Pearson's Chi-square Test Research Articles

Loneliness and Social Isolation in Older Adults in Latvia and Iceland During COVID-19

Abstract Background The COVID-19 pandemic has significantly impacted the mental health and wellbeing of older populations across Europe, exacerbating feelings of loneliness and social isolation, known risk factors for poor physical and mental health outcomes. This study aims to understand the extent and implications of these changes in Latvia and Iceland, providing essential insights for targeted public health interventions. Methods This comparative study utilized data from two key sources: the Survey of Health, Ageing, and Retirement in Europe (SHARE) for Latvia and the HL20 study for Iceland, focusing on individuals aged 67 and above. Both quantitative surveys were conducted during the pandemic, offering data on health status, loneliness, and social isolation. A novel approach was applied in analyzing older populations to standardize comparisons between the two distinct datasets. This methodological innovation is part of a bilateral EEA initiative FM2021/23 aimed at strengthening research collaboration between Latvia and Iceland. Descriptive statistics and the Pearson Chi-square test were used to compare outcomes between the two countries and within demographic subgroups. Results The study revealed stark differences between the two countries: 80% of Latvian older adults reported social isolation compared to 42.7% in Iceland. Similarly, 45% of Latvians experienced loneliness versus 30% of Icelanders. Significant associations were found between social isolation, loneliness, and deteriorating mental and physical health, with worse outcomes noted in socially isolated individuals. Conclusions Our findings demonstrate a clear link between social isolation and adverse health outcomes among the older adults, exacerbated by the COVID-19 pandemic. The study supports the need for proactive public health measures in Latvia and Iceland, including the development of community engagement programs and mental health support services tailored to the needs of older adults. Key messages • Study shows significant health impact of social isolation among older adults in Latvia and Iceland, highlighting urgent need for targeted public health interventions. • Effective public health strategies and innovative digital outreach can mitigate adverse effects of loneliness and isolation observed in older populations.

Performance Assessment of GPT 4.0 on the Japanese Medical Licensing Examination.

To evaluate the accuracy and parsing ability of GPT 4.0 for Japanese medical practitioner qualification examinations in a multidimensional way to investigate its response accuracy and comprehensiveness to medical knowledge. We evaluated the performance of the GPT 4.0 on Japanese Medical Licensing Examination (JMLE) questions (2021-2023). Questions are categorized by difficulty and type, with distinctions between general and clinical parts, as well as between single-choice (MCQ1) and multiple-choice (MCQ2) questions. Difficulty levels were determined on the basis of correct rates provided by the JMLE Preparatory School. The accuracy and quality of the GPT 4.0 responses were analyzed via an improved Global Qualily Scale (GQS) scores, considering both the chosen options and the accompanying analysis. Descriptive statistics and Pearson Chi-square tests were used to examine performance across exam years, question difficulty, type, and choice. GPT 4.0 ability was evaluated via the GQS, with comparisons made via the Mann-Whitney U or Kruskal-Wallis test. The correct response rate and parsing ability of the GPT4.0 to the JMLE questions reached the qualification level (80.4%). In terms of the accuracy of the GPT4.0 response to the JMLE, we found significant differences in accuracy across both difficulty levels and option types. According to the GQS scores for the GPT 4.0 responses to all the JMLE questions, the performance of the questionnaire varied according to year and choice type. GTP4.0 performs well in providing basic support in medical education and medical research, but it also needs to input a large amount of medical-related data to train its model and improve the accuracy of its medical knowledge output. Further integration of ChatGPT with the medical field could open new opportunities for medicine.

Eight Year Follow-Up After Gastric Bypass and Sleeve Gastrectomy in a Brazilian Cohort: Weight Trajectory and Health Outcomes.

Despite Sleeve Gastrectomy (SG) being the most commonly performed bariatric surgery today, studies with over 5years of follow-up show that patients undergoing SG have inferior weight loss compared to those undergoing Roux-en-Y gastric bypass (RYGB). The aim of this study was to examine differences in weight loss and the prevalence of weight regain between SG and RYGB up to 8years after surgery. Retrospective study including adult patients undergoing SG or RYGB between 2015 and 2018 at a tertiary center in Brazil. We evaluate the weight trajectory and pre- and postoperative behavior of type 2 diabetes (T2D), hypertension, and dyslipidemia. Differences betwen variables were tested using Student t-test, Mann-Whitney U, Pearson's chi-square or Fisher's exact test as appropriate. The level of significance adopted was p < 0,005. Among 591 patients (40 ± 10years; baseline body mass index 41.7 [IQR 39.1-45]; 83% women), 327 underwent RYGB (55%) and 264 SG (45%). Preoperatively, 14% had T2D, 40% hypertension, and 53% dyslipidemia. The mean total percentage of weight loss was higher in the RYGB group after 8years: 32% compared to 19% after SG (difference 13%, p < 0.004). At 8years, weight regain was also lower in RYGB (23%) compared to SG (39%) (p < 0.001). At 5years postoperatively, the remission rates for T2D, hypertension, and dyslipidemia were 63%, 42%, and 51%, respectively, among the patients who remained in follow-up. Patients undergoing RYGB showed greater weight loss and less weight regain 8years after bariatric surgery compared to those undergoing SG.

Predictors of dental arch abnormalities in children with primary dentition (part two)

Relevance. Assessing the influence of risk factors during the primary dentition period on the development of dental arch abnormalities is essential for planning preventive and therapeutic interventions, as well as encouraging compliance with these measures. The first part of this article focused on identifying predictors of malocclusion, while this second part aims to determine the predictors of dental arch abnormalities.Purpose. To identify prognostic factors (predictors) of dental arch abnormalities in children during the primary dentition period.Materials and methods. This study presents the results of a retrospective analysis of the oral health status of 123 children (55 boys and 68 girls). The initial examination took place when the children were between 4.0 and 5.5 years old (mean age 5.1 ± 0.6 years), with follow-up examinations conducted between the ages of 6.0 and 10.5 years (mean age 8.7 ± 1.3 years). The relationship between risk factors in primary dentition and the development of dental arch abnormalities in early mixed dentition was evaluated using Pearson's chi-squared test (χ2) and Welch's t-test (V). For each pair of "primary dentition risk factor – dental arch abnormality in early mixed dentition," the odds ratio with a 95% confidence interval was calculated.Results. Differentiating predisposing factors and analyzing the effects of their various combinations allowed the identification of predictor clusters in primary dentition, where the probability of developing dental arch abnormalities in mixed dentition exceeds 95%. For upper arch abnormalities, the cluster includes infantile swallowing and early extraction of deciduous molars in the lower jaw (χ2 =19.67, V=0.50); for lower arch abnormalities, the cluster consists of infantile swallowing, "lazy" chewing, sucking habits, and a deep bite in the anterior region (χ2 =16.58, V=0.67); For lower incisor crowding, the cluster includes "lazy" chewing, infantile swallowing, and a deep bite in the anterior region (χ2 =17.54, V=0.63); for diastema in the upper arch, the cluster includes an abnormal labial frenum and interdental tongue position (χ2 =19.16, V=0.49); for maxillary anterior spacing, early extraction of deciduous canines in the upper jaw is the primary factor (χ2 =16.23, V=0.46).Conclusion. Identifying and addressing predictors of dental arch abnormalities in children during the primary dentition period can significantly reduce the risk of developing pathological conditions during the mixed dentition period.

Finnish pre-service teachers’ knowledge about the Indigenous Sámi people

ABSTRACT Teacher education worldwide faces challenges in preparing prospective teachers for diverse classrooms. Understanding pre-service teachers’ knowledge and attitudes toward diversity is crucial for achieving this goal. This article details a study surveying first-year pre-service teachers at a Finnish university to evaluate their knowledge of and attitudes toward the Indigenous Sámi people. A web survey (n = 172) was used to collect the data. The data analysis was conducted using Fisher’s exact test and the Pearson chi-squared test. The findings indicate that although the pre-service teachers had some prior knowledge of the Sámi people, there is a need for culturally responsive education (CRE) that meets the Finnish National Board of Education’s standards for teaching about national cultures. The insights derived from this study offer clear directives for fostering inclusive teacher education practices that address the diverse needs of students from Indigenous and multicultural backgrounds.

Turkish Translation And Validation of The Expectations of Aesthetic Rhinoplasty Scale.

The aim of this study was to translated, validate, and culturally adapt the original English version of the Expectations of Aesthetic Rhinoplasty Scale (EARS) into Turkish for use in Turkish-speaking communities. Fifty-one patients who wanted to undergo primary rhinoplasty and were literate in Turkish were included in the study. The control group consisted of 81 healthy volunteers who did not require rhinoplasty. A Turkish version of the EARS (EARS-T) was created. The participants completed the EARS-T questionnaire twice, four weeks apart. The internal consistency of the scale (Cronbach's α), the test-retest reliability (intraclass correlation coefficient [ICC]), and differences between the patient and control groups (Pearson's chi-square test) were analyzed. A statistically significant difference was found between the age and gender of the patient and control groups (p = 0.001 and p = 0.001, respectively). Univariate analysis showed that this significant difference did not affect the study results (age: p = 0.2; gender: p = 0.12). In addition, a statistically significant difference was found between the scale scores of the control and rhinoplasty groups (all p < 0.05). The EARS-T had good internal consistency, with high Cronbach's α scores ranging between 0.74 and 0.87. Test-retest reliability was demonstrated by high ICC scores ranging from 0.71 to 0.87. Our study revealed that the EARS-T has good internal consistency, reliability, and validity. Therefore, it can be used to assess the expectations of aesthetic rhinoplasty patients in preoperative consultation practice and in clinical studies related to rhinoplasty.

Enhanced Safety and Efficacy of O-Arm Navigation Over C-Arm Guidance in Percutaneous Kyphoplasty for Patients With Osteoporotic Vertebral Compression Fractures and Spinal Deformity: A Comparative Study.

Although percutaneous kyphoplasty (PKP) under C-arm guidance is an effective treatment for osteoporotic vertebral compression fractures (OVCF), obtaining high-definition images in patients with OVCF and spinal deformities can be challenging or insufficient using traditional C-arm guidance, prompting our institution to adopt the O-arm navigation system-which offers comprehensive 3D imaging and precise navigation-and this study compares its safety and efficacy with conventional C-arm-assisted PKP. This was a retrospective study. From February 2019 to February 2022, we enrolled 28 patients with OVCF (44 vertebrae) with spinal deformity treated with O-arm navigation-assisted PKP and 30 patients with OVCF (42 vertebrae) with spinal deformity treated with C-arm-guided PKP. We recorded puncture times, single-segment operation time, number of cases with bone cement leakage, and length of stay. The visual analog scales (VASs), Oswestry disability indexes (ODIs), recovery of Cobbs angle, and vertebral height were used to assess treatment effect before the operation, on the first day postoperation, the first month postoperation, and at the final follow-up. The chi-squared test was utilized for comparing discrete variables, an independent samples t-test was used for continuous variables, and Pearson's chi-squared test and Fisher's exact test were applied for categorical data. Demographic features were comparable between the groups. The O-arm navigation group showed a significant reduction in puncture adjustment per vertebrae, single-segment operation time, and the rate of trocar needle malposition compared to the C-arm guidance group. The rate of cement leakage was decreased in the O-arm-guided PKP group, and other complications did not differ between the two groups. Intragroup comparisons revealed significant improvements in VAS scores and ODI on the first day, first month, and final follow-up after the operation (p < 0.05). The VAS score was significantly lower in the O-arm navigation-assisted PKP group than in the C-arm-guided PKP group on the first day postoperatively (p = 0.049). However, no significant differences in VAS scores were observed between the groups at the first month postoperatively or at the final follow-up. In each follow-up period, there was no significant difference in ODI, Cobb angle, and the percent of anterior vertebral height (AVH %) between the groups. O-arm navigation-assisted PKP demonstrates better clinical safety and efficacy than C-arm-guided PKP, marking it as a minimally invasive, safe, and effective procedure for treating patients with OVCF with spinal deformity.

The Effect of Glucagon-like-Peptide-1 Receptor Agonists on Diabetic Retinopathy Progression, Central Subfield Thickness, and Response to Intravitreal Injections.

Objectives: To examine the effects of glucagon-like-peptide-1 receptor agonists (GLP1-RAs) on diabetic retinopathy (DR) progression, visual acuity (VA), central subfield thickness (CST), and response to intravitreal injections (IVIs) in the Hadassah ophthalmological cohort. Methods: Of 4500 Hadassah patients with DR, 146 had a documented first course of GLP1-RA treatment lasting at least a year along with ophthalmological follow-up. Of these, 35 underwent at least two optical coherence tomography (OCT) exams with a one-year interval. These 35 GLP1-RA-naïve patients were compared to a control group of 31 patients with DR who did not receive GLP1-RA treatment. We compared demographics, medical records, ocular data, and OCT characteristics between the two study groups. Results: At baseline, patients who received GLP1-RA treatment had a significantly higher prevalence of retinal detachment and vitreous hemorrhage, as well as a higher (though not statistically significant) prevalence of cardiovascular comorbidities compared to the control group. At the end of the follow-up period, the GLP1-RA group had a higher prevalence of DR progression compared to controls (3/19 vs. 0/20, respectively; p = 0.106, Fisher's exact test), but also showed a better response to IVIs (27/35 vs. 17/31, respectively; unadjusted OR: 2.78, p = 0.058; 95% CI: [0.963, 8.020], Pearson's chi-square test). However, vitreous hemorrhage and hyperreflective retinal foci were confounding factors (adjusted IVI response OR: 1.76, p = 0.229, 95% CI: [0.553, 5.650], logistic regression). No significant differences were observed between the two groups in terms of change in visual acuity (-0.135 vs. -0.063 logMAR, respectively; p = 0.664, Student's t-test) or CST (-13.49 vs. -30.13 μm; p = 0.464, Student's t-test). Conclusions: This study presents preliminary findings showing no significant differences in DR progression, visual acuity, and CST between patients treated with GLP1-RA and control patients. Moreover, GLP1-RA therapy was not significantly associated with improved IVI response, with ocular parameters acting as confounding factors.

When library cares: mining insights from LibQUAL+ to determine university students’ priorities

PurposeThis study aims to evaluate students' satisfaction with university library services in southern Punjab, Pakistan, emphasizing their perspective on service quality (SQ).Design/methodology/approachA LibQUAL+® survey with 22 core items was conducted within university settings using convenience sampling. In total, 345 usable responses were returned through Google Forms. Data analysis involved descriptive statistics, ordinal logistic regression test, Pearson and Deviance statistics and chi-square test to assess the satisfaction status of library users.FindingsThe study found that libraries generally meet SQ standards. However, there were minor gaps in information control (IC) and library as place (LP).Practical implicationsThe study provides library administrators with actionable insights to enhance services, encouraging stakeholders to adopt optimal library practices for heightened efficiency and user satisfaction.Social implicationsIt highlights the crucial role of libraries in shaping future societal progress by emphasizing the need for elevated user services. Librarians can use this knowledge to modify their planning and take impactful initiatives that align with the evolving needs of their users.Originality/valueWhile many studies have utilized LibQUAL, this research is unique for its focus on addressing university library services in underdeveloped regions facing economic challenges. It attempts to fill the information gap by offering a transferable approach for strategic priorities in similar settings.

Complications associated with loop ileostomy reversal delayed greater than twelve months.

Diverting loop ileostomy is performed after colectomy to allow for anastomotic healing, and prevention of pelvic sepsis when an anastomotic leak occurs. There is no consensus on the optimal timing of ileostomy closure, and there is limited data on complications associated with ileostomy closure greater than 12 months after creation. The aim of this study is to investigate outcomes of delayed loop ileostomy closure greater than 12 months after creation. Patients undergoing loop ileostomy closure between 2013 and 2023 at Carilion Medical Center, in Roanoke, VA were reviewed. Cohorts compared were defined as Control Group (closure < 4 months) and Delayed Group (closure > 12 months). Demographics and outcomes were compared. Statistical comparisons were performed using either Wilcoxon rank sum test, Pearson's Chi-squared test or Fisher's exact test. Statistical modeling included binary logistic regression for 30-day readmissions and a generalized linear modeling for days till bowel function returns. Adjusted odds ratios, confidence intervals, and p-values were calculated. There were 135 patients in the Control Group and 19 patients in the Delayed Group. Demographics were similar between the groups except for a higher percentage of patients with diabetes, renal failure and history of cancer in Delayed Group (all p < 0.05). Operative time was longer for Delayed loop ileostomy closure (p < 0.05). Patients in the Delayed Group demonstrated a higher hospital readmission rate within 30 days (p < 0.05). Both groups had similar return of bowel function on post-operative day 2, similar length of stay, and similar rates of postoperative ileus (p = NS). Delayed loop ileostomy closure more than 12 months after creation does not delay return of bowel function but may lead to higher hospital readmission rates within 30 days.

The Effects of Baby Calming Training Provided to Primiparous Mothers on Maternal Role Perception, Maternal Attachment, and Breastfeeding Self-Efficacy: A Randomized Controlled Trial.

Background: Mothers of crying babies have difficulty adapting to their roles and problems with breastfeeding and attachment. Objective: This study aimed to assess the impact of the baby calming training provided to primiparous mothers on maternal role perception, maternal attachment, and breastfeeding self-efficacy. Methods: The study was conducted in a randomized controlled experimental design between March 2023 and March 2024 in the gynecology and obstetrics services of a public hospital in northeastern Turkey (Clinical Trial Number: NCT05594836). The research was conducted with a total of 84 primiparous mothers, including 41 intervention and 43 control groups, who met the inclusion criteria. The Baby Calming Training was administered face-to-face in the intervention group, utilizing a baby swaddling blanket, a sleep companion emitting white noise, and a training booklet. The control group received routine care. Data were collected through the Mother and Baby Introductory Information Form, Semantic Difference Scale-Me as a Mother, Maternal Attachment Inventory, Breastfeeding Self-Efficacy Scale-Short Form, and Infant Sleep Activity Record. The data were analyzed using descriptive statistics, Pearson's chi-square test, independent samples t-test, Mann-Whitney U test, Wilcoxon test, mixed design ANOVA analysis, Cohen's d, and 95% confidence interval (CI). This study adhered to CONSORT research guidelines. Results: Mothers in the intervention group exhibited higher mean scores on the perception of maternal role (mean ± SD: 70.37 ± 5.92, t: 8.590, 95% confidence interval [CI]: [1.347-2.375], d: 1.865, p < 0.001), maternal attachment (mean ± SD: 100.42 ± 1.52, U: 151.500, 95% CI: [0.732-0.892], d: 0.828, p < 0.001), and breastfeeding self-efficacy (mean ± SD: 64.00 ± 5.98, t: 8.109, 95% CI: [1.248-2.258], d: 1.757, p < 0.001) than the control group. It was determined that the total sleep time of the babies in the intervention group was higher, and the total crying duration was lower (p < 0.001). Conclusion: The study revealed that infant soothing training for primiparous mothers enhanced maternal role perception, maternal attachment, breastfeeding self-efficacy, and extended infants' sleep duration. Furthermore, infants exhibited reduced crying.

Uterine fibroids with heavy menstrual bleeding stratified by race in a commercial and Medicaid database

BackgroundHistorically, the clinical characteristics and treatment pathways for patients with uterine fibroids and heavy menstrual bleeding have differed between White and Black women. ObjectiveTo provide a contemporary comparison of patient characteristics and treatment patterns among White and Black women with uterine fibroids and heavy menstrual bleeding in the United States. Study DesignThis retrospective cohort study included administrative claims data from 46,139 White and 17,297 Black women with uterine fibroids and heavy menstrual bleeding from the Optum Clinformatics database (January 2011–December 2020) and 7353 White and 16,776 Black women from the IBM MarketScan Multi-State Medicaid Insurance database (January 2010–December 2019). Patients were indexed at their initial uterine fibroid diagnosis claim and were required to have a claim for heavy menstrual bleeding and ≥12 months of continuous enrollment pre- and postindex. Patients were followed until the earliest of death, disenrollment, hysterectomy date, or end of study database. Outcomes were stratified by race and included patient demographics, clinical characteristics, pharmacologic treatment patterns, and surgeries/procedures. Pearson's Chi-square test for categorical variables and Student's t-test for continuous data were used to evaluate differences in baseline characteristics. Descriptive statistics were used to characterize treatment pathways for hormonal contraceptive use in women with ≥24 months of follow-up. Kaplan–Meier survival analysis was used to estimate time until hysterectomy, with log-rank testing to assess between-group differences. ResultsThe mean (standard deviation) duration of follow-up was 44.6 (27.9) and 41.0 (24.9) months in the commercial and Medicaid databases, respectively. Mean (standard deviation) age at uterine fibroid diagnosis was lower for Black than White women in both databases (commercial: 42.3 [6.5] vs 44.4 [6.3] years; P<.0001; Medicaid: 39.6 [7.1] years vs 40.2 [7.2] years; P<.0001). Anemia was more prevalent in Black vs White women in both databases (commercial: 5.9% [1028/17,297] vs 3.6% [1648/46,139]; P<.0001; Medicaid: 7.0% [1180/16,776] vs 4.5% [331/7353]; P<.0001). In the commercial database, approximately one-half of women had claims for ≥1 bulk symptom, with no significant differences between groups. In the Medicaid database, significantly more White than Black women had claims for bulk symptoms (77.0% [5665/7353] vs 68.4% [11,477/16,776]; P<.0001). Approximately 40% of all patients received hormonal drug therapies as initial treatment, most commonly hormonal contraceptives. However, discontinuation of hormonal contraceptive therapy was nearly universal, with one-half discontinuing within a median treatment duration of ∼5 months. Most women stopped treatment after 1 or 2 agents (commercial: White, 89.9% [9757/10,857]; Black, 90.0% [3594/3993]; Medicaid: White, 92.2% [1635/1773]; Black, 94.2% [4454/4726]). Hysterectomy was the most common procedure, and was more common among White vs Black women (commercial: 43.9% [20,235/46,139] vs 37.8% [6536/17,297]; Medicaid: 46.8% [3444/7353] vs 32.0% [5364/16,776]). ConclusionsBlack women with UF-HMB were diagnosed at a younger age than White women, and White women had higher hysterectomy rates than Black women, representing a shift from earlier researched treatment patterns. Patients with UF-HMB were also highly reliant on hormonal contraceptives, followed by nearly universal therapeutic discontinuation.

Factors associated with dentists' fear of infecting family members as a consequence of dental practice

Dentists are exposed to the risk of infection by respiratory diseases to aerosols potentially contaminated. The factors associated with dentists' fear of infecting relatives because of dental practice were investigated. Questionnaires structured in Google Forms were sent to dentists in Belo Horizonte city, Brazil, who worked before and during the COVID-19 pandemic. The dependent variable was “fear of infecting family members”. The independent variables were sociodemographic characteristics, use of personal protective equipment (PPE) before and during the pandemic, important actions to prevent infection, knowledge and feelings about the pandemic, and the future of the profession. Analyses were performed using Pearson's chi-square test and Fisher's exact test (p≤0.05). The prevalence of fear was 84.3%. Having changed the use of surgical masks (p=0.038) and N95/PFF2/PFF3 masks (p = 0.043), having not changed the use of lab coats (p=0.013), greater anxiety during the pandemic period (p=0.004), and fear of being infected by a patient or colleague (p&lt;0.001) were associated with the fear of infecting family members. The fear of infecting relatives made the dentists more anxious, with the fear of infection by patients or co-workers as well as more careful about the use of PPE.

Elevated Plasma Atherogenic and Triglyceride-Glucose Indices: Markers of Cardiovascular Risk in Transfusion-Dependent Thalassemia

Background Transfusion-dependent thalassemia (TDT) is an autosomal recessive disorder characterized by defective hemoglobin synthesis, leading to severe complications such as iron overload and multi-organ dysfunction. This study aims to elucidate the distinctive clinical and biochemical profiles of TDT patients compared to healthy controls, with an emphasis on cardiovascular risk assessment using novel markers such as the Plasma Atherogenic Index (PAI) and Triglyceride-Glucose (TyG) index. Methods This cross-sectional study included 32 TDT patients and 36 healthy controls, matched for age and gender. Comprehensive demographic, laboratory, and imaging data were collected and analyzed. TDT patients were further stratified based on cardiac involvement and ferritin levels. Key assessments included hemoglobin levels, liver enzymes, lipid profiles, and cardiac imaging. The PAI and TyG index were calculated to evaluate cardiovascular risks. Statistical analyses were performed using SPSS 27.0, employing Student’s t-test, Mann–Whitney U test, and Pearson chi-square test as appropriate. Results No significant differences in basic demographic parameters were observed between groups; however, TDT patients exhibited significant clinical and laboratory differences. Notably, these patients had lower hemoglobin levels, higher platelet counts, elevated liver enzymes (ALT and AST), and markedly increased ferritin levels. Lipid profiles were significantly altered, with lower levels of total cholesterol, HDL, and LDL but elevated triglycerides. Importantly, the PAI was significantly higher in TDT patients, suggesting an increased atherosclerotic risk. Subgroup analysis revealed that patients with cardiac involvement had worse metabolic profiles, higher TyG indices, and prolonged QT intervals, indicating heightened cardiovascular risk. As the iron burden increases, the TyG index and PAI may lose their sensitivity in distinguishing between varying levels of iron overload, suggesting that their effectiveness plateaus beyond a certain threshold of iron accumulation. Conclusion TDT patients show significant hematological and metabolic deviations, including elevated cardiovascular risk markers like PAI and TyG index. As iron burden increases, these markers lose discriminative power, and cardiac involvement escalates rapidly once a critical iron threshold is surpassed, as supported by studies showing a non-linear relationship between iron load and cardiac complications. Comprehensive cardiovascular risk assessment and tailored management are essential for these patients. Future studies should focus on tracking cardiovascular risk progression and the effects of targeted interventions.

"Legislative Impact and Persistent Disparities: Post-Mastectomy Breast Reconstruction Rates in the United States Among 224,506 Patients".

Breast reconstruction following mastectomy for the treatment of breast cancer restores form and enhances patient satisfaction. The Affordable Care Act (ACA) of 2010 aimed to impact trends in breast reconstruction, but recent information regarding racial and ethnic disparities is lacking. We analyzed National Surgical Quality Improvement Program (NSQIP) data spanning 2005-2022 to investigate the impact of ACA on racial and ethnic diversity in immediate breast reconstruction post-mastectomy. Patient demographics, including race and ethnicity, were considered. Statistical analyses included Pearson chi-square tests and multivariable logistic regressions to assess trends and disparities over time. In total, 224,506 patients met inclusion criteria. Analysis revealed that in the pre-ACA era, American Indian or Alaska Native, Asian, and Black or African American individuals underwent immediate breast reconstruction at lower rates compared to White patients (P < 0.001). Additionally, Hispanic patients were less likely to undergo breast reconstruction compared to non-Hispanic patients (28.0% vs 33.4%; P < 0.001). In the post-ACA period, this trend persisted with all racial groups undergoing immediate breast reconstruction at lower rates compared to White patients (P < 0.001). However, Hispanic patients were more likely to undergo immediate breast reconstruction compared to non-Hispanic patients (53.8% vs 47.9%, P < 0.001). Despite legislative efforts and a steady increase in immediate breast reconstruction rates over the years, racial disparities in breast reconstruction rates persist, highlighting the need for ongoing monitoring and targeted interventions to ensure equitable reconstructive care for all patients.

Structure and process of Parkinson's disease rehabilitation in the southern sector of Ghana: A cross-sectional survey.

The structure, process and outcome (SPO) framework has been used to establish that improved structures of care influences an enhanced process of stroke care resulting in improved outcome. Although, both stroke and Parkinson's disease (PD) are neurological conditions that require prolonged period of care and rehabilitation, the SPO framework has not yet been used to describe the existing structures and processes of PD care and rehabilitation in Ghana. To describe the current structures and processes of PD rehabilitation across the three healthcare levels (primary, secondary and tertiary) in the southern sector of Ghana. An online cross-sectional descriptive survey design was used via REDCap. Fifty-two therapists, including department heads, physiotherapists, occupational therapists and speech and language therapists from seven healthcare facilities were purposefully sampled and invited to complete the survey on structures and processes of PD rehabilitation. Descriptive statistical analysis was performed with SPSS v29.0. Comparative analysis was performed using Pearson's chi-square and Kruskal-Wallis test (H-test) as appropriate. Statistical significance was set at p < 0.05. Forty-nine (94.2%) responses were received and four incomplete responses were excluded from analysis. Structure of rehabilitation: Most of the participants were physiotherapists (n = 36/45; 80.0%) and tertiary level professionals (n = 31/45; 68.9%). Only physiotherapy service was available across all the healthcare levels. Persons with PD were mostly referred for rehabilitation at Hoehn and Yahr stage III as reported by 55.6% (n = 20/36) of the therapists. Process of rehabilitation: Most therapists treated persons with PD two times weekly (n = 19/33; 57.6%) and on individual basis (n = 29/33; 87.9%). Only 9 (27.2%) and 7 (21.2%) therapists often used clinical guidelines or outcome measures respectively in managing PD and 93.9% of the therapists had no local protocols. The structures and processes needed for PD rehabilitation exist but differ across the healthcare levels and among therapists. Physiotherapy was the most common rehabilitation service available at all levels of healthcare.

Pairwise likelihood estimation and limited-information goodness-of-fit test statistics for binary factor analysis models under complex survey sampling.

This paper discusses estimation and limited-information goodness-of-fit test statistics in factor models for binary data using pairwise likelihood estimation and sampling weights. The paper extends the applicability of pairwise likelihood estimation for factor models with binary data to accommodate complex sampling designs. Additionally, it introduces two key limited-information test statistics: the Pearson chi-squared test and the Wald test. To enhance computational efficiency, the paper introduces modifications to both test statistics. The performance of the estimation and the proposed test statistics under simple random sampling and unequal probability sampling is evaluated using simulated data.

Improvement of quality of life on breast cancer-related lymphedema patients through a postmastectomy care program in Mexico: a prospective study.

To assess whether health-related quality of life (HRQOL) improved through a postmastectomy care program focused on breast cancer-related lymphedema (BCRL) protection/awareness. Postoperative breast cancer patients were enrolled prospectively (February-2018 to September-2019) at Nursing and Obstetrics Faculty, Durango, Mexico. Sociodemographic/clinical characteristics, arm measurements, and HRQOL evaluation with Functional Assessment Cancer Therapy-Breast Cancer were collected at baseline and after six follow-up assessments between six-to-twelve-month postmastectomy. Lymphedema was verified through circometry. Descriptive analysis and McNemar-Bowker test were used to evaluate paired differences in HRQOL. Subgroup analysis was conducted to assess sociodemographic/clinical characteristics of BCRL using Pearson's chi-squared or Fisher exact test along with odds ratios (OR) and 95% confidence intervals (CI). All tests were two-sided with P-values < 0.05 considered statistically significant. One-hundred-two patients developed BCRL (incidence 66.2%, n = 154). All dimensions of HRQOL improved after the postmastectomy care program (P < 0.05). The subgroup analysis indicated that elementary academic degree (OR = 2.40, 95%CI: 1.01-5.69), laborer (OR = 9.85, 95%CI: 3.30-29.3), and total mastectomy (OR = 4.23, 95%CI: 1.20-14.9) were more associated with BCRL (P < 0.05). Conversely, high school academic degree (OR = 0.46, 95%CI: 0.22-0.94), married status (OR = 0.42, 95%CI: 0.21-0.86), housewife (OR = 0.27, 95%CI: 0.12-0.61), professional occupation (OR = 0.10, 95%CI: 0.01-0.64), and having no comorbidities (OR = 0.31, 95%CI: 0.15-0.63) were less associated with BCRL (P < 0.05). Although HRQOL improved through the postmastectomy care program, our findings suggest that lower education, working as a laborer, and total mastectomy may be more associated with BCRL. Continuing research may uncover liabilities among BCRL patients within limited-resources settings.

Characteristics of potential head injury situations at the FIFA World Cup Qatar 2022TM.

This exploratory video analysis study aimed to review characteristics of potential head injury situations during a men's professional international football tournament. For 64 matches of the FIFA World Cup Qatar 2022™ FIFA analysts used match footage to record all potential head injury situations. A potential head injury situation was defined as a player staying down for more than 5 s and/or requesting medical attention, and where the body impact location included the player's head. Characteristics were further recorded for match, player (i.e. player action including aerial duels), medical assessment, and outcome (e.g. substitution). Descriptive statistics are reported as well as Pearson's Chi-squared test (or Fisher's exact test) to explore potential head injury situations more likely to result in medical attention. In total, 149 potential head injury situations occurred in 56 matches (mean 2.33/match, range 0-6) involving 117 players. Eight matches resulted in no incidents. Aerial duels were the most frequent match characteristic leading to a potential head injury situation. Injury stoppage with on-pitch medical assessment occurred in 35 of the 149 potential head injury situations (23%), with pitch-side assessment also occurring in 15 situations (10%), resulting in four concussion substitutions. Players were more likely to require medical attention for potential head injuries sustained when the ball was loose (χ2 = 6.88; p = 0.038) when the injured player was jumping (FET p = 0.044) and for head-to-head contact (FET p = <0.001). Further exploration of aerial duels during match play which do and do not lead to potential and actual head injuries is recommended.

Sex disparities in outcomes of transcatheter aortic valve implantation- a multi-year propensity-matched nationwide study

Transcatheter Aortic Valve Implantation (TAVI) has revolutionized the management of severe aortic stenosis (AS), but the impact of sex on TAVI outcomes remains unclear. In this study, we examined differences between men and women in the post-procedural outcomes of TAVI, including healthcare burden and readmission rates. The Nationwide Readmissions Database (2016–2020) was utilized to identify hospitalizations for TAVI. A propensity score matching (PSM) model was used to match males and females. Outcomes were examined using Pearson's chi-squared test. Among 320,324 hospitalizations for TAVI, 142,054 (44.3 %) procedures were performed in women. After propensity matching (N = 165,894 with 82,947 hospitalizations in each group), women had higher in-hospital mortality (2.48 % vs 2.11 %, p: 0.001), stroke (2.14 % vs 1.49 %, p < 0.001), post-procedural bleeding (2.34 % vs 1.72 %, p < 0.001), vascular complications (1.2 % vs 0.7 %, p < 0.001), pericardial complications (1.13 % vs 0.60 %, p < 0.001), acute respiratory failure (ARF) (5.10 % vs 4.63 %, p < 0.001), need for transfusion (7 % vs 5.56 %, p < 0.001), need for vasopressors (2.48 % vs 2.11 %, p < 0.001) and major adverse cardiac and cerebrovascular events (MACCE) (7.53 % vs 6.85 %, p < 0.001). Meanwhile, women had modestly lower incidence of acute kidney injury (AKI) (10.17 % vs 11.88 %, p < 0.001), sudden cardiac arrest (SCA) (0.96 % vs 1.06 %, p: 0.042), cardiogenic shock (1.69 % vs 2.05 %, p < 0.001) and mechanical circulatory support (MCS) requirement (0.69 % vs 0.84 %, p < 0.001). With regard to readmissions, men had higher readmission rates at 30 days (16.07 % vs 14.75 %, p < 0.001) and 90 days (23.8 % vs 21.9 %, p < 0.001). No significant difference was observed in 180-day readmission rates between men and women after TAVI. Notably, procedure-related mortality decreased for both sexes from 2016 to 2020, accompanied by faster recovery times and reduced hospitalization costs (p-trend <0.001). In conclusion, women had higher mortality and post-procedural complication rates, while men had higher readmission rates, cardiogenic shock, AKI and need for mechanical circulatory support. While procedure-related mortality and resource utilization for TAVI have improved over time from 2016 to 2020, irrespective of sex, our findings highlight that significant disparities exist in TAVI outcomes.