Category: Statistics

J Med Internet Res. 2024 Nov 27;26:e54248. doi: 10.2196/54248.

ABSTRACT

BACKGROUND: Detecting early dropout from digital interventions is crucial for developing strategies to enhance user retention and improve health-related behavioral outcomes. Bricker and colleagues proposed a single metric that accurately predicted early dropout from 4 digital tobacco cessation interventions based on log-in data in the initial week after registration. Generalization of this method to additional interventions and modalities would strengthen confidence in the approach and facilitate additional research drawing on it to increase user retention.

OBJECTIVE: This study had two research questions (RQ): RQ1-can the study by Bricker and colleagues be replicated using data from a large-scale observational, multimodal intervention to predict early dropout? and RQ2-can first-week engagement patterns identify users at the greatest risk for early dropout, to inform development of potential “rescue” interventions?

METHODS: Data from web users were drawn from EX, a freely available, multimodal digital intervention for tobacco cessation (N=70,265). First-week engagement was operationalized as any website page views or SMS text message responses within 1 week after registration. Early dropout was defined as having no subsequent engagement after that initial week through 1 year. First, a multivariate regression model was used to predict early dropout. Model predictors were dichotomous measures of engagement in each of the initial 6 days (days 2-7) following registration (day 1). Next, 6 univariate regression models were compared in terms of their discrimination ability to predict early dropout. The sole predictor of each model was a dichotomous measure of whether users had reengaged with the intervention by a particular day of the first week (calculated separately for each of 2-7 days).

RESULTS: For RQ1, the area under the receiver operating characteristic curve (AUC) of the multivariate model in predicting dropout after 1 week was 0.72 (95% CI 0.71-0.73), which was within the range of AUC metrics found in the study by Bricker and colleagues. For RQ2, the AUCs of the univariate models increased with each successive day until day 4 (0.66, 95% CI 0.65-0.67). The sensitivity of the models decreased (range 0.79-0.59) and the specificity increased (range 0.48-0.73) with each successive day.

CONCLUSIONS: This study provides independent validation of the use of first-week engagement to predict early dropout, demonstrating that the method generalizes across intervention modalities and engagement metrics. As digital intervention researchers continue to address the challenges of low engagement and early dropout, these results suggest that first-week engagement is a useful construct with predictive validity that is robust across interventions and definitions. Future research should explore the applicability and efficiency of this model to develop interventions to increase retention and improve health behavioral outcomes.

PMID:39602788 | DOI:10.2196/54248

J Med Internet Res. 2024 Nov 27;26:e60590. doi: 10.2196/60590.

ABSTRACT

BACKGROUND: Teledentistry is a field of activities that comprises information and communication technologies (ICTs) applied to dentistry, including the exchange of clinical information, patient care, and the use of educational strategies across remote distances. Its use has grown progressively over the past decades-intensified by the COVID-19 pandemic-and has been improving the provision of dental services and educational strategies ever since.

OBJECTIVE: This evidence gap map (EGM) study aims to present a collection of systematic reviews (SRs) with meta-analyses to answer the question “What are the applications of teledentistry in dental services and dental education?” by identifying gaps and current evidence on the improvement of health care and education.

METHODS: The EGM methodology has been developed by the Latin American and Caribbean Center on Health Sciences Information and is based on the concept created by the International Initiative for Impact Evaluation. Embase, PubMed, and Virtual Health Library databases were used for the literature research, using terms for teledentistry associated with eHealth, dental education, and oral health care. The data obtained from the included studies were then characterized in a Microsoft Excel spreadsheet, with a matrix containing 8 intervention groups (combined interventions, e-learning and tele-education, teleconsultation and teleservice, telemonitoring, telediagnosis, telescreening, ICTs, and artificial intelligence) and 8 outcome groups (diagnosis accuracy, education and professional training, user behavior, clinical practice, patient-centered outcomes, clinical outcomes, health services management, and access to health services). The quality of the studies was assessed using AMSTAR2 (A Measurement Tool to Assess Systematic Reviews). The visual analytics platform Tableau (Salesforce) was used to graphically display the confidence level, number of reviews, health outcomes, and intervention effects.

RESULTS: The confidence level obtained by the criteria applied was high for 28% (19/68) of the studies, moderate for 6% (4/68), low for 15% (10/68), and critically low for 51% (35/68). Among the interventions, the ICT group stood out with 182 (36.8%) out of 494 associations, followed by interventions with e-learning and tele-education (n=96, 19.4% of associations), telediagnosis (n=67, 13.6%), and combined interventions (n=53, 10.7%). Most of the outcomes were aimed at education and professional training (97/494, 19.6% of associations), patient-centered outcomes (74/494, 15%), and health services management (60/494, 12.1%).

CONCLUSIONS: This EGM presents an overview of the contributions of teledentistry in patient care, health services, clinical practice, and education. The study results may help guide future research and policy decisions and serve as a convenient virtual tool for accessing valuable evidence-based information on teledentistry.

PMID:39602783 | DOI:10.2196/60590

J Med Internet Res. 2024 Nov 27;26:e56651. doi: 10.2196/56651.

ABSTRACT

BACKGROUND: Online wellness influencers (individuals dispensing unregulated health and wellness advice over social media) may have incentives to oppose traditional medical authorities. Their messaging may decrease the overall effectiveness of public health campaigns during global health crises like the COVID-19 pandemic.

OBJECTIVE: This study aimed to probe how wellness influencers respond to a public health campaign; we examined how a sample of wellness influencers on Twitter (rebranded as X in 2023) identified before the COVID-19 pandemic on Twitter took stances on the COVID-19 vaccine during 2020-2022. We evaluated the prevalence of provaccination messaging among wellness influencers compared with a control group, as well as the rhetorical strategies these influencers used when supporting or opposing vaccination.

METHODS: Following a longitudinal design, wellness influencer accounts were identified on Twitter from a random sample of tweets posted in 2019. Accounts were identified using a combination of topic modeling and hand-annotation for adherence to influencer criteria. Their tweets from 2020-2022 containing vaccine keywords were collected and labeled as pro- or antivaccination stances using a language model. We compared their stances to a control group of noninfluencer accounts that discussed similar health topics before the pandemic using a generalized linear model with mixed effects and a nearest-neighbors classifier. We also used topic modeling to locate key themes in influencer’s pro- and antivaccine messages.

RESULTS: Wellness influencers (n=161) had lower rates of provaccination stances in their on-topic tweets (20%, 614/3045) compared with controls (n=242 accounts, with 42% or 3201/7584 provaccination tweets). Using a generalized linear model of tweet stance with mixed effects to model tweets from the same account, the main effect of the group was significant (β₁=-2.2668, SE=0.2940; P<.001). Covariate analysis suggests an association between antivaccination tweets and accounts representing individuals (β=-0.9591, SE=0.2917; P=.001) but not social network position. A complementary modeling exercise of stance within user accounts showed a significant difference in the proportion of antivaccination users by group (χ²₁[N=321]=36.1, P<.001). While nearly half of the influencer accounts were labeled by a K-nearest neighbor classifier as predominantly antivaccination (48%, 58/120), only 16% of control accounts were labeled this way (33/201). Topic modeling of influencer tweets showed that the most prevalent antivaccination themes were protecting children, guarding against government overreach, and the corruption of the pharmaceutical industry. Provaccination messaging tended to encourage followers to take action or emphasize the efficacy of the vaccine.

CONCLUSIONS: Wellness influencers showed higher rates of vaccine opposition compared with other accounts that participated in health discourse before the pandemic. This pattern supports the theory that unregulated wellness influencers have incentives to resist messaging from establishment authorities such as public health agencies.

PMID:39602782 | DOI:10.2196/56651

Opt Lett. 2024 Dec 1;49(23):6609-6612. doi: 10.1364/OL.538457.

ABSTRACT

The mode-pairing quantum key distribution (MP-QKD) protocol, which can achieve high key rates over long distances without phase locking, is a potential candidate for implementing intercity QKD. However, achieving precise control of the light source intensity in a field MP-QKD experiment is an exceedingly challenging task. In this Letter, we study the decoy-state MP-QKD protocol with light source intensity fluctuations. Furthermore, we propose a statistical analysis method based on the T-distribution to calculate confidence intervals of intensity fluctuations. Finally, in the field MP-QKD experiments, considering intensity fluctuations and the finite size effect, we obtain secure key rates of 1.03 × 10^-6 bit/pair and 3.64 × 10^-6 bit/pair for the symmetric (195.8 km) and asymmetric (127.7 km) cases, respectively.

PMID:39602706 | DOI:10.1364/OL.538457

Appl Opt. 2024 Dec 1;63(34):8760-8770. doi: 10.1364/AO.537840.

ABSTRACT

Soft matter research often involves studying correlation functions such as the intermediate scattering function. Wave scattering experiments or digital Fourier microscopy are usually used to obtain this function, generating large amounts of data that must be analyzed to obtain reliable information. However, this process can be time-consuming and requires an optimized data analysis procedure to minimize calculations while ensuring statistical validity. To address this issue, we have developed an algorithm that uses an efficient sampling technique to reduce the number of calculations needed for fast statistical convergence in digital Fourier microscopy. Our algorithm provides information equivalent to traditional analysis but in a much shorter time frame, up to 2 orders of magnitude faster.

PMID:39602682 | DOI:10.1364/AO.537840

Neurol Neuroimmunol Neuroinflamm. 2025 Jan;12(1):e200335. doi: 10.1212/NXI.0000000000200335. Epub 2024 Nov 27.

ABSTRACT

BACKGROUND AND OBJECTIVES: Multiple sclerosis (MS) is a CNS disease, characterized by demyelination, inflammation, and neurodegeneration. Recent advances in technology allow measurement of the axonal damage marker neurofilament light chain in peripheral blood. Two studies have shown that patients with MS have elevated neurofilament light levels before their first symptom, but longitudinal studies are lacking. We aimed to investigate the intraindividual neurofilament light dynamics during the presymptomatic phase of MS.

METHODS: The Danish Blood Donor Study (DBDS) has stored plasma samples from blood donors for more than 10 years. We identified DBDS participants, who had subsequently been diagnosed with MS, and included all samples donated before their first demyelinating symptom (median 5.00 samples per case). As controls, we included 2 healthy donors per case. Plasma levels of neurofilament light were measured and compared with quality-of-life data. We used a Bayesian approach to derive estimates for the percentage of cases with presymptomatic increased neurofilament light levels.

RESULTS: We observed that 12 (17%, 95% CI 9%-28%) of 69 presymptomatic MS donors had intermittently increased neurofilament light levels preclinically. Increased levels were present up to 9 years before clinical onset, also in primary progressive MS. Healthy donors and presymptomatic MS donors with and without increased neurofilament light levels reported equally high physical and mental well-being. Model-based estimates suggested that 55% of cases (95% credible interval [28%-87%]) had experienced increased presymptomatic neurofilament light levels.

DISCUSSION: Patients with MS periodically sustain axonal injury up to 9 years before clinical onset, even in primary progressive disease. This most likely represents asymptomatic disease activity. Some or even all patients are affected by this intermittent axonal injury, prompting the need for further studies of the presymptomatic phase in relation to prognosis and as a therapeutic window of opportunity.

PMID:39602675 | DOI:10.1212/NXI.0000000000200335

JCO Glob Oncol. 2024 Nov;10:e2400123. doi: 10.1200/GO.24.00123. Epub 2024 Nov 27.

ABSTRACT

PURPOSE: Breast cancer remains a major public health challenge worldwide, and understanding the trends and changes in breast cancer diagnosis and treatment over time is crucial for improving patient outcomes and guiding public health strategies. The Argentine Society of Mastology has maintained a comprehensive Breast Cancer Registry that provides valuable data for analyzing these trends.

MATERIALS AND METHODS: This retrospective analysis of the Breast Cancer Registry database evaluated changes in stages at the time of surgery, patterns of surgical care, and factors associated with higher stage diagnoses in patients with breast cancer in Argentina from January 2000 to December 2019.

RESULTS: Overall, 13,239 patients met the inclusion criteria. Significant differences were observed in the axillary procedure performed, with sentinel lymph node biopsy increasing from 14.9% (2000-2004) to 69.5% (2015-2019; P < .001). A higher proportion of in situ carcinoma was detected in the last 5-year period compared with the first (11.3% v 9.4%; P = .01) and fewer patients were stage III (17.1% v 14.2%). In multivariate analysis, postmenopausal status (odds ratio [OR], 0.72 [95% CI, 0.64 to 0.80]; P < .001), health coverage (social health insurance OR, 0.53 [95% CI, 0.46 to 0.61]; P < .001 and private insurance OR, 0.36 [95% CI, 0.31 to 0.42]; P < .001), tumor grade (grade 3 OR, 2.97 [95% CI, 2.54 to 3.47]; P < .001), and phenotype (hormone receptor-positive [HR+]/human epidermal growth factor receptor 2 [HER2]+ OR, 1.36 [95% CI, 1.10 to 1.70]; P = .005; HR-/HER2+ OR, 2.14 [95% CI, 1.62 to 2.83]; P < .001; HR-/HER2- OR, 1.40 [95% CI, 1.19 to 1.66]; P < .001) were associated with the risk of diagnosis at stages II-III.

CONCLUSION: Significant advances in the patterns of surgical care were identified. Numerous clinical and pathologic factors correlated with higher stage at diagnosis. However, multivariate analysis failed to show a noteworthy reduction in stage at diagnosis. This observation underscores the imperative to persistently strive to improve breast cancer care in Argentina.

PMID:39602672 | DOI:10.1200/GO.24.00123

Gac Med Mex. 2024;160(3):265-273. doi: 10.24875/GMM.M24000895.

ABSTRACT

BACKGROUND: Specific dietary compounds are essential for cognitive health.

OBJECTIVE: To examine differences in the consumption of macronutrients and inorganic nutrients between people with a higher and lower risk of cognitive impairment.

MATERIAL AND METHODS: Cross-sectional analysis of the 3Ollin study. Minimal Mental State Examination determined cognitive status. Two groups were obtained from the median of the score: higher and lower risk of cognitive deterioration. Diet was assessed using two 24-hour recalls. Descriptive statistics and comparison analysis of medians using Mann-Whitney U and Spearman correlation analysis were performed between nutrients and MMSE scores. The results were considered statistically significant when p ≤ 0.05.

RESULTS: Data from 425 people were analyzed; the median age was 71 years (P25-P75 = 65-77). In the group with a lower risk of cognitive impairment, a higher consumption of calories, protein, carbohydrates, fiber, folate, phosphorus, ascorbic acid, vitamin E, alpha-tocopherol, vitamin B₆, vitamin B₁₂, zinc, selenium, and lycopene were observed. Also, a greater consumption of fruits and vegetables (p < 0.005).

CONCLUSIONS: There are significant differences in diet between groups at risk for cognitive impairment.

PMID:39602619 | DOI:10.24875/GMM.M24000895

Gac Med Mex. 2024;160(3):301-307. doi: 10.24875/GMM.M24000898.

ABSTRACT

BACKGROUND: Aging in Mexico is heterogeneous considering the ethnic diversity and social inequality that prevails. The condition of ethnicity allows us to delve deeper into the social and health inequalities that do not allow for healthy aging.

OBJECTIVE: The objective of this article is to compare the levels of functionality of older people by ethnicity and its associated factors in Mexico.

MATERIAL AND METHODS: People aged 60 years and over were selected from the 2020 Census sample, grouping according to their ethnic status (Indigenous, Afro-Mexican and non-Indigenous and non-afro Mexican). As a dependent variable, the Functional Impairment Index (IDF) was constructed with principal components analysis, using the battery of disability questions; Generalized linear models were performed to analyse the factors associated by ethnicity status.

RESULTS: Indigenous older people have higher IDF values, followed by Afro-Mexican. Indigenous women and those who live in rural areas have higher values of functional impairment.

CONCLUSIONS: It is necessary to address the needs of the older Indigenous and Afro-Mexican population who face an old age with greater social disadvantage and functional deterioration.

PMID:39602617 | DOI:10.24875/GMM.M24000898

Gac Med Mex. 2024;160(3):247-257. doi: 10.24875/GMM.24000074.

ABSTRACT

BACKGROUND: Information about access to the public health system for elders is lacking in Mexico.

OBJECTIVE: Develop a cascade of access to the public health system in Mexican older adults and identify factors that could promote or hinder it.

MATERIAL AND METHODS: A cross-sectional analysis using data from the 2018, 2021, and 2022 National Health and Nutrition Survey rounds. A cascade of access to the public health system was constructed. Multivariate regression models were performed to identify related factors.

RESULTS: 43.33%, 40.85%, and 43.79% of older adults had access to the public health system in 2018, 2021, and 2022, respectively. In 2018, frailty increased 2.419 times the probability of having access. While, being married or in union, being literate, and living in an urban residency increased access in 2021 and 2022.

CONCLUSIONS: There are persistently low levels of public healthcare access among older Mexican adults. Frailty elders had more probability of having access in 2018. Seguro Popular might have promoted access by overcoming organizational obstacles from the public system and surpassing sociodemographic barriers. After its elimination, sociodemographic variables became more relevant in promoting or reducing access.

PMID:39602615 | DOI:10.24875/GMM.24000074