Journal of Statistics on Health Decision

Analysis of the pattern of Oral and Maxillofacial Trauma in the world: A Systematic Review and Meta-Analysis

Cristiana Palmela Pereira — 2022-07-20

Purpose: The objective of this review was to determine the prevalence of the oral maxillofacial trauma injuries and their relationship with sex, age, and etiology of in the world.

Materials and Methods: All articles were published in the English language in databases such as Google Scholar, EBSCO, PubMed, NCBI, Medline, ELSEVIER and SCOPUS were reviewed for oral maxillofacial trauma from the world during the last 11 years (between 2010-2020). Joanna Briggs Institute Checklist was used to access the Risk of Bias. Grading of recommendations, assessment, development, and the evaluation (GRADE) method was applied to assess the quality of the evidence. The studies were distributed into five group of countries: Asia, Africa, Latin America, Europe, and Muslin regions.

Results and Conclusions: The results show that road traffic accidents (55.37%) were the most frequent type of trauma, followed by assault (17.56%) and falls (10.21%). Fractures were the most prevalent injuries (84.3%). It was possible to establish an association between road traffic accidents and Asian countries. Assaults are more frequent in Africa, predominantly males, whilst falls increase with age, amongst women, in European countries. Fratures are usually observed in Muslin regions.

Epidemiological pattern and etiology of Oral and Maxillofacial Trauma: A Retrospective Study among Patients from a Portuguese Central Hospital

Cristiana Palmela Pereira — 2022-07-20

Objective

To evaluate the etiology and types of oral and maxillofacial injuries in Portugal.

Materials and Methods

An epidemiological clinical observational study was performed in Centro Hospitalar Lisboa Norte with a sample of 384 subjects diagnosed with oral and maxillofacial trauma, between 2018 and 2020. Data was collected through clinical reports and analyzed in SPSS, version 27.

Results

Both sexes had a similar distribution, 49.5% females and 50.5% males. 2020

had a lower amount of trauma compared to the remaining years. Falls were the most frequent etiology (44.3%), followed by assault (24.7%). The upper central incisors (174) were the most affected teeth with uncomplicated fractures and the most frequent treatment was the prescription of painkillers.

Conclusion

A relationship between falls, women, and age increase, and between assault,

men and adults have been highlighted. Falls and assault were the main etiology and 2020 shows a decline in the number of traumas due to the current pandemic situation.

Purpose in life and caregiver burden in kidney failure: Preliminary results from a hierarchical multiple regression analysis

Helena Sousa — 2022-07-20

The Covid-19 impact on family caregivers’ mental health in the Municipality of Aveiro

Inês Magalhães — 2022-07-20

Portugal had the first Covid case on March 2nd, 2022. In the following month, 81.087 new cases and 266 deaths were reported. Directorate-General for Health (DGS) took some measures to control the pandemic, including social isolation, and other methods. Social isolation adds to the disruption on Family Caregivers’ (FCs) routines, challenging their abilities to adopt new procedures, reconciling them with the existing ones. This caused increased tension, distress, and overload to caregivers, which in turn may have affected caregiver’s mental health, triggering feelings of loneliness, insomnia, anxiety, and depression. In this context, social isolation associated with other existing factors, may have contributed to further weakening of caregivers’ physical and mental health. The purpose of this study is to identify the effects of social isolation on family caregivers’ (of elderlies and/or dependent people) mental health resulting from the COVID-19 pandemic.

Caregiver burden and family functioning – the moderating effect of educational level

José Joaquim Alvarelhão — 2022-07-20

Real-world data from an online health education program for pregnancy and transition to parenthood: process indicators

marilia santos rua — 2022-07-20

Charlson Comorbidity Index Score and the odds of death in COVID-19 patients

Leonor Carvalho Rodrigues — 2022-07-20

Content validation index of an interdisciplinary intervention plan to support informal caregivers in Autonomous Region of Azores

Vitorino Silva Baião — 2022-07-20

Transition to parenthood recognition and accepting the maternal role.

Sandra Maria Campinos Rodrigues — 2022-07-20

The impact of Intensive Care Unit admission, sex and vaccination on COVID-19 death

Catarina Silva Cardoso — 2022-07-20

Features related to respiratory disability and performance of inhaler technique in COPD population.

Sérgio Marques — 2022-07-20

Thyroid Cancer Incidence in North Region of Portugal

Marisa Magno — 2022-07-20

Do Variant Histologies of Urothelial Carcinoma change the survival outcome in patients managed with radical cystectomy?

João Nuno Pereira — 2022-07-20

Evolution of diet patterns over time in Europe from 1963 to 2013

Mariana Pinto — 2022-07-20

Mortality prediction scores in burn patients – a comparative analysis

Gonçalo Tomé Ferreira — 2022-07-19

Introduction:

The aim of this study consisted of accuracy assessment and comparison of different mortality prediction models performance used in the burn population from our burns unit (BU), comparing survivors and non-survivors clinical and demographic characteristics.

Methods:

A retrospective study of adult burn patients admitted to our BU in a 5-year period was performed. Toxic epidermal necrolysis and polytraumatized patients were not included. Mortality rate was assessed. Survivors and non-survivors clinical and sociodemographic characteristics were analyzed and compared. Four models were included, namely Abbreviated Burn Severity Index (ABSI), Belgian Outcome in Burn Injury (BOBI), revised-Baux and Ryan model. Observed and predicted mortality were compared using Hosmer-Lemeshow test for models goodness-of-fit, receiver operating curves (ROC) and area under curve (AUC) for discriminative performance evaluation.

Results:

Our cohort consisted of 641 patients, in which 58,2% were male. Patients mean age was 60.02 ± 18.97 years and total burned surface area (TBSA) was 12.94 ± 15.11 %. Third degree burns were present in 71% and inhalation injury in 12.3%. Observed mortality rate was 9.4% (n=60). Non-survivors were significantly older (73 vs. 60 years; p<0.001), had a larger TBSA (27.75 vs. 7%; p<0.001), higher frequency of third-degree burns (96.7 vs. 68.3%; p<0.001) and inhalation injury (31,7% vs. 10,3%; p<0.001), but no gender significant difference was verified. All models demonstrated an adequate goodness-of-fit, all with p-values >0.05 in Hosmer-Lemeshow test assessment. Revised-Baux (AUC 0.870 ± 0.025), ABSI (AUC 0.850 ± 0.026) and BOBI (AUC 0.831 ± 0.026) have demonstrated good discriminative power and Ryan model (0.774 ± 0.030) was only moderate.

Discussion:

The four models revealed proper predictive performance, with revised-Baux presenting as the most accurate model for mortality prediction. Their use in the BU represents a practical and valuable tool for risk stratification, treatment appropriateness and improve the burns care quality control.

Applying machine learning methods to predict the Parkinson´s Disease Questionnaire-39 Summary Index

Daniel Magano — 2022-07-20

Assessment of the stability of a procedure for variables selection in high dimensionality data: an application to genomic data - Alzheimer’s Disease

Leonor Carvalho Rodrigues — 2022-07-20

Exploratory Analysis based on Relative Risk on the incidence of different causes of death in mortality in the Region of Aveiro

Diana Lucas Almeida — 2022-07-19

Prognostic predictors in stroke patients undergoing thrombectomy with recanalization

Vanusa Rocha — 2022-07-20

(Dis)similarities of primary health care indicators, a special case of USF Arte Nova

Catarina S. Cardoso — 2022-07-20

Antimicrobial susceptibility profile of bacteria associated with urinary tract infections in Aveiro, 2021

Leonor Carvalho Rodrigues — 2022-07-20

Hydroxychloroquine reports to EudraVigilance database during COVID-19

Cristiano Matos — 2022-07-20

Introduction: Hydroxychloroquine is an antimalarial drug that belongs to the 4-aminoquinolone group. [1] Despite of this properties presents several immunomodulatory and anti-inflammatory characteristics. [1,2] In 2020, with the emergence of the COVID-19 pandemic, researchers used existing drugs with potential for the treatment of COVID-19, including hydroxychloroquine, which ended up being used off-label. [3,4] From the clinical trials hydroxychloroquine has many adverse effects that can increase risk for the SARS-COV-2 patients health. Common adverse effects are related to gastrointestinal and cardiovascular systems, neurotoxicity and retinopathy. [2,5]. The objective of this research was to describe the adverse effects profile of hydroxychloroquine in COVID-19 patients and to characterize the risks associated with off-label use of hydroxychloroquine.

Methods: An observational, retrospective and descriptive study was conducted. Information collected from the “Eudravigilance” database was analyzed using descriptive statistics with R Studio® software. Information about the source of reporting, patient sex, serious adverse reactions, deaths and off-label cases and their outcome, were evaluated and compared in the pre- and post-pandemic period.

Results: The number of reports of adverse reactions to hydroxychloroquine increased significantly during the pandemic period (increase of 310.3%), with health professionals reporting the most (92.0%). The potential for harm has increased as off-label administration of hydroxychloroquine is associated with an increased incidence and severity of adverse reactions. Serious outcomes, as deaths presented an increased number during pandemic. The total number of suspected adverse drug reactions reports increased from a mean of 7.7 reactions per month pre pandemic to 114.5 reactions after the pandemic. Serious outcomes also increased during pandemic: a total of 361 (6.8%) reactions were considered serious before pandemic, and 2740 (26.6%) after pandemic begins. Finally, deaths associated with the use of hydroxychloroquine were also evaluated, of which 67.0% are described in off-label use.

Discussion: The profile of safety of hydroxychloroquine appears to change during the pandemic with the off-label use. Hydroxychloroquine present different adverse reactions, which should be reported whenever possible. Its off-label use for COVID-19 has been shown to be a risk for patients, as it causes them more risks than usual use. In short, hydroxychloroquine appears to not bring benefits to COVID-19 and it ends up bringing several complications when it is administered.

Impact of the Covid-19 pandemic on dispensing of anticoagulant therapy

Vânia Izabel da Veiga Semedo — 2022-07-20

Development and validation of COVID-19 mitigation measures instrument

Inês Viseu — 2022-07-20

Functional Status in People with COPD: A Cluster Analysis with Bootstrap Resampling

Guilherme Rodrigues — 2022-07-20

Characterization of mental health issues in the region of Aveiro — A retrospective analysis

Filipa Rocha — 2022-07-20

Graph Theory approach to COVID-19 transmission across adjacent municipals

Cristiana Silva — 2022-07-20

Can exercise training reduce central systolic blood pressure among patients with resistant hypertension?

Susana Lopes — 2022-07-20

Introduction:

Resistant hypertension is a problematic phenotype marked by the limited efficacy of available blood pressure-lowering treatments [1], such as antihypertensive medicines and kidney denervation [2-4]. Given its economic and health-related impact, it is a major medical and societal concern. Patients with resistant hypertension have a higher risk of myocardial infarction, stroke, heart failure, chronic renal disease, and death, in addition to the cost of multiple drugs [5,6]. Cardiovascular disease risk is associated to central blood pressure. Central blood pressure has been evocated as being more closely related with target organ damage and long-term cardiovascular outcomes than traditional brachial blood pressure [7,8]. Increased aortic stiffness, assessed by carotid-femoral pulse wave velocity, is also an independent predictor of cardiovascular risk [9]. However, there are few studies on exercise interventions to improve these markers in people with resistant hypertension.

The EnRicH (The Exercise Training in the Treatment of Resistant Hypertension) was a prospective, single-blinded randomized clinical trial. The current analysis details the effect of aerobic exercise training intervention or usual care on central blood pressure and carotid–femoral pulse wave velocity.

Methods:

Patients with resistant hypertension were randomized 1:1 to a 12-week moderate-intensity aerobic exercise program (added to usual care) or usual care. Exercise training sessions were supervised and took place three times per week. Each session included a 10-min warm-up and cool-down period, and 40 minutes of aerobic exercise. Walking and cycling were the main chosen exercises and intensity was 50-70% of maximum oxygen uptake (VO2 max). Secondary outcome measures included central blood pressure and carotid–femoral pulse wave velocity. The Complior Analyse (Alam Medical, Saint Quentin Fallavier, France) and the SphygmoCor (AtCor Medical, Sydney, NSW, Australia) were used to measure central blood pressure and carotid–femoral pulse wave velocity. The two devices offer highly correlated measurements and similar outcomes. The carotid–femoral pulse wave velocity measurements were taken in accordance with Van Bortel et al. (2012) expert's consensus document. SPSS version 28.0 was used for all statistical analyses (SPSS Inc., Chicago, Illinois, USA). Student's independent t-test was used to compare between-group differences at baseline, following the exercise program, and between changes in continuous variables from baseline to the end of the study. Student’s paired t-tests were performed for within-group comparisons from baseline to the end of the study. The level of significance was set as P ≤ 0.05.

Results:

Fifty-three patients (exercise n = 26, mean age 59.3 ± 8.2; control n = 27, mean age 60.8 ± 9.2) completed the study. No differences were found between groups at baseline. The change in central systolic blood pressure was significantly different between groups by -12.22 (95% CI, -1.88 to -22.57, P = 0.022), with a mean change of -11.3 ± 19.2 mm Hg in the exercise arm vs 0.9 ± 11.8 mm Hg in the control arm. There were no differences in carotid–femoral pulse wave velocity between groups (P = 0.197).

Discussion:

This study demonstrated that a12-week exercise training program reduces central blood pressure among patients with resistant hypertension. Our study agrees with previous evidence in patients with prehypertension and hypertension [10,11].

A limitation of this study is that exercise training program consisted of moderate-intensity aerobic exercises. Therefore, other exercise intensities and types of exercise need investigation.

This trial demonstrated a benefit of 12-week of moderate-intensity aerobic exercise training on reducing central blood pressure in patients with resistant hypertension. The central blood pressure reduction is clinically promising as theis indicator is associated with target organ damage, cardiovascular risk, and mortality.

Ethics committee and informed consent:

All patients provided written informed consent. The study was approved by the Ethics Committee of the Centro Hospitalar do Baixo Vouga

Clinical study registration number: NCT03090529

Acknowledgements:

This work was funded by the European Union through the European Regional Development Fund Operational Competitiveness Factors Program (COMPETE) and by the Portuguese government through the Foundation for Science and Technology (grants P2020-PTDC/DTP-DES/1725/2014 and POCI-01-0145-FEDER-016710).

Susana Lopes was awarded with a Portuguese Foundation for Science and Technology PhD grant (grant SFRH/ BD/129454/2017).

Institute of Biomedicine (iBiMED; reference No. UID/BIM/04501/2020), Research Centre in Physical Activity, Health and Leisure (CIAFEL; reference No. UID/DTP/00617/ 2020), and Research Center in Sports Sciences, Health and Human Development (CIDESD; reference No. UID/DTP/ 04045/2020) are research units supported by the Portuguese Foundation for Science and Technology.

Cátia Leitão is grateful to FCT for the research contract CEECIND/00154/2020 and the projects UIDB/50025/2020, UIDP/50025/2020 and LA/P/0037/2020, financed by national funds through the FCT/MEC.

References:

1. Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, et al. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension. 2018;72(5):e53-e90. Epub 2018/10/26. doi: 10.1161/HYP.0000000000000084. PubMed PMID: 30354828; PubMed Central PMCID: PMCPMC6530990.
Bakris GL, Townsend RR, Liu M, Cohen SA, D'Agostino R, Flack JM, et al. Impact of renal denervation on 24-hour ambulatory blood pressure: results from SYMPLICITY HTN-3. Journal of the American College of Cardiology. 2014;64(11):1071-8. Epub 2014/05/27. doi: 10.1016/j.jacc.2014.05.012. PubMed PMID: 24858423.
Agasthi P, Shipman J, Arsanjani R, Ashukem M, Girardo ME, Yerasi C, et al. Renal Denervation for Resistant Hypertension in the contemporary era: A Systematic Review and Meta-analysis. Sci Rep. 2019;9(1):6200. Epub 2019/04/19. doi: 10.1038/s41598-019-42695-9. PubMed PMID: 30996305; PubMed Central PMCID: PMCPMC6470219.
Bhatt DL, Kandzari DE, O'Neill WW, D'Agostino R, Flack JM, Katzen BT, et al. A controlled trial of renal denervation for resistant hypertension. The New England journal of medicine. 2014;370(15):1393-401. Epub 2014/04/01. doi: 10.1056/NEJMoa1402670. PubMed PMID: 24678939.
Daugherty SL, Powers JD, Magid DJ, Tavel HM, Masoudi FA, Margolis KL, et al. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation. 2012;125(13):1635-42. doi: 10.1161/CIRCULATIONAHA.111.068064. PubMed PMID: 22379110; PubMed Central PMCID: PMCPMC3343635.
Sapoval M, Hale BC, Armstrong S, Da Deppo L, Hertz D, Briggs A. The Burden of Resistant Hypertension in 5 European Countries. Value in Health. 2013;16:A520-A1. doi: 10.1016/j.jval.2013.08.1252.
Kollias A, Lagou S, Zeniodi ME, Boubouchairopoulou N, Stergiou GS. Association of Central Versus Brachial Blood Pressure With Target-Organ Damage: Systematic Review and Meta-Analysis. Hypertension. 2016;67(1):183-90. Epub 2015/11/26. doi: 10.1161/HYPERTENSIONAHA.115.06066. PubMed PMID: 26597821.
Vlachopoulos C, Aznaouridis K, O'Rourke MF, Safar ME, Baou K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. European heart journal. 2010;31(15):1865-71. Epub 2010/03/04. doi: 10.1093/eurheartj/ehq024. PubMed PMID: 20197424.
Cardoso CRL, Salles GF. Prognostic Value of Changes in Aortic Stiffness for Cardiovascular Outcomes and Mortality in Resistant Hypertension: a Cohort Study. Hypertension. 2022;79(2):447-56. Epub 2022/01/13. doi: 10.1161/HYPERTENSIONAHA.121.18498. PubMed PMID: 35020459.
Beck DT, Martin JS, Casey DP, Braith RW. Exercise Training Reduces Peripheral Arterial Stiffness and Myocardial Oxygen Demand in Young Prehypertensive Subjects. American Journal of Hypertension. 2013;26:1093-102. doi: 10.1093/ajh/hpt080.
Nualnim N, Parkhurst K, Dhindsa M, Tarumi T, Vavrek J, Tanaka H. Effects of Swimming Training on Blood Pressure and Vascular Function in Adults > 50 Years of Age. AMERICAN JOURNAL OF CARDIOLOGY. 2012;109:1005-10. doi: 10.1016/j.amjcard.2011.11.029.

Figures captions/legends:

Figure 1. Change from baseline to the end of treatment in central blood pressure and carotid-femoral pulse wave velocity in both study groups.

What are the predictors of clinical improvement in adolescents with chronic neck pain after pain neuroscience education and exercise? – secondary analysis of a randomized controlled trial

Rosa Andias — 2022-07-20

A recent study by our team suggested that interventions based on pain neuroscience education and exercise are similarly effective in the treatment of adolescents with neck pain (NP). However, we were unable to find any studies that explored factors of treatment response. Thus, this study aimed to explore whether sociodemographic data, pain characteristics, psychosocial factors, sleep, symptoms of central sensitization, pressure pain thresholds and neck muscles endurance at baseline predicted clinical improvement when using different standards: the Patient Global Impression of Change (PGIC) scale and the minimal change in the Numeric Pain Rating Scale (NPRS) for pain intensity and the Functional Disability Inventory (FDI) for disability, at post-intervention and 6-month follow-up. This study is a secondary analysis of a randomized controlled trial conducted with 127 adolescents with NP. To classify adolescents who improved, clinical improvement criteria were used: i) reporting a PGIC≥5 (moderately better, better, or a great deal better), ii) ≥50% reduction of pain intensity in the NPRS, iii) ≥50% reduction of disability in the FDI, and iv) ≥50% reduction in the NPRS and in the FDI, from baseline levels. Independent logistic-regression analyses were used to examine univariable and multivariable associations between the independent and dependent (clinical improvement) variables. At post-intervention, a multivariable model was found for the improvement of 50% in the FDI in which older age (OR=0.64, p<0.05) and moderate physical activity (OR=1.00, p<0.05) remained associated with decreased and increased likelihood of improvement, respectively. At 6-month follow-up, two multivariable model were found for the improvement of 50% in the NPRS in which higher disability (OR=0.94, p<0.05) remained associated with decreased likelihood of improvement and for the improvement of 50% in the FDI in which having pain often (OR=0.23, p<0.05) and higher neck flexors endurance (OR=1.07, p<0.05) were associated with decreased and increased likelihood of improvement, respectively.

Study of associations between COVID-19 and bacterial infections: a retrospective study

Raquel Diaz — 2022-07-20

The COVID-19 pandemic disease, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-CoV-2), has affected millions of people worldwide. Clinical practice highlights that the number of patients with COVID-19 diagnosed with bacterial infections during periods of hospitalization is increasing. Rapid characterization of co-infection is essential in the treatment of most patients with COVID-19, as it can result in failure of antimicrobial therapy. Some studies report the prevalence of variable coinfection among patients with COVID-19, however, it can be up to 50% in patients who did not survive. ^{(1, 2)}

The present study aims:

- To assess the occurrence of associations between COVID-19 and bacterial infections in patients hospitalized at Centro Hospitalar Baixo Vouga – Aveiro between April 1, 2020 and December 31, 2021.

- Contribute to the definition of pharmacological therapy strategies in patients with mixed, bacterial and Sars-CoV-2 infections.

Technology-mediated intervention and cognitive functioning: a systematic review and meta-analysis

Pollyanna Stefane — 2022-07-20

There are several types of physical activity activities that are mediated by technology, including sports (8-10) or dancing (11-14). These activities are believed to require both physical and cognitive abilities and have been used to improve physical and cognitive functions in older adults (15-17). To our knowledge there is no systematic review that aimed at synthetizing and evaluating existing evidence on the impact of technology-mediated physical activity on cognitive functioning of older adults with clinical conditions, therefore this study aims to assess the impact of technology-mediated physical activity on the cognitive function of older adults with clinical conditions. A meta-analysis was performed using R packages meta and metafor in RStudio Version 1.4.1103 (Rstudio Team, 2020) running R version 4.0.5 (R Core Team, 2021). Cognitive function was classified into five domains, (1) general cognition (2) immediate verbal memory, (3) delayed verbal memory, (4) attention, and (5) inhibition. Thirteen studies were included in this systematic review (10, 15, 21-31). Results suggest no difference between interventions mediated by technology and the other interventions (i.e. physical exercise and combined physical and cognitive exercise) on the cognition of older adults with clinical conditions. Given the potential benefits of interventions mediated by technology, more research is needed to establish the effective components for cognition and physical function and apply this understanding to the development of evidence-based interventions and stablished guidelines for the best prevention or treatment of cognitive decline.

Modelling the impact of the disease on people with COPD – a comparison of feature selection methods

Jorge Vaz Ramos Rodrigues de Cabral — 2022-07-20

Lockdown due to The COVID-19 pandemic is likely to have influenced the daily life of people with chronic obstructive pulmonary disease. Criteria to choose the most appropriate methods to select features in datasets are unclear. We aimed to compare feature selection methods and describe the effect of the COVID-19 lockdown, sociodemographic and clinical features on the impact of the disease on people with COPD. A total of 42 participants with mean age 66.3 years (sd 7.8), 3 to 4 comorbidities (64.3%) and a median CAT score of 9.0 ([Q1,Q3]=[5.3,11.0]) were included, 24 (57.1%) of whom in the pre-lockdown group. The model obtained with 3 features selected by the entropy approach was at least not worse than the remaining. Our model suggests that lockdown had no influence in COPD impact but those with comorbidities but no emergencies tended to recover well from the pandemic.

Comparison of comorbidities prevalence in patients with HIV vs non HIV

Alina Humenyuk — 2022-07-20

Changes in consumer habits in community pharmacies in Portugal during the SARS-CoV-2 pandemic using Market Basket Analysis and Network Diagrams

Rúben Duarte Pereira — 2022-07-20

Introduction:

The sales of over-the-counter (OTC) products in community pharmacies in Portugal is analogous to standard retail business. Several techniques such as cross-selling have been used to increase sales in this segment by encouraging customers to purchase complementary products or services. This technique analyzes transactional data using different methodologies, such as market basket analysis (MBA), which explores associations between items within transactions to uncover customer buying habits and trends. The pairings are supported by measures of interestingness such as the exclusivity of associations of items, lift [1].

OTC products are divided in hierarchical categories, such as beauty, hygiene, and body care, all which include sublevels (e.g. skin, face and hair). Previous works explored the use of network diagrams to group categories based on interpretation of the association rules as links between items [2].

This work explores the association of product categories through generation of rules using MBA in yearly transactional data prior to and during the SARS-CoV-2 pandemic period (2019 and 2020-2021, respectively) to uncover changes in basket purchasing behavior.

Methods:

Data comprising transactions from 1st January 2019 through 31st December 2021 were collected from 2519 community pharmacies in Portugal (approximately 86,2% of all community pharmacies countrywide) and divided in three yearly subsets. Each set was analyzed using the MBA apriori algorithm [3] to extract association rules composed of one antecedent and one consequent product category. Lift measures of the resulting rules were compared across the 3 years to conclude about changes in basket associations. Results were filtered considering absolute variation in lift higher than 10 from 2019 to 2020, and lower than 10 from 2020 to 2021. Moreover, minimum support of 300 occurrences in any of the subsets was imposed. Changes in OTC groups were interpreted by visualizing the networks of product categories produced by the association rules calculated for each subset (year).

Results:

The total number of transactions analyzed from 2019, 2020 and 2021 were 65.232.346, 58.374.315 and 63.858.049, respectively, and a total of 54 associations were considered for analysis. Among these, three use cases stand out: (i) the occurrence of iron supplements and products containing vitamin D in the same transaction was observed in only 19 transactions in 2019. In 2020 and 2021 the support was 613 and 784, respectively, and lift increased from 1.46 to 19.55 and 20.42 in the same years. Figure 1 shows strong association of iron supplements with breastfeed products in 2019. The lack of solar exposition can explain the purchase increase of products containing vitamin D during the pandemic lockdowns (Figure 2); (ii) contrarily, the lift of the association of appetite suppressants and female anti-cellulite products reduced from 63.09 (2019) to 9.51 (2020) and 4.90 (2021). Also, a significant decreased was observed in the number of transactions with the association from pre to the pandemic period, from 353 (2019) to 35 (2020) and 24 (2021). The seasonality of weight loss purchases coupled with the decrease in social and summer activities in 2020 and 2021 decreased the strengths of associations of these products overall (Figures 3 and 4); (iii) the sales of surgical masks, previously highly coupled with various disposable material (e.g. gloves, tissues and bags) stand out as a mixture of effects of both previous use cases. Though the lift reduced from 15.98 (2019) to 3.17 (2020) and 5.37 (2021), the support increased from 740 (2019) to 5053 (2020) and 2293 (2021). Surgical masks were very likely to be bought with almost any product in community pharmacies during the pandemic, which decreased the exclusivity of this association.

Discussion:

The recommendations generated by analytical approaches from retail unravel a panoply of possibilities from evidence-based medicine to monetary profit. Despite the progressive adoption as a contributor to business of community pharmacies, the approach proposed allows recommendation of medication for managing treatment secondary effects and decrease discomfort, which ultimately promotes quality of life.

Acute Kidney Injury after Coronary Artery Bypass Graft Surgery: The heterogeneity of the Available Real-World Data Through a Meta-analysis

Patrícia Sousa — 2022-07-20

Introduction:

Meta-analysis is the method to pool data from studies that report the same event in a comparable sample and, thus, summarize information from different populations. However, data extraction is limited to the information provided in the included studies. Frequently, individual patient information is not available, hence, real world data access is limited.

Individual patient data (IPD) meta-analysis in a research area like health sciences constitutes the ideal method to analyse real world data, assuming a high level of evidence. (1) This method is based on a collaboration network in which variables can be merged among datasets once a single definition is determined reducing methodological heterogeneity. The use of IPD for meta-analysis has advantages, (allows adjustment for confounding factors), and limitations (obtaining individual patient data knowing that data collection and management are often unclear). (1, 2)

To tackle high heterogeneity in a study-level meta-analysis, sensitivity analyses are recommended. Leave-one-out analysis is an option that evaluates the cumulative effect of each study by excluding one at a time, portraying its influence in the overall result (3).

Considering the lack of long-term data on postoperative acute kidney injury (AKI) in coronary artery bypass grafting surgery (CABG) patients, paired with the expected study heterogeneity, we intend to summarize evidence regarding its effect on early and long-term survival, evaluate heterogeneity and perform sensitivity analysis.

Methods:

Systematic searches were performed in MEDLINE and ISI Web of Science, restricted by date of publication (January 1960–April 2021). Inclusion criteria comprised observational studies reporting incidence of postoperative AKI in adult patients, submitted to isolated CABG with at least 1-year of follow-up and survival estimates.

Analyses were performed using Review Manager 5.4. and R environment. Random effects models were used to compute pooled HR and OR (95% CI), through generic inverse variance method and Mantel-Haenszel method or generalized linear mixed-effects model and logit-transformed proportions of AKI were used for analysis of prevalence data. Heterogeneity was defined using I² statistics and was considered low (<49%), moderate (50-74%), or high (>75%) (4). Between-study heterogeneity was studied using sensitivity analyses, namely, leave-one-out evaluations (metagen (meta R package)). Early and late survival were evaluated through this sensitivity analysis and were present according to each study impact on both effect size estimates and observed I². (5)

Results:

Thirteen retrospective observational studies comprising 63209 patients were included, (N AKI=11366, N non-AKI=51843). AKI incidence ranged 0.6%-54% with a pooled incidence of 16%.

Postoperative AKI was associated with higher early mortality (OR (95%CI): 7.59 (3.18-18.15), p<0.01; I²=94%, Chi²=80.14, Tau²=1.06, p<0.01), but also with long-term mortality (HR (95%CI): 2.23 (1.83-2.70), p<0.01), with moderate heterogeneity (I²=74%, Chi²=42.92, Tau²=0.08, p<0.01).

In early mortality results, we observed a high effect on the leave-one-out analysis on both effect size (Figure 1) and I² (Figure 2) by Ivert et al. (6) study which showed a relevant impact on heterogeneity. After removing this study, I² reduced to 0% and the pooled OR decreased and the 95% CI narrowed, (4.78 (3.74 - 6.09), p<0.001).

We observed the same for long-term mortality (Figures 3 and 4). The 2 most relevant studies for heterogeneity were Di Mauro et al. (7) and Lv et al. (8). Although I² remained higher than 50% (I²=65%), after removing these two studies, the long-term survival pooled HR decreased and the 95% CI also narrowed, (1.98 (1.68-2.35), p<0.001).

Discussion and Conclusion:

AKI is a frequent complication after isolated CABG surgery, being associated with higher long-term mortality.

The high heterogeneity found may be due to the different populations and variables’ definitions. For instance, Ivert et al. (6) focused their analysis on patients who required postoperative dialysis, translating on a lower incidence of AKI, but also higher severity. Di Mauro et al. (9) defined AKI as an increase above 1 mg/dL or a postoperative value > 2 mg/dL according to preoperative renal function status, which differs from the most traditional criteria used by the other studies: increment of at least 0.3 mg/dL.

Leave-one-out analysis showed that one must pay attention to real-world data, since different variable definitions, namely: different AKI definitions and the samples included in each study, influence overall measures.

Acknowledgements:

This study is funded by national funds through FCT - Portuguese Foundation for Science and Technology, under the scope of the Cardiovascular R&D Center – UnIC@RISE [grant numbers UIDB/00051/2020, UIDP/00051/2020].

R. Moreira is supported by FCT - Portuguese Foundation for Science and Technology, FSE – European Social Fund, NORTE 2020 - Programa Operacional Regional do Norte (POR-Norte), (UI/BD/150657/2020).

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Health status assessment through scales and questionnaires: an important tool in Public Health

Ilka Martins Rosa — 2022-07-20

The development of measurement instruments is an important tool in epidemiological studies. During the preparation of a scientific study protocol, the collection of information is an important step in the research plan. When constructing questionnaires, mastering some concepts is fundamental, such as defining construct, domains, items, and index. How to select the content of the questionnaire? How to write a good question in the questionnaire? And what is the format of the answers? Is it ordinal? Is it Likert answers format? This extended abstract tries to demystify and clarify the important steps to be able to perform a straight-forward statistical evaluation of a questionnaire. There are important guidelines on how to construct and evaluate a scale-type instrument. It provides the tools to assess whether it has accuracy, validity and reliability. The example discussed here is in Mental Health (the presumed construct). An attempt is made to develop a scale with the domains Stress (S) and Eating Disorders (ED). If the two domains are related enough to each other, this hypothetical scale is able to represent the construct mental health. The questions for domain S were adapted from the original SF-36 scale; and for ED, from the EDE-A scale. This manuscript clarifies the important sections of a questionnaire: sociodemographic data; items for the domains S and ED; items to test criterion and construct validity; finally, the informed consent. Statistical analysis was performed in SPSS-28, with a significance level of 5%. The objective is to guide how to make and evaluate scale as a tool in epidemiological studies.