Tag: statistics

Neurol Sci. 2022 Oct 12. doi: 10.1007/s10072-022-06443-8. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aims to longitudinally explore whether and how rapid eye movement sleep behavior disorder (RBD), depression, and anxiety mediate the association between dopaminergic replacement therapy (DRT) and impulse control disorders (ICDs) in patients with Parkinson’s disease (PD).

METHODS: Subjects were selected from the Parkinson’s Progression Markers Initiative. After excluding missing data, 268, 223, 218, 238, and 219 patients with PD diagnosed at 12, 24, 36, 48, and 60 months prior, respectively, were included. We used the Questionnaire for Impulsive-Compulsive Disorders, RBD Screening Questionnaire, Geriatric Depression Scale, and State-Trait-Anxiety Inventory to assess ICBs, RBD, depression, and anxiety, respectively. We constructed three causal mediation analysis models to infer potential contingent pathways from DRT to ICD mediated by depression, anxiety, and RBD separately.

RESULTS: DRT was associated with an increased risk of PD incidence. Aggravation of ICDs was partly explained by improvements in depression (the average causal mediation effect accounted for 8.0% of the total effect) and RBD (the average causal mediation effect of RBD accounted for 16.4% of the total effect). This suggested that anxiety (the average causal mediation effect accounted for 12.7% of the total effect) plays a mediating role.

CONCLUSIONS: Focusing on changes in RBD, depression, and anxiety associated with hyperdopaminergic status should be an essential part of strategies to prevent ICDs in patients with Parkinson’s disease.

PMID:36221041 | DOI:10.1007/s10072-022-06443-8

Sci Rep. 2022 Oct 11;12(1):17046. doi: 10.1038/s41598-022-21481-0.

ABSTRACT

Coronavirus Disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to persist due to mutations resulting in newer, more infectious variants of concern. We aimed to leverage an ongoing private SARS-CoV-2 testing laboratory’s infrastructure to monitor SARS-CoV-2 variants in two large California counties. Study enrollment was offered to adults aged 18 years or older in Los Angeles County and Riverside County who recently tested positive for SARS-CoV-2 with a polymerase chain reaction (PCR) assay. A cycle threshold value less than or equal to 30 cycles was considered a positive test for sequencing purposes. Within 5 days of study enrollment, clinician-monitored, self-collected oral fluid and anterior nares swab specimens were obtained from participants. Specimens were transported and stored at 8 °C or cooler. Samples underwent ribonucleic acid extraction, library preparation, and sequencing. SARS-CoV-2 lineages were identified using sequencing data. Participant and genomic data were analyzed using statistical tools and visualized with toolkits. The study was approved by Advarra Institutional Review Board (Pro00053729). From May 27, 2021 to September 9, 2021, 503 individuals were enrolled and underwent specimen collection. Of the 503 participants, 238 (47.3%) participants were women, 329 (63.6%) participants were vaccinated, and 221 (43.9%) participants were of Hispanic or Spanish origin. Of the cohort, 496 (98.6%) participants had symptoms at the time of collection. Among the 503 samples, 443 (88.1%) nasal specimens and 353 (70.2%) oral specimens yielded positive sequencing results. Over our study period, the prevalence of the Alpha variant of SARS-CoV-2 decreased (initially 23.1% [95% confidence interval (95% CI): 0-0.49%] to 0% [95% CI 0.0-0.0%]) as the prevalence of the Delta variant of SARS-CoV-2 increased (initially 33.3% [95% CI 0.0-100.0%] to 100.0% [95% CI 100.0-100.0%]). A strain that carried mutations of both Delta and Mu was identified. We found that outpatient SARS-CoV-2 variant surveillance could be conducted in a timely and accurate manner. The prevalence of different variants changed over time. A higher proportion of nasal specimens yielded results versus oral specimens. Timely and regional outpatient SARS-CoV-2 variant surveillance could be used for public health efforts to identify changes in SARS-CoV-2 strain epidemiology.

PMID:36221029 | DOI:10.1038/s41598-022-21481-0

Biol Trace Elem Res. 2022 Oct 12. doi: 10.1007/s12011-022-03439-5. Online ahead of print.

ABSTRACT

Breast cancer is a multifactorial disease, and among the many factors which are involved in the onset, progression, and invasion of the disease, oxidative stress plays a significant role. The concentration and activity of enzymatic antioxidants are proportional to the concentration of trace elements, and the concentration of trace elements is often deficient in malignancies. Therefore, in the present study, we studied the tissue levels of oxidative stress, antioxidant status, zinc (Zn), and copper (Cu) in breast cancer patients. Tissue samples were collected from 40 patients with breast cancer and 40 tumor margin tissue as a control group. All subjects gave their informed consent. The tissue samples were measured for superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX), total antioxidants capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI), malondialdehyde (MDA), Zn, and Cu. Data of all biochemical parameters of two groups were statistically analyzed by SPSS software, t test, and GraphPad Prism. Concentrations of MDA, TOS, and OSI in tumor tissue were significantly higher than tumor margin tissue, but the level of TAC and CAT, SOD, and GPX activities was significantly reduced in tumor tissue (p<0.05). It was found that the concentrations of Zn and Cu in breast cancer patients were higher than tumor margin tissue. Patients with breast cancer have a rise in oxidative stress indicators and a decrease in antioxidant stress markers. Since oxidative stress is a significant contributor to the development and progression of breast cancer, more research might lead to a more effective method of breast cancer treatment. Considering the dual role of oxidative stress in cancer, which can both cause survival and adaptation, and the death of cancer cells, and with more information, it can be used to manage the treatment and destruction of cancer cells.

PMID:36221018 | DOI:10.1007/s12011-022-03439-5

Sci Rep. 2022 Oct 11;12(1):17008. doi: 10.1038/s41598-022-21421-y.

ABSTRACT

Mediterranean diet (MD) can play a major role in decreasing the risks of non-communicable diseases and preventing overweight and obesity. In order for a person to follow the MD and assess their adherence to it, proper dietary assessment methods are required. We have developed an Artificial Intelligence-powered system that recognizes the food and drink items from a single meal photo and estimates their respective serving size, and integrated it into a smartphone application that automatically calculates MD adherence score and outputs a weekly feedback report. We compared the MD adherence score of four users as calculated by the system versus an expert dietitian, and the mean difference was 3.5% and statistically not significant. Afterwards, we conducted a feasibility study with 24 participants, to evaluate the system’s performance and to gather the users’ and dietitians’ feedback. The image recognition system achieved 61.8% mean Average Precision for the testing set and 57.3% for the feasibility study images (where the ground truth was taken as the participants’ annotations). The feedback from the participants of the feasibility study was also very positive.

PMID:36220998 | DOI:10.1038/s41598-022-21421-y

Surg Endosc. 2022 Oct 11. doi: 10.1007/s00464-022-09671-3. Online ahead of print.

ABSTRACT

BACKGROUND: To investigate the value of routine colonoscopy, post-computed tomography (CT) confirmed diverticulitis. The current practice is to scope patients 6-8 weeks post an episode of acute diverticulitis. We hypothesise that this practice has a relatively low value.

METHODS: A retrospective cohort study was conducted on adult patients presenting acute diverticulitis n = 1680 (uncomplicated = 1005, complicated = 675) between January 2017 and July 2019 at three tertiary hospitals in Perth. The National Bowel Cancer Screening Program (NBCSP) positive cases were the reference group (n = 1800). Data were analysed using SPSS v.27.

RESULTS: One thousand two hundred seventy-two patients had a subsequent colonoscopy during the follow-up period, of which 24% (n = 306) were uncomplicated diverticulitis, 34% (n = 432) complicated diverticulitis, and 42% (n = 534) as the reference cohort. Patient demographics were similar between centres and subgroups. Incidence of primary colorectal cancer (CRC) was n = 3 (1.0%), n = 9 (2.1%), and n = 10 (1.9%) for uncomplicated diverticulitis, complicated diverticulitis, and NBCSP, respectively (p = 0.50). Subgroup analysis by age revealed a statistically significant higher rate of negative colonoscopy in uncomplicated diverticulitis patients aged over 50.

CONCLUSION: Routine colonoscopy for patients with uncomplicated diverticulitis is not a cost-effective strategy for colorectal cancer screening patients over 50 years. These patients should participate in the NBCSP with biennial FOBT instead. We suggest continuing routine endoscopic evaluation for patients with uncomplicated diverticulitis under 50 years and all patients admitted with complicated diverticulitis.

PMID:36220990 | DOI:10.1007/s00464-022-09671-3

Appl Physiol Nutr Metab. 2022 Oct 11. doi: 10.1139/apnm-2022-0201. Online ahead of print.

ABSTRACT

Nutrition risk is linked to hospitalization, frailty, depression, and death. Loneliness during the COVID-19 pandemic may have heightened nutrition risk. We sought to determine prevalence of high nutrition risk and if loneliness, mental health, and assistance with meal preparation/delivery were associated with risk in community-dwelling older adults (65+ years) after the first wave of COVID-19, in association analyses and when adjusting for meaningful covariates. Data were collected from May 12 to August 19, 2020. Descriptive statistics, association analyses, and linear regression analyses were conducted. For our total sample of 272 participants (78±7.3 years old, 70% female), the median SCREEN-8 score (nutrition risk) was 35 [1st Quartile, 3rd Quartile: 29, 40] and 64% were at high risk (SCREEN-8 < 38). Fifteen percent felt lonely two or more days a week. Loneliness and meal assistance were associated with high nutrition risk in association analyses. In multivariable analyses controlling for other lifestyle factors, loneliness was negatively associated with SCREEN-8 scores (-2.92, 95% CI [-5.51, -0.34]), as was smoking (-3.63, [-7.07, -0.19]). Higher SCREEN-8 scores were associated with higher education (2.71, [0.76, 4.66]), living with others (3.17, [1.35, 4.99]), higher self-reported health (0.11, [0.05, 0.16]), and resilience (1.28, [0.04, 2.52]). Loneliness was associated with nutrition risk in older adults after the first wave of COVID-19, but not mental health and meal assistance. Future research should consider longitudinal associations between loneliness, nutrition, and resilience.

PMID:36219874 | DOI:10.1139/apnm-2022-0201

Infant Ment Health J. 2022 Oct 11. doi: 10.1002/imhj.22014. Online ahead of print.

ABSTRACT

To understand the role of experience in parenting beliefs about caring for infants, we examined the parenting beliefs of pregnant women who were expecting their first child with those of pregnant women who already had at least one other child. A culturally diverse sample of 550 British and Italian women completed self-report measures evaluating their beliefs about the value of attunement and structure in caregiving, parenting self-efficacy, and home chaos. Psychometric evaluation confirmed the two-factor structure of the Baby Care Questionnaire (BCQ) for measuring attunement and structure but did not support configural invariance across the different samples. Beliefs about attunement and structure were related to parenting experience: pregnant women who already had at least one other child reported stronger beliefs in attunement, whereas pregnant women expecting their first child reported stronger beliefs in structure. Regression analyses revealed that the associations between parenting beliefs and experience remained when controlling for country, age, and education. Despite the limitations imposed by the lack of configural invariance, this cross-sectional, cross-cultural study constitutes an important first step in examining the relations between parenting experience and parenting beliefs during pregnancy.

PMID:36219866 | DOI:10.1002/imhj.22014

Menopause. 2022 Oct 11. doi: 10.1097/GME.0000000000002055. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate changes in objective sleep quality with hormone therapy (HT) in women with late menopausal transition.

METHODS: Healthy midlife women with sleep difficulty who received HT were included. Those undergoing late menopausal transition were screened. Sleep patterns and self-reported questionnaires were collected before and 10 weeks after starting HT.

RESULTS: Ten women who met the criteria (age, 50.1 ± 2.8 years) showed higher sleep efficiency and shorter wakefulness after sleep onset (WASO) 10 weeks after starting HT. However, no significant change was found in objective sleep quality after adjustment for multiple comparisons: sleep efficiency, 84.2 ± 7.7 versus 88.2% ± 4.7%, P = 0.037, adjusted P = 0.259; WASO, 59.0 ± 27.2 minutes versus 41.4 ± 17.4 minutes, P = 0.020, adjusted P = 0.140; average duration per awakening, 2.9 ± 1.0 minutes versus 2.2 ± 0.5 minutes, P = 0.033, adjusted P = 0.231. A better score of subjective sleep quality in the Pittsburgh Sleep Quality Index was observed 10 weeks after starting HT (2.0 ± 0.0 vs 1.2 ± 0.4, P = 0.006, adjusted P = 0.042), but sensitivity analysis did not show consistent results after adjustment for multiple comparisons (2.0 ± 0.0 vs 1.1 ± 0.4, P = 0.020, adjusted P = 0.140). Total scores of the Insomnia Severity Index and Menopause Rating Scale were better 10 weeks after starting HT (Insomnia Severity Index, 14.7 ± 3.0 vs 9.1 ± 3.8, P = 0.010; Menopause Rating Scale, 29.0 ± 5.2 vs 21.6 ± 3.0, P = 0.009) with consistent results in sensitivity analyses. There was no difference in the Epworth Sleepiness Scale before and after HT (7.2 ± 1.7 vs 8.6 ± 4.5, P = 0.309). The change in each objective sleep quality variable before and after HT showed strong positive or negative correlations with the change in only a few items in subjective sleep quality.

CONCLUSION: Women in the late menopausal transition period showed higher sleep efficiency and shorter WASO after HT; however, multiple comparisons showed no statistically significant difference in objective sleep quality between before and after HT.

PMID:36219812 | DOI:10.1097/GME.0000000000002055

Menopause. 2022 Oct 11. doi: 10.1097/GME.0000000000002076. Online ahead of print.

ABSTRACT

IMPORTANCE: Menopause is a biological stage associated with increased cardiovascular morbidity and mortality due to changes in sex hormone levels.

OBJECTIVE: This systematic review aimed to investigate the benefits and harms of RT in menopausal and postmenopausal women.

EVIDENCE REVIEW: We searched PubMed, Embase, CENTRAL, Scopus, and Web of Science from inception to 2021, and clinical trial registries. Randomized controlled trials (RCT) in menopausal and postmenopausal women that compared women undergoing RT programs with a control group were included. The primary outcomes were C-reactive protein level and adverse events; and, the secondary outcomes were lipid profile and waist circumference. Two reviewers independently selected the studies, extracted data, and assessed the completeness of RT programs, risk of bias, and quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach (GRADE). A random-effects model was used. Statistical significance was set at P < 0.05.

FINDINGS: Twelve RCTs published from 2012 to 2020 met the inclusion criteria (n = 482). Four follow-up periods were assessed. RT caused reductions in C-reactive protein levels compared to those in the control group in postmenopausal women in the short- to long-term follow-up (mean difference, -0.47 mg/dL; 95% confidence interval, -0.66 to -0.29; P < 0.00001). Furthermore, RT may reduce C-reactive protein levels even at moderate and moderate-to-high intensity (P < 0.0001 and P = 0.0005, respectively). Similar findings were found for lipid profiles in the short- to long-term follow-up (P < 0.05). RT may have had little to no effect on waist circumference. The certainty of the body of evidence was assessed as very low and downgraded owing to serious study limitations, inconsistency, imprecision, and publication bias.

CONCLUSIONS AND RELEVANCE: There was very low-quality evidence supporting the benefits of RT compared with control for C-reactive protein levels and lipid profile. No benefits were found for the outcome of waist circumference in postmenopausal women with different comorbidities or risk factors. Safety data were scarce. We have little confidence in the results, and the true effect is likely to be substantially different. Further well-conducted and well-reported RCTs are warranted to strengthen the evidence.

PROTOCOL REGISTRATION: PROSPERO CRD42020213125.

PMID:36219807 | DOI:10.1097/GME.0000000000002076

Neurology. 2022 Sep 6;99(10):e999-e1008. doi: 10.1212/WNL.0000000000200807. Epub 2022 Jun 8.

ABSTRACT

BACKGROUND AND OBJECTIVES: About 30% of patients with glioma need an add-on antiseizure medication (ASM) due to uncontrolled seizures on ASM monotherapy. This study aimed to determine whether levetiracetam combined with valproic acid (LEV + VPA), a commonly prescribed duotherapy, is more effective than other duotherapy combinations including either LEV or VPA in patients with glioma.

METHODS: In this multicenter retrospective observational cohort study, treatment failure (i.e., replacement by, addition of, or withdrawal of an ASM) for any reason was the primary outcome. Secondary outcomes included (1) treatment failure due to uncontrolled seizures and (2) treatment failure due to adverse effects. Time to treatment failure was estimated from the moment of ASM duotherapy initiation. Multivariable cause-specific Cox proportional hazard models were estimated to study the association between risk factors and treatment failure. The maximum duration of follow-up was 36 months.

RESULTS: A total of 1,435 patients were treated with first-line monotherapy LEV or VPA, of which 355 patients received ASM duotherapy after they had treatment failure due to uncontrolled seizures on monotherapy. LEV + VPA was prescribed in 66% (236/355) and other ASM duotherapy combinations including LEV or VPA in 34% (119/355) of patients. Patients using other duotherapy vs LEV + VPA had a higher risk of treatment failure for any reason (cause-specific adjusted hazard ratio [aHR] 1.50 [95% CI 1.07-2.12], p = 0.020), due to uncontrolled seizures (cause-specific aHR 1.73 [95% CI 1.10-2.73], p = 0.018), but not due to adverse effects (cause-specific aHR 0.88 [95% CI 0.47-1.67], p = 0.703).

DISCUSSION: This observational cohort study suggests that LEV + VPA has better efficacy than other ASM combinations. Similar toxicities were experienced in the 2 groups.

CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with glioma with uncontrolled seizures on ASM monotherapy, LEV + VPA has better efficacy than other ASM combinations.

PMID:36219797 | DOI:10.1212/WNL.0000000000200807