Category: Statistics

Taiwan J Obstet Gynecol. 2024 Nov;63(6):880-886. doi: 10.1016/j.tjog.2024.01.039.

ABSTRACT

OBJECTIVE: Gestational diabetes mellitus (GDM) is a disorder that can occur during the second trimester of pregnancy. Our main objective was to perform a retrospective propensity-score matched analysis of a general population and to examine commonly occurring adverse maternal and infant outcomes in Taiwanese primiparous women with GDM.

MATERIALS AND METHODS: We conducted a nationwide population-based, retrospective propensity-score matched cohort study using the claims data from the Taiwan’s National Health Insurance program between 2000 and 2015. A 1:4 propensity matched cohort of women who aged 18 years or older with GDM (n = 5981) were compared with women without GDM (n = 23,924). Propensity score was calculated based on women’s age, residential urbanicity, delivery mode, antepartum comorbidity, and index year of delivery.

RESULTS: The GDM group had a significantly higher risk of overall emergency caesarean section, infant health conditions, and postpartum complications than the comparison group. Women in the GDM group were more likely to undergo emergency C-section for fetal distress, uterine atony, obstructed labor, delayed delivery, failed induction of labor, and umbilical cord prolapse. Infants of women with GDM were also more likely to encounter pregnancy complications of malpresentation, pre-maturity and post-maturity. Being the most common infant conditions, roughly one-third (36.41%) of all infant were affected by jaundice, particularly in women with GDM than those without GDM (45.96% vs 34.02%). There were also significant differences in perinatal period infection, congenital anomalies, transitory tachypnea, fetal distress and asphyxia, respiratory distress, and birth injury between the groups. Women with GDM were associated with increased risks of developing postpartum complications in perineum laceration, mastitis, postpartum hemorrhage, and subinvolution of uterus.

CONCLUSION: The present study suggests that GDM is associated with increased risks of adverse maternal and infant outcome in primiparous women without pre-existing mental diseases.

PMID:39481996 | DOI:10.1016/j.tjog.2024.01.039

Taiwan J Obstet Gynecol. 2024 Nov;63(6):867-873. doi: 10.1016/j.tjog.2024.03.024.

ABSTRACT

OBJECTIVE: To investigate the prevalence and longitudinal trend of severe maternal morbidity (SMM) at nationwide level in Taiwan. The associated maternal factors contributing to SMM were also analyzed.

MATERIALS AND METHODS: A population-based secondary analysis using administrative datasets released by Ministry of Health and Welfare of Taiwan from 2011 to 2021 was carried out. SMM was defined from ICD-9 or10-CM diagnosis and procedure codes previously released by CDC. The existence of any SMM indicators identified by delivery and postpartum hospitalizations between≧20 weeks of gestational age and within 42 days after childbirth was retrieved for analysis. Kendall Tau-b correlation was applied for trend test. Logistic regression was used to investigate the associated maternal factors for SMM. All the data were analyzed using SAS statistical software version 9.4. Statistical significance was defined as P value < 0.05.

RESULTS: A total of 2,054,010 delivery hospitalization records were identified during the study period. 6961 subjects met the SMM indicators, yielding an average SMM rate of 3.4 per 1000 deliveries. The pure transfusion rate was 2.33%. The overall SMM rate including transfusion reached 26.7 per thousand deliveries. The trend of SMM including and excluding transfusion demonstrated significantly increasing. Extreme maternal age and cesarean delivery were two main maternal associated factors for SMM.

CONCLUSION: Our findings demonstrated the steadily increasing trend of SMM in the past decade from nationwide study in Taiwan. The sharply growing rates of blood transfusion made the prevention of obstetric hemorrhage imperative. Health policies should be focused on the encourage of early childbearing and avoidance of unnecessary cesarean delivery to reduce the maternal risks associated with SMM. Continuous surveillance of SMM is required to improve obstetric care and reduce severe maternal complications.

PMID:39481994 | DOI:10.1016/j.tjog.2024.03.024

Taiwan J Obstet Gynecol. 2024 Nov;63(6):846-852. doi: 10.1016/j.tjog.2024.06.012.

ABSTRACT

OBJECTIVE: Laser vaporization is less invasive than conization for cervical intraepithelial neoplasia (CIN). The outcome of laser vaporization for CIN is empirically known to depend on the colposcopic findings, especially localization of the lesion. In this study, we sought to identify factors involved in the outcome of laser vaporization.

MATERIALS AND METHODS: We retrospectively investigated 290 cases of CIN (CIN2, n = 180; CIN3, n = 110) treated with laser evaporation at Nishikawa Women’s Health Clinic between 2018 and 2021. All treatments were performed using a carbon dioxide laser under either colposcopic vision (n = 172) or direct vision using a vaginal speculum (n = 118). Risk factors were statistically examined for cure rate after treatment.

RESULTS: Multivariate analysis using a logistic regression model identified independent factors affecting the success of treatment to be high-risk human papillomavirus infection status preoperatively, CIN grade, presence of CIN lesions at the periphery of the cervix, and the surgical method used. Colposcopy-guided laser vaporization reduced the risk of treatment failure by 84% (odds ratio 0.16, 95% confidence interval 0.06-0.46; p = 0.001) compared with direct vision using a vaginal speculum. For lesions at the periphery of the cervix, most of the treatment failures were in the group that was not guided by colposcopy (p = 0.031).

CONCLUSION: The presence of a peripheral CIN lesion was suggested to be a risk factor for treatment failure. Laser vaporization under colposcopic vision is recommended for treatment of peripheral CIN lesions.

PMID:39481991 | DOI:10.1016/j.tjog.2024.06.012

J Environ Sci (China). 2025 May;151:667-676. doi: 10.1016/j.jes.2024.04.035. Epub 2024 Apr 27.

ABSTRACT

The ambient air quality has improved significantly under strict emission controls in Beijing, China over the last decade. Black carbon (BC), as a short-lived climate forcer in ambient aerosols, profoundly impacts the air quality and climate. Previous studies have demonstrated a decline in the mass concentration of BC. In this study, we characterized the chemical compositions and size distributions of BC-containing particles during the cold season of 2022 in Beijing using state-of-the-art instruments capable of exclusively measuring BC-containing particles. The optical properties of BC-containing particles were further calculated based on the Mie theory. Moreover, we compared the properties of BC-containing particles in 2022 with the results of previous studies. The results showed that the diameters of BC cores became larger while the coating thickness of BC-containing particles became thinner in 2022. For the coating materials, the mass fraction of nitrate increased obviously, and even replaced organic matter as the dominant component during the peak of the pollution period. Variations in chemical compositions and size distributions resulted in lower mass absorption cross-sections (MAC) of BC-containing particles from 10.5 ± 1.1 m²/g in 2016 to 7.3 ± 0.8 m²/g in 2022, reduced by 30.5%. Our results demonstrate the synergistic benefits of air pollution control in improving air quality and mitigating climate change. Therefore, the MAC of BC adopted in climate models should vary with the changing air pollution levels. This study emphasizes that it is imperative to conduct long-term observations of BC-containing particles to better estimate BC’s climate effects.

PMID:39481971 | DOI:10.1016/j.jes.2024.04.035

J Environ Sci (China). 2025 May;151:652-666. doi: 10.1016/j.jes.2024.04.024. Epub 2024 Apr 26.

ABSTRACT

Studying the spatiotemporal distribution and transboundary transport of aerosols, NO₂, SO₂, and HCHO in typical regions is crucial for understanding regional pollution causes. In a 2-year study using multi-axis differential optical absorption spectroscopy in Qingdao, Shanghai, Xi’an, and Kunming, we investigated pollutant distribution and transport across Eastern China-Ocean, Tibetan Plateau-Central and Eastern China, and China-Southeast Asia interfaces. First, pollutant distribution was analyzed. Kunming, frequently clouded and misty, exhibited consistently high aerosol optical depth throughout the year. In Qingdao and Shanghai, NO₂ and SO₂, as well as SO₂ in Xi’an, increased in winter. Elevated HCHO in summer in Shanghai and Xi’an, especially Xi’an, suggests potential ozone pollution issues. Subsequently, pollutant transportation across interfaces was studied. At the Eastern China-Ocean interface, the gas transport flux was the largest among other interfaces, with the outflux exceeding the influx, especially in winter and spring. The input of pollutants from the Tibetan Plateau to central-eastern China was larger than the output in winter and spring, with SO₂ having the highest transport flux in winter. The pollution input from Southeast Asia to China significantly exceeded the output, with spring and winter inputs being 3.22 and 3.03 times the output, respectively. Lastly, the transportation characteristics of a pollution event at Kunming were studied. During this period, pollutants were transported from west to east, with the maximum SO₂ transport flux at an altitude of 2.87 km equaling 27.74 µg/(m²·s). It is speculated that this pollution was caused by the transport from Southeast Asian countries to Kunming.

PMID:39481970 | DOI:10.1016/j.jes.2024.04.024

J Environ Sci (China). 2025 May;151:640-651. doi: 10.1016/j.jes.2024.04.019. Epub 2024 Apr 21.

ABSTRACT

Majority of carbon emissions originate from fossil energy consumption, thus necessitating calculation and monitoring of carbon emissions from energy consumption. In this study, we utilized energy consumption data from Sichuan Province and Chongqing Municipality for the years 2000 to 2019 to estimate their statistical carbon emissions. We then employed nighttime light data to downscale and infer the spatial distribution of carbon emissions at the county level within the Chengdu-Chongqing urban agglomeration. Furthermore, we analyzed the spatial pattern of carbon emissions at the county level using the coefficient of variation and spatial autocorrelation, and we used the Geographically and Temporally Weighted Regression (GTWR) model to analyze the influencing factors of carbon emissions at this scale. The results of this study are as follows: (1) from 2000 to 2019, the overall carbon emissions in the Chengdu-Chongqing urban agglomeration showed an increasing trend followed by a decrease, with an average annual growth rate of 4.24%. However, in recent years, it has stabilized, and 2012 was the peak year for carbon emissions in the Chengdu-Chongqing urban agglomeration; (2) carbon emissions exhibited significant spatial clustering, with high-high clustering observed in the core urban areas of Chengdu and Chongqing and low-low clustering in the southern counties of the Chengdu-Chongqing urban agglomeration; (3) factors such as GDP, population (Pop), urbanization rate (Ur), and industrialization structure (Ic) all showed a significant influence on carbon emissions; (4) the spatial heterogeneity of each influencing factor was evident.

PMID:39481969 | DOI:10.1016/j.jes.2024.04.019

JMIR Public Health Surveill. 2024 Oct 31;10:e53673. doi: 10.2196/53673.

ABSTRACT

BACKGROUND: Benign prostatic hyperplasia (BPH) is a global age-related disease. It has been reported that over half of the Chinese male population aged 70 years or older are experiencing BPH. Solid fuel, which is the major source of household air pollution, has been reportedly associated with several adverse events, including sex hormone disorders. Due to the certain relationship between sex hormone levels and prostate disease, the relationship between solid fuel use and lower urinary tract symptoms (LUTSs) suggestive of BPH (LUTS/BPH) deserves further exploration.

OBJECTIVE: This study mainly aimed to investigate the association between solid fuel use and LUTS/BPH.

METHODS: The data used in this study were obtained from the West China Natural Population Cohort Study. Household energy sources were assessed using questionnaires. LUTS/BPH was evaluated based on participant self-reports. We performed propensity score matching (PSM) to reduce the influence of bias and unmeasured confounders. The odds ratio (OR) and 95% CI of LUTS/BPH for the solid fuel group compared with the clean fuel group were calculated. We also conducted stratified analyses based on BMI, metabolic syndrome, waist to hip ratio, drinking status, smoking status, and age.

RESULTS: A total of 5463 participants were included in this study, including 399 solid fuel users and 5064 clean fuel users. After PSM, the solid fuel group included 354 participants, while the clean fuel group included 701 participants. Solid fuel use was positively correlated with LUTS/BPH before and after PSM (OR 1.68, 95% CI 1.31-2.15 and OR 1.81, 95% CI 1.35-2.44, respectively). In stratified analyses, the OR of the nonsmoking group was higher than that of the smoking group (OR 2.56, 95% CI 1.56-4.20 and OR 1.47, 95% CI 0.99-2.18, respectively). Similarly, the OR of the nondrinking group was higher than that of the drinking group (OR 2.70, 95% CI 1.46-4.99 and OR 1.48, 95% CI 1.01-2.17, respectively).

CONCLUSIONS: A positive correlation between solid fuel use and LUTS/BPH was observed. The results suggest that improving fuel structure for household cooking and other household needs can possibly help reduce the risk of LUTS/BPH.

PMID:39481119 | DOI:10.2196/53673

JMIR Res Protoc. 2024 Oct 31;13:e63761. doi: 10.2196/63761.

ABSTRACT

BACKGROUND: Sexual minority men are disproportionately affected by methamphetamine use, with recent studies suggesting an increase in use specifically among Black sexual minority men. Black sexual minority men face unique structural barriers to achieving optimal health. Given its harmful effects, and in light of existing health disparities, an increase in methamphetamine use among Black sexual minority men poses a significant public health concern.

OBJECTIVE: The Health Impacts and Struggles to Overcome the Racial Discrimination of Yesterday (HISTORY) study is investigating the potential impacts of exposure to the census tract-level structural racism and discrimination (SRD) on methamphetamine use among Black sexual minority men in Atlanta, Georgia, and will identify intervention targets to improve prevention and treatment of methamphetamine use in this population.

METHODS: This study uses a mixed methods and multilevel design over a 5-year period and incorporates participatory approaches. Individual-level quantitative data will be collected from a community-based cohort of Black sexual minority men (N=300) via periodic assessment surveys, ecological momentary assessments, and medical record abstractions. Census tract-level measures of SRD will be constructed using publicly available administrative data. Qualitative data collection will include longitudinal, repeated in-depth interviews with a subset (n=40) of study participants. Finally, using a participatory group model-building process, we will build on our qualitative and quantitative data to generate causal maps of SRD and methamphetamine use among Black sexual minority men, which in turn will be translated into actionable recommendations for structural intervention.

RESULTS: Enrollment in the HISTORY study commenced in March 2023 and is anticipated to be completed by November 2024.

CONCLUSIONS: The HISTORY study will serve as a crucial background upon which future structural interventions can be built, to mitigate the effects of methamphetamine use and SRD among Black sexual minority men.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63761.

PMID:39481101 | DOI:10.2196/63761

J Med Internet Res. 2024 Oct 31;26:e57040. doi: 10.2196/57040.

ABSTRACT

BACKGROUND: The concept of health literacy (HL) is constantly evolving, and social determinants of health (SDoH) have been receiving considerable attention in public health scholarship. Since a 1-size-fits-all approach for HL fails to account for multiple contextual factors and as a result poses challenges in improving literacy levels, there is a need to develop a deeper understanding of the current state of HL and digital health literacy (DHL) research.

OBJECTIVE: This study examined scholars’ conceptualization and scope of work focused on HL and DHL.

METHODS: Using a search string, investigators (N=2042) focusing on HL, DHL, or both were identified from the grantee websites of the National Institutes of Health RePORTER (RePORT Expenditures and Results) and the Canadian Institutes of Health Research. The investigators were emailed a survey via Qualtrics. Survey questions examined the focus of work; whether the investigators studied HL/DHL in combination with other SDoH; the frameworks, definitions, and approaches used; and research settings. We analyzed survey data using SPSS Statistics version 28 and descriptive analysis, including frequencies and percentages, was conducted. Chi-square tests were performed to explore the association between the focus of work, settings, and age groups included in the investigators’ research.

RESULTS: A total of 193 (9.5%) of 2042 investigators responded to the online survey. Most investigators (76/153, 49.7%) were from public health, 83/193 (43%) reported their research focused on HL alone, 46/193 (23.8%) mentioned DHL, and 64/193 (33.2%) mentioned both. The majority (133/153, 86.9%) studied HL/DHL in combination with other SDoH, 106/135 (78.5%) conducted HL/DHL work in a community setting, and 100/156 (64.1%) reported not using any specific definition to guide their work. Digital tools (89/135, 65.9%), plain-language materials (82/135, 60.7%), and visual guides (56/135, 41.5%) were the top 3 approaches used. Most worked with adults (131/139, 94.2%) and all races and ethnicities (47/121, 38.8%).

CONCLUSIONS: HL and DHL research largely considered SDoH. Multiple HL tools and approaches were used that support the examination and improvement of literacy and communication surrounding health care issues.

PMID:39481097 | DOI:10.2196/57040

J Med Internet Res. 2024 Oct 31;26:e58066. doi: 10.2196/58066.

ABSTRACT

BACKGROUND: Cervical cancer is a significant cause of mortality in women. Although screening has reduced cervical cancer mortality, screening rates remain suboptimal. Electronic health interventions emerge as promising strategies to effectively tackle this issue.

OBJECTIVE: This systematic review and meta-analysis aimed to determine the effectiveness of electronic health interventions in cervical cancer screening.

METHODS: On December 29, 2023, we performed an extensive search for randomized controlled trials evaluating electronic health interventions to promote cervical cancer screening in adults. The search covered multiple databases, including MEDLINE, the Cochrane Central Registry of Controlled Trials, Embase, PsycINFO, PubMed, Scopus, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature. These studies examined the effectiveness of electronic health interventions on cervical cancer screening. Studies published between 2013 and 2022 were included. Two independent reviewers evaluated the titles, abstracts, and full-text publications, also assessing the risk of bias using the Cochrane Risk of Bias 2 tool. Subgroup analysis was conducted based on subjects, intervention type, and economic level. The Mantel-Haenszel method was used within a random-effects model to pool the relative risk of participation in cervical cancer screening.

RESULTS: A screening of 713 records identified 14 articles (15 studies) with 23,102 participants, which were included in the final analysis. The intervention strategies used in these studies included short messaging services (4/14), multimode interventions (4/14), phone calls (2/14), web videos (3/14), and internet-based booking (1/14). The results indicated that electronic health interventions were more effective than control interventions for improving cervical cancer screening rates (relative risk [RR] 1.464, 95% CI 1.285-1.667; P<.001; I²=84%), cervical cancer screening (intention-to-treat) (RR 1.382, 95% CI 1.214-1.574; P<.001; I²=82%), and cervical cancer screening (per-protocol; RR 1.565, 95% CI 1.381-1.772; P<.001; I²=74%). Subgroup analysis revealed that phone calls (RR 1.82, 95% CI 1.40-2.38), multimode (RR 1.62, 95% CI 1.26-2.08), SMS (RR 1.41, 95% CI 1.14-1.73), and video- and internet-based booking (RR 1.25, 95% CI 1.03-1.51) interventions were superior to usual care. In addition, electronic health interventions did not show a statistically significant improvement in cervical cancer screening rates among women with HPV (RR 1.17, 95% CI 0.95-1.45). Electronic health interventions had a greater impact on improving cervical cancer screening rates among women in low- and middle-income areas (RR 1.51, 95% CI 1.27-1.79). There were no indications of small study effects or publication bias.

CONCLUSIONS: Electronic health interventions are recommended in cervical cancer screening programs due to their potential to increase participation rates. However, significant heterogeneity remained in this meta-analysis. Researchers should conduct large-scale studies focusing on the cost-effectiveness of these interventions.

TRIAL REGISTRATION: CRD42024502884; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=502884.

PMID:39481096 | DOI:10.2196/58066