Tag: statistics

Ther Apher Dial. 2021 Aug 11. doi: 10.1111/1744-9987.13722. Online ahead of print.

ABSTRACT

Long term dialysis involves a chronic inflammatory state and produces a high prevalence of vitamin D deficiency. A clinical trial was conducted in hemodialysis with serum 25-hydroxyvitamin D (25[OH]D) level < 30 ng/mL. The conventional-group (N = 35) and the high-dose group (N = 35) were treated with ergocalciferol according to the K/DOQI guidelines and double dosage of ergocalciferol from the recommendation for 8 weeks, respectively. The main outcomes were measured by serum 25[OH]D and interleukin-6 (IL-6). At the end of 8 weeks, a statistically significantly greater increase was observed of mean serum 25[OH]D levels and decrease of mean PTH levels in the high-dose group compared with the conventional-dose group. The high dose group had higher achievement of vitamin D sufficiency than the conventional-dose group (97.4% vs. 76.4%, P = 0.012). No significance difference was found in mean changes of serum IL-6 level in the both groups, except subgroup patients with vitamin D deficiency or serum 25[OH]D < 20 ng/mL, high dose treatment suppressed serum IL-6 level (-2.67 pg/mL [IQR -6.56 to -0.17], P = 0.039). No differences were observed between the two groups in adverse events. Oral high-dose ergocalciferol supplementation has achieved higher vitamin D sufficiency than standard dose in ESRD patients on dialysis.

PMID:34378863 | DOI:10.1111/1744-9987.13722

J Cosmet Dermatol. 2021 Aug 11. doi: 10.1111/jocd.14375. Online ahead of print.

ABSTRACT

OBJECTIVE: To study the application of evidence-based nursing in prosthesis postoperative complications.

METHODS: A total of 78 cases of patients who underwent prosthetic breast augmentation were selected from July 2017 to July 2019. All the patients were divided into control group and study group according to the random number table method. The patients in the control group received routine nursing interventions, and the patients in the study group performed evidence-based nursing interventions based on the control group’s care. The mental health, external esthetic effects, and complications of the two groups were observed and compared.

RESULTS: Before the implementation of nursing intervention, there was no significant difference in mental health indicators (SAS, SDS) between the two groups (p > 0.05). After the intervention, the SAS and SDS scores of the two groups were lower than before the intervention, and the study group was lower than the control group, and the difference was statistically significant (p < 0.05); before the implementation of nursing intervention, there was no significant difference in the scores of HADS-A and HADS-D between the two groups (p > 0.05). After the intervention, the scores of HADS-A and HADS-D of the two groups were lower than those before the intervention, and the scores of the study group were lower than those of the control group, and the difference was statistically significant (p < 0.05); 94.9% (37 / 39) was better than 71. 8% (28 / 39) in the control group. The difference was statistically significant (p < 0.05), and the total incidence of postoperative complications in the study group was 5.1% (2 / 39), which was lower than 15.4% (6 / 39) in the control group (p < 0.05).

CONCLUSION: Evidence-based nursing intervention is effective in preventing postoperative complications of silicone breast augmentation prosthesis. It can effectively reduce postoperative complications, improve external esthetic effects, and improve the level of mental health of patients. It is worthy of clinical promotion and application.

PMID:34378842 | DOI:10.1111/jocd.14375

Obes Rev. 2021 Aug 10:e13217. doi: 10.1111/obr.13217. Online ahead of print.

ABSTRACT

To meet the need for regular and reliable data on the prevalence of overweight and obesity among children in Europe, the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was established in 2007. The resulting robust surveillance system has improved understanding of the public health challenge of childhood overweight and obesity in the WHO European Region. For the past decade, data from COSI have helped to inform and drive policy action on nutrition and physical activity in the region. This paper describes illustrative examples of how COSI data have fed into national and international policy, but the real scope of COSI’s impact is likely to be much broader. In some countries, there are signs that policy responses to COSI data have helped halt the rise in childhood obesity. As the countries of the WHO European Region commit to pursuing United Action for Better Health in Europe in WHO’s new European Programme of Work, COSI provides an excellent example of such united action in practice. Further collaborative action will be key to tackling this major public health challenge which affects children throughout the region.

PMID:34378847 | DOI:10.1111/obr.13217

J Ultrasound Med. 2021 Aug 11. doi: 10.1002/jum.15805. Online ahead of print.

ABSTRACT

OBJECTIVES: Use of point-of-care lung ultrasound (POC-LUS) has increased significantly in pediatrics yet it remains under-studied in the pediatric intensive care unit (PICU). No studies explicitly evaluate the reliability of POC-LUS artifact interpretation among critically ill children with acute respiratory failure (ARF) in the PICU. We thus designed this study to determine the inter-rater reliability of POC-LUS interpretation in pediatric ARF among pediatric intensivists trained in POC-LUS and an expert intensivist.

METHODS: We compared the interpretation of lung sliding, pleural line characteristics, ultrasound artifacts, and POC-LUS diagnoses among pediatric intensivists and an expert intensivist in a cohort of children admitted to the PICU for ARF. Kappa statistics (k) adjusted for maximum attainable agreement (k/k_max ) were used to quantify chance-correct agreement between the pediatric intensivist and expert physician.

RESULTS: We enrolled 88 patients, evaluating 3 zones per hemithorax (anterior, lateral, and posterior) for lung sliding, pleural line characteristics, ultrasound artifacts, and diagnosis. There was moderate agreement between the PICU intensivist and expert-derived diagnoses with 56% observed agreement (k/k_max = 0.46, 95% confidence interval [CI] 0.31-0.65). Agreement in identification of lung sliding (k = 0.19, 95% CI -0.17 to 0.56) and pleural line characteristics (k = 0.24, 95% CI 0.08-0.40) was slight and fair, respectively, while agreement in the interpretation of ultrasound artifacts ranged from moderate to substantial.

CONCLUSIONS: Evidence supporting the evaluation of neonatal and adult patients with POC-LUS should not be extrapolated to critically ill pediatric patients. This study adds to the evidence supporting use of POC-LUS in the PICU by demonstrating moderate agreement between PICU intensivist and expert-derived POC-LUS diagnoses.

PMID:34378821 | DOI:10.1002/jum.15805

Neurogastroenterol Motil. 2021 Aug 11:e14234. doi: 10.1111/nmo.14234. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Gastroesophageal reflux disease (GERD) seriously lowers the quality of life of patients, and its prevalence has gradually increased in recent years. Some studies have showed that metabolic syndrome (MetS) is related to GERD, but the results remain controversial. This study explored the relationship between MetS and GERD through systematic retrieval and analysis of published studies.

METHODS: Retrieve related research from PubMed, Web of Science, and Cochrane Library. Including cohort studies that compare the prevalence of GERD between patients with MetS and patients without, and case-control studies or cross-sectional studies that compare the prevalence of MetS between patients with GERD and patients without. In addition to analyzing the relationship between MetS and GERD, individual metabolic components are also analyzed. Use a random effects model (DerSimmonian and Laird) to merge the odd ratio (OR). Cochran’s Q test and Higgins’ I-squared statistic were performed to assess heterogeneity. Publication bias was assessed by Egger’s test.

KEY RESULTS: A total of 103,048 patients from 15 studies were included. The combined results suggest that MetS is a risk factor of GERD (OR: 1.66, 95%CI: 1.38-1.99). Among the individual metabolic components, abdominal obesity (OR: 1.42, 95%CI: 1.22-1.64), hypertriglyceridemia (OR: 1.50, 95%CI: 1.27-1.78), hyperglycemia (OR: 1.31, 95%CI: 1.07-1.61), and hypertension (OR: 1.19, 95%CI: 1.07-1.33) are risk factors of GERD. Conclusions and Inferences. MetS is a risk factor of GERD, and among the abnormal metabolic components that establish the diagnosis of MetS, abdominal obesity, hypertriglyceridemia, hyperglycemia, and hypertension are risk factors of GERD.

PMID:34378835 | DOI:10.1111/nmo.14234

Endokrynol Pol. 2021 Aug 11. doi: 10.5603/EP.a2021.0074. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effect of selenium supplementation on autoantibody titers, thyroid ultrasonography and thyroid function in patients with Hashimoto’s thyroiditis (autoimmune thyroiditis) and normal thyroid reference range.

METHODS: A total of 100 patients were given 200 ug/d selenium yeast orally, their thyroid function, levels of serum selenium, thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TGAb) and urine iodine were measured and thyroid ultrasonography was performed before administration and three and six months afterwards, and the data were statistically analysed.

RESULTS: The subjects exhibited a selenium deficiency before the administration of selenium, and the serum levels increased to moderate levels three and six months after the selenium supplementation (p<0.05). The titers of TGAb decreased significantly in patients after six months of Selenium lack prevention measure(p<0.05). In the high antibody group, TgAb decreased after 6 months compared with baseline (P<0.05), and TPOAb decreased after 3 and 6 months of selenium supplementation compared with baseline (P<0.05).

CONCLUSION: In patients with autoimmune thyroiditis and normal thyroid reference range, there was a general selenium deficiency but, after six months of treatment, it was shown that the Selenium lack prevention measure may be effective in reducing the titers of TGAb and TPOAb.

PMID:34378788 | DOI:10.5603/EP.a2021.0074

Laryngoscope. 2021 Aug 11. doi: 10.1002/lary.29815. Online ahead of print.

ABSTRACT

OBJECTIVES/HYPOTHESIS: For patients with submandibular sialolithiasis, there are many gland-preserving treatment options including sialendoscopy. Sialendoscopy, however, requires expensive instrumentation with limited availability, which may not be required for routine cases. The objective of this study is to compare the outcomes of patients with submandibular sialolithiasis undergoing sialendoscopy versus those undergoing transoral incisional sialithotomy.

STUDY DESIGN: Longitudinal, prospective study of patient undergoing gland-preserving therapy for submandibular sialolithiasis.

METHODS: The study was a prospective, nonrandomized trial of 30 patients with submandibular sialolithiasis who received gland-preserving treatment by either sialendoscopy-assisted techniques (Scope group; 14 patients) or transoral sialithotomy with or without dochoplasty (No Scope group; 16 patients). Factors analyzed between the two groups included age, race, gender, size of stone, location of stone, gland(s) involved, surgical method, and modified salivary Oral Health Impact Profile (sOHIP) scores before and after therapy.

RESULTS: There were no significant differences between the Scope and No Scope groups regarding age, race, or gender. There was a significant difference in stone size between the groups, with the No Scope group having larger stones on average. Both treatments led to statistically significant symptomatic improvement in sOHIP scores. There was no statistically significant difference in salivary quality of life improvement between the Scope and No Scope groups (P = .33).

CONCLUSIONS: Sialendoscopy is an important diagnostic and therapeutic tool in the management of salivary disorders, but is not associated with improved outcomes in gland-preserving treatments for routine submandibular sialolithiasis. Transoral stone removal alone may have equivalent symptomatic outcomes in the management of select sialoliths.

LEVEL OF EVIDENCE: III Laryngoscope, 2021.

PMID:34378799 | DOI:10.1002/lary.29815

Cien Saude Colet. 2021 Aug;26(8):3301-3310. doi: 10.1590/1413-81232021268.08882020. Epub 2020 Jun 3.

ABSTRACT

The aim of this study was to analyze health service accessibility and the care pathways of children admitted to hospital for ambulatory care sensitive conditions (ACSCs). A cross-sectional study was conducted of a random sample of children hospitalized over a period of one year in a town in the north of Minas Gerais, Brazil. The Primary Care Assessment Tool Child Edition, adapted and validated for use in Brazil (PCAT-CE), was used to assess accessibility and interviews were conducted with the children’s carers to determine the pathway taken to hospitalization. Of the 376 pediatric hospitalizations assessed, 109 (28.9%) were classified as ACSC admissions. Health service accessibility and utilization scores were low for both the ACSC and non-ACSC groups. No statistically significant differences (p<0.05) were found between the two groups. The care pathways reveal that most families visited hospitals as the first service and that visits to other health services were frequent. Well over half (63.3%) of the families of children admitted for ACSCs did not seek primary health services at any time. Accessibility was poor among the study group, regardless of the reason that led to hospitalization. The care pathways reveal an irregular pattern of service utilization for children admitted for ACSCs, suggesting a fragile health care network.

PMID:34378717 | DOI:10.1590/1413-81232021268.08882020

Rev Bras Epidemiol. 2021 Aug 9;24:e210026. doi: 10.1590/1980-549720200026. eCollection 2021.

ABSTRACT

OBJECTIVES: To characterize the study population, estimating the in-hospital lethality rate by state and analysing associated factors with COVID-19-related deaths.

METHODS: A retrospective cohort study was carried out of hospitalised children and adolescents diagnosed with COVID-19, confirmed by RT-PCR, whose outcome was death by COVID-19 or recovery, from 2020 March 1 to August 1. The data source was the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe in Brazilian acronym), where patients with Severe Acute Respiratory Syndrome (SARS) are notified. Children were defined as those between the ages of 0 and 11, and adolescents those between 12 and 18. A bi and multivariate analysis were performed using Poisson Regression with robust variance, with adjusted Relative Risk as the final association measure.

RESULTS: A total of 4,930 cases were analysed; 2,553 (51.8%) were males, 2,335 (47.4%) were brown-skinned. The Federative Unit of Roraima presented the highest in-hospital case-fatality rate, with 68.8% (11/16). Multivariate analysis showed that belonging to the age group adolescent (RR = 1.59; 95%CI 1.12 – 2.25; p = 0.009), SARS-critical patient (RR = 4.56; 95%CI 2, 77 – 7.51; p < 0.001) and presenting immunological disorders (RR = 2.24; 95%CI 1.58 – 3.17; p < 0.001) as comorbidities were statistically associated factors with death by COVID-19.

CONCLUSION: It was observed that adolescents, SARS-critical patients, and presence of immunological disorders were important factors associated with death. Active surveillance and differentiated care are recommended for patients with chronic diseases and special immunological conditions.

PMID:34378752 | DOI:10.1590/1980-549720200026

Endokrynol Pol. 2021 Aug 11. doi: 10.5603/EP.a2021.0070. Online ahead of print.

ABSTRACT

BACKGROUND: Gynecomastia (GM) is benign unilateral or bilateral proliferation of the glandular tissue of breast in males. Its development during adolescence is usually considered a physiologic phenomenon and is expected to resolve within months. Sometimes however it is due to pathologic conditions or diseases and it is not uncommon these not to be recognized on time. The present study aims to investigate the causes of prepubertal and pathologic pubertal GM, its association with obesity, age of appearance and whether GM has a psychological impact on boys and adolescents admitted at endocrine department.

MATERIAL AND METHODS: A total of 157 boys and adolescents with GM were included in a cross-sectional retrospective study in a single tertiary center for endocrine diseases. Patients were evaluated by anthropometric measurements, serum hormonal levels and a questionnaire.

RESULTS: For the period 2009-2018 a total of 157 boys and adolescents were diagnosed with GM (76.43 % obese, 3.18%- overweight). Twelve (7.64 %, mean age of GM development -7.53 years) were prepubertal, 5.09%- with primary or secondary testicular damage, 5.73% with hypogonadotropic hypogonadism, 11.48% -with elevated prolactin level and 110 boys (70.06%) with physiologic pubertal GM. A statistically significant difference was found between the age of development of physiologic GM -11.85 years (9.35-16.92) and those due to hypergonadotropic 13.57 years (10-16.25) (p=0.006) and hypogonadotropic 12.77 (10.50-14.0) (p=0.028) hypogonadism. Onset of pubertal GM in normal weight boys was 13.13 years, and in obese/overweight -11.69 years (p <0.001). Eighty four patients (53.5%) confessed a psychological burden of GM, 12.1 % consulted because of its development, in 8.2 % led to cessation of sports and 2.5 % changed their clothes.

CONCLUSIONS: Prepubertal and pubertal GM has a high association with obesity. Excess adipose tissue has an impact on the age of development in both groups. Nearly a quarter of pubertal cases are due to pathologic conditions and those are often diagnosed more than 18 months after the appearance of breast. So although greater number of pubertal GM is physiologic it may be reasonable adolescents to be evaluated within the first 6 months of breast development so not to delay the diagnosis of pathologic ones. Additionally we have found that GM has a complex influence on psychologic state of boys and adolescents.

PMID:34378787 | DOI:10.5603/EP.a2021.0070