Tag: statistics

Aust N Z J Public Health. 2021 Jun 7. doi: 10.1111/1753-6405.13122. Online ahead of print.

ABSTRACT

BACKGROUND: The acute effects of alcohol consumption are a major risk factor for suicide. Positive blood alcohol concentrations are present in almost one-third of all suicides at time of death. These suicides are defined as alcohol-related suicides. This cross-sectional study examines the geospatial distribution/clustering of high proportions of alcohol-related suicides and reports on socioeconomic and demographic risk factors.

METHODS: National Coronial Information System (NCIS) data were used to calculate proportions of suicides with alcohol present at the time of death for each level 3 statistical areas (SA3) in Australia. A density analysis and hotspot cluster analysis were used to visualise and establish statistically significant clustering of areas with higher (hotspots) and lower (coldspots) proportions. Subsequently, socioeconomic and demographic risk factors for alcohol use and suicide were reported on for hot and cold spots.

RESULTS: Significant clustering of areas with higher proportions of alcohol-related suicide occurred in northern Western Australia, the Northern Territory and Queensland, as well as inland New South Wales and inland Queensland. Clustering of SA3s with significantly lower proportions occurred in major city and inner regional Sydney and Melbourne. Conclusion and implications for public health: Results from this study identify areas in which prevention strategies should target alcohol use and can be used to inform prevention strategy design. Additionally, hotspots and coldspots identified in this study can be used for further analysis to better understand contextual risk factors for alcohol-related suicide.

PMID:34097331 | DOI:10.1111/1753-6405.13122

Ultrasound Obstet Gynecol. 2021 Jun 7. doi: 10.1002/uog.23706. Online ahead of print.

ABSTRACT

OBJECTIVE: Monochorionic pregnancies complicated by twin-twin transfusion syndrome (TTTS) and treated with fetoscopic laser photocoagulation (FLP) can be associated with neurodevelopmental impairment (NDI). This meta-analysis aimed to identify the prevalence and risk factors of NDI among TTTS survivors after FLP.

METHODS: We searched PubMed, Embase, Scopus and Web of Science, from the inception of the database until 13^th February 2021. Data regarding the severity of TTTS at the time of diagnosis (by Quintero staging), FLP procedure related complications and perinatal outcomes were compared between the survivors with and without NDI (defined as performance on a cognitive or developmental assessment tool > 2 SD below than the mean or a defined neurological disability). The random-effect model was used to pool the mean differences or odds ratios (OR) and the corresponding 95% confidence intervals (CIs). Heterogeneity was assessed using the I² value.

RESULTS: Nine studies with a total of 1499 TTTS survivors were included. The overall incidence of NDI was 14.0% (95% CI, 9.0-18.0%). Occurrence of NDI in TTTS survivors was associated with higher gestational age (GA) at FLP (weeks) (mean difference 0.94, 95% CI 0.50, 1.38, P <0.001; I² 0%), lower GA at delivery (weeks) (mean difference -1.44, 95% CI -2.28, -0.61, P <0.001; I² 49%) and lower birth weight (grams) (mean difference -343.26, 95% CI -470.59, -215.92, P <0.001; I² 27%). Using different GA cut-off values, preterm birth < 32 weeks was associated with risk of NDI later in childhood (OR 2.25, 95% CI 1.02, 4.94, P 0.04; I2 35%). No statistical difference was found between NDI vs non-NDI survivors in terms of Quintero staging, being recipient or donor status, development of post-laser TAPS, recurrence of TTTS, rates of small for gestational age (SGA) and co-twin fetal demise.

CONCLUSION: TTTS survivors with advanced GA at the time of FLP, lower GA at delivery and lower birth weight are at the higher risk of developing NDI. No significant association was found between Quintero staging and risk of NDI. Together, our findings may be helpful for parental counseling and highlighting the need for future studies to better understand the risk factors of NDI among TTTS survivors. This article is protected by copyright. All rights reserved.

PMID:34097320 | DOI:10.1002/uog.23706

J Am Geriatr Soc. 2021 Jun 7. doi: 10.1111/jgs.17286. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Homecare staff often take over activities instead of “doing activities with” clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients’ sedentary behavior and improve their independence. This study evaluated the effectiveness of the “Stay Active at Home” (SAaH) reablement training program for homecare staff on older homecare clients’ sedentary behavior.

DESIGN: Cluster randomized controlled trial (c-RCT).

SETTING: Dutch homecare (10 nursing teams comprising a total of 313 staff members).

PARTICIPANTS: 264 clients (aged ≥65 years).

INTERVENTION: SAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual.

MEASUREMENTS: Sedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed.

RESULTS: We found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI] -22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI -1.5, 2.6], p = 0.589) or for most secondary outcomes.

CONCLUSION: Our c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.

PMID:34097301 | DOI:10.1111/jgs.17286

Int Nurs Rev. 2021 Jun 7. doi: 10.1111/inr.12693. Online ahead of print.

ABSTRACT

AIM: To describe the impact of the COVID-19 pandemic on stress, resilience and depression in health professionals from a public hospital in Barcelona, Spain after the first peak of pandemic.

BACKGROUND: The COVID-19 pandemic in Spain has pushed boundaries in health systems and, especially, for health professionals. Analysis of resilience as an individual resource and it is essential to understand the mechanisms that make staff react unfavourably to stressors caused by the pandemic.

DESIGN: A descriptive cross-sectional study was designed.

PARTICIPANTS: Health professionals supervised by the nursing department, including registered nurses, health care assistants, health technicians, final year nurse student nurses, foreign nurses, and other nurse-related health workers.

METHODS: The study complies with the STROBE checklist for cross-sectional studies. An online survey was administered to all health professionals supervised by the nursing department between 6 and 27 May 2020. The survey included the ER-14 Resilience Scale, the widely-used PHQ-9 depression scale, the Spanish version of the Nursing Stress Scale, and an ad-hoc questionnaire to obtain sociodemographic and occupational variables.

RESULTS: A total of 686 participants answered the survey. Resilience was high or very high in health professionals, with an inverse correlation with stress and depression scores. Personal on fixed shifts showed better resilience. The most stressed health professionals were full-time registered nurses, followed by health care assistants. Up to 25% of nursing professionals had depression.

CONCLUSION: Our study showed a high degree of resilience among nurse professionals despite the overwhelming nature of the COVID-19 pandemic. Relevant signs of depression and stress were detected among participants. Occupational factors heavily influenced nurses’ resilience, stress and depression.

IMPLICATIONS FOR NURSING & HEALTH POLICY: Government policy shifts are needed in Spain to improve nurses’ workforce conditions, enhance the ratio of nurses to patient numbers, and avoid workforce losses. Maintaining the resilience of health professionals would assist in improving their health and their capacity to possible future emergency situations.

PMID:34097305 | DOI:10.1111/inr.12693

Methods Mol Biol. 2021;2326:167-195. doi: 10.1007/978-1-0716-1514-0_12.

ABSTRACT

Environmental epidemiology is a science that applies traditional epidemiology methods and combines the characteristics of the relationship between environment and population health, and studies the relationship between external environmental factors and population health from a macro perspective. The following methods are usually used. (1) Descriptive research: including ecological research and current situation research. (2) Analytical research: including case-control research and group research. (3) Experimental epidemiological research. In this section, according to the short-term and long-term effects of studying environmental risk factors, it is divided into two parts. Short-term effect methods include time series study, case-crossover study, and panel study. Long-term effect methods include cross-sectional study, case-control study, and cohort study.

PMID:34097268 | DOI:10.1007/978-1-0716-1514-0_12

Sports Med. 2021 Jun 7. doi: 10.1007/s40279-021-01486-x. Online ahead of print.

ABSTRACT

BACKGROUND: The relationship between exercise-induced muscle damage (EIMD) indicators and acute training loads (TL) is yet to be reviewed extensively in semi-elite and elite athlete populations.

OBJECTIVES: The objectives of this systematic review and meta-analysis were threefold: (1) to evaluate studies of EIMD following the initial period of the preseason in semi-elite and elite athletes: (2) to examine acute physiological and performance responses across two periods of the season with similar TL; and (3) to examine acute physiological and performance responses to acute changes in TL during the season.

METHODS: The CINAHL, PubMed, Scopus, SPORTDiscus and Web of Science databases were systematically searched for studies that investigated: (1) semi-elite or elite athletes in team or individual sports following a periodised training programme; and (2) measured acute responses to training. Studies were excluded if: (1) conducted in animals; (2) non-English language; or (3) a conference abstract, review or case report. The Kmet Quality Scoring of Quantitative Studies tool was used for study appraisal.

SYNTHESIS METHODS: Data were quantitatively analysed by generating forest plots to report test statistics for statistical significance and inter-trial heterogeneity.

RESULTS: Of the included studies (n = 32), athletes experienced greater creatine kinase (CK) concentrations (Z = 4.99, p < 0.00001, I² = 74%), inflammatory factors and other indirect measures of muscle damage in the initial phase of the preseason period compared to the off-season; there were no changes in CK (Z = 1.43, p = 0.15, I² = 74%) across two time points of similar TL; and there were concurrent increases in CK with increases in TL (Z = 4.26, p < 0.0001, I² = 36%) and vice versa (Z = 4.33, p < 0.0001, I² = 79%).The qualitative analysis identified that the response of inflammatory factors and other indirect measures of muscle damage to changes in load were inconclusive.

LIMITATIONS: This review included varying age, sex, sports and competition levels. The group level meta-analysis failed to identify within-athlete or position-specific differences across time.

CONCLUSION: Blood biomarkers of EIMD may not differ across periods of similar TL, however can be considered a sensitive monitoring tool for assessing responses following acute TL changes in semi-elite and elite athletes.

PMID:34097298 | DOI:10.1007/s40279-021-01486-x

J Am Geriatr Soc. 2021 Jun 7. doi: 10.1111/jgs.17295. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Hypertension treatment reduces cardiovascular events. However, uncertainty remains about benefits and harms of deintensification or further intensification of antihypertensive medication when systolic blood pressure (SBP) is tightly controlled in older multimorbid patients, because of their frequent exclusion in trials. We assessed the association of hypertension treatment deintensification or intensification with clinical outcomes in older adults with tightly controlled SBP.

DESIGN: Longitudinal cohort study (2011-2013) with 9-month follow-up.

SETTING: U.S.-nationwide primary care Veterans Health Administration healthcare system.

PARTICIPANTS: Veterans aged 65 and older with baseline SBP <130 mmHg and ≥1 antihypertensive medication during ≥2 consecutive visits (N = 228,753).

EXPOSURE: Deintensification or intensification, compared with stable treatment.

MAIN OUTCOMES AND MEASURES: Cardiovascular events, syncope, or fall injury, as composite and distinct outcomes, within 9 months after exposure. Adjusted logistic regression and inverse probability of treatment weighting (IPTW, sensitivity analysis).

RESULTS: Among 228,753 patients (mean age 75 [SD 7.5] years), the composite outcome occurred in 11,982/93,793 (12.8%) patients with stable treatment, 14,768/72,672 (20.3%) with deintensification, and 11,821/62,288 (19.0%) with intensification. Adjusted absolute outcome risk (95% confidence interval) was higher for deintensification (18.3% [18.1%-18.6%]) and intensification (18.7% [18.4%-19.0%]), compared with stable treatment (14.8% [14.6%-15.0%]), p < 0.001 for both effects in the multivariable model). Deintensification was associated with fewer cardiovascular events than intensification. At baseline SBP <95 mmHg, cardiovascular event risk was similar for deintensification and stable treatment, and fall risk lower for deintensification than intensification. IPTW yielded similar results. Mean follow-up SBP was 124.1 mmHg for stable treatment, 125.1 mmHg after deintensification (p < 0.001), and 124.0 mmHg after intensification (p < 0.001).

CONCLUSION: Antihypertensive treatment deintensification in older patients with tightly controlled SBP was associated with worse outcomes than continuing same treatment intensity. Given higher mortality among patients with treatment modification, confounding by indication may not have been fully corrected by advanced statistical methods for observational data analysis.

PMID:34097300 | DOI:10.1111/jgs.17295

Environ Sci Pollut Res Int. 2021 Jun 7. doi: 10.1007/s11356-021-14732-6. Online ahead of print.

ABSTRACT

This paper investigates the dynamic short-term and long-term relationships among real GDP per capita, energy consumption, urbanization, and carbon dioxide emissions within the framework of the environmental Kuznets curve (EKC) hypothesis for Southeastern Europe (SEE) from 1997 to 2014. The evidence highlights an inverted U-shaped nexus between real GDP per capita and carbon dioxide emissions (i.e., the EKC hypothesis is verified in the long-run in the sample as a whole). The short-run estimates provide evidence of inverted U-shaped EKC only for Greece and Moldova. Two-way causal relationship between urbanization and pollutant emission was also established in the short-run, as well as one-way causality flowing from real GDP per capita to pollutant emission. The coefficients with the real GDP per capita and energy consumption are negative and statistically significant in the long-term. These findings indicate the existence of an error correction mechanism that drives the observed variables back to their equilibrium. Moreover, the findings show that the consistent increase in energy consumption has not reduced environmental pressures.

PMID:34097219 | DOI:10.1007/s11356-021-14732-6

Obes Surg. 2021 Jun 7. doi: 10.1007/s11695-021-05455-1. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the efficacy and safety of the OAGB at least 10 years after surgery.

MATERIAL AND METHODS: We retrospectively reviewed our prospectively collected data on consecutive morbid patients with obesity receiving OAGB from January 2005 to December 2007.

RESULTS: A total of 385 patients met the inclusion criteria. The mean follow-up was 149 months. Of all patients, 52% underwent OAGB as a primary procedure and 48% as a revisional procedure. At the 10-year follow-up, the mean body mass index (BMI) was 30.7 ± 11.8, the mean %TWL was 33.4 ± 10.6, and the mean %EWL was 64.1 ± 24.6. We did not find a significant statistical difference in terms of weight loss between primary OAGB and secondary OAGB. In total, 43% of patients achieved a %EWL greater than 75%, while 29% of the patients had an EWL% that was below 50%. All of the comorbidities related to obesity showed a high improvement or fully resolved. Early complications occurred in 9 patients (2.3%), while the overall rate of late complications was 17.1%. Nineteen patients (4.9%) developed an ulcer at the gastrojejunal anastomosis level, nine patients (2.3%) were re-hospitalized for major malnutrition, thirty-eight patients (9.8%) showed a postoperative biliary reflux, and five patients (2.7%) experienced severe anemia, which required several hospitalizations for iron I.V. supplementation.

CONCLUSION: According to results of the present study, we believe that OAGB has shown to be a technique with a reasonable balance between long-term efficacy and undesirable sequelae.

PMID:34097238 | DOI:10.1007/s11695-021-05455-1

Psychometrika. 2021 Jun 7. doi: 10.1007/s11336-021-09771-4. Online ahead of print.

ABSTRACT

The model-implied instrumental variable (MIIV) estimator is an equation-by-equation estimator of structural equation models that is more robust to structural misspecifications than full information estimators. Previous studies have concentrated on endogenous variables that are all continuous (MIIV-2SLS) or all ordinal . We develop a unified MIIV approach that applies to a mixture of binary, ordinal, censored, or continuous endogenous observed variables. We include estimates of factor loadings, regression coefficients, variances, and covariances along with their asymptotic standard errors. In addition, we create new goodness of fit tests of the model and overidentification tests of single equations. Our simulation study shows that the proposed MIIV approach is more robust to structural misspecifications than diagonally weighted least squares (DWLS) and that both the goodness of fit model tests and the overidentification equations tests can detect structural misspecifications. We also find that the bias in asymptotic standard errors for the MIIV estimators of factor loadings and regression coefficients are often lower than the DWLS ones, though the differences are small in large samples. Our analysis shows that scaling indicators with low reliability can adversely affect the MIIV estimators. Also, using a small subset of MIIVs reduces small sample bias of coefficient estimates, but can lower the power of overidentification tests of equations.

PMID:34097200 | DOI:10.1007/s11336-021-09771-4