Category: Statistics

JMIR Form Res. 2024 Jul 8;8:e58063. doi: 10.2196/58063.

ABSTRACT

BACKGROUND: More people who smoke and are living with HIV now die from tobacco-related diseases than HIV itself. Most people are ambivalent about quitting smoking and want to quit someday but not yet. Scalable, effective interventions are needed to motivate and support smoking cessation among people ambivalent about quitting smoking (PAQS) who are living with HIV.

OBJECTIVE: This study aims to develop an app-based intervention for PAQS who are living with HIV and assess its feasibility, acceptability, and potential impact. Results of this study will inform plans for future research and development.

METHODS: In phase 1, PAQS living with HIV (n=8) participated in user-centered design interviews to inform the final intervention app design and recruitment plan for a subsequent randomized pilot study. In phase 2, PAQS living with HIV were randomized to either a standard care control app or a similar experimental app with additional content tailored for PAQS and those with HIV. Participants were followed for 3 months. Feasibility focused on recruitment, retention, and participants’ willingness to install the app. The study was not powered for statistical significance. Indices of acceptability (satisfaction and use) and impact (smoking behavior change and treatment uptake) were assessed via automated data and self-report among those who installed and used the app (n=19).

RESULTS: Recruitment for both study phases was a challenge, particularly via web-based and social media platforms. Enrollment success was greater among people living with HIV recruited from a health care provider and research registry. Once enrolled, retention for the phase 2 randomized study was good; 74% (14/19) of the participants completed the 3-month follow-up. Phase 1 findings suggested that PAQS living with HIV were receptive to using an app-based intervention to help them decide whether, when, and how to stop smoking, despite not being ready to quit smoking. Phase 2 findings further supported this conclusion based on feedback from people who agreed to use an app, but group differences were observed. Indices of acceptability favored the experimental arm, including a descriptively higher mean number of sessions and utilization badges. Similarly, indices of potential impact were descriptively higher in the experimental arm (proportion reducing smoking, making a quit attempt, or calling free tobacco quitline). No participants in either arm quit smoking at the 3-month follow-up.

CONCLUSIONS: On the basis of this formative work, PAQS living with HIV may be receptive to using a mobile health-based app intervention to help them decide whether, when, or how to stop using tobacco. Indices of acceptability and impact indicate that additional research and development are warranted.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05339659; https://clinicaltrials.gov/study/NCT05339659.

PMID:38976321 | DOI:10.2196/58063

J Glaucoma. 2024 Jul 1. doi: 10.1097/IJG.0000000000002455. Online ahead of print.

ABSTRACT

PRECIS: Among 1,861 adults with ocular hypertension or mild or moderate primary open-angle glaucoma, those with Medicaid or no insurance had a statistically significantly lower likelihood of receiving laser trabeculoplasty compared with those with other insurance.

PURPOSE: To determine whether social determinants of health are associated with undergoing treatment with laser trabeculoplasty (LTP) among individuals with ocular hypertension (OHT) or mild or moderate primary open angle glaucoma (POAG).

METHODS: In this cross-sectional study, we included patients with OHT or mild or moderate POAG from the National Institutes of Health All of Us Research Program, a diverse US nationwide dataset. Logistic regression was performed to study the association between LTP treatment status and seven covariates (diagnosis severity, age, gender, race/ethnicity, income, insurance status, and education).

RESULTS: 1,861 subjects were included (median age of 72 y). In univariable logistic regression, diagnosis severity, older age, higher income, and insurance (non-Medicaid) were associated with LTP treatment. On multivariable logistic regression models, those with mild POAG (OR, 3.49; 95% CI [2.12-5.87]) and moderate POAG (OR, 7.15 [4.49-11.8]) were still more likely than OHT patients to have received LTP. Moreover, compared with participants with Medicaid or no insurance, participants with other insurance (e.g. employer provided, Medicare) were still more likely to have received LTP (OR, 2.24 [1.08-5.29]). There was no significant difference in the LTP treatment likelihood based on race/ethnicity.

CONCLUSIONS: After controlling for confounders, the likelihood of receiving LTP appears to be driven primarily by insurance rather than income or race/ethnicity. Potential reasons for decreased utilization of LTP among Medicaid patients include higher rates of declining the procedure, or LTP may have been offered less frequently due to Medicaid’s lower levels of reimbursement and longer reimbursement delays.

PMID:38976304 | DOI:10.1097/IJG.0000000000002455

JAMA Pediatr. 2024 Jul 8. doi: 10.1001/jamapediatrics.2024.1991. Online ahead of print.

ABSTRACT

IMPORTANCE: Since the COVID-19 pandemic, emergency department boarding of youth with mental health concerns has increased.

OBJECTIVE: To summarize characteristics (including gender, age, race, ethnicity, insurance, diagnosis, and barriers to placement) of youth who boarded in emergency departments while awaiting inpatient psychiatric care and to test for racial, ethnic, and gender disparities in boarding lengths and inpatient admission rates after boarding. Secondarily, to assess whether statewide demand for inpatient psychiatric care correlated with individual outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis included administrative data collected from May 2020 to June 2022 and represented a statewide study of Massachusetts. All youth aged 5 to 17 years who boarded in Massachusetts emergency departments for 3 or more midnights while awaiting inpatient psychiatric care were included.

EXPOSURE: Boarding for 3 or more midnights while awaiting inpatient psychiatric care.

MAIN OUTCOMES AND MEASURES: Emergency department boarding length (number of midnights) and whether inpatient care was received after boarding. Statistical analyses performed included logistic and gamma regressions; assessed gender, racial, and ethnic disparities; and correlations between statewide demand for psychiatric care and boarding outcomes.

RESULTS: A total of 4942 boarding episodes were identified: 2648 (54%) for cisgender females, 1958 (40%) for cisgender males, and 336 (7%) for transgender or nonbinary youth. A total of 1337 youth (27%) were younger than 13 years. Depression was the most common diagnosis (2138 [43%]). A total of 2748 episodes (56%) resulted in inpatient admission, and 171 transgender and nonbinary youth (51%) received inpatient care compared with 1558 cisgender females (59%; adjusted difference: -9.1 percentage points; 95% CI, -14.7 to -3.6 percentage points). Transgender or nonbinary youth boarded for a mean (SD) of 10.4 (8.3) midnights compared with 8.6 (6.9) midnights for cisgender females (adjusted difference: 2.2 midnights; 95% CI, 1.2-3.2 midnights). Fewer Black youth were admitted than White youth (382 [51%] and 1231 [56%], respectively; adjusted difference: -4.3 percentage points; 95% CI, -8.4 to -0.2 percentage points). For every additional 100 youth boarding statewide on the day of assessment, the percentage of youth admitted was 19.4 percentage points lower (95% CI, -23.6% to -15.2%) and boarding times were 3.0 midnights longer (95% CI, 2.4-3.7 midnights).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, almost one-half of 3 or more midnight boarding episodes did not result in admission, highlighting a need to understand the effects of boarding without admission. Gender and racial disparities were identified, suggesting the need for targeted resources to reduce boarding and promote equitable access to care.

PMID:38976283 | DOI:10.1001/jamapediatrics.2024.1991

Clin Neuropharmacol. 2024 Jun 24. doi: 10.1097/WNF.0000000000000602. Online ahead of print.

ABSTRACT

OBJECTIVES: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurobehavioral disorder in school-aged children. Although there are several drug treatment options, some patients do not have adequate therapeutic responses to conventional medications or experience considerable adverse effects. Citicoline is an endogenous molecule that has beneficial effects on attention, impulsivity, and memory and is a potential treatment for ADHD. This study aimed to evaluate the effect of citicoline in pediatric patients diagnosed with ADHD.

METHODS: This randomized, crossover, double-blind, placebo-controlled clinical trial included with patients aged 7-12 years diagnosed with ADHD.

RESULTS: As a result, no statistically significant difference was noted between the use of citicoline and placebo in the evaluated parameters. The treatment had no adverse effects.

CONCLUSIONS: Citicoline seems to be a safe molecule to be administered in the pediatric age group. Further studies are required to assess the therapeutic potential of citicoline in ADHD.

PMID:38976279 | DOI:10.1097/WNF.0000000000000602

JAMA Netw Open. 2024 Jul 1;7(7):e2419229. doi: 10.1001/jamanetworkopen.2024.19229.

NO ABSTRACT

PMID:38976273 | DOI:10.1001/jamanetworkopen.2024.19229

JAMA Netw Open. 2024 Jul 1;7(7):e2419268. doi: 10.1001/jamanetworkopen.2024.19268.

ABSTRACT

IMPORTANCE: A nonadjuvanted bivalent respiratory syncytial virus (RSV) prefusion F (RSVpreF [Pfizer]) protein subunit vaccine was newly approved and recommended for pregnant individuals at 32 0/7 to 36 6/7 weeks’ gestation during the 2023 to 2024 RSV season; however, clinical vaccine data are lacking.

OBJECTIVE: To evaluate the association between prenatal RSV vaccination status and perinatal outcomes among patients who delivered during the vaccination season.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational cohort study was conducted at 2 New York City hospitals within 1 health care system among patients who gave birth to singleton gestations at 32 weeks’ gestation or later from September 22, 2023, to January 31, 2024.

EXPOSURE: Prenatal RSV vaccination with the RSVpreF vaccine captured from the health system’s electronic health records.

MAIN OUTCOME AND MEASURES: The primary outcome is preterm birth (PTB), defined as less than 37 weeks’ gestation. Secondary outcomes included hypertensive disorders of pregnancy (HDP), stillbirth, small-for-gestational age birth weight, neonatal intensive care unit (NICU) admission, neonatal respiratory distress with NICU admission, neonatal jaundice or hyperbilirubinemia, neonatal hypoglycemia, and neonatal sepsis. Logistic regression models were used to estimate odds ratios (ORs), and multivariable logistic regression models and time-dependent covariate Cox regression models were performed.

RESULTS: Of 2973 pregnant individuals (median [IQR] age, 34.9 [32.4-37.7] years), 1026 (34.5%) received prenatal RSVpreF vaccination. Fifteen patients inappropriately received the vaccine at 37 weeks’ gestation or later and were included in the nonvaccinated group. During the study period, 60 patients who had evidence of prenatal vaccination (5.9%) experienced PTB vs 131 of those who did not (6.7%). Prenatal vaccination was not associated with an increased risk for PTB after adjusting for potential confounders (adjusted OR, 0.87; 95% CI, 0.62-1.20) and addressing immortal time bias (hazard ratio [HR], 0.93; 95% CI, 0.64-1.34). There were no significant differences in pregnancy and neonatal outcomes based on vaccination status in the logistic regression models, but an increased risk of HDP in the time-dependent model was seen (HR, 1.43; 95% CI, 1.16-1.77).

CONCLUSIONS AND RELEVANCE: In this cohort study of pregnant individuals who delivered at 32 weeks’ gestation or later, the RSVpreF vaccine was not associated with an increased risk of PTB and perinatal outcomes. These data support the safety of prenatal RSVpreF vaccination, but further investigation into the risk of HDP is warranted.

PMID:38976271 | DOI:10.1001/jamanetworkopen.2024.19268

JAMA Netw Open. 2024 Jul 1;7(7):e2420479. doi: 10.1001/jamanetworkopen.2024.20479.

ABSTRACT

IMPORTANCE: Understanding the heterogeneity of neuropsychiatric symptoms (NPSs) and associated brain abnormalities is essential for effective management and treatment of dementia.

OBJECTIVE: To identify dementia subtypes with distinct functional connectivity associated with neuropsychiatric subsyndromes.

DESIGN, SETTING, AND PARTICIPANTS: Using data from the Open Access Series of Imaging Studies-3 (OASIS-3; recruitment began in 2005) and Alzheimer Disease Neuroimaging Initiative (ADNI; recruitment began in 2004) databases, this cross-sectional study analyzed resting-state functional magnetic resonance imaging (fMRI) scans, clinical assessments, and neuropsychological measures of participants aged 42 to 95 years. The fMRI data were processed from July 2022 to February 2024, with secondary analysis conducted from August 2022 to March 2024. Participants without medical conditions or medical contraindications for MRI were recruited.

MAIN OUTCOMES AND MEASURES: A multivariate sparse canonical correlation analysis was conducted to identify functional connectivity-informed NPS subsyndromes, including behavioral and anxiety subsyndromes. Subsequently, a clustering analysis was performed on obtained latent connectivity profiles to reveal neurophysiological subtypes, and differences in abnormal connectivity and phenotypic profiles between subtypes were examined.

RESULTS: Among 1098 participants in OASIS-3, 177 individuals who had fMRI and at least 1 NPS at baseline were included (78 female [44.1%]; median [IQR] age, 72 [67-78] years) as a discovery dataset. There were 2 neuropsychiatric subsyndromes identified: behavioral (r = 0.22; P = .002; P for permutation = .007) and anxiety (r = 0.19; P = .01; P for permutation = .006) subsyndromes from connectivity NPS-associated latent features. The behavioral subsyndrome was characterized by connections predominantly involving the default mode (within-network contribution by summed correlation coefficients = 54) and somatomotor (within-network contribution = 58) networks and NPSs involving nighttime behavior disturbance (R = -0.29; P < .001), agitation (R = -0.28; P = .001), and apathy (R = -0.23; P = .007). The anxiety subsyndrome mainly consisted of connections involving the visual network (within-network contribution = 53) and anxiety-related NPSs (R = 0.36; P < .001). By clustering individuals along these 2 subsyndrome-associated connectivity latent features, 3 subtypes were found (subtype 1: 45 participants; subtype 2: 43 participants; subtype 3: 66 participants). Patients with dementia of subtype 3 exhibited similar brain connectivity and cognitive behavior patterns to those of healthy individuals. However, patients with dementia of subtypes 1 and 2 had different dysfunctional connectivity profiles involving the frontoparietal control network (FPC) and somatomotor network (the difference by summed z values was 230 within the SMN and 173 between the SMN and FPC for subtype 1 and 473 between the SMN and visual network for subtype 2) compared with those of healthy individuals. These dysfunctional connectivity patterns were associated with differences in baseline dementia severity (eg, the median [IQR] of the total score of NPSs was 2 [2-7] for subtype 3 vs 6 [3-8] for subtype 1; P = .04 and 5.5 [3-11] for subtype 2; P = .03) and longitudinal progression of cognitive impairment and behavioral dysfunction (eg, the overall interaction association between time and subtypes to orientation was F = 4.88; P = .008; using the time × subtype 3 interaction item as the reference level: β = 0.05; t = 2.6 for time × subtype 2; P = .01). These findings were further validated using a replication dataset of 193 participants (127 female [65.8%]; median [IQR] age, 74 [69-77] years) consisting of 154 newly released participants from OASIS-3 and 39 participants from ADNI.

CONCLUSIONS AND RELEVANCE: These findings may provide a novel framework to disentangle the neuropsychiatric and brain functional heterogeneity of dementia, offering a promising avenue to improve clinical management and facilitate the timely development of targeted interventions for patients with dementia.

PMID:38976268 | DOI:10.1001/jamanetworkopen.2024.20479

JAMA Netw Open. 2024 Jul 1;7(7):e2420695. doi: 10.1001/jamanetworkopen.2024.20695.

ABSTRACT

IMPORTANCE: Patients often visit the emergency department (ED) near the end of life. Their common disposition is inpatient hospital admission, which can result in a delayed transition to hospice care and, ultimately, an inpatient hospital death that may be misaligned with their goals of care.

OBJECTIVE: To assess the association of hospice use with a novel multidisciplinary hospice program to rapidly identify and enroll eligible patients presenting to the ED near end of life.

DESIGN, SETTING, AND PARTICIPANTS: This pre-post quality improvement study of a novel, multifaceted care transitions program involving a formalized pathway with email alerts, clinician training, hospice vendor expansion, metric creation, and data tracking was conducted at a large, urban tertiary care academic medical center affiliated with a comprehensive cancer center among adult patients presenting to the ED near the end of life. The control period before program launch was from September 1, 2018, to January 31, 2020, and the intervention period after program launch was from August 1, 2021, to December 31, 2022.

MAIN OUTCOME AND MEASURES: The primary outcome was a transition to hospice without hospital admission and/or hospice admission within 96 hours of the ED visit. Secondary outcomes included length of stay and in-hospital mortality.

RESULTS: This study included 270 patients (median age, 74.0 years [IQR, 62.0-85.0 years]; 133 of 270 women [49.3%]) in the control period, and 388 patients (median age, 73.0 years [IQR, 60.0-84.0 years]; 208 of 388 women [53.6%]) in the intervention period, identified as eligible for hospice transition within 96 hours of ED arrival. In the control period, 61 patients (22.6%) achieved the primary outcome compared with 210 patients (54.1%) in the intervention period (P < .001). The intervention was associated with the primary outcome after adjustment for age, race and ethnicity, primary payer, Charlson Comorbidity Index, and presence of a Medical Order for Life-Sustaining Treatment (MOLST) (adjusted odds ratio, 5.02; 95% CI, 3.17-7.94). In addition, the presence of a MOLST was independently associated with hospice transition across all groups (adjusted odds ratio, 1.88; 95% CI, 1.18-2.99). There was no significant difference between the control and intervention periods in inpatient length of stay (median, 2.0 days [IQR, 1.1-3.0 days] vs 1.9 days [IQR, 1.1-3.0 days]; P = .84), but in-hospital mortality was lower in the intervention period (48.5% [188 of 388] vs 64.4% [174 of 270]; P < .001).

CONCLUSIONS AND RELEVANCE: In this quality improvement study, a multidisciplinary program to facilitate ED patient transitions was associated with hospice use. Further investigation is needed to examine the generalizability and sustainability of the program.

PMID:38976266 | DOI:10.1001/jamanetworkopen.2024.20695

JAMA Netw Open. 2024 Jul 1;7(7):e2422833. doi: 10.1001/jamanetworkopen.2024.22833.

ABSTRACT

IMPORTANCE: The COVID-19 pandemic resulted in multiple socially restrictive public health measures and reported negative mental health impacts in youths. Few studies have evaluated incidence rates by sex, region, and social determinants across an entire population.

OBJECTIVE: To estimate the incidence of hospitalizations for mental health conditions, stratified by sex, region, and social determinants, in children and adolescents (hereinafter referred to as youths) and young adults comparing the prepandemic and pandemic-prevalent periods.

DESIGN, SETTING, AND PARTICIPANTS: This Canadian population-based repeated ecological cross-sectional study used health administrative data, extending from April 1, 2016, to March 31, 2023. All youths and young adults from 6 to 20 years of age in each of the Canadian provinces and territories were included. Data were provided by the Canadian Institute for Health Information for all provinces except Quebec; the Institut National d’Excellence en Santé et en Services Sociaux provided aggregate data for Quebec.

EXPOSURES: The COVID-19-prevalent period, defined as April 1, 2020, to March 31, 2023.

MAIN OUTCOMES AND MEASURES: The main outcome measures were the prepandemic and COVID-19-prevalent incidence rates of hospitalizations for anxiety, mood disorders, eating disorders, schizophrenia or psychosis, personality disorders, substance-related disorders, and self-harm. Secondary measures included hospitalization differences by sex, age group, and deprivation as well as emergency department visits for the same mental health conditions.

RESULTS: Among Canadian youths and young adults during the study period, there were 218 101 hospitalizations for mental health conditions (ages 6 to 11 years: 5.8%, 12 to 17 years: 66.9%, and 18 to 20 years: 27.3%; 66.0% female). The rate of mental health hospitalizations decreased from 51.6 to 47.9 per 10 000 person-years between the prepandemic and COVID-19-prevalent years. However, the pandemic was associated with a rise in hospitalizations for anxiety (incidence rate ratio [IRR], 1.11; 95% CI, 1.08-1.14), personality disorders (IRR, 1.21; 95% CI, 1.16-1.25), suicide and self-harm (IRR, 1.10; 95% CI, 1.07-1.13), and eating disorders (IRR, 1.66; 95% CI, 1.60-1.73) in females and for eating disorders (IRR, 1.47; 95% CI, 1.31-1.67) in males. In both sexes, there was a decrease in hospitalizations for mood disorders (IRR, 0.84; 95% CI, 0.83-0.86), substance-related disorders (IRR, 0.83; 95% CI, 0.81-0.86), and other mental health disorders (IRR, 0.78; 95% CI, 0.76-0.79).

CONCLUSIONS AND RELEVANCE: This cross-sectional study of Canadian youths and young adults found a rise in anxiety, personality disorders, and suicidality in females and a rise in eating disorders in both sexes in the COVID-19-prevalent period. These results suggest that in future pandemics, policymakers should support youths and young adults who are particularly vulnerable to deterioration in mental health conditions during public health restrictions, including eating disorders, anxiety, and suicidality.

PMID:38976264 | DOI:10.1001/jamanetworkopen.2024.22833

JAMA Pediatr. 2024 Jul 8. doi: 10.1001/jamapediatrics.2024.2044. Online ahead of print.

ABSTRACT

IMPORTANCE: Hospitalizations for eating disorders rose dramatically during the COVID-19 pandemic. Public health restrictions, or stringency, are believed to have played a role in exacerbating eating disorders. Few studies of eating disorders during the pandemic have extended to the period when public health stringency restrictions were lifted.

OBJECTIVE: To assess the association between hospitalization rates for eating disorders and public health stringency during the COVID-19 pandemic and after the easing of public health restrictions.

DESIGN, SETTING, AND PARTICIPANTS: This Canadian population-based cross-sectional study was performed from April 1, 2016, to March 31, 2023, and was divided into pre-COVID-19 and COVID-19-prevalent periods. Data were provided by the Canadian Institute for Health Information and the Institut National d’Excellence en Santé et Services Sociaux for all Canadian provinces and territories. Participants included all children and adolescents aged 6 to 20 years.

EXPOSURE: The exposure was public health stringency, as measured by the Bank of Canada stringency index.

MAIN OUTCOMES AND MEASURES: The primary outcome was hospitalizations for a primary diagnosis of eating disorders (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code F50), stratified by region, age group, and sex. Interrupted time series analyses based on Poisson regression were used to estimate the association between the stringency index and the rate of hospitalizations for eating disorders.

RESULTS: During the study period, there were 11 289 hospitalizations for eating disorders across Canada, of which 8726 hospitalizations (77%) were for females aged 12 to 17 years. Due to low case counts in other age-sex strata, the time series analysis was limited to females within the 12- to 17-year age range. Among females aged 12 to 17 years, a 10% increase in stringency was associated with a significant increase in hospitalization rates in Quebec (adjusted rate ratio [ARR], 1.05; 95% CI, 1.01-1.07), Ontario (ARR, 1.05; 95% CI, 1.03-1.07), the Prairies (ARR, 1.08; 95% CI, 1.03-1.13), and British Columbia (ARR, 1.11; 95% CI, 1.05-1.16). The excess COVID-19-prevalent period hospitalizations were highest at the 1-year mark, with increases in all regions: Quebec (RR, 2.17), Ontario (RR, 2.44), the Prairies (RR, 2.39), and British Columbia (RR, 2.02).

CONCLUSION AND RELEVANCE: In this cross-sectional study of hospitalizations for eating disorders across Canada, hospitalization rates for eating disorders in females aged 12 to 17 years were associated with public health measure stringency. The findings suggest that future pandemic preparedness should consider implications for youths at risk for eating disorders and their resource and support needs.

PMID:38976259 | DOI:10.1001/jamapediatrics.2024.2044