Nonparametric Research Articles

Trends in the Mortality and Death of Periviable Preterm Infants in the United States, 2011 to 2020.

This study aimed to examine the trends in the infant mortality rate (IMR) and the trends in the timing of death among periviable preterm infants at 22 to 24 weeks' gestational age (GA) in the United States from 2011 to 2020. Retrospective, serial cross-sectional analysis of periviable preterm infants born in the United States at 22 to 24 weeks' GA using the linked birth/infant death records from the Centers for Disease Control and Prevention. Data were analyzed from 2011 to 2020. The exposure was the year of death, and the outcome was the changes over time in the IMR and the timing of death. Further, we evaluated racial differences in the timing of death. We used nonparametric trend analysis to evaluate changes in mortality rate across the study period. The IMR was inversely related to GA, and for each GA and race/ethnicity, the IMR significantly declined during the study period. The IMR rate was highest in the first 7 days of life for all GAs and races/ethnicities. While Non-Hispanic White infants had a higher infant neonatal mortality rate than non-Hispanic Black infants, non-Hispanic Black infants had a higher postneonatal mortality rate. The IMR among periviable infants born at 22 to 24 weeks' GA improved for all GAs and races in the United States between 2011 and 2020. However, significant racial differences in the timing of death exist. · As expected, the IMR was inversely related to gestational age at 22 to 24 weeks.. · At each gestational age and for each racial/ethnic group, the overall IMR decreased during the study period.. · Non-Hispanic White infants had a higher neonatal mortality rate, whereas non-Hispanic Black infants had a higher postneonatal mortality rate..

Possible inhibition effects of resveratrol on pancreatic tumorigenesis in the azaserine-rat model.

Resveratrol, which is thought to have a preventive effect on the formation of different types of cancer, is abundant in grapes and other foods. Resveratrol has been shown to have anti-cancer effects by in vitro andin vivo studies, however this is the first time its effect on atypical acinar cell foci (AACF), known as precursor forms of pancreatic carcinoma, has been experimentally investigated. Male Sprague Dawley rats, each consisting of 5 experimental groups (Cont, AzCont, AzRes10, AzRes15, and AzRes20), 10 of which were 14 days old, were used in the study. In the azaserine groups (AzCont, AzRes10, AzRes15, and AzRes20), it was investigated how the development of Atypical Cell Foci (AACF) resulting from intraperitoneal injection (i.p.) of azaserine (30 mg/kg bw) in 14-day-old rats was affected by dietary restoration. Male rats in the resveratrol group (AzRes10, AzRes15, and AzRes20) were fed diets containing 10%, 15%, or 20% mmol resveratrol for an 8-month experimental period 1 week after the last azaserine injection. Pancreas preparations prepared from histological sections were examined for AACF burden and analyzed via a video image analyzer. One-way analysis of variance (ANOVA) non-parametric statistical analyses were performed to test whether there was a difference between the averages of the experimental and control groups. The AACF load in the azaserine group (AzCont) compared to the control group (Cont) was found to be statistically significant in all categories (p < 0.05). The calculated estimated mean AACF volume (mm3) values and the AACF ratio as a percentage of the calculated organ volume were statistically significantly lower in all resveratrol groups (AzRes10, AzRes15, and AzRes20) compared to the azaserine control group (AzCont). The calculated estimated mean AACF volume (mm3) values and the AACF ratio as a percentage of the calculated organ volume were statistically significantly lower in all resveratrol groups (AzRes10, AzRes15, and AzRes20) compared to the azaserine control group (AzCont) (p < 0.05). In addition, the calculated estimated mean AACF diameter (mm) in the AzRes10 and AzRes15 groups, in the AzRes15 group the calculated estimated mean AACF number in the whole organ and the calculated average AACF number per unit area were found to be statistically significant compared to the azaserine control group (AzCont) (p < 0.05). According to the results of our study, it has been shown that atypical acinar cell foci (AACF) formed in the exocrine pancreas of rats with azaserine can be reduced by a diet containing resveratrol. It was determined that the tumor burden decreased statistically significantly (p ≤ 0.05) in resveratrol-treated rats. Accordingly, it is thought that the inhibitory effects of resveratrol may contribute to studies that reduce the occurrence of pancreatic cancer.

A novel ranking method in data envelopment analysis: a real case on Chinese banking industry

Purpose This study aims to address the lack of discrimination between fully efficient decision-making units in nonparametric efficiency analysis models by introducing a new ranking technique that incorporates contextual variables. Design/methodology/approach The proposed method combines Data Envelopment Analysis (DEA) and Ordinary Least Squares (OLS). First, DEA evaluates the partial efficiency of each unit, considering all inputs and only one output. Next, OLS removes the influence of contextual variables on the partial efficiencies. Finally, a ranking criterion based on modified partial efficiencies is formulated. The method is applied to data from 100 Chinese banks, including state-owned, commercial and industrial institutions, for the year 2020. Findings The ranking results show that the top six positions are assigned to highly esteemed banks in China, demonstrating strong alignment with real-world performance. The method provides a comprehensive ranking of all units, including nonextreme efficient ones, without excluding any. It resolves infeasibility issues that arise during the ranking of efficient units and ensures uniqueness in efficiency scores, leading to a more reliable and robust ranking process. Contextual variables exerted a greater influence on the first partial efficiency compared to the second. Notably, Total Capital Adequacy (TCA) significantly impact bank efficiency. Originality/value This study introduces a novel ranking method that effectively integrates contextual variables into DEA-based efficiency analysis, addressing limitations of existing methods. The practical application to Chinese banks demonstrates its utility and relevance.

Microbiological profile of patients with generalized gingivitis undergoing periodontal therapy and administration of Bifidobacterium animalis subsp. lactis HN019: A randomized clinical trial.

To evaluate the adjunctive use of the probiotic Bifidobacterium animalis subsp. lactis HN019 (B. lactis HN019) to conventional therapy on clinical and microbiological parameters in patients with generalized gingivitis. Sixty systemically healthy individuals with untreated generalized gingivitis were submitted to periodontal therapy and allocated to receive Placebo (n = 30) or Probiotic (n = 30) lozenges, twice a day for 8 weeks. Bleeding on Marginal Probing (BOMP) was evaluated at baseline, after 2 and 8 weeks. Supra and subgingival biofilm were obtained at baseline and 8 weeks post-therapy for analyses by 16S rRNA gene sequencing. Differences between therapeutic groups were analyzed by non-parametric tests (p<0.05). The Placebo and Probiotic groups showed a significant reduction in BOMP at 8 weeks compared to baseline (p<0.05). The Probiotic group had a lower percentage of BOMP when compared with the Placebo group at 8 weeks (p<0.0001). Alpha and beta-diversity showed no statistical significance between groups and time points. At phylum level, no significant differences were observed between groups and time points. At genus level, an increase in the relative abundances of Bergeyella and Corynebacterium were significantly associated with a greater reduction in bleeding in the Placebo group and with less reduction in bleeding in the Probiotic group, respectively. At species level, Schaalia spp., Streptococcus gordonii, and Leptotrichia wadei increased in Placebo and decreased in the Probiotic group after treatment. Granulicatella adiacens decreased significantly after the probiotic therapy, while Saccharibacteria (TM7) spp., Solobacterium moorei, and Catonella morbi increased significantly. In the Placebo group, Bergeyella sp. HMT-322 was associated with a greater percentage of reduction in bleeding. In both groups, Actinomyces species were related to less reduction in bleeding. The adjuvant use of B. lactis HN019 alongside conventional therapy enhanced the reduction in BOMP and promoted greater changes in the microbiological profile of patients with generalized gingivitis. The study was registered at Brazilian Clinical Trials Registry (ReBEC; protocol number: RBR-59v2yb).

INNV-19. MULTIMODAL THERAPY FOR BRAF V600E MUTANT MELANOMA BRAIN METASTASES: CHARACTERIZATION OF CHRONOLOGICAL TREATMENT STRATEGIES AND ASSOCIATIONS WITH OVERALL SURVIVAL

Abstract BACKGROUND B-raf proto-oncogene (BRAF)-mutant melanoma brain metastases (BRAF MBM) are associated with poor prognosis. Amidst our large institutional experience treating patients with BRAF MBM with multimodality therapy, our aim was to identify disease and treatment-related prognostic features, accounting for longitudinal sequence of events, to inform clinical decision-making. METHODS We retrospectively reviewed electronic health records of 100 patients with primary cutaneous melanoma diagnosed with BRAF MBM. Demographic, disease, and clinical factors including treatment sequencing were tabulated. Descriptive statistics were used to summarize the study population and non-parametric tests were used to evaluate differences across groups. A multivariable Cox regression identified factors associated with overall survival (OS) following BRAF MBM diagnosis. RESULTS Median follow-up was 22 months and median OS was 33.5 months. Patients received an average [standard deviation (SD)] of 3.36 [1.06] unique therapies. After adjustment for covariates, greater number of brain metastases at initial diagnosis (hazard ratio (HR) 2.3 [1.14-4.62], p=0.01 for 3-10 metastases and HR 2.54 [1.01-6.36], p=0.04 for &amp;gt;10 metastases, respectively), receipt of combination IO and targeted therapy prior to BRAF MBM diagnosis (HR 2.91 [1.08-7.86], p=0.03), and receipt of no unique subsequent therapy after initial management strategy (HR 3.89 [1.48-10.16], p=0.005) were significantly associated with worse OS. CONCLUSIONS Despite heterogeneity in individual treatment sequences, patients with greater intracranial disease burden and those receiving combination targeted and immunotherapy prior to BRAF MBM diagnoses had the worst outcomes. Dynamic changes in therapy resistance may inform optimal treatment strategies for individuals with BRAF MBM.

NCOG-42. SPEECH-SPECIFIC ERRORS IN LEXICAL RETRIEVAL PREDICT GLIOMA MOLECULAR FEATURES

Abstract Recent work confirms that low and high-grade gliomas, remodel neural circuits which influence speech production. The extent to which speech kinetics and category of speech error during lexical retrieval may predict glioma molecular features remains unknown. Here, we extracted audiovisual speech production from 550 patients totaling over 26,400 individual stimuli to identify correlations with glioma molecular features including IDH, TERT, 1p19q co-deletion, and CDK2AB. Nonparametric statistics were used for analysis. IDH wild-type tumors were more likely to be temporoparietal, while IDH mutant tumors were more likely to be insular (p=0.02). Patients with IDH wild-type glioblastoma exhibited more errors (8.23 vs 3.79, p=0.02), with a higher occurrence of anomia (p=0.004), circumlocution (p=0.034) and general delay (p=0.04) when compared with IDH mutant WHO grade 4 astrocytoma. Binomial logistic regression identified lexical retrieval anomia, circumlocution, and initiation delays as an independent predictor of having an IDH wild-type tumor. Within the IDH mutant group, anomia (p=0.03) and articulation (p=0.014) errors were associated with malignant molecular features (after controlling for prognostic variables such as tumor volume). Binomial logistic regression identified articulation or anomia for picture naming as an independent risk predictor for WHO grade 2 gliomas with greater risk molecular features (based on Ki67 and CDK2AB). Distinct patterns of language errors were observed in patients with IDH wild-type and IDH mutant tumors. Further work is required to elucidate the functional and biological correlates of these findings.

Elementary School Students' Literal Thinking Ability in Solving Flat Figure Problems Seen from the Adversity Question

This research aims to analyze students' literal thinking ability in solving plane problems in terms of the adversity quotient (AQ). This type of research is quasi-experimental and involves 55 elementary school students in Central Maluku Regency, Maluku Province, Indonesia. The data obtained was analyzed using non-parametric statistical tests with the Kruskal Wallis test type. The results of the research show that there are differences in students' literal thinking abilities in solving flat - shape problems in terms of AQ. By using the Post-Hoc test, it was found that the literal thinking ability of AQ-Cb students was significantly different from AQ-Q and AQ-Cp, while AQ-Q and AQ-Cp level students had no significant difference. This difference is because AQ-Cb level students are more thorough and work harder in solving flat shape problems compared to AQ-Q and AQ-Cp level students. Students with high AQ are generally more skilled at understanding information, interpreting problems, and being able to make solutions correctly. Keywords: lateral thinking, adversity quotient (AQ), mathematical problem solving

Hubungan Antara Sindrom Nefrotik Resisten Steroid Dengan Gangguan Pertumbuhan Pada Anak

Background: The incidence of nephrotic syndrome is increasing and has been reported to be the second most common disease found in pediatric nephrology. Most children with nephrotic syndrome tend to be picky eaters and have poor appetite due to malabsorption due to intestinal edema and abdominal pain, combined with enteropathic protein loss which can further impair nutrition. In addition, corticosteroid treatment in patients with nephrotic syndrome also has an important role in growth disorders in children that can have a long-term effect and reduce their quality of life if not detected and not intervened early. Aims : to identify the association between steroid-sensitive nephrotic syndrome and growth retardation in children Methods: This study used a cross-sectional study. The calculation of the sample size used the unpaired categorical analytic formula and purposive sampling method in taking the sample size. The research subjects in this study was 50 patients with nephrotic syndrome. Data analysis was performed using non-parametric statistics testing, Chi-square. Results: The results of the Chi Square test showed a significant value or p value = 0.248 (p&gt; 0.05, so it can be concluded that there is no relationship between steroid-resistant nephrotic syndrome (SNRS) and growth retardation in children. Odds Ratio in this study is 1.962. Conclusion: There is no significant association between steroid resistant nephrotic syndrome and growth disorders in children. Keywords: Nephrotic Syndrome, Growth Retardation

CTNI-77. PHASE 1 DOSE FINDING STUDY EVALUATING THE SAFETY, TOLERABILITY, AND EFFICACY OF IOPOFOSINE I 131 IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS WITH INOPERABLE RELAPSED OR REFRACTORY HIGH-GRADE GLIOMAS: A TRIAL-IN-PROGRESS

Abstract Iopofosine I 131, a radioconjugate therapy targeting tumor lipid rafts, is being assessed in CLOVER-2 [NCT05610891]–an ongoing dose-finding study evaluating iopofosine in children, adolescents, and young adults with relapsed, refractory, recurrent high-grade gliomas (HGGs) and ependymoma. Major inclusion criteria include patients aged 10-25 years, previously confirmed HGGs or ependymoma, ≥1 measurable intracranial lesion (≥10 mm in longest diameter), and performance status ≥60. Patients are assigned 1:1 to 2 treatment arms which will be assessed in parallel. Arm 1 has 2 cycles, each composed of 2 doses of 20 mCi/m2 given 14 days apart (± 1 day). Cycle 2 is given 8 weeks (± 4 days) post-initial infusion. Arm 2 patients receive 3 cycles of 10 mCi/m2 per dose. Patients in either arm are eligible for 1 additional cycle at the physician’s discretion. If after the first 10 patients, Arm 1 is not tolerated, dosing is reduced to 15 mCi/m2 per infusion. If after the first 10 patients in Arm 2 are deemed to be ineffective and Arm 1 is deemed to be tolerated, dosing is increased to 15 mCi/m2 per infusion. Final visits occur 57 days following the last cycle initiation, with quarterly follow-ups in year 1 and annually in years 2 and 3. Primary endpoints include safety, tolerability, and progression-free survival (PFS). Secondary endpoints are dosimetry, recommended phase 2 dosing determination, overall survival, antitumor and therapeutic activity, and duration of response and clinical benefit. Safety analysis uses the Wilson score method and nonparametric Wilcoxon signed-rank test. Efficacy analyses use the Response Assessment in Pediatric Neuro-Oncology criteria and the Kaplan-Meier method to detect a median PFS of 5 months compared to a historical control of 2 months. For 90% power by a 1-sided, 1-sample log-rank test: ≥10 evaluable patients must be enrolled (≤90) across ≤15 sites.

IDENTIFICATION OF PERIODONTAL PATHOGENS IN PATIENTS WITH CHRONIC GENERALIZED PERIODONTITIS DEPENDING ON THE SEVERITY OF INFLAMMATION

Introduction. The progression of chronic generalized periodontitis is associated with gram-negative anaerobic bacteria. Microbiological diagnostics of periodontal disease provides an opportunity for selecting the most effective therapeutic approach for both local and systemic conditions in patients. Aim of this study is to conduct a qualitative assessment of the presence of pathogenic microorganisms in the periodontal pockets of patients, based on the severity of inflammation. Materials and methods. The presence of five key pathogenic microorganisms in the periodontal pocket contents of 90 individuals aged 25-60 years (45 with grade I severity and 45 with grade II) was assessed using real-time polymerase chain reaction (PCR). The analysis was conducted with the CFX96™ Real-Time PCR Detection System (BIO-RAD) and the PeriodontScreen Real-TM reagent kit (Sacace Biotechnologies Srl, Italy). Non-parametric correlation statistical analysis was performed to calculate Kendall’s Tau and Gamma coefficients. In 27 patients (60%) with grade I severity, bacteria of a single species were identified. Two types of periodontal pathogens were detected in 13 patients (28.9%), with the most common combination being Tannerella forsythia and Aggregatibacter actinomycetemcomitans, found in 5 patients (11.1%); 5 patients (11.1%) showed the presence of three microbial species: Tannerella forsythia, Treponema denticola, and Porphyromonas gingivalis. Among the patients with grade II severity, 8 patients (17.8%) had bacteria of one species, specifically Prevotella intermedia. Two microbial species were identified in 9 patients (20%), while three species were present in 15 patients (33.3%). The most frequent combination included Prevotella intermedia, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans, found in 5 patients (11.1%). Four types of microbes were detected in 13 patients (28.9%), with the predominant combination being Tannerella forsythia, Porphyromonas gingivalis, Treponema denticola, and Aggregatibacter actinomycetemcomitans (17.8%). None of the patients with grade II severity had all five periodontopathogenic agents. The correlation analysis confirmed that chronic periodontitis is strongly associated with the presence of Tannerella forsythia within microbial associations. Conclusions. The spectrum of periodontal pathogens affects the severity of inflammation in the periodontium. In grade II inflammation, associations of periodontal pathogens were detected by 82.2% of cases, while in grade I by in 40%. Tannerella forsythia was detected in 42.2% of patients with grade I inflammation, 15.6% of them as a mono-infection; in patients with grade II inflammation in 71.1%, in associations with Treponema denticola in 48.9%. Determining the spectrum of periodontal pathogens, taking into account their characteristics and associated virulence factors, is necessary for choosing the effective differentiated treatment approach.

Comparison of BMI, triponderal mass index, and paediatric body adiposity Index for predicting body fat and screening obesity in preschool children.

Several novel anthropometric indices, including paediatric body adiposity index (BAIp) and triponderal mass index (TMI), have emerged as potential tools for estimating body fat in preschool children. However, their comparative validity and accuracy, particularly when compared to established indicators such as Body Mass Index (BMI), have not been thoroughly investigated. This cross-sectional study enrolled 2869 preschoolers aged 3-6 years in Wuhan, China. The nonparametric Bland-Altman analysis was employed to evaluate the agreement between BMI, BAIp, and TMI with percentage of body fat (PBF), determined by bioimpedance analysis (BIA), serving as the reference measure of adiposity. Additionally, Receiver Operating Characteristic Curve (ROC) analysis was conducted to assess the effectiveness of BMI, BAIp, and TMI in screening for obesity. BAIp demonstrated the least bias in estimating PBF, showing discrepancies of 3.64% (95%CI: 3.40% to 4.12%) in boys and 3.95% (95%CI: 3.79% to 4.23%) in girls. Conversely, BMI underestimated PBF by 3.89% (95%CI: 3.70% to 4.37%)in boys and 4.81% (95%CI: 4.59% to 5.09%) in girls, while TMI also underestimated PBF by 5.15% (95%CI: 4.90% to 5.52%) in boys and 5.68% (95%CI: 5.30% to 5.91%) in girls. BAIp exhibited the highest area under the curve (AUC) values (AUC=0.867-0.996) in boys, whereas in girls, there was no statistically significant difference between BMI (AUC = 0.936, 95% CI: 0.921-0.948) and BAIp(AUC = 0.901, 95% CI 0.883-0.916) in girls (P=0.054). In summary, when considering the identification of obesity, BAIp shows promise as a screening tool for both boys and girls.

The Influence of Job Crafting on Nurses’ Intent to Stay: A Cross-Sectional Study

Background/Objectives: The increasing rates of nurse turnover pose significant challenges to healthcare systems, negatively impacting patient outcomes and increasing operational costs. Despite the recognized importance of retaining nursing staff, factors contributing to turnover intentions, such as job dissatisfaction and burnout, remain inadequately addressed. Developing job crafting skills among nurses can be a proactive strategy to mitigate these issues, leading to a more engaged and committed workforce. The aim of this study was to analyze nurses’ job crafting and its relationship with the intention to stay at their working hospitals or to leave the nursing profession. Methods: A cross-sectional, correlational study was conducted with a sample of 284 registered nurses using a self-reported online questionnaire with the standardized Spanish version of the Job Crafting Scale. Mann–Whitney U and Kruskal–Wallis nonparametric tests were used to determine statistically significant differences between two or more different groups for the job crafting variable, respectively. The Spearman correlation coefficient was calculated to explore the relationships between variables. Results: Mean scores obtained for the Job Crafting Scale indicated that nurses in the study had a high level of job crafting. Nurses with lower scores for the ‘Decreasing hindering job demands’ subscale had a significantly lower intention to stay at their workplace. Greater ‘Decreasing hindering job demands’ scores were significantly associated with a lower intention to leave the nursing profession. Lower nurses’ intention to leave the nursing profession was significantly associated with a greater intention to stay at hospitals. Conclusions: Improving ‘Decreasing hindering job demands’ job crafting skills to “decrease hindering job demands” through workload management, time management training, supportive supervision, resource availability, autonomy encouragement, promotion of team collaboration, and mental health support. It could lead to greater retention of nurses in their workplaces and in the nursing profession. Nursing managers and leaders should consider improving the job crafting skill “Decrease Hindering Job Demands” among nurses as a potential strategy for effective retention of nurses to address the challenges of the global nursing shortage.

Exploring the factors influencing the adult population's reluctance to accept the COVID-19 vaccine in Tehran.

While evidence of efficacy, safety, and technical feasibility is crucial when introducing a vaccine, it is equally important to consider the psychological, social, and political factors influencing vaccine acceptance. This study aims to identify the factors contributing to COVID-19 vaccine hesitancy among adults in Tehran, Iran. The study employed a descriptive and analytical cross-sectional design carried out from 2021 to 2022. It involved 260 eligible individuals residing in the catchment areas of Tehran and Shahid Beheshti Universities of Medical Sciences who declined to receive the COVID-19 vaccine, selected through systematic sampling. Data collection was accomplished through a researcher-developed questionnaire and analyzed using SPSS 26 software. The analysis utilized descriptive statistics and non-parametric tests including Mann-Whitney U, Kruskal-Wallis, and Multiple Linear Regression, to examine the relationships between variables. The average scores (SD) across dimensions were as follows: the individual's health status and perceived risk, 15.53 (1.70); contextual and social effects, 17.68 (2.53); awareness, 14.81 (2.34); and beliefs and concerns. 14.91 (2.64), indicating a concerning situation regarding contextual and social impacts and a moderate status as to other areas. The primary reasons for vaccine refusal included fear, lack of belief in the vaccine, concerns about its reliability, illness, and lack of access or time. Acceptance of the vaccine was associated with education, occupation, marital status, number of children at home, and income reduction due to COVID-19. The findings indicate that fear, lack of belief in the vaccine, concerns regarding its reliability, illness, and lack of access or time were the most important factors influencing reluctance to receive the vaccine. Health organizations should consider these factors when encouraging the population to receive the COVID-19 vaccine.

Reliability Analysis for Unknown Age Class of Lifetime Distribution with Real Applications in Medical Science

Analyzing the reliability of the aging class of life distribution provides important information about how long a product lasts and sustainability measures that are essential for determining the environmental impact and formulating resource-saving plans. The study emphasizes the goodness-of-fit technique of the nonparametric test for the NBRUmgf class because age data are crucial for applications. Evaluations were conducted using the test’s asymptotic properties and Pitman efficiency methodology for some selected asymmetric probability models, and the outcomes were compared with those of alternative methods. We assessed the test’s power against widely used reliability distributions for some well-known alternative asymmetric distributions, including the Weibull, Gamma, and linear failure rate (LFR) distributions, and provided percentiles for both censored and uncensored data. This study shows the efficacy of the test in various sectors using real-world datasets and comprehensive tables of test statistics.

MEDICAL-SOCIOLOGICAL ANALYSIS OF HEALTH AND QUALITY OF LIFE OF PERSONS AGE 60+ RESIDING IN THE GRODNO REGION

Aim: to analyze indicators of self-assessment of quality of life, satisfaction with health, their relationship with socio-demographic factors and objective indicators of public health, among people aged 60+ living in the Grodno region. Materials and methods: data from official demographic and health statistics, a representative database of 1270 people aged 60+ of the Grodno region of the Republic of Belarus by gender, residence, age (WHOQOL-BREF tools) were analyzed. Nonparametric statistics methods were used. Results: The Grodno region demonstrates life expectancy at birth values ​​close to the republican average. The minimum values ​​in all regions are detected among men living in the village. In the structure of causes of death rate, diseases of the cardiovascular system lead by far. When self-assessing the quality of life, the options “good” or “neither bad nor good” predominate; satisfaction with the state of health is option “3” of the five-point scale. Men compared to women, rural residents compared to urban residents, unmarried compared to married people rate the quality of life lower. The hypothesis about the positive impact on the quality of life of the respondent having children is confirmed; the hypothesis about the influence of the old-age pension is not confirmed. Health satisfaction reveals resistance to socio-demographic factors. A positive medium-strength correlation is revealed between health satisfaction and self-assessment of quality of life in all socio-demographic groups. With increasing age, there is a decrease in self-esteem of quality of life, and an even more pronounced decrease in satisfaction with health. Conclusion: men aged 60+ living in rural areas are at risk of low self-assessments of quality of life, in connection with low life expectancy; at the same time, health satisfaction does not reveal gender differences.

Comparing anti-drug antibody signal-to-noise ratios to assess immunogenicity and interchangeability in adalimumab biosimilar studies

ABSTRACT Background To support an interchangeability designation for Sandoz adalimumab biosimilar (GP2017), antidrug antibody (ADA) signal-to-noise (S/N) ratios were assessed in the GP2017 ADACCESS trial to directly assess potential changes in immunogenicity. Research design and methods ADACCESS was a 51-week trial in patients with moderate-to-severe plaque psoriasis that included patients treated continuously with reference adalimumab (cH), and patients who experienced four switches between reference adalimumab and GP2017 (H2H). ADAs were measured every 6 weeks during the switching phase using an electrochemiluminescence assay. A non-parametric analysis was performed to estimate the 90% confidence interval (CI) of the median of difference in ADA S/N ratios between the cH and H2H treatment groups at week 41. If the 90% CI was within the margin of –0.16 to 0.16 (representing assay noise), this was considered a non-clinically meaningful difference in immunogenicity. Results The 90% CIs of the median of difference in ADA S/N ratios between the two treatment groups were within the defined margin of –0.16 to 0.16 at week 41, and at all other time points. Efficacy and safety data were also similar between the treatment groups. Conclusion Analysis of ADA S/N ratios showed no increase in immunogenicity following up to four switches between reference adalimumab and GP2017. Trial registration NCT02016105

Assessing the Work Productivity Impact of Overactive Bladder Syndrome Among Employees at a Brazilian Hospital.

Few studies have investigated the relationship between work productivity (WP) and overactive bladder syndrome (OABS). The majority of those that do use generic productivity questionnaires or only include WP as a secondary outcome. We evaluated the impact of OABS on specific domains of WP, with the hypothesis that OABS has an impact on the domains of efficiency, concentration, vigor, and irritability, lost working hours, interruptions, and impairment to the work schedule. An observational, cross-sectional study with 576 female employees (without SBH 447, dry OABS 63, wet OABS 66) was carried out. The 8-item Overactive Bladder Questionnaire (OAB-V8), International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB), and a WP questionnaire developed by the authors were used. Non-parametric tests were adopted to associate OABS with productivity. The correlation between the instruments was performed using the Spearman test, adopting a value of p = 0.05. There was a significant impact of urinary symptoms on WP (p = 0.03) in the domains of productivity/efficiency (p = 0.03), restlessness (p < 0.05), and interruptions to go to the bathroom (p = 0.03), which was higher among employees with wet OABS. Urgency and urge urinary incontinence (UUI) were the symptoms with the greatest productive impact (p = 0.01, p < 0.001). A significant correlation was found between WP scores and OAB-V8 and ICIQ-AOB scores in both groups (p < 0.05). OABS impacted WP, in the domains of efficiency, restlessness, and interruptions to go to the bathroom, with urgency and UUI being the symptoms with the greatest impact on productivity.

Examining malaria treatment and prevention spending efficiency in malaria-endemic countries, 2000–2020

BackgroundIn 2021, an estimated 750,000 people died from malaria. Despite this significant burden, globally, malaria incidence and mortality rates have substantially dropped over the last 30 years. However, growth in spending on malaria and improved outcomes have recently stagnated. This development has made it more important than ever to understand what constitutes efficient spending on malaria.MethodsData from various sources, including disaggregated data on malaria spending from the WHO Global Malaria Programme, National Health Accounts, and the Global Burden of Disease 2021 study was used in this study. The National Health Account report is produced at the end of a national accounting exercise that aims to map the flow of financial resources from all perspectives—incl. sources, agencies—in the health sector. Malaria spending estimates for all malaria-endemic countries from 2000 to 2020, with government and donor spending disaggregated into 11 key programme areas were generated in this study. Then, these spending estimates were combined with outcome data and estimated country efficiency using robust non-parametric stochastic frontier analysis and linear regression to examine the types of malaria spending associated with better malaria outcomes.ResultsAcross malaria-endemic countries, there is wide variation in malaria spending, with spending associated with the malaria burden within the country. Argentina, Paraguay, and Turkmenistan stood out as examples of low spending relative to their respective malaria incident per person at risk rates, while the Philippines, Guatemala, and Sri Lanka stood out as countries with case fatality ratios that were low relative to their malaria spending. Having a greater proportion of malaria spending sourced from donors or on prevention was associated with increases in incidence efficiency, while having a greater proportion of spending on anti-malarial medicines was associated with increases in case fatality efficiency.ConclusionsPrioritization of spending on prevention, anti-malarial medicines, and health systems strengthening can fight incident cases and fatalities simultaneously, especially in resource-scarce, malaria-endemic countries. Furthermore, improving the availability, frequency of collection, and quality of detailed disaggregated spending data is essential to support work that strengthens the evidence base on spending efficiency and work that improves understanding of how spending on malaria could be leveraged to bridge gaps in equity across population groups.

An evaluation of 30 years’ experience in the use of botulinum toxin injections in the management of sixth nerve palsies

ABSTRACT Intrroduction Sixth nerve palsy is the most common type of extraocular muscle palsy. The therapy options in sixth nerve palsies include monitoring with or without conservative treatment, botulinum toxin injections or strabismus surgery. The aim of this retrospective study was to compare botulinum toxin (BT) injections into the medial rectus to conservative treatment in sixth nerve palsies. The rate of patients improved after intervention and treatment outcomes for the two treatment options were be evaluated at a German tertiary referral center. Methods A service evaluation was conducted on adult patients with sixth nerve palsy. Patient files were reviewed and data including abduction deficit and size of deviation were collected retrospectively. Patients which presented between January 1987 and April 2022 were considered. Patients were allocated into two treatment groups: BT injected into medial rectus or conservative treatment, which included observation, providing occlusion and Fresnel prisms. Inclusion criteria were attendance of two visits with orthoptic assessment. Exclusion criteria included presence of further oculomotor palsies, strabismus, strabismus surgery and suppression. Non-parametric statistical analysis was conducted using IBM® SPSS Statistics. Results A total of 606 adult patients with unilateral or bilateral sixth nerve palsy attended during the named period. A total of 137 adult patients met the inclusion criteria. Of which, 36 had a bilateral palsy, 101 had a unilateral palsy. 45.26% (n = 62) were treated with BT injections and 54.75% (n = 75) were treated conservatively. The median initial abduction deficit was greater in the BT group, (−4 to −5 after Scott and Kraft) than in the conservative treatment group (−1). The initial angle of deviation at distance was significantly larger in the BT group than in the conservative treatment group (p = <0.001). The rate of improvement in the BT group was 24.19% (n = 15) and 20% (n = 15) in the conservative treatment group. When excluding longstanding palsies rates of improvement in both groups increased to 28.85%. The improvement of the angle of deviation at distance in all patients was greater in the BT group (p = <.001). The improvement of abduction in bilateral palsies were greater in the BT group (p = .016), but in unilateral palsies, there was no significant difference in abduction improvement in the two treatment groups (OD p = .3, OS p = .406). Conclusion This service evaluation found that BT injection into medial rectus in unilateral and bilateral sixth nerve palsies did not increase the rate of improvement compared to conservative treatment. But BT injections reduced the angle of deviation to a greater extent than conservative treatment. Additionally, BT was able to improve abduction in bilateral palsies to a greater extent than conservative treatment. It is recommended a BT injection is considered in symptomatic bilateral sixth nerve palsies to enable fixation and improved ocular motility. More research is needed to verify reliable clinical guidelines for the use of BT in sixth nerve palsies.

Prognosis impact and clinical findings in renal cancer patients: comparative analysis between public and private health coverage in a cross-sectional and multicenter context.

Research on disparities in prognosis and clinical characteristics between public and private healthcare sectors in developing countries remains limited. The study aimed to determine whether patients with public health coverage (1) have a greater mean tumor size at diagnosis compared to those with private health coverage; (2) exhibit differences in clinical staging and TNM classification between groups; and (3) show variations in demographic, clinical characteristics, histopathological findings, and surgical approaches among cohorts. A cross-sectional, multicenter study was conducted on 629 patients from both private and public healthcare sectors, all histologically confirmed and surgically treated for Renal Cell Carcinoma (RCC), between 2011 and 2021 in high-volume hospitals in Monterrey, Mexico. To compare variables between groups, we employed independent samples t-tests, Mann Whitney U nonparametric test, along with Pearson's chi-square test complemented by post hoc analyses. Mean tumor size in the public group was 1.9cm greater than in the private group (7.39 vs. 5.51cm, p < 0.001). Patients in the public sector more frequently presented with larger tumors, a higher prevalence of risk factors (excluding BMI and hypertension), advanced disease (OR 2.12, 95% CI 1.43-3.16, p < 0.001), presence of symptoms, elevated TNM, lymphovascular invasion and a lower prevalence of minimally invasive surgery. A male-to-female ratio of 2.6:1 was noted in the private coverage group. This study highlights a notable association between public health coverage and a higher prevalence of advanced RCC, with tumors in private coverage patients being smaller yet larger than commonly reported. There is a crucial need to develop new health policies for early detection of renal cancer in developing countries.