Tag: statistics

Eur Urol Focus. 2022 Oct 19:S2405-4569(22)00228-0. doi: 10.1016/j.euf.2022.09.019. Online ahead of print.

ABSTRACT

BACKGROUND: Peyronie’s disease (PD) is a fibrotic condition of the penis characterized by abnormal plaque formation. Intralesional collagenase Clostridium histolyticum (CCh) is effective in noncalcified PD; however, its effectiveness in calcified PD is not well characterized.

OBJECTIVE: To assess curvature improvement in calcified PD plaques treated with CCh.

DESIGN, SETTING, AND PARTICIPANTS: We prospectively evaluated men with calcified PD electing CCh treatment at our institution from October 2018 to November 2020. We assessed curvature with artificial erection and goniometer before and at least 3 mo after treatment. We classified the type of plaque calcification based on ultrasound.

INTERVENTION: Intralesional CCh. Each treatment cycle consisted of two CCh injections (0.58 mg) into the plaque at the point of maximal penile curvature. The second injection was performed 72 h to 1 wk later, after which participants began modeling. All men were intended to receive a total of eight injections in four cycles, each 6 wk apart.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Change in penile curvature after CCh was measured. We assessed for differences in outcomes based on the number of injections and type of calcification. Unless otherwise specified, data are presented as medians (interquartile range).

RESULTS AND LIMITATIONS: Sixty men with calcified PD elected CCh; 47 had complete follow-up data. Thirty-nine men completed treatments with eight injections, while the remaining discontinued after a median of five (four to six) injections. There was no difference in response between type 2 and type 3 plaques. Curvature significantly improved by 17.5° (37.5-10.0°) in patients who completed treatment and by 15.0° (20.0-0.0°) in those who discontinued. Limitations include a small sample.

CONCLUSIONS: Men with calcified PD plaques improve with CCh treatment and show similar improvements regardless of calcification type.

PATIENT SUMMARY: In this study, we evaluated the efficacy of collagenase Clostridium histolyticum (CCh) treatment in calcified Peyronie’s disease (PD) plaques. We found that treatment in calcified plaques demonstrated significant improvement in curvature and the grading of calcification did not impact the degree of curvature improvement. We conclude that participants with calcified PD plaques can benefit from nonsurgical CCh treatment.

PMID:36272924 | DOI:10.1016/j.euf.2022.09.019

Am J Geriatr Psychiatry. 2022 Sep 28:S1064-7481(22)00519-X. doi: 10.1016/j.jagp.2022.09.009. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine whether and how the COVID-19 pandemic affected the use of antipsychotics among residents with Alzheimer’s disease and related dementias in nursing homes.

DESIGN: Observational study based on the Minimum Data Set and Medicare claims.

SETTING: Medicare- and/or Medicaid-certified nursing homes.

PARTICIPANTS: Nursing home residents diagnosed with Alzheimer’s disease and related dementias between 2017 and 2020.

MEASUREMENTS: The main outcome variable was any antipsychotic use during a quarter. The secondary outcome was certified nursing assistants’ staffing hours per bed per day in a quarter. We categorized nursing homes into quartiles based on the distribution of nursing home racial and/or ethnic composition. To explore the relationship between the COVID-19 pandemic and the frequency of antipsychotic use, we estimated a linear probability model with robust standard errors, individual and facility random effects. We used a similar model for certified nursing assistant hours.

RESULTS: About 23.7% of residents with ADRD had antipsychotic uses during the study period. The frequency of antipsychotic use declined from 23.7%-23.1% between the first quarter of 2017 (2017Q1) and the first quarter of 2020 (2020Q1) but increased to 24.8% by the last quarter of 2020 (2020Q4). Residents in all four racial and/or ethnic groups experienced an increase in antipsychotic use during the COVID-19 pandemic, but the extent of the increase varied by race and/or ethnicity. For example, while residents in the very-high minority nursing homes experienced a greater increase in antipsychotic use than did the residents of other nursing homes at the beginning of the pandemic, the increasing trend during the pandemic was smaller in the very-high minority nursing homes compared to the low-minority nursing homes (0.2 percentage points less, p<0.001, based on heteroskedasticity-robust t statistics, t = 3.67, df = 8,155,219). On average, the certified nursing assistant hours decreased from 1.8-1.7 hours per bed per day between 2017Q1 and 2020Q1, and further decreased to 1.5 hours per bed per day by 2020Q4. There was also a decreasing trend in staffing hours across all racial and/or ethnic groups during the pandemic.

CONCLUSIONS AND RELEVANCE: The COVID-19 pandemic was associated with an increase in the use of antipsychotics among nursing home residents with Alzheimer’s disease and related dementias and decreased staffing of certified nursing assistants, especially among nursing homes with a high minority penetration. Future research is needed to explore means for reducing antipsychotic use, particularly in homes with a high penetration of minority residents.

PMID:36272888 | DOI:10.1016/j.jagp.2022.09.009

Trends Microbiol. 2022 Oct 19:S0966-842X(22)00257-8. doi: 10.1016/j.tim.2022.09.011. Online ahead of print.

ABSTRACT

The vaginal microbiome (VMB) is critical to female reproductive health; however, the mechanisms associated with optimal and non-optimal states remain poorly understood due to the complex community structure and dynamic nature. Quantitative systems biology techniques applied to the VMB have improved understanding of community composition and function using primarily statistical methods. In contrast, fewer mechanistic models that use a priori knowledge of VMB features to develop predictive models have been implemented despite their use for microbiomes at other sites, including the gastrointestinal tract. Here, we explore systems biology approaches that have been applied in the VMB, highlighting successful techniques and discussing new directions that hold promise for improving understanding of health and disease.

PMID:36272885 | DOI:10.1016/j.tim.2022.09.011

J Pediatr Nurs. 2022 Oct 19:S0882-5963(22)00245-7. doi: 10.1016/j.pedn.2022.09.024. Online ahead of print.

ABSTRACT

BACKGROUND: Childhood overweight and obesity rates in the United States continue to climb. Providers must identify feasible interventions to improve health habits to prevent and treat obesity in children.

METHODS: Parents (n = 91) of four-to eight-year-old children were recruited and surveyed regarding their child’s current health habits and perception of their child’s weight status. A conversation starter tool was developed and utilized to improve health habits in children ages four-to-eight over a period of four-to-six weeks.

FINDINGS: Health habits in children improved in the comparison and intervention groups. There was a 42% improvement in health habits in the intervention group who chose a specific goal to work on compared to 30% improvement in the comparison group. There was no statistically significant relationship between health habit adherence and the assigned group when assessing the health habits individually.

DISCUSSION: Overall, 42% of the selected goals were met, according to parent report at the follow-up survey; however, use of the conversation starter tool did not demonstrate statistically significant improvement in health habits. Parental perception of children’s weight status remained unchanged. Health habits in children improved in the comparison and intervention groups. Further studies should enroll a larger sample to assess differences between these two groups.

APPLICATION TO PRACTICE: The conversation starter tool was designed to be implemented into practice without the need for any specific training. The tool can be used on all children to promote improved health habits.

PMID:36272882 | DOI:10.1016/j.pedn.2022.09.024

J Pediatr Nurs. 2022 Oct 19:S0882-5963(22)00217-2. doi: 10.1016/j.pedn.2022.08.018. Online ahead of print.

ABSTRACT

AIM: This research aimed to explore the level of care readiness and positive feelings of family caregivers of children with liver transplantation, and predictive factors of care readiness were alsoinvestigated.

BACKGROUND: Children with liver transplant require high level and extensive postoperative care. Family caregivers lack professional care knowledge and experience for surgical trauma, postoperative care, anti rejection drug guidance and so on. Good care readiness can not only promote family caregivers to improve their positive emotions and physical and mental health, but also play a positive role in the recovery of children’s diseases. Therefore, efforts are needed to improve the readiness of family caregivers.

DESIGN/METHODS: A total of 107 family caregivers of children undergoing liver transplantation participated in this cross-sectional study. Sociodemographic data, disease characteristics, and measures of care readiness and positive feelings were collected using questionnaires.The Care Preparedness Scale (CPS) was used to assess care readiness, and the Positive Aspects of Caregiving (PAC) was used to assess positive feelings of family caregivers of children with liver transplantation. This paper adhered to the STROBE guidelines.

RESULTS: According to the statistical results, the total score of the CPS was 18.07 ± 5.51, and that of the PAC was 26.63 ± 4.05. There was a positive correlation between care readiness and positive feelings (r = 0.413, p < 0.05). Multiple linear step-wise regression analysis revealed that the total score of the PAC, undernourishment, caregiver education, relationship with children and care trainingresidence were the independent influencing factors of the readiness of caregivers (p < 0.05).

CONCLUSIONS: The care readiness of the family caregivers of children with liver transplantation was at a medium level. Medical personnel can implement targeted health education and carry out personalized care skill training to improve the positive feelings of caregivers and then improve the readiness of caregivers.

PMID:36272881 | DOI:10.1016/j.pedn.2022.08.018

Vaccine. 2022 Oct 19:S0264-410X(22)01243-9. doi: 10.1016/j.vaccine.2022.10.005. Online ahead of print.

ABSTRACT

An antenatal pertussis vaccination programme was introduced in 2012 in the UK in the context of a national outbreak of pertussis. It has been shown that a lower antibody response to primary immunisation can be seen for certain pertussis antigens in infants born to women who received pertussis-containing antenatal vaccines, a phenomenon known as blunting. The longer-term impact of this has not been documented previously, and accordingly was evaluated in this study. Children were predominantly recruited from a previous study in which their mothers had received acellular pertussis-containing antenatal vaccines (dTaP₃-IPV [diphtheria toxoid, tetanus toxoid, three antigen acellular pertussis and inactivated polio] or dTaP₅-IPV [diphtheria toxoid, tetanus toxoid, five antigen acellular pertussis and inactivated polio]), or no pertussis-containing vaccine. Blood samples were obtained prior to and one month after the acellular pertussis-containing preschool booster (dTaP₅-IPV) was given at around age 3 years 4 months. Pre- and post-booster immunoglobulin G (IgG) geometric mean concentrations (GMCs) against pertussis toxin, filamentous haemagglutinin, fimbriae 2 & 3, and pertactin, were compared. Prior to the receipt of the preschool booster, there was no difference in the IgG GMCs against pertussis-specific antigens between children born to women vaccinated with dTaP₃-IPV and dTaP₅-IPV; however, IgG GMCs against pertussis toxin were significantly lower in children born to women vaccinated with dTaP₃-IPV compared with children born to unvaccinated women (geometric mean ratio 0.42 [95 % CI 0.22-0.78], p = 0.03). One month after the receipt of the preschool booster there was no differences between the groups. The blunting effect of antenatal pertussis vaccine on pertussis responses in children can persist until preschool age, although it is overcome by the administration of a booster dose. ClinicalTrials.gov registration number: NCT03578120.

PMID:36272877 | DOI:10.1016/j.vaccine.2022.10.005

Rhinology. 2022 Oct 22. doi: 10.4193/Rhin22.294. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to compare the prevalence of olfactory dysfunction (OD) at different stages of the COVID-19 pandemic by evaluating subjects diagnosed with SARS-CoV-2 infection during the Omicron wave with psychophysical tests and comparing the results with those obtained from patients infected during the D614G, Alpha and Delta waves and with those of a control group.

METHODOLOGY: The study included adult patients diagnosed with SARS-CoV-2 infection. Depending on the time of diagnosis, the subjects were divided into four study groups: D614G; Alpha, Delta and Omicron variant groups. A group of uninfected individuals was used as control. All subjects underwent psychophysical evaluation of the olfactory function with the Connecticut Chemosensory Clinical Research Center olfactory test (D614G and Alpha groups) or the extended version of the Sniffin’Sticks test (Delta, Omicron and control groups).

RESULTS: 372 cases (134 D614G group, 118 Alpha group, 32 in Delta group and 88 Omicron group) were recruited and evaluated within 10 days of infection, alongside 80 controls. Patients self-reported olfactory loss in 72.4% of cases in the D614G group, in 75.4% of cases in the Alpha group, in 65.6% of cases in the Delta group and in 18.1% in the Omicron group. Psychophysical evaluation revealed a prevalence of OD: 80.6%, 83.0%, 65.6% and 36.3% in the D614G, Alpha, Delta and Omicron group respectively. The differences between the D614G, Alpha and Delta groups were not statistically significant. The Omicron group demonstrated a significantly lower prevalence of OD than the other variants but still significantly higher than the controls.

CONCLUSIONS: During the Omicron wave OD was less prevalent than during the D614G, Alpha and Delta periods. One-third of patients have reduced olfactory function on psychophysical evaluation during the Omicron wave. Our results should be considered with caution as the VOC has not been determined with certainty.

PMID:36272169 | DOI:10.4193/Rhin22.294

Infect Dis (Lond). 2022 Oct 22:1-8. doi: 10.1080/23744235.2022.2134447. Online ahead of print.

ABSTRACT

OBJECTIVES: No study has evaluated the follow-up of asymptomatic norovirus infection among healthy adults. This study compared norovirus detection rates between previously known norovirus-positive and norovirus-negative adults without diarrheal symptoms, and evaluated reinfection risk among the previously-norovirus-positive group, and new asymptomatic norovirus infection risk among the previously-norovirus-negative group after 600 days.

METHODS: This prospective age- and sex-matched cohort study, conducted in 2019 at a Japan teaching hospital, included apparently healthy asymptomatic adults with a positive norovirus result and those with a negative result (ratio 1:3) during the 2016-2017 screening. The primary outcome was real-time reverse-transcription polymerase chain reaction-confirmed norovirus in stool specimens. We evaluated descriptive statistics and associated factors, including demographics, social habits, and clinical parameters.

RESULTS: Of 288 participants [mean age, 59.9 (standard deviation: 12.6) years; male, 143 (49.7%)], 73 [genogroup (G) I 35; GII 37; both included 1 each] were positive for norovirus previously, while 215 were negative. After a median of 599 (interquartile range 515-799) days between baseline screening and follow-up, 14 (4.9%; GI 0; GII 14) tested positive for norovirus (2.7% and 5.6% among positive- and negative-norovirus groups at baseline, respectively). Among previously norovirus-negative participants, being older, having elevated blood pressure and haemoglobin A1c level, and drinking Japanese sake at baseline were associated with positive results at follow-up.

CONCLUSIONS: Genogroup homotypic protective effect may exist for subsequent asymptomatic infection. There may be higher risks of future asymptomatic norovirus infection in previously no-norovirus asymptomatic infection people with specific lifestyles or medical histories. SUMMARYThe detection follow-up rates of norovirus were 2.7% and 5.6% among asymptomatic adults with positive- and negative-norovirus status at baseline, respectively. Specific lifestyles or medical histories may confer higher risk of norovirus detection.

PMID:36272144 | DOI:10.1080/23744235.2022.2134447

J Gastroenterol Hepatol. 2022 Oct 22. doi: 10.1111/jgh.16036. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Diagnosis of abdominal TB is an exigent task due to variable anatomical sites and non-specific clinical manifestations that closely resemble other diseases. Most of the available diagnostic modalities yield low sensitivities and need expertise to handle the specialized equipments. Hence, there is an urgent need to develop a rapid and reliable diagnostic test, so as to reduce the unnecessary morbidity. Therefore, we designed a multi-targeted loop-mediated isothermal amplification (MT-LAMP) for diagnosing abdominal TB.

METHODS: We evaluated an MT-LAMP (using mpt64 and IS6110) to diagnose abdominal TB within ascitic fluids and intestinal/peritoneal biopsies, and compared these results with multiplex-PCR (M-PCR) using the same targets. MT-LAMP products were analyzed by gel electrophoresis and visual detection methods, i.e. hydroxy naphthol blue and SYBR Green I reaction.

RESULTS: Sensitivities of 80.9% and 84.6% were obtained in suspected (n=42) and total abdominal TB (n=52) cases, respectively by gel-based MT-LAMP, with 97.3% (n=37) specificity in non-TB controls. Notably, sensitivities attained by gel-based/SYBR Green I MT-LAMP in both clinically suspected and total abdominal TB cases were significantly higher (p<0.05) than M-PCR. Furthermore, sensitivity obtained with SYBR Green I was equivalent to that of gel-based MT-LAMP, while somewhat lesser specificity (94.6%) was attained with SYBR Green I, compared with gel-based MT-LAMP.

CONCLUSION: Both gel-based and SYBR Green MT-LAMP exhibited equivalent sensitivities to diagnose abdominal TB. Since SYBR Green LAMP is easier to perform than a gel-based assay, we are currently focused on improving the specificity of this assay so as to develop a diagnostic kit.

PMID:36272130 | DOI:10.1111/jgh.16036

J Neurosurg Spine. 2022 Oct 21:1-8. doi: 10.3171/2022.8.SPINE22644. Online ahead of print.

ABSTRACT

OBJECTIVE: The ejection seat is one of the most important rescue tools for military aircrews. However, the high ejection speeds place high loads on the pilots, which is mainly absorbed by the pilot’s spine. The differentiated evaluation of spinal injuries is of particular importance because this has a decisive influence on the further personal life and career of the affected aircrew members. Factors influencing the occurrence of a fracture as well as the impact of a spinal injury on military flight certification have not been addressed sufficiently to date.

METHODS: The authors conducted a retrospective evaluation of ejection seat evacuations in German Armed Forces combat aircraft accidents between 1975 and 2021. The total number of aviation accidents with ejection seat initiations and the survived ejections were collected. Accident-specific data and pilot-specific data were collected. In addition, it was evaluated whether aircrew members were recertified for military flight after the accident. The type of spinal injury and the location of the injury were evaluated. In addition to the descriptive statistics, two logistic regression models were developed to assess prediction values of accident- and pilot-specific factors for spine injuries.

RESULTS: A total of 103 aircrew members were included in this retrospective analysis. The overall prevalence of spine injuries was 56.3%, and the overall prevalence of spine fractures was 33.0%. In the first regression model analysis, there was no association with pilot flight experience, age, height, weight, BMI, and being diagnosed with a spine fracture. Similarly, aircraft type, altitude, and airspeed were not associated with the occurrence of spine fractures. In the regression model analysis for predictors of rejection in military flight recertification after ejection seat evacuation, lumbar spine fractures were associated with higher odds of being rejected for recertification.

CONCLUSIONS: Military aircraft crew members have a high risk of suffering from a spine injury after emergency evacuation using an ejection seat. In the subsequent medical workup, special attention should be paid to the spine, and ideally a consultation with a spine surgeon should be performed. Lumbar spine fractures may have major consequences for military flight certification, and therefore special attention should be paid to successful rehabilitation.

PMID:36272126 | DOI:10.3171/2022.8.SPINE22644