Pearson's Χ2 Test Research Articles

Feasibility, Reliability, and Validity of the Modified Forward Hop Test After Anterior Cruciate Ligament Reconstruction: Double- Instead of Single-legged Landing is Reliable and Results in Greater Hopping Distance

ObjectiveTo investigate the feasibility, reliability, and validity of the Modified forward hop (MFH) test in participants after ACL reconstruction (ACLR). DesignReliability study. SettingAssessments were administered at different clinical locations in Germany and Switzerland by the same 2 investigators. ParticipantsForty-eight active individuals participated in this study (N=48). Main Outcome MeasuresThe participants performed MFHs and Forward hops for distance in a predetermined order. The feasibility of the MFH was quantified with proportions of successfully executed attempts and Pearson's χ2 test. Its reliability was estimated using intraclass correlation coefficient (ICC) and standard error of measurement (SEM). Test validity was explored using Pearson's product moment correlation analyses. ResultsFewer failed attempts were recorded among the participants (age: 30 [Standard deviation 11] years; 22 women, 26 (13) months post-surgery) when compared with the Forward hop for distance test (25/288 trials; 9% vs 72/288 trials; 25%). Within-session ICC values were excellent (>0.95) for both types of Forward hop tests, independent of the side examined. The SEM values were comparable between the Modified (injured: 5.6 cm, uninjured: 5.9 cm) and the classic Forward hop (injured: 4.3 cm, uninjured: 7.2 cm). ConclusionThe MFH is a feasible, reliable, and valid tool for judging neuromuscular performance after ACLR. If the aim of a hop for distance incorporates enhanced perceived or real landing safety, landing on both feet should be used.

Are There Racial Differences in the Rate of Surgical Site Infection Based on Surgical Subspecialty?

Background: Surgical site infection (SSI) is a common, morbid post-operative complication. We hypothesized the presence of racial differences in SSI rates, comparing black/African American (BAA) to white non-Hispanic (WNH) patients. Patients and Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2017), BAA and WNH surgery patients across 10 surgical specialties were identified: general surgery (GS), vascular surgery (VS), cardiac surgery (CS), thoracic surgery (TS), orthopedics (OS), neurosurgery (NS), urology (US), otolaryngology (ENT), plastic surgery (PS), and gynecology (GYN). The primary outcome was SSI rate (superficial, deep incisional, or organ/space). The secondary outcome was rate of non-surgical infection. Pearson χ2 and Fisher exact tests were used to test group differences of categorical variables. Continuous variables were tested with the Student t-test, or Mann-Whitney U test, with statistical significance set at a value of p < 0.05. Multivariable logistic regression models were conducted to analyze the association between race/ethnicity and the infection outcomes. Results: A total of 740,144 patients were included: 99,425 (13.4%) BAA and 640,749 (86.6%) WNH, distributed as follows; 32,2976 GS, 17,6175 OS, 44,383 VS, 2,227 CS, 9,645 TS, 42,298 NS, 42,726 US, 18,518 ENT, 20,709 PS, and 60,517 GYN cases. Surgical site infection rates were higher among WNH in GS (4.4% vs. 4.1%; p = 0.003) and TS (3.1% vs. 1.7%; p = 0.015); lower in VS (3.2% vs. 4.4%; p < 0.001), OS (1.2% vs.1.6%; p < 0.001), and GYN (2.4% vs. 3%; p < 0.001); and similar between WNH and BAA in ENT (1.8% vs 1.8%; p = 0.76), and US (1.9% vs. 1.9%; p = 0.90). Non-surgical infection was higher in BAA in NS (3.2% vs. 2.5%; p = 0.003), and higher in WNH in GYN (2.6% vs. 2%; p < 0.001), OS (1.7% vs. 1.1%; p < 0.001), US (4.4% vs. 3.6%; p = 0.014), and VS (3.4% vs. 2.6%; p < 0.001). Conclusions: Variation exists in SSI rates between WNH and BAA patients among surgical subspecialties. Further research is required to understand these differences and address racial disparities in outcomes.

Patterns of Antibiotic Use in Young Children Hospitalized with RSV in Amman, Jordan

Abstract Introduction Antibiotic misuse is associated with the emergence of antimicrobial-resistant bacteria. It is therefore important to limit antibiotic use for respiratory infections, especially those that are virus-associated. In developing countries, without point-of-care testing for common respiratory viruses (e.g., respiratory syncytial virus, or RSV), clinicians rely on clinical judgment clinicians relay on clinical judgement to distinguish between viral and bacterial causes of illness. We sought to evaluate patterns of antibiotic use in young, hospitalized children with RSV in Amman, Jordan. Methods A prospective acute respiratory viral surveillance study was conducted between January 8 and March 17, 2020. Eligible children were &amp;lt;2 years old presenting with fever and/or respiratory symptoms within 72 hours of hospitalization. Nasal or throat swabs were collected from each child. Research molecular testing for RSV and other respiratory viruses was performed. Demographic and clinical data were collected through parental interviews and chart abstractions. For this analysis, we restricted our study to children with RSV detected by research molecular testing. We classified antibiotic patterns into three categories: 1) 1st line/empiric: ampicillin, ceftriaxone, cefuroxime, cefotaxime, and gentamycin; 2) azithromycin; 3) expanded: vancomycin, amikacin, imipenem/meropenem, and metronidazole. We compared clinical characteristics and outcomes between the three antibiotic groups using Pearson's χ2 test for categorical variables and linear regression with robust standard errors for continuous variables. Results Of the 531 children who were enrolled, 400 (75.3%) were RSV-positive by research molecular testing: 221 (55.3%) were male, median age was 2.9 months (IQR, 1.7–6.4), 174/390 (44.6%) reported consuming an antibiotic prior to hospitalization, and 387 (96.8%) received at least one antibiotic during their hospitalization. The most common antibiotic category was empiric 261 (67.4%), followed by azithromycin (n=106; 27.4%) and expanded (n=16; 4.1%). Table 1 compares clinical and demographic data between antibiotic categories for RSV-positive children during hospitalization. Children in the empiric group had higher mean age and were more likely to be diagnosed with bronchopneumonia at admission, while those in the azithromycin group were more likely to be diagnosed with pertussis-like cough or bronchiolitis at admission. Children in the expanded group were more likely to have fever, be diagnosed with pneumonia at admission, require oxygen, and be admitted to the intensive care unit. Among those who had a blood, urine, and/or CSF culture performed (n=209; 54%), a total of 10 (2.6%) were positive for gram-positive bacteria. Conclusion In our study, most children received an antibiotic during their hospital stay. Antibiotic stewardship programs and the implementation of point-of-care testing in Jordanian hospitals are needed to help limit antibiotic use for RSV.

Socio-demographic variation in adherence to the World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Cancer Prevention Recommendations within the UK Biobank prospective cohort study.

The 2018 (WCRF)/American Institute for Cancer Research (AICR) Cancer Prevention Recommendations are evidence-based lifestyle recommendations which aim to reduce the risk of cancer worldwide. Sociodemographic factors modulate lifestyle behaviours, and both cancer incidence and survival are socio-economically patterned. We investigated adherence to these recommendations and examined patterns of adherence across sociodemographic subgroups in the UK Biobank cohort. We included 158 415 UK Biobank participants (mean age 56years, 53% female). Total adherence scores were derived from dietary, physical activity and anthropometric data using the 2018 WCRF/AICR standardized scoring system. One-Way analysis of variance (ANOVA) was used to test for differences in total scores and in values for individual score components according to sociodemographic factors and Pearson's Χ2 test to investigate associations between sociodemographic factors according to tertiles of adherence score. Mean total adherence score was 3.85 points (SD 1.05, range 0-7 points). Higher total scores were observed in females, and older (>57years), Chinese or South Asian, and more educated participants. We found significant variations in adherence to individual recommendations by sociodemographic factors including education, Townsend deprivation index and ethnicity. Identifying and understanding lifestyle and dietary patterns according to sociodemographic factors could help to guide public health strategies for the prevention of cancers and other non-communicable diseases.

Velopharyngeal Insufficiency Following Furlow Versus Straight Line Repair With Intravelar Veloplasty: A Single-institution Experience

Background: Measurements of postoperative velopharyngeal dysfunction (VPD) can be used to determine the efficacy of a palatoplasty operation. Hypernasality and audible nasal air emission are typical manifestations of VPD during speech. We aimed to longitudinally compare VPD outcomes in postpalatoplasty patients who underwent Furlow repair versus straight line repair with intravelar veloplasty (IVVP). Additionally, we examined the relationship between VPD outcomes and select pre-existing patient characteristics. Methods: Retrospective chart review was performed to identify primary palatoplasty patients treated from April 2012 to March 2021. Variables collected included gender, syndromic status, primary language, Veau cleft type, type of speech assessment, age at time of surgery, degree of hypernasality, presence of audible nasal air emission, and overall adequacy of velopharyngeal function. Pearson χ2 test and multivariable t tests were used to analyze variables. Logistic regression was used to control for statistically significant variables. Results: Of the 118 patients included, 38 received a Furlow procedure and 80 received a straight line with IVVP procedure. Audible nasal air emission was present in 57.3% of straight line with IVVP patients and 42.9% of Furlow patients, with no statistically significant difference between groups. Clinically significant hypernasality was present in 42.1% of straight line with IVVP patients and 22.9% of Furlow patients (P=0.05). Velopharyngeal function was classified as adequate in 63.5% of straight line with IVVP patients and 83.3% of Furlow patients (P=0.03). However, after stratifying by syndromic versus nonsyndromic status, there was no statistically significant difference between straight line with IVVP and Furlow patients for postoperative hypernasality and velopharyngeal function. Conclusions: This study suggests that there are no statistically significant differences between straight line with IVVP and Furlow palatoplasty techniques regarding speech outcomes including hypernasality, audible nasal air emission, and overall VP function. Furthermore, select patient characteristics such as gender, primary language, syndromic status, age at repair, and Veau cleft type do not significantly impact postoperative speech outcomes.

Evaluation of osteopathic treatment effectiveness in patients with upper thoracic aperture syndrome

Background. Upper thoracic aperture syndrome occurs in 2–8% of people in the population and affects patients of the most working age, mainly women.&#x0D; Aim. Evaluation of the combined (drug + osteopathic) treatment effectiveness of patients with upper thoracic aperture syndrome compared to drug therapy.&#x0D; Material and methods. In a randomized study, patients with signs of upper thoracic aperture syndrome were divided into two groups: the main group received combined (osteopathic + drug) treatment for 2 months; the control group received only drug treatment (non-steroidal anti-inflammatory drugs, muscle relaxants, thioctic acid preparations) for 2 months. Each group consisted of 15 women aged from 25 to 47 years (main group — 36.31±7.33 years, control group — 35.18±6.76 years), the duration of the disease ranged from 6 to 18 months (main group — 12.02±3.57 months, control group — 11.07±3.97 months). The groups were comparable in age composition and duration of the disease. To assess the effectiveness of the treatment, the dynamics of symptoms of neuropathic pain, stimulation electroneuromyography, and the dynamics of osteopathic status indicators were used. Data were presented as arithmetic mean and standard deviation. When analyzing intergroup differences, the nonparametric Mann–Whitney test (U-test), and when analyzing intragroup differences, the nonparametric Wilcoxon test (W-test) were used. The statistical significance of the difference in the frequency of osteopathic dysfunctions and other frequency parameters before and after treatment was assessed using the Pearson χ2 test. The critical level of statistical significance was taken as 5% (p=0.05).&#x0D; Results. The combination of osteopathic and drug treatment led to a difference in conduction along the right ulnar nerve between groups (p=0.0003) in the main group — an increase in speed from 48.1±1.54 m/s to 61.0±3.34 m/s (p=0.0007), in the control group — from 46.8±1.89 m/s to 50.2±4.85 m/s (p=0.0009). Analysis of the NTTSS-9 scale (assessment of symptoms of neuropathic pain) after treatment showed no difference between the groups (p=0.0941): the main group — before treatment 14±2.14 points, after treatment 2±1.4 points (p =0.0003), control group — before treatment 15±1.95 points, after treatment 6±2.80 points (p=0.0007).&#x0D; Conclusion. In the group that received combined (osteopathic + drug treatment), a greater increase in conductivity along the ulnar nerve was found.

Modified Harborview Risk Score accurately predicts mortality for patients with ruptured abdominal aortic aneurysm

ObjectiveThe modified Harborview Risk Score (HRS) is a simple measure initially derived from a single institutional dataset used to predict ruptured abdominal aortic aneurysm (rAAA) repair survival preoperatively using basic labs and vital signs collected upon presentation. However, validation of this widely applicable scoring system has not been performed. This study aims to validate this scoring system using a large multi-institutional database. MethodsAll patients who underwent repair of an rAAA from 2011 to 2018 in the National Surgical Quality Improvement Program (NSQIP) and at a single academic medical center were included. The modified HRS was calculated by assigning 1 point for each of the following: age >76 years, creatinine >2 mg/dL, international normalized ratio >1.8, and any systolic blood pressure less than 70 mmHg. Assessment of the prediction model was then completed. Using a primary outcome measure of 30-day mortality, the receiver operating characteristic area under the curve was calculated. The discrimination between datasets was compared using a Delong test. Mortality rates for each score were compared between datasets using the Pearson χ2 test. Comparative analysis for patients with a score of 4 was limited due to a small sample size. ResultsA total of 1536 patients were identified using NSQIP, and 163 patients were assessed in the institutional dataset. There were 518 patients with a score of 0 (455 NSQIP, 63 institutional), 676 patients with a score of 1 (617 NSQIP, 59 institutional), 391 patients with a score of 2 (364 NSQIP, 27 institutional), 106 with a score of 3 (93 NSQIP, 13 institutional), and 8 patients with a score of 4 (7 NSQIP, 1 institutional). No difference was found in the receiver operating characteristic area under the curves between datasets (P = .78). Thirty-day mortality was 10% NSQIP vs 22% institutional for a score of 0; 28% NSQIP vs 36% institutional for a score of 1; 41% NSQIP vs 44% institutional for a score of 2; 45% NSQIP vs 69% institutional for a score of 3; and 57% NSQIP vs 100% institutional for a score of 4. Score 0 was the only score with a significant mortality rate difference between datasets (P = .01). ConclusionsThe modified HRS is confirmed to be broadly applicable as a clinical decision-making tool for patients presenting with rAAAs. Therefore, this easily applicable model should be applied for all patients presenting with rAAAs to assist with provider and patient decision-making prior to proceeding with repair.

Mechanical thrombectomy is associated with shorter length of hospital stay and lower readmission rates compared with conservative therapy for acute submassive pulmonary embolism: a propensity-matched analysis.

To determine if mechanical thrombectomy (MT) for submassive pulmonary embolism (PE) positively impacts length of hospital stay (LOS), intensive care unit stay (ICU LOS), readmission rate, and in-hospital mortality compared with conservative therapy. This was a retrospective review of all patients with submassive PE who either underwent MT or conservative therapy (systemic anticoagulation and/or inferior vena cava filter) between November 2019 and October 2021. Pediatric patients (age <18) and those with low-risk and massive PEs were excluded from the study. Patient characteristics, comorbidities, vitals, laboratory values (cardiac biomarkers, hospital course, readmission rates, and in-hospital mortality) were recorded. A 2:1 propensity score match was performed on the conservative and MT cohorts based on age and the PE severity index (PESI) classification. Fischer's exact test, Pearson's χ2 test, and Student's t-tests were used to compare patient demographics, comorbidities, LOS, ICU LOS, readmission rates, and mortality rates, with statistical significance defined as P < 0.05. Additionally, a subgroup analysis based on PESI scores was assessed. After matching, 123 patients were analyzed in the study, 41 in the MT cohort and 82 in the conservative therapy cohort. There was no significant difference in patient demographics, comorbidities, or PESI classification between the cohorts, except for increased incidence of obesity in the MT cohort (P = 0.013). Patients in the MT cohort had a significantly shorter LOS compared with the conservative therapy cohort (5.37 ± 3.93 vs. 7.76 ± 9.53 days, P = 0.028). However, ICU LOS was not significantly different between the cohorts (2.34 ± 2.25 vs. 3.33 ± 4.49, P = 0.059). There was no significant difference for in-hospital mortality (7.31% vs. 12.2%, P = 0.411). Of those that were discharged from the hospital, there was significantly lower incidence of 30-day readmission in the MT cohort (5.26% vs. 26.4%, P < 0.001). A subgroup analysis did not demonstrate that the PESI score had a significant impact on LOS, ICU LOS, readmission, or in-hospital mortality rates. MT for submassive PE can reduce the total LOS and 30-day readmission rates compared with conservative therapy. However, in-hospital mortality and ICU LOS were not significantly different between the two groups.

CYP2D6 genotyping and the clinical impact on outcomes in breast cancer tamoxifen-treated patients.

Aims: To report the distribution of allele frequencies of CYP2D6 gene and to evaluate their influence on the clinical outcomes of a group of breast cancer patients receiving adjuvant tamoxifen treatment from Uruguay. Patients & methods: 199samples were genotyped through real-time polymerase chain reaction assays. Metabolization profiles were inferred from the genotypes. Correlations were evaluated using Pearson's χ2 test. Results: Phenotype frequencies were0.65 normal (NM), 0.30 intermediate (IM)and 0.05 poor metabolizers (PM). Similar clinical outcomes between NM and (PM+IM) patient groups (odds ratio=1.011, 95% CI=0.2703-3.7826;p=0.987) were found. Conclusion: CYP2D6 allele frequencies were analyzed for the first time in a cohort from Uruguay. Results did not support any impact of CYP2D6 gene polymorphisms on clinical outcomes.

What are patients asking and reading online? An analysis of online patient searches for rotator cuff repair.

Patients undergoing rotator cuff surgery often search the internet for information regarding the procedure. One popular source, Google, compiles frequently asked questions and links to websites that may provide answers. This study provides an analysis of the most frequently searched questions associated with rotator cuff surgery. We hypothesize that there will be distinct search patterns associated with online queries about rotator cuff surgery that could provide unique insights into patient concerns. A set of search terms were entered into Google Web Search using a clean-install Google Chrome browser. Frequently associated questions and their webpages were extracted to a database via a data mining extension. Questions were categorized by topics relevant for rotator cuff arthroscopy. Websites were categorized by source and scored for quality using the JAMA Benchmark Criteria. Pearson's χ2 tests were used to analyze nominal data. Student t tests were performed to compare JAMA Benchmark Scores. Of the 595 questions generated from the initial search, 372 unique questions associated with 293 websites were extracted and categorized. The most popular question topics were activities/restrictions (20.7%), pain (18.8%), and indications/management (13.2%). The 2 most common websites searched were academic (35.2%) and medical practice (27.4%). Commercial websites were significantly more likely to be associated with questions about cost (57.1% of all cost questions, P=.01), anatomy/function (62.5%, P=.001), and evaluation of surgery (47.6%, P<.001). Academic websites were more likely to be associated with questions about technical details of surgery (58.1%, P<.001). Medical practice and social media websites were more likely associated with activities/restrictions (48.1%, P<.001, and 15.6%, P<.001, respectively). Government websites were more likely associated with timeline of recovery (12.8%, P=.01). On a scale of 0-4, commercial and academic websites had the highest JAMA scores (3.06 and 2.39, respectively). Patients seeking information regarding rotator cuff repair primarily use the Google search engine to ask questions regarding postoperative activity and restrictions, followed by pain, indications, and management. Academic websites, which were associated with technical details of surgery, and medical practice websites, which were associated with activities/restrictions, were the 2 most commonly searched resources. These results emphasize the need for orthopedic surgeons to provide detailed and informative instructions to patients undergoing rotator cuff repair, especially in the postoperative setting.

Examining the link between impulse control disorder and antidepressant use in Parkinson's disease

IntroductionImpulse control disorders (ICD) in Parkinson's disease (PD) and hypomanic episodes of bipolar disorder show overlapping symptoms, suggesting a shared neurobiology. To explore this, the following hypotheses are tested: (1) larger changes in affective symptoms from OFF to ON medication states will be associated with ICD, (2) antidepressant exposure will be associated with larger OFF to ON affective symptom changes, and (3) antidepressant exposure will be associated with ICD. Methods200 participants (mean age 65, 61 % male) were evaluated in “off” and “on” dopamine states. Affective symptoms were captured using the Hamilton Anxiety and Depression Rating Scales. Differences in clinical outcomes were compared using two-sample Wilcoxon rank-sum tests and Pearson χ2 tests. We performed multivariable logistic regression to assess the association of antidepressant exposure on ICD. ResultsParticipants with an ICD had higher anxiety and depressive scores in “on” and “off” states and larger changes in depressive symptoms from OFF to ON states compared to those without an ICD. Participants on antidepressants had higher anxiety scores in “on” and “off” states, higher depressive scores in the “off” state, and larger changes in anxiety symptoms from OFF to ON states than those not on an antidepressant. Antidepressant use was associated with a higher odds of an ICD (OR 2.3, CI [1.0–4.5], p-value 0.04). ConclusionsAffective symptom severity in “on” and “off” dopamine states is associated with ICD. Antidepressant therapy may be associated with ICD. Future prospective studies clarifying temporal associations between antidepressant initiation and ICD emergence are needed.

Treatment of Unstable Sacral Fractures with Robotically-aided Minimally Invasive Triangular Fixation.

The treatment of unstable sacral fractures is huge challenge to surgeons. Robotically-aided minimally invasive triangular fixation (RoboTFX) is the most advanced technique up to now. This study is to evaluate the clinical outcomes of unstable sacral fractures treated with RoboTFX. From March 2017 to October 2021, 48 consecutive patients with unstable sacral fractures were included in the study. All patients received surgical treatment with triangular fixation (TFX). Patients were divided into four groups according to the number of fractures (uni- or bilateral) and surgical method employed (RoboTFX or traditional open TFX). Between these four groups, clinical data on operation time, intraoperative bleeding, intraoperative fluoroscopy time, infection rate, fracture healing rates, insertion accuracy, Majeed pelvic outcome score, Mears' criterion, and Gibbons score were compared. Quantitative data were expressed as mean ± standard deviation and compared using Student's t-test. Categorical variable were compared using the Pearson's χ2 test. Comparing unilateral RoboTFX versus open TFX, neither fracture healing rate, infection rate, Majeed pelvic outcome score, Mears' radiological evaluation criterion, nor Gibbons score of the two groups were statistically significantly different (p > 0.05). However, operation time, intraoperative bleeding, intraoperative fluoroscopy time, and insertion accuracy in the RoboTFX group were all significantly better than those of the traditional open group (p < 0.05). Likewise, operation time, intraoperative bleeding, intraoperative fluoroscopy time, and accuracy of fixation insertion of the bilateral RoboTFX group were significantly better than those of the bilateral open group (p < 0.05). Meanwhile infection rate, fracture healing rate, Majeed score, Mears' criterion, and Gibbons score of two groups were not significantly different (p > 0.05). RoboTFX has the advantages of less operation time, less intraoperative bleeding and fluoroscopy, more accurate fixation insertion, and a higher healing rate compared to traditional open methods in the treatment of unstable sacral fractures. However, RoboTFX requires a few critical considerations, and the indications of its operation should be strictly evaluated.

Health behaviour and cardiovascular risk in women living in a disadvantaged region in Hungary

Abstract Background The risk factors for non-communicable diseases more prevalent among socioeconomically disadvantaged (SED) adults. The aim of our study was to investigate monitored health status and health behaviour, including risk factors for cardiovascular disease, among women living in disadvantaged regions of Hungary. Methods In the monitored study, nutritional status was measured by a medical body composition analyser and vascular status by the arterial stiffness parameter (PWVao) measured by arteriograph (ARG), supplemented by a health questionnaire. Descriptive statistical analyses were performed to analyse the database, within a 95% confidence interval (CI). Pearson's χ2 test and analysis of variance (ANOVA) were used to test assumptions. The source population of the study was women living in the Abaúj region, the most disadvantaged regions of Hungary. A total of 150 SED adult women constituted the target population. Results The average age of the study participants was 52.8 (SD:15.9) years. More than half of the participants had at completed 8 years of primary education or less (52.3%; 95% CI: 44-61). They were overweight in terms of Body Mass Index (mean BMI=28.7 SD:6.6), and mean systolic blood pressure was 139 mmHg (SD:21.43). The mean PWVao measured in the population was 10.51m/s (SD:6.9). Elevated BMI was significantly (ANOVA p &amp;lt; 0.011) associated with higher PWVao. 36.2% (95% CI: 48-64) of the target group smoked daily. More than half of smokers (55%; 95%CI:38-76) smoked 11-20 cigarettes per day. Smokers scored an average of 4.82 (SD = 2.3) on the Fagerström Test for Nicotine Dependence (FTND) scale of moderate dependence. Lower educational attainment status (χ2 p &amp;lt; 0.001) significantly increase the proportion of smokers in the sample. Conclusions Obesity, smoking and elevated PWVao, are associated with higher circulatory and vascular risk and higher atherosclerotic organ damage, which may contribute to higher premature mortality among disadvantaged women. Key messages • Examining the association between heath behaviour and cardivascular risk of socioeconomically disadvantaged individuals can enhance the development of interventions to decrease health inequalities. • Targeted community health promotion for disadvantaged women is a priority, because their health behaviour determines the health of their children and families.

Partition Dosimetry and Outcomes of Metastatic Neuroendocrine Tumors after Yttrium-90 Resin Microsphere Radioembolization

PurposeTo characterize estimated mean tumor-absorbed dose (ADT) and objective response of metastatic neuroendocrine tumor (NET) after resin microsphere yttrium-90 (90Y) hepatic radioembolization using partition dosimetry. Materials and MethodsIn this retrospective, single-center study, multicompartment dosimetry of index tumors receiving 90Y radioembolization between 2013 and 2022 involved the use of Sureplan (MIM Software, Cleveland, Ohio) and technetium-99m macroaggregated albumin single photon emission computed tomography (SPECT) combined with computed tomography. Thirty-six patients with NET underwent treatment of 56 index tumors. Patients underwent imaging every 3–6 months after treatment to determine best response per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and modified RECIST (mRECIST) criteria. Responses were categorized as objective response (OR) or nonresponse (NR). Wilcoxon rank sum test evaluated differences in continuous variables, and Pearson χ2 test evaluated differences in categorical variables. ResultsMedian follow-up was 582 days (IQR, 187–1,227 days). Per RECIST 1.1, 27 patients (75%) experienced OR and 9 patients experienced (25%) NR. Of the 36 patients, 33 (92%) showed hypervascular, mRECIST-evaluable tumors. Among them, 28 patients (85%) showed mRECIST OR and 5 patients (15%) showed NR. The mRECIST OR group received a higher ADT than the NR group (median, 107 Gy; IQR, 95.1–154 Gy vs median, 70.4 Gy; IQR, 62.9–87.6 Gy; P = .048). All tumors receiving at least 120 Gy showed mRECIST OR. ConclusionsIn hypervascular metastatic NET treated by 90Y resin microsphere radioembolization, higher tumor dose was associated with better tumor response per mRECIST. Doses of ≥120 Gy led to OR.

Lower-Extremity Injuries Predominate in American High School Tennis Players

To describe injury epidemiology in U.S. adolescent tennis players between 2014 and 2018 via the High School Reporting Information Online (HS RIO) database. The HS RIO database was queried for injury data on high school tennis players as reported by athletic trainers between 2014 and 2018. Injuries were analyzed according to athlete demographics, injury type, location, and context. Variables of interest between male and female athletes were compared using Pearson χ2 test or Fisher exact test. In total, 176 injuries in high school tennis players between 2014 and 2018 were identified in the HS RIO database. Overall, 25.6% (45/176) occurred in the ankle, 12.5% (22/176) in the knee, and 9.7% (17/176) in the wrist. The most common types of injuries were ligament sprains and muscle strains at 35.2% (62/176) and 17.6% (31/176) of injuries, respectively. Although most injuries were unrelated to contact, such as overuse and heat exertion or stroke, 28.7% (47/176) of injuries were the result of rotation around a planted foot/inversion of the foot. We found no difference in injury patterns between male and female high school tennis athletes. We found no difference in injury patterns between male and female U.S. high school tennis athletes. The ankles, knees, and wrists were the most commonly injured areas in this population. The most common types of injuries were ligament sprains and muscle strains. Although many injuries were new, athletes rarely required surgery and returned to play. Finally, we found no difference in injury patterns between male and female high school tennis athletes. The epidemiology of injuries among high school tennis players is poorly understood. The information from this study will help us to understand these injuries and how we may be able to better prevent them.

Examining healthcare needs and decisions to seek health services among Venezuelan migrants living in Trinidad and Tobago using Andersen's Behavioral Model.

Beginning in 2016, Trinidad and Tobago experienced increasing flows of migrants and refugees from Venezuela. Through a Government Registration Exercise in 2019, followed by a Re-registration Exercise in 2020, migrants and refugees benefitted from access to publicly available primary care and emergency medical services. By applying Andersen's Behavioral Model for Health Service Use, our study examined the non-communicable disease care needs of migrants, and factors influencing their decision to seek public and private health services. Between September and December 2020, a health questionnaire was administered via telephone to n = 250 migrants from Venezuela. Descriptive statistics summarized the constructs of Andersen's Behavioral Model. The model comprised of predisposing factors including migrants' social characteristics; enabling factors namely monthly earnings, education level and most trusted source of information on medical needs; need for care factors such as migrants self-reported health status, presence of non-communicable health conditions and having visited a doctor in the past 12 months; and the outcome variables which were migrants' decisions to seek public and private health services. Pearson χ2 tests, odds ratios and multivariable logistic regression with backward elimination examined the factors influencing a migrant's decision to seek health services. Overall, 66.8% of migrants reported they would seek public health services, while 22.4% indicated they would seek private health services. Predisposing factors namely length of time residing in Trinidad and Tobago (p = 0.031) and living with family/friends (p = 0.049); the enabling factor of receiving information from publicly available sources (p = 0.037); and the need for care factor of visiting a doctor for a physical health problem (p = 0.010) were significant correlates of their decision to seek care in the public sector. Predisposing factors namely living with family/friends (p = 0.020) and the enabling factor of having difficulty accessing healthcare services (p = 0.045) were significant correlates of their decision to seek care from private providers. Our findings demonstrated the positive association between social networks and a migrant's decision to use public and private health services, thus underscoring the importance of family and friends in facilitating health service use, promoting proper health practices and preventing diseases. Overall, the use of Andersen's Behavioral Model aided in identifying the factors associated with the use of health services by Venezuelan migrants in Trinidad and Tobago. However, further studies are needed to better understand their need for ongoing care, to inform policy, and to plan targeted health interventions for addressing the gaps in health service access, barriers and use.

Relationships between the vaginal microbiota and genitourinary syndrome of menopause symptoms in postmenopausal women: the Study of Women's Health Across the Nation.

To describe vaginal microbiota classified by community state types (CST) in a diverse cohort of postmenopausal women and evaluate relationships among genitourinary syndrome of menopause (GSM) symptoms (vaginal dryness, vulvovaginal irritation, sexual pain, dysuria, urinary urgency), CSTs, estrogen, vaginal maturation index (VMI), and vaginal pH. In the Study of Women's Health Across the Nation, 1,320 women aged 60.4 to 72.5 years self-collected (2015-2017) vaginal samples analyzed for microbiota composition and structure (CSTs) using 16S rRNA gene amplicon sequencing, VMI, and pH. GSM symptoms were collected with self-administered questionnaires; interviewers elicited estrogen use and measured body mass index. Serum E2 and E1 were measured using high-performance liquid chromatography. We analyzed data using Pearson χ2 tests, analysis of variance, Kruskal-Wallis tests, and binomial logistic regression. The most frequently occurring CST was low Lactobacillus species IV-C (49.8%); 36.4% of women had CSTs dominated by Lactobacillus species. More than half of the women with vaginal atrophy biomarkers (VMI <50 and pH >5) had CST IV-C0, whereas women using estrogen or with higher E1 and E2 levels had a higher prevalence of Lactobacillus crispatus-dominated CST I (P values < 0.001). Sexual pain was associated with atrophy biomarkers and independently associated with Streptococcus species-dominated CST IV-C1 (odds ratio, 2.26; 95% confidence intervals, 1.20-4.23). For all other GSM symptoms, we found no consistent associations with E1 or E2 levels, atrophy biomarkers, or any CST. Although close relationships exist among estrogen, CSTs, VMI, and pH, sexual pain was the only GSM symptom associated with the structure of vaginal microbiota and atrophy biomarkers.

Health Belief Model Factors and Personal Characteristics Associated With COVID-19 Vaccination Behaviors in Adults.

Prior studies have mainly examined factors regarding COVID-19 vaccination intentions. This study investigated the factors associated with COVID-19 vaccination behaviors in Korean adults. A total of 620 adults recruited from a survey company between July and August 2021 completed an online survey asking about their personal characteristics, health beliefs, and COVID-19 vaccination status. The collected data were analyzed using descriptive statistics, Pearson's χ2 test, independent-samples t test, and logistic regression analysis. Less than half the participants received COVID-19 vaccinations, whereas 56.3% did not. The full regression model explained 33.3% of the variance in COVID-19 vaccination status. Age older than 60 years, perception of feeling healthy, presence of chronic diseases, past flu shot experiences, and five health belief model factors were significant factors associated with COVID-19 vaccination behaviors. COVID-19 vaccination intention was the most closely related factor (odds ratio, 12.37; 95% confidence interval, 3.54-43.26; P < .001). Vaccinated participants were more likely than unvaccinated to perceive susceptibility to COVID-19 infection, benefits, self-efficacy, moral responsibility, and subjective norms regarding COVID-19 vaccination. Based on the results, vaccinated and unvaccinated individuals showed different attitudes toward COVID-19 infection and vaccination. This study suggests that COVID-19 vaccination intentions lead to actual vaccination behavior.

Prospective Evaluation of AI Triage of Pulmonary Emboli on CT Pulmonary Angiograms.

Background Artificial intelligence (AI) algorithms have shown high accuracy for detection of pulmonary embolism (PE) on CT pulmonary angiography (CTPA) studies in academic studies. Purpose To determine whether use of an AI triage system to detect PE on CTPA studies improves radiologist performance or examination and report turnaround times in a clinical setting. Materials and Methods This prospective single-center study included adult participants who underwent CTPA for suspected PE in a clinical practice setting. Consecutive CTPA studies were evaluated in two phases, first by radiologists alone (n = 31) (May 2021 to June 2021) and then by radiologists aided by a commercially available AI triage system (n = 37) (September 2021 to December 2021). Sixty-two percent of radiologists (26 of 42 radiologists) interpreted studies in both phases. The reference standard was determined by an independent re-review of studies by thoracic radiologists and was used to calculate performance metrics. Diagnostic accuracy and turnaround times were compared using Pearson χ2 and Wilcoxon rank sum tests. Results Phases 1 and 2 included 503 studies (participant mean age, 54.0 years ± 17.8 [SD]; 275 female, 228 male) and 1023 studies (participant mean age, 55.1 years ± 17.5; 583 female, 440 male), respectively. In phases 1 and 2, 14.5% (73 of 503) and 15.9% (163 of 1023) of CTPA studies were positive for PE (P = .47). Mean wait time for positive PE studies decreased from 21.5 minutes without AI to 11.3 minutes with AI (P < .001). The accuracy and miss rate, respectively, for radiologist detection of any PE on CTPA studies was 97.6% and 12.3% without AI and 98.6% and 6.1% with AI, which was not significantly different (P = .15 and P = .11, respectively). Conclusion The use of an AI triage system to detect any PE on CTPA studies improved wait times but did not improve radiologist accuracy, miss rate, or examination and report turnaround times. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Murphy and Tee in this issue.

Incidence of Major Depression, Suicidal Ideation, and Mental Health Treatment Amongst Cancer Survivors

Receiving a cancer diagnosis and undergoing subsequent treatments can result in a significant psychological burden for cancer patients. However, there is conflicting literature on the incidence of major depression in cancer patients compared to patients without cancer. The purpose of this study was to investigate and further clarify the incidence of major depression, associated treatments, and suicidal ideation in cancer survivors compared to a non-cancer cohort. This is a retrospective, population-based study using survey responses from the National Survey on Drug Use and Health collected from January 2015 to December 2019. Survey data sets were queried for all respondents aged 18 years or older who provided a cancer history. Patients with a reported history of cancer ("cancer survivors") were further stratified by whether they reported a "recent" cancer diagnosis within the past 12 months. Survey responses were then evaluated for recent diagnoses of and treatments for major depressive disorder and suicidal ideation. Rates were compared between cancer survivors and participants without cancer using the Pearson χ2 test and multivariable logistic regression models, respectively. Among the 212,411 survey respondents identified, 7,635 (3.6%) reported a cancer history, with 1,486 (0.7%) reporting a recent cancer history. The incidence of major depression was not different between cancer survivors and participants without cancer (9.3% vs. 9.2%; p = 0.762), though the incidence was slightly higher amongst recent cancer survivors (10.0% vs. 9.2%; p = 0.259). Among patients diagnosed with major depression, cancer survivors were significantly more likely to receive treatment for depression (78.6% vs. 60.3%, p<0.001), with 72.6% discussing depressive symptoms with a medical professional and 64.3% receiving prescription medication. Suicidal ideation was significantly lower among cancer survivors (5.1% vs. 6.2%, p<0.001) including recent survivors (5.0% vs. 6.2%, p<0.001). Suicidal ideation was higher in patients with underlying major depression in both cancer survivors and participants without cancer (30.6% vs. 35.6%, p = 0.015). On logistic regression, respondents with underlying depression receiving treatment were more likely to have suicidal ideation (OR: 1.49; p<0.001) while having a cancer diagnosis did not correlate with suicidal ideation (OR: 0.87; p = 0.869). There was no significant overall difference in the incidences of major depression between cancer survivors and patients without cancer. However, one consideration is the under-diagnosis depression among cancer survivors. Symptoms of depression may be overlooked and mistakenly attributed to appropriate grief from a cancer diagnosis. Among patients diagnosed with major depression, cancer survivors were more likely to receive treatment for depression. These results highlight the importance of early depression assessment and treatment for cancer survivors.