Tag: statistics

Am J Perinatol. 2021 Dec 13. doi: 10.1055/s-0041-1740193. Online ahead of print.

ABSTRACT

OBJECTIVE: Inflammatory bowel disease (IBD) reproductive health counseling is associated with higher knowledge, lower voluntary childlessness, greater medication adherence during pregnancy, and improved outcomes of pregnancy. Our aims were to assess counseling and knowledge about IBD and reproductive health in a tertiary care IBD patient population.

STUDY DESIGN: We anonymously surveyed women and men ages 18 to 45 cared for at the Stanford IBD clinic about reproductive health and administered the CCPKnow questionnaire. STATA was used to summarize descriptive statistics and compare categorical variables using Fisher’s exact test.

RESULTS: Of the 100 patients (54% women) who completed the survey, only 33% reported prior reproductive health counseling. Both men and women considered not having a child due to IBD (31% women, 15% men) and most (83%) had no prior counseling. A minority of patients had an adequate (>8/17) CCPKnow score (45% women, 17% men). The majority of women with prior pregnancy had pre-existing IBD (67%), yet many did not seek gastrointestinal (GI) care (38% preconception, 25% during pregnancy) and 33% stopped/changed medications, with 40% not discussing this with a physician. Prior counseling was significantly associated with education level (p = 0.013), biologic use (p = 0.003), and an adequate CCPKnow score (p = 0.01). Overall, 67% of people wanted more information on IBD and reproductive health.

CONCLUSION: In an educated tertiary care cohort, the majority of patients had low CCPKnow scores and rates of IBD reproductive health counseling. Many patients with IBD prior to pregnancy reported no GI care preconception or during pregnancy and stopped/changed medications without consulting a physician. There is an urgent need for proactive counseling by gastroenterologists and obstetricians on IBD and reproductive health.

KEY POINTS: · There is inadequate reproductive health counseling in IBD.. · Many IBD patients do not seek prenatal/perinatal GI care.. · Patients change medications without consultation.. · GIs and OBs should proactively counsel IBD patients..

PMID:34902866 | DOI:10.1055/s-0041-1740193

Am J Trop Med Hyg. 2021 Dec 13:tpmd210261. doi: 10.4269/ajtmh.21-0261. Online ahead of print.

ABSTRACT

Cystic echinococcosis (CE) is a zoonosis with a cosmopolitan distribution caused by Echinococcus granulosus sensu lato tapeworms. Although Uzbekistan and other countries in Central Asia are considered endemic, estimates of disease burden are lacking. We present data regarding surgically managed cases of CE obtained from Uzbekistan’s national disease surveillance registry. These data are from medical centers in Uzbekistan authorized to treat the disease and reported to the Uzbek Center for Sanitation and Epidemiology from the period 2011 to 2018. Information included data regarding the patient age class (children 14 years or younger), but no data regarding the cyst location. Incidence rates were calculated using data from the national population registry, and the Cuzick nonparametric test for trends was used to test for differences in the incidence over time at the country level and regional levels. A total of 7,309 CE cases were reported. Of these, 857 (11.73%) involved pediatric patients. The mean incidence rates were 4.4 per 100,000 population in 2011 and 2.3 per 100,000 population in 2018 (P = 0.016). One region (Republic of Karalpakistan) showed a nonstatistically significant increase (P = 0.824). All other regions except three showed a statistically significant decrease. We present the decrease in the incidence of surgically treated CE in Uzbekistan from 2011 to 2018. However, the presence of cases involving children suggest ongoing parasite transmission. The absence of clinical information (starting with cyst stage and localization) needs to be addressed to improve the national surveillance system. Field studies are also needed to further explore the epidemiology of CE in the country.

PMID:34902836 | DOI:10.4269/ajtmh.21-0261

Sleep Med Rev. 2021 Nov 11;61:101569. doi: 10.1016/j.smrv.2021.101569. Online ahead of print.

ABSTRACT

Insomnia (ID) is the most common sleep disorder; however pathogenetic mechanisms underlying ID symptoms are not fully understood. Adopting a multifactorial view and considering ID a condition that involves interregional neuronal coordination would be useful to understand the ID pathophysiology. Functional connectivity (FC) may help to shed light on functional processes and neural correlates underlying ID symptoms. Despite a growing number of studies assessing FC anomalies, insight into ID pathophysiology is still fragmentary. This systematic review aims to search empirical evidence regarding FC changes in ID during resting-state. Thirty-one studies involving 1052 ID participants met the inclusion criteria for this review. Results suggested several associations between ID symptoms and impaired intra- and inter-hemispheric interactions of principal resting-state networks. Overall, evidence supported the hypothesis that a disrupted organization of the brain functional connectome characterizes ID, resulting in a decline in sleep, cognition, emotion, and memory. However, the wide methodological heterogeneity between reviewed studies and limitations in terms of study protocols and statistical approaches raised from this systematic review, makes it difficult to provide a univocal framework of ID pathophysiology. Future researches in this field should lead towards shared and rigorous search designs to ensure solid research evidence in the ID pathophysiology.

PMID:34902821 | DOI:10.1016/j.smrv.2021.101569

Sleep Med Rev. 2021 Nov 26;61:101573. doi: 10.1016/j.smrv.2021.101573. Online ahead of print.

ABSTRACT

The efficacy and safety of dual orexin receptor antagonists (DORAs) for primary insomnia have been well verified in several large randomized controlled trials (RCTs) over the past several decades. However, there have been few systematic comparisons of different DORAs, and the best DORA for insomniacs has remained unclear. Here, Medline, Embase, Cochrane library, and clinicaltrials.gov were searched for RCTs (through December 31, 2020) to evaluate different DORAs versus a placebo. We pooled data from 13 RCTs. DORAs were superior to the placebo in all efficacy outcomes except the subjective number of awakenings (P = 0.90), but also showed higher risks of somnolence, abnormal dreams, fatigue, and dry mouth (somnolence: P < 0.00001; abnormal dreams: P = 0.03; fatigue: P = 0.001; dry mouth: P = 0.007). No statistical differences were found between any two of the DORAs in terms of primary efficacy outcomes. However, lemborexant yielded the three-highest surfaces under the curve ranking area (SUCRA) values (78.25%, 96.25% and 89.13%). Taken together, we conclude that DORAs are superior to the placebo in terms of efficacy and safety measures.

PMID:34902823 | DOI:10.1016/j.smrv.2021.101573

Value Health Reg Issues. 2021 Dec 10;29:93-99. doi: 10.1016/j.vhri.2021.10.001. Online ahead of print.

ABSTRACT

OBJECTIVES: Reducing healthcare costs is a constant endeavor of all healthcare organizations, governments, policy makers, and individuals. A comparative study of available healthcare policies from the patient’s perspective is not available. Furthermore, an analysis of how the various components of these policies affect the healthcare cost of a patient is required.

METHODS: Data were collected from 150 hospitalized patients in India regarding their views on 7 healthcare cost categories covering 22 cost components. These are statistically analyzed under 4 commonly used health insurance policies (2 government insurance schemes: ex-servicemen contributory health scheme and employee state insurance; private insurance schemes; and self-financing-ie, no insurance) to assess which healthcare cost component is more important under which policy option.

RESULTS: Under 7 healthcare cost categories, 22 cost components were studied, and out of these 22, 16 were found statistically significant. Results revealed that the treatment of all 16 significant cost components under the 4 health insurance policy options was statistically different.

CONCLUSIONS: Patients covered under government sector health insurance policies were found to be less concerned about healthcare costs, whereas those covered under private health insurance policies were found to be more cost-conscious. Access to healthcare or transportation costs to the healthcare facility is a key concern area for self-financed patients.

PMID:34902812 | DOI:10.1016/j.vhri.2021.10.001

Ecotoxicol Environ Saf. 2021 Dec 10;229:113061. doi: 10.1016/j.ecoenv.2021.113061. Online ahead of print.

ABSTRACT

The accurate evaluation of groundwater contamination vulnerability is essential for the management and prevention of groundwater contamination in the watershed. In this study, advanced multiple machine learning (ML) models of Radial Basis Neural Networks (RBNN), Support Vector Regression (SVR), and ensemble Random Forest Regression (RFR) were applied to determine the most accurate performance for the evaluation of groundwater contamination vulnerability. Eight vulnerability factors of DRASTIC-L were rated based on the modified DRASTIC model (MDM) and were used as input data. The adjusted vulnerability index (AVI) with nitrate values was used as output data for the modeling process. The performance of three models was verified using the statistical performance criteria of MAE, RMSE, r², and ROC/AUC values. The ensemble RFR model showed the highest performance in comparison with standalone SVR and RBNN models. Specifically, ensemble RFR kept all promising solutions during the model performance due to its flexibility and robustness, and the vulnerability map obtained by the RFR model was more accurate for predicting the most vulnerable areas to contamination. It was concluded that ensemble RFR was a robust tool to enhance the evaluation of groundwater contamination vulnerability, and that it could contribute to environmental safety against groundwater contamination.

PMID:34902776 | DOI:10.1016/j.ecoenv.2021.113061

Heart Lung. 2021 Dec 10;52:71-75. doi: 10.1016/j.hrtlng.2021.11.013. Online ahead of print.

ABSTRACT

BACKGROUND: Sarcopenia, or skeletal muscle depletion, was common in the elderly and often led to a poor prognosis of diseases. The area of the psoas muscle in abdominal computed tomography (CT) is the most common used for diagnosing sarcopenia. However, patients with pneumonia routinely only undergo chest CT.

OBJECTIVES: This study aimed to determine whether paraspinal muscle area (PMA) obtained by chest CT can predict death for community-acquired pneumonia (SCAP) patients entering intensive care unit (ICU).

METHODS: This study enrolled 208 SCAP patients admitted to ICU after undergoing chest CT. PMA, paraspinal muscle radiodensity (PMD), and lean paraspinal muscle area (LPMA) were calculated on chest CT images. The main outcome was mortality during hospitalization. Logistic regression, receiver operating characteristic (ROC) curve, and Kaplan-Meier curves were used to evaluate forecasting effectiveness.

RESULTS: The primary outcome occurred in 76 (36.53%) patients. In multivariate logistic regression, PMA, lactic dehydrogenase (LDH), invasive mechanical ventilation (IMV), red blood cell (RBC) and age≥ 65 years were independent risk factors predicting death during hospitalization (adjusted Odds Ratio [OR]: 0.886, 1.002, 3.178, 0.612 and 2.003, respectively). The area under curve (AUC) of PMA to predict death was 0.720 (P< 0.001). During hospitalization, the median survival time of high-PMA (51.00 days) and low-PMA groups (20.00 days) was statistically significant (P< 0.001).

CONCLUSION: Lower PMA was associated with an increased risk of death for SCAP patients admitted to the ICU. In other words, PMA may help early identify adverse prognosis of SCAP patients admitted to ICU.

PMID:34902778 | DOI:10.1016/j.hrtlng.2021.11.013

Geriatr Nurs. 2021 Dec 9;43:159-166. doi: 10.1016/j.gerinurse.2021.11.016. Online ahead of print.

ABSTRACT

This cross-sectional study aimed to analyze dysphagia-specific quality of life and its influencing factors in aged patients with neurologic disorders, and is reported according to the STROBE checklist for observational research. The study included 120 outpatients, aged ≥65 years, diagnosed with neurologic diseases at a general hospital Neurology Department in Seoul, Korea. Data collected during a one-month (March and April 2021) questionnaire survey were statistically analyzed using SPSS. Factors related to dysphagia-specific quality of life were gender, education level, neurological diagnosis, type of diet, subjective swallowing disturbance, and affectionate support-a subscale of social support. The combined explanatory power of these factors was 42.1%. It is essential to note that the factors related to the emotional, functional, and physical domains-the subscales of dysphagia-specific quality of life-are different. Therefore, each factor should be considered when planning nursing interventions to improve dysphagia-specific quality of life.

PMID:34902750 | DOI:10.1016/j.gerinurse.2021.11.016

Mult Scler Relat Disord. 2021 Dec 4;57:103448. doi: 10.1016/j.msard.2021.103448. Online ahead of print.

ABSTRACT

BACKGROUND: Ocrelizumab maintains B-cell depletion via six-monthly dosing. Whilst this controls relapsing multiple sclerosis, it also inhibits seroconversion following SARS-CoV-2 vaccination unlike that seen following alemtuzumab and cladribine treatment. Emerging reports suggest that 1-3% B-cell repopulation facilitates seroconversion after CD20-depletion.

OBJECTIVE: To determine the frequency of B-cell repopulation levels during and after ocrelizumab treatment.

METHODS: Relapse data, lymphocyte and CD19 B-cell numbers were obtained following requests to clinical trial data-repositories. Information was extracted from the phase II ocrelizumab extension (NCT00676715) trial and the phase III cladribine tablet (NCT00213135) and alemtuzumab (NCT00530348/NCT00548405) trials obtained clinical trial data requests RESULTS: Only 3-5% of people with MS exhibit 1% B-cells at 6 months after the last infusion following 3-4 cycles of ocrelizumab, compared to 50-55% at 9 months, and 85-90% at 12 months. During this time relapses occurred at consistent disease-breakthrough rates compared to people during standard therapy. In contrast most people (90-100%) exhibited more than 1% B-cells during treatment with either cladribine or alemtuzumab.

CONCLUSIONS: Most people demonstrate B cell repletion within 3 months of the last treatment of alemtuzumab and cladribine. However, few people repopulate peripheral B-cells with standard ocrelizumab dosing. Controlled studies are warranted to examine a view that delaying the dosing interval by 3-6 months may allow more people to potentially seroconvert after vaccination.

PMID:34902760 | DOI:10.1016/j.msard.2021.103448

Neuroimage Clin. 2021 Dec 10;33:102908. doi: 10.1016/j.nicl.2021.102908. Online ahead of print.

ABSTRACT

INTRODUCTION: Individuals with Down syndrome (DS) are at an increased risk of developing Alzheimer’s Disease (AD). One of the early underlying mechanisms in AD pathology is the accumulation of amyloid protein plaques, which are deposited in extracellular gray matter and signify the first stage in the cascade of neurodegenerative events. AD-related neurodegeneration is also evidenced as microstructural changes in white matter. In this work, we explored the correlation of white matter microstructure with amyloid load to assess amyloid-related neurodegeneration in a cohort of adults with DS.

METHODS: In this study of 96 adults with DS, the relation of white matter microstructure using diffusion tensor imaging (DTI) and amyloid plaque burden using [¹¹C]PiB PET were examined. The amyloid load (Aβ_L) derived from [¹¹C]PiB was used as a global measure of amyloid burden. Aβ_L and DTI measures were compared using tract-based spatial statistics (TBSS) and corrected for imaging site and chronological age.

RESULTS: TBSS of the DTI maps showed widespread age-by-amyloid interaction with both fractional anisotropy (FA) and mean diffusivity (MD). Further, diffuse negative association of FA and positive association of MD with amyloid were observed.

DISCUSSION: These findings are consistent with the white matter microstructural changes associated with AD disease progression in late onset AD in non-DS populations.

PMID:34902714 | DOI:10.1016/j.nicl.2021.102908