Category: Statistics

BMC Geriatr. 2023 Aug 14;23(1):491. doi: 10.1186/s12877-023-04186-5.

ABSTRACT

BACKGROUND: While some studies have explored the health-related quality of life (HRQOL) of older adults with diabetes mellitus (DM) in South Korea using a theoretical framework, these studies suffer sample-related limitations, as they focus only on a specific subgroup of older adults. To address this gap, this study aimed to investigate the predictors of HRQOL of older adults with DM in South Korea, using extensive national data and based on the theory of Health-Related Quality of Life in South Korean Older Adults with Type 2 Diabetes (The HIKOD theory).

METHODS: A secondary data analysis was conducted using data from 1,593 participants aged 65 years and older with DM sourced from the 2015-2019 Korea National Health and Nutrition Examination Survey (KNHANES). The variables included in this study are as follows: demographic factors (gender, age, household income, and education level), disease-specific factors (duration of DM, treatment of DM, and control of HbA1c), barriers (number of comorbidities), resources (living alone status), psychosocial factors (perceived stress), and health-promoting behaviors (physical activity and fundus examination). Considering the complex sampling design employed in this study, statistical analyses including Rao-Scott chi-square tests, correlation analysis, and hierarchical multiple regression analysis were conducted.

RESULTS: Mobility (45.0%) was the HRQOL dimension with which participants experienced the highest number of problems. Number of comorbidities (r = -0.36, p < 0.001), living alone status (r_pb = 0.16, p < 0.001), perceived stress (r_pb = 0.14, p < 0.001), and physical activity (r_pb = 0.12, p < 0.001) were correlated with HRQOL. While adjusting for background factors, HRQOL was negatively predicted by higher number of comorbidities (estimate B = -0.03, p < 0.001), living alone (estimate B = -0.03, p = 0.043), higher perceived stress (estimate B = -0.09, p < 0.001), and lower physical activity (estimate B = -0.03, p < 0.001).

CONCLUSION: Complex and diverse factors influence HRQOL among older adults with DM in South Korea. To improve their HRQOL, intervention programs that integrally regard HRQOL, along with various predictors, are necessary.

PMID:37580707 | DOI:10.1186/s12877-023-04186-5

Phys Med. 2023 Aug 12;113:102647. doi: 10.1016/j.ejmp.2023.102647. Online ahead of print.

ABSTRACT

PURPOSE: In Parkinson’s disease (PD), 5-10% of cases are of genetic origin with mutations identified in several genes such as leucine-rich repeat kinase 2 (LRRK2) and glucocerebrosidase (GBA). We aim to predict these two gene mutations using hybrid machine learning systems (HMLS), via imaging and non-imaging data, with the long-term goal to predict conversion to active disease.

METHODS: We studied 264 and 129 patients with known LRRK2 and GBA mutations status from PPMI database. Each dataset includes 513 features such as clinical features (CFs), conventional imaging features (CIFs) and radiomic features (RFs) extracted from DAT-SPECT images. Features, normalized by Z-score, were univariately analyzed for statistical significance by the t-test and chi-square test, adjusted by Benjamini-Hochberg correction. Multiple HMLSs, including 11 features extraction (FEA) or 10 features selection algorithms (FSA) linked with 21 classifiers were utilized. We also employed Ensemble Voting (EV) to classify the genes.

RESULTS: For prediction of LRRK2 mutation status, a number of HMLSs resulted in accuracies of 0.98 ± 0.02 and 1.00 in 5-fold cross-validation (80% out of total data points) and external testing (remaining 20%), respectively. For predicting GBA mutation status, multiple HMLSs resulted in high accuracies of 0.90 ± 0.08 and 0.96 in 5-fold cross-validation and external testing, respectively. We additionally showed that SPECT-based RFs added value to the specific prediction of of GBA mutation status.

CONCLUSION: We demonstrated that combining medical information with SPECT-based imaging features, and optimal utilization of HMLS can produce excellent prediction of the mutations status in PD patients.

PMID:37579523 | DOI:10.1016/j.ejmp.2023.102647

Int J Health Policy Manag. 2023;12:6896. doi: 10.34172/ijhpm.2023.6896. Epub 2023 Feb 13.

ABSTRACT

BACKGROUND: Digital information management systems for health financing are implemented on the assumption thatdigitalization, among other things, enables strategic purchasing. However, little is known about the extent to which thesesystems are adopted as planned to achieve desired results. This study assesses the levels of, and the factors associated withthe adoption of the Insurance Management Information System (IMIS) by healthcare providers in Tanzania.

METHODS: Combining multiple data sources, we estimated IMIS adoption levels for 365 first-line health facilities in2017 by comparing IMIS claim data (verified claims) with the number of expected claims. We defined adoption as abinary outcome capturing underreporting (verified<expected) vs. not-underreporting, using four different approaches.We used descriptive statistics and analysis of variance (ANOVA) to examine adoption levels across facilities, districts,regions, and months. We used logistic regression to identify facility-specific factors (ie, explanatory variables) associatedwith different adoption levels.

RESULTS: We found a median (interquartile range [IQR]) difference of 77.8% (32.7-100) between expected and verifiedclaims, showing a consistent pattern of underreporting across districts, regions, and months. Levels of underreportingvaried across regions (ANOVA: F=7.24, P<.001) and districts (ANOVA: F=4.65, P<.001). Logistic regression resultsshowed that higher service volume, share of people insured, and greater distance to district headquarter were associatedwith a higher probability of underreporting.

CONCLUSION: Our study shows that the adoption of IMIS in Tanzania may be sub-optimal and far from policy-makers’expectations, limiting its capacity to provide the necessary information to enhance strategic purchasing in the healthsector. Countries and agencies adopting digital interventions such as openIMIS to foster health financing reform areadvised to closely track their implementation efforts to make sure the data they rely on is accurate. Further, our studysuggests organizational and infrastructural barriers beyond the software itself hamper effective adoption.

PMID:37579470 | DOI:10.34172/ijhpm.2023.6896

Int J Health Policy Manag. 2023;12:6901. doi: 10.34172/ijhpm.2023.6901. Epub 2023 Feb 14.

ABSTRACT

BACKGROUND: There is evidence of the benefits of integrated knowledge translation (IKT), yet there is limited research outlining the purpose of a knowledge broker (KB) within this approach. The Maritime SPOR SUPPORT Unit (MSSU) acts as a KB to support patient-oriented research across the Maritime provinces in Canada. The “Bridge Process” was developed by the Nova Scotia (NS) site as a strategy that involves work leading up to and following the Bridge Event. The process supports research addressing priority health topics discussed at the event by stakeholder groups. The objectives of this paper were to (1) describe the outputs/outcomes of this IKT approach; and (2) examine the role of the KB.

METHODS: Quantitative data were collected from registration and evaluation surveys. Outputs are described with descriptive statistics. Qualitative data were collected through evaluation surveys and internal documents. Data related to KB tasks were categorized into three domains: (1) Knowledge Manager, (2) Linkage and Exchange Agent, and (3) Capacity Developer.

RESULTS: The Bridge Process was implemented four times. A total of 314 participants including government, health, patient/citizen, community, and research personnel attended the events. We identified 24 priority topics, with 7 led by teams receiving support to complete related projects. Participants reported improved understanding of the research gaps and policy needs and engaged with individuals they would not have otherwise. Although patients/citizens attended each Bridge Event, only 61% of participants who completed an evaluation survey indicated that they were ‘actively engaged in group discussion.’ The KB’s role was identified in all three domains including Knowledge Manager (eg, defining questions), Linkage and Exchange Agent (eg, engaging stakeholders), and Capacity Builder (eg, research interpretation).

CONCLUSION: The MSSU facilitated an IKT approach by acting as a KB throughout the Bridge Process. This deliberative and sequential process served as an effective strategy to increase collaborative health research in the province.

PMID:37579467 | DOI:10.34172/ijhpm.2023.6901

Int J Health Policy Manag. 2023;12:7614. doi: 10.34172/ijhpm.2023.7614. Epub 2023 Jun 27.

ABSTRACT

Vaccine hesitancy (VH) has risen significantly during the COVID-19 pandemic, becoming a major global health concern. VH is characterized by the delay or refusal of vaccination despite its availability. Various frameworks have been developed to understand the complex factors influencing VH, with attitudes, beliefs, and external influences being the most significant. The surge in VH has reignited the debate on the best approach to address it: persuasive/ educational or coercive. Attwell and Hannah studied the political and social reasons behind the adoption of mandatory vaccination in four jurisdictions (Italy, France, Australia, and California) due to declining vaccine coverage below the safety threshold. However, these methods may foster parental disbeliefs and opposition to vaccination campaigns. To combat VH, it is crucial to systematically assess its determinants within specific contexts and population groups. Increasing awareness about vaccination benefits, engaging with social media, and employing tailored strategies can foster spontaneous adherence to vaccination programs, eliminating the need for coercive measures.

PMID:37579365 | DOI:10.34172/ijhpm.2023.7614

Int J Health Policy Manag. 2023;12:7648. doi: 10.34172/ijhpm.2023.7648. Epub 2023 Jul 18.

ABSTRACT

BACKGROUND: The European Union Medical Device Regulation (MDR) requires manufacturers to undertake post-market clinical follow-up (PMCF) to assess the safety and performance of their devices following approval and Conformité Européenne (CE) marking. The quality and reliability of device registries for this Regulation have not been reported. As part of the Coordinating Research and Evidence for Medical Devices (CORE-MD) project, we identified and reviewed European cardiovascular and orthopaedic registries to assess their structures, methods, and suitability as data sources for regulatory purposes.

METHODS: Regional, national and multi-country European cardiovascular (coronary stents and valve repair/replacement) and orthopaedic (hip/knee prostheses) registries were identified using a systematic literature search. Annual reports, peer-reviewed publications, and websites were reviewed to extract publicly available information for 33 items related to structure and methodology in six domains and also for reported outcomes.

RESULTS: Of the 20 cardiovascular and 26 orthopaedic registries fulfilling eligibility criteria, a median of 33% (IQR: 14%-71%) items for cardiovascular and 60% (IQR: 28%-100%) items for orthopaedic registries were reported, with large variation across domains. For instance, no cardiovascular and 16 (62%) orthopaedic registries reported patient/ procedure-level completeness. No cardiovascular and 5 (19%) orthopaedic registries reported outlier performances of devices, but each with a different outlier definition. There was large heterogeneity in reporting on items, outcomes, definitions of outcomes, and follow-up durations.

CONCLUSION: European cardiovascular and orthopaedic device registries could improve their potential as data sources for regulatory purposes by reaching consensus on standardised reporting of structural and methodological characteristics to judge the quality of the evidence as well as outcomes.

PMID:37579359 | DOI:10.34172/ijhpm.2023.7648

Int J Health Policy Manag. 2023;12:7390. doi: 10.34172/ijhpm.2023.7390. Epub 2023 Jul 24.

ABSTRACT

BACKGROUND: Pneumonia is one of the leading causes of hospital admission in the United States with a global health burden of about 6.8 million hospitalizations and 1.1 million deaths in patients over 65 years old in 2015. This study aimed to identify possible patient and hospital-related risk factors for in-hospital pneumonia death across US hospitals.

METHODS: The National Inpatient Sample (NIS) was used to identify nationwide pneumonia patients (n=374 766, weighted n=1 873 828) from 2016 to 2019. We examined the characteristics of the study sample and their association with in-hospital death. Multivariate survey logistic regression models were used to identify risk factors.

RESULTS: During the study periods, in-hospital death rates continuously decreased (2.45% in 2016 to 2.19% in 2019). Descriptive statistics showed that patient and hospital factors had varied in-hospital death rates. Survey logistic regression results suggested that male, very low income, non-Medicare, government hospitals, rural hospitals, and specific hospital regions were associated with higher in-hospital death rates than their reference groups.

CONCLUSION: Socioeconomic factors, including income and insurance, are associated with pneumonia mortality. Census region, hospital ownership, and rural location are also related to in-hospital mortality. Such findings in underserved, impoverished, and rural areas to identify possible health disparities.

PMID:37579357 | DOI:10.34172/ijhpm.2023.7390

J Urol. 2023 Aug 14:101097JU0000000000003650. doi: 10.1097/JU.0000000000003650. Online ahead of print.

ABSTRACT

BACKGROUND: To determine whether clinical risk factors and morphometric features on pre-operative imaging can be utilized to identify those patients with cT1 tumors who are at higher risk of upstaging (pT3a).

METHODS: A retrospective international case control study of consecutive patients treated surgically with radical or partial nephrectomy for non-metastatic RCC (cT1 N0) conducted between January 2010 and December 2018. Multivariable logistic regression models were used to study associations of pre-operative risk factors on pT3a pathological upstaging among all patients, as well as subsets with those with pre-operative tumors <4cm, renal nephrometry scores, tumors <4cm with nephrometry scores, and clear cell histology. We also examined association with pT3a subsets (renal vein, sinus fat, perinephric fat).Resultsand Limitations: Among the 4092 PN and 2056 RN patients, pathologic upstaging occurred in 4.9% and 23.3% patients, respectively. Among each group independent factors associated with pT3a upstaging were increasing preoperative tumor size, increasing age, and the presence of diabetes. Specifically, among PN subjects diabetes (odds ratio, OR =1.65; 95% CI 1.17,2.29), male sex (OR = 1.62; 95% CI 1.14,2.33), and increasing BMI (OR =1.03; 95%CI 1.00,1.05 per one unit BMI) were statistically associated with upstaging. Subset analyses identified hilar tumors as more likely to be upstaged (PN OR = 1.91; 95%CI 1.12,3.16 | RN OR = 2.16; 95% 1.44, 3.25).

CONCLUSIONS: Diabetes and higher BMI were associated with pathologic upstaging, as were preoperative tumor size, increased age, and male sex. Similarly, hilar tumors were frequently upstaged.

PMID:37579345 | DOI:10.1097/JU.0000000000003650

Am J Epidemiol. 2023 Aug 11:kwad169. doi: 10.1093/aje/kwad169. Online ahead of print.

ABSTRACT

Cognitive functioning in older age profoundly impacts quality of life and health. Whilst most research in cognition in older age has focussed on mean levels, intraindividual variability (IIV) around this may have risk factors and outcomes independent of the mean. Investigating risk factors associated with IIV has typically involved deriving a summary statistic for each person from residual error around a fitted mean. However, this ignores uncertainty in the estimates, prohibits exploring associations with time-varying factors, and is biased by floor/ceiling effects. To address this, we propose a mixed-effects location scale beta-binomial model to estimate average probability and IIV in a word recall test in the English Longitudinal Study of Aging. After adjusting for mean performance, an analysis of 9,873 individuals across 7 (mean: 3.4) waves (2002-2015), found IIV greater: at older ages; with lower education; in females; with more difficulties with activities of daily living; in later cohorts; and when interviewers recorded issues potentially affecting the tests. Our study introduces a novel method to identify groups with greater IIV in bounded discrete outcomes. Our findings have implications for daily functioning and care, with further work needed to identify the impact for future health outcomes.

PMID:37579319 | DOI:10.1093/aje/kwad169

J Hist Med Allied Sci. 2023 Aug 14:jrad048. doi: 10.1093/jhmas/jrad048. Online ahead of print.

ABSTRACT

In a profession shaped by Whiteness and masculinity, the few Black women physicians who earned medical degrees prior to the Second World War found some of their rare professional opportunities in public health. Though their choices were often constrained by racism and sexism, they embraced public health work as a means of carrying out their “mission” in marginalized communities and as a way of practicing medicine with a more expansive definition than treating individual patients or illnesses. Black women physicians shaped public health by creating unique programming to meet the needs of the communities they served, including mobile health clinics and community health weeks. The first Black women physicians who worked in public health in the nineteenth and early twentieth centuries applied the new tool of public health “vital” statistics to Black lives and questioned the limits of their utility when created by White practitioners with racial biases. In the 1930s, some Black women physicians began earning some of the first master’s degrees in public health, just as the field was beginning to professionalize. Throughout the twentieth century, Black women physicians pioneered community health programming and, though born from exclusionary policies that limited where they could practice, experimented with alternative clinical spaces, even as the hospital and laboratory became the primary sites of medicine for White clinicians. By embracing public health, Black women physicians shaped the field and used it as a tool to address racial health disparities in the communities they served, acting on their belief that Black health could be improved, thereby contesting notions of biological inferiority.

PMID:37579294 | DOI:10.1093/jhmas/jrad048