Univariate Repeated Measures Analysis Research Articles

2Steps4Health project: Promotion of mental health in junior professional sports

Abstract: Introduction: This brief report and study protocol emphasizes the growing recognition of the importance of mental health in young elite athletes, particularly during the vulnerable phase of adolescence, where bio-psycho-social demands are significant. It presents the 2Steps4Health project, which aims to reduce the risk of mental illness and enhance well-being by addressing stressors and empowering young elite athletes with coping strategies. Methods: 2Steps4Health is a stepped-care prevention program for young elite athletes aged 12–21 and comprises two levels (universal and indicated prevention). The evaluation study employs a longitudinal (quasi-) randomized intervention study design with a waiting control group, and it aims to equip participants with psychological skills to enhance overall well-being and resilience. The effectiveness of the program will be assessed using empirically validated questionnaires, with specific hypotheses for both prevention levels regarding life satisfaction, stress, recovery, self-esteem, and internalizing symptoms. Results: Available data will be analyzed using univariate repeated measures analysis of variance (ANOVAs), allowing for both within and between group comparisons. Conclusion: With the help of its two prevention levels, 2Steps4Health combines clinical psychology approaches for symptom reduction with positive psychology for flourishing. Anticipated challenges include tight schedules and mental health stigma, addressed by offering group programs during training times and fostering support through connections with authorities. The project emphasizes the need for additional prevention actions targeting institutional factors influencing the mental health of young elite athletes.

Role of shear wave elastography in the evaluation of the treatment and prognosis of supraspinatus tendinitis.

BACKGROUNDSupraspinatus tendinitis recurs easily after treatment. One of the main reasons is the lack of objective tools for the efficacy evaluation. Shear wave elastography (SWE) can quantitatively analyze the tissue elasticity of region of interest by measuring the Young’s modulus (YM) value.AIMTo explore the role of SWE in the efficacy and prognostic evaluation of supraspinatus tendinitis.METHODSEighty-seven patients with supraspinatus tendinitis treated in Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences were recruited. Another 30 healthy volunteers were enrolled as the control group. The visual analogue scale (VAS) and Constant-Murley Score (CMS) were recorded before treatment. All participants were scanned by SWE scan, and the YM value of the region of interest were recorded. Spearman correlation analysis was performed on YM values with VAS and CMS. Univariate repeated measures analysis of variance was used to calculate the changing trend of VAS, CMS and SWE under different treatment courses. After treatment, the patients were further grouped based on who achieved significantly effective and curative treatment. The patients in the continued treatment group continued to receive treatment according to the YM value, and the remaining patients who stopped receiving treatment were included in the stopped treatment group. All patients were followed up for 1 year, and the difference in recurrence rates between the continued treatment group and the stopped treatment group were compared.RESULTSThe SWE images of supraspinatus muscle in healthy volunteers were mainly blue, while those of patients with supraspinatus tendinitis showed regional red and green areas. The average YM value of the supraspinatus muscle in healthy volunteers was 26.12 ± 4.03 kPa. The average YM value of patients with supraspinatus muscle was greater than that of healthy volunteers (average YM = 60.61 ± 11.53 kPa, t = 26.344, P < 0.001). The YM value was positively correlated with VAS (r = 0.564, P < 0.001) and negatively correlated with CMS (r = -0.411, P < 0.001). The changes of VAS and CMS were the most obvious in course 1 and then decreased gradually. The degree of change in YM values was similar in different courses. After a 1-year follow-up, the cumulative relapse-free rate in the continued treatment group was 91.43%, which was significantly higher than that in the stopped treatment group (64.71%, X2 = 7.379, P = 0.007).CONCLUSIONSWE can objectively indicate the severity of supraspinatus tendinitis. Using the YM value as a criterion for curative effect may reduce the recurrence rate.

Effectiveness of a theory-based back care intervention on spine-related behavior among pupils: a school-based randomised controlled trial (T-Bak study)

BackgroundChildren’s health and welfare have a special place in research and policy in many countries. One of the most important concerns is the increasing rate of backache in children due to many of behavioral risk factors. The aim of this study was to evaluate the effectiveness of an educational program on promoting back-related behavior as well as knowledge, skills, beliefs, and self-efficacy among fifth grade girls.MethodsThe theory-based back care (T-Bak) study was a school-based randomised controlled trial (RCT) that assessed the effectiveness of developing a back care training program based on the social cognitive theory (SCT). A total of 104 schoolchildren aged 11 ± 1.0 years were assigned to intervention (n = 52) and control (n = 52) groups. The intervention group received six sessions training on proper lifting and carrying techniques, having proper posture during daily activities, and correct backpack wearing techniques with a 1-week interval while the control group received nothing. Then, the two groups were assessed for knowledge, skills, self-efficacy, beliefs, and behavior at four points in time: baseline, immediate, three and six-months post-intervention. The changes of the outcomes investigated using univariate repeated measures analysis of variance. Partial eta squared measure (ηp2) was used to calculate effect sizes.ResultsA positive change was found for the intervention group back-related behavior from baseline to immediate post-intervention and follow-ups (F = 78.865, p < 0.001, ηp2 = 0.22). Overall there were 36.4% improvement for knowledge (ηp2 = 0.21), 53.2% for the skills (ηp2 = 0.25), 19.5% for the self-efficacy (ηp2 = 0.11), and 25.6% for the beliefs (ηp2 = 0.14) scores from baseline to 6 months’ follow-up assessments among the intervention group (p < 0.001). The results also showed a significant interaction effect between group and time.ConclusionThe T-Bak intervention was effective in improving back-related behavior in pupils. It is now available and could be evaluated further in back-care related studies.Trial registrationCurrent Controlled Trials IRCT20180528039885N1, 30th Oct 2018, ‘Prospectively registered’. https://www.irct.ir/trial/31534

Synergistic Improvement in Children with Cerebral Palsy Who Underwent Double-Course Human Wharton's Jelly Stem Cell Transplantation.

Background Our previous studies confirmed that human Wharton's Jelly stem cell (hWJSC) transplantation improved motor function in children with spastic cerebral palsy (CP). This study investigated the dose-effect relationship between the transplanted cell dosage and efficacy in CP children. Methods CP children who received one- or two-course (four or eight times lumbar puncture, 4 or 8 × 107 hWJSCs) cell therapy were recruited into this study. Assessments of motor function were performed according to scales for gross motor function measurement (GMFM) and fine motor function measurement (FMFM). The measurement data obtained in the two different groups were analyzed by t-test. Univariate repeated measures analysis of variance was used to compare the data obtained at baseline and 6 or 12 months posttransplantation and met the conditions for Mauchly's sphericity test. Results The results for fifty-seven pediatric CP patients (including 35 male and 22 female patients) who completed follow-up showed that gross and fine motor functions improved after cell therapy. Interestingly, the GMFM and FMFM scores in patients who received one course of transplantation were significantly increased at 6 months after treatment. Moreover, another course of transplantation further improved gross and fine motor function in children. The scores for GMFM and FMFM were significantly higher at 6 months posttransplantation than at baseline and showed a linear upward trend. There was no gender difference in GMFM. Interestingly, there was a significant difference between male and female patients in the B and C dimensions of FMFM. These results reveal a gender-related susceptibility to stem cell therapy, especially for movement capability of the upper extremity joint and grasping ability. Similarly, in the group aged ≤3 years old, the improvement observed in dimension A (lying and rolling) of GMFM was nearly exponential and showed a quadratic trend. The results for FMFM were similar to those for GMFM. Moreover, the improvement in motor function was not age dependent. Conclusions In this study, our data collectively reveal that CP children display sex- or age-dependent responses to hWJSC therapy; these results shed light on the clinical utility of this approach in specific populations.

Prospective study of shoulder strength, shoulder range of motion, and lymphedema in breast cancer patients from pre-surgery to 5years after ALND or SLNB.

Determine the changes in shoulder strength, shoulder range of motion, and arm volume in breast cancer patients treated with sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) METHOD: Sixty-eight SLNB and 44 ALND patients were followed up from pre-surgery to 5years after surgery. Primary outcomes were the differences between affected and non-affected sides for the following: shoulder strength measured by dynamometry, shoulder range of motion measured by goniometry, and lymphedema measured by volume. As a secondary outcome, health-related quality of life (HRQL) was assessed by the Short Form-36 Health Survey (SF-36) and the Functional Assessment of Cancer Therapy for breast cancer (FACT-B+4) questionnaires. Changes over time were tested for SLNB and ALND using univariate repeated measures analysis of variance. Generalized estimating equation models were constructed to assess the effect of SLNB and ALND over time. After 5years, the ALND group had significant loss of strength for internal rotators (1.39kg, p = 0.001) and significant arm volume increase (132.45mL, p = 0.031). The ALND group had a greater number of patients with clinically relevant internal rotator strength loss (38.7 vs. 13.6%, p = 0.012) and a greater number of lymphedema requiring treatment (33.3 vs. 3.4%, p < 0.001) than the SLNB group. A loss of strength for shoulder external rotators, shoulder range of motion, and HRQL in physical and arm domains persisted at 5years in both SLNB and ALND groups. These results could help understand and plan the prevention, needs, and long-term care of breast cancer patients.

Effects of Tongue Strength Training on Mealtime Function in Long-Term Care.

The primary aim of this study was to determine the feasibility and effectiveness of an 8-week tongue-strengthening intervention protocol for seniors with mild to moderately severe cognitive impairment in the long-term care setting. Outcome measures of interest included tongue strength, mealtime duration, and food intake. In this pre-post group study of treatment outcomes, data were collected from 7 adults (aged 84-99 years). Participants were observed across a series of mealtimes to determine mealtime duration and intake before and after 16 treatment sessions. During therapy, participants performed isometric strength exercises and tongue pressure accuracy tasks using the Iowa Oral Performance Instrument (model number 2.1, IOPI Medical). Differences in tongue strength as a function of treatment were explored between the first 3 and final 3 sessions using univariate repeated-measures analysis of variance. Single-subject methods were used to explore baseline and posttreatment data for measures of mealtime function. Anterior and posterior tongue strength increased significantly with therapy. There were no changes in mealtime function. This study shows proof of concept that some older adults with cognitive impairment are able to participate in a tongue-strengthening intervention and achieve improvements in tongue strength. Failure to find evidence of associated changes of mealtime function suggests that mealtime measures may not be directly sensitive to changes in tongue strength.

Quality of life in persons living with HIV in Burkina Faso: a follow-up over 12 months.

BackgroundIn Burkina Faso, very little is known about the quality of life of persons living with HIV through their routine follow- up. This study aimed to assess the quality of life of persons living with HIV, and its change over a 1-year period.MethodsFour hundred and twenty four (424) persons living with HIV were monitored during twelve (12) months from September 2012 to September 2013 in Ouagadougou, the capital city of Burkina Faso. Three interviews were conducted in order to assess the quality of life of patients and its change over time, using the World Health Organization Quality of Life assessment brief scale in patients with Human Immunodeficiency Virus infection (WHOQOL HIV-BREF). The Friedman test was used to assess significant differences in quantitative variables at each of the three follow-up interviews. Groups at baseline, at 6 months and at 12 months were compared using Wilcoxon signed rank test for quantitative data and McNemar test for qualitative variables. Pearson Chi2 was used when needed. Multivariable logistic regression models were fit to estimate adjusted odds ratio (OR) and 95 % confidence intervals (95 % CI). Trends in global quality of life score and subgroups (status related to Highly Active Anti Retroviral Treatment (HAART) using univariate repeated measures analysis of variance were assessed. A p-value less than 0.05 was considered significant.ResultsAt baseline, quality of life scores were highest in the domain of spirituality, religion and personal beliefs (SRPB) and lowest in the environmental domain. This trend was maintained during the 12-month follow-up. The global score increased significantly from the beginning up to the twelfth month of follow-up. Over the 12 months, the baseline factors that were likely to predict an increase in the global quality of life score were: not having support from relatives for medical care (P = 0.04), being under HAART (P = 0.001), being self-perceived as healthy (P = 0.03), and having a global quality of life score under 77 (P < 0.001).ConclusionsOur findings suggest the need to promote interventions to empower people living with HIV/AIDS through income generating activities. Such activities will enhance the quality of life of persons living with HIV in Burkina Faso. This could focus mostly on treatment-naïve HIV patients, lacking support from relatives and those who perceive themselves as ill.

Movement Disorder-Childhood Rating Scale: A Sensitive Tool to Evaluate Movement Disorders

BackgroundThe Movement Disorder-Childhood Rating Scale represents a new tool for assessment of movement disorders during developmental age. In this study, we evaluated a cohort of 68 patients affected by various types of movement disorders and treated with specific drugs over one year to verify the usefulness of the Movement Disorder-Childhood Rating Scale. MethodThe participants were divided into two groups according to their ages (0-3 years; 4-18 years) and were evaluated using Movement Disorder-Childhood Rating Scale 0-3 or 4-18 at baseline (i.e., before starting pharmacological treatment [T0], after 6 months [T1], and after 12 months [T2] of treatment. Univariate repeated measures analysis of variance with a Greenhouse-Geisser correction by SPSS 20 was performed to analyze the scale responsiveness for the three indices (e.g., Index I, Index II, Global Index) in each group with time (T0, T1, and T2). In addition, the Bonferroni test was performed to identify the source of significant differences among means. ResultsSignificant differences were found between time points (T1 versus T0, T2 versus T0, and T2 versus T1) in both scales for all indexes with the exception for T2 versus T1 for Index II in both scales and for T2 versus T1 for the Global Index in the older age group. There was no significant correlation between observed changes in the scores and the age of the children, either for Movement Disorder-Childhood Rating Scale 0-3 or 4-18. ConclusionOur results suggest that Movement Disorder-Childhood Rating Scale is a suitable tool to detect changes independently from age and could be used as outcome measure for clinical trials.

Effectiveness of the Dynamic Movement Orthosis Glove for a Child with Cerebral Palsy Hemiplegia and Obstetric Brachial Plexus Palsy

The purpose of this case series was to 1) describe the use of a custom-fitted Dynamic Movement Orthosis® (DMO) glove and 2) to provide data on the effect of wearing the DMO over time. Two subjects, one child with cerebral palsy (CP) hemiplegia and the other child with obstetric brachial plexus palsy (OBPP), using the DMO glove were followed. Assessments were conducted at baseline (T0), 1 month of wearing the DMO (T1), 3 months (T2), and 6 months (T3). The Melbourne Assessment of Unilateral Upper Limb Function (Melbourne Assessment) was used to measure outcomes for unimanual capacity. The overall affected upper-limb control improved after the use of the DMO. Improvements were observed in unimanual capacity, and the gains were maintained after 6 months of use. Using univariate repeated-measures analysis of variance (ANOVA), DMO was associated with functional improvement over time (p = 0.007). The use of the DMO glove is another alternative for providing alignment to the affected upper limb and may assist a child’s ability to use his/her hand, thus enhancing the acquisition of goal-directed functional skills.

The effects of jigsaw- and constructive controversy-based collaborative learning strategies on older adults’ eHealth literacy

A collaborative eHealth literacy intervention for older adults was developed using two collaborative learning strategies (jigsaw and constructive controversy) and tested by comparing learning outcomes with those produced using individualistic learning strategies. This paper presents results from an experiment conducted from October 2011 to March 2012 using a 2x2 mixed factorial design where learning method (individualistic; collaborative) was the between-participants variable and time of measurement (pre; post) was the within-participants variable. In total, 172 participants (age range: 50-87; M =67.58; SD =7.47) were randomly assigned to the collaborative learning or individualistic learning condition (collaborative: 75; individualistic: 97). The interventions comprised four 2-hour sessions held at a public library. Univariate repeated measures analyses detected asignificant difference in computer and web knowledge by learning method, with individualistic learning outperforming collaborative learning: F 1,127 =7.13; p=0.009. No significant difference was detected in computer and web skill F 1,125 =2.30; p=1.32, or eHealth literacy skill F 1,123 =1.96; p=1.64. The results suggest individualistic learning outperforms collaborative learning for simple recall tasks, but not complex tasks requiring knowledge transfer.

The Impact of Seasonality on Changes in Body Weight and Physical Activity in Mexican-American Women

This 12-month, longitudinal panel study examined seasonal variability in body weight and physical activity in Mexican-American women. Fifty-nine women (20 to 63 years of age) were measured five times at intervals of three months between March 2010 and March 2011. Complete data were collected for all measures at all times on 36 women. Repeated measures multivariate analysis of variance with follow-up univariate repeated measures analysis of variance revealed that body weight increased on average by 1.36 kg (p < .01), with the greatest increase occurring during the fall (+0.80 kg). Changes in vigorous-intensity aerobic activity were statistically significant, with the greatest increase occurring in the spring (+51.99 min/week) and the greatest decline occurring in the fall (–30.11 min/week). Significant changes were observed in muscle-strengthening activity during the summer (–32.38 min/week). Moderate-intensity aerobic activity remained relatively stable. The decline in muscle-strengthening activity during the summer and subsequent decline in vigorous-intensity aerobic activity in the fall likely led to the observed increase in body weight during the fall. Thus, weight management interventions should consider the time of year when Mexican-American women's physical activity declines and include strategies specifically designed to prevent weight gain during the fall season.

Impact of Hindustani Ragas on Visual Acuity, Spatial Orientation, and Cognitive Functions in Patients With Cerebrovascular Accident and Diffuse Head Injury

The objective of this article is to study the impact of Hindustani ragas on the cognitive functions of the right and left cerebral hemispheres, especially of the parieto-occipital lobe, in patients with cerebrovascular accident and diffuse head injury. A randomized control trial was conducted. The case group consisted of 30 patients who received both medicine and ragas, while the control group of 30 patients received only medicine. A total of 10 Hindustani ragas were taken up, and 4 follow-ups with baseline were conducted. Nahor-Benson test, a subtest of the Post Graduate Institute–Battery for Brain Dysfunction, was used at different time intervals. Univariate repeated measures analysis revealed significant differences between the 2 groups at different time intervals, confirming that listening to ragas improved visual perceptual acuity, spatial orientation, and the cognitive functions involving both right and left hemispheres of the case group patients.

Comparison of Lipid and Calorie Loss From Donor Human Milk Among 3 Methods of Simulated Gavage Feeding

The objective of this study was to compare the differences in lipid loss from 24 samples of banked donor human milk (DHM) among 3 feeding methods: DHM given by syringe pump over 1 hour, 2 hours, and by bolus/gravity gavage. Comparative, descriptive. There were no human subjects. Twenty-four samples of 8 oz of DHM were divided into four 60-mL aliquots. Timed feedings were given by Medfusion 2001 syringe pumps with syringes connected to narrow-lumened extension sets designed for enteral feedings and connected to standard silastic enteral feeding tubes. Gravity feedings were given using the identical syringes connected to the same silastic feeding tubes. All aliquots were analyzed with the York Dairy Analyzer. Univariate repeated-measures analyses of variance were used for the omnibus testing for overall differences between the feeding methods. Lipid content expressed as grams per deciliter at the end of each feeding method was compared with the prefed control samples using the Dunnett's test. The Tukey correction was used for other pairwise multiple comparisons. The univariate repeated-measures analysis of variance conducted to test for overall differences between feeding methods showed a significant difference between the methods (F = 58.57, df = 3, 69, P < .0001). Post hoc analysis using the Dunnett's approach revealed that there was a significant difference in fat content between the control sample and the 1-hour and 2-hours feeding methods (P < .0001), but we did not find any significant difference in fat content between the control and the gravity feeding methods (P = .3296). Pairwise comparison using the Tukey correction revealed a significant difference between both gravity and 1-hour feeding methods (P < .0001), and gravity and 2-hour feeding method (P < .0001). There was no significant difference in lipid content between the 1-hour and 2-hour feeding methods (P = .2729). Unlike gravity feedings, the timed feedings resulted in a statistically significant loss of fat as compared with their controls. These findings should raise questions about how those infants in the neonatal intensive care unit are routinely gavage fed.

In vivo microcomputed tomography evaluation of rat alveolar bone and root resorption during orthodontic tooth movement

To observe the real-time microarchitecture changes of the alveolar bone and root resorption during orthodontic treatment. A 10 g force was delivered to move the maxillary left first molars mesially in twenty 10-week-old rats for 14 days. The first molar and adjacent alveolar bone were scanned using in vivo microcomputed tomography at the following time points: days 0, 3, 7, and 14. Microarchitecture parameters, including bone volume fraction, structure model index, trabecular thickness, trabecular number, and trabecular separation of alveolar bone, were measured on the compression and tension side. The total root volume was measured, and the resorption crater volume at each time point was calculated. Univariate repeated measures analysis of variance with Bonferroni corrections were performed to compare the differences in each parameter between time points with significance level at P < .05. From day 3 to day 7, bone volume fraction, structure model index, trabecular thickness, and trabecular separation decreased significantly on the compression side, but the same parameters increased significantly on the tension side from day 7 to day 14. Root resorption volume of the mesial root increased significantly on day 7 of orthodontic loading. Real-time root and bone resorption during orthodontic movement can be observed in 3 dimensions using in vivo micro-CT. Alveolar bone resorption and root resorption were observed mostly in the apical third on day 7 on the compression side; bone formation was observed on day 14 on the tension side during orthodontic tooth movement.

Assessment of respondent acceptability for preference measures in stuttering

PurposeTo assess the feasibility of using one or more of four standard economic preference measures to assess health-related quality of life in stuttering, by assessing respondents’ views of the acceptability of those measures. Method and resultsA graphic positioning scale approach was used with 80 adults to assess four variables previously defined as reflecting the construct of respondent acceptability (difficulty of decision making, clarity of text, reasonableness for decision making, and comfort in decision making) for four types of preference measurement approaches (rating scale, standard gamble, time trade-off, and willingness to pay). A multivariate repeated measures analysis of variance (p<.001) and follow-up univariate repeated measures analyses of variance (all p<.01) were all significant, indicating that respondents perceived differences among the preference measurement methods on all four acceptability variables. ConclusionThe rating scale was perceived as the easiest, clearest, most reasonable, and most comfortable tool, but it is not a measure of utility (an economic term for desirability or worth). If utility is the objective, such as for cost-utility analyses in stuttering, then the present results suggest the use of standard gamble (rather than time trade-off). These results also support the use of willingness to pay assessments for cost-benefit analyses in stuttering. These findings supplement results previously obtained for other chronic conditions.Learning outcomes: The reader will be able to: (1) describe how four standard economic preference measures [rating scale (RS), time trade-off (TTO), standard gamble (SG), and willingness to pay (WTP)] can be used in economic analyses; (2) describe how RS, TTO, SG and WTP can be measured; and (3) describe how respondents perceive the use of RS, TTO, SG and WTP in measuring changes in stuttering.

Flaxseed Lignan Complex Administration in Older Human Type 2 Diabetics Manages Central Obesity and Prothrombosis—An Invitation to Further Investigation into Polypharmacy Reduction

Aim. Animal and human study evidence supports the hypothesis that flaxseed lignan complex (FLC) at a dose of 600 mg secoisolariciresinol diglucoside (SDG)/day for three months would combat hyperglycaemia, dyslipidemia, blood pressure, central obesity, prothrombotic state, inflammation, and low density lipoprotein (LDL) oxidation. Methods. Sixteen type 2 diabetic patients completed this double-blind, randomised crossover placebo-controlled study. A univariate repeated measures analysis of covariance (significance P < 0.05) was followed by a mixed linear model effects analysis corrected for multiple comparisons (MCC). Results. Prior to MCC, FLC caused decreased fasting plasma glucose, A1c, inflammation (c-reactive protein (CRP) and interleukin-6 (IL-6)), and increased bleeding time. After correction for multiple comparisons, FLC induced a statistically significant increase in bleeding time and smaller waist circumference gain. No treatment effect occurred in the other variables before or after adjustment. Conclusions. It is concluded that FLC significantly increased bleeding time thus reducing the prothrombotic state, reduced central obesity gain as measured by waist circumference, and did not affect significantly the other dependent variables measured after adjustment for multiple comparisons. These findings, not yet published in human type 2 diabetes, suggest that this FLC dose over at least three months, may, subject to further investigation, reduce polypharmacy.

The Relationship Between Early Sexual Debut and Psychosocial Outcomes: A Longitudinal Study of Dutch Adolescents

In a longitudinal dataset of 470 Dutch adolescents, the current study examined the ways in which early sexual initiation was related to subsequent attachment, self-perception, internalizing problems, and externalizing problems. For male adolescents, analyses revealed general attachment to mother and externalizing problems at Wave 1 to predict to early transition at Wave 2. However, there was no differential change in these psychosocial factors over time for early initiators of sexual intercourse and their non-initiating peers. For female adolescents, the model including psychosocial factors at Wave 1 did not predict to sexual initiation at Wave 2. However, univariate repeated measures analyses revealed early initiators to have significantly larger increases in self-concept and externalizing problems than their non-initiating female peers. While the difference between female early initiators and non-initiators were statistically significant, the mean levels of problem behaviors were very low. The findings suggest that, contrary to previous research, early sexual initiation does not seem to be clustered with problem behaviors for this sample of Dutch adolescents.

Health-Related Quality of Life 2 Years After Treatment With Radical Prostatectomy, Prostate Brachytherapy, or External Beam Radiotherapy in Patients With Clinically Localized Prostate Cancer

To compare treatment impact on health-related quality of life (HRQL) in patients with localized prostate cancer, from before treatment to 2 years after the intervention. This was a longitudinal, prospective study of 614 patients with localized prostate cancer treated with radical prostatectomy (134), three-dimensional external conformal radiotherapy (205), and brachytherapy (275). The HRQL questionnaires administered before and after treatment (months 1, 3, 6, 12, and 24) were the Medical Outcomes Study 36-Item Short Form, the Functional Assessment of Cancer Therapy (General and Prostate Specific), the Expanded Prostate Cancer Index Composite (EPIC), and the American Urological Association Symptom Index. Differences between groups were tested by analysis of variance and within-group changes by univariate repeated-measures analysis of variance. Generalized estimating equations (GEE) models were constructed to assess between-group differences in HRQL at 2 years of follow-up after adjusting for clinical variables. In each treatment group, HRQL initially deteriorated after treatment with subsequent partial recovery. However, some dimension scores were still significantly lower after 2 years of treatment. The GEE models showed that, compared with the brachytherapy group, radical prostatectomy patients had worse EPIC sexual summary and urinary incontinence scores (-20.4 and -14.1; p < 0.001), and external radiotherapy patients had worse EPIC bowel, sexual, and hormonal summary scores (-3.55, -5.24, and -1.94; p < 0.05). Prostatectomy patients had significantly better EPIC urinary irritation scores than brachytherapy patients (+4.16; p < 0.001). Relevant differences between treatment groups persisted after 2 years of follow-up. Radical prostatectomy had a considerable negative effect on sexual functioning and urinary continence. Three-dimensional conformal radiotherapy had a moderate negative impact on bowel functioning, and brachytherapy caused moderate urinary irritation. These results provide relevant information for clinical decision making.

HYPOTHESIS TESTING IN COMPARATIVE AND EXPERIMENTAL STUDIES OF FUNCTION-VALUED TRAITS

Many traits of evolutionary interest, when placed in their developmental, physiological, or environmental contexts, are function-valued. For instance, gene expression during development is typically a function of the age of an organism and physiological processes are often a function of environment. In comparative and experimental studies, a fundamental question is whether the function-valued trait of one group is different from another. To address this question, evolutionary biologists have several statistical methods available. These methods can be classified into one of two types: multivariate and functional. Multivariate methods, including univariate repeated-measures analysis of variance (ANOVA), treat each trait as a finite list of data. Functional methods, such as repeated-measures regression, view the data as a sample of points drawn from an underlying function. A key difference between multivariate and functional methods is that functional methods retain information about the ordering and spacing of a set of data values, information that is discarded by multivariate methods. In this study, we evaluated the importance of that discarded information in statistical analyses of function-valued traits. Our results indicate that functional methods tend to have substantially greater statistical power than multivariate approaches to detect differences in a function-valued trait between groups.

Relationship between landing strategy and patellar tendinopathy in volleyball

Objective: The aetiology of patellar tendinopathy (jumper’s knee) remains unclear. To see whether landing strategy might be a risk factor for the development of this injury, this study examined whether...