Category: Nevin Manimala

BMC Med Res Methodol. 2024 Mar 9;24(1):62. doi: 10.1186/s12874-024-02184-8.

ABSTRACT

INTRODUCTION: Interrupted time series (ITS) design is a commonly used method for evaluating large-scale interventions in clinical practice or public health. However, improperly using this method can lead to biased results.

OBJECTIVE: To investigate design and statistical analysis characteristics of drug utilization studies using ITS design, and give recommendations for improvements.

METHODS: A literature search was conducted based on PubMed from January 2021 to December 2021. We included original articles that used ITS design to investigate drug utilization without restriction on study population or outcome types. A structured, pilot-tested questionnaire was developed to extract information regarding study characteristics and details about design and statistical analysis.

RESULTS: We included 153 eligible studies. Among those, 28.1% (43/153) clearly explained the rationale for using the ITS design and 13.7% (21/153) clarified the rationale of using the specified ITS model structure. One hundred and forty-nine studies used aggregated data to do ITS analysis, and 20.8% (31/149) clarified the rationale for the number of time points. The consideration of autocorrelation, non-stationary and seasonality was often lacking among those studies, and only 14 studies mentioned all of three methodological issues. Missing data was mentioned in 31 studies. Only 39.22% (60/153) reported the regression models, while 15 studies gave the incorrect interpretation of level change due to time parameterization. Time-varying participant characteristics were considered in 24 studies. In 97 studies containing hierarchical data, 23 studies clarified the heterogeneity among clusters and used statistical methods to address this issue.

CONCLUSION: The quality of design and statistical analyses in ITS studies for drug utilization remains unsatisfactory. Three emerging methodological issues warranted particular attention, including incorrect interpretation of level change due to time parameterization, time-varying participant characteristics and hierarchical data analysis. We offered specific recommendations about the design, analysis and reporting of the ITS study.

PMID:38461257 | DOI:10.1186/s12874-024-02184-8

Lipids Health Dis. 2024 Mar 9;23(1):73. doi: 10.1186/s12944-024-02059-3.

ABSTRACT

BACKGROUND: Abdominal aortic calcification (AAC) is a crucial indicator of cardiovascular health. This study aims investigates the associations between dietary fatty acid intake and AAC.

METHODS: In this study, a cross-sectional assessment was performed on a group of 2,897 individuals aged 40 and above, utilizing data from the NHANES. The focus was on examining dietary consumption of various fatty acids, including Saturated (SFA), Monounsaturated (MUFA), Polyunsaturated (PUFA), as well as Omega-3 and Omega-6. The evaluation of AAC was done by applying the Kauppila AAC score to results obtained from dual-energy X-ray absorptiometry scans. For statistical analysis, weighted multivariate linear and logistic regression were employed, with adjustments for variables like gender, age, ethnicity, and overall health condition.

RESULTS: Participants with higher intake of SFA and PUFA showed a positive association with AAC score, while higher levels of dietary Omega-3 and Omega-6 fatty acids was connected with a negative correlation. Subgroup analyses indicated consistent associations across different sexes and age groups. The study found that an increase in SFA and PUFA intake correlated with an increase in AAC score, whereas Omega-3 and Omega-6 intake correlated with a decrease.

CONCLUSION: This study underscores the importance of dietary fatty acid composition in the prevalence of AAC and its potential implications for dietary guidelines and cardiovascular disease prevention strategies.

PMID:38461250 | DOI:10.1186/s12944-024-02059-3

BMC Oral Health. 2024 Mar 9;24(1):317. doi: 10.1186/s12903-024-04080-5.

ABSTRACT

BACKGROUND: Surgical guides have been proposed in an attempt to reach more predictable outcomes for esthetic crown lengthening. The objective of the present study was to evaluate the effectiveness of esthetic crown lengthening using 3D-printed surgical guides in the management of excessive gingival display due to altered passive eruption type 1B.

MATERIALS AND METHODS: Sixteen patients diagnosed with altered passive eruption type 1B, were divided into two groups. In the control group, the procedure was carried out conventionally, and in the study group, a dual surgical guide was used. The parameters of wound healing (swelling, color, probing depth, bleeding index, and plaque index), pain scores, gingival margin stability, and operating time were assessed at 1 week, 2 weeks, 3 months, and 6 months postoperatively.

RESULTS: There was no statistically significant difference in terms of wound healing, pain scores, and gingival margin stability between both groups at different time intervals (P = 1), however, there was a statistical difference between both groups in terms of operating time with the study group being significantly lower (P < 0.001).

CONCLUSION: Digitally assisted esthetic crown lengthening helps shorten the operating time and reduces the possibility of human errors during the measurements. This will be useful in helping practitioners achieve better results.

PRACTICAL IMPLICATIONS: The conventional method remains to be the gold standard. However, shorter operating time and lower margins for errors will help reduce costs as the chair side time is reduced as well as the possibility for a second surgery is lower. This will improve patient satisfaction as well.

PMID:38461241 | DOI:10.1186/s12903-024-04080-5

BMC Womens Health. 2024 Mar 9;24(1):168. doi: 10.1186/s12905-024-03005-2.

ABSTRACT

BACKGROUND: South African women have been exposed to epidemic proportions of intimate partner violence (IPV) amongst heterosexual relationships but not much is known about same-sex partnerships. Sexual minorities are excluded from research but are subject to intimate partner violence as much as heteronormative persons. The purpose of this study is to determine the association between age-disparity and IPV outcomes among females with same-sex partners in South Africa.

METHODS: A cross-sectional study of the nationally representative South African National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM 2017) is used. A weighted sample of 63,567 female respondents identified as having a same-sex partner are analysed. IPV is measured as ever been physically and/ or sexually abused. Any experience of IPV is included in the dependent variable of this study. Descriptive and inferential statistics are used to estimate the relationship between demographic, socioeconomic, age-disparity and IPV.

RESULTS: Almost 16% of females in same-sex relationships experienced IPV and about 22% from younger partners. In female same-sex partnerships, partner age-disparity (OR: 1.30, CI: 1.18 – 1.51), type of place of residence (OR: 2.27, CI: 1.79 – 3.79), highest level of education (OR: 1.07, CI: 0.97 – 1.17), marital status (OR: 1.60, CI: 1.37 – 1.88), and race (OR: 1.47, CI: 1.41 – 1.54) are associated with an increased likelihood of violence.

CONCLUSION: IPV programs that are specifically targeted for non-heteronormative orientations are needed. These programs should promote health equity and safety for non-confirmative sexual identities in the country.

PMID:38461233 | DOI:10.1186/s12905-024-03005-2

Popul Health Metr. 2024 Mar 9;22(1):4. doi: 10.1186/s12963-024-00324-2.

ABSTRACT

BACKGROUND: Studying long-term trends in educational inequalities in health is important for monitoring and policy evaluation. Data issues regarding the allocation of people to educational groups hamper the study and international comparison of educational inequalities in mortality. For the UK, this has been acknowledged, but no satisfactory solution has been proposed.

OBJECTIVE: To enable the examination of long-term mortality trends by educational level for England and Wales (E&W) in a time-consistent and internationally comparable manner, we propose and implement an approach to deal with the data issues regarding mortality data by educational level.

METHODS: We employed 10-year follow-ups of individuals aged 20+ from the Office for National Statistics Longitudinal Study (ONS-LS), which include education information from each decennial census (1971-2011) linked to individual death records, for a 1% representative sample of the E&W population. We assigned the individual cohort data to single ages and calendar years, and subsequently obtained aggregate all-cause mortality data by education, sex, age (30+), and year (1972-2017). Our data adjustment approach optimised the available education information at the individual level, and adjusts-at the aggregate level-for trend discontinuities related to the identified data issues, and for differences with country-level mortality data for the total population.

RESULTS: The approach resulted in (1) a time-consistent and internationally comparable categorisation of educational attainment into the low, middle, and high educated; (2) the adjustment of identified data-quality related discontinuities in the trends over time in the share of personyears and deaths by educational level, and in the crude and the age-standardised death rate by and across educational levels; (3) complete mortality data by education for ONS-LS members aged 30+ in 1972-2017 which aligns with country-level mortality data for the total population; and (4) the estimation of inequality measures using established methods. For those aged 30+ , both absolute and relative educational inequalities in mortality first increased and subsequently decreased.

CONCLUSION: We obtained additional insights into long-term trends in educational inequalities in mortality in E&W, and illustrated the potential effects of different data issues. We recommend the use of (part of) the proposed approach in other contexts.

PMID:38461232 | DOI:10.1186/s12963-024-00324-2

BMC Oral Health. 2024 Mar 9;24(1):316. doi: 10.1186/s12903-024-04073-4.

ABSTRACT

OBJECTIVE: This study aimed to predict adolescents with untreated dental caries through a machine-learning approach using three different algorithms METHODS: Data came from an epidemiological survey in the five largest cities in Mato Grosso do Sul, Brazil. Data on sociodemographic characteristics, consumption of unhealthy foods and behaviours (use of dental floss and toothbrushing) were collected using Sisson’s theoretical model, in 615 adolescents. For the machine learning, three different algorithms were used: (1) XGboost; (2) decision tree and (3) logistic regression. The epidemiological baseline was used to train and test predictions to detect individuals with untreated dental caries, through eight main predictor variables. Analyzes were performed using the R software (R Foundation for Statistical Computing, Vienna, Austria). The Ethics Committee approved the study..

RESULTS: For the 615 adolescents, xgboost performed better with an area under the curve (AUC) of 84% versus 81% for the decision tree algorithm. The most important variables were the use of dental floss, unhealthy food consumption, self-declared race and exposure to fluoridated water.

CONCLUSIONS: Family health teams can improve the work process and use artificial intelligence mechanisms to predict adolescents with untreated dental caries, and, in this way, schedule dental appointments for the treatment of adolescents earlier.

PMID:38461227 | DOI:10.1186/s12903-024-04073-4

Sci Rep. 2024 Mar 9;14(1):5822. doi: 10.1038/s41598-024-56446-y.

ABSTRACT

The aim of the study was to optimize the seat for a personal vehicle equipped with a crankset mechanism, meant for everyday use. The inclination of the seat backrest was selected on the basis of theoretical considerations. Then dynamic tests were carried out on a group of young, healthy men in order to verify the ergonomic aspects of the seat position in relation to the crankset and determine the efficiency of the human-mechanism system with a load of 50 W. The data obtained from the dynamic tests were subject to statistical analysis. Research has shown that higher seat positions result in statistically higher efficiencies. In addition, a holistic analysis of the personal vehicle design problem shows that the upper position of the seat is also the best. The results of the research can be used to optimize personal vehicles using human force as a drive.

PMID:38461198 | DOI:10.1038/s41598-024-56446-y

Hepatol Int. 2024 Mar 9. doi: 10.1007/s12072-024-10648-8. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The identification of reliable predictors for hepatitis B surface antigen (HBsAg) seroclearance remains controversial. We aimed to summarize potential predictors for HBsAg seroclearance by pegylated interferon-α (PegIFNα) in patients with chronic HBV infection.

METHODS: A systematic search of the Cochrane Library, Embase, PubMed, and Web of Science databases was conducted from their inception to 28 September 2022. Meta-analyses were performed following the PRISMA statement. Predictors of HBsAg seroclearance were evaluated based on baseline characteristics and on-treatment indicators.

RESULTS: This meta-analysis encompasses 27 studies, including a total of 7913 patients. The findings reveal several factors independently associated with HBsAg seroclearance induced by PegIFNα-based regimens. These factors include age (OR = 0.961), gender (male vs. female, OR = 0.537), genotype (A vs. B/D; OR = 7.472, OR = 10.738), treatment strategy (combination vs. monotherapy, OR = 2.126), baseline HBV DNA (OR = 0.414), baseline HBsAg (OR = 0.373), HBsAg levels at week 12 and 24 (OR = 0.384, OR = 0.294), HBsAg decline from baseline to week 12 and 24 (OR = 6.689, OR = 6.513), HBsAg decline from baseline ≥ 1 log₁₀ IU/ml and ≥ 0.5 log₁₀ IU/ml at week 12 (OR = 18.277; OR = 4.530), and ALT elevation at week 12 (OR = 3.622). Notably, subgroup analysis suggests no statistical association between HBsAg levels at week 12 and HBsAg seroclearance for treatment duration exceeding 48 weeks. The remaining results were consistent with the overall analysis.

CONCLUSIONS: This is the first meta-analysis to identify predictors of HBsAg seroclearance with PegIFNα-based regimens, including baseline and on-treatment factors, which is valuable in developing a better integrated predictive model for HBsAg seroclearance to guide individualized treatment and achieve the highest cost-effectiveness of PegIFNα.

PMID:38461186 | DOI:10.1007/s12072-024-10648-8

Sci Rep. 2024 Mar 9;14(1):5788. doi: 10.1038/s41598-024-55798-9.

ABSTRACT

Future state prediction for nonlinear dynamical systems is a challenging task. Classical prediction theory is based on a, typically long, sequence of prior observations and is rooted in assumptions on statistical stationarity of the underlying stochastic process. These algorithms have trouble predicting chaotic dynamics, “Black Swans” (events which have never previously been seen in the observed data), or systems where the underlying driving process fundamentally changes. In this paper we develop (1) a global and local prediction algorithm that can handle these types of systems, (2) a method of switching between local and global prediction, and (3) a retouching method that tracks what predictions would have been if the underlying dynamics had not changed and uses these predictions when the underlying process reverts back to the original dynamics. The methodology is rooted in Koopman operator theory from dynamical systems. An advantage is that it is model-free, purely data-driven and adapts organically to changes in the system. While we showcase the algorithms on predicting the number of infected cases for COVID-19 and influenza cases, we emphasize that this is a general prediction methodology that has applications far outside of epidemiology.

PMID:38461184 | DOI:10.1038/s41598-024-55798-9

J Emerg Med. 2023 Dec 3:S0736-4679(23)00581-4. doi: 10.1016/j.jemermed.2023.11.020. Online ahead of print.

ABSTRACT

BACKGROUND: Opioid overdose is a major cause of mortality in the United States. In spite of efforts to increase naloxone availability, distribution to high-risk populations remains a challenge.

OBJECTIVE: To assess the effects of multiple different naloxone distribution methods on patient obtainment of naloxone in the emergency department (ED) setting.

METHODS: Naloxone was provided to patients in three 12-month phases between February 2020 and February 2023. In Phase 1, physicians could offer patients electronic prescriptions, which were filled in a nearby in-hospital discharge pharmacy. In Phase 2, physicians directly provided patients with take-home naloxone at discharge. In Phase 3, distribution was expanded to allow ED staff to hand patients take-home naloxone at time of discharge. The total number of prescriptions, rate of prescription filling, and amount of take-home naloxone kits provided to patients were then statistically analyzed using 95% confidence intervals (CI) and chi-squared testing.

RESULTS: In Phase 1, 348 naloxone prescriptions were written, with 133 (95% CI 112.5-153.5) filled. In Phase 2, 327 (95% CI 245.5-408.5) take-home naloxone kits were given to patients by physicians. In Phase 3, 677 (95% CI 509.5-844.5) take-home naloxone kits were provided to patients by ED staff. There were statistically significant increases in naloxone distribution from Phase 1 to Phase 2, and Phase 2 to Phase 3.

CONCLUSIONS: Take-home naloxone increases access when compared with naloxone prescriptions in the ED setting. A multidisciplinary approach combined with the removal of regulatory and administrative barriers allowed for further increased distribution of no-cost naloxone to patients.

PMID:38461132 | DOI:10.1016/j.jemermed.2023.11.020