Tag: statistics

Sichuan Da Xue Xue Bao Yi Xue Ban. 2022 Sep;53(5):872-879. doi: 10.12182/20220960507.

ABSTRACT

OBJECTIVE: To analyze the current status of social support for middle-aged and older adults with multimorbidity and to explore the correlation between different dimensions of social support and multimorbidity and the related outcomes on the basis of China Health and Retirement Longitudinal Study (CHARLS) 2015 survey data so as to reveal the complex social background of multimorbidity and the impact of social support on multimorbidity.

METHODS: A total of 9168 valid samples, with an average age of 59.60 years, were included in the study. Using the social support-related variables of the respondents, we conducted factor analysis and constructed regression models of common factors of social support and multimorbidity-related outcomes, intending to analyze the impact of common factors of social support on multimorbidity in the middle-aged and older adults.

RESULTS: The multimorbidity of middle-aged and older adults in China was related to multiple factors of social support, and the differences were statistically significant. Logistic regression showed that social support in the form of activity/recreational facilities and medical resources was a protective factor of multimorbidity, that family emotional support and economic support had a positive effect on life satisfaction of comorbid patients, and that social support in the form of education, social life and housing conditions was negatively correlated with catastrophic medical expenditure of the comorbid population ( P<0.05).

CONCLUSION: Social support for middle-aged and older adults in China is unevenly distributed. Social support in the form of activity/recreational facilities and medical resources may reduce the risks of multimorbidity among middle-aged and older adults. Good family economic and emotional support can improve the life satisfaction of middle-aged and older adults with multimorbidity. Social support in the form of education, social life and housing conditions may reduce the risk of catastrophic medical expenditure in middle-aged and older adults with multimorbidity.

PMID:36224691 | DOI:10.12182/20220960507

Sichuan Da Xue Xue Bao Yi Xue Ban. 2022 Sep;53(5):866-871. doi: 10.12182/20220960504.

ABSTRACT

OBJECTIVE: To examine the prevalence of suicide-related behaviors among junior middle school students, and to explore the mediating role of depression in the relationship between suicide-related behaviors and family function.

METHODS: A total of 2572 junior middle school students from three middle schools in Chengdu were interviewed face-to-face by using suicide-related items from Youth Risk Behavior Surveillance System (YRBSS), Chinese Family Assessment Instrument (C-FAI), and Center for Epidemiologic Studies Depression Scale for Children (CES-DC). The mediating role of depression was analyzed with structural equation model.

RESULTS: The prevalence of suicide-related behaviors was 26.01% among the respondents. The prevalence of suicide ideation, suicide plan and suicide attempt were 24.38%, 13.49% and 10.77%, respectively. Depression played a partial mediating role in how family function impacted on suicide-related behaviors, presenting a direct effect value of 0.170 (95% CI: 0.117-0.218, P<0.001) and an indirect effect value of 0.205 (95% CI: 0.176-0.234, P<0.001), with the mediating effect accounting for 54.67% of the total effect.

CONCLUSION: Poor family function may increase the risk of suicide-related behaviors, and this effect is produced mostly through the impact on children’s mental health. Improving family function will not only improve children’s psychological status, but also reduce suicide-related behaviors.

PMID:36224690 | DOI:10.12182/20220960504

Sichuan Da Xue Xue Bao Yi Xue Ban. 2022 Sep;53(5):770-776. doi: 10.12182/20220960108.

ABSTRACT

OBJECTIVE: To analyze the impact of high or low levels of anatomical risk of hepatic alveolar echinococcosis (HAE) on complications after radical resection.

METHODS: The baseline, surgical, and complication data were retrospectively collected from hepatic alveolar echinococcosis patients who underwent radical resection at the Ganzi Branch Hospital, West China Hospital, Sichuan University from 2015 to 2022. The patients were divided into anatomical low-risk (ALR) and anatomical high-risk (AHR) groups based on the PNM staging system designed by the World Health Organization (WHO-PNM). Complications were analyzed according to the Clavien-Dindo classification. Univariate and multivariate logistic regression analyses were performed to assess the effect of high and low risks of lesion anatomy on complications.

RESULTS: Radical surgery was performed in 216 HAE patients and 102 of whom were in the AHR group. The median operative time was 230 (175, 300) min, the median intraoperative blood loss was 600 mL, and 129 (59.7%) patients developed complications. The complication rate was 73.5% (75/102) in the AHR group and 47.4% (54/114) in the ALR group, demonstrating statistically significant difference ( P<0.05). The incidence of serious complications was 36.3% (37/102) in the AHR group and 13.2% (15/114) in the ALR group, demonstrating statistically significant difference ( P<0.05). There was significant difference in the proportions of patients having postoperative complications of bile leak, anemia, fever, pleural effusion and ascites between the AHR group and the ALR group ( P<0.05). Multivariate logistic regression analysis suggested that AHR was the only independent risk factor for complications, including bile leak, anemia, fever, and pleural effusion, and severe complications.

CONCLUSION: The anatomical risk of hepatic alveolar echinococcosis is independently associated with the development of multiple postoperative complications, and physicians should choose surgical procedures cautiously according to the actual situation when dealing with patients defined as AHR according to WHO-PNM.

PMID:36224677 | DOI:10.12182/20220960108

Int J Retina Vitreous. 2022 Oct 12;8(1):74. doi: 10.1186/s40942-022-00424-x.

ABSTRACT

BACKGROUND: To evaluate the additive effect of topical or sub-tenon injection of interferon (IFN)-α 2b in the treatment of refractory diabetic macular edema.

METHODS: In this prospective study patients with center-involved DME who were unresponsive to 3 monthly consecutive IVB injections were recruited. Patients were divided into three groups: group1, received IFN- α 2b topical drop at a dose of 1mIU/ml four times a day for 3 months. Group 2, received a single sub-tenon injection of 1mIU/ml IFN- α 2b at the enrollment. Group 3 received artificial tears four times a day for 3 months (control group). All groups received three consecutive monthly IVB injections and were evaluated monthly up to 1 month following the last IVB injection.

RESULTS: In this study, 59 eyes of 35 patients with refractory DME were assessed. The final follow-up showed that although CMT decreased in all groups, only patients in Group 2 had statistically significant lower CMT compared to their baseline values (change in CMT: – 117 ± 213 µm; p-value = 0.025). Comparison of CMT changes between three groups showed no statistically significant difference, although it was higher in group 2 (change in CMT: – 117 ± 213 µm (Group2) vs. – 49 ± 173 (Group 1) vs. – 36 ± 86 (Group 3); p-value = 0.085). Considering eyes with baseline CMT > 400 µm, sub-tenon injection of IFN α2b led to a significant reduction of CMT at the first month and final follow-up visit (CMT change: – 166 ± 210, – 145 ± 231 µm; p-value = 0.018 and 0.035, respectively). In this subgroup, eyes in Group 2 had lower CMT at the first month following treatment in comparison with the control group (CMT: 444 ± 123 µm vs. 544 ± 96 µm, p-value = 0.042). Alterations of CDVA were not statistically significant among groups, although patients in Group 1 had a significant improvement in vision at second and last follow up (CDVA change: – 0.23 ± 0.39, – 0.20 ± 0.43 logMAR; p-value = 0.030 and 0.010, respectively).

CONCLUSIONS: In short term, Sub-tenon injection of IFN might have an additive anatomical effect in eyes with refractory DME. Validation of this observation requires further prospective controlled studies.

PMID:36224669 | DOI:10.1186/s40942-022-00424-x

BMC Nutr. 2022 Oct 12;8(1):112. doi: 10.1186/s40795-022-00606-8.

ABSTRACT

BACKGROUND: The burden of undernutrition among children with epilepsy in low- and middle-income countries is not well studied. This study aimed to assess the magnitude of undernutrition and associated factors among children with epilepsy at the University of Gondar Comprehensive and Specialized Hospital, Northwest Ethiopia.

METHOD: A single-center cross-sectional study was conducted on 239 epileptic children with epilepsy visiting the University of Gondar Comprehensive Specialized Hospital pediatric neurology clinic from June 2021 to September 2021. A pre-tested, researcher-administered questionnaire and medical record review were used for data collection. We included all participants who fulfilled the inclusion criteria. We did anthropometric measurements and defined undernutrition based on the world health organization criteria. Binary and multivariable logistic regressions were employed to determine factors associated with undernutrition. The statistical association between dependent and independent variables was declared at p-value of ≤ 0.05.

RESULT: The mean(+/-SD) age was 9.38 ± 0.29 years, with a male to female ratio of 1.8: 1, and school-age children account for 35.6%. The overall magnitude of undernutrition was 141(59%) of which 89(63.1%) had moderate to severe stunting, 91(64.5%) moderate to severe wasting, and 39(27.7%) had both. Being male (AOR = 1.96, 95%CI, 1.05-3.69), low paternal level of education (AOR = 1.88, 95%CI, 1.01-3.50), presence of delay in motor development (AOR = 5.91,95%CI, 1.55-22.49), and gum hyperplasia (AOR = 0.32,95%CI, 0.12-0.81), were significantly associated with undernutrition.

CONCLUSION: The magnitude of undernutrition among children with epilepsy was high. Male sex, low paternal level of education, presence of delay in motor development, and gum hyperplasia were significantly associated with undernutrition. Therefore, nutritional screening and intervention are recommended to be part of routine epileptic care.

PMID:36224637 | DOI:10.1186/s40795-022-00606-8

BMC Res Notes. 2022 Oct 12;15(1):323. doi: 10.1186/s13104-022-06209-7.

ABSTRACT

OBJECTIVE: This study aimed to determine the effect of intermittent fasting 5:2 on body composition in employees with obesity in Jakarta.

RESULTS: Fifty participants were included; 25 were allocated to the fasting group and 25 to the control group. There was no significant change in fat mass, fat-free mass, skeletal muscle, and BMI (p > 0.05). Significant in-group changes were observed in body weight (p = 0.023) and BMI (p = 0.018) in the fasting group. Dietary intake was similar before and during the intervention. The reduction in macronutrient intake resulted in a statistically significant difference in carbohydrate, protein, and fat intake in the two groups (p < 0.05). Intermittent fasting 5:2 results in weight loss but does not affect fat mass and fat-free mass reductions. None of the between-group differences were clinically relevant.

TRIAL REGISTRATION: ClinicalTrials.gov with ID: NCT04319133 registered on 24 March 2020.

PMID:36224641 | DOI:10.1186/s13104-022-06209-7

J Pharm Policy Pract. 2022 Oct 12;15(1):61. doi: 10.1186/s40545-022-00457-5.

ABSTRACT

BACKGROUND: Medication adherence, one of the most important aspects in the process of optimal medicines use, is unfortunately still a major challenge in modern healthcare, and further research is required into how adherence can be assessed and optimised. The aim of this study was to use a combined method approach of self-report and dried blood spot (DBS) sampling coupled with population pharmacokinetic (PopPK) modelling, to assess adherence to metformin in adult patients with type 2 diabetes. Further aims were to assess metformin exposure levels in patients, determine factors associated with non-adherence with prescribed metformin, and to explore the relationship between adherence and therapeutic outcomes.

METHODS: A combined method approach was used to evaluate metformin adherence in patients with type 2 diabetes who had been prescribed metformin for a minimum period of 6 months. Patients were recruited from consultant-led diabetic outpatient clinics at three hospitals in Northern Ireland, UK. Data collection involved self-reported questionnaires [Medication Adherence Report Scale (MARS), Beliefs about Medicines Questionnaire and Centre for Epidemiologic Studies Depression Scale], direct measurement of metformin concentration in DBS samples, and researcher-led patient interviews. The DBS sampling approach was coupled with population pharmacokinetic (PopPK) modelling, which took account of patient characteristics, metformin dosage and type of formulation prescribed (immediate or sustained release).

RESULTS: The proportion of patients considered to be adherent to their prescribed metformin, derived from self-reported MARS scores and metformin concentration in DBS samples, was 61.2% (74 out of 121 patients). The majority (n = 103, 85.1%) of recruited patients had metformin exposure levels that fell within the therapeutic range. However, 17 patients (14.1%) had low exposure to metformin and one patient (0.8%) had undetectable metformin level in their blood sample (non-exposure). Metformin self-administration and use of a purchased adherence pill box significantly increased the probability of a patient being classified as adherent based on logistic regression analysis. Both HbA1c and random glucose levels (representing poor glycaemic control) in the present research were, however, not statistically linked to non-adherence to metformin (P > 0.05).

CONCLUSIONS: A significant proportion of participating patients were not fully adherent with their therapy. DBS sampling together with the use of a published PopPK model was a useful, novel, direct, objective approach to estimate levels of adherence in adult patients with type 2 diabetes (61.2%).

PMID:36224634 | DOI:10.1186/s40545-022-00457-5

Nutr Metab (Lond). 2022 Oct 12;19(1):68. doi: 10.1186/s12986-022-00701-4.

ABSTRACT

BACKGROUND: Membrane nephropathy (MN) often presents as nephrotic syndrome with characteristic lipid metabolism that could not be explained by lipid indicators commonly used in clinical practice. Studies have shown that invigorating spleen and qi, activating blood and detoxication in the treatment of MN is an effective method proved by randomized controlled clinical trial. However, the alterations of lipid profile before and after traditional Chinese medicine (TCM) treatment and the related lipid markers that affect the therapeutic effect have not been fully clarified.

METHODS: We analyzed plasma lipid profiles of 92 patients with MN before and after TCM treatment by high-coverage targeted lipidomics.

RESULTS: 675 lipids were identified, of which 368 stably expressed lipids (coefficient of variation less than 30% and deletion value less than 10%) were eventually included for statistical analysis. 105 lipids were altered mainly including spingolipids, glycerides, glycerophosholipid, fatty acyl and steroids, among which, the abundance of ceramides (Cers), sphingomyelins (SMs), diacylglycerols (DGs), phosphatidylcholines (PCs) were lower than those before treatment with statistically significant difference. The WGCNA network to analyze the correlation between the collective effect and the therapeutic effect showed that the triglyceride (TG) molecules were most relevant to the therapeutic effect. Analysis of 162 triglyceride molecules showed that 11 TGs were significantly down-regulated in the effective group which were concentrated in carbon atom number of 52-56 and double bond number of 0-4. TGs molecules including TG56:2-FA20:0, TG56:2-FA20:1, TG56:3-FA20:0 and TG56:5-FA20:2 were most closely related to the therapeutic effect of TCM after adjusting the influence of clinical factors. ROC curve analysis showed that these four lipids could further improve the predictive efficacy of treatment based on clinical indicators.

CONCLUSION: Our work demonstrated that the therapeutic effect of invigorating spleen and qi, activating blood and detoxication in the treatment of MN may be exerted by regulating lipid metabolism. High-coverage targeted lipidomics provided a non-invasive tool for discovery of lipid markers to improve the predictive efficacy of TCM therapy.

PMID:36224633 | DOI:10.1186/s12986-022-00701-4

BMC Med Educ. 2022 Oct 12;22(1):717. doi: 10.1186/s12909-022-03783-z.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has not only brought many aspects of disaster medicine into everyday awareness but also led to a massive change in medical teaching due to the necessity of contact restrictions. This study aimed to evaluate student acceptance of a curricular elective module on disaster and deployment medicine over a 5-year period and to present content adjustments due to COVID-19 restrictions.

METHODS: Since 2016, 8 semesters of the curricular elective module took place in face-to-face teaching (pre-COVID-19 group). From the summer semester of 2020 to the summer semester of 2021, 3 semesters took place as online and hybrid courses (mid-COVID-19 group). Student attitudes and knowledge gains were measured using pretests, posttests, and final evaluations. These data were statistically compared across years, and new forms of teaching under COVID-19 conditions were examined in more detail.

RESULTS: A total of 189 students participated in the module from the summer semester of 2016 through the summer semester of 2021 (pre-COVID-19: n = 138; mid-COVID-19: n = 51). There was a high level of satisfaction with the module across all semesters, with no significant differences between the groups. There was also no significant difference between the two cohorts in terms of knowledge gain, which was always significant (p < 0.05). COVID-19 adaptations included online seminars using Microsoft Teams or Zoom, the interactive live-streaming of practical training components, and digital simulation games.

CONCLUSION: The high level of satisfaction and knowledge gained during the module did not change even under a digital redesign of the content offered. The curricular elective module was consistently evaluated positively by the students, and the adaptation to online teaching was well accepted. Experiences with digital forms of teaching should also be used after the COVID-19 pandemic to create digitally supported blended learning concepts in the field of deployment and disaster medicine and thus further promote the expansion of teaching in this important medical field.

PMID:36224618 | DOI:10.1186/s12909-022-03783-z

World J Emerg Surg. 2022 Oct 12;17(1):52. doi: 10.1186/s13017-022-00457-5.

ABSTRACT

BACKGROUND: In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved.

METHODS: Using a modified Delphi method, we sought to explore ongoing areas of controversy in the NOM of splenic trauma and reach a consensus among a group of 48 international experts from five continents (Africa, Europe, Asia, Oceania, America) concerning optimal follow-up strategies in patients with splenic injuries treated with NOM.

RESULTS: Consensus was reached on eleven clinical research questions and 28 recommendations with an agreement rate ≥ 80%. Mobilization after 24 h in low-grade splenic trauma patients (WSES Class I, AAST Grades I-II) was suggested, while in patients with high-grade splenic injuries (WSES Classes II-III, AAST Grades III-V), if no other contraindications to early mobilization exist, safe mobilization of the patient when three successive hemoglobins 8 h apart after the first are within 10% of each other was considered safe according to the panel. The panel suggests adult patients to be admitted to hospital for 1 day (for low-grade splenic injuries-WSES Class I, AAST Grades I-II) to 3 days (for high-grade splenic injuries-WSES Classes II-III, AAST Grades III-V), with those with high-grade injuries requiring admission to a monitored setting. In the absence of specific complications, the panel suggests DVT and VTE prophylaxis with LMWH to be started within 48-72 h from hospital admission. The panel suggests splenic artery embolization (SAE) as the first-line intervention in patients with hemodynamic stability and arterial blush on CT scan, irrespective of injury grade. Regarding patients with WSES Class II blunt splenic injuries (AAST Grade III) without contrast extravasation, a low threshold for SAE has been suggested in the presence of risk factors for NOM failure. The panel also suggested angiography and eventual SAE in all hemodynamically stable adult patients with WSES Class III injuries (AAST Grades IV-V), even in the absence of CT blush, especially when concomitant surgery that requires change of position is needed. Follow-up imaging with contrast-enhanced ultrasound/CT scan in 48-72 h post-admission of trauma in splenic injuries WSES Class II (AAST Grade III) or higher treated with NOM was considered the best strategy for timely detection of vascular complications.

CONCLUSION: This consensus document could help guide future prospective studies aiming at validating the suggested strategies through the implementation of prospective trauma databases and the subsequent production of internationally endorsed guidelines on the issue.

PMID:36224617 | DOI:10.1186/s13017-022-00457-5