Tag: statistics

Saudi Med J. 2021 Jul;42(7):728-734. doi: 10.15537/smj.2021.42.7.20200797.

ABSTRACT

OBJECTIVES: To estimate the prevalence mono-resistant tuberculosis (MR-TB) and multidrug resistant TB (MDR-TB), and evaluate the risk factors associated with the drug-resistant tuberculosis (DR-TB).

METHODS: A descriptive, retrospective study was applied, utilizing the TB patients’ medical records at King Fahd Armed Forces Hospital (KFAFH), Jeddah, Saudi Arabia. The records of patients notified between 2000 and 2018 were reviewed and culture positive cases for Mycobacterium tuberculosis species were included. Moreover, the risk factors included were age, gender, smoking history, renal disease, liver disease, hyperbilirubinemia, diabetes mellitus, and human immunodeficiency virus (HIV).

RESULTS: Nine hundred and one cases in entirety were involved in the research, out of which 193 had drug-resistant tuberculosis (DR-TB) (21.4%). Out of the 21.4% DR-TB, 91.7% were MR-TB and 8.3% were MDR-TB. The highest MR prevalence was for pyrazinamide at 33.4%, while the lowest resistance was for ethambutol at 7.1%. For the risk factors of drug-resistant TB, only age depicted a statistically significant (p<0.01) but weak negative (r= -0.145) correlation with anti-TB drug resistance.

CONCLUSION: Rates of DR-TB reported in the study are considered higher compared to the recently reported national and international rates. According to the results, only younger people are at risk of developing DR-TB. Moreover, genetic mutation may play a role in drug resistance among our cases specifically for pyrazinamide monoresistance.

PMID:34187916 | DOI:10.15537/smj.2021.42.7.20200797

Saudi Med J. 2021 Jul;42(7):769-775. doi: 10.15537/smj.2021.42.7.20200750.

ABSTRACT

OBJECTIVES: To compare the clinicopathological, histological and immunohistochemical features of breast cancer (BC) in between young (≤40 years) and older (>40 years) patients.

METHODS: This retrospective study included histopathological reports of all patients with primary BC diagnose at the King Fahad Hospital, Madinah, Saudi Arabia between January 2006 and November 2020.

RESULTS: During the study period, a total of 708 patients with BC were identified; 173 cases (24.4%) were ≤40 years old and 535 (75.6%) were above 40 years. There were significant differences in tumor size (p=0.046), tumor grade (p<0.0001), tumor stage (p=0.047), lymphovascular invasion (p<0.0001), and distant metastasis (p<0.0001) between the 2 groups. Comparing the status of the hormone receptors and molecular subtypes between the 2 age groups, BCs in the younger patients were triple-negative (p=0.008) in majority of the cases and less likely to be estrogen receptor (ER) and progesterone receptor (PR) hormone receptors-positive (p=0.0001, p<0.0001). Young patients exhibited the HER2/neu type with more frequent statistical significance (p=0.016) and the tumor type luminal A (p=0.002) with less frequent statistical significance compared to old patients.

CONCLUSION: Although BC in young women is uncommon, it may be different with regards to poor prognostic outcomes, which are attributed to more aggressive histopathological features and less favorable receptor status when compared to the cases diagnosed in older women.

PMID:34187921 | DOI:10.15537/smj.2021.42.7.20200750

Ortop Traumatol Rehabil. 2021 Jun 30;23(3):181-192. doi: 10.5604/01.3001.0014.9155.

ABSTRACT

BACKGROUND: Traumatic musculoskeletal injuries are more and more frequently regarded as an important health, social and economic problem. According to WHO statistics, injuries are a major present-day health problem. The main aim of the study is to identify the number of new patients who sustained knee structure injuries during a year and to classify them based on data on services provided under National Health Fund agreements.

MATERIAL AND METHODS: Information on the number of patients with a knee injury was obtained in a three stage process. First an inventory of relevant diagnoses was determined. Then, the National Health Fund data from 2016-2019 was queried in accordance with the adopted methodology and assumptions. The analysis was based on the report submitted by the NHF in response to the query.

RESULTS: According to the NHF reporting data, knee injuries affect approx. 244,000 people per year. There are slightly more men (approx. 52%) than women (48%). People aged 11-20 years constitute the most numerous group of patients with knee injuries, with approx. 41,342 cases per year. The most frequently reported diagnoses in both groups were S80.0 Contusion of knee (approx. 30%), S83.6 Sprain and tear of other and unspecified parts of knee (approx. 21%) and M23.8 Other internal derangements of knee (approx. 9%). According to available data, the overall rate of knee injuries in 2019 was 6.4 per 1000 population.

CONCLUSIONS: 1. Knee injuries pose a major health problem. In Poland, according to the reporting data, approx. 244,000 knee injuries occur every year. 2. Knee injuries are more common among men than women, and people aged 11-20 years constitute the most numerous group of patients. 3. The National Health Fund reporting data is a very valuable source of information on the magnitude of the problem of injuries.

PMID:34187936 | DOI:10.5604/01.3001.0014.9155

Proc Natl Acad Sci U S A. 2021 Jul 13;118(28):e2026664118. doi: 10.1073/pnas.2026664118.

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic is heterogeneous throughout Africa and threatening millions of lives. Surveillance and short-term modeling forecasts are critical to provide timely information for decisions on control strategies. We created a strategy that helps predict the country-level case occurrences based on cases within or external to a country throughout the entire African continent, parameterized by socioeconomic and geoeconomic variations and the lagged effects of social policy and meteorological history. We observed the effect of the Human Development Index, containment policies, testing capacity, specific humidity, temperature, and landlocked status of countries on the local within-country and external between-country transmission. One-week forecasts of case numbers from the model were driven by the quality of the reported data. Seeking equitable behavioral and social interventions, balanced with coordinated country-specific strategies in infection suppression, should be a continental priority to control the COVID-19 pandemic in Africa.

PMID:34187879 | DOI:10.1073/pnas.2026664118

Saudi Med J. 2021 Jul;42(7):714-720. doi: 10.15537/smj.2021.42.7.20210082.

ABSTRACT

OBJECTIVES: To develop an externally validated multivariable prognostic model for an underprivileged dialysis population.

METHODS: This was a multicenter retrospective cohort study of 5 years duration from January 2013 to December 2017. A total of 758 patients (37.5% female; mean±SD age, 44.26±14.77 years) were enrolled for construction of the prognostic model. The data were analyzed using a proportional hazards model to identify predictors of survival. Three risk groups were identified at the 25th and 75th percentiles of the resultant prognostic index. The model was externally validated with another dataset of 622 dialysis patients.

RESULTS: The prognostic index included 5 predictor variables: hemoglobin, serum potassium, interdialytic weight gain, serum albumin, and duration of dialysis, which had good predictive performance on the calibration and discrimination aspects of the model (Harrell’s c statistic: 0.748, Gonen and Heller k statistic: 0.647, Somers’ D statistic: 0.496, calibration slope: 1.156). There were significant interaction effects between weight and hemoglobin, weight and albumin, albumin and potassium, and albumin and hemoglobin.

CONCLUSIONS: We developed an externally validated model that contained 5 routinely collected prognosticators and confirmed its calibration and discrimination abilities in obtaining reliable prognostic estimates in developing countries. The model will assist clinicians in deciding the prognosis of dialysis patients. The application of this model in different clinical settings of developing countries can indicate interesting findings regarding public health.

PMID:34187914 | DOI:10.15537/smj.2021.42.7.20210082

Cancer Epidemiol Biomarkers Prev. 2021 Jun 29:cebp.0404.2021. doi: 10.1158/1055-9965.EPI-21-0404. Online ahead of print.

ABSTRACT

BACKGROUND: Results of observational studies of the association between dietary fat and risk of invasive breast cancer (BC) have been inconsistent. In the Women’s Health Initiative Dietary Modification (DM) randomized trial designed to lower fat intake, the intervention was not associated with a statistically significant reduction of overall BC risk. However, the DM association with risk of ductal carcinoma in situ (DCIS) of the breast, a putative breast cancer precursor, has not been reported.

METHODS: A total of 48,835 postmenopausal women, ages 50-79 years (y) at enrollment, with no BC history and {greater than or equal to}32% of total energy intake from fat, were randomly assigned either to a dietary intervention (n=19,541) designed to reduce total fat intake to 20% of energy and to increase vegetable, fruit and grain consumption, or to a comparison group (n=29,294). Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals for the association between the intervention and DCIS risk.

RESULTS: During 18.7y (median) cumulative follow-up, including intervention (~8.7y) and post-intervention phases (~13.0y), 817 DCIS cases were ascertained. No evidence of an association between the DM intervention and DCIS risk was observed overall, or by trial phase (intervention and post-intervention). Similarly, no associations were found in subgroups defined by potential risk factors for DCIS.

CONCLUSIONS: Dietary modification aiming to reduce fat intake was not associated with altered risk of DCIS.

IMPACT: These results do not provide evidence of an association between dietary fat reduction and the risk of DCIS among postmenopausal women.

PMID:34187856 | DOI:10.1158/1055-9965.EPI-21-0404

J Neurol Neurosurg Psychiatry. 2021 Jun 29:jnnp-2021-326920. doi: 10.1136/jnnp-2021-326920. Online ahead of print.

NO ABSTRACT

PMID:34187868 | DOI:10.1136/jnnp-2021-326920

BMJ Open. 2021 Jun 29;11(6):e046913. doi: 10.1136/bmjopen-2020-046913.

ABSTRACT

INTRODUCTION: Metacarpal shaft fractures (MSF) are common traumatic hand injuries that usually affect young people of working age. They place a significant burden on healthcare resources and society; however, there is a lack of evidence to guide their treatment. Identifying the most beneficial and cost-efficient treatment will ensure optimisation of care and provide economic value for the National Health Service. The aim of this study is to assess the feasibility of a randomised controlled trial comparing surgical and non-surgical treatment for MSF in adults.

METHODS AND ANALYSIS: This is a multicentre prospective cohort study, with a nested qualitative study consisting of patient interviews and focus groups, and an embedded factorial randomised substudy evaluating the use of text messages to maximise data collection and participant retention. The outcomes of interest include eligibility, recruitment and retention rates, completion of follow-up, evaluation of primary outcome measures, calculation of the minimal clinically important difference (MCID) for selected outcome measures and establishing the feasibility of data collection methods and appropriate time-points for use in a future trial. Data will be captured using a secure online data management system. Data analyses will be descriptive and a thematic inductive analysis will be used for qualitative data. Minimum clinically important effects for each patient-reported outcome measure will be estimated using anchor-based responsiveness statistics and distribution-based methods.

ETHICS AND DISSEMINATION: This study has received ethical approval from the Research Ethics Committee and the Health Research Authority (REC reference 20/EE/0124). Results will be made available to patients, clinicians, researchers and the funder via peer-reviewed publications and conference presentations. Social media platforms, local media and feedback from the Patient Advisory Group will be used to maximise circulation of findings to patients and the public.

TRIAL REGISTRATION NUMBER: ISRCTN13922779.

PMID:34187822 | DOI:10.1136/bmjopen-2020-046913

BMJ Open. 2021 Jun 29;11(6):e046943. doi: 10.1136/bmjopen-2020-046943.

ABSTRACT

INTRODUCTION: Non-pharmacological approaches are recommended as first-line treatment for patients with fibromyalgia. This randomised controlled trial investigated the effects of a multicomponent rehabilitation programme for patients with recently diagnosed fibromyalgia in primary and secondary healthcare.

METHODS: Patients with widespread pain ≥3 months were referred to rheumatologists for diagnostic clarification and assessment of study eligibility. Inclusion criteria were age 20-50 years, engaged in work or studies at present or during the past 2 years, and fibromyalgia diagnosed according to the American College of Rheumatology 2010 criteria. All eligible patients participated in a short patient education programme before inclusion and randomisation. The multicomponent programme, a 10-session mindfulness-based and acceptance-based group programme followed by 12 weeks of physical activity counselling was evaluated in comparison with treatment as usual, that is, no treatment or any other treatment of their choice. The primary outcome was the Patient Global Impression of Change (PGIC). Secondary outcomes were self-reported pain, fatigue, sleep quality, psychological distress, physical activity, health-related quality of life and work ability at 12-month follow-up.

RESULTS: In total, 170 patients were randomised, 1:1, intervention:control. Overall, the multicomponent rehabilitation programme was not more effective than treatment as usual; 13% in the intervention group and 8% in the control group reported clinically relevant improvement in PGIC (p=0.28). No statistically significant between-group differences were found in any disease-related secondary outcomes. There were significant between-group differences in patient’s tendency to be mindful (p=0.016) and perceived benefits of exercise (p=0.033) in favour of the intervention group.

CONCLUSIONS: A multicomponent rehabilitation programme combining patient education with a mindfulness-based and acceptance-based group programme followed by physical activity counselling was not more effective than patient education and treatment as usual for patients with recently diagnosed fibromyalgia at 12-month follow-up.

TRIAL REGISTRATION NUMBER: BMC Registry (ISRCTN96836577).

PMID:34187823 | DOI:10.1136/bmjopen-2020-046943

BMJ Open. 2021 Jun 29;11(6):e049590. doi: 10.1136/bmjopen-2021-049590.

ABSTRACT

OBJECTIVES: To evaluate the impact of the first COVID-19 lockdown in 2020 on the burnout and study satisfaction of medical students.

DESIGN: A cross-sectional study with a presurvey and postsurvey.

SETTING: University of Split School of Medicine (USSM), Split, Croatia. The lockdown in the COVID-19 pandemic lasted from late March to mid-May 2020. There was a full switch to e-learning at the USSM during this period, and all clinical teaching was stopped.

PARTICIPANTS: Students enrolled in the 2019/2020 academic year. Data were collected before lockdown in December 2019 and January 2020 and again after the end of lockdown in June 2020.

PRIMARY AND SECONDARY OUTCOME MEASURES: Study satisfaction was assessed using the study satisfaction survey. Burnout was assessed using two instruments: Oldenburg Burnout Inventory and Copenhagen Burnout Inventory. We used Bayesian statistics to compare before-and-after differences.

RESULTS: 437 independent responses (77.2% response rate) were collected before and 235 after lockdown (41.5% response rate). 160 participant responses were eligible for pairing. There was no significant difference for both paired and unpaired participants in study satisfaction before (3.38 on a 1-5 scale; 95% credible interval (95% CrI) 3.32 to 3.44) and after (3.49, 95% CrI 3.41 to 3.57) lockdown. We found no evidence (Bayes factor (BF₁₀) >3.00 as a cut-off value) for an increase in the level of burnout before and after lockdown, both in independent and paired samples.

CONCLUSIONS: It seems that the first pandemic-related lockdown and a switch to e-learning did not affect burnout levels among medical students or their perception of their study programme. More insight is needed on the short-term and long-term effects of the COVID-19 pandemic on medical students and their education. Well-structured longitudinal studies on medical student burnout during the COVID-19 pandemic are needed.

PMID:34187830 | DOI:10.1136/bmjopen-2021-049590