Mahalanobis Distance Matching Research Articles

Intravitreal Antibiotics versus Early Vitrectomy plus Intravitreal Antibiotics for Post-Injection Endophthalmitis: an IRIS® Registry (Intelligent Research in Sight)

PurposeTo determine if intravitreal injection of antibiotics alone versus early pars plana vitrectomy (PPV) plus injection of intravitreal antibiotics predicted better or worse visual outcomes for patients with endophthalmitis after anti-vascular endothelial growth factor (anti-VEGF) injections. DesignRetrospective cohort study ParticipantsPatients developing endophthalmitis after receiving an intravitreal anti-VEGF injection from the American Academy of Ophthalmology IRIS® Registry between 2016 and 2020. MethodsInclusion criteria were endophthalmitis diagnosis within 1 to 28 days after anti-VEGF injection and a recorded visual acuity (VA) at baseline, on the day of diagnosis, and post-treatment. Patients in the Injection Only group underwent intravitreal injection of antibiotics alone and in the Early Vitrectomy group received PPV with intravitreal antibiotics or intravitreal injection followed by PPV within 2 days of diagnosis. Patients were excluded if they had cataract surgery during the study, intravitreal steroids before endophthalmitis, or intermediate/posterior uveitis or cystoid macular edema. The study created a 1:1 matched cohort using Mahalanobis Distance Matching, accounting for the differences in VA at baseline and diagnosis. Main Outcome MeasuresPost-treatment logMAR VA Results1,044 patients diagnosed with post-injection endophthalmitis met the inclusion and exclusion criteria. In the unmatched cohort, there were 935 patients in the Injection Only and 109 in the Early Vitrectomy group. In 1:1 matched cohort 218 patients (109 in each group) were included; the median logMAR VAs were 0.32 [20/40-20/50] at baseline, 0.88 [∼20/150] at diagnosis, and 0.57 [20/70-20/80] post-treatment. There were no statistically significant differences in the visual outcomes between the two matched treatment groups (b = 0.05, p = 0.23); including the subgroup of patients with VA worse than 1.0 logMAR (b = 0.05, p = 0.452). ConclusionsThere was no significant difference in final VA outcomes between patients receiving Injection Only and those treated with Early Vitrectomy for post-injection endophthalmitis. The findings support the use of either treatment strategy.

Gender disparities in outcomes of cardiogenic shock secondary to Takotsubo cardiomyopathy

BackgroundTakotsubo cardiomyopathy (TTC) has a preponderance for females, particularly postmenopausal. However, recent data from multicenter registries identified a worse prognosis in male patients, particularly with cardiogenic shock. We aim to investigate gender disparities in outcomes of TTC-associated cardiogenic shock (TTC-CS). MethodsThe National Readmission Database (2016–2020) was utilized to identify TTC-CS hospitalizations. Cohorts were stratified by gender. A Propensity Score Matching (PSM) model, which utilized complete Mahalanobis Distance Matching within the Propensity Score Caliper following multivariate regression, successfully matched males and females. Pearson's χ2 test was applied to the propensity-matched cohorts to compare outcomes. ResultsAmong 12,803 TTC-CS hospitalizations, the majority (74.1 %) were females (N: 9490), and 25.9 % were males (N: 3313). On propensity-matched cohorts (2609), males were found to have higher in-hospital mortality (31 % vs. 26 %, p < 0.001), higher incidence of sudden cardiac arrest (14 % vs. 10.8 %, p < 0.001), endotracheal intubation (52.1 % vs. 48.8 %, p: 0.001), acute liver injury (18 % vs. 15.9 %, p: 0.004), acute stroke (7.2 % vs. 5.8 %, p: 0.004), cardiac arrhythmias (55.1 % vs. 49.3 %, p < 0.001) and acute kidney injury (63.1 % vs. 49 %, p < 0.001); while female patients were found to have higher utilization of mechanical circulatory support (MCS) modalities (16.1 % vs 13.2 %, p < 0.001).Males had a higher adjusted cost of hospitalization ($54,537 vs. $42,805, p < 0.001) with a higher median length of hospital stay (10 vs. 9 days, p < 0.001). The two groups had no significant difference in 30, 90, and 180-day readmission rates (p > 0.05). From 2016 to 2020; mortality has not changed significantly for TTC-CS, while the use of percutaneous coronary angiogram (PCA) and MCS has down-trended (p-trend < 0.05). ConclusionFor TTC-CS hospitalization, males have higher in-hospital mortality and complication rates, along with higher LOS and cost of hospitalization. Despite advances in the management of CS, there was no significant difference in mortality from 2016 to 2020.

Transcatheter Versus Surgical Aortic Valve Replacement in Recipients of Solid Organ Transplants and Liver Cirrhosis: A Propensity-Matched Analysis of National Readmission Data

Transcatheter aortic valve replacement (TAVR) continues to grow in the United States. There are limited data on recipients of solid organ transplant (SOT) and patients with liver cirrhosis who undergo aortic valve replacement (AVR). Our study aims to evaluate outcomes in these populations. Using the national readmission database (2016 to 2020), we identified recipients of SOT and patients with liver cirrhosis without previous liver transplants who were admitted for severe aortic stenosis and underwent either TAVR or surgical AVR (SAVR). We used multivariable regression for adjusted analysis and the propensity score matching model, implementing complete Mahalanobis distance matching within the Propensity Score Caliper (0.2) to match TAVR and SAVR cohorts for outcomes. Of 3,394 hospitalizations for AVR in recipients of SOT, 2,181 underwent TAVR, and 1,213 underwent SAVR. On propensity-matched analysis, SAVR was associated with more adverse events than was TAVR, including in-hospital mortality (5.2% vs 1.1%, adjusted odds ratio [aOR] 4.49, p <0.001), acute kidney injury (43.7% vs 10.2%, p <0.001), cardiogenic shock (9.0% vs 1.6%, p <0.001), sudden cardiac arrest (15.9 vs 6.0%, p <0.001), major adverse cardiac and cerebrovascular events (28% vs 10.4%, p <0.001), and net adverse events (72.8 vs 37.6%, p <0.001). A greater median length of stay (10 vs 2 days, p <0.001) and adjusted cost ($80,842 vs $57,014, p <0.001) were also observed. The readmission rates were the same for both cohorts after a 6-month follow-up. Similarly, in 14,763 hospitalizations for AVR in liver cirrhosis, 7,109 patients underwent TAVR, and 7,654 underwent SAVR. In propensity-matched cohorts (n = 2,341), SAVR was found to be associated with greater adverse events, including in-hospital mortality (19.8% vs 10%), stroke (6.7% vs 2%), acute kidney injury (67.7% vs 30.3%), cardiogenic shock (41.9% vs 19.9%), sudden cardiac arrest (31.8% vs 13.2%, aOR 2.89), major adverse cardiac and cerebrovascular events (66.2% vs 35.7%), and net adverse events (86% vs 59.5%) (p <0.001). A greater median length of stay (16 vs 3 days) and cost ($500,218 vs $263,383) were also observed (p <0.001). However, the rate of readmissions at 30-day (9% vs 11.1%) and 180-day intervals (33.4% vs 39.8%) was lower for the SAVR cohort (p <0.05). In recipients of SOT and patients with liver cirrhosis, SAVR is associated with greater short-term mortality, adverse events, and healthcare burden than is TAVR. TAVR is a relatively safer alternative to SAVR in these patient populations, although further studies are warranted to compare the long-term outcomes.

Tachyarrhythmias burden in hospitalized patients with cancer: A nationwide propensity matched analysis.

e24032 Background: Remarkable progress has been made in the management of cancer with the advent of new therapies. However, significant concern exists over the cardiotoxic effects of chemotherapy and radiation therapy. We aim to evaluate the different cardiac tachyarrhythmias in hospitalized cancer patients. Methods: The national readmission database (2016-2020) was queried to identify all-cause admissions for patients with active malignancy of any origin. Multivariate regression model was used to obtain adjusted odds ratio (aOR). Univariate screening was utilized for regression building model. Multicollinearity among different variables were determined by variation inflation factor (VIF). VIF &gt; 5 was taken as cut off for significant collinearity. Cohorts were stratified based on the presence of tachyarrhythmias. A propensity score matching (PSM) model, implementing complete Mahalanobis Distance Matching within the Propensity Score caliper (set at 0.2), matched cancer patients with and without tachyarrhythmias. Inverse Probability weighting(IPW) was utilized, and Pearson's x2 test was applied to the PSM matched cohorts to compare outcomes. Results: Among 10.6 million all-cause hospitalizations of cancer patients, about 1.7 million (16%) developed tachyarrhythmia. On a propensity-matched cohort, patients with active malignancy had the highest rates of atrial fibrillation (AF) (14.1%), followed by supraventricular tachycardia (SVT) (1.1%), ventricular tachycardia (VT) (0.8%) and atrial flutter (AFL) (0.4%) [p &lt; 0.001]. Cancer patients with tachyarrhythmias had increased in-hospital mortality. The mortality was highest for VT (aOR 3.9, CI 3.7 - 4.01, P &lt; 0.001), followed by SVT (aOR 2.6,CI 2.51 - 2.67, p &lt; 0.001), AFL (aOR 2.5, CI 2.38 - 2.59, p &lt; 0.001 ) and AF (aOR 1.54, CI 1.52 -1.56, p &lt; 0.001). Readmissions among patients who developed tachyarrhythmias during index hospitalization showed that 18.7% and 34.3 % had recurrent AF, 17.4% and 33% had recurrent SVT, 17.3% and 32.1% had recurrent AFL, and 15.4% and 31.1% developed recurrent VT at 30 and 90- day readmissions respectively. Resource utilization was also higher in the cohort complicated by tachyarrhythmias, with the highest length of stay (LOS)(7 vs 4 days) and total cost ($31,718 vs $17,659) in hospitalization complicated by VT (p &lt; 0.001). A similar increase in LOS and total inpatient cost was also seen in cancer patients whose hospitalization was complicated with SVT, AFT and AF compared to patients without arrhythmias (p &lt; 0.01). Conclusions: Hospitalizations in cancer patients complicated by tachyarrhythmias were associated with higher in-hospital mortality, LOS, and adjusted cost. VT is associated with the highest mortality; however, AF appears to be most prevalent during index admission and readmissions. This study signifies the importance of close cardiac monitoring in hospitalized cancer patients to prevent adverse outcomes.

Attrition from Jail Reentry Program Increases Recidivism

Reentry programs represent an increasingly popular method to reduce recidivism for individuals exiting prison and jail systems throughout the United States. Most evaluations tend to focus on recidivism as the primary outcome of interest. Attrition, however, can function an important supplementary measure that complements recidivism outcomes. To demonstrate, we analyze a jail reentry program built around peer navigators serving as staff members that refer participants to necessary support services while also serving as a mentor to participants exiting jail. We use a combination of general linear models (GLMs), Mahalanobis distance matching (MDM), and panel regression to both predict attrition and compare recidivism outcomes between three attrition groups: program completers, program quitters, and matched controls. Participants that successfully completed the program did not avoid new convictions or reincarceration significantly more or less than matched controls. Participants that quit the program, however, saw significantly higher conviction and reincarceration rates compared to matched controls. The nuance added to our program evaluation by adding attrition as a differential factor is worth consideration by other reentry programs who may not be realizing the full picture of their results by presenting recidivism outcomes alone.

Food insecurity and associated health and social determinants among older adults in Ghana: Analysis of the WHO’s study on global AGEing and adult health (SAGE), 2014–2015

This study was conducted to assess the prevalence and factors associated with Food Insecurity (FI) and further quantify its association with unmet need for health services and health-related outcomes among older adults aged 50 years and above in Ghana. The Ghana Study on Global AGEing and Adult Health was used. Body Mass Index (BMI), depressive episodes, functional difficulties (FD), low Quality of Life (QoL), memory decline, and Unmet Needs of Health Services (UNHS) are the the study outcomes. Ordinary Least Square, and Poisson regression analysis modified with Mahalanobis distance matching within propensity score caliper weights were employed. Stata 16.1 was used to perform analysis and a p-value < 0.05 was deemed significant. The prevalence of FI among older adults aged 50 years or older in Ghana was approximately 28 %(95 %CI = 24.5–31.7) and was strongly associated with lower educational attainment and social support. The prevalence ratio of depression, FD, low QoL and UNHS among older adults who experienced FI were; 3.43(95 %CI = 2.25–5.21), 1.18(95 %CI = 1.12–1.23), 2.01(95 %CI = 1.54–2.62), and 1.46(95 %CI = 1.01–2.11). Memory significantly decreased by 85 percentage points% among food insecure older adults [aβ(95 %CI) = −0.85(−1.62–−0.07)]. Older adults with relatively higher educational attainment and social support are less likely to suffer FI and associated limited health and poor social well-being. In the national quest to achieve SDG 2, these health and social determinants of FI among older adults should be considered in the implementation of the national ageing policy to improve the health and well-being of older adults in Ghana.

The influence of parental involvement on students’ non-cognitive abilities in rural ethnic regions of northwest China

The development of children’s non-cognitive abilities is crucial for both individuals and society as a whole. In this study, using a follow-up survey on 5369 primary students in rural ethnic regions of northwest China, we aim to examine the levels of parental involvement in rural ethnic regions and investigate its effect on students’ non-cognitive abilities. Our results show the following: first, parental involvement in rural ethnic regions of northwest China is quite low. Parents pay more attention to their children’s academic performance than to their non-cognitive abilities and the personal involvement is seriously lacking. Second, students from families with more favorable economic status, high parental education levels, non-migrant parents, and primary caregivers who are parents experience higher levels of parental involvement. Though Han students generally have higher maternal involvement and lower paternal involvement than minorities, the ethnic differences are reduced after controlling the covariates. Third, using the value-added model, after controlling for individual, family, class, county and baseline variables, we find that maternal behavioral and personal involvement and paternal cognitive and behavioral involvement have significant positive effects on children’s non-cognitive abilities. We use causal identification methods including propensity score matching and Mahalanobis distance matching to do the robustness test.

Does new airport investment promote urban economic development?: Global evidence from nighttime light data

This study aims to provide global evidence on the net impact of new airport investment on urban economic development by analyzing cities with/without new airport construction in a quasi-experimental design framework. A two-way fixed difference-in-differences (DID) method along with Mahalanobis distance matching (MDM) is applied to scrutinize the causal association of new airport investment with urban economic development. This empirical analysis assumes nighttime light intensity at a grid-cell scale of 15 arc-second as an economic indicator. We regress nighttime light intensity from 2015 to 2019 for 27 treatment cities with new airport construction from 2015 to 2017 and other control cities selected from 13,038 cities in the world. The estimation results indicate that new airport construction increases nighttime light intensity by (1) about 10.8 % in cities that had demonstrated relatively low nighttime light intensity and (2) about 9.5 % in cities that had introduced their first airports. This study presents empirical evidence on the positive economic impacts of new airport investment for relatively small cities in emerging economies, wherein economic statistics are insufficient or unavailable.

Why do undervalued firms repurchase shares? Evidence based on the market-timing effect in China

It is puzzling that few undervalued firms in China make repurchase announcements despite the value-adding motive of share repurchases. Inspired by this conundrum, this study explores the market-timing effect of repurchase signaling. Our sample consists of A-share listed firms that made stock repurchase announcements in China between 2005 and 2019, as well as their comparable peers obtained through the Mahalanobis distance matching. Changes in market indices before and after the repurchase announcements are used to measure overall market timing, followed by regression analyses. We find a positive relationship between post-announcement price reactions and market performance measures, suggesting that firms time repurchase announcements based on historical pricing information as well as overall market trends. We further propose that firms' timing capabilities are honed through attention to the capital market, which significantly increases the willingness to announce repurchase plans. Our findings help to explain why firms in China with undervalued shares make repurchase announcements.

Aseptic revisions and pulmonary embolism after surgical treatment of femoral neck fractures with cemented and cementless hemiarthroplasty in Germany : An analysis from the Germany Arthroplasty Registry (EPRD)

Femoral neck fractures (FNF) are among the most common fractures in Germany and are often treated by hemiarthroplasty (HA). The aim of this study was to compare the occurrence of aseptic revisions after cemented and uncemented HA for the treatment of FNF. Secondly, the rate of pulmonary embolism was investigated. Data collection for this study was performed using the German Arthroplasty Registry (EPRD). HAs after FNF were divided into subgroups stratified by stem fixation (cemented vs uncemented) and paired according to age, sex, BMI, and the Elixhauser score using Mahalanobis distance matching. Examination of 18,180 matched cases showed a significantly increased rate of aseptic revisions in uncemented HA (p < 0.0001). After 1 month 2.5% of HAs with uncemented stems required an aseptic revision, whereas 1.5% were reported in cemented HA. After 1 and 3years' follow-up 3.9% and 4.5% of uncemented HA and 2.2% and 2.5% of cemented HA needed aseptic revision surgery. In particular, the proportion of periprosthetic fractures was increased in cementless implanted HA (p < 0.0001). During in-patient stays, pulmonary emboli occurred more frequently after cemented HA (0.81% vs 0.53% in cementless HA [OR: 1.53; p = 0.057]). For uncemented hemiarthroplasties a statistically significantly increased rate of aseptic revisions and periprosthetic fractures was evident within a time period of 5years after implantation. During the in-hospital stay, patients with cemented HA experienced an increased rate of pulmonary embolism compared with patients with cementless HA, but this difference was not statistically significant. Based on the present results, with knowledge of prevention measures and the correct cementation technique, the use of cemented HA should be preferred in the treatment of femoral neck fractures.

Evaluating Different Covariate Balancing Methods: A Monte Carlo Simulation

Abstract We investigate the effectiveness of five weighting and matching techniques, including propensity score matching (PSM), in improving covariate balance and reducing bias when estimating treatment effects in finite-sample situations through Monte Carlo simulations. King and Nielsen (2019. “Why Propensity Scores Should Not Be Used for Matching.” Political Analysis 27 (4): 435–54) argue that pruning observations based on PSM with 1-to-1 greedy matching can worsen rather than improve covariate balance and can increase the bias in the estimates of treatment effects. In our simulations, we observed this phenomenon not only in PSM with 1-to-1 greedy matching but also in other covariate balancing techniques that King and Nielsen (2019. “Why Propensity Scores Should Not Be Used for Matching.” Political Analysis 27 (4): 435–54) recommend as better matching methods, i.e. Mahalanobis distance matching (MDM) and coarsened exact matching (CEM). Regardless of the weighting/matching techniques and the data generation processes in this study, our findings indicate that matching and weighting under extreme caliper or cut-point settings does not improve covariate balance. In addition, once a substantially improved covariate balance is achieved in a given sample, the estimated bias tends to worsen slightly as the covariate balance continues to improve. Moreover, our simulation results suggest that OLS with proper covariates reduces selection bias as well as other weighting and matching methods. The results suggest that when analyzing observational data, it is important to avoid looking for a one-size-fits-all estimator and to identify the appropriate nonexperimental estimator carefully for the sample by thoroughly investigating the available data’s characteristics.

Changes in trends and patterns of glycaemic control at Ghana's National Diabetes Management and Research Centre during the era of the COVID-19 pandemic.

Maintaining optimal glycaemic control (GC) delays the onset and progression of diabetes-related complications, especially microvascular complications. We aimed to establish the trend and pattern of GC, and its associated factors in persons living with diabetes (PLWD), and to examine the influence of COVID-19 on GC. A retrospective study involving secondary data from 2,593 patients' physical records from the National Diabetes Management and Research Centre (NDMRC) in Accra, extracted from 2015-2021. Growth rate of GC was assessed, and ordinal logistic and Poisson models weighted with Mahalanobis distance matching within propensity caliper were adopted to assess the impact of COVID-19 pandemic on GC. Stata 16.1 was utilized and the significant value set as p≤0.05. GC pattern indicated a steady deterioration ranging from 38.6% (95%CI = 34.5-42.9) in 2015 to 69.2% (95%CI = 63.5-74.4) in 2021. The overall growth from 2015-2021 was 8.7%. Being a woman and increasing diastolic pressure significantly increase the likelihood of poor glycaemic control (PGC) by 22% and 25%, respectively compared with their respective counterparts [aOR(95%CI = 1.01-1.46 and 1.25(1.10-1.41), respectively]; whilst lower age increased the risk of PGC throughout the years. We found that risk of PGC during the era of COVID-19 was approximately 1.57(95%CI = 1.08-2.30) times significant, whilst the adjusted prevalence ratio (aPR) of PGC during the era of COVID-19 was approximately 64% significantly higher than the era without COVID-19 (aPR = 1.64, 95%CI = 1.10-2.43). GC worsened from 2015-2021, especially during the COVID era. Younger age, uncontrolled blood pressure and/or being a woman were associated with PGC. The NDMRC and other centres that provide specialist healthcare in resource-limited settings, must determine the factors that militate against optimal service delivery in the era of the COVID-19 pandemic, and implement measures that would improve resilience in provision of essential care in the face of shocks.

Development of railway station plazas: Impact on land prices of surrounding areas

Improvement in the built environment is an essential component of transit-oriented development; however, the economic effects of such investments have not yet been fully understood because their investigation requires a suitable empirical case. Using the decentralized development of station plazas, this study identified the conditions under which plaza development raises the economic value of the surrounding areas. We empirically analyzed the impact of station plaza development on the land prices of 3870 properties in the surrounding areas at 181 of the 1556 stations in the Tokyo Metropolitan Area from 2000 to 2010, where station plazas were developed for the revitalization of station areas in a mature urban economy. Mahalanobis distance matching was applied to obtain the treatment effect, and the heterogeneity in the effects on the land price of properties by land-use pattern and geographical location was analyzed. The results showed that the properties benefited from station plaza development depending on the accessibility to and from the nearest station and the Tokyo Station (the central station) and their land-use patterns. The study found that there could be a redistributive effect in that the plaza development had positive effects on land price changes around the stations and negative effects in places far from the stations.

Steeper memory decline after COVID-19 lockdown measures

BackgroundDuring COVID-19 lockdown measures, memory clinic patients reported worries for faster cognitive decline, due to loss of structure and feelings of loneliness and depression. We aimed to investigate the impact of the COVID-19 lockdown on rate of cognitive decline in a mixed memory clinic population, compared to matched historical controls.MethodsWe included patients who visited Alzheimer Center Amsterdam 6 months to 1 week before the first Dutch COVID-19 lockdown, and had a second visit 1 year later, after this lockdown period (n = 113; 66 ± 7 years old; 30% female; n = 55 dementia, n = 31 mild cognitive impairment (MCI), n = 18 subjective cognitive decline (SCD), n = 9 postponed diagnosis). Historical controls (visit in 2016/2017 and second visit 1 year later (n = 640)) were matched 1:1 to lockdown patients by optimal Mahalanobis distance matching (both groups n = 113). Groups were well matched. Differences between lockdown patients and historical controls over time in Mini-Mental State Examination, Trail Making Test part A and B, Rey-Auditory Verbal Learning Test (RAVLT) immediate and delayed recall, and category fluency scores were analyzed using linear mixed effect models with random intercepts. We examined differences in rate of cognitive decline between whole groups, and after stratification in SCD, MCI, and dementia separately.ResultsLockdown patients had a faster rate of memory decline compared to controls on both RAVLT immediate [B(SE) = − 2.62 (1.07), p = 0.015] and delayed recall [B(SE) = − 1.07 (0.34), p = 0.002]. Stratification by syndrome diagnosis showed that this effect was largely attributable to non-demented participants, as we observed faster memory decline during lockdown in SCD and MCI (RAVLT immediate [SCD: B(SE) = − 6.85 (2.97), p = 0.027; MCI: B(SE) = − 6.14 (1.78), p = 0.001] and delayed recall [SCD: B(SE) = − 2.45 (1.11), p = 0.035; MCI: B(SE) = − 1.50 (0.51), p = 0.005]), but not in dementia.ConclusionMemory clinic patients, specifically in pre-dementia stages, showed faster memory decline during COVID-19 lockdown, providing evidence that lockdown regulations had a deleterious effect on brain health. In individuals that may have been able to deal with accumulating, subclinical neuropathology under normal and structured circumstances, the additional stress of lockdown regulations may have acted as a “second hit,” resulting in less beneficial disease trajectory.

Accrual-Based Accounting and Fiscal Performance: Empirical Evidence from Higher Education Institutions

This study aims to advance our knowledge about the role of accrual accounting regimes in financial decision-making process at Higher Education Institutions. The advantages of accrual accounting in the public sector are well documented from the theoretical perspective. However, empirical findings are relatively rare and primarily rely on either normative arguments or storytelling narratives drawn from case studies. Our paper intends to fill this void by combining archival and survey data from higher education institutions. We investigate whether and to what extent universities with accrual accounting enhance fiscal performance. Based on the results of Mahalanobis distance matching and regression with matched pairs, accrual accounting regimes have a small but positive impact on reducing the debt ratio of such institutions. This paper has the potential to provide information regarding the intended effects of accrual accounting on public organizations.

The impact of COVID‐19 lockdown on cognitive decline over time

AbstractBackgroundDuring the COVID‐19 pandemic, memory clinic patients reported worries for faster cognitive decline as a consequence of lockdown measures, e.g. loss of structure and feelings of loneliness and depression. We aimed to investigate the impact of the COVID‐19 lockdown on cognitive decline over time in a mixed memory clinic population, compared to historical controls.MethodWe included patients who visited Alzheimer Center Amsterdam six months to a week before the first COVID‐19 lockdown in the Netherlands (mid‐March 2020), and a second visit one year later, after this lockdown period (n = 114; 67±7 years old; 30% female; Mini‐Mental State Examination (MMSE): 25±3; diagnosis: n = 55 dementia, n = 32 mild cognitive impairment, n = 18 subjective cognitive decline, n = 9 postponed diagnosis). We selected historical controls with a visit in 2016 or 2017 and a second visit one year later (n = 641). Historical controls were matched 1:1 to patients during COVID‐19 lockdown by optimal Mahalanobis distance matching based on age, sex, diagnosis, MMSE, type of visit (baseline/follow‐up) and time between the first and second visit. Matching was successful and led to balanced groups (both n = 114) on all matching variables (table 1). We used linear mixed models with terms for time, group (i.e. lockdown patients vs. historical controls) and the interaction between time and group. Outcome measures were MMSE, Trail Making Test part A and B, Rey‐Auditory Verbal Learning Test (RAVLT) immediate and delayed recall and category fluency.ResultAs expected, there was no effect of group on baseline test performance for any of the tests. We found significant interactions between time and group for RAVLT immediate recall [B(SE) = ‐2.74(1.07), p = 0.011] and delayed recall [B(SE) = ‐1.07(0.34), p = 0.002], indicating steeper cognitive decline during lockdown. In non‐matched historical controls, we found similar results; significant interactions between group and time for RAVLT immediate recall [B(SE) = ‐3.34(0.80), p&lt;0.001] and delayed recall [B(SE) = ‐0.94(0.23), p&lt;0.001], and additionally steeper decline on category fluency [B(SE) = ‐1.42(0.51), p = 0.005].ConclusionMemory clinic patients during COVID‐19 lockdown show steeper decline in memory than matched historical controls, providing evidence that lockdown regulations contributed to faster cognitive decline.

In comparison with polypectomy, colorectal resection is associated with improved survival for patients diagnosed with malignant polyps.

Patients diagnosed with a malignant polyp generally have favourable overall survival (OS) and cancer-specific survival (CSS). However, it is unclear how choice in management for malignant polyps may affect survival. Data from the Queensland Oncology Repository was analysed to derive a population wide assessment of the impact of management strategy on OS and CSS for patients diagnosed with malignant polyps. Log-rank testing, Kaplan-Meier and Cox-regression models were performed. Patients were matched using propensity score and Mahalanobis distance matching. A total of 1,646 patients were included with 240 deaths and 52 colorectal cancer related deaths until censor date. Following propensity score and Mahalanobis distance matching of patients undergoing polypectomy alone versus colorectal resection, there was no significant difference in the age groups (<60 years of age or ≥60 years of age), American Society of Anesthesiology score, comorbidity count or Association of ColoProctology of Great Britain and Ireland risk category. However, of note Log-rank testing demonstrated a significant difference in OS (p < 0.001) and CSS (p=0.0061) between management strategies. Multivariable Cox-regression models in matched and un-matched patient cohorts demonstrated significantly lower hazards of death for OS with resection (p < 0.001). However, CSS was no longer significantly different between management groups in multivariable Cox-regression analysis (p=0.073). Patients who underwent colorectal resection had significantly improved OS and CSS compared with polypectomy alone. Improved OS was furthermore seen on multivariable analysis, and in matched cohorts. Future research should investigate why this unexpected finding may be the case and whether updates to guidelines should be considered.

청소년의 사이버불링피해가 자살생각에 미치는 영향: 자아존중감의 조절효과를 중심으로

Objectives: In Korea, the rising rate of adolescent suicide is a serious social issue. Although cyberbullying victimization is a critical determinant of suicidal behaviors, the relationship between cyberbullying victimization and suicidal behaviors has not been well studied. The current study aims to examine the association between cyberbullying victimization and suicidal ideation employing Selye’s general adaptation syndrome and investigate the moderating effect of self-esteem based on Baumeister’s escape theory. Methods: Data from the 2019 Survey on Human Rights of Children and Adolescents were employed for the analysis. The study used 2,028 adolescents’ data selected using Mahalanobis Distance Matching. Polynomial regression was used as the primary analysis method, and the response surface method was employed for result visualization. Results: The analysis results are as follows: First, cyberbullying victimization and suicidal ideation were curvilinearly associated with suicidal ideation. Second, self-esteem was negatively associated with suicidal ideation. Third, self-esteem moderated the effect of cyberbullying victimization on suicidal ideation. Conclusion: The results empirically and partially confirm Selye’s general adaptation syndrome and Baumeister’s escape theory. Implications were discussed for theories concerning suicidal behaviors and social work practices for the prevention of suicidal behavior among adolescents.

Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?

The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated. Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes. The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle's maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality. Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.

Association between stressful life events and non-optimal lipid levels among women with hyperlipidaemia.

Psychological stress has been linked to lipid dysregulation with noticeable gender differences, but it remains unclear whether women are more susceptible to non-optimal lipid levels than men, when experiencing stressful life events. This study aims to examine the association between stressful life events and non-optimal lipid levels among persons with hyperlipidaemia and whether the association differs between men and women. A nested case-control study was performed using data from the Wisconsin Sleep Cohort (WSC) Study from 2011 to 2015, including 224 participants with hyperlipidaemia and without a history of myocardial infarction or heart failure. Among them, 63 participants with non-optimal LDL cholesterol or triglyceride levels were identified as cases, and 161 participants with optimal LDL cholesterol and triglyceride levels were identified as controls. Cases and controls were traced back to their self-reported life events collected through the Retirement and Sleep Trajectories study during 2010-11. The association between stressful life events and non-optimal lipid levels was examined using multivariable logistic regression; confounding effects were addressed using propensity score weighting and Mahalanobis distance matching; gender differences were examined using subgroup analysis. Results showed that a higher number of stressful life events during 2010-11 was associated with greater odds of non-optimal lipid levels during 2011-15 (odds ratio = 1.45, P = 0.03) among women with hyperlipidaemia, whereas the association was not significant among men with hyperlipidaemia (P = 0.910). Future studies are needed to examine the underlying mechanisms that explain gender differences in the association between stressful life events and non-optimal lipid levels. ClinicalTrials.gov NCT00005557.