Category: Statistics

JCO Oncol Pract. 2024 Oct 17:OP2400354. doi: 10.1200/OP.24.00354. Online ahead of print.

ABSTRACT

PURPOSE: To study the influence of the Affordable Care Act (ACA) policy and its Medicaid expansion on insurance status and survival in patients with HIV with aggressive lymphoma.

METHODS: We used the National Cancer Database, a hospital-based national registry, to identify adults age 18-64 years with HIV-associated aggressive B-cell non-Hodgkin lymphomas (HIV-a-B-NHLs), diagnosed during 2007 to 2016. Survival analysis was performed on a subset of patients with HIV-a-B-NHL for whom location data were available who resided in Medicaid expansion-adopted and nonadopted states. Using a quasi-experimental difference-in-difference model, the difference in adjusted 2-year survival rates obtained with a flexible parametric Weibull model was compared for states that adopted the Medicaid expansion of ACA against those that did not adopt the expansion.

RESULTS: We identified 8,231 patients with HIV-a-B-NHL and 50,650 non-HIV patients with a-B-NHL. We found that a lower proportion of individuals were uninsured at diagnosis in the expansion states compared with nonexpansion states. We also found that the ACA policy adoption led to a reduction in the proportion of uninsured individuals with HIV-a-B-NHL in expansion states of 34.9%, compared with 15.9% in non-expansion-adopted states. There was a statistically significant improvement in the 2-year survival rate among patients with HIV-a-B-NHL in the expansion compared with nonexpansion states with the adoption of ACA (7.17% v 1.58%, P = .02).

CONCLUSION: Using a novel quasi-experimental model, we found that the ACA policy corresponded with a greater survival improvement in patients with HIV-a-B-NHL within Medicaid expansion-adopted states compared with nonexpansion states. We believe that this evidence should be taken into consideration in future policy making.

PMID:39418621 | DOI:10.1200/OP.24.00354

N Z Med J. 2024 Oct 18;137(1604):62-72. doi: 10.26635/6965.6552.

ABSTRACT

AIM: Acute alcohol use (AAU) can increase suicide risk. It is unknown if this effect differs by population sub-group in New Zealand, and what characteristics are associated with alcohol being coded as contributory to death, when AAU is identified. This study aimed to answer: 1) are the characteristics associated with suicide involving AAU different between females and males, and 2) among suicides that involved AAU, what factors are associated with alcohol being coded as a contributory factor?

METHOD: Secondary analysis was conducted of suicide data from 2007-2020, from the National Coronial Information System. Binomial regression models for females and males were used to estimate sex-specific differences in risk of suicide involving AAU. Poisson regression modelling was used to estimate the relative risk of alcohol being coded as contributory where AAU was identified.

RESULTS: Suicide was more likely to involve AAU among Māori females (adjusted risk ratio [ARR] 1.35, 95% confidence interval [CI] 1.08-1.68) and Pacific females (ARR 1.75, 95% CI 1.22-2.51), compared to European females. Compared to males who were employed, all other employment statuses had significantly lower risk of suicide that involved AAU. Those who died by hanging (ARR 0.75, 95% CI 0.62-0.92) or firearms (ARR 0.55, 95% CI 0.38-0.90) were less likely to have alcohol coded as contributory, compared to those who died by poisoning.

CONCLUSION: Targeted public health interventions designed by and for specific demographic groups (particularly Māori and Pacific females) are needed, alongside universal interventions that address social and structural determinants. Data systems and coding must accurately reflect the association between AAU and suicide in New Zealand.

PMID:39418606 | DOI:10.26635/6965.6552

N Z Med J. 2024 Oct 18;137(1604):35-41. doi: 10.26635/6965.6533.

ABSTRACT

AIMS: To estimate the cost-impact if faricimab were approved for the treatment of neovascular age-related macular degeneration (nAMD) in New Zealand.

METHODS: A retrospective, single-centre cost-analysis study. Data on intravitreal agent and injection intervals were obtained and statistically compared. Cost estimates were based on internal facility and publicly available data. The current costs of care were compared to two scenarios: one where all eyes receive faricimab, and another where eyes receiving aflibercept switch to faricimab.

RESULTS: A total of 352 eyes from 292 patients were analysed. Present values locally over 10 years were estimated at -$6,776,340 for the first scenario and $5,015,922 for the second, releasing 252 and 176 hours of clinical time per year, respectively. Nationally, the savings extrapolated to -$187,925,737 and $139,104,706, respectively. The analysis indicates significant direct cost savings for the health sector and potential reductions in patient harm due to fewer injections.

CONCLUSIONS: The approval of faricimab for the treatment of nAMD could result in substantial direct cost savings for the health sector. Additional benefits include reducing patient harm and improving ophthalmic health inequalities for Māori and Pacific peoples. Further research in diverse patient populations across multiple centres is needed to estimate the magnitude of cost savings more accurately. This study highlights the potential of faricimab to alleviate the treatment burden and provide a more sustainable healthcare option for nAMD in New Zealand, especially in cases of recalcitrant nAMD, if used in a tailored and patient-specific manner alongside the existing armamentarium of treatments.

PMID:39418603 | DOI:10.26635/6965.6533

N Z Med J. 2024 Oct 18;137(1604):13-21. doi: 10.26635/6965.6599.

ABSTRACT

AIM: To determine if high normal early pregnancy HbA1c (35-40mmol/mol), in the absence of diabetes, was associated with increased risk of adverse perinatal outcomes compared to normal HbA1c (<35mmol/mol).

METHOD: A retrospective chart review was carried out on all singleton births in the Wellington region from 1 July 2019 to 31 December 2019. Exclusion criteria were participants domiciled outside the Wellington region, HbA1c ≥50mmol/mol, pre-existing diabetes, gestational diabetes in current pregnancy, no HbA1c performed <20 weeks or the first HbA1c was taken at ≥20 weeks. Baseline characteristics, HbA1c and pregnancy outcomes were obtained. The primary outcome was birth weight and was analysed using multiple linear regression.

RESULTS: There were 1,067 participants in the normal HbA1c (nHbA1c) group and 186 in the high normal HbA1c (hnHbA1c) group. There was no difference in birth weight between hnHbA1c and nHbA1c. hnHbA1c had significantly lower odds of post-partum haemorrhage and composite maternal adverse outcomes compared to nHbA1c (OR 0.52, 95% CI 0.35-0.76) and (OR 0.64, 95% CI 0.46-0.89).

CONCLUSION: High normal HbA1c was not associated with increased risk of adverse perinatal outcomes in pregnant people who did not develop gestational diabetes.

PMID:39418601 | DOI:10.26635/6965.6599

Health Care Women Int. 2024 Oct 17:1-15. doi: 10.1080/07399332.2024.2413448. Online ahead of print.

ABSTRACT

The authors aimed to explore the association between anthropometric indicators and cognitive function and determine which aspects of anthropometric indicators are most closely related to cognitive function. A sum of 3269 older women were included in this study. Body mass index (BMI), waist circumference, hip circumference, calf circumference, and waist-to-hip ratio were obtained to reflect anthropometric indicators. Cognitive function was assessed using Mini-Mental State Examination (MMSE). Researchers revealed statistically significant differences in total MMSE scores among the low, medium, and high groups of BMI, waist circumference, hip circumference, and calf circumference. Researchers also observed that calf circumference, hip circumference, and waist circumference are significantly associated with the total MMSE score. Our findings highlighted that older women with greater BMI, waist circumference, hip circumference, and calf circumference have a better level of cognitive function. Calf circumference is the most closely anthropometric indicator related to cognitive function in Chinese older women.

PMID:39418595 | DOI:10.1080/07399332.2024.2413448

Environ Sci Technol. 2024 Oct 17. doi: 10.1021/acs.est.4c05327. Online ahead of print.

ABSTRACT

To assess the potential risks of contemporary levels of plastic pollution in freshwater ecosystems, a large-scale experiment was conducted over 10 weeks in a boreal lake at the IISD-Experimental Lakes Area (Ontario, Canada). Fragments of common polymers (polyethylene, polystyrene, and polyethylene terephthalate), each with distinct colors and buoyancies, were added as a single pulse to seven in-lake mesocosms in equal contributions in a range of environmentally relevant nominal concentrations (6-29,240 particles/L). Two additional mesocosms with no added microplastics were used as controls. Zooplankton ingested low levels of microplastics (mean of 0.06 particles/individual ± SD 0.07) and generally their total abundance and community composition were not negatively impacted. Temporary changes were however observed; total zooplankton abundance and abundance of calanoid copepods were temporarily stimulated by increasing nominal microplastic concentrations, and modest, short-term reductions in egg production of the cyclopoid copepod Tropocyclops extensus and abundance of copepod nauplii occurred. Collectively, these results suggest that microplastics could have complex impacts on zooplankton communities, stimulating some species while negatively impacting others.

PMID:39418533 | DOI:10.1021/acs.est.4c05327

J Craniofac Surg. 2024 Oct 1;35(7):2009-2014. doi: 10.1097/SCS.0000000000010592. Epub 2024 Oct 1.

ABSTRACT

OBJECTIVE: The aim of the study was to develop and evaluate an automated preoperative planning algorithm based on anatomical landmark point recognition for enhancing the efficiency and intelligence of preoperative planning for mandibular angle osteotomy.

METHODS: A retrospective cohort of 34 patients underwent preoperative planning with this algorithm. The present algorithm was developed using a method based on anatomical marker point recognition. The efficiency, symmetry, and safety of the automated preoperative planning and esthetics were statistically analyzed by paired t test and χ2 test.

RESULTS: The results showed that the automated planning algorithm was able to achieve a great improvement in preoperative planning efficiency as well as safety and symmetry. A prospective case report of 2 patients is then reported, illustrating the safety and esthetics of the algorithm with 1-year postoperative follow-up and postoperative esthetic scores.

CONCLUSION: This algorithm can help to improve the efficiency of preoperative planning for surgeons while ensuring safety and esthetics and can be further applied to other craniomaxillofacial personalized design surgeries in the preoperative design in the future.

PMID:39418506 | DOI:10.1097/SCS.0000000000010592

J Craniofac Surg. 2024 Oct 1;35(7):1952-1957. doi: 10.1097/SCS.0000000000010593. Epub 2024 Oct 1.

ABSTRACT

BACKGROUND: Racial and ethnic disparities have been extensively reported across surgical specialties, highlighting existing healthcare inequities. Nevertheless, evidence is lacking regarding their influence on postoperative outcomes after head and neck reconstruction. This study aimed to evaluate the impact of race and ethnicity on postoperative complications in head and neck microvascular reconstruction.

METHODS: The ACS-NSQIP database was used to identify patients who underwent head and neck microvascular reconstruction between 2012 and 2022. Baseline characteristics were compared based on race (White, non-White) and ethnicity (Hispanic, non-Hispanic). Group differences were assessed using t tests and Fisher Exact tests. Multivariable logistic regression models were constructed to evaluate postoperative complications between the groups. A Cochran-Armitage test was conducted to evaluate the significance of trends over time.

RESULTS: A total of 11,373 patients met inclusion criteria. Among them, 9,082 participants reported race, and 9,428 reported ethnicity. Multivariable analysis demonstrated that Hispanic patients were more likely to experience 30-day readmission (OR 6.7; 95% CI, 1.17-38.4; P=0.032) and had an average total length of stay of 5.25 days longer (95% CI, 0.84-9.65; P=0.020) compared with non-Hispanic patients. Additional subgroup analyses revealed higher rates of all readmissions among non-White patients, particularly those indicated by malignancy (OR 1.23; 95% CI, 1.1-1.4; P=0.002). No significant differences were found in mortality, reoperation rates, and operative times between racial and ethnic groups.

CONCLUSIONS: The findings of this study suggest that ethnicity may be a significant risk factor for readmission in head and neck microvascular reconstruction. However, future studies are needed to further clarify the impact of race and ethnicity on longer postoperative outcomes, particularly in head and neck cancer minorities.

PMID:39418505 | DOI:10.1097/SCS.0000000000010593

Braz J Cardiovasc Surg. 2024 Oct 17;e20230245(e20230245). doi: 10.21470/1678-9741-2023-0245.

ABSTRACT

INTRODUCTION: Serum lactate is a consequence of tissue hypoperfusion and has been used routinely for patient management following cardiac surgery. This study aims to determine the association of lactate with early mortality and postoperative morbidity.

METHODS: This is a prospective cohort study carried out in the Department of Cardiovascular and Thoracic Surgery, King George’s Medical University (India), from January 2020 to December 2022. A total of 270 patients were included in this study. Serum lactate levels were measured preoperatively, intraoperatively on-pump, coming off-pump, and at six, 12, 24, and 48 hours postoperatively.

RESULTS: Early mortality was noted in 17 cases (6.3%). While both lactate and lactate clearance correlated with duration of mechanical ventilation, vasopressor duration, and intensive care unit and hospital stay, correlation with early mortality was noted only with lactate at 24 hours. Logistic regression analysis demonstrated that lactate levels at preoperative period (adjusted odds ratio [OR] 4.76 [1.67-13.59], P=0.004) and at 24 hours after bypass (OR 1.21 [1.00-1.47], P=0.046) and vasopressor duration (OR 1.11 [1.04-1.19], P=0.002) are independent predictors of mortality. Receiver operating characteristic curve analysis showed that arterial lactate on-pump, off-pump, and at six, 12, and 24 hours after surgery had significant area under the curve for predicting mortality.

CONCLUSION: Arterial lactate and lactate clearance show good correlation with duration of mechanical ventilation, vasopressor support, and intensive care unit and hospital stay and can serve as a good indicator to guide therapeutic decisions in postoperative period. However, it fails to be a sensitive predictor of mortality.

PMID:39418497 | DOI:10.21470/1678-9741-2023-0245

Psychol Addict Behav. 2024 Oct 17. doi: 10.1037/adb0001029. Online ahead of print.

ABSTRACT

OBJECTIVE: Rates of problematic cannabis use among young adults are high and increasing. Craving for cannabis varies throughout the day and is an important risk factor for cannabis use, yet no studies to date have tested interventions offered at the moment craving is experienced in the natural environment.

METHOD: This study used an efficient and innovative microrandomized trial design to test two distinct types of coping messages (mindfulness strategy vs. distraction strategy) offering brief coping strategies when moderate to severe craving was reported via ecological momentary assessment (EMA).

RESULTS: Young adults who regularly use cannabis (N = 53) were readily engaged in this 4-week intervention, and EMA completion was high throughout, demonstrating excellent feasibility of this approach. However, results indicated that coping messages did not reduce craving at the next EMA relative to control (thank you) messages, with no significant change in efficacy over time. Furthermore, exploratory analyses found that neither mindfulness nor distraction resulted in reduced craving relative to the control message.

CONCLUSIONS: Despite this outcome, this method of testing digital interventions targeting momentary risks for substance use such as craving holds promise for rapidly and efficiently screening a wide variety of intervention strategies for inclusion in future just-in-time adaptive interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:39418443 | DOI:10.1037/adb0001029