Category: Statistics

Ann Work Expo Health. 2024 Nov 27:wxae090. doi: 10.1093/annweh/wxae090. Online ahead of print.

ABSTRACT

OBJECTIVES: Information systems focusing on occupational carcinogen exposure, whether categorized by industry or occupation, play a pivotal role in the prevention of occupational cancers. Recently, the Korean CARcinogen EXposure (K-CAREX) system was developed to assess carcinogen exposure by industry. However, corresponding information categorized by occupation has yet to be developed. This study aimed to develop an occupation-based exposure matrix for occupational carcinogens as an extension of the K-CAREX framework.

METHODS: The Work Environment Measurement Database (WEMD) and the Special Health Examination Database (SHED) were combined to estimate exposure intensity by occupation. The WEMD supplied exposure levels, whereas the SHED provided occupation information. Additionally, the SHED served as the primary data source for constructing an indicator of exposure prevalence by occupation, utilizing standard occupational classification.

RESULTS: A total of 22 carcinogens were selected for evaluating exposure intensity, and 20 carcinogens were selected for assessing exposure prevalence. Exposure intensity and prevalence were assigned to 156 occupational groups based on these carcinogens. For instance, in terms of welding fume exposure, welders were assigned an exposure intensity rating of 3 and exhibited exposure prevalence of 26%.

CONCLUSIONS: Our findings complement the previously developed K-CAREX, which offered an industry-based exposure matrix. The resultant comprehensive K-CAREX, incorporating both industry- and occupation-based matrices, can be utilized for occupational cancer prevention and epidemiological studies.

PMID:39603817 | DOI:10.1093/annweh/wxae090

Public Health Nurs. 2024 Nov 27. doi: 10.1111/phn.13499. Online ahead of print.

ABSTRACT

AIM: Hypertension is one of the most common chronic diseases worldwide. Therefore, it is essential to improve patients’ adherence to treatment in order to control their blood pressure. The present study aims to examine the effect of a smartphone application-supported nursing care program provided by a nurse on medication adherence and achievement of normal systolic and diastolic blood pressure levels among patients diagnosed with primary hypertension and registered at the Family Health Center within the context of patients’ self-management behaviors.

METHODS: A randomized controlled experimental study design. CONSORT flow chart was used in the study. The study sample consisted of 41 hypertensive patients in the intervention group and 41 hypertensive patients in the control group. The intervention group was supported with a smartphone application named “HiperDostum” based on the health belief model, whereas the control group continued to receive standard healthcare services provided by the Family Health Center, to which they were affiliated. Data were collected using the “Patient Information Form,” “Blood Pressure Monitoring Form,” and the “Medication Adherence Self-Efficacy Scale-Short Form.”

RESULTS: It was observed that the intervention group participants had higher medication adherence self-efficacy scale scores when compared to the control group participants. Comparing the blood pressure values by group, time, and group*time interaction, it was determined that there were statistically significant differences in systolic blood pressure values by time and group*time interaction.

CONCLUSION: Considering the widespread use of smartphones and smartphone application-supported nursing care can be successfully used to enhance self-management and improve treatment adherence among hypertensive patients in primary healthcare institutions.

TRIAL REGISTRATION: Registration number: NCT0532140; NAME OF TRIAL REGISTRY: The Effect of Smart Phone Application Supported Nursing Care Program on the Self-Management of Hypertensive Patients.

PMID:39603812 | DOI:10.1111/phn.13499

Eur J Hosp Pharm. 2024 Nov 27:ejhpharm-2024-004218. doi: 10.1136/ejhpharm-2024-004218. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the impact of pharmaceutical care on the number of readmissions and visits to the emergency department due to heart failure 30 days after hospital discharge, based on a programme of continuous pharmaceutical care throughout the care process, and to assess the differences between the control and intervention groups at 90 days after discharge (number of readmissions and visits to the emergency department, time from discharge to new readmission or visit to the emergency department).

METHODS: A single-centre experimental longitudinal prospective open and parallel-group study with balanced randomisation (1:1) was carried out in a tertiary hospital in Spain. Patients with a diagnosis of primary or decompensated heart failure admitted to the Cardiology Service or the Heart Failure and Vascular Risk Unit were recruited between March 2019 and November 2021 and randomly assigned, using a randomised block model, to the control (standard care) or intervention (continuing care model) groups. Epidemiological, clinical and pharmacology data were recorded. As a measure of association, we used the mean difference and the Student’s t-test. A p value of <0.05 was considered significant.

RESULTS: 296 patients were included (150 randomised to the control group, 146 to the intervention group). The results showed no significant differences between the control and intervention groups in the number of readmissions and visits to the emergency department during the 30 days after discharge (p=0.092), but a statistically significant difference was seen at 90 days (p=0.043). The number of days until the first visit to the emergency department or readmission was higher in the intervention group (p=0.021).

CONCLUSIONS: Continuous care and follow-up by the pharmacist 30 days after discharge has a neutral impact on hospital readmissions and visits to the emergency department of patients with heart failure, but it is positive in the 90 days following discharge.

PMID:39603805 | DOI:10.1136/ejhpharm-2024-004218

J Clin Anesth. 2024 Nov 26;100:111706. doi: 10.1016/j.jclinane.2024.111706. Online ahead of print.

ABSTRACT

BACKGROUND: No previous research has specifically investigated the relationship between postoperative glycemic variability (GV) and acute kidney disease (AKD) in patients undergoing cardiac surgery. In this study, several methods of modelling postoperative GV were used to examine the association between GV and AKD risk and subtypes of AKD.

METHODS: We undertook a retrospective study involving a total of 8,090 adult patients from three academic medical centers in Eastern China who underwent cardiac surgery with cardiopulmonary bypass between 2015 and 2023. Seven-day postoperative GV was calculated using the standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), average daily risk range (ADRR), and time out of target range (TOR). The primary focus was on the occurrence of AKD between 8 and 90 days post-surgery, which was further categorized into persistent AKD and delayed AKD depending on the acute kidney injury (AKI) status in the first 7 days.

RESULTS: During the 8-90 days postoperative period, AKD occurred in 522 out of 8,090 patients (6.5%). Seven-day postoperative GV was significantly and consistently higher in the AKD group (p<0.001 for each metric). After adjusting for relevant covariates, 7-day GV metrics were significantly associated with elevated AKD risk (standardized hazard ratio (SHR):1.20 (95% confidence interval (CI): (1.12 – 1.27) for SD; SHR: 1.30 (95% CI: 1.20 – 1.40) for TOR). GV was correlated with persistent AKD, while no statistically significant association was observed between GV and delayed AKD. Unique cutoff thresholds were calculated for each GV metric to provide a quantitative indicator of high GV, enhancing its practical utility.

CONCLUSIONS: Our study highlights the association between postoperative GV and increased AKD risk, and identifies specific GV thresholds in adults undergoing cardiac surgery.

PMID:39602857 | DOI:10.1016/j.jclinane.2024.111706

Injury. 2024 Nov 19;56(2):112033. doi: 10.1016/j.injury.2024.112033. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the prevalence and influencing factors of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) in trauma patients, and to explore the predictive effect of ASD on PTSD.

METHODS: A prospective study was conducted on patients hospitalized due to injuries. The first survey used the ASD scale to assess the occurrence of ASD. In one month and three months of follow-up after injury, patients were assessed for the occurrence of PTSD by using the PTSD checklist-civilian version.

RESULTS: The prevalence rates of ASD, one-month PTSD, and three-month PTSD in trauma inpatients were 20.7%, 19.5%, and 17.6%, respectively. ASD is a strong predictor of PTSD, and combining it with severe injury and critical illness can improve the sensitivity and positive predictive ability of predicting the occurrence of PTSD (AUC_Max: 0.827). The important predictive factor for the diagnosis of PTSD is the high alert symptom group of ASD. Moreover, the analysis results showed that the season of trauma happened, comatose state, fear state, psychological burden, and pain intensity were the influencing factors for ASD (P<0.05), while critical illness during hospitalization, psychological burden, and pain intensity were the influencing factors for PTSD (P<0.05).

LIMITATIONS: Some patients with minor and extremely serious injuries were overlooked or missed, resulting in selection bias and information bias that could not be completely avoided.

CONCLUSION: Both trauma conditions and clinical features may affect the occurrence of ASD and PTSD in trauma patients. If ASD in trauma patients is identified early and targeted interventions, it may reduce the occurrence and development of PTSD.

PMID:39602847 | DOI:10.1016/j.injury.2024.112033

JMIR Serious Games. 2024 Nov 27;12:e56918. doi: 10.2196/56918.

ABSTRACT

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of the common neurodevelopmental disorders in children and virtual reality (VR) has been used in the diagnosis and treatment of ADHD.

OBJECTIVE: This paper aims to systematically evaluate the effect of VR technology on the attention and motor ability of children with ADHD.

METHODS: The intervention method of the experimental group was VR technology, while the control group adopted non-VR technology. The population was children with ADHD. The outcome indicators were attention and motor abilities. The experimental design was randomized controlled trial. Two researchers independently searched PubMed, Cochrane Library, Web of Science, and Embase for randomized controlled trials related to the effect of VR technology on ADHD children’s attention and motor ability. The retrieval date was from the establishment of each database to January 4, 2023. The PEDro scale was used to evaluate the quality of the included literature. Stata (version 17.0; StataCorp LLC) was used for effect size combination, forest map-making, subgroup analyses, sensitivity analyses, and publication bias. GRADEpro (McMaster University and Evidence Prime Inc) was used to evaluate the level of evidence quality.

RESULTS: A total of 9 literature involving 370 children with ADHD were included. VR technology can improve ADHD children’s attention (Cohen d=-0.68, 95% CI -1.12 to -0.24; P<.001) and motor ability (Cohen d=0.48, 95% CI 0.16-0.80; P<.001). The intervention method and diagnosis type for VR technology had a moderating effect on the intervention’ impact on children’s attention (P<.05). The improvement in children’s attention by “immersive” VR technology was statistically significant (Cohen d=-1.05, 95% CI -1.76 to -0.34; P=.004). The improvement of children’s attention by “nonimmersive” VR technology was statistically significant (Cohen d=-0.28, 95% CI -0.55 to -0.01; P=.04). VR technology had beneficial effects on both children with an “informal diagnosis” (Cohen d=-1.47, 95% CI -2.35 to -0.59; P=.001) and those with a “formal diagnosis” (Cohen d=-0.44, 95% CI -0.85 to -0.03; P=.03).

CONCLUSIONS: VR technology can improve attention and motor ability in children with ADHD. Immersive VR technology has the best attention improvement effect for informally diagnosed children with ADHD.https://www.crd.york.ac.uk/PROSPERO/.

PMID:39602820 | DOI:10.2196/56918

J Am Acad Orthop Surg. 2024 Nov 22. doi: 10.5435/JAAOS-D-24-00469. Online ahead of print.

ABSTRACT

INTRODUCTION: Orthopaedic surgery has been recognized as one of the least diverse surgical specialties. Previous studies have demonstrated that women are heavily underrepresented within orthopaedic surgery. The purpose of this study was to determine whether orthopaedic surgery residency programs with a higher presence of women faculty had a higher proportion of women residents.

METHODS: The Fellowship and Residency Electronic Interactive Database was used to identify all orthopaedic surgery residency programs in the United States. Resident and faculty’s sex and degree were recorded in addition to faculty administrative title (eg, program director, chair) and academic rank (clinician, professor, etc). Pearson correlation coefficients were used to compare the number of women residents with the number of women faculty.

RESULTS: A total of 192 orthopaedic surgery programs were analyzed. Of the 5,747 faculty members and 4,268 residents identified, 13.1% (n = 752) and 22.6% (n = 963) were women, respectively. The number of women residents markedly correlated with the number of women faculty in leadership positions (r = 0.516, P < 0.001), such as chief or chair. The most significant correlations were among women with the academic role of “professor” (r = 0.575, P < 0.001), “assistant professor” (r = 0.555, P < 0.001), and women who held faculty positions but held no higher academic appointment (r = 0.509, P < 0.001). Program directors and assistant program directors were not found to have significant correlations with the number of women residents.

CONCLUSION: This study demonstrates a positive correlation between women faculty and residents at orthopaedic surgery residencies. Some academic positions, such as division chief, held more significant associations, whereas other positions, such as professor emeritus, were not held by any women, thereby limiting statistical analysis. Further investigation into minority representation in orthopaedic surgery and initiatives to address the observed disparities is paramount.

PMID:39602816 | DOI:10.5435/JAAOS-D-24-00469

J Med Internet Res. 2024 Nov 27;26:e55185. doi: 10.2196/55185.

ABSTRACT

BACKGROUND: Many patients do not receive a comprehensive medication reconciliation, mostly owing to limited resources. We hence need an approach to identify those patients at the emergency department (ED) who are at increased risk for clinically relevant discrepancies.

OBJECTIVE: The aim of our study was to develop and externally validate a prediction model to identify patients at risk for at least 1 clinically relevant medication discrepancy upon ED presentation.

METHODS: A prospective, multicenter, observational study was conducted at the University Hospitals Leuven and General Hospital Sint-Jan Brugge-Oostende AV, Belgium. Medication histories were obtained from patients admitted to the ED between November 2017 and May 2022, and clinically relevant medication discrepancies were identified. Three distinct datasets were created for model development, temporal external validation, and geographic external validation. Multivariable logistic regression with backward stepwise selection was used to select the final model. The presence of at least 1 clinically relevant discrepancy was the dependent variable. The model was evaluated by measuring calibration, discrimination, classification, and net benefit.

RESULTS: We included 824, 350, and 119 patients in the development, temporal validation, and geographic validation dataset, respectively. The final model contained 8 predictors, for example, age, residence before admission, number of drugs, and number of drugs of certain drug classes based on Anatomical Therapeutic Chemical coding. Temporal validation showed excellent calibration with a slope of 1.09 and an intercept of 0.18. Discrimination was moderate with a c-index (concordance index) of 0.67 (95% CI 0.61-0.73). In the geographic validation dataset, the calibration slope and intercept were 1.35 and 0.83, respectively, and the c-index was 0.68 (95% CI 0.58-0.78). The model showed net benefit over a range of clinically reasonable threshold probabilities and outperformed other selection criteria.

CONCLUSIONS: Our software-implemented prediction model shows moderate performance, outperforming random or typical selection criteria for medication reconciliation. Depending on available resources, the probability threshold can be customized to increase either the specificity or the sensitivity of the model.

PMID:39602806 | DOI:10.2196/55185

JMIR Ment Health. 2024 Nov 27;11:e59145. doi: 10.2196/59145.

ABSTRACT

BACKGROUND: The need for scalable solutions facilitating access to eating disorder (ED) treatment services that are efficient, effective, and inclusive is a major public health priority. Remote access to synchronous and asynchronous support delivered via health apps has shown promise, but results are so far mixed, and there are limited data on whether apps can enhance health care utilization.

OBJECTIVE: This study aims to examine the effects of app-augmented treatment on clinical outcomes and health care utilization for patients receiving treatment for an ED in outpatient and intensive outpatient levels of care.

METHODS: Recovery Record was implemented in outpatient and intensive outpatient services in a California-based health maintenance organization. We examined outcomes for eligible patients with ED by comparing clinical and service utilization medical record data over a 6-month period after implementation with analogous data for the control group in the year prior. We used a logistic regression model and inverse-weighted estimates of the probability of treatment to adjust for treatment selection bias.

RESULTS: App-augmented treatment was associated with a significant decrease in emergency department visits (P<.001) and a significant increase in outpatient treatment utilization (P<.001). There was a significantly larger weight gain for patients in low-weight categories (ie, underweight, those with anorexia, or those with severe anorexia) with app-augmented treatment (treatment effect: 0.74, 0.25, and 0.35, respectively; P=.02), with a greater percentage of patients moving into a higher BMI class (P=.01).

CONCLUSIONS: Integrating remote patient engagement apps into ED treatment plans can have beneficial effects on both clinical outcomes and service utilization. More research should be undertaken on long-term efficacy and cost-effectiveness to further explore the impact of digital health interventions in ED care.

PMID:39602804 | DOI:10.2196/59145

JMIR Res Protoc. 2024 Nov 27;13:e59545. doi: 10.2196/59545.

ABSTRACT

BACKGROUND: Rapid global population growth and urbanization have led to an increase in urban populations in low- and middle-income countries. Although these urban areas have generally better health outcomes than lower-income rural areas, many environmental, social, and health challenges remain. Vientiane, the capital of Lao People’s Democratic Republic (Lao PDR), has approximately 1.5 of the 7.5 million Laotian population (2022) and provides a unique opportunity to examine health outcomes among socioeconomically diverse populations in the rapidly urbanizing context of the country.

OBJECTIVE: The aim of the Vientiane multigenerational birth cohort (VITERBI) project is to (1) establish a multigenerational birth cohort in Vientiane capital, Lao PDR, which is representative of the local population, (2) serve as the basis for additional observational (ie, cross-sectional) and intervention studies that promote population health in Vientiane province, and (3) investigate the social, epidemiological, and medical problems of public health importance to Lao PDR.

METHODS: VITERBI is a prospective multigenerational birth cohort. The study population is structured around children born between July 1, 2022, and June 30, 2023, who reside in Chanthabuly, Sikhottabong, Sangthong, or Mayparkngum districts of Vientiane. Whenever possible, children and their mothers are enrolled during pregnancy; nonreported pregnancies are enrolled after birth. The cohort plans to enroll 3000 pregnant women and their children and the infants’ fathers, grandparents, and great-grandparents for a total study population of approximately 13,000 individuals. Participants will be followed throughout the life course with a range of data collected, including demographics, behavior, diet, physical activity, physiology, neurodevelopment, health history, quality of life, environmental exposures, depression, anxiety, stress, resilience, household characteristics, obstetric history, birth outcomes, and various living and dementia scales for older adults. Biomarkers collected include height, weight, blood pressure, and hemoglobin levels. Currently, no statistical analyses are planned.

RESULTS: As of April 2024, this study has enrolled 3500 pregnant women and 4579 family members. Study participation is ongoing until May 2025 at minimum, with the goal to extend follow-up until 2050.

CONCLUSIONS: The study cohort will be used as a basis for further observational (cross-sectional, longitudinal) and intervention studies. It also serves as a tool to investigate social, epidemiological, and medical problems of public health importance to Lao PDR, which will contribute to broader understanding of regional and international contexts.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/59545.

PMID:39602796 | DOI:10.2196/59545