compare the learning outcomes of students learning the procedure of fractional curettage in an online video-assisted teaching program to those of students learning the procedure in a traditional class.

METHODS: A quasi-experimental study was conducted among fourth-year medical students who rotated to Obstetrics and Gynecology courses between April 2021 and October 2021. Participants in the first two rotations were enrolled in traditional classes, and the online video-assisted teaching program was introduced in the subsequent two rotations. Both study groups took OSCEs (objective structured clinical examinations), a pre-test and post-test with MCQs (multiple choice questions), and a confidence and satisfaction level questionnaire.

RESULTS: A total of 106 fourth-year medical students, 54 in the traditional group and 52 in the online video-assisted teaching program, were recruited. The online video-assisted group showed a statistically better mean OSCE score (85.67 ± 11.29 vs. 73.87 ± 13.01, p < 0.001) and mean post-test MCQ score than the traditional group (4.21 ± 0.87 vs. 3.80 ± 0.98, p = 0.0232). Moreover, the mean difference between the two groups’ pre and post-test MCQ scores was significantly different (0.96 ± 1.37 vs. 1.79 ± 1.50 in traditional and online video-assisted teaching program groups, respectively, P = 0.0038). The participants in the experimental group reported significantly greater confidence (P < 0.001) in performing the fractional curettage procedure. However, the mean satisfaction score was significantly higher in the control group (p = 0.0053).

CONCLUSION: The online video-assisted teaching program on the fractional curettage procedure, a necessary and skill-demanding procedure, is an effective and advantageous education tool that improves skills, knowledge, and confidence in fourth-year medical students. We recommend that the video-assisted teaching program is another effectively procedural teaching method for medical students.

PMID:36732732 | DOI:10.1186/s12909-023-04052-3

BMC Pregnancy Childbirth. 2023 Feb 3;23(1):91. doi: 10.1186/s12884-023-05358-2.

ABSTRACT

BACKGROUND: It has been hypothesized that the coronavirus disease 2019 (COVID-19) pandemic may have changed the conduct of obstetric practices at the time of labor, delivery, and birth. In Brazil, many practices lacking scientific evidence are implemented in this care, which is charcaterized by excessive use of unnecessary interventions. This scenario may have been worsened by the pandemic. Thus, we analyzed the effects of the pandemic on care during prenatal care and delivery by comparing the results of two surveys (one was administered before the pandemic and the other during the pandemic) in public hospitals in Belo Horizonte – Minas Gerais (MG), Brazil.

METHODS: This cross-sectional and comparative study analyzed preliminary data from the study “Childbirth and breastfeeding in children of mothers infected with SARS-CoV-2”, which was conducted in three referral maternity hospitals in Belo Horizonte – MG during the pandemic in the first half of 2020 in Brazil. The final sample consisted of 1532 eligible women. These results were compared with data from 390 puerperae who gave birth in the three public hospitals in the study “Birth in Belo Horizonte: labor and birth survey”, conducted before the pandemic to investigate the changes in practices of labor and delivery care for the mother and her newborn, with or without COVID-19 infection, before and during the pandemic. In this research, “Birth in Belo Horizonte: labor and birth survey”, data collection was performed between November 2011 and March 2013 by previously trained nurses. Between study comparisons were performed using Pearson’s chi-square test, with a confidence level of 95%, and using Stata statistical program.

RESULTS: We found a significant increase in practices recommended by the World Health Organization during the pandemic including the following: diet offering (48.90 to 98.65%), non-pharmacological pain relief (43.84 to 67.57%), and breastfeeding in the newborn´s first hour of life (60.31 to 77.98%) (p < 0.001). We found a significant reduction of non-recommended interventions, such as routine use of episiotomy (15.73 to 2.09%), the Kristeller maneuver (16.55 to 0.94%), oxytocin infusion misused (45.55 to 28.07%), amniotomy (30.81 to 15.08%), and lithotomy position during labor (71.23 to 6.54%) (p < 0.001).

CONCLUSION: Our study revealed a statistically significant increase in the proportion of use of recommended practices and a reduction in non-recommended practices during labor and delivery. However, despite advances in the establishment of World Health Organization recommended practices in labor, delivery, and birth, the predominance of interventionist and medicalized practices persists, which is worsened by events, such as the pandemic.

PMID:36732728 | DOI:10.1186/s12884-023-05358-2

BMC Endocr Disord. 2023 Feb 2;23(1):30. doi: 10.1186/s12902-023-01278-6.

ABSTRACT

PURPOSE: Metabolic syndrome is a risk factor for several diseases. The relationship between metabolic syndrome and hypogonadism is well known. Our objetive is to assess whether a low carbohydrate diet can increase total serum testosterone and improve erectile function in hypogonadal men with metabolic syndrome.

METHODS: An open label randomized clinical trial was conducted comparing a low carbohydrate diet and controls, during three months, in hypogonadal men with metabolic syndrome. Anthropometric measurements were evaluated as well as total serum testosterone levels, and symptoms of hypogonadism, using the ADAM and AMS scores, and sexual function using IIEF-5 score.

RESULTS: Eighteen men were evaluated. Anthropometric measures were improved only in low carbohydrate diet group. The intervention group also had a statistically increase in IIEF-5 score and a significant reduction in AMS and ADAM scores (p < 0.001). The increase in serum total testosterone levels was statistically significant in the low carbohydrate group compared to the control group as well as calculated free testosterone (p < 0.001).

CONCLUSIONS: Low carbohydrate diet may increase serum levels of testosterone and improve erectile function in hypogonadal men with metabolic syndrome. However, larger studies are necessary to strongly prove the effectiveness of low carbohydrate diet in treating male hypogonadism.

PMID:36732722 | DOI:10.1186/s12902-023-01278-6

BMC Public Health. 2023 Feb 2;23(1):225. doi: 10.1186/s12889-022-14949-1.

ABSTRACT

BACKGROUND: Empowering adolescent girls is an important component of combating malnutrition in this age group. Because empowerment is multidimensional and context specific, it can be difficult for policymakers and practitioners to target the dimensions of empowerment associated with adolescent girls’ nutrition in a particular setting. This study sought to identify the empowerment dimensions significantly associated with married adolescent girls’ nutritional status in East Africa; a region where malnutrition and gender inequality stubbornly persist.

METHODS: We used cross-sectional Demographic and Health Survey (DHS) data from Ethiopia (2016), Kenya (2014), Tanzania (2015-16) and Uganda (2016) to construct and test theoretically informed structural equation models of the relationship between six dimensions of empowerment and BMI-for-age and haemoglobin levels for married adolescent girls aged 15-19 years.

RESULTS: Our models were found to be a good fit for the data. Married adolescent girls’ access to information, measured by their education level and mass media use, was directly and positively associated with their BMI-for-age (p < 0.05). Asset ownership, measured by owning a house or land alone or jointly, was directly and positively associated with haemoglobin (p < 0.05) and reduced odds of being moderately to severely anemic. Rejecting justifications for intimate partner violence, a measure of respondents’ intrinsic agency, was directly and positively associated with the odds of being overweight or obese. Adolescent girls’ level of empowerment across all dimensions had a direct relationship with their country of residence and household wealth.

CONCLUSIONS: Our findings suggest that investment in girls’ access to information through education and mass/social media and their economic empowerment may be important contributors to their overall empowerment and nutritional status. However, caution is needed as greater autonomy may contribute to increased consumption of unhealthy foods that can contribute to overweight and obesity. Strategies to empower married adolescent girls should be tailored to their specific circumstances. There is an urgent need for better data on adolescent empowerment and health, including increased research into age-, sex- and gender-appropriate empowerment measures and longitudinal data to assess causality. The use of statistical models should be complemented by robust qualitative research to further results interpretation.

PMID:36732719 | DOI:10.1186/s12889-022-14949-1

BMC Public Health. 2023 Feb 2;23(1):224. doi: 10.1186/s12889-023-15106-y.

ABSTRACT

BACKGROUND: Using XGBoost (XGB), this study demonstrates how flexible machine learning modelling can complement traditional statistical modelling (multinomial logistic regression) as a sensitivity analysis and predictive modelling tool in occupational health research.

DESIGN: The study predicts welfare dependency for a cohort at 1, 3, and 5 years of follow-up using XGB and multinomial logistic regression (MLR). The models’ predictive ability is evaluated using tenfold cross-validation (internal validation) and geographical validation (semi-external validation). In addition, we calculate and graphically assess Shapley additive explanation (SHAP) values from the XGB model to examine deviation from linearity assumptions, including interactions. The study population consists of all 20-54 years old on long-term sickness absence leave due to self-reported common mental disorders (CMD) between April 26, 2010, and September 2012 in 21 (of 98) Danish municipalities that participated in the Danish Return to Work program. The total sample of 19.664 observations is split geospatially into a development set (n = 9.756) and a test set (n = 9.908).

RESULTS: There were no practical differences in the XGB and MLR models’ predictive ability. Industry, job skills, citizenship, unemployment insurance, gender, and period had limited importance in predicting welfare dependency in both models. On the other hand, welfare dependency history and reason for sickness absence were strong predictors. Graphical SHAP-analysis of the XGB model did not indicate substantial deviations from linearity assumptions implied by the multinomial regression model.

CONCLUSION: Flexible machine learning models like XGB can supplement traditional statistical methods like multinomial logistic regression in occupational health research by providing a benchmark for predictive performance and traditional statistical models’ ability to capture important associations for a given set of predictors as well as potential violations of linearity.

TRIAL REGISTRATION: ISRCTN43004323.

PMID:36732716 | DOI:10.1186/s12889-023-15106-y

Clin Neurol Neurosurg. 2023 Jan 20;226:107609. doi: 10.1016/j.clineuro.2023.107609. Online ahead of print.

ABSTRACT

OBJECTIVE: This study compared the impact of the combination therapy of onabotulinum toxin A and greater occipital nerve block (GoNT-A) with onabotulinum toxin A monotherapy (BoNT-A) based on its efficacy and safety in relation to the quality of life of adult chronic migraine (CM) patients.

BACKGROUND: Prophylactic treatment of CM is still difficult and complex. Combination treatments do not have an evidence base yet.

METHODS: This retrospective study included 85 patients. For greater occipital nerve block (GONB), 4 ml of the solution prepared using 1 ml of 0.5% bupivacaine and 3 ml of saline on both sides were bilaterally applied to 30 patients. For BoNT-A treatment, a total of 155 units of onabotulinum toxin A (BOTOX®) was intramuscularly injected into 31 specific points around the head and neck in 27 patients. Both protocols were similarly applied to 28 patients for GoNT-A treatment. MIDAS and HIT-6 scores were evaluated to measure patients’ quality of life three months after the treatment.

RESULTS: When MIDAS and HIT-6 score groups were statistically compared, both GONB and GoNT-A applications showed a statistically significant reduction compared to the BoNT-A application (p < 0.05). The decrease in the MIDAS and HIT-6 scores of GONB and GoNT-A applications did not show a statistical difference (p > 0.05).

CONCLUSION: The combination of BoNT-A and GONB was superior to BoNT-A applied as monotherapy. Alternately, no significant difference was found between GONB therapy and combination therapy in all data. Combination treatments were well tolerated.

PMID:36731164 | DOI:10.1016/j.clineuro.2023.107609

Top Cogn Sci. 2023 Feb 2. doi: 10.1111/tops.12640. Online ahead of print.

ABSTRACT

This article discusses the possibility of practitioners who mistake organic memory loss for dissociative amnesia. It starts with the case of a young man with complete retrograde amnesia due to a traumatic head injury. Because he did not show any gross neurological abnormalities, a neurologist thought his amnesia had a psychological origin. An extensive neuropsychological examination revealed that the man did have an organic reason for his amnesia. Next, the existence of dissociative memory loss as well as isolated organic retrograde amnesia is considered. While cases of organic memory loss are well-documented, there is hardly any evidence for dissociative amnesia. It is argued that organic memory loss might be mistakenly taken for dissociative amnesia. In line with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, practitioners are advised to rule out the possibility of organic memory loss, before diagnosing a patient with dissociative amnesia.

PMID:36731123 | DOI:10.1111/tops.12640

J Craniofac Surg. 2022 Aug 10. doi: 10.1097/SCS.0000000000008810. Online ahead of print.

ABSTRACT

The authors attempt to approach hemifacial microsomia with macroscopic techniques and look for a link between clinical manifestations with pathogenesis. In this study, for the first time mandibular medullary cavities as essential parts of the mandible were intravitally measured based on the 3-dimensional models. A total of 153 patients were included. The 3-dimensional models of patients’ mandibles were reconstructed and medullary cavity volumes (mm3) were measured. The ratio of medullary cavity volume to mandible volume was calculated to determine the proportion of the marrow in the bone. Statistical significance was found in mandible volumes (P<0.001) and medullary cavity volumes (P<0.001) on different sides. Medullary cavity volumes were significantly related to mandible volumes on both sides (both P<0.001). Medullary cavity volumes on the nonaffected and affected side were both in correlation with age but in different degrees (r=0.214, P=0.008 versus r=0.170, P=0.036). The ratios of medullary cavity volume and the mandible were significantly different (P<0.001) on 2 sides. The volume ratio on the nonaffected side correlated to age while this correlation did not exist on the affected side (r=0.195, P=0.016 versus r=0.129, P=0.112). A smaller medullary cavity found on the affected side could lead to a reduced amount of bone marrow cells and consequently reduced osteogenic and hematopoietic potential. This could result in abnormal bone formation on the affected side of mandible. Proportions of marrow in bone on the affected side irrelevant to patients’ ages signify a poorer potential of expansion. This may explain a higher reluctancy of growth in affected mandibular sides.

PMID:36731104 | DOI:10.1097/SCS.0000000000008810

Cornea. 2022 Sep 29. doi: 10.1097/ICO.0000000000003112. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to evaluate characteristics and outcomes of pediatric phlyctenulosis at a tertiary care center in the United States.

METHODS: A retrospective cohort study of phlyctenulosis diagnosis in patients younger than 18 years was conducted. Demographics, presenting features, treatment regimens, and outcomes were analyzed.

RESULTS: Seventy patients (95 eyes) with phlyctenulosis were identified. Fifty-four patients (77.1%) were Hispanic, which was greater than the center’s proportion of pediatric patients identifying as Hispanic (53.8%, P < 0.0001). Common comorbidities included adjacent external/lid disease (82.9%), allergic/atopic disease (18.6%), and viral infections (8.6%). Nine patients had tuberculosis testing which was negative in all cases. Five patients had vitamin A testing which revealed deficiency in 1 patient. Treatment regimens were diverse and included varying combinations of topical and systemic medications. Complications included corneal scarring (27.4%), corneal neovascularization (40.0%), amblyopia (16.8%), corneal perforation (3.2%), and severe limbal stem-cell deficiency (1.1%). 26.3% of affected eyes had final visual acuity worse than 20/40. Differences in rates of corneal complications between Hispanic and non-Hispanic patients were not statistically significant, although severe corneal complications including perforation occurred only in the Hispanic group.

CONCLUSIONS: This study presents a modern cohort of phlyctenulosis at a tertiary center in the United States and includes a larger proportion of Hispanic patients than expected. Phlyctenulosis carries high corneal morbidity and may frequently result in reduced visual acuity. Similar rates of corneal complications were seen in Hispanic versus non-Hispanic patients, but severe corneal complications were seen only in the Hispanic group.

PMID:36731094 | DOI:10.1097/ICO.0000000000003112