Tag: statistics

Infect Dis Poverty. 2021 Mar 22;10(1):36. doi: 10.1186/s40249-021-00817-4.

ABSTRACT

BACKGROUND: Leprosy is known to be unevenly distributed between and within countries. High risk areas or ‘hotspots’ are potential targets for preventive interventions, but the underlying epidemiologic mechanisms that enable hotspots to emerge, are not yet fully understood. In this study, we identified and characterized leprosy hotspots in Bangladesh, a country with one of the highest leprosy endemicity levels globally.

METHODS: We used data from four high-endemic districts in northwest Bangladesh including 20 623 registered cases between January 2000 and April 2019 (among ~ 7 million population). Incidences per union (smallest administrative unit) were calculated using geospatial population density estimates. A geospatial Poisson model was used to detect incidence hotspots over three (overlapping) 10-year timeframes: 2000-2009, 2005-2014 and 2010-2019. Ordinal regression models were used to assess whether patient characteristics were significantly different for cases outside hotspots, as compared to cases within weak (i.e., relative risk (RR) of one to two), medium (i.e., RR of two to three), and strong (i.e., RR higher than three) hotspots.

RESULTS: New case detection rates dropped from 44/100 000 in 2000 to 10/100 000 in 2019. Statistically significant hotspots were identified during all timeframes and were often located at areas with high population densities. The RR for leprosy was up to 12 times higher for inhabitants of hotspots than for people living outside hotspots. Within strong hotspots (1930 cases among less than 1% of the population), significantly more child cases (i.e., below 15 years of age) were detected, indicating recent transmission. Cases in hotspots were not significantly more likely to be detected actively.

CONCLUSIONS: Leprosy showed a heterogeneous distribution with clear hotspots in northwest Bangladesh throughout a 20-year period of decreasing incidence. Findings confirm that leprosy hotspots represent areas of higher transmission activity and are not solely the result of active case finding strategies.

PMID:33752751 | DOI:10.1186/s40249-021-00817-4

Trials. 2021 Mar 22;22(1):223. doi: 10.1186/s13063-021-05147-2.

ABSTRACT

BACKGROUND: Limb salvage with endoprosthetic reconstruction is the current standard practice for the surgical management of lower extremity bone tumors in skeletally mature patients and typically includes tumor resection followed by the functional limb reconstruction with modular metallic and polyethylene endoprosthetic implants. However, owing to the complexity and length of these procedures, as well as the immunocompromised nature of patients treated with chemotherapy, the risk of surgical site infection (SSI) is high. The primary research objective of the Prophylactic Antibiotic Regimens In Tumor Surgery (PARITY) trial is to assess whether a 5-day regimen of post-operative antibiotics decreases the risk of SSI at 1 year post-operatively compared to a 1-day regimen. This article describes the statistical analysis plan for the PARITY trial.

METHODS/DESIGN: The PARITY trial is an ongoing multi-center, blinded parallel two-arm randomized controlled trial (RCT) of 600 participants who have been diagnosed with a primary bone tumor, a soft tissue sarcoma that has invaded the bone or oligometastatic bone disease of the femur or tibia that requires surgical resection and endoprosthetic reconstruction. This article describes the overall analysis principles, including how participants will be included in each analysis, the presentation of results, adjustments for covariates, the primary and secondary outcomes, and their respective analyses. Additionally, we will present the planned sensitivity and sub-group analyses.

DISCUSSION: Our prior work has demonstrated (1) high rates of SSI after the treatment of lower extremity tumors by surgical excision and endoprosthetic reconstruction, (2) highly varied opinion and practice among orthopedic oncologists with respect to prophylactic antibiotic regimens, (3) an absence of applicable RCT evidence, (4) extensive support from international investigators to participate in a RCT, and (5) the feasibility of conducting a definitive RCT to evaluate a 5-day regimen of post-operative antibiotics in comparison with a 1-day regimen.

TRIAL REGISTRATION: ClinicalTrials.gov NCT01479283 . Registered on 24 November 2011.

PMID:33752752 | DOI:10.1186/s13063-021-05147-2

J Med Case Rep. 2021 Mar 23;15(1):128. doi: 10.1186/s13256-021-02715-7.

ABSTRACT

BACKGROUND: We present a minimal skin wound abdominal hysterectomy for patients with leiomyomas and describe the characteristics of this technique. The skin wound was made as small as possible, with a maximum length of 6 cm.

METHODS: In addition to introducing minimal skin wound abdominal hysterectomy, we retrospectively analyzed the medical records of 82 patients treated with minimal skin wound abdominal hysterectomy exclusively by two experts at Maruyama Memorial General Hospital between January 2013 and December 2016. Relationships between the leiomyoma characteristics and the difficulty of this operation, as estimated by operation time and blood loss, were statistically investigated.

RESULTS: First, we introduce a case in which we performed minimal skin wound abdominal hysterectomy on a 46-year-old Japanese patient with multiple leiomyomas (maximum 8 cm in diameter). Then, we assessed the impacts of the leiomyoma characteristics on the difficulty of this operation. On multivariate analysis, the number of leiomyomas significantly affected operation difficulty. Other characteristics of the target leiomyoma showed no effect. Additionally, higher body mass index also made the operation more difficult.

CONCLUSIONS: Although multiple leiomyomas can make this procedure difficult, minimal skin wound abdominal hysterectomy is safe and effective for use in many cases.

PMID:33752748 | DOI:10.1186/s13256-021-02715-7

Clin Exp Pediatr. 2021 Mar 19. doi: 10.3345/cep.2020.01438. Online ahead of print.

ABSTRACT

BACKGROUND: Over the past few decades, various goals have been defined to reduce the mortality of children caused by acute lower respiratory infections (ALRI) worldwide. However, few spatial studies to date have reported on ALRI deaths.

PURPOSE: We aimed to assess the spatial modeling of mortality from ALRI in children under 5 years of age during 2000-2017 using a global data.

METHODS: The data on the mortality of children under 5 years old caused by ALRI were initially obtained from the official website of the World Health Organization. The income status of their home countries was also gathered from the Country Income Groups (World Bank Classification) website and divided into five categories. After that, in the ArcGIS 10.6 environment, a database was created and the statistical tests and related maps were extracted. The Global Moran’s I Statistic, Getis-Ord Gi statistic, and geographically weighted regression were used for the analyses. In this study, higher Z-scores indicated the hot spots, while lower Z-scores indicated the cold spots.

RESULTS: In 2000-2017, child mortality showed a downward trend from 17.6 per 100000 children to 8.1 and had a clustered pattern. Hot spots were concentrated in Asia in 2000 but shifted toward African countries by 2017. A cold spot that formed in Europe in 2007 showed an ascending trend by 2017. Based on the results of geographically weighted regression test, the regions identified as the hot spots of mortality from ALRI in children under 5 years old were among the middle-income countries (R2 = 0.01, adjusted R2 = 8.77).

CONCLUSION: While the total number of child deaths in 2000-2017 has decreased, the number of hot spots has increased among countries. This study also concluded that, during the study period, Central and Western Africa countries became the main new hot spots of deaths from ALRI.

PMID:33752281 | DOI:10.3345/cep.2020.01438

Clin Respir J. 2021 Mar 22. doi: 10.1111/crj.13364. Online ahead of print.

ABSTRACT

OBJECTIVE: The impact on executive function performance of sleep-related disorders in asthmatic children has been scarcely studied in community settings. The aims of the present study were to assess the prevalence of sleep-related breathing disorders (SRBD) in children with intermittent or mild persistent asthma in primary care settings, and to examine possible correlations with measures of executive function.

METHODS: We performed a case-control study including 76 children with asthma (intermittent or mild persistent), and 85 healthy controls. The parents of both patients and controls completed the Pediatric Seep Questionnaire (PSQ), and the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire.

RESULTS: We did not find any statistically significant differences regarding the scales of PSQ. Additionally, there were no statistical differences between asthmatic children and controls regarding the scales of the BRIEF questionnaire. In both asthmatic children and controls the score of the scale of obstructive sleep related breathing disorder was significantly correlated with the T scores of the two composite scales (BRI and MI) and the Global Executive Composite (GEC).

CONCLUSION: In children with intermittent or mild persistent asthma under the care of private general paediatricians there were no statistically significant differences regarding subjective SBD compared to healthy controls. Also there were no statistical differences between asthmatic children and controls regarding behavioral correlates of executive function during everyday life.

PMID:33752268 | DOI:10.1111/crj.13364

Rom J Intern Med. 2021 Mar 22. doi: 10.2478/rjim-2021-0012. Online ahead of print.

ABSTRACT

INTRODUCTION: Pure extra-thoracic sarcoidosis is rare and poorly characterized in the literature. Herein we present features of pure extra-thoracic sarcoidosis, in comparison with sarcoidosis with intra-thoracic involvement, in a population from the south of Tunisia.

METHODS: Retrospective, descriptive and comparative study of the patients presenting systemic sarcoidosis and attending the Department of Internal Medicine at the Hedi Chaker University Hospital, Sfax, Tunisia, for 21 years, from January1996 to December2016.

RESULTS: Twenty-four patients presented pure extra-thoracic sarcoidosis (30% of the cases of systemic sarcoidosis). There was a female predominance (79%). The mean age was 50 years. The main features were polyadenopathies (10 patients:41,7%), cutaneous involvement (10 patients:41,6%), inflammatory polyarthralgia (8 cases:33.3%), general symptoms (6 patients:25%), uveitis (6cases:25%), cholestasis (3cases) and kidney involvement (2cases). Lymphopenia, hypercalcemia, and hypercalciuria were observed each one in 12.5% of the cases, and high angiotensin converting enzyme (ACE) level in 38,5% of the cases. The histological proof was required in all the patients. Statistically significant associations identified were mainly hepatic involvement with general symptoms (p=0.035), peripheral lymphadenopathies (p=0.035) and kidney damage (p=0.022), and cutaneous involvement with articular manifestations (p=0.032). Systemic corticosteroids were used in half of the cases, with a good outcome in 21 cases, and recurrence in two cases. One patient was lost to follow up. The comparison to the form with mediastino-pulmonary involvement showed less lymphadenopathies(p=0.001), less lymphopenia (p=0.006), and less frequent use of corticosteroids(p=0.044).

CONCLUSION: Our series was characterized by the frequency of the pure extra-thoracic form and the diversity of the systemic manifestations.

PMID:33752271 | DOI:10.2478/rjim-2021-0012

Cardiovasc Res. 2021 Mar 22:cvab111. doi: 10.1093/cvr/cvab111. Online ahead of print.

ABSTRACT

AIMS: Free fatty acid receptor 4 (Ffar4) is a G-protein coupled receptor for endogenous medium/long-chain fatty acids that attenuates metabolic disease and inflammation. However, the function of Ffar4 in the heart is unclear. Given its putative beneficial role, we hypothesized that Ffar4 would protect the heart from pathologic stress.

METHODS AND RESULTS: In mice lacking Ffar4 (Ffar4KO), we found that Ffar4 is required for an adaptive response to pressure overload induced by transverse aortic constriction (TAC), identifying a novel cardioprotective function for Ffar4. Following TAC, remodeling was worsened in Ffar4KO hearts, with greater hypertrophy and contractile dysfunction. Transcriptome analysis 3-days post-TAC identified transcriptional deficits in genes associated with cytoplasmic phospholipase A2α signaling and oxylipin synthesis as well as reduction of oxidative stress in Ffar4KO myocytes. In cultured adult cardiac myocytes, Ffar4 induced production of the eicosapentaenoic acid (EPA)-derived, pro-resolving oxylipin 18-hydroxyeicosapentaenoic acid (18-HEPE). Furthermore, activation of Ffar4 attenuated cardiac myocyte death from oxidative stress, while 18-HEPE rescued Ffar4KO myocytes. Systemically, Ffar4 maintained pro-resolving oxylipins and attenuated autoxidation basally, and increased pro-inflammatory and pro-resolving oxylipins, including 18-HEPE, in high density lipoproteins post-TAC. In humans, Ffar4 expression decreased in heart failure, while the signaling-deficient Ffar4 R270H polymorphism correlated with eccentric remodeling in a large clinical cohort paralleling changes observed in Ffar4KO mice post-TAC.

CONCLUSIONS: Our data indicate that Ffar4 in cardiac myocytes responds to endogenous fatty acids, reducing oxidative injury, and protecting the heart from pathologic stress, with significant translational implications for targeting Ffar4 in cardiovascular disease.

PMID:33752243 | DOI:10.1093/cvr/cvab111

BJU Int. 2021 Mar 22. doi: 10.1111/bju.15399. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the accuracy and completeness of surgeon reported radical prostatectomy outcome data across a national health system by comparison with a national dataset gathered independently from clinicians directly involved in patient care.

PATIENTS AND METHODS: Data submitted by surgeons to the British Association of Urological Surgeons (BAUS) radical prostatectomy audit for all men undergoing radical prostatectomy between 2015 and 2016 was assessed by cross linkage to the National Prostate Cancer Audit (NPCA) database. Specific data-items collected in both databases were selected for comparison analysis. Data completeness and agreement were assessed by percentages and Cohen’s kappa statistic.

RESULTS: Data from 4,707 men in the BAUS and NPCA databases were matched for comparison. Compared with the NPCA, dataset completeness was higher in the BAUS dataset for type of nerve sparing procedure (92% vs 42%) and post-operative margin status (89% vs 48%) but lower for readmission (87% vs 100%) and Charlson score (80% vs 100%). For all other variables assessed completeness was comparable. Agreement and data reliability was high for most variables. However despite good agreement the inter-cohort reliability was poor for Readmission, M stage and Charlson score (κ< 0.30).

CONCLUSIONS: For the first time in urology we show that surgeon reported data from the BAUS radical prostatectomy audit can reliably be used to benchmark peri-operative radical prostatectomy outcomes. For co-morbidity data, to assist with risk analysis, and longer term outcomes NPCA routinely collected data provides a more comprehensive source.

PMID:33752249 | DOI:10.1111/bju.15399

Clin Physiol Funct Imaging. 2021 Mar 22. doi: 10.1111/cpf.12700. Online ahead of print.

ABSTRACT

BACKGROUND: Multi-frequency bioelectrical impedance analysis (MF-BIA) offers enhanced body composition outcomes in a time efficient manner. The accuracy of stand-up MF-BIA compared against a four-compartment (4C) criterion lacks evidence.

OBJECTIVES: To validate a stand-up MF-BIA compared to a 4C criterion for fat mass (FM), fat free mass (FFM), and body fat percentage (%fat).

SUBJECTS/METHODS: Eighty-two healthy (32% men) normal weight (BMI: 18.5 – 24.9 kg/m² ) young adults were measured for body composition determined from a stand-up MF-BIA and 4C model. Validity statistics included total error (TE) and standard error of the estimate (SEE) to examine prediction error between methods.

RESULTS: For the total sample, prediction error was the highest for %fat (TE=4.2 %; SEE=3.9 %) followed by FM (TE=2.4 kg; SEE=2.2 kg) and FFM (TE=2.4 kg; SEE=2.2 kg). In men, %fat (TE=2.5 %; SEE=2.2 %) and FM (TE=1.9 kg; SEE=1.6 kg) were ideal; FFM was similar to FM (TE=1.9 kg; SEE=1.6 kg). In women, %fat (TE=4.7 %; SEE=4.4 %) ranged from good to fairly good, and FM was very good to excellent (TE=2.6 kg; SEE=2.4 kg); FFM was similar to FM (TE=2.6 kg; SEE=2.3 kg).

CONCLUSIONS: Stand-up MF-BIA may overestimate %fat and FM, and underestimate FFM compared to a 4C model. FM and FFM estimates from MF-BIA demonstrate good agreement to a 4C model and may be a practical measure of body composition in normal weight adults. The highest error was seen in %fat for both sexes, with greater error in women.

PMID:33752260 | DOI:10.1111/cpf.12700

Int J Hyg Environ Health. 2021 Mar 19;234:113738. doi: 10.1016/j.ijheh.2021.113738. Online ahead of print.

ABSTRACT

AIM: Living in areas with neighborhood greenness may be associated with the incidence of cardiovascular diseases (CVDs). However, little evidence in this regard has emerged from developing countries. In the present study, we examined neighborhood greenness associated with CVDs and the lipid accumulation product (LAP) and pulse pressure (PP) in China.

METHODS: We undertook our analysis using a community cross-sectional survey conducted in Longzihu District of Bengbu from July to August 2015. We measured triglyceride levels, waist circumference, and blood pressure. To assess exposure to neighborhood greenness, we used the average normalized difference vegetation index (NDVI) at 1,000-, 1,500-, and 2,000-m buffers in the participant community. We employed generalized mixed models to determine the association among neighborhood greenness, CVDs, LAP, and PP. We conducted stratified analysis by age, gender, income, and education. We assessed the potential mediating effects of road proximity and physical activity on greenness and CVDs, PP, and LAP.

RESULTS: The highest tertiles of NDVI_1500-m were steadily and significantly associated with lower odds of CVDs prevalence: the adjusted OR of such prevalence was 0.612 (95% CI, 0.462-0.811); higher NDVI was significantly associated with lower PP levels. The NDVI was strongly associated with CVDs prevalence among participants who were male and had high income. Ambient road proximity significantly mediated 9.7% of the estimated association between greenness and PP, there was no evidence of mediation effects for physical activity.

CONCLUSIONS: Higher neighborhood greenness could have a beneficial effect on CVDs and biomarkers. There were higher associations between residential greenness and CVDs among male and higher-income individuals; road proximity partially mediated the observed association between greenness and PP.

PMID:33752171 | DOI:10.1016/j.ijheh.2021.113738