Evaluation of psychometric properties of the Dental Anxiety Inventory (DAI-36) questionnaire using iterative hybrid ordinal logistic: Differential item functioning (DIF)

OBJECTIVES

Dental Anxiety Inventory (DAI-36) questionnaire is an instrument for assessing dental anxiety. The different perceptions of the questionnaire items in the individual at the same level of underlying dental anxiety may lead to different reported dental anxieties. This study aims to determine the differential item functioning (DIF) of the DAI-36 measure items.

METHODS

The DAI-36 was completed by 950 participants. An iterative hybrid ordinal logistic regression model was used to detect DIF across gender, education, and age groups. DIF analysis was done by lordif package in R3.1.3 software.

RESULTS

The chi-square statistics declared 7, 7, and 4 nonuniform DIF items, and 2, 5, and 4 uniform DIF items across gender, education, and age groups, respectively. ΔR2 was always lower than 0.07 in all uniform and nonuniform DIF items. However, Δβ1 revealed significant uniform DIF in items 1 and 8 across gender (Δβ1(item 1) = 0.0137, Δβ1(item 8) = 0.0124) and items 22 and 27 across age categories (Δβ1(item 22) = 0.0110, Δβ1(item 27) = 0.0136).

CONCLUSIONS

DIF items had no large magnitude or cancel out each other, so statements phrased in the DAI-36 questionnaire have equivalent meaning across participants, regardless of their gender, education, and age groups.

COVID-19 screening: use of an artificial neural network

OBJECTIVES

COVID-19 is the biggest pandemic of the 21st century. The disease can be influenced by various sociodemographic factors and can manifest as clinical, pulmonary and gastrointestinal symptoms. This study used an artificial neural network (ANN) model with important sociodemographic factors as well as clinical, pulmonary and gastrointestinal symptoms to screen patients for COVID-19. Patients themselves can screen for these symptoms at home.

METHODS

Data on all registered patients were extracted in autumn. The best ANN model was selected from different combinations of connections, some hidden layers and some neurons in each hidden layer. In this study, 70% of the data were used in the network training process and the remaining 30% were used to evaluate the function of the multilayer, feed-forward, back-propagation algorithm.

RESULTS

The sensitivity and specificity of the ANN model in diagnosing patients with COVID-19 were 94.5% and 17.4%. In order of priority, clinical symptoms, sociodemographic factors, pulmonary symptoms and gastrointestinal symptoms were important predictive factors for COVID-19 using the ANN model. Screening patients for COVID-19 using clinical symptoms and sociodemographic factors (80% importance) remains essential.

CONCLUSIONS

Home monitoring of oxygen saturation and body temperature as well as old age and drug addiction can be helpful in self-screening symptoms of COVID-19 at home, thereby preventing unnecessary visits to medical centres and reducing burden on medical services.

An Evaluation of Antibacterial Effects of Human Amniotic Fluid on Pathogenic and Probiotic Bacteria In Vitro

Background

Amniotic fluid in the uterus is beneficial for the fetus growth and protection due to its nutritional elements as well as its antibacterial and anti-inflammatory properties. Today, body membranes are increasingly being used in multiple fields. The purpose of the current study was evaluation of the antibacterial effects of amniotic fluid and comparison of its effects on pathogenic and probiotic bacteria.

Methods

This experimental study was conducted on amniotic fluid obtained from 43 healthy mothers who gave birth by selective cesarean section. Then, antibacterial effects of amniotic fluids were investigated on 8 standard bacterial strains, including Bacillus cereus, Escherichia coli, Staphylococcus aureus, Shigella flexneri, Pseudomonas aeruginosa, Klebsiella pneumoniae, Bacillus cereus, and Lactobacillus plantarum by agar well-diffusion method. Data analysis was performed by SPSS software, vs. 22 (IBM, US).

Results

Amniotic fluid revealed an inhibitory effect on the growth of bacterial strains. Staphylococcus aureus and Streptococcus pyogenes strains showed growth inhibition in 39% and 17% of samples, respectively. In other bacterial strains, there was growth inhibition in less than 5% of the samples. Also, the zone of growth inhibition for Staphylococcus aureus and Streptococcus pyogenes was significantly higher than the other strains. Amniotic fluid samples had an antibacterial effect on all pathogen strains in general, but not on the Lactobacillus plantarum probiotic strain.

Conclusion

Our findings suggest that the antibacterial effect of amniotic fluid on pathogenic bacteria is significantly higher than the Lactobacillus plantarum as a probiotic one. Overall, the findings support the use of natural substances as alternative therapeutic agents to combat antibiotic resistance.

Molecular characterisation and phylogenetic study of the fusion gene of Newcastle disease viruses isolated from broiler farms of Iran in 2018-2019

Avian orthoavulavirus, commonly known as Newcastle disease virus (NDV) has been a constant threat for the poultry industry of Iran for decades. Recently, a couple of preliminary studies on backyard and commercial chicken suggested that a major subgenotype circulating in Iran may be VII(L) subgenotype, which is now known as VII.1.1 according to the new classification system. The unique subgenotype was not reported from other parts of the world and was slightly (≥3%) different from the closest group that was VIId. The study was conducted between July 2018 and March 2019 to determine the exact NDV genotypes/subgenotypes circulating in Iranian broiler poultry farms; five-hundred and forty chickens were sampled from thirty-six broiler farms located in eighteen provinces of Iran. As other genotypes/subgenotypes such as XIII and VI.2 are circulating in neighbouring countries, border provinces were also sampled. The F gene of the NDV isolates was sequenced and phylogenetic analysis was conducted. All the isolates clustered under the VII.1.1 group. The evolutionary analysis also revealed that the distances were between 0.0 and 0.7% meaning that the Iranian NDV circulating in broiler farms were not only of VII.1.1 sub-genotype, but also genetically very identical, indicating that the routine control measures for ND in Iran were not able to prevent the circulating NDVs. Although stricter biosecurity measures have been really effective in developed countries, surveillance of NDV to determine the circulating genotypes might also help us to implement better vaccination strategies in the future.

Report of a new meq gene size: The first study on genetic characterisation of Marek's disease viruses circulating in Iranian commercial layer and backyard chicken

1. In recent months, several outbreaks with clinical signs of MDV-1 were reported in Iranian parent and laying hen farms, in addition to backyard chickens. Several meq gene sequences from these outbreaks were amplified and molecularly characterised.2. The meq protein sequences revealed three different sizes, namely the standard 339 aa, a shorter form of 338 aa lacking a proline residue at position 191, and a very short (vs) size of 265 aa. Based on sequence and size, the 265 aa meq has never been reported from international research groups before. The protein has only one PPPP repeat motif suggesting it belongs to a highly virulent strain.3. The standard meq sequences showed 100% BLAST identity to the vv+ isolate Polen5. However, the 338 aa form clustered to the clade usually reported from North America.4. This is the first report on genetic analysis of MDV-1 from Iran, but further study is required to obtain a better picture of the diversity and prevalence of different MDV-1 strains circulating in the country's farms, backyard poultry and other bird species.

Dry Eye and Meibomian Glands in Vitiligo

Objectives

To evaluate aqueous and lipid tear film parameters and the meibomian glands (MGs) with non-contact meibography in patients with vitiligo.

Materials and Methods

This case-control study was conducted in the right (OD) and left (OS) eyes of 43 patients with vitiligo and 43 controls in Birjand, Iran. In addition to demographic information and skin disease characteristics, the Ocular Surface Disease Index (OSDI) questionnaire was completed for each patient, followed by eye examinations including slit lamp examination, Schirmer test, strip meniscometry (SMTube), and tear break-up time (TBUT) measurement. The MGs were also imaged using a non-contact meibography system (SBM System, Italy). The data were analyzed using SPSS version 22.0 with a significant level of less than 0.05.

Results

Patients had higher OSDI score than controls but it was not significant (10.90±13.03 vs. 5.57±6.85; p=0.07). There were significant differences between the groups in mean Schirmer test values for both eyes (OD: 8.07±5.47 vs. 17.37±6.52; OS: 7.60±5.00 vs. 17.30±6.44, p<0.001) and mean SMTube results (OD: 4.49±2.40 vs. 9.74±3.67; OS: 4.30±2.81 vs. 9.65±4.52; p<0.001). However, mean TBUT did not differ between the groups (OD: 9.14±3.17 vs. 10.12±2.08, p=0.27; OS: 9.16±3.30 vs. 10.05±2.10, p=0.25). Meibography also showed no significant difference in MG dropout between the groups (OD: 20.86±9.79 vs. 21.05±12.07; p=0.74; OS: 18.16±8.83 vs. 19.53±10.30; p=0.51).

Conclusion

Vitiligo is associated with a reduction in the production of aqueous tear film, but does not affect the structure and function of the MGs.

The study of dry eye and meibomian glands in psoriasis

BACKGROUND

To investigate aqueous and lipid layers of the tear film as well as meibomian gland structure by meibography in psoriatic patients in the Iranian population.

METHODS

This case-control study was conducted on 31 psoriasis patients and 31 controls in Birjand University of Medical Sciences in 2018. The sampling method was available from the date of approval of the proposal in the Ethics Committee until it reached the sample size. After entering the study, patients were examined individually with a slit lamp. Then, Ocular Surface Disease Index (OSDI) score assessment, Schirmer test 1, lacrimal measurement with SM tube, tear break-up time (TBUT), and meibomian glands imaging by SBM Sistemi were done. Finally, the obtained data were entered into SPSS 15 software and analyzed at a significant level of less than 0.05.

RESULTS

The two groups were matched according to age and gender (p = 0.39 and p = 0.80; respectively). With the exception of the SM Tube score, the mean of all tear film and meibomian glands functional and structural parameters including Schirmer test 1, TBUT, and meibography were significantly different between patients and control groups. Moreover, the proportion of abnormal OSDI (OSDI ⩾ 13) and the dry eye was significantly higher in psoriasis patients.

CONCLUSIONS

Psoriasis is associated with dry eye as well as meibomian glands atrophy and dysfunction.

Association between Cardiometabolic risk factor and responsiveness to vitamin D supplementation: a new approach using artificial neural network analysis

Background

There are increasing data highlighting the effectiveness of vitamin D supplementation in the treatment of vitamin D deficiency. But individuals vary in their responsiveness to vitamin D supplementation. In this study, the association between several cardiometabolic risk factors and the magnitude of response to vitamin D supplementation (change in vitamin D level) was investigated using a novel artificial neural networks (ANNs) approach.

Methods

Six hundred eight participants aged between 12 to 19 years old were recruited to this prospective interventional study. Nine vitamin D capsules containing 50,000 IU vitamin D/weekly were given to all participants over the 9 week period. The change in serum 25(OH) D level was calculated as the difference between post-supplementation and basal levels. Suitable ANNs model were selected between different algorithms in the hidden and output layers and different numbers of neurons in the hidden layer. The major determinants for predicting the response to vitamin D supplementation were identified.

Results

The sigmoid in both the hidden and output layers with 4 hidden neurons had acceptable sensitivity, specificity and accuracy, assessed as the area under the ROC curve, was determined in our study. Baseline serum vitamin D (30.4%), waist to hip ratio (10.5%), BMI (10.5%), systolic blood pressure (8%), heart rate (6.4%), and waist circumference (6.1%) were the most important factors in predicting the response to serum vitamin D levels.

Conclusion

We provide the first attempt to relate anthropometric specific recommendations to attain serum vitamin D targets. With the exception of cardiometabolic risk factors, the relative importance of other factors and the mechanisms by which these factors may affect the response requires further analysis in future studies (Trial registration: IRCT201509047117N7; 2015-11-25; Retrospectively registered).

Differential item functioning analysis of the Bar-On Emotional Quotient Inventory (EQ-i) across gender and age groups

There has been a heated debate on emotional intelligence (EI) and, more particularly, on the Bar-On Emotional Quotient Inventory (EQ-i) measuring all dimensions of emotional intelligence. To ensure measurement equivalence of EQ-i, the present article evaluated whether statements phrased in EQ-i questionnaire have equivalent meaning across respondents, regardless of their sex and age group membership. For 2,078 participants, three EI subscale (item 50 in reality testing, items 4 and 19 in stress tolerance, and items 7, 52, and 82 in interpersonal) for age groups had clinically significant Differential item functioning (DIF). So previous observed associations between EI and age might be misleading and deserve further study after removing or replacing DIF items.

The relationship between neuropsychological function and responsiveness to vitamin D supplementation using artificial neural networks

BACKGROUND

Vitamin D has recently attracted interest for its pleiotropic effects. Vitamin D supplements are a potentially important public health intervention, but the response to supplementation varies between individuals.

AIM

We aimed to assess the association between several neuropsychological parameters and the magnitude of response to vitamin D supplementation using an artificial neural network method.

METHODS

Neuropsychological function was assessed in 619 participants using standard questionnaires. The study participants received vitamin D capsules containing 50,000 IU vitamin D per week over 9 weeks. To assess the relationship between responsiveness to vitamin D supplements and the impact on these neuropsychological parameters, the best-performing artificial neural network algorithms were selected from a combination of different transfer functions in hidden and output layers and variable numbers of hidden layers (between two and 50). The performance of the artificial neural network algorithm was assessed by receiver operating characteristic analysis and variables of importance were identified.

RESULTS

The artificial neural network algorithm with sigmoid transfer function in both hidden and output layers could predict responsiveness to vitamin D supplementation effectively. The sensitivity and specificity were between 0.60 and 0.70 and 0.66 and 0.70, respectively. Cognitive abilities (42.5%), basal vitamin D (21.3%), body mass index (9.5%), and daytime sleepiness (8%) are the most widely used variables to predict changes in serum vitamin D levels.

CONCLUSIONS

Cognitive abilities status and baseline 25-hydroxyvitamin D are important novel modifiers of the enhancement in circulating 25-hydroxyvitamin D after vitamin D supplementation.

The Effect of High-Dose Vitamin C on Biochemical Markers of Myocardial Injury in Coronary Artery Bypass Surgery

OBJECTIVE

To evaluate the effect of high-dose vitamin C on cardiac reperfusion injury and plasma levels of creatine kinase-muscle/brain (CK-MB), troponin I, and lactate dehydrogenase (LDH) in patients undergoing coronary artery bypass grafting (CABG).

METHODS

This is a double-blind randomized clinical trial study. Fifty patients (50-80 years old) who had CABG surgery were selected. The intervention group received 5 g of intravenous vitamin C before anesthesia induction and 5 g of vitamin C in cardioplegic solution. The control group received the same amount of placebo (normal saline). Arterial blood samples were taken to determine the serum levels of CK-MB, troponin I, and LDH enzymes. Left ventricular ejection fraction was measured and hemodynamic parameters were recorded at intervals.

RESULTS

High doses of vitamin C in the treatment group led to improvement of ventricular function (ejection fraction [EF]) and low Intensive Care Unit (ICU) stay. The cardiac enzymes level in the vitamin C group was lower than in the control group. These changes were not significant between the groups in different time intervals (anesthesia induction, end of bypass, 6 h after surgery, and 24 h after surgery) for CK-MB, LDH, and troponin I. Hemodynamic parameters, hematocrit, potassium, urinary output, blood transfusion, arrhythmia, and inotropic support showed no significant difference between the groups.

CONCLUSION

Vitamin C has significantly improved the patients' ventricular function (EF) 72 h after surgery and reduced the length of ICU stay. No significant changes in cardiac biomarkers, including CK-MB, troponin I, and LDH, were seen over time in each group.

IRCT CODE

IRCT2016053019470N33.

Comparison of Infusion of Propofol and Ketamine-Propofol Mixture (Ketofol) as Anesthetic Maintenance Agents on Blood Pressure of Patients Undergoing Orthopedic Leg Surgeries

Background

Some studies have reported the effects of anesthesia induction using a single propofol dose and low ketamine doses in short-term outpatient operations.

Objectives

In this study, we aimed to evaluate the intra and post-operative hemodynamic effects of ketamine-propofol mixture (Ketofol) infusion in comparison with propofol infusion.

Methods

This study was performed on 54 class I and II of the American Society of Anesthesia patients aged 15 to 45 years who were candidates for leg fracture surgery. The patients were randomly assigned to propofol and ketofol groups. In the propofol and ketofol groups, propofol infusion (100 µg/kg/min) and propofol-ketamine infusion (50 µg/kg/min propofol + 25 µg/kg/min ketamine) were used for the maintenance of anesthesia, respectively. Heart rate and systolic, diastolic and mean blood pressure before, immediately after the induction of anesthesia and at 10-minute intervals were measured and recorded. Pain, nausea, and vomiting were recorded immediately after surgery and each 2 hours until 6 hours.

Results

Systolic, diastolic and mean blood pressure were significantly higher in the ketofol group than in the propofol group at 10 - 60 min intervals (P < 0.05). There was no significant difference, however, between the two groups in terms of the severity of nausea and pain and vomiting frequency.

Conclusions

Infusion of hypnotic doses of ketofol leads to increase in diastolic and systolic blood pressure and improves blood pressure stability in addition to inducing more as compared with propofol infusion, but it leads to higher risk of nausea and vomiting.

Effects of ambient air pressure on surface structures produced by ultrashort laser pulse irradiation

We report an experimental analysis addressing striking effects of residual air ambient pressure, from atmospheric conditions (10³  mbar) to high vacuum (10^-4  mbar), on the surface structures induced on a silicon target by direct femtosecond laser irradiation. We observe an interesting direct impact of the ambient pressure on the period and depth of the generated ripples as well as on the formation of microgrooves. Moreover, a significant correlation is observed between the ripples' period and depth. The change of pressure is accompanied by a variation of the degree of nanoparticle coverage, which is eventually recognized as an important factor for the development of the final surface structures. These results shed light on the intriguing mechanisms underlying the formation of the various surface textures, also evidencing that the ambient pressure can act as an effective parameter to tailor some characteristic features of the processed surface.

Testing measurement equivalence of the SF-36 questionnaire across patients on hemodialysis and healthy people

BACKGROUND

Differential item functioning (DIF) occurs when members from different groups respond differently to particular items in a health-related quality of life (HRQoL) questionnaire after controlling for underlying HRQoL construct. This study aimed to assess DIF in the SF-36 questionnaire and its effect on comparing HRQoL scores across patients on HD and healthy people.

METHODS

One hundred fifty patients on maintenance hemodialysis (HD) and 642 healthy individuals filled out the Persian version of the SF-36 questionnaire. Multiple-group multiple-indicator multiple-causes (MG-MIMIC) model was used to assess DIF across patients on HD and healthy population.

RESULTS

Sixteen out of 36 (44.4 %) items were flagged with DIF. Six out of 16 items (37.5 %) were flagged with uniform DIF, nine items (56.2 %) with non-uniform DIF, and one item (6.2 %) with both uniform DIF and non-uniform DIF. DIF items were associated with all subscales with the exception of the limitation due to physical problems and bodily pain subscales. The significant lower HRQoL scores of patients on HD in comparison with healthy people in the physical functioning and vitality subscales did not change after removing the items with uniform DIF.

CONCLUSIONS

Our findings revealed that patients on HD and healthy people perceived the meaning of the items in SF-36 questionnaire differently. Although the impact of DIF is minimal, the cross-group comparison across patients on HD and healthy people should be performed with caution.

Item-level informant discrepancies across obese-overweight children and their parents on the PedsQL™ 4.0 instrument: an iterative hybrid ordinal logistic regression

PURPOSE

Child obesity has become a major health concern worldwide. In order to provide successful intervention strategies, it is necessary to understand how obese-overweight children and their parents perceive obesity and its consequences on child's health-related quality of life (HRQoL). This study aimed to assess measurement equivalence of the PedsQL™ 4.0 across obese-overweight children and their parents.

METHODS

The items in the PedsQL™ 4.0 were analysed for differential item functioning (DIF) across obese-overweight children and their parents using an iterative hybrid ordinal logistic regression/item response theory approach. The sample included 647 overweight-obese children and their parents, who completed child and parent reports of the PedsQL™ 4.0, respectively.

RESULTS

Overall, 17 out of 23 (74%) items were flagged with DIF across two groups: eight items exhibited uniform DIF and nine items non-uniform DIF. In addition, parents of obese children rated the child's HRQoL significantly lower than their children in all domains of the PedsQL™ 4.0, and this finding did not change whether or not items with uniform DIF were included.

CONCLUSIONS

Although obese-overweight children and their parents interpret items of the PedsQL™ 4.0 in a conceptually different manner, removing or retaining DIF items in the subscales had no significant effects on group differences. Accordingly, it appears that observed differences in HRQoL scores across child and parent reports are a true difference and not a reflection of measurement artefact.

Combination of remifentanil with isoflurane or propofol: effect on the surgical stress response

BACKGROUND

Hormonal and metabolic changes following surgery are markers of the stress response to surgery. We compared hemodynamic parameters and stress response markers (glucose, cortisol, and C-reactive protein) in two groups of patients receiving either propofol or isoflurane combined with remifentanil for maintenance of anesthesia.

METHODS

We randomly assigned 100 women (ASA I-II) scheduled for diagnostic gynecologic laparoscopy to receive either isoflurane (0.8% end-tidal) or propofol (100 mg/kg/min) in addition to remifentanil (0.25 mg/ kg/min). Heart rate and mean arterial pressure were recorded after induction, 30 seconds after intubation, at four time points after incision, and 60 min after surgery. Serum C-reactive protein, cortisol and glucose concentrations were measured before induction, one hour after incision, and one hour after surgery.

RESULTS

After induction, heart rate decreased significantly from baseline in both groups, and remained below baseline until the end of surgery. Mean arterial pressure also decreased significantly in both groups. C-reactive protein levels were not significantly different between groups. In the propofol group, cortisol decreased significantly one hour after incision, but increased in the isoflurane group. Glucose increased significantly in both groups, but was significantly lower in the propofol group one hour after the incision and one hour after surgery.

CONCLUSION

An anesthetic regimen combining propofol and remifentanil attenuates two indicators of the stress response more efficiently than a isoflurane - remifentanil combination.