Tag: statistics

Int J Dent Hyg. 2022 Jan 24. doi: 10.1111/idh.12581. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the direct and indirect influence of fluoridated toothpastes and fluoride-free toothpaste with hydroxyapatite (HAP) as active ingredient on initial bacterial colonization on enamel in situ.

METHODS: For this clinical-experimental pilot-study, eight subjects were instructed to brush their teeth with three different toothpastes (Elmex®: 1400 ppm AmF, Meridol®: 1400ppm AmF + SnF2, Karex®: HAP), using each for two consecutive days. As a control, brushing without toothpaste was performed. To evaluate bacterial colonization, subject wore splints with buccally placed bovine enamel-platelets overnight. Two modes were tested. In a first pass (regimen A), the splints were inserted after toothbrushing to examine the indirect effects of the dentifrices. In order to investigate the direct effects, the specimens were brushed in situ in a second pass (regimen B). Biofilm formation was visualized and quantified using fluorescence microscopy (DAPI and BacLight) and transmission electron microscopy (TEM).

RESULTS: For brushing regimen A (indirect effect of dentifrices), no statistical differences were detected between any of the tested dentifrices or the control. Likewise, no statistically significant differences were recorded for brushing regimen B (direct effect of dentifrices). Furthermore, no differences between the different brushing techniques were determined with regard to the ultrastructure of the overnight biofilm.

CONCLUSION: Within the limitations of the present pilot study, it can be concluded that in patients with good oral hygiene, dentifrices and their chemical composition have no statistically significant effect on the initial bacterial colonization of enamel platelets in situ, irrespectively of the mode of application.

PMID:35075780 | DOI:10.1111/idh.12581

J Clin Nurs. 2022 Jan 24. doi: 10.1111/jocn.16227. Online ahead of print.

ABSTRACT

BACKGROUND: Games are increasingly being used as a means of alleviating pain and anxiety in paediatric patients, in the view that this form of distraction is effective, non-invasive and non-pharmacological.

AIMS: To determine whether a game-based intervention (via gamification or virtual reality) during the induction of anaesthesia reduces preoperative pain and anxiety in paediatric patients.

METHODS: A systematic review with meta-analysis of randomised controlled trials was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using RevMan software. The review was based on a search of the EMBASE, CINAHL, Medline, SciELO and Scopus databases, conducted in July 2021. No restriction was placed on the year of publication.

RESULTS: 26 studies were found, with a total study population of 2525 children. Regarding pain reduction, no significant differences were reported. For anxiety during anaesthesia induction, however, a mean difference of -10.62 (95% CI -13.85, -7.39) on the Modified Yale Preoperative Anxiety Scale, in favour of game-based intervention, was recorded.

CONCLUSIONS: Game-based interventions alleviate preoperative anxiety during the induction of anaesthesia in children. This innovative and pleasurable approach can be helpful in the care of paediatric surgical patients.

RELEVANCE TO CLINICAL PRACTICE: In children, preoperative management is a challenging task for healthcare professionals, and game-based strategies could enhance results, improving patients’ emotional health and boosting post-surgery recovery. Distractive games-based procedures should be considered for incorporation in the pre-surgery clinical workflow in order to optimise healthcare.

PMID:35075716 | DOI:10.1111/jocn.16227

Eur J Neurol. 2022 Jan 24. doi: 10.1111/ene.15258. Online ahead of print.

ABSTRACT

BACKGROUND: There are no systematic reviews of cerebrospinal fluid and blood biomarkers for sporadic Creutzfeldt-Jakob disease (sCJD) in specialised care settings that compare diagnostic accuracies in a network meta-analysis (NMA).

METHODS: We searched Medline, Embase, and Cochrane Library for diagnostic studies of sCJD biomarkers. Studies had to use established diagnostic criteria for sCJD and for diseases in the non-CJD groups, which had to represent a consecutive population of patients suspected as a CJD case, as reference standard. Risk of bias was assessed with QUADAS-2. We conducted individual biomarker meta-analyses with generalised bivariate models. To investigate heterogeneity, we performed subgroup analyses based on QUADAS-2 quality and clinical criteria. For the NMA, we applied a Bayesian beta-binomial ANOVA model. The study protocol was registered at PROSPERO (CRD42019118830).

RESULTS: Out of 2,976 publications screened, we included 16 studies, which investigated 14-3-3β (n=13), 14-3-3γ (n=3), neurofilament light chain (NfL, n=1), neuron specific enolase (n=1), p-tau181/t-tau ratio (n=2), RT-QuIC (n=7), S100B (n=3), t-tau (n=12), and t-tau/Aβ42 ratio (n=1). Excluded diagnostic studies had strong limitations in study design. In the NMA, RT-QuIC (0.91; 95% CI [0.83, 0.95]) and NfL (0.93 [0.78, 0.99]) were the most sensitive biomarkers for the diagnosis of definite, probable and possible sCJD cases. RT-QuIC was the most specific biomarker (0.97 [0.89, 1.00]). Heterogeneity in accuracy estimates was high between studies.

CONCLUSIONS: We identified RT-QuIC as the most accurate biomarker, partially confirming currently applied diagnostic criteria. The shortcomings identified in many diagnostic studies for sCJD biomarkers need to be addressed in future studies.

PMID:35075751 | DOI:10.1111/ene.15258

J Magn Reson Imaging. 2022 Jan 24. doi: 10.1002/jmri.28076. Online ahead of print.

ABSTRACT

BACKGROUND: Time-resolved three-directional velocity-encoded (4D flow) magnetic resonance imaging (MRI) enables the quantification of left ventricular (LV) intracavitary fluid dynamics and energetics, providing mechanistic insight into LV dysfunctions. Before becoming a support to diagnosis and patient stratification, this analysis should prove capable of discriminating between clearly different LV derangements.

PURPOSE: To investigate the potential of 4D flow in identifying fluid dynamic and energetics derangements in ischemic and restrictive LV cardiomyopathies.

STUDY TYPE: Prospective observational study.

POPULATION: Ten patients with post-ischemic cardiomyopathy (ICM), 10 patients with cardiac light-chain cardiac amyloidosis (AL-CA), and 10 healthy controls were included.

FIELD STRENGTH/SEQUENCE: 1.5 T/balanced steady-state free precession cine and 4D flow sequences.

ASSESSMENT: Flow was divided into four components: direct flow (DF), retained inflow, delayed ejection flow, and residual volume (RV). Demographics, LV morphology, flow components, global and regional energetics (volume-normalized kinetic energy [KE_V ] and viscous energy loss [EL_V ]), and pressure-derived hemodynamic force (HDF) were compared between the three groups.

STATISTICAL TESTS: Intergroup differences in flow components were tested by one-way analysis of variance (ANOVA); differences in energetic variables and peak HDF were tested by two-way ANOVA. A P-value of <0.05 was considered significant.

RESULTS: ICM patients exhibited the following statistically significant alterations vs. controls: reduced KE_V , mostly in the basal region, in systole (-44%) and in diastole (-37%); altered flow components, with reduced DF (-33%) and increased RV (+26%); and reduced basal-apical HDF component on average by 63% at peak systole. AL-CA patients exhibited the following alterations vs. controls: significantly reduced KE_V at the E-wave peak in the basal segment (-34%); albeit nonstatistically significant, increased peaks and altered time-course of the HDF basal-apical component in diastole and slightly reduced HDF components in systole.

DATA CONCLUSION: The analysis of multiple 4D flow-derived parameters highlighted fluid dynamic alterations associated with systolic and diastolic dysfunctions in ICM and AL-CA patients, respectively.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 3.

PMID:35075711 | DOI:10.1002/jmri.28076

Stat Med. 2022 Jan 25. doi: 10.1002/sim.9308. Online ahead of print.

ABSTRACT

Major advances have been made regarding the utilization of machine learning techniques for disease diagnosis and prognosis based on complex and high-dimensional data. Despite all justified enthusiasm, overoptimistic assessments of predictive performance are still common in this area. However, predictive models and medical devices based on such models should undergo a throughout evaluation before being implemented into clinical practice. In this work, we propose a multiple testing framework for (comparative) phase III diagnostic accuracy studies with sensitivity and specificity as co-primary endpoints. Our approach challenges the frequent recommendation to strictly separate model selection and evaluation, that is, to only assess a single diagnostic model in the evaluation study. We show that our parametric simultaneous test procedure asymptotically allows strong control of the family-wise error rate. A multiplicity correction is also available for point and interval estimates. Moreover, we demonstrate in an extensive simulation study that our multiple testing strategy on average leads to a better final diagnostic model and increased statistical power. To plan such studies, we propose a Bayesian approach to determine the optimal number of models to evaluate simultaneously. For this purpose, our algorithm optimizes the expected final model performance given previous (hold-out) data from the model development phase. We conclude that an assessment of multiple promising diagnostic models in the same evaluation study has several advantages when suitable adjustments for multiple comparisons are employed.

PMID:35075684 | DOI:10.1002/sim.9308

Mov Disord. 2022 Jan 24. doi: 10.1002/mds.28935. Online ahead of print.

NO ABSTRACT

PMID:35075696 | DOI:10.1002/mds.28935

Fam Process. 2022 Jan 24:e12755. doi: 10.1111/famp.12755. Online ahead of print.

ABSTRACT

OBJECTIVE: Child asthma disparities are prevalent in socio-economically stressed single-parent families. Stress impacts childhood asthma mediated by immune and autonomic pathways, but specific family stress pathways are not well established. This study tests the hypothesis, derived from a version of the Biobehavioral Family Model, that single parent maternal depression impacts child asthma mediated by insecure attachment and child depression.

METHODS: In a cross-sectional study, children with asthma (age 7-17 years old) from a socio-economically disadvantaged population and their single parent mothers (N = 202) were assessed for depression and attachment security. Child asthma disease activity was assessed by symptom report and lung function tests. Structural equation modeling (SEM) was used to test a model in which caregiver depression impacts child asthma disease activity mediated by insecure attachment and child depression.

RESULTS: SEM results indicated that maternal depression statistically predicted child depression (β = 0.21, p < 0.01) and insecure mother-child attachment (β = 0.17, p < 0.05). In addition, insecure attachment statistically predicted child depression (β = 0.50, p < 0.001). Child depression mediated the adverse effects of maternal depression and insecure attachment on child asthma disease activity (β = 0.43, p < 0.01). There was no direct effect of insecure attachment on child asthma.

CONCLUSION: In single-parent families, maternal depression may impact child asthma disease activity, mediated serially by insecure attachment and child depression. Longitudinal and/or intervention studies are needed to establish a causal effect. These findings suggest that caregiver depression and parent-child relationships may be important targets for family intervention. These interventions may help improve child asthma outcomes and reduce health disparities.

PMID:35075639 | DOI:10.1111/famp.12755

J Sch Health. 2022 Jan 24. doi: 10.1111/josh.13136. Online ahead of print.

ABSTRACT

BACKGROUND: School settings offer an opportunity to impact student health and wellness. Quality wellness policies are important in establishing strong wellness environments, but current resources to support policy development, maintenance, and dissemination are lacking. The Building Healthy Schools Program aimed to develop capacity of school districts to improve the strength and comprehensiveness of wellness policies and sustain these activities.

METHODS: Fifteen school districts in Pennsylvania participated in a program to facilitate the improvement of district wellness policies and practices. Program staff provided technical assistance to evaluate wellness policies before and after program implementation. Professional development and tailored training was provided for school personnel to create sustainability. Statistical analysis was performed to evaluate policy improvement.

RESULTS: Thirteen of the 15 participating districts completed a policy revision. Median strength (p = .001) and comprehensiveness (p = .002) scores improved from baseline to post-program and there were significant improvements in most assessment sub-sections. Some districts were hesitant to make strong language improvements due to their limited capacity (ie, staff) for implementation. Champions (n = 13; 87%) reported confidence to revise wellness policy language independently in the future.

CONCLUSIONS: Technical assistance provided to districts facilitated significant improvements to wellness policy language, especially in the implementation, evaluation, and communication; critical components for policy impact on school wellness environments. In addition, participant feedback suggested an ability to sustain activities in the future. Both external (ie, technical assistance) and internal resources are needed to facilitate school districts’ ongoing wellness policy improvement and implementation, including improved model wellness policy language and enforcement within schools, respectively.

PMID:35075644 | DOI:10.1111/josh.13136

J Child Psychol Psychiatry. 2022 Jan 24. doi: 10.1111/jcpp.13572. Online ahead of print.

ABSTRACT

BACKGROUND: While transactional models suggest that parent and child mental health reciprocally influence one another over development, research has largely focused on parent-to-child effects. Additionally, it is not known whether observed associations hold when appropriate statistical tools are used to operationalise within-family dynamics.

METHODS: We investigated within-family mental health dynamics using autoregressive latent trajectory models with structured residuals, stratified by child gender. Parental psychological distress was assessed using the Kessler (K6) scale, and children’s internalising and externalising problems were assessed using the Strengths and Difficulties Questionnaire. Both measures were administered at the age 3, 5, 7, 11, 14 and 17 waves of the Millennium Cohort Study (N = 10,746, ~50% female).

RESULTS: Maternal psychological distress was positively associated with subsequent internalising and externalising problems for girls but only with internalising problems for boys. Paternal psychological distress was associated with boys’ later internalising and externalising problems during early adolescence. Among boys, internalising problems were associated with later maternal psychological distress, while externalising problems were associated with later paternal psychological distress. Among girls, internalising problems were associated with subsequent paternal psychological distress, while externalising problems were associated with later maternal psychological distress. Finally, maternal and paternal psychological distress showed negative bidirectional associations in early childhood but positive associations in middle childhood and early adolescence.

CONCLUSIONS: Findings support a transactional model of family mental health, with both child-to-parent and parent-to-child effects playing a role in the development of mental health difficulties. Mental health intervention efforts should, therefore, target the whole family system.

PMID:35075634 | DOI:10.1111/jcpp.13572

Urol J. 2022 Jan 25. doi: 10.22037/uj.v19i.6946. Online ahead of print.

ABSTRACT

PURPOSE: Although extracorporeal shockwave lithotripsy (SWL) has been confirmed to be effective in treating ureteral stone, a definitive conclusion which patient’s position is optimal option during SWL treatment remains unclear. We therefore performed this updated meta-analysis to further clarify it.

MATERIALS AND METHODS: PubMed, Embase and Cochrane library were performed to capture all potentially eligible studies from their inception to October 2020. After screening eligible studies, extracting essential data, and assessing the risk of bias, we used STATA 14.0 to complete all statistical analyses.

RESULTS: We included 7 studies involving 8 cohorts in the final analysis. Our meta-analysis suggested that the prone position was inferior to supine position in terms of stone fragmentation and stone clearance rate after completing first treatment (95% CI: 0.30-0.63; OR = 0.44;), however subgroup analysis indicated that the difference between supine and prone positions for stone fragmentation and stone clearance rate was only getting statistical significance for distal ureteral stone (95% CI: 0.23-0.53; OR = 0.35). Moreover, subgroup analysis of two eligible randomized controlled trials suggested that the mean number of sessions per patient in the supine group was less than that in the prone group (95% CI: 0.11-0.48; WMD = 0.294). No major and severe complication was detected to be done with the association with positions.

CONCLUSION: SWL of the supine position may be the preferred option because this strategy can increase the distal ureteral stone-free rate compared to the prone position.

PMID:35075627 | DOI:10.22037/uj.v19i.6946