Category: Statistics

JAMA Netw Open. 2024 Aug 1;7(8):e2429696. doi: 10.1001/jamanetworkopen.2024.29696.

ABSTRACT

IMPORTANCE: Postelimination outbreaks threaten nearly a quarter century of measles elimination in the US. Understanding these dynamics is essential for maintaining the nation’s measles elimination status.

OBJECTIVE: To examine the demographic characteristics and transmission dynamics of the 2022 to 2023 central Ohio measles outbreak.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used electronic medical records and publicly available measles reports within an extensive central Ohio primary care network involving inpatient and outpatient settings. Participants included 90 children in Ohio with confirmed measles cases in 2022.

EXPOSURE: The exposure of interest was confirmed measles cases in Ohio in 2022. This included 5 internationally imported cases and 85 locally acquired cases.

MAIN OUTCOMES AND MEASURES: The primary outcome involved documenting and analyzing confirmed measles cases in Ohio in 2022, focusing on demographic characteristics, immunization status, and transmission links in outbreak-related cases.

RESULTS: This study analyzed 90 measles cases (47 [52.2%] male participants) in Ohio during 2022. Most participants self-identified as African or American Black (72 [80.0%]), with additional race categories including Asian, Hispanic, multirace (6 [6.7%]), White, and unknown (6 [6.7%]). Most participants were of Somali descent (64 [71.1%]), with additional ethnicity categories including American (16 [17.8%]), Guatemalan, Nepali, and unknown (6 [6.7%]). Participants were predominantly younger than 6 years (86 [95.5%]), unimmunized (89 [98.9%]), and resided in Franklin County, Ohio (83 [92.2%]). Prior to November 20, 2022, all cases occurred among unimmunized children of Somali descent in the Columbus area. Nosocomial superspreading events expanded the outbreak beyond the initially affected community.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of measles cases in Ohio during 2022 found that the outbreak primarily affected unimmunized children of Somali descent, highlighting the necessity for culturally tailored public health strategies to maintain measles elimination in the US. These findings underscore the importance of implementing targeted interventions and enhancing community engagement to increase vaccination rates.

PMID:39186272 | DOI:10.1001/jamanetworkopen.2024.29696

JAMA Netw Open. 2024 Aug 1;7(8):e2429820. doi: 10.1001/jamanetworkopen.2024.29820.

ABSTRACT

IMPORTANCE: The optimal treatment of acute uncomplicated appendicitis in older adults with frailty is not defined.

OBJECTIVE: To examine outcomes associated with treatment strategies for acute uncomplicated appendicitis in older adults with or without frailty.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used National Inpatient Sample data from adults 65 years or older with a diagnosis of uncomplicated appendicitis from January 1, 2016, to December 31, 2018. Data were analyzed from July to November 2023. The National Inpatient Sample database approximates a 20% stratified sample of all inpatient hospital discharges in the US.

EXPOSURES: Study patients were categorized into 3 groups: nonoperative management, immediate operation, and delayed operation.

MAIN OUTCOMES AND MEASURES: Clinical outcomes, including hospital complications and in-hospital mortality, were assessed among older adults with and without frailty, identified using an adapted claims-based frailty index.

RESULTS: A total of 24 320 patients were identified (median [IQR] age, 72 [68-79] years; 50.9% female). Of those, 7290 (30.0%) were categorized as having frailty. Overall, in-hospital mortality was 1.4%, and the incidence of complications was 37.3%. In patients with frailty, multivariable analysis showed both nonoperative management (odds ratio [OR], 2.89; 95% CI, 1.40-5.98; P < .001) and delayed appendectomy (OR, 3.80; 95% CI, 1.72-8.43; P < .001) were associated with increased in-hospital mortality compared with immediate appendectomy. In patients without frailty, immediate appendectomy was associated with increased hospital complications compared with nonoperative management (OR, 0.77; 95% CI, 0.64-0.94; P = .009) and lower hospital complications compared with delayed appendectomy (OR, 2.05; 95% CI, 1.41-3.00; P < .001).

CONCLUSIONS AND RELEVANCE: In this cohort study of older adults with uncomplicated appendicitis, outcomes differed among management strategies based on frailty status. Routine frailty assessments incorporated in the care of older adult patients may help guide discussions for shared decision-making.

PMID:39186270 | DOI:10.1001/jamanetworkopen.2024.29820

JAMA Netw Open. 2024 Aug 1;7(8):e2429826. doi: 10.1001/jamanetworkopen.2024.29826.

ABSTRACT

IMPORTANCE: Extreme weather has major implications for state and national health care systems; however, statistics examining weather-related injuries and fatalities are limited.

OBJECTIVE: To examine the frequency and regional distribution of major disaster events (MDEs) in the US.

DESIGN, SETTING, AND PARTICIPANTS: This ecologic cross-sectional study of MDEs occurring between January 1, 2006, and December 31, 2021, evaluated US data on all injuries and fatalities included in the National Oceanic and Atmospheric Administration National Centers for Environmental Information Storm Events Database. The data analysis was performed between February 22, 2023, and April 1, 2024.

EXPOSURES: Major disaster events defined as an environmental event that caused either at least 50 injuries or at least 10 deaths.

MAIN OUTCOMES AND MEASURES: All MDEs were evaluated using descriptive statistics for event type, property damage, and rural or urban classification according to the National Centers for Health Statistics Urban-Rural Classification Scheme for Counties. The location of events according to Administration for Strategic Preparedness and Response (ASPR) region and hospital bed capacity of ASPR regions were also examined.

RESULTS: Between 2006 and 2021, 11 159 storm events caused 42 254 injuries and 9760 deaths. Major disaster events accounted for 209 weather events (1.9%) but caused 19 463 weather-associated injuries (46.1%) and 2189 weather-associated deaths (22.4%). The majority of MDEs were caused by extreme heat (86 [41.1%]) and tornadoes (67 [32.1%]). While a larger proportion of MDEs occurred in urban areas (151 [75.1%]) vs rural areas (50 [24.9%]), rural MDEs caused a median of 9 (IQR, 2-16) deaths per event vs 4 (IQR, 0-14) deaths per event in urban areas. The majority of MDEs occurred in either ASPR region 4 (51 [24.5%]) or region 9 (45 [21.6%]). Certain event types, such as fires, wind, and hurricanes or storms, were geographically concentrated, while extreme heat and floods affected regions across the US equally. Urban counties had disproportionately greater hospital bed capacity than rural counties relative to population and MDE distributions.

CONCLUSIONS AND RELEVANCE: The findings of this ecologic study indicate that while MDEs accounted for a small proportion of all weather events, they were associated with a disproportionate number of injuries and fatalities. Integrating these data into county, state, and regional hazard vulnerability analyses is crucial to ensuring preparedness and mitigating climate risk.

PMID:39186269 | DOI:10.1001/jamanetworkopen.2024.29826

JAMA Netw Open. 2024 Aug 1;7(8):e2430198. doi: 10.1001/jamanetworkopen.2024.30198.

ABSTRACT

IMPORTANCE: Robust longitudinal studies of within-child changes in mental health associated with the COVID-19 pandemic are lacking, as are studies examining sources of heterogeneity in such changes.

OBJECTIVE: To investigate within-child changes, overall and between subgroups, in youth mental health from prepandemic to midpandemic.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used longitudinal prepandemic and midpandemic data from the Environmental influences on Child Health Outcomes (ECHO) Program, collected between January 1, 2015, and March 12, 2020 (prepandemic), and between March 13, 2020, and August 31, 2022 (midpandemic). Data were analyzed between December 1, 2022, and June 1, 2024. The sample included 9 US-based observational longitudinal pediatric ECHO cohorts. Cohorts were included if they collected the Child Behavior Checklist (CBCL) School Age version before and during the pandemic on more than 20 participants of normal birth weight aged 6 to 17 years.

EXPOSURE: The COVID-19 pandemic.

MAIN OUTCOMES AND MEASURES: Prepandemic to midpandemic changes in CBCL internalizing, externalizing, depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) scores were estimated, and differences in outcome trajectories by child sociodemographic characteristics (age, sex, race, ethnicity, and poverty level) and prepandemic mental health problems were examined using established CBCL clinical score thresholds.

RESULTS: A total of 1229 participants (mean [SD] age during the pandemic, 10.68 [2.29] years; 625 girls [50.9%]) were included. The sample was socioeconomically diverse (197 of 1056 children [18.7%] lived at ≤130% of the Federal Poverty Level; 635 (51.7%) identified as White, 388 (31.6%) as Black, 147 (12.0%) as multiracial, 40 (3.3%) as another race, and 118 (9.6%) as Hispanic). Generalized linear mixed-effects models revealed minor decreases in externalizing problems (β = -0.88; 95% CI, -1.16 to -0.60), anxiety (β = -0.18; 95% CI, -0.31 to -0.05), and ADHD (β = -0.36; 95% CI, -0.50 to -0.22), but a minor increase in depression (β = 0.22; 95% CI, 0.10 to 0.35). Youth with borderline or clinically meaningful prepandemic scores experienced decreases across all outcomes, particularly externalizing problems (borderline, β = -2.85; 95% CI, -3.92 to -1.78; clinical, β = -4.88; 95% CI, -5.84 to -3.92). Low-income (β = -0.76; 95% CI, -1.14 to -0.37) and Black (β = -0.52; 95% CI, -0.83 to -0.20) youth experienced small decreases in ADHD compared with higher income and White youth, respectively.

CONCLUSIONS AND RELEVANCE: In this longitudinal cohort study of economically and racially diverse US youth, there was evidence of differential susceptibility and resilience for mental health problems during the pandemic that was associated with prepandemic mental health and sociodemographic characteristics.

PMID:39186267 | DOI:10.1001/jamanetworkopen.2024.30198

JAMA Netw Open. 2024 Aug 1;7(8):e2430205. doi: 10.1001/jamanetworkopen.2024.30205.

ABSTRACT

IMPORTANCE: Department of Veterans Affairs (VA) health care spending has increased in the past decade, in part due to legislative changes that expanded access to VA-purchased care.

OBJECTIVE: To understand how insurance coverage and enrollment in VA has changed between 2010 and 2021.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from surveys conducted from 2010 to 2021. Participants were respondents across 4 national surveys who reported being a US veteran and reported on health insurance enrollment. Data were analyzed from October 2023 to June 2024.

MAIN OUTCOMES AND MEASURES: Self-reported health insurance coverage, reliance on VA insurance, and self-reported health.

RESULTS: Among a total of 3 644 614 survey respondents (mean [SE] age, 60 [0.04] years; 91.3% [95% CI, 91.2%-91.5%] male) included, 52.2% (95% CI, 52.0%-52.4%) were out of the labor market and 63.1% (95% CI, 62.9%-63.3%) were married. In 2010, 94% of all veterans and 94% of veterans younger than age 65 years reported having health insurance coverage on the American Community Survey. Insurance enrollment increased over time, and by 2020, 97% of all veterans and 95% of veterans younger than 65 years reported having health insurance coverage on the American Community Survey. Insurance enrollment estimates were similar across the surveys. Approximately one-third of veterans reported being enrolled in VA health coverage. Of those who enrolled in VA insurance, more than 75% had more than 1 form of coverage, with Medicare and private insurance being the most common second insurance sources. VA insurance enrollment was negatively associated with income and health status. Veterans without insurance tended to be unemployed and younger.

CONCLUSIONS AND RELEVANCE: This study of veterans who responded to 4 national surveys found that veterans enrolled in VA health coverage had high rates of dual coverage. Further legislative efforts to increase access without recognizing the high rates of dual coverage may yield unintended consequences, such payer shifting.

PMID:39186266 | DOI:10.1001/jamanetworkopen.2024.30205

JAMA Netw Open. 2024 Aug 1;7(8):e2435535. doi: 10.1001/jamanetworkopen.2024.35535.

ABSTRACT

IMPORTANCE: One-third of older adults in the US have depression, often treated with psychotherapy and antidepressants. Previous studies suggesting an increased risk of falls and related injuries (FRI) associated with antidepressant use may be affected by confounding by indication or immortal time bias.

OBJECTIVE: To evaluate the association between FRI risk and first-line treatments in older adults with depression.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a target trial emulation framework with a cloning-censoring-weighting approach with Medicare claims data from 2016 to 2019. Participants included fee-for-service beneficiaries aged 65 years or older with newly diagnosed depression. Data were analyzed from October 1, 2023, to March 31, 2024.

EXPOSURES: First-line depression treatments including psychotherapy, sertraline, escitalopram, citalopram, mirtazapine, duloxetine, trazodone, fluoxetine, bupropion, paroxetine, and venlafaxine.

MAIN OUTCOME AND MEASURE: One-year FRI rate, restricted mean survival time (RMST), and adjusted hazard ratio (aHR) with 95% CI.

RESULTS: Among 101 953 eligible beneficiaries (mean [SD] age, 76 [8] years), 63 344 (62.1%) were female, 7404 (7.3%) were Black individuals, and 81 856 (80.3%) were White individuals. Compared with the untreated group, psychotherapy use was not associated with FRI risk (aHR, 0.94 [95% CI, 0.82-1.17]), while other first-line antidepressants were associated with a decreased FRI risk (aHR ranged from 0.74 [95% CI, 0.59-0.89] for bupropion to 0.83 [95% CI, 0.67-0.98] for escitalopram). The FRI incidence ranged from 63 (95% CI, 53-75) per 1000 person-year for those treated with bupropion to 87 (95% CI, 83-90) per 1000 person-year for those who were untreated. The RMST ranged from 349 (95% CI, 346-350) days for those who were untreated to 353 (95% CI, 350-356) days for those treated with bupropion.

CONCLUSIONS AND RELEVANCE: In this cohort study of older Medicare beneficiaries with depression, first-line antidepressants were associated with a decreased FRI risk compared with untreated individuals. These findings provide valuable insights into their safety profiles, aiding clinicians in their consideration for treating depression in older adults.

PMID:39186265 | DOI:10.1001/jamanetworkopen.2024.35535

Poult Sci. 2024 Aug 6;103(11):104177. doi: 10.1016/j.psj.2024.104177. Online ahead of print.

ABSTRACT

Acid oils and fatty acid distillates are fat by-products of the refining process of edible oils and are characterized by their high proportion of free fatty acids (FFA). While lipids are essential in poultry diets, their chemical structure may interfere with calcium absorption. Therefore, this study investigated the effects of dietary FFA content and the degree of fat saturation on bone metabolism in commercial layers. For 15-wk, a total of 144 laying hens (19-wk-old) were randomly assigned to 8 treatments (6 replicates with 3 birds each), which were obtained by gradually replacing crude soybean oil (rich in unsaturated fatty acids [UFA]) with soybean acid oil (rich in UFA and FFA), or crude palm oil (rich in saturated fatty acids [SFA]) with palm fatty acid distillate (rich in SFA and FFA). Following a 2 × 4 factorial design, 4 UFA-rich and 4 SFA-rich diets were created with varying FFA content: 10, 20, 30, and 45%. Tibiae (6 birds/treatment) were collected at the end of the trial for the assessment of mineral composition, morphological properties, and mechanical characteristics. The data were analyzed using a 2-way ANOVA with the GLM procedure. Orthogonal polynomial contrasts were employed to determine the linear effect of increasing %FFA, with statistical significance set at P < 0.05. The degree of saturation was found to negatively impact on calcium and phosphorus bone content, with higher levels found in soybean-based diets (P < 0.001). A significant interaction was observed for medullary bone mineral content, showing a linear decrease as the dietary %FFA increased (P < 0.05) in palm diets. In contrast, morphological and mechanical bone traits, total ash content, and cortical bone mineral composition remained unaffected (P > 0.05). These results suggest that the degree of fat saturation exerts a greater impact than FFA content on bone mineral metabolism, supporting the commercial use of fat by-products rich in FFA in laying hen diets, at least during the early stages of the laying cycle.

PMID:39180782 | DOI:10.1016/j.psj.2024.104177

Physiother Res Int. 2024 Oct;29(4):e2124. doi: 10.1002/pri.2124.

ABSTRACT

BACKGROUND AND PURPOSE: The article’s significance lies in the substantial rise in the risk of developing Parkinson’s disease (PD), necessitating the exploration of various approaches to rehabilitation and medical treatment. The purpose of the article is to detect the direct effect of physiotherapy for patients with PD and to identify how it helps in slowing down cardio-pulmonary failure, improving the posture, balance, bradykinesia and tremor.

METHODS: The research utilised clinical data from 407 PD patients aged 30-100 years at the Central Polyclinic of Durrës, spanning 2011-2022, and included a systematic literature review and statistical analysis comparing physiotherapy outcomes with European Union standards.

RESULTS: The research demonstrates the efficiency of physiotherapy in the short and long term in the treatment of PD for patients and medical personnel. All information can be used to increase the functional abilities of patients and minimise complications after physiotherapy and to estimate the effectiveness of different exercises in delaying PD. Older adults, particularly those aged 71-80, are most affected by PD, with males more likely to be diagnosed. Physiotherapy rehabilitation improves motor symptoms, posture, and balance in 30-80-year-olds, but its effectiveness declines with age. Advanced rehabilitation methods in Italy lead to better outcomes, suggesting the potential for improvement in Durres disease.

CONCLUSIONS: The study emphasises the need for improved rehabilitation strategies for older patients by recommending tailored programs, advanced methods, standardisation, training, and long-term monitoring. Further research should concentrate on the long-term sustainability of physiotherapy benefits, the development of targeted interventions for older patients, and the integration of innovative therapeutic approaches.

PMID:39180752 | DOI:10.1002/pri.2124

Dermatol Ther (Heidelb). 2024 Aug 24. doi: 10.1007/s13555-024-01248-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Ultraviolet-free (UV-free) blue light phototherapy has emerged as a promising option due to its reported efficacy and minimal adverse effects. This study aims to evaluate the effectiveness of full-body blue light irradiation in both adult and pediatric patients with atopic dermatitis (AD), assessing its impact on skin condition and mood regulation by investigating serum concentrations of serotonin and kynurenine pathway metabolites.

METHODS: 20 patients (age 9-45) with moderate and severe AD were included in the study. Treatment consisted of 10 irradiations with Full Body Blue device (453 nm). Serum concentrations of serotonin, quinolinic acid, kynurenic acid, tryptophan, and kynurenine were measured before and after irradiations.

RESULTS: After 10 sessions of full blue light therapy (453 nm) statistically significant improvements were observed in Eczema Area Severity Index (EASI 13.16 vs. 8.65; p = 0.00016), SCORing Atopic Dermatitis (SCORAD 44.99 vs. 23.73; p < 0.00001), Visual Analogue Scale (VAS 6.53 vs. 3.95; p = 0.00251), 10-item pruritus severity scale (13.32 vs. 7.05; p < 0.00001). Moreover, statistically significant decrease in Dermatology Life Quality Index (DLQI) was noted (14.37 vs. 7.42; p = 0.00351). Additionally, increase in the serum concentration of serotonin was observed after completing 10 irradiation sessions (median 139.77 mg/ml vs. 274.92 mg/ml; p < 0.00001).

CONCLUSION: Blue light may be a promising and safe treatment in patients with AD. It might also positively influence mood. Further investigations are needed to confirm those findings.

TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT06516783.

PMID:39180711 | DOI:10.1007/s13555-024-01248-3

Clin Transl Oncol. 2024 Aug 24. doi: 10.1007/s12094-024-03676-1. Online ahead of print.

ABSTRACT

BACKGROUND: To explore the value of high-resolution computed tomography (HRCT) in the differential diagnosis of benign and malignant ground-glass nodules (GGNs), and to provide a theoretical basis for the clinical application of HRCT.

METHODS: A total of 208 patients with GGN who had been clinically confirmed by surgical pathology and clinical confirmation were collected, and HRCT target scanning technology was used to scan and collect general information of patients, and observe the distribution of GGN, GGN size, GGN cross-sectional area, diameter, transverse diameter, solid composition, relationship with bronchi, and relationship with blood vessels and other indicators. Multivariate regression analysis and risk factor prediction are performed.

RESULTS: The differences were statistically significant in multivariate regression analysis, such as nodule location, maximum diameter, maximum cross-sectional area, GGN status, nodule boundary and relationship with blood vessels (P < 0.05). The results of ROC curve showed that the AUC value of nodule site and nodule boundary was greater than 0.5, and the nodule boundary AUC value was 0.676, which was more sensitive to predict whether GGN deteriorated to lung adenocarcinoma (LUAD).

CONCLUSION: Nodule site and nodule boundary are effective risk predictors for LUAD in patients with GGN, and nodule boundary is the most valuable independent predictor.

PMID:39180703 | DOI:10.1007/s12094-024-03676-1