Strengthening The Reporting Of Observational Studies In Epidemiology Research Articles

Role of statins in patients with MINOCA. A systematic review and meta-analysis

Abstract Background Given the complex etiology and a limited amount of evidence, the medical treatment (including statin use) of myocardial infarction with non-obstructive coronary artery disease (MINOCA) remains uncertain. The objective of the present study was to evaluate the effect of statin therapy on major cardiovascular events (MACE) and mortality in MINOCA patients. Methods A systematic review and meta-analysis of time-to-event outcomes were performed from statin's studies therapy on MINOCA patients, reporting data from MACE or mortality, after searching the PubMed/MEDLINE, Embase, Science Direct, Scopus, Google Scholar, and Cochrane databases. The Meta-analysis Of Observational Studies (MOOSE) and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were used to check the reporting of observational studies. The quality of the included studies was assessed by two independent review authors using the Newcastle-Ottawa Scale (NOS). The summary effect of statin therapy on the endpoints were calculated. Measures of effect size were expressed as HRs, and the I2 statistic was calculated to quantify between-studies heterogeneity and inconsistency. A fixed-effects meta-analysis model and sensitivity analysis was then applied. The level of statistical significance was set at a 2-tailed alpha of 0.05. Results Six observational studies of statin therapy on MINOCA, involving a total of 11171 patients, were identified and considered eligible for analysis (9129 subjects received statin therapy while 2042 patients were part of the respective control arms). Quantitative analysis (5 studies were included) showed that statin use was associated with lower mortality (HR: 0.65; 95% CI: 0.56–0.75, I2: 0%). Also, the meta-analysis showed that statin therapy was associated with a lower incidence of MACE (HR: 0.78; 95% CI: 0.69–0.88, I2: 27%). Conclusion Our data suggest that in a population with MINOCA, the use of statin therapy results in significant reduction on MACE and mortality. These results must be confirmed in future clinical trials. Funding Acknowledgement Type of funding sources: None. Mortality and MACESensitivity analysis

Characteristics of Online Crowdfunding Campaigns for Urological Cancers in the United States.

We examined the characteristics and financial outcomes of online crowdfunding campaigns for patients with major urological cancers in the U.S. This cross-sectional study analyzed publicly available data from GoFundMe, the largest online medical crowdfunding service, via automated web scraping. Online campaigns from 2010 to 2018 with the following primary cancer types were included: kidney, prostate, bladder and testicular. Financial outcomes were compared using Kruskal-Wallis and Wilcoxon rank-sum tests. Multivariable analyses were utilized to identify predictors of campaign financial outcomes. Kidney cancers were the most frequent online campaign type (478), followed by prostate (379), bladder (202) and testicular (175) malignancies. Urological cancer campaign recipients frequently requested funding for medical expenses (71%) during active treatment (57%). After adjustment, testicular cancer and children's cancer campaigns generated more donations than other urological and adult cancer campaigns (p <0.05). Family and friend-authored campaigns generated more donations and average donation amounts than self-authored campaigns (p <0.05). Campaign narratives focused on disheartening circumstances received fewer donations than narratives focused on the recipient's high moral character or contributions to society (p <0.05), and unclear narratives received the smallest donation amounts (p <0.05). Urological cancer crowdfunding in the U.S. is primarily used to finance uncovered costs associated with medical care during active treatment. Crowdfunding financial outcomes are likely related to the campaign recipient's age, malignancy type, social network and primary appeal of the narrative. Urologists should be aware of trends in medical crowdfunding in order to better understand the financial burden this patient population faces.

The influence of spinal position on imaging findings: an observational study of thoracolumbar spine upright MRI in elite gymnasts

PurposeTo investigate whether upright magnetic resonance imaging (MRI) has a role in defining thoracolumbar spine pathology in elite gymnastics.MethodsA prospective cross-sectional observational study of National Senior and Junior Artistic gymnasts in three MRI positions (standard supine, upright flexed and extended positions). Two specialist musculoskeletal radiologists independently analysed images with neutral as a baseline with the effects of flexion and extension reported in line with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.ResultsForty (18 males) gymnasts aged 13–24 years with a mean (SD) of 32 (5.3) training hours per week consented with 75% showing MRI abnormalities. Degenerative disc disease (DDD) was evident in 55% participants with vertebral end plate (VEP) changes in 42.5%. Spondylolysis was present in 40% with an additional 17% showing chronic bilateral complete L5 pars defects. 23% participants demonstrated different MRI findings in upright flexion compared to neutral.ConclusionFindings suggest a high levels of MRI abnormalities in elite gymnastics including altered disc morphology and posterior element abnormalities. High prevalence of T11/12 DDD and VEP changes reflects the thoracolumbar junction being a transition zone. Upright MRI and varying spine position offer promise for enhanced visualisation of posterior element abnormalities.

Neuropsychiatric comorbidities in genetic/idiopathic generalized epilepsies and their effects on psychosocial outcomes

IntroductionIdiopathic/genetic generalized epilepsy (GGE) accounts for 15–20% of all epilepsy cases. Neuropsychiatric comorbidities and disorders, such as attention-deficit hyperactivity disorder (ADHD), academic failure, and poor social competence, are present at a higher rate in patients with epilepsy compared with the general population. In this study, we aimed to determine the frequency of neuropsychiatric comorbidities in GGE subgroups, and to reveal the risk factors in the patient group with neuropsychiatric comorbidities. Material and methodThis hospital-based, cross-sectional study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Patients with seizure-controlled GGE were invited to a semi-structured interview at the hospital. Variables [photosensitivity, valproic acid (VPA) resistance, timing of the neuropsychiatric comorbidities Attention deficit and hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and low academic performance), seizure control, and timing of the antiepileptic treatment] were statistically analyzed and evaluated in terms of their association with GGE subgroups [Generalized tonic-clonic seizures alone (EGTGS), juvenile myoclonic epilepsy (JME), and juvenile absence epilepsy (JAE)], ResultsTotal 101 patients with GGE were included in the study and the mean age was 13.94 ± 1.66 years. A total of 12.9% (n = 13) of the patients had EGTGS, 49.5% (n = 50) had JME, and 37.6% (n = 38) had JAE. VPA resistance, photosensitivity, and the presence of neuropsychiatric symptoms before the starting of epilepsy were found to be risk factors in the GGE group with neuropsychiatric comorbidities compared with the group without neuropsychiatric comorbidities (p < 0.001). The subgroups of GGE did not show any relationship with psychiatric disorders, including ADHD, ODD, and low academic performance (neuropsychiatric comorbidities) (p > 0.005). No correlation was found between seizure control and decline in neuropsychiatric symptoms (p > 0.05). ConclusionIn this study, the onset of psychiatric symptoms prior to the onset of epilepsy, photosensitivity, and VPA resistance were the most important factors affecting neuropsychiatric comorbidities. The JME, JAE, and EGTCS subgroups, early initiation of antiepileptic treatment, and seizure control were found to have no effect on poor psychosocial outcome and neuropsychiatric comorbidities.

Improving Social Justice in COVID-19 Health Research: Interim Guidelines for Reporting Health Equity in Observational Studies.

The COVID-19 pandemic has highlighted the global imperative to address health inequities. Observational studies are a valuable source of evidence for real-world effects and impacts of implementing COVID-19 policies on the redistribution of inequities. We assembled a diverse global multi-disciplinary team to develop interim guidance for improving transparency in reporting health equity in COVID-19 observational studies. We identified 14 areas in the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist that need additional detail to encourage transparent reporting of health equity. We searched for examples of COVID-19 observational studies that analysed and reported health equity analysis across one or more social determinants of health. We engaged with Indigenous stakeholders and others groups experiencing health inequities to co-produce this guidance and to bring an intersectional lens. Taking health equity and social determinants of health into account contributes to the clinical and epidemiological understanding of the disease, identifying specific needs and supporting decision-making processes. Stakeholders are encouraged to consider using this guidance on observational research to help provide evidence to close the inequitable gaps in health outcomes.

Health-related needs and barriers in transgender populations: a systematic review study

Purpose Identifying the health-related needs in transgender (TG) people can help to formulate strategies for providing appropriate and accessible health services and promoting health and social justice, as well as human rights in these populations. This systematic review aims to determine health-related needs, problems and barriers, as well as ways to solve them in TG people from the viewpoint of TG individuals and health policymakers. Design/methodology/approach All international electronic databases such as PubMed (Medline), Embase, CINAHL, Scopus, Web of Sciences, Cochrane, PsycInfo and Google Scholar (Gray Literature) were searched from December 1990 to December 2019. After the search, the articles were screened based on their title, abstract and full text. The quality of articles was assessed using the Strengthening the reporting of observational studies in epidemiology (STROBE), Consolidated Standards of Reporting Trials (CONSORT) and Standards for Reporting Qualitative Research (SRQR) checklists. The search strategy, data extraction and quality evaluation of articles were independently performed by two researchers. Findings The general health-related needs identified in TG individuals from the viewpoint of themselves included access to legal hormone therapy, psychological and psychiatric counseling, privacy, health and hygiene needs, equality and freedom of expression. General health-related needs in TG individuals from the viewpoint of health policymakers included screening tests to detect sexually transmitted diseases, especially HIV, cancers and other diseases, as well as training service providers (physicians, nurses, health workers, etc.). Research limitations/implications One of the limitations of this study was nonreporting of health-related needs in initial articles by different TG groups because these groups have had different needs and different barriers to accessing health-care services. In this study, health-related needs and barriers to satisfy them were categorized from the viewpoint of TG populations and health policymakers around the world, which may influence future decisions to provide services to TG populations. The results of this systematic review can help to develop different strategies by considering all TGs from individual, family and social aspects to better provide services for this group. However, given the dynamics and changes in the existing communities and the limited studies on gender minorities in developing countries, further research is required to comprehensively address the subject. Originality/value The findings can be used as an incentive to improve existing conditions and to address problems and shortcomings. The results of this systematic review formulate strategies for providing appropriate and accessible health services and better lives for TGs, planning for more effective participation of these individuals in local communities, improving their physical problems and mental health through counseling, as well as promoting health and social justice, and human rights for these populations.

Drug Utilization Study of Antidiabetic Drugs in Patients Attending Geriatric Outpatient Department at a Tertiary Care Hospital.

IntroductionDiabetes has increased in prevalence from 108 million individuals in 1980 to 463 million individuals in 2021. As people's life expectancies have risen, it's become increasingly necessary to be worried about diseases that affect the elderly. To focus and manage these diseases effectively, the illumination of current knowledge about the pattern of anti-diabetic drug utilization in the elderly is important. As a result, it is necessary to evaluate the pattern of anti-diabetic medication use among diabetes patients of the geriatric age group and determine if there is room for improvement in light of current knowledge. With this information, we intend to provide feedback and suggestions for the health care providers. This research aimed to study and analyze the drug utilization of antidiabetic medications in patients attending the geriatric outpatient department.MethodsThe data of 600 patients visiting the geriatric outpatient department from January 1, 2016 to September 30, 2017 were collected from the electronic medical record (EMR) database. The protocol was designed using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Subjects were grouped according to gender, age, drug combination use, and underlying co-morbidities. Indicators of drug usage and the total number of drugs prescribed and prescription patterns were analyzed. Then, the recorded data were classified according to the anatomical therapeutic chemical (ATC) - daily defined dose (DDD) classification. Prescribed daily dose (PDD) values and PDD/DDD ratio of antidiabetic drugs prescribed to a sample of patients (n=600) were calculated. Cost analysis of the prescribed drugs was analyzed and the cost index for each drug is described.ResultsA total of 600 diabetic patients (286 males) were recruited in the study. In the study, the average age of participants was 69.30±11.34 years. The most common comorbidity associated with diabetes mellitus (DM) was hypertension followed by hypertension along with chronic heart disease. Glibenclamide and pioglitazone (thiazolidenediones) had PDD/DDD ratio equal to 1. The ratios for glimepiride (sulfonylurea), metformin (biguanides), sitagliptin (sodium-glucose cotransporter 2 inhibitor), insulin glargine, insulin lispro, insulin aspart, were 1.85, 1.29, 1.66, 1.63, 1.42, and 1.21, respectively, whereas the premixed insulin had a ratio of 0.83. The average cost per prescription was USD 3.36 and around 87.72% of the cost per prescription was due to the prescribed antidiabetics. Metformin + glibenclamide was the most commonly prescribed combination followed by metformin + glimepiride.ConclusionOn the whole, the principles of rational prescription were followed in accordance with the different WHO drug usage indicators. Many of the drugs prescribed by generic name were supplied from hospital pharmacy thus reducing the burden to some extent.

Does administration of vaginal estrogens increase the risk of venous thromboembolism: A case-control study.

Does administration of vaginal estrogens increase the risk of venous thromboembolism: A case-control study.

Evaluating the utility and quality of large administrative databases in pediatric spinal neurosurgery research.

The purpose of this study was to assess the quality of articles utilizing large administrative databases toanswer questions related to pediatric spinal neurosurgery by quantifying their adherence to standard reportingguidelines. A systematic literature search was conducted with search terms including "pediatric" and "neurosurgery," associated neurosurgical diagnoses, and the names of known databases. Study abstracts were reviewed to identify clinical studies involving pediatric populations, spine-related pathology or procedures, and large administrative databases. Included studies were graded using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. A total of 28 papers of the initial 1496 identified met inclusion criteria. These papers involved 10 databases and had a mean study period of 11.46 ± 12.27 years. The subjects of these research papers were undergoing treatment of scoliosis (n = 5), spinal cord injury (n = 5), spinal cord tumors (n = 9), and spine surgery in general (n = 9). The mean STROBE score was 19.41 ± 2.02 (out of 22). Large administrative databases are commonly used within pediatric spine-related neurosurgical research to cover a broad spectrum of research questions and study topics. The heterogeneity of research to this point encourages the continued use of large databases to better understand treatment and diagnostic trends, perioperative and long-term outcomes, and rare pathologies within pediatric spinal neurosurgery.

Towards nursing leadership for professional and career outcomes of Bachelor of Nursing (Honours) students: A case study

BackgroundWithin Australia and internationally, there is increasing and widespread recognition of the importance of developing nurses’ capabilities in research and evidence-based practice to advance the discipline. Literature is sparse on the contribution of nursing Honours degrees to academic, professional, and industry outcomes in nursing. Aims and objectivesTo critically evaluate the contribution of a Bachelor of Nursing (Honours) degree to individual career development and nursing leadership, the profession, higher education, and the health industry to inform future directions. MethodsThis case study of a longstanding Bachelor of Nursing (Honours) degree uses data collected from multiple sources. The data included university and public records, as well as an anonymous online survey in 2018-19 of all students who had enrolled in the programme since 2004. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Cross-Sectional Studies checklist was followed. FindingsOf the 95 Honours programme graduates, 22.1% (n = 21) progressed to PhD studies, and 33.7% (n = 32) produced one or more publications. Of the 42 participants who accessed the survey, 78.6% (n = 33) had completed the nursing Honours programme, and 21.4% (n = 9) had commenced but did not complete the degree. Insufficient time was the main reason for not completing the nursing Honours degree, and qualitative responses indicated the nursing Honours degree developed student confidence and skills relevant to research and professional practice. DiscussionFindings highlight opportunities for nursing Honours degrees to contribute to individual achievement, best practices in healthcare, development of future leaders in nursing, and discipline-specific research outcomes. ConclusionNursing Honours degrees can offer important benefits to the individual, as well as the profession and the healthcare industry.

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. Translation to Russian

Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalisability of its results. Taking into account empirical evidence and theoretical considerations, a group of methodologists, researchers, and editors developed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations to improve the quality of reporting of observational studies. The STROBE Statement consists of a checklist of 22 items, which relate to the title, abstract, introduction, methods, results and discussion sections of articles. Eighteen items are common to cohort studies, case-control studies and cross-sectional studies and four are specific to each of the three study designs. The STROBE Statement provides guidance to authors about how to improve the reporting of observational studies and facilitates critical appraisal and interpretation of studies by reviewers, journal editors and readers. This explanatory and elaboration document is intended to enhance the use, understanding, and dissemination of the STROBE Statement. The meaning and rationale for each checklist item are presented. For each item, one or several published examples and, where possible, references to relevant empirical studies and methodological literature are provided. Examples of useful flow diagrams are also included. The STROBE Statement, this document, and the associated Web site (http://www. strobe-statement.org/) should be helpful resources to improve reporting of observational research.&#x0D; This article is the reprint with Russian translation of the original that can be observed here: Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. PLoS Med. 2007;4(10):e297. doi: 10.1371/journal.pmed.0040297.

Triggers and Interventions of Patients Who Require Medical Emergency Team Reviews: A Cross-Sectional Analysis of Single Versus Multiple Reviews.

Medical emergency teams constitute part of the escalation protocol of early warning systems in many hospitals. The literature indicates that medical emergency teams may reduce hospital mortality and cardiac arrest. A greater understanding of pathways of patients who experience multiple medical emergency team reviews will inform clinical decision-making. To explore differences between patients who require a single medical emergency team review and those who require multiple reviews, and to identify any differences between patients who were reviewed only once during admission and patients who required multiple reviews. Data for this retrospective cross-sectional review, including demographic data, call triggers, outcomes, and interventions, were routinely collected from January 2013 through December 2015. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) collaborative's cross-sectional studies checklist (version 4). Of 54 787 admitted patients, 1274 (2%) required a call to a medical emergency team; of those, 260 patients (20%) needed multiple calls. Patients requiring multiple calls demonstrated higher mortality (odds ratio, 1.49 [95% CI, 1.12-1.98]). A logistic regression model identified surgical patients and those receiving antibiotics and respiratory interventions at the first medical emergency team review as being more likely to require multiple reviews. Patients transferred to a higher level of care after the first review were less likely to require another review. Patients requiring multiple medical emergency team reviews have higher mortality. Surgical patients have a higher risk of requiring multiple reviews. Hospitals need to include more details on surgical patients when auditing medical emergency team activation.

Reporting of "Theoretical Design" in Explanatory Research: A Critical Appraisal of Research on Early Life Exposure to Antibiotics and the Occurrence of Asthma.

“Theoretical design” comprises the development of an occurrence relation and the specification of the study domain. In explanatory research, the occurrence relation causally relates one determinant to the occurrence (of an event or a state) taking into account other relevant characteristics (confounders and modifiers). Conflicting results in explanatory research might be (partially) explained by differences in the “theoretical design” or by a mismatch between the “theoretical design” and the “design of data collection”. In this critical review, the reporting of “theoretical design” is assessed in articles on the association between early life antibiotic use and the occurrence of asthma. Articles investigating a relationship between early life antibiotic use and the occurrence of asthma were searched in PubMed and systematically selected for critical review. The full text was read and important elements of study design were extracted (the research question/hypothesis, seven key elements of “theoretical design” (measure of occurrence, case (event or state) definition, conceptualization (and operationalization) of the exposure, temporal relation between outcome and exposure, confounders and effect modifiers taken into account and the domain of the study), the method of data collection and the method of data processing). A comparison was made between articles published before and after the publication of the “Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) statement (2007). Sixty-three articles were included for review. Thirteen articles reported the seven key elements of “theoretical design” that were questioned. No marked differences in reporting were observed pre- and post-STROBE. All articles reported some key elements of “theoretical design”; however, the reporting is not structured and not linked to the concept of “theoretical design”. Conceptualizing, delineating and explicit reporting of “theoretical design” is quintessential for the quality and transparency of explanatory research.

The relationship of nurses' psychological well-being with their coronaphobia and work-life balance during the COVID-19 pandemic: A cross-sectional study.

Aims and ObjectivesThis study aimed to determine the relationship of nurses’ psychological well‐being with their coronaphobia and work–life balance during the COVID‐19 pandemic.BackgroundCOVID‐19 is a global life‐threatening disease. The COVID‐19 pandemic negatively affects nurses’ mental health. No studies have been conducted to determine the factors that affect nurses’ psychological well‐being during the COVID‐19 pandemic in Turkey. If nurses’ psychological well‐being is impaired during the COVID‐19 pandemic, the quality of nursing care and the nurses’ performance may be negatively affected.DesignThis is a descriptive, correlational and cross‐sectional study. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) reporting guideline checklist for cross‐sectional studies was used for reporting in this study.MethodsThe study population consisted of the nurses working in a Health Application and Research Center in Turkey. Data were collected using Google forms between June–August 2020. The study sample consisted of 295 nurses who voluntarily agreed to participate in the study and used social media tools. The data were collected using a Sociodemographic Characteristics Form, the COVID‐19 Phobia Scale (C19P‐S), the Work–Life Balance (WLB) Scale and the Psychological Well‐Being (PWB) Scale. The factors that affect psychological well‐being were determined using the stepwise multiple linear regression analysis.ResultsThe nurses’ work–life balance and psychological well‐being were negatively affected during the COVID‐19 pandemic. Their COVID‐19 phobia was mild‐to‐moderate level. The nurses’ psychological well‐being was significantly affected by the variable of neglecting life the most, followed by coronaphobia and work–life balance, which explain 75% of the variance.ConclusionsThis study shows that coronaphobia experienced by nurses and work–life balance was related to their psychological well‐being during the COVID‐19 pandemic. Managers should take measures (regulating the working hours) to decrease nurses’ COVID‐19 phobia (education, counselling or psychotherapy) and work–life imbalance.Relevance to clinical practiceNurses’ peers, managers and organisations need to take into account nurses’ negative emotions and behaviours and organise training programmes to help them overcome their fears, communicate clearly and provide for their basic needs. Organisations, including managers and nurses, must recognise the distress being experienced by their nurses and create safe environments in which to have significant conversations. Nurses’ mental health can be screened regularly by multidisciplinary teams, psychological support can be provided when required, and working hours can be regulated through appropriate shifts and breaks that will ensure work–life balance during and after the COVID‐19 pandemic. Nurses receiving emotional support from their families and friends (via chatting and sharing troubles) can also contribute positively. These measures and regulations will positively affect nurses’ psychological well‐being and contribute to an increase in the quality of care and nurses’ performance.

The clinical management of orthodontically-induced external root resorption: A questionnaire survey

With more dentists performing orthodontics, identifying and managing patients at risk or affected by orthodontically-induced external root resorption (OIERR) is paramount. This study, conducted according to STROBE (STrengthening the Reporting of OBservational studies in Epidemiology), studied Australian orthodontists. Orthodontists were asked to complete a clinical questionnaire evaluating their diagnostic and management approaches to OIERR. Orthodontists most commonly use a history of previous root resorption and the use of an orthopantomogram to screen and monitor patients. An orthopantomogram is used either 6months for those identified as at risk of OIERR or 10-12months for those who are not. Once detected, most orthodontists will record OIERR in terms of severity. If severe root resorption was detected, orthodontists would compromise on the treatment outcome and promptly complete treatment; if extraction sites remain closed, most orthodontists will interrupt treatment for 3-6months. After treatment, orthodontists' retention protocol is unchanged regardless of OIERR experience. Treatment planning for patients with generalized OIERR before treatment (P=0.002) was the only decision shown to be associated with years of clinical experience (P>0.05). It is shown that no 1 method for managing OIERR exists, with most orthodontists arguing patient specificity to treatment modality. The various selected clinical approaches accurately reflect the current state of scientific literature on the topic.

Machine Learning Assisted Oncotype Dx Recurrence Risk Classification Forecast System for Breast Cancer Based on 111,635 Patients Covering 11 Years

Background: TAILORx data confirm that using Oncotype DX (ODX) to assess the risk of early-stage breast cancer recurrence can spare women unnecessary chemotherapy. However, high up-front costs (list price, $4175) could dissuade usage. Also, from a technical perspective, this test cannot be widely used in developing countries, especially in relatively poor areas. Methods: By analyzing the Surveillance, Epidemiology, and End-Results database, multinomial ordinal logistic regression, random forest, gradient boosting decision tree, extreme gradient boosting, and multi-layer perceptron were adopted to develop an assistant forecast system for recurrence risk—low to intermediate (RS=2–25) or high (RS=26–100)—based on individuals’ sociodemographic and clinicopathological information. We validated the system using an independent dataset (training-test split of the original dataset) as validation. Results: We identified 111,635 patients with breast cancer: 86,617 patients (77.59%) were aged 50 years or younger; 23,514 patients (21.1%) had low risk scores, 71,439 patients (64.0%) had intermediate risk scores, and 16,682 patients (14.9%) had high risk scores. Variables closely associated (all P<0.05) with RS included age, sex, race, primary tumor site, histopathological grade, tumor size, pathology, and progesterone receptor status. In validation, for the multi-layer perceptron model, overall accuracy was 86.1% (sensitivity=0.69, specificity=0.87, and area under the curve=0.80).Conclusions Our assistant forecast system, based on sociodemographic and clinicopathological data, provides an alternative tool to estimate patients’ breast cancer recurrence risk. Funding: This work was supported by the Natural Science Foundation of China (No. 81872160), the Natural Science Foundation of China (No. 82072940), the China National Key R&D (or Research and Development) Program (No. 2020AAA0105000 and 2020AAA0105004), the Beijing Municipal Natural Science Foundation (Key Project) (No. 7191009), the Beijing Municipal Natural Science Foundation (No. 7204293), the Special Research Fund for Central Universities, Peking Union Medical College (No. 3332019053), the Beijing Hope Run Special Fund of Cancer Foundation of China (No. LC2019B03), the Beijing Hope Run Special Fund of Cancer Foundation of China (No. LC2019L07), the Beijing Hope Run Special Fund of Cancer Foundation of China (No. LC2020L01), the Golden Bridge Project Seed Fund of Beijing Association for Science and Technology (No. ZZ20004), and the National Key R&D Program of China (No. 2018YFC1315000 and No. 2018YFC1315003). Declaration of Interest: None to declare. Ethical Approval: The analysis followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College institutional review board approved this study as exempt.

Global epidemiology of mucopolysaccharidosis type III (Sanfilippo syndrome): an updated systematic review and meta-analysis.

Mucopolysaccharidosis III, an autosomal recessive lysosomal storage disorder, is characterized by progressive mental retardation and behavioral problems. Meta-analysis of global mucopolysaccharidosis III epidemiology, which serves as a fundamental reference for public health decision-making, was not available prior to this study. To provide a systematic review and meta-analysis of birth prevalence of mucopolysaccharidosis III in multiple countries. MEDLINE and EMBASE databases were searched for original research articles on the epidemiology of mucopolysaccharidosis III from inception until 1st July, 2020. A checklist adapted from STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) was used to assess the quality of all studies involved. Meta-analysis, adopting a random effects logistic model, was performed to estimate pooled birth prevalence of mucopolysaccharidosis III and its subtypes. Twenty-five studies screened out of 1,826 records were included for data extraction. The pooled global mucopolysaccharidosis III birth prevalence was 0.76 cases (95% CI:0.57-0.96) per 100,000 live births. The pooled global birthprevalence of mucopolysaccharidosis III subtypes (A,B,and C) was 0.52 cases (95% CI: 0.33-0.72), 0.21 cases (95% CI: 0.12-0.30) and 0.01 cases (95% CI: 0.005-0.02) per 100,000 live births, respectively. Based on the global population size (7.8 billion) and the life span of patients, there would be 12-19 thousand mucopolysaccharidosis III patients worldwide. To our knowledge, this is the first comprehensive systematic review that presented quantitative data fundamental for evidence-based public health decision-making by evaluating global epidemiology of mucopolysaccharidosis III.

Predicting the Risk of Stroke and Delirium During Cardiac Surgery Using a Novel EEG Based Index of Interhemispheric Synchronization

Introduction: Neurological complications after surgery (e.g. stroke, delirium and cognitive dysfunction) remain a major concern despite advancements in surgical and anaesthetic techniques and technology. The aim of this study was to evaluate whether a novel electroencephalogram (EEG)-based index of interhemispheric synchronization, between two prefrontal EEG channels, could predict stroke or delirium following cardiac surgery. Methods: Two-channel EEG was analyzed in 803 patients undergoing cardiac surgery, without prior documentation of stroke. 31 patients suffered from stroke upon waking up from surgery (stroke group), for another 48 patients post-operative delirium was documented (delirium group) and the rest (724 patients) did not suffer from a documented neurological complication (no dysfunction group). A novel EEG-based index, the Lateral Interconnection Ratio (LIR) index, of frontal interhemispheric synchronization was calculated every 10 seconds and compared among the three patient groups over five key periods during surgery: start, pre-bypass, on-bypass, post-bypass, and end of surgery. The LIR index was analyzed in a blinded manner, without knowledge of patient group affiliation, and only compared among groups at the final analysis step. Results: The LIR index of patients with stroke decreased by 0.17±0.11 (mean±95% CI) from the start of surgery period to the immediate post bypass period in comparison to its relative stability of -0.03±0.02 in the no dysfunction group (p<0.0001). The LIR index of patients with delirium decreased from the start of surgery period to the end of surgery period by 0.20±0.13 in comparison to its relative stability of 0.02±0.02 in the no dysfunction group (p≈0.001). Summary: LIR index drops may provide an intraoperative alert to the occurrence of brain injury. The timing of LIR drops (post-bypass or end of surgery) may provide hints regarding the pathophysiology of the injury. For even better results it might be advisable to continue the monitoring during the post-operative period, especially while the patient is still anesthetized in the ICU, as there is continued risk for stroke and delirium also after surgery ends. Funding: The original study (Clinicaltrials.gov identifier: NCT02976584) was supported by the Bangerter-Rhyner Foundation and the Clinical Trials Unit of the University Hospital of Bern, University of Bern, Switzerland. Drs Hight & Kaiser were supported by the Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland. Declaration of Interest: GS and DBS are spouses. GS founded several companies in the field of EEG analysis and DBS consulted one of these companies up to ~1 year ago. However, the present study is not related to these companies and their technology. It is based on developments in GS academic laboratory at Rambam Health Care Campus. The other authors have no conflict of interest to declare. Ethical Approval: The ethics committee of the canton of Bern, Switzerland, approved the prospective observational study (KEK#210/15). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies was used to guide the methods of the study and to structure the manuscript

The Association Between Antioxidant Status and Excess Weight in Children: A Systematic Review and Meta-analysis

Background: The prevalence of childhood obesity with its complications has increased in the world. Obesity, along with antioxidants deficiency (due to an unhealthy diet), might change the balance in favor of oxidative stress. Objectives: The current study aims to assess the literature on the relationship between obesity and antioxidant status through a systematic review and meta-analysis Results: β-Carotene levels was significantly lower in obese children than non-obese ones (mean difference: 0.13, 95%CI: 0.09-0.16, P&lt;0.001), with significant heterogeneity (P&lt;0.001, I2=85%). There was a significant difference between obese and non-obese children in both α-tocopherol (pooled mean difference respectively: 0.36, 95% CI: 0.04-0.96, P&lt;0.001 ) with non-significant heterogeneity (P&gt;0.05, I2=0.0% ) and α-tocopherol per lipoid (pooled mean difference: 0.42, 95%CI: 0.28-0.55, P&lt;0.001), with significant heterogeneity (P=0.048, I2=58.8%). There was no significant association between vitamin E level and obesity (pooled mean difference: 0.40, 95%CI: -0.05-0.85, P&gt;0.05), with significant heterogeneity (P&lt;0.001, I2=84.5%). There was significant association between zinc, magnesium, copper, and selenium level and obesity (P&gt;0.05), with significant heterogeneity (P&lt;0.001). Conclusions: This review revealed a significant inverse relationship between childhood obesity and serum antioxidant levels. More studies are necessary to find the underlying mechanisms and clinical impacts of this finding. Data Sources: This systematic review and meta-analysis were performed among English language articles published until September 2020 without any time limit. An electronic search was conducted in international databases of Google Scholar, PubMed, Web of Science, Scopus, Medline, and Cochrane. Study Selection: First, 1255 papers were found. After removing duplicates and quality assessment, 46 were used in the systemic review, and 19 articles were entered into the meta-analysis. Data Extraction: Two researchers independently searched the following keywords in the databases: “Vitamin C”, “Vitamin E”, “Vitamin A”, “Carotenoids”, “Antioxidants”, “Selenium”, “Magnesium”, “Copper”, “Zinc”, “Ascorbic acid”, “Tocopherol”, “Obesity”, “Overweight”, “Childhood”, “Pediatric”, and “Adolescence”. Articles that examined the association between obesity and antioxidant status were included in the study. The research on animals, interventional studies, case studies, case reports, and irrelevant studies were excluded. The research team determined the quality of studies using the STROBE (strengthening the reporting of observational studies in epidemiology) checklist. Heterogeneity of studies was evaluated using index (I2) and probability of diffusion bias by funnel plot and Begg’s and Egger’s tests.

Negative Factors Affecting the Sleep Quality of the Elderly in Iran: A Systematic Review

Objective: As age increases, different physical and mental problems, including sleep disorders, occur in the elderly. The Person-Environment-Occupation (PEO) model is one of the most common practical models in occupational therapy. The current study aims to review negative factors affecting the sleeping quality of the elderly in Iran based on the PEO model. Materials &amp; Methods: According to PRISMA (the preferred reporting items for systematic reviews and meta-analyses) guidelines and in this systematic review study, we searched Google Scholar, Scopus, PubMed, Magiran, IranMedex, and SID databases using the keywords of “Elderly”, “aging”, “geriatric”, “older adult”, “Iran”, and “sleep” in English and Persian articles published from 2010 to 2019. Studies on the sleep problems of other age groups, letters to the editor, duplicate studies, studies on non-Iranian seniors, studies published in languages other than Persian and English, and those with unavailable full-texts were excluded. In the next stage, the titles and abstracts of the retrieved articles were independently reviewed by two researchers to identify the studies that meet the inclusion criteria. The dispute was resolved through discussion and reaching an agreement. Then, the full text of eligible articles was retrieved. Articles approved based on at least 20 out of 22 items of the STROBE (strengthening the reporting of observational studies in epidemiology) checklist were included in the study. Finally, 24 articles that were in line with the research objectives were selected for an in-depth review. Results: Out of 24 studies, 11 reported quantitative sleep problems, 9 of which claimed that more than 70% of the elderly had sleep problems. The negative factors affecting the sleep quality of Iranian older adults were presented and categorized based on personal, environmental, and occupational factors. Eighteen articles addressed personal factors, where the most common factor was related to personal health issues. Eleven articles reported environmental factors, where the most common factor was related to the physical environment. In three articles, the factors that had a negative effect on sleeping are occupational and included the change of sleeping place and not talking to others before going to bed. Conclusion: Personal factors (e.g. aging, female gender, disease), environmental factors (e.g. lack of communication with relatives and friends, inappropriate physical environment, and living in a nursing home), and occupational factors (e.g. change of sleeping place, hospitalization, and not talking to others before going to sleep) are negative factors affecting the sleep quality of the elderly in Iran.