Tag: statistics

Am J Infect Control. 2021 Dec 29:S0196-6553(21)00859-2. doi: 10.1016/j.ajic.2021.12.014. Online ahead of print.

ABSTRACT

BACKGROUND: Poor securement potentiates PICC complications. A dressing device (KT FIX Plusࣨ) offers stronger skin attachment, which may reduce the risk of dressing disruption. We aimed to evaluate this device.

METHODS: We conducted a single-center parallel-group open-label randomized controlled trial. Hospitalized and outpatient consecutive adults requiring PICCs were randomized to KT FIX Plusࣨ or standard of care (SOC). The primary endpoint was the composite of PICC- associated complications until removal, including occlusion, migration, accidental withdrawal, infection, thrombosis and hematoma.

RESULTS: No statistically significant difference was observed in terms of complications: 67 (35%) in the KT FIX Plusࣨ group versus 36 (37%) in the SOC group (log-rank p=0.76). In multivariate Cox analysis, independent risk factors for PICC-associated complications were obesity (adjusted hazard ratio (aHR), 1.08, p<0.001) and diabetes (aHR, 1.85, p=0.039), adjusting for chronic renal failure, number of lumens, catheter/vein diameter ratio and duration of home- based care. Multiple lumen catheters increased the risk of accidental withdrawal and migration (HR, 2.4, p=0.008).

CONCLUSIONS: In our study, the use KT FIX Plus® did not reduce the risk of complications adjusting for other risk factors such as obesity and diabetes. The number of catheter lumens is one of the modifiable factors to reduce complications. Further studies are required to find the best securement and dressing system.

PMID:34973357 | DOI:10.1016/j.ajic.2021.12.014

Am J Infect Control. 2021 Dec 29:S0196-6553(21)00851-8. doi: 10.1016/j.ajic.2021.12.010. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to describe the effect of Dry Hydrogen Peroxide (DHP™), as an adjunct to environmental cleaning and disinfection, on the incidence of hospital-acquired infections (HAIs) at Unidad Nacional de Oncologia Pediatrica (UNOP) in Guatemala City, Guatemala.

METHODS: A retrospective study of all HAI data from the hospital’s surveillance system, which follows Centers for Disease Control and Prevention (CDC) protocols, was conducted from January 2019 to November 2020. DHP was installed in all Pediatric Intensive Care Unit (PICU) rooms in January 2020, but nowhere else in the hospital, including the Intermediate Care Unit (IMCU).

RESULTS: There were 189 HAI cases during the study period, with 173 occurring in either the PICU or IMCU. A statistically significant decrease in HAI incidence rates occurred in the PICU in 2020 compared to 2019 (p=0.028), including Clostridiodes-associated gastroenteritis (p=0.048). Logistic multivariate regression yielded a significant association between DHP exposure and a reduced odds of developing an HAI during the study (OR=0.3857, p=0.029).

CONCLUSION: The use of DHP as an adjunct technology for environmental cleaning and disinfection contributed to the reduction in HAIs in the PICU. Our study highlights the value of such an approach as an addition to manual cleaning to decrease the risk of infection from environmental contamination.

PMID:34973358 | DOI:10.1016/j.ajic.2021.12.010

Sci Total Environ. 2021 Dec 29:152686. doi: 10.1016/j.scitotenv.2021.152686. Online ahead of print.

ABSTRACT

The rationale of this paper was to investigate whether earthquakes impact airborne pollen concentrations, considering some meteorological parameters. Atmospheric pollen concentrations in the Region of Murcia Aerobiological Network (Spain) were studied in relation to the occurrence of earthquakes of moment magnitude (up to M_w = 5.1) and intensity (intensity up to grade VII on the European Macroseismic Scale). In this study, a decade (2010-2019) was considered across the cities of the network. Earthquakes were detected in 12 out of 1535 days in the Olea Main Pollen Season in Cartagena, 49 out of 1481 days in the Olea Main Pollen Season in Lorca, and 39 out of 1441 days in the Olea Main Pollen Season in Murcia. The Olea pollen grains in this network were attributed to the species Olea europaea, i.e., the olive tree, a taxon that appears widely in the Mediterranean basin, in both cultivated and wild subspecies. Differences between the Olea concentration on days with and without earthquakes were only found in Lorca (Kruskal-Wallis: p-value = 0.026). The low frequency and intensity of the earthquakes explained these results. The most catastrophic earthquake felt in Lorca on May 11th, 2011 (IVII, M_w = 5.1, 9 casualties) did not result in clear variations in pollen concentrations, while meteorology (e.g., African Dust Outbreak) might have conditioned these pollen concentrations. The research should be broadened to other active seismological areas to reinforce the hypothesis of seismological impact on airborne pollen concentrations.

PMID:34973329 | DOI:10.1016/j.scitotenv.2021.152686

Sci Total Environ. 2021 Dec 29:152701. doi: 10.1016/j.scitotenv.2021.152701. Online ahead of print.

ABSTRACT

A study was made of the physicochemical properties (among others: pH, temperature, conductivity, hardness, chlorides, dissolved oxygen, ammonia, nitrites, nitrates, manganese, iron) and microbiological quality (coliform, psychrophilic and mesophilic microorganisms) of rainwater harvested from the roofs of three large buildings and from a parking lot, stored in three large underground tanks (with storage volume from 60 m³ to ca. 200 m³), including the variability of the quality. The underground tanks were located in the city of Poznań, and were characterized by different parameters, rainwater sources, rainwater treatment processes, and types of rainwater use. Samples of rainwater harvested in these tanks were collected from March 2019 to February 2020. Physicochemical and microbiological laboratory analyses were performed to determine selected parameters which have an impact on potential treatment and disinfection methods. The results obtained underwent statistical analysis. The laboratory tests showed that the physicochemical quality of rainwater collected in the three underground tanks met the Polish and EU requirements for drinking water standards. The main problem concerns microbiological quality: the number of coliform bacteria reached a value of 19,300 CFU/100 mL, the number of psychrophilic bacteria was over 264,000 CFU/1 mL, and the number of mesophilic bacteria was over 100,000 CFU/1 mL. Also the variability of microbiological quality was very high for all tanks. Analysis of the calcium carbonate equilibrium showed that the harvested water had corrosive properties. The treatment of the investigated rainwater for potable purposes should focus mainly on biological and chemical stability.

PMID:34973316 | DOI:10.1016/j.scitotenv.2021.152701

Sci Total Environ. 2021 Dec 29:152734. doi: 10.1016/j.scitotenv.2021.152734. Online ahead of print.

ABSTRACT

Today, the interest in hair as alternative matrix for human biomonitoring of environmental pollutants has increased, but available data on chemical levels in hair remain scarce. In this study, the measurement of 2 bisphenols (A and S), 3 parabens (methyl-, ethyl- and propylparabens) and 8 perfluroralkyl compounds (PFCs) namely perfluoroctanesulfonate (PFOS), perfluorohexanesulfonate (PFHxS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluroroheptanoic acid (PFHpA), perfluoropentanoic acid (PFPeA) and perfluorohexanoic acid (PFHxA) was carried out, using a thoroughly validated UPLC-MS/MS method, in the hair from 114 adults living in Liege (Belgium) and surrounding areas. The most frequently quantified compounds in the population were: bisphenol S (97.4%, median = 31.9 pg·mg^-1), methylparaben (94.7%, median = 28.9 pg·mg^-1), bisphenol A (93.9%, median = 46.6 pg·mg^-1), ethylparaben (66.7%, median = 5.2 pg·mg^-1), propylparaben (54.8%, median = 16.4 pg·mg^-1) and PFOA (46.4%, median < 0.2 pg·mg^-1). The other PFCs were detected only in few samples although current exposure of the Belgian population to PFCs was previously demonstrated using blood analyses. Nonparametric statistical analyses were performed to evaluate the influence of gender, hair treatments and hair length, but no significant difference was observed. Only age was positively correlated with the propylparaben contamination. Although blood seems to remain more suitable for PFCs exposure assessment, the results of this study suggest that hair can be an appropriate matrix for biomonitoring of organic pollutants such as parabens or bisphenols.

PMID:34973319 | DOI:10.1016/j.scitotenv.2021.152734

World J Pediatr. 2022 Jan 1. doi: 10.1007/s12519-021-00489-y. Online ahead of print.

ABSTRACT

BACKGROUND: Few studies have addressed the effects of human leukocyte antigen (HLA) alleles on different clinical sub-phenotypes in childhood steroid-sensitive nephrotic syndrome (SSNS), including SSNS without recurrence (SSNSWR) and steroid-dependent nephrotic syndrome/frequently relapse nephrotic syndrome (SDNS/FRNS). In this study, we investigated the relationship between HLA system and children with SSNSWR and SDNS/FRNS and clarified the value of HLA allele detection for precise typing of childhood SSNS.

METHODS: A total of 241 Chinese Han individuals with SSNS were genotyped using GenCap-WES Capture Kit, and four-digit resolution HLA alleles were imputed from available Genome Wide Association data. The distribution and carrying frequency of HLA alleles in SSNSWR and SDNS/FRNS were investigated. Additionally, logistic regression and mediating effects were used to examine the relationship between risk factors for disease process and HLA system.

RESULTS: Compared with SSNSWR, significantly decreased serum levels of complement 3 (C3) and complement 4 (C4) at onset were detected in SDNS/FRNS (C3, P < 0.001; C4, P = 0.018). The average time to remission after sufficient initial steroid treatment in SDNS/FRNS was significantly longer than that in SSNSWR (P = 0.0001). Low level of C4 was further identified as an independent risk factor for SDNS/FRNS (P = 0.008, odds ratio = 0.174, 95% confidence interval 0.048-0.630). The HLA-A*11:01 allele was independently associated with SSNSWR and SDNS/FRNS (P = 0.0012 and P = 0.0006, respectively). No significant HLA alleles were detected between SSNSWR and SDNS/FRNS. In addition, a mediating effect among HLA-I alleles (HLA-B*15:11, HLA-B*44:03 and HLA-C*07:06), C4 level and SDNS/FRNS was identified.

CONCLUSIONS: HLA-I alleles provide novel genetic markers for SSNSWR and SDNS/FRNS. HLA-I antigens may be involved in steroid dependent or frequent relapse in children with SSNS as mediators of immunoregulation.

PMID:34973118 | DOI:10.1007/s12519-021-00489-y

J Gastrointest Surg. 2022 Jan 1. doi: 10.1007/s11605-021-05211-x. Online ahead of print.

ABSTRACT

BACKGROUND: An important prognostic indicator of hilar cholangiocarcinoma (HCCA) in patients after surgery is metastasis of lymph nodes (LN). However, there are many types of LN staging systems to the issue of a better determination of the prognosis of patients through the lymphatic staging system which needs research. Based on the above, we tried to re-evaluate the staging system of HCCA LNs. We compared the American Joint Committee on Cancer (AJCC), number of metastatic LNs (MLN), ratio of LN (LNR), and log odds of MLNs (LODDS) in individuals undergoing curative resection to determine the best LN staging system.

METHODS: In the current study, we retrospectively analyzed 229 patients undergoing curative resection. We evaluated the impact of the stage of AJCC pN, LNR, LODDS, and MLN on OS (overall survival) and RFS (recurrence-free survival). According to the curve of receiver operating characteristic (ROC), we compared the predictive capacity of different staging systems of LN for survival and recurrence.

RESULTS: Multivariate analysis results revealed that LODDS > – 0.45 (95% CI = 1.115-2.709, P = 0.015; 95% CI = 1.187-2.780, P = 0.006) are independent risk factors affecting OS and RFS, respectively. Compared with LN status, AJCC pN stage, MLN, and LNR, the variable having the highest area under the ROC curve (AUC) was LODDS when predicting 1-year, 3-year, and 5-year OS and RFS.

CONCLUSION: This study shows that metastasis of LNs is a key indicator for predicting patient death and recurrence. Among them, LODDS is the best LN staging system for the prognostic evaluation of HCCA patients after surgery. Clinicians can incorporate LODDS into HCCA patient lymphatic staging system for a more accurate prognosis of HCCA patients post-surgery.

PMID:34973138 | DOI:10.1007/s11605-021-05211-x

Adv Health Sci Educ Theory Pract. 2022 Jan 1. doi: 10.1007/s10459-021-10087-2. Online ahead of print.

ABSTRACT

Critical reflection supports enactment of the social roles of care, like collaboration and advocacy. We require evidence that links critical teaching approaches to future critically reflective practice. We thus asked: does a theory-informed approach to teaching critical reflection influence what learners talk about (i.e. topics of discussion) and how they talk (i.e. whether they talk in critically reflective ways) during subsequent learning experiences? Pre-clinical students (n = 75) were randomized into control and intervention conditions (8 groups each, of up to 5 interprofessional students). Participants completed an online Social Determinants of Health (SDoH) module, followed by either: a SDoH discussion (control) or critically reflective dialogue (intervention). Participants then experienced a common learning session (homecare curriculum and debrief) as outcome assessment, and another similar session one-week later. Blinded coders coded transcripts for what (topics) was said and how (critically reflective or not). We constructed Bayesian regression models for the probability of meaning units (unique utterances) being coded as particular what codes and as critically reflective or not (how). Groups exposed to the intervention were more likely, in a subsequent learning experience, to talk in a critically reflective manner (how) (0.096 [0.04, 0.15]) about similar content (no meaningful differences in what was said). This difference waned at one-week follow up. We showed experimentally that a particular critical pedagogical approach can make learners’ subsequent talk, ways of seeing, more critically reflective even when talking about similar topics. This study offers the field important new options for studying historically challenging-to-evaluate impacts and supports theoretical assertions about the potential of critical pedagogies.

PMID:34973100 | DOI:10.1007/s10459-021-10087-2

Eur Radiol. 2022 Jan 1. doi: 10.1007/s00330-021-08422-7. Online ahead of print.

ABSTRACT

OBJECTIVES: Estimating the maximum acceptable cost (MAC) per screened individual for low-dose computed tomography (LDCT) lung cancer (LC) screening, and determining the effect of additionally screening for chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), or both on the MAC.

METHODS: A model-based early health technology assessment (HTA) was conducted to estimate whether a new intervention could be cost-effective by calculating the MAC at a willingness-to-pay (WTP) of €20k/quality-adjusted life-year (QALY) and €80k/QALY, for a population of current and former smokers, aged 50-75 years in The Netherlands. The MAC was estimated based on incremental QALYs gained from a stage shift assuming screened individuals are detected in earlier disease stages. Data were obtained from literature and publicly available statistics and validated with experts.

RESULTS: The MAC per individual for implementing LC screening at a WTP of €20k/QALY was €113. If COPD, CVD, or both were included in screening, the MAC increased to €230, €895, or €971 respectively. Scenario analyses assessed whether screening-specific disease high-risk populations would improve cost-effectiveness, showing that high-risk CVD populations were more likely to improve economic viability compared to COPD.

CONCLUSIONS: The economic viability of combined screening is substantially larger than for LC screening alone, primarily due to benefits from CVD screening, and is dependent on the target screening population, which is key to optimise the screening program. The total cost of breast and cervical cancer screening is lower (€420) than the MAC of Big-3, indicating that Big-3 screening may be acceptable from a health economic perspective.

KEY POINTS: • Once-off combined low-dose CT screening for lung cancer, COPD, and CVD in individuals aged 50-75 years is potentially cost-effective if screening would cost less than €971 per screened individual. • Multi-disease screening requires detailed insight into the co-occurrence of these diseases to identify the optimal target screening population. • With the same target screening population and WTP, lung cancer-only screening should cost less than €113 per screened individual to be cost-effective.

PMID:34973103 | DOI:10.1007/s00330-021-08422-7

Support Care Cancer. 2022 Jan 1. doi: 10.1007/s00520-021-06683-y. Online ahead of print.

ABSTRACT

BACKGROUND: The number of gastric cancer survivors has been increasing, and such survivors experience various changes in their lives post-recovery. Adapting to these changes requires appropriate interventions that can improve their quality of life (QoL). This study was conducted to investigate the factors affecting the QoL of gastric cancer survivors and provide basic data for effective intervention.

METHODS: Data were collected between September 8 and September 29, 2017, from the Gastric Cancer Center at a tertiary hospital. Questionnaire surveys were conducted using the EORTC QLQ-C30/STO22, Self-Efficacy-Scale, Multidimensional Scale of Perceived Social Support, and Quality of Life-Cancer Survivors Questionnaire on gastric cancer survivors who were followed up for 3 years after gastrectomy. Data were analyzed using descriptive statistics, t test, ANOVA, Pearson’s correlation coefficient, and multiple regression analysis.

RESULTS: A total of 136 gastric cancer survivors completed the questionnaire survey. There were significant positive correlations of QoL with self-efficacy, functional status, and social support (r = .35, p < .001; r = .53, p < .001; r = .26, p < .001, respectively). There were significant negative correlations of QoL with general symptoms (r = – .39, p < .001) and gastric cancer-specific symptoms (r = – .51, p < .001). The regression model explained 48.3% of the QoL, and the affecting factors were gastric cancer-specific symptoms (β = – .397, p < .001), religious belief (β = .299, p < .001), functional status (β = .251, p = .003), and self-efficacy (β = .191, p = .004).

CONCLUSION: This study confirmed that gastric cancer-specific symptoms, spiritual well-being, self-efficacy, and functional status affect the QoL of gastric cancer survivors. Hence, these factors should be considered in the interventions to improve the QoL of gastric cancer survivors.

PMID:34973098 | DOI:10.1007/s00520-021-06683-y