Tag: statistics

JAMA Netw Open. 2022 Aug 1;5(8):e2228002. doi: 10.1001/jamanetworkopen.2022.28002.

ABSTRACT

IMPORTANCE: Placenta previa is widely acknowledged as a risk factor for placenta accreta spectrum (PAS) disorders, which are severe maternal complications; however, data are limited regarding whether placenta previa is associated with a higher risk of worse maternal outcomes among patients with PAS disorders.

OBJECTIVE: To examine the association between placenta previa and the risk of severe maternal morbidities (SMMs) and higher resource use among patients with PAS disorders.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study extracted records of 3793 patients with PAS diagnosis and delivery indicators between October 1, 2015, and December 31, 2019, from the US National Inpatient Sample database.

EXPOSURES: Placenta previa.

MAIN OUTCOMES AND MEASURES: Data on 21 Centers for Disease Control and Prevention-defined SMMs and 25 study-defined surgical morbidities associated with PAS were extracted. Six surgical procedures (cystoscopy, intra-arterial balloon occlusion, cesarean delivery, hysterectomy, cystectomy, and oophorectomy), hospital length of stay, and inpatient costs were compared. Multivariable Poisson regression models built in the generalized estimating equation framework were used.

RESULTS: Among 3793 patients with PAS (median [IQR] age at admission, 33 [29-37] years), 621 women (16.4%) were Black, 765 (20.2%) were Hispanic, 1779 (46.9%) were White, 441 (11.6%) were of other races and/or ethnicities (47 [1.2%] were American Indian, 220 [5.8%] were Asian or Pacific Islander, and 174 [4.6%] were of multiple or other races and/or ethnicities), and 187 (4.9%) were of unknown race and ethnicity. A total of 1323 patients (34.9%) had placenta previa and 2470 patients (65.1%) did not; of those with placenta previa, 405 patients (30.6%) had invasive PAS. Patients with vs without placenta previa had a significantly higher rate and risk of any SMM (935 women [70.7%] vs 1087 women [44.0%]; P < .001; adjusted risk ratio [aRR], 1.19; 95% CI, 1.12-1.27) and any surgical morbidity (1170 women [88.4%] vs 1667 women [67.5%]; P < .001; aRR, 1.18; 95% CI, 1.13-1.23). With regard to specific outcomes, those with vs without placenta previa had a significantly higher rate of peripartum hemorrhage (878 patients [66.4%] vs 1217 patients [49.3%]; P < .001), blood product transfusion (413 patients [31.2%] vs 610 patients [24.7%]; P < .001), shock (83 patients [6.3%] vs 108 patients [4.4%]; P = .01), disseminated intravascular coagulation or other coagulopathy (77 patients [5.8%] vs 105 patients [4.3%]; P = .04), and urinary tract injury (44 patients [3.3%] vs 41 patients [1.7%]; P = .002). Patients with vs without placenta previa were more likely to undergo cesarean delivery (1292 patients [97.7%] vs 1787 patients [72.3%]; P < .001), hysterectomy (786 patients [59.4%] vs 689 patients [27.9%]; P < .001), cystoscopy (301 patients [22.8%] vs 203 patients [8.2%]; P < .001), cystectomy (157 patients [11.9%] vs 98 patients [4.0%]; P < .001), and intra-arterial balloon occlusion (121 patients [9.1%] vs 77 patients [3.1%]; P < .001) and to have significantly longer hospital length of stay (median [IQR], 5 [4-11] days vs 3 [3-5] days; P < .001) and total inpatient costs (median [IQR], $17 496 [$10 863-$30 619] vs $9728 [$6130-$16 790]; P < .001). Hypertensive disorder of pregnancy was associated with a decreased risk of placenta previa (aRR, 0.67; 95% CI, 0.46-0.96) among patients with PAS.

CONCLUSIONS AND RELEVANCE: In this study, placenta previa was associated with an increased risk of maternal and surgical morbidities and higher resource use among women with PAS. These findings suggest that interventions to alleviate maternal and surgical morbidities are especially needed for patients with placenta previa-complicated PAS disorders.

PMID:35994286 | DOI:10.1001/jamanetworkopen.2022.28002

JAMA Intern Med. 2022 Aug 22. doi: 10.1001/jamainternmed.2022.3171. Online ahead of print.

ABSTRACT

IMPORTANCE: Risk prediction for coronary heart disease (CHD) is a cornerstone of primary prevention strategies. Polygenic risk scores (PRSs) have emerged as a new approach to predict risk in asymptomatic people. Polygenic risk scores for CHD have been studied in several populations, but there is lack of agreement about the incremental value of PRS beyond traditional risk factor scores in the primary prevention of CHD.

OBSERVATIONS: This narrative review critically appraised the 5 most highly cited studies published through 2021 that also included a large number (>45 000) of single-nucleotide variations (formerly single-nucleotide polymorphisms) and evaluated the incremental value of PRS in CHD risk prediction according to published PRS reporting standards. The cohorts studied included the Atherosclerosis Risk in Communities Study, FINRISK, the Framingham Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the UK Biobank. All of the studies focused predominantly on populations of European ancestry. The hazard ratio per standard deviation of PRS ranged from 1.24 (95% CI, 1.15-1.34) to 1.74 (95% CI, 1.61-1.86). The C statistic for PRS alone ranged from 0.549 to 0.623. The change in C statistic when PRS was added to a standard risk factor model ranged between -0.001 to +0.021. Net reclassification index was reported in 4 of the 5 studies and varied from 0.001 to 0.097. At a sensitivity (true-positive rate) of 90%, positive predictive values ranged from 1.8% to 16.6%, and false-positive rates ranged from 77.1% to 85.7%.

CONCLUSIONS AND RELEVANCE: In this review, PRS was significantly associated with CHD risk in all studies. The degree of improvement in C statistic and the net reclassification indexes when PRS was added to traditional risk scores ranged from negligible to modest. Based on established metrics to assess risk prediction scores, the addition of PRS to traditional risk scores does not appear to provide meaningful improvements in clinical decision-making in primary prevention populations.

PMID:35994254 | DOI:10.1001/jamainternmed.2022.3171

Brain Inj. 2022 Aug 22:1-10. doi: 10.1080/02699052.2022.2109732. Online ahead of print.

ABSTRACT

BACKGROUND: To assess whether concussion history adversely affects multisensory integration, we compared susceptibility to the Sound-Induced Flash Illusion (SIFI) in retired professional rugby players compared to controls.

METHODS: Retired professional rugby players ((N = 58) and retired international rowers (N = 26) completed a self-report concussion history questionnaire and the SIFI task. Susceptibility to the SIFI (i.e., perceiving two flashes in response to one flash paired with two beeps) was assessed at three stimulus onset asynchronies (70 ms, 150 ms or 230 ms).Logistic mixed-effects regression modeling was implemented to evaluate how athlete grouping, previous concussion history and total number of years playing sport, impacted the susceptibility to the SIFI task. The statistical significance of a fixed effect of interest was determined by a likelihood ratio test.

RESULTS: Former rugby players had significantly more self-reported concussions than the rower group (p < 0.001). There was no impact of athlete grouping (i.e., retired professional rugby players and retired international rowers), years participation in elite sport or concussion history on performance in the SIFI.

CONCLUSION: A career in professional rugby, concussion history or number of years participating in professional rugby was not found to be predictive of performance on the SIFI task.

PMID:35994241 | DOI:10.1080/02699052.2022.2109732

Comput Inform Nurs. 2022 Aug 22. doi: 10.1097/CIN.0000000000000927. Online ahead of print.

ABSTRACT

Bronchial asthma among children is a common chronic disease that may impact quality of life. Health education is one of the strategies to improve knowledge and quality of life. This study aims to assess the effect of health education via a mobile application in promoting the quality of life among schoolchildren with asthma in urban Malaysia during the COVID-19 era. A quasi-experimental, pre- and post-intervention design was used in this study involving a total of 214 students, randomly assigned into two groups (an intervention group and a control group). The control group received face-to-face health education, whereas the experimental group received health education via a mobile application. The findings showed that the total score of quality of life improved from a mean total score at pre-intervention of 5.31 ± 1.27 to post-intervention of 5.66 ± 1.28 for the control group, compared with the experimental group with a mean total score of quality of life at pre-intervention of 5.01 ± 1.36 and post-intervention of 5.85 ± 1.29. A comparison between the experimental and control groups using an independent t test showed statistically significant differences in their mean quality of life scores. The effect of health education via a mobile application showed a statistically significant improvement in the mean quality of life score from pre- to post-intervention (F1,288 = 57.46, P < .01). As recommended, the use of mobile technology in health education improved the quality of life of schoolchildren with asthma as compared with the traditional methods of a face-to-face lecture and/or a handbook. Thus, educational modules using mobile applications do improve quality of life.

PMID:35994240 | DOI:10.1097/CIN.0000000000000927

BioDrugs. 2022 Aug 22. doi: 10.1007/s40259-022-00547-5. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with severe psoriasis are prone to deterioration of renal function. Whether biologics with potent anti-inflammatory action can prevent deterioration of renal function in psoriatic patients was unclear.

OBJECTIVE: To investigate the effects of different biologics on renal function in patients with severe psoriasis.

METHODS: By using the Chang Gung Research Database in Taiwan during 2006-2018, we analyzed the changes in renal function of psoriatic patients from 2 years before biologic treatments to baseline (start of biologic treatment) to after 2 years’ treatment with different classes of biologics (anti-TNF, anti-IL-12/23, and anti-IL-17 agents). The renal function was evaluated by estimated glomerular filtration rate (eGFR) and the staging of chronic kidney disease (CKD). We further analyzed the risk factors of progression on the staging of CKD during biologics treatment.

RESULTS: We included 601 patients with severe psoriasis receiving continuous use of biologics for ≥ 2 years. We detected no significant differences between pre-biologic treatment with conventional systemic treatment and post-biologic treatment in the levels of eGFR and progression of CKD staging among psoriatic patients receiving different classes of biologics. Most patients (97.8%) remained at stable CKD stage, while progression of CKD stage over time occurred in 13 patients (2.2%), with seven treated with anti-TNF biologics and six treated with anti-IL-12/23 biologics. Of note, all 52 patients receiving anti-IL-17 biologics had stable CKD. Progression of CKD during biologics use was associated with lower baseline levels of eGFR, higher baseline CKD stage, older age, diabetes, and dyslipidemia. Further multiple logistic regression analysis showed diabetes as an independent factor for the deterioration of renal function during biologic treatment.

CONCLUSIONS: Biologic treatments failed to improve but did not worsen renal function of psoriatic patients during a 2-year follow-up period. Diabetes is an important risk factor for the deterioration of renal function.

PMID:35994233 | DOI:10.1007/s40259-022-00547-5

Discov Oncol. 2022 Aug 22;13(1):79. doi: 10.1007/s12672-022-00546-6.

ABSTRACT

Cervical cancer (CC) is considered as the fourth most common women cancer globally.that shows malignant features of local infiltration and invasion into adjacent organs and tissues. There are several individual studies in the literature that explored CC-causing hub-genes (HubGs), however, we observed that their results are not so consistent. Therefore, the main objective of this study was to explore hub of the HubGs (hHubGs) that might be more representative CC-causing HubGs compare to the single study based HubGs. We reviewed 52 published articles and found 255 HubGs/studied-genes in total. Among them, we selected 10 HubGs (CDK1, CDK2, CHEK1, MKI67, TOP2A, BRCA1, PLK1, CCNA2, CCNB1, TYMS) as the hHubGs by the protein-protein interaction (PPI) network analysis. Then, we validated their differential expression patterns between CC and control samples through the GPEA database. The enrichment analysis of HubGs revealed some crucial CC-causing biological processes (BPs), molecular functions (MFs) and cellular components (CCs) by involving hHubGs. The gene regulatory network (GRN) analysis identified four TFs proteins and three miRNAs as the key transcriptional and post-transcriptional regulators of hHubGs. Then, we identified hHubGs-guided top-ranked FDA-approved 10 candidate drugs and validated them against the state-of-the-arts independent receptors by molecular docking analysis. Finally, we investigated the binding stability of the top-ranked three candidate drugs (Docetaxel, Temsirolimus, Paclitaxel) by using 100 ns MD-based MM-PBSA simulations and observed their stable performance. Therefore the finding of this study might be the useful resources for CC diagnosis and therapies.

PMID:35994213 | DOI:10.1007/s12672-022-00546-6

J Dent Educ. 2022 Aug 22. doi: 10.1002/jdd.13081. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate student perception of integrating biomedical and clinical sciences based on survey of dental students on the concurrent teaching of a didactic systems-based course and a case-based course.

METHODS: First-year to fourth-year students (DS1-DS4) students were surveyed for their experiences in concurrent teaching. Student response rate for the survey was 55% (229/420). Pearson’s Chi-squared tests and Kruskal-Wallis rank sum tests were used to assess statistical significance (p < 0.05).

RESULTS: Of the students surveyed, 83% strongly agreed or agreed that concurrent teaching of the didactic and case-based courses helped them better understand the biomedical science background and the clinical ramifications (p < 0.001). On average, 75% percent strongly agreed or agreed that concurrent teaching kept them engaged, motivated, think critically, apply the course content and prepare for clinical practice (p < 0.001). Of the students surveyed, 69% support expanding concurrent teaching to all four years (p < 0.001). Mean responses from DS1 and DS4 students differed for questions relating to understanding of biomedical sciences, critical thinking and application to clinic (p < 0.01). Qualitative data showed that students enjoyed the reinforcement of concepts and application to clinical scenarios.

CONCLUSIONS: Concurrent teaching of didactic and case-based learning courses, thus showing clinical relevance of biomedical sciences in the first year of dental curriculum, is perceived by students as an effective method of educating dental students. Such integrative learning process with horizontal and vertical integration and concurrent curriculum is even more relevant with the implementation of the integrated national board dental examination.

PMID:35994207 | DOI:10.1002/jdd.13081

Environ Sci Pollut Res Int. 2022 Aug 22. doi: 10.1007/s11356-022-22567-y. Online ahead of print.

ABSTRACT

This study analyzes how economic resources invested in roads may affect mortality, depending on the level of economic development of a country. To this end, 23 European countries were classified into two groups-high-income countries and low-income countries-according to their average Gross Domestic Product (GDP) per capita over the period 1998-2016. The economic resources are considered through the investment in construction and the maintenance expenditure. Further variables are included to control for several factors related to the infrastructure, socioeconomics, legislation, and meteorology. Fixed-effects panel data models were built separately for the interurban road network of each group of countries. These models also capture the international inequalities within each group and the country-specific national trend for the study period. The main results indicate a reduction effect on the fatality rate of road maintenance expenditure (in both groups), and of the investment in construction (in the low-income countries). Other variables-such as proportion of motorways, motorization rate, unemployment rate, GDP per capita, alcohol consumption, Demerit Point System, and mean annual precipitation-showed statistically significant results as well. Finally, the country-specific fixed effects and the country-specific trend were mapped geographically, to better reflect national conditions for achieving lower fatality rates in the high-income countries, and greater progress in reducing fatalities in the low-income countries. In the end, this study provides evidence to policy-makers that can help to achieve a safer and more sustainable transport system, namely, how to tackle an ongoing major problem-traffic-related deaths-when attending and allocating the economic resources that road infrastructure needs.

PMID:35994145 | DOI:10.1007/s11356-022-22567-y

Clin Oral Investig. 2022 Aug 22. doi: 10.1007/s00784-022-04674-9. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate t he long-term outcomes following treatment of RT 1 multiple adjacent gingival recessions (MAGR) using the modified coronally advanced tunnel (MCAT) with either a collagen matrix CM or a connective tissue graft (CTG).

MATERIAL AND METHODS: Sixteen of the original 22 subjects included in a randomized, controlled split-mouth clinical trial were available for the 9-year follow-up (114 sites). Recessions were randomly treated by means of MCAT + CM (test) or MCAT + CTG (control). Complete root coverage (CRC), mean root coverage (MRC), gingival recession depth (GRD), probing pocket depth (PD), keratinized tissue width (KTW), and thickness (KGT) were compared with baseline values and with the 12-month results.

RESULTS: After 9 years, CRC was observed in 2 patients, one in each group. At 9 years, MRC was 23.0 ± 44.5% in the test and 39.7 ± 35.1% in the control group (p = 0.179). The MRC reduction compared to 12 months was – 50.1 ± 47.0% and – 48.3 ± 37.7%, respectively. The upper jaw obtained 31.92 ± 43.0% of MRC for the test and 51.1 ± 27.8% for the control group (p = 0.111) compared to the lower jaw with 8.3 ± 46.9% and 20.7 ± 40.3%. KTW and KGT increased for both CM and CTG together from 2.0 ± 0.7 to 3.1 ± 1.0 mm (< 0.0001). There were no statistically significant changes in PD.

CONCLUSION: The present results indicate that (a) treatment of MAGR using MCAT in conjunction with either CM or CTG is likely to show a relapse over a period of 9 years, and (b) the outcomes obtained in maxillary areas seem to be more stable compared to the mandibular ones.

CLINICAL RELEVANCE: The mean root coverage at 12 months could not be fully maintained over 9 years. On a long-term basis, the results seem to be less stable in the mandible as compared to maxillary areas.

PMID:35994126 | DOI:10.1007/s00784-022-04674-9

Int J Biometeorol. 2022 Aug 22. doi: 10.1007/s00484-022-02350-x. Online ahead of print.

ABSTRACT

Cattle being non-seasonal breeding species, effects of photoperiods on sperm traits and morphology had been reported inadequately in breeding bulls. To elucidate the plausible existence of effects of photoperiods and seasons, seminal traits of Holstein Friesian × Sahiwal crossbred dairy bulls (N = 557) were analysed using different statistical models. A present study revealed that the biological rhythm of reproduction oscillated almost in parallel to the annual changes of natural photoperiods even in non-seasonal breeding species like cattle bulls. Semen traits diminished to the lowest in winter solstice (WS ± 45 days), progressively increased with the rising day length of spring (vernal equinox ± 45 days), reached a peak in summer solstice (SS ± 45 days), and then gradually reduced with decreasing photoperiod of the autumn equinox (AE ± 45 days). From summer solstice to winter solstice, sperm concentration reduced by 90.53 million/ml (8.85%), total sperm count/ejaculate decreased by 785 million (13.87%), total motile sperm count/ejaculate reduced by 17.59%, and total post-thaw motile sperm counts/ejaculates diminished by 38.64%. In short-duration photoperiods (≤ 12 h), bulls had a significantly (P < 0.01) higher incidence of major, minor, tail abnormality and total aberrant sperm% compared to that of long-duration photoperiods (> 12 h). Solstice equinox-based seasonal classification provided better insight into photoperiodicity on bulls’ semen quality and sperm traits as compared to conventional meteorological classification of seasons. It was concluded that photoperiods affect sperm productivity, semen quality, and sperm morphology in non-seasonal breeding species like dairy bulls, maintained at transitional latitude (29° N) tropical climate. Bulls’ reproductive ability was more influenced by the phases of increasing/decreasing day length duly primed by climax/trough of photoperiods, compared to mere long/short duration of photoperiods.

PMID:35994121 | DOI:10.1007/s00484-022-02350-x