Tag: statistics

Andrology. 2021 Dec 22. doi: 10.1111/andr.13148. Online ahead of print.

ABSTRACT

BACKGROUND: In the literature, there is not sufficient data on factors affecting the development of complications in patients with penile fracture after early surgical intervention.

OBJECTIVES: To investigate the predictors of long-term complications in patients who underwent immediate surgical repair for penile fracture.

MATERIALS/METHODS: This clinical study included a total of 31 cases of penile fracture in which surgical treatment was performed within the first 24 hours and penile fracture was confirmed during the operation. The patients with and without late complications were compared in terms of parameters such as age, tear size of the tunica albuginea of the penis, bilateral involvement of the corpora cavernosa involvement, urethral injuries, and duration from penile fracture to surgery.

RESULTS: The median age of the patients was 42 (interquartile range [IQR]: 34-51) years. The median time from penile fracture to surgery was 13 (8-18) hours. The median tear size was 16 (11-21) mm. Late complications were seen in 13 (41.9%) patients in the postoperative period. Erectile dysfunction (ED) developed in five (16.1%) patients in the postoperative period. There was no statistically significant relationship between age, tear size, time from penile fracture to surgery, and bilateral corporeal involvement in terms of ED development. Painful erections, penile deviations, urethral strictures, tunical scars, and re-fracture were the other late complications. There was a significant relationship between the development of any complication and time from penile fracture to surgery (p = 0.028) and tear size (p = 0.031). In the receiver operating characteristic analysis of complication development, the cut-off value for the time from penile fracture to surgery was 13.5 hours.

DISCUSSION AND CONCLUSION: We found that the longer time interval between penile fracture and surgery worsened the patient outcomes. In addition, tear size was determined to be a predictor for long-term complications. In our opinion, early treatment of penile fracture can prevent severe complications in these cases. This article is protected by copyright. All rights reserved.

PMID:34939748 | DOI:10.1111/andr.13148

J Intellect Disabil Res. 2021 Dec 23. doi: 10.1111/jir.12907. Online ahead of print.

ABSTRACT

BACKGROUND: There is no widely used instrument to detect frailty in people with intellectual disabilities (IDs). We aimed to develop and validate a shorter and more practical version of a published frailty index for people with IDs.

METHOD: This study was part of the longitudinal ‘Healthy Ageing and Intellectual Disability’ study. We included 982 people with IDs aged 50 years and over. The previously developed and validated ID-Frailty Index consisting of 51 deficits was used as the basis for the shortened version, the ID-FI Short Form. Content of the ID-FI Short Form was based on statistics and clinical and practical feasibility. We evaluated the precision and validity of the ID-FI Short Form using the internal consistency, the correlation between the ID-FI Short Form and the original ID-Frailty Index, the agreement in dividing participants in the categories non-frail, pre-frail and frail, and the association with survival.

RESULTS: Seventeen deficits from the original ID-Frailty Index were selected for inclusion in the ID-FI Short Form. All deficits of the ID-FI Short Form are clinically and practically feasible to assess for caregivers and therapists supporting people with ID. We showed acceptable internal consistency with Cronbach’s alpha of 0.75. The Pearson correlation between the ID-Frailty Index and the ID-FI Short Form was excellent (r = 0.94, P < 0.001). We observed a good agreement between the full and short forms in dividing the participants in the frailty categories, with a kappa statistic of 0.63. The ID-FI Short Form was associated with survival; with every 1/100 increase on the ID-FI Short Form, the mortality probability increased by 7% (hazard ratio 1.07, P < 0.001).

CONCLUSION: The first validation of the ID-FI Short Form shows it to be a promising, practical tool to assess the frailty status of people with ID.

PMID:34939710 | DOI:10.1111/jir.12907

Acta Ophthalmol. 2021 Dec 23. doi: 10.1111/aos.15085. Online ahead of print.

ABSTRACT

PURPOSE: To study the safety and efficacy of indirect ophthalmoscopy with (Sp) or without (speculum free, SpF) the use of lid speculum and scleral indentation for retinopathy of prematurity (ROP) screening.

METHODS: In this crossover randomized controlled trial, preterm infants received either the Sp on their first and the SpF technique on their second examination a week later or vice versa. Video recordings of the infants’ reactions were assessed by two observers, using Premature Infant Pain Profile-Revised score and the crying score of the Bernese Pain Scale for Neonates. Fundoscopy adequacy, its duration and adverse events within the first 24 hr postscreening were also recorded.

RESULTS: Thirty-seven infants with median (interquartile range) gestational age of 28.7 (28.0, 30.2) weeks and mean (standard deviation, SD) birth weight 1225 (377) grams were enrolled. The mydriasis-induced stress was similar between the Sp and SpF exam (mean difference [MD]: 0.78, 95% confidence interval [CI]: -0.83, 2.38; p = 0.33). The stress induced by fundoscopy (MD: 4.98, 95% CI: 3.58, 6.37; p < 0.001) and examination overall (MD: 2.32, 95% CI: 0.96, 3.67; p = 0.001) were higher in the Sp than in the SpF exam, and so was the crying score during fundoscopy (MD: 1.31, 95% CI: 1.06, 1.56; p < 0.001). Adverse events in the two groups were similar (p = 0.13). Fundoscopy was adequate in identifying the absence of treatment-requiring ROP in all cases, and lasted longer in the Sp than in the SpF exam (p < 0.001).

CONCLUSION: Our study suggests that the use of speculum and indentation should be reserved for the few cases where fundus visualization is insufficient for excluding the presence of severe ROP.

PMID:34939742 | DOI:10.1111/aos.15085

J Magn Reson Imaging. 2021 Dec 23. doi: 10.1002/jmri.28021. Online ahead of print.

ABSTRACT

BACKGROUND: Because of long diagnostic intervals, soft-tissue sarcoma (STS) patients can undergo several MRIs before treatments. However, only the latest pre-treatment MRI is used in clinical practice and the natural changes in MRI presentations of STS occurring before any medical procedure remain unknown.

PURPOSE: To qualitatively and quantitatively depict the natural history of MRI presentations of STS prior to medical intervention, to investigate their prognostic value, and to compare methods to calculate the changes in radiomics features (named delta-radiomics features).

STUDY TYPE: Retrospective.

SUBJECTS: Sixty-eight patients with locally advanced histologically proven STS and two pre-treatment contrast-enhanced (CE) MRIs (median age: 64 years, median delay between MRIs: 77 days).

FIELD STRENGTH/SEQUENCE: Two-dimensional (2D) turbo spin echo (TSE) T1-weighted-imaging (WI) and T2-WI; 2D TSE or 3D gradient echo CE-T1-WI at 1.5 T. Radiomics analysis was performed on 2D TSE CE-T1-WI.

ASSESSMENT: Three radiologists independently reported morphological features, evaluating changes in STS dimensions, intra-tumoral necrotic and hemorrhagic signals and heterogeneity, and changes in the tumor peritumoral enhancement, edema, and tail sign. After homogenizing the MRIs to account for differences in acquisition parameters, STS were 3D-segmented on both CE-T1-WI MRIs and radiomic features (RFs) were extracted. Changes in RFs between the two MRIs were calculated according to five methods: absolute, absolute/time between MRIs, relative, relative/time between MRIs, and log ratio. Histopathological samples were reviewed to count mitosis and Ki67 immunostaining. Survival data regarding local relapse, metastatic relapse, and disease-related deaths were collected.

STATISTICAL TESTS: Reproducibility analysis (using intra-class correlation coefficient and [weighted] kappa), hierarchical clusterings based on changes in RFs, survival analyses (using Cox regressions), and association with histopathology (using Student’s t-test, Wilcoxon, or Chi-squared test). A P-value of <0.05 was considered to be statistically significant.

RESULTS: There were 15 and 26 local and metastatic progressions, respectively. Average tumor size increase between scans was +39.8%. Metastatic relapse-free survival (MFS) was associated with: increases in size, tumor heterogeneity on T1-WI, T2-WI, and CE-T1-WI, necrotic signal, peritumoral enhancement, and tail sign. Local relapse-free survival (LFS) was associated with: increase in tumor heterogeneity on T1-WI, necrotic signal, hemorrhagic signal and peritumoral edema, and clusters based on the logarithmic changes in RFs (Log-RF). Increase in heterogeneity on CE-T1-WI and Log-RF clusters were independent predictors for MFS and LFS, respectively, in stepwise multivariate Cox regression (hazard ratio [HR] = 2.78 and HR = +∞ respectively). Associations were found between changes in necrotic signal, heterogeneity on CE-T1-WI and peritumoral enhancement, and histological markers of proliferation.

DATA CONCLUSION: Changes in MRI presentation of STS before any treatment are frequent, associated with histopathology, and could help in patients’ prognostication, in addition to baseline MRI feature.

LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 3.

PMID:34939705 | DOI:10.1002/jmri.28021

J Child Psychol Psychiatry. 2021 Dec 23. doi: 10.1111/jcpp.13564. Online ahead of print.

ABSTRACT

BACKGROUND: Measures based on pupillometry, such as the pupillary light reflex (PLR) and baseline pupil size, reflect physiological responses linked to specific neural circuits that have been implicated as atypical in some psychiatric and neurodevelopmental conditions.

METHODS: We investigated the contribution of genetic and environmental factors to the baseline pupil size and the PLR in 510 infant twins assessed at 5 months of age (281 monozygotic and 229 dizygotic pairs), and its associations with common genetic variants associated with neurodevelopmental (autism spectrum disorder and attention deficit hyperactivity disorder) and mental health (bipolar disorder, major depressive disorder and schizophrenia) conditions using genome-wide polygenic scores (GPSs).

RESULTS: Univariate twin modelling showed high heritability at 5 months for both pupil size (h² = .64) and constriction in response to light (h² = .62), and bivariate twin modeling indicated substantial independence between the genetic factors influencing each (r_G = .38). A statistically significant positive association between infant tonic pupil size and the GPS for schizophrenia was found (β = .15, p = .024), while there was no significant association with the GPS for autism or any other GPSs.

CONCLUSIONS: This study shows that some pupil measures are highly heritable in early infancy, although substantially independent in their genetic etiologies, and associated with common genetic variants linked to schizophrenia. It illustrates how genetically informed studies of infants may help us understand early physiological responses associated with psychiatric disorders which emerge much later in life.

PMID:34939671 | DOI:10.1111/jcpp.13564

Indoor Air. 2021 Dec 23. doi: 10.1111/ina.12978. Online ahead of print.

ABSTRACT

A three-dimensional (3D) printing pen is a popular writing instrument that uses a heated nozzle, and is similar to a 3D-printer. Processing thermoplastic filaments with a 3D-pen can emit ultrafine particles (UFPs). 3D-pen education sessions were held with “∏”-shaped partitions for the prevention of coronavirus disease (COVID-19). This study aimed to characterize UFP emissions from two types of 3D-pens and evaluate the influence of “∏”-shaped partitions on UFP exposure. Measurements of UFP emission rates and the size distribution of particles emitted from 3D-pens were conducted in a chamber (2.5 m³ ). The partition’s influence on UFP exposure was evaluated with and without a “∏”-shaped partition on a desk. A scanning mobility particle sizer (SMPS) and an optical particle spectrometer (OPS) were used to measure the particle number concentration (PNC) and size distribution. For both 3D-pen A and B, the average emission rates were statistically significantly highest for acrylonitrile butadiene styrene (ABS) filament (8.4 × 10⁶ [3.4] particles/min and 1.1 × 10⁶ [1.8] particles/min), followed by polylactic acid (PLA) (2.8 × 10⁵ [1.5] particles/min and 4.8 × 10⁴ [1.8] particles/min) and polycaprolactone (PCL) filaments (1.4 × 10⁴ [2.8] particles/min and 2.0 × 10⁴ [2.8] particles/min). For all filaments, particles in the Aitken mode (30-100 nm) accounted for the highest proportion. In 3D-pen A, PNCs were higher with the partition than without it for ABS (1.2 × 10⁶ [1.15] particles/cm³ vs. 1.4 × 10⁵ [1.29] particles/cm³ ) and PLA (6.2 × 10⁵ [1.38] particles/cm³ vs. 8.9 × 10⁴ [1.12] particles/cm³ ), whereas for 3D-pen B, they were higher with the partition for ABS (9.6 × 10⁵ [1.13] particles/cm³ vs. 4.9 × 10⁵ [1.22] particles/cm³ ) only. With the partition installed, PNCs decreased to the background level after the operation ended, whereas it took 2-6 min without the partition. However, the mass concentrations of PLA and PCL with 3D-pen A were not statistically significantly different with respect to the partition status. The use of 3D-pens with a partition can lead to high UFP exposure. Therefore, guidelines are required for the safe use of 3D-pens and partitions.

PMID:34939703 | DOI:10.1111/ina.12978

Med Lav. 2021 Dec 23;112(6):496-505. doi: 10.23749/mdl.v112i6.12285.

ABSTRACT

OBJECTIVE: To evaluate the psychological state of healthcare workers (HCWs) in the field of rehabilitation during the COVID-19 pandemic.

METHODS: Cross-sectional observational study. Sample of 334 HCWs including: nurses, medical doctors, therapists, scientists, and clerical workers working at the IRCCS San Raffaele Roma rehabilitation hospital during the second wave of the COVID-19 pandemic. Anonymous web-based questionnaire included 14-item Resilience Scale, Brief-COPE, Hospital Anxiety Depression Scale, Fear of COVID-19 Scale. Occupational and sociodemographic characteristics.

RESULTS: High levels of resilience, low levels of anxiety, depression, and fear were observed in the study population; the most frequently used coping strategies in the Brief-COPE were acceptance, planning, and active coping. Specifically, 87% of the participants reported a moderate to high level of resilience, with the highest level observed in nurses while physicians show the lowest level. HCWs showed symptoms of anxiety (29%), depressive symptoms (10%), and fear caused by the COVID-19 pandemic (44%). Statistically significant differences were observed between different occupations for fear (p <0.05) and resilience (p <0.01). Levels of anxiety and fear appeared to be higher in female and younger workers. The latter group – who also reported higher levels of depression – showed lower levels of resilience.

CONCLUSIONS: In our study hospital and non-hospital workers show different emotional, cognitive, and behavioural resources when facing stressful situations, like in the case of the SARS-CoV-2 pandemics. Our results support the role of resilience and the proper use of problem-focused and emotion-focused coping strategies as protective factors from psychological distress.

PMID:34939618 | DOI:10.23749/mdl.v112i6.12285

Histol Histopathol. 2021 Dec 23:18414. doi: 10.14670/HH-18-414. Online ahead of print.

ABSTRACT

BACKGROUND: Fetal vascular malperfusion (FVM) can be diagnosed on placental examination based on histology of distal placental villi and large muscular placental vessels. While histology of both those placental compartments can be low grade or high grade, it is not known if these are clinically equivalent. This retrospective study aimed to compare the impact of placental distal villous and large vessel FVM lesions on clinical and placental phenotypes.

METHODS: Clinical and placental phenotypes of 479 consecutive ≥20 weeks of gestation at delivery cases of placental FVM were analyzed among 3 groups: Group 1: 86 cases with distal FVM (clusters of sclerotic distal villi and/or those with stromal vascular karyorrhexis and/or mineralization, and/or endothelial fragmentation by CD34 immunostain) without large vessel lesions; Group 2: 186 cases with large vessel lesions (fetal vascular ectasia, vascular thrombi, stem vessel obliteration, intramural fibrin deposition) without distal villous lesions; and Group 3: 207 cases showing both distal villous lesions and large fetal vessel lesions.

RESULTS: Statistically significant differences (Bonferroni correction) were observed in: average gestational age at delivery 31, 35, 34 weeks, fetal growth restriction 24, 9, 25%, average placental weight 318, 413, 366 g, postuterine pattern of chronic hypoxic placental injury 12, 2, 6%, luminal vascular abnormalities in stem vessels 16, 3, 11%, and high grade FVM 33, 16, 39%, among Groups 1-3, respectively.

CONCLUSION: Because of longer time needed for its development, distal FVM portends poorer prognosis for the fetus than large vessel FVM.

PMID:34939657 | DOI:10.14670/HH-18-414

Psychiatr Hung. 2021;36(4):504-517.

ABSTRACT

The “Act on the Development of the Health Care System, CXXXII/2006” ordered a general reduction in the number of hospital beds, which sensitively affected the care of psychiatric inpatients, too. In this wave of downsizing, the National Institute of Psychiatry and Neurology, an institute with the traditions of one and a half centuries, also ceased to exist. Based on statistical data, the article examined the effect of the law on inpatient and outpatient psychiatric/ addictological care. The reduction in the number of beds had a long-term effect only upon the reduction in the capacity of acute inpatient care; while the number of acute patients treated decreased, the number of involuntary hospital admissions increased and oddly enough, bed occupancy also decreased. This last phenomenon can in part be attributed to a reduction in nursing time. The patient care decreased in both adult and pediatric psychiatric out – patient care, as did similarly the turnover of outpatient clinics for addicts. However, the changes observed in outpatient care were not related to the bed number reduction, but rather meant the continuation of previously started decline in psychiatric/addictological care. There were no detectable changes in the trends for other examined characteristics, such as homelessness and involuntary treatment. A temporary increase was observed only in the number of completed suicides, but the previously seen decreasing trend was restored in this respect after 2011. All in all, the reduction in the number of beds forced by law caused only temporary care disruptions and had no significant effect, either positive or negative, on the negative trends in psychiatric/addictological care that started earlier. However, the reasons for these negative trends observed in Hungarian psychiatric/addictological care, and which still persist to this day, are unclear.

PMID:34939569

J Public Health Manag Pract. 2021 Dec 21. doi: 10.1097/PHH.0000000000001469. Online ahead of print.

ABSTRACT

CONTEXT: Sexually transmitted infections (STIs) continue to increase in the United States. Publicly funded sexually transmitted disease (STD) clinics provide important safety net services for communities at greater risk for STIs. However, creating financially sustainable models of STI care remains a challenge.

OBJECTIVE: Characterization of clinic insurance billing practices and patient willingness to use insurance.

DESIGN: Cross-sectional survey assessment of clinic administrators and patients.

SETTING: Twenty-six STD clinics and 4138 patients attending these clinics in high STD morbidity metropolitan statistical areas in the United States.

PARTICIPANTS: Clinic administrators and patients of these clinics.

INTERVENTION: Survey assessment.

MAIN OUTCOME MEASURE: Insurance billing practices of STD clinics and patient insurance status and willingness to use their insurance.

RESULTS: Fifteen percent of clinics (4/26) indicated that they billed only Medicaid, 58% (15/26) billed both Medicaid and private insurance, 27% (7/26) did not bill for any health insurance, and none (0%) billed only private health insurance companies. Of 4138 patients surveyed, just more than one-half of patients (52.6%) were covered by some form of health insurance. More than one-half (57.2%) of all patients covered by health insurance indicated that they would be willing to use their health insurance for that visit. After adjusting for patient demographics and clinic characteristics, the patients covered by government insurance were 3 times as likely (odds ratio: 3.16; 95% confidence interval, 2.44-4.10) than patients covered by private insurance to be willing to use their insurance for their visit.

CONCLUSION: Opportunities exist for sustainable STI services through the enhancement of billing practices in STD clinics. The STD clinics provide care to large numbers of individuals who are both insured and who are willing to use their insurance for their care. As Medicaid expansion continues across the country, efforts focused on improving reimbursement rates for Medicaid may improve financial sustainability of STD clinics.

PMID:34939604 | DOI:10.1097/PHH.0000000000001469