Category: Statistics

BMJ Open Qual. 2024 Jul 4;13(3):e002673. doi: 10.1136/bmjoq-2023-002673.

ABSTRACT

BACKGROUND: Improving the quality of life (QoL) is a significant healthcare priority, and it is an important health outcome for elderly individuals with Alzheimer’s disease. Quality of Life in Late-Stage Dementia (QUALID) is a specific scale used to measure the QoL in elderly individuals with Alzheimer’s. So far, limited quantitative research has been conducted on the psychometric properties of this scale.

AIMS: This study was conducted to translate the QUALID Scale into Persian and evaluate its psychometric properties among family and professional caregivers of elderly individuals with Alzheimer’s disease in Tehran.

METHODS: A cross-sectional methodological study was conducted among family and professional caregivers of elderly individuals with Alzheimer’s in Tehran, Iran in 2022. The questionnaire was translated into Persian using the forward-backward method. Face and content validity were assessed. Additionally, construct validity was examined using exploratory factor analysis (EFA) with Equamax rotation (n=210) and confirmatory factor analysis (CFA) (n=155). Cronbach’s alpha and interclass correlation coefficient (ICC) were estimated to determine reliability.

RESULTS: A total of 365 caregivers with a mean age of 14.18±42.60 years participated in this study. In the face and content validity phase, all 11 items were retained. To determine the construct validity, two factors were extracted in the EFA phase, including behavioural signs of discomfort and behavioural signs of social interaction. The findings of the CFA also indicated that all goodness of fit indices supported the final model. The Cronbach’s alpha was excellent for both factors (0.814), and the ICC was calculated as 0.98.

CONCLUSION: Based on the findings of this study, it can be concluded that the Persian version of the QUALID Scale has sufficient validity and reliability for measuring the QoL in elderly Iranian individuals with Alzheimer’s.

PMID:38964884 | DOI:10.1136/bmjoq-2023-002673

BMJ Glob Health. 2024 Jul 4;9(7):e014428. doi: 10.1136/bmjgh-2023-014428.

ABSTRACT

RATIONALE: A small number of earlier studies have suggested an effect of temporary abstinence campaigns on alcohol consumption. However, all were based on self-reported consumption estimates.

OBJECTIVES: Using a time series of 23-year monthly alcohol sales data, this study examined the effect of an annual temporary abstinence campaign, which has been organised annually since 2003 during the Buddhist Lent period (spanning 3 months), on population-level alcohol consumption.

METHODS: Data used in the analysis included a time series of monthly alcohol sales data from January 1995 to September 2017 and the midyear population counts for those years. Generalised additive models (GAM) were applied to estimate trends as smooth functions of time, while identifying a relationship between the Buddhist Lent abstinence campaigns on alcohol consumption. The sensitivity analysis was performed using a seasonal autoregressive integrated moving average with exogenous variables (SARIMAX) model.

INTERVENTION: The Buddhist Lent abstinence campaign is a national mass media campaign combined with community-based activities that encourages alcohol abstinence during the Buddhist Lent period, spanning 3 months and varying between July and October depending on the lunar calendar. The campaign has been organised annually since 2003.

MAIN OUTCOME: Per capita alcohol consumption using monthly alcohol sales data divided by the midyear total population number used as a proxy.

RESULTS: Median monthly per capita consumption was 0.43 (IQR: 0.37 to 0.51) litres of pure alcohol. Over the study period, two peaks of alcohol consumption were in March and December of each year. The significant difference between before-campaign and after-campaign coefficients in the GAM, -0.102 (95% CI: -0.163 to -0.042), indicated an effect of the campaign on alcohol consumption after adjusting for the time trend and monthly seasonality, corresponding to an average reduction of 9.97% (95% CI: 3.65% to 24.18%). The sensitivity analyses produced similar results, where the campaign was associated with a decrease in consumption of 8.1% (95% CI: 0.4% to 15.7%).

CONCLUSIONS: This study demonstrated that the temporary abstinence campaign was associated with a decrease in population-level alcohol consumption during campaign periods. The finding contributed to a growing body of evidence on the effectiveness of emerging temporary abstinence campaigns.

PMID:38964881 | DOI:10.1136/bmjgh-2023-014428

World J Surg. 2024 Jul 4. doi: 10.1002/wjs.12280. Online ahead of print.

ABSTRACT

PURPOSE: It is well established that hollow viscus perforation leads to sepsis and acute kidney injury (AKI) in non-trauma patients. However, the relationship between traumatic hollow viscus injury (HVI) and AKI is not well understood. Utilizing data from the National Trauma Data Bank, we investigated whether HVI serves as a risk factor for AKI. Additionally, we examined the characteristics of AKI in stable patients who underwent conservative treatment.

METHODS: We reviewed blunt abdominal trauma (BAT) cases from 2012 to 2015, comparing patients with and without AKI. Significant factors from univariate analysis were tested in a multivariate logistic regression (MLR) to identify independent AKI determinants. We also analyzed subsets: patients without HVI and stable patients given conservative management.

RESULTS: Out of the 563,040 BAT patients analyzed, 9073 (1.6%) developed AKI. While a greater proportion of AKI patients had HVI than those without AKI (13.3% vs. 5.2%, p < 0.001), this difference wasn’t statistically significant in the MLR (p = 0.125). Notably, the need for laparotomy (odds = 3.108, p < 0.001) and sepsis (odds = 13.220, p < 0.001) were identified as independent risk factors for AKI. For BAT patients managed conservatively (systolic blood pressure >90 mmHg, without HVI or laparotomy; N = 497,066), the presence of sepsis was a significant predictor for the development of AKI (odds = 16.914, p < 0.001).

CONCLUSIONS: While HVI wasn’t a significant risk factor for AKI in BAT patients, the need for laparotomy was. Stable BAT patients managed conservatively are still at risk for AKI due to non-peritonitis related sepsis.

PMID:38964867 | DOI:10.1002/wjs.12280

Thorax. 2024 Jul 4:thorax-2023-221150. doi: 10.1136/thorax-2023-221150. Online ahead of print.

ABSTRACT

BACKGROUND: Antenatal factors and environmental exposures contribute to recurrent wheezing in early childhood.

AIM: To identify antenatal and environmental factors associated with recurrent wheezing in children from birth to 48 months in the mother and child in the environment cohort, using time-to-event analysis.

METHOD: Maternal interviews were administered during pregnancy and postnatally and children were followed up from birth to 48 months (May 2013-October 2019). Hybrid land-use regression and dispersion modelling described residential antenatal exposure to nitrogen dioxide (NO₂) and particulate matter of 2.5 µm diameter (PM_2.5). Wheezing status was assessed by a clinician. The Kaplan-Meier hazard function and Cox-proportional hazard models provided estimates of risk, adjusting for exposure to environmental tobacco smoke (ETS), maternal smoking, biomass fuel use and indoor environmental factors.

RESULTS: Among 520 mother-child pairs, 85 (16%) children, had a single wheeze episode and 57 (11%) had recurrent wheeze. Time to recurrent wheeze (42.9 months) and single wheeze (37.8 months) among children exposed to biomass cooking fuels was significantly shorter compared with children with mothers using electricity (45.9 and 38.9 months, respectively (p=0.03)). Children with mothers exposed to antenatal ETS were 3.8 times more likely to have had recurrent wheeze compared with those not exposed (adjusted HR 3.8, 95% CI 1.3 to 10.7). Mean birth month NO₂ was significantly higher among the recurrent wheeze category compared with those without wheeze. NO₂ and PM_2.5 were associated with a 2%-4% adjusted increased wheezing risk.

CONCLUSION: Control of exposure to ETS and biomass fuels in the antenatal period is likely to delay the onset of recurrent wheeze in children from birth to 48 months.

PMID:38964859 | DOI:10.1136/thorax-2023-221150

Int J Epidemiol. 2024 Jun 12;53(4):dyae088. doi: 10.1093/ije/dyae088.

NO ABSTRACT

PMID:38964853 | DOI:10.1093/ije/dyae088

Sex Transm Infect. 2024 Jul 4:sextrans-2024-056124. doi: 10.1136/sextrans-2024-056124. Online ahead of print.

ABSTRACT

OBJECTIVES: Sexually transmitted infections (STIs) have markedly increased over the last decade in Spain, calling for prevention and control innovative approaches. While there is evidence indicating the effectiveness of self-sampling for STI diagnosis, no kits for this purpose have been authorised in Spain.

METHODS: A prospective single-blind cross-sectional study carried out between November and December 2022 in an STI clinic in Madrid, Spain, to determine the validity, feasibility and acceptability of self-sampling kits used by non-healthcare professionals from vagina, pharynx, rectum and urethra to diagnose Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). Self-samples were compared with samples collected by healthcare professional (HC samples) and analysed by PCR. Frequency of CT and NG diagnosis by sample type was compared using McNemar’s test for paired data. Sensitivity and specificity of self-samples for CT and NG diagnosis were also calculated.

RESULTS: 306 self-samples from 51 participants were analysed. 80% were men with median age of 33 (IQR: 28-38) years. Self-samples and HC samples showed no significant statistical differences in CT and NG diagnosis. Self-samples had a sensitivity of 81% for CT and 93% for NG, with a specificity of 97% for CT and 95% for NG. More than 90% of participants had no difficulty understanding the kit instructions and 71% expressed high levels of satisfaction with the self-sampling kit.

CONCLUSION: Self-sampling kits for CT and NG diagnosis can be safely and effectively used by non-healthcare professionals in Spain. National strategies for STI prevention and control should prioritise self-sampling strategies.

PMID:38964838 | DOI:10.1136/sextrans-2024-056124

Semin Pediatr Neurol. 2024 Jul;50:101134. doi: 10.1016/j.spen.2024.101134. Epub 2024 May 10.

ABSTRACT

Child maltreatment is common and pediatric healthcare providers are becoming increasingly aware of risk factors and signs of abuse.^1-4 Children with disabilities and those with special medical needs are recognized as a population at increased risk of child maltreatment. Understanding this risk and recognizing that not all disabilities confer the same risks can provide deeper insight for pediatric providers regarding the supports these children and their families need to prevent maltreatment.

PMID:38964809 | DOI:10.1016/j.spen.2024.101134

BMJ Open. 2024 Jul 4;14(7):e086099. doi: 10.1136/bmjopen-2024-086099.

ABSTRACT

INTRODUCTION: Persistent infection with high-risk human papillomavirus (HPV) is the causal agent of several cancers including cervical, anal and oropharyngeal cancer. Transgender men and transmasculine non-binary (TMNB) people with a cervix are much less likely to undergo cervical cancer screening than cisgender women. Transgender women and transfeminine non-binary (TWNB) people assigned male at birth may be at increased risk of HPV. Both TMNB and TWNB people face many barriers to HPV testing including medical mistrust due to stigma and discrimination.

METHODS AND ANALYSIS: The Self-TI Study (Self-TI) is a pilot study designed to measure acceptability and feasibility of HPV self-testing among transgender and non-binary people in England. TMNB people aged 25-65 years, with at least 1 year of testosterone, and TWNB people, aged 18 years and over, are eligible to participate. Participants self-collect up to four samples: an oral rinse, a first void urine sample, a vaginal swab (if applicable) and an anal swab. TMNB participants are asked to have an additional clinician-collected cervical swab taken following their routine Cervical Screening Programme sample. TWNB people are asked to take a self-collection kit to perform additional self-collection at home and mail the samples back to the clinic. Acceptability is assessed by a self-administered online survey and feasibility is measured as the proportion of samples returned in the clinic and from home.

ETHICS AND DISSEMINATION: Self-TI received ethical approval from the Research Ethics Committee of Wales 4 and ethical review panel within the Division of Cancer Epidemiology and Genetics at the US National Cancer Institute. Self-TI was coproduced by members of the transgender and non-binary community, who served as authors, collaborators and members of the patient and public involvement (PPI) group. Results of this study will be shared with the community prior to being published in peer-reviewed journals and the PPI group will help to design the results dissemination strategy. The evidence generated from this pilot study could be used to inform a larger, international study of HPV self-testing in the transgender and non-binary community.

TRIAL REGISTRATION NUMBER: NCT05883111.

PMID:38964803 | DOI:10.1136/bmjopen-2024-086099

BMJ Open. 2024 Jul 4;14(7):e083720. doi: 10.1136/bmjopen-2023-083720.

ABSTRACT

INTRODUCTION: Suicidal behaviour is common among medical students, and the prevalence rates might vary across various regions. Even though various systematic reviews have been conducted to assess suicidal behaviours among medical students in general, no review has ever assessed or carried out a sub-analysis to show the burden of suicidal behaviours among Bangladeshi medical students.

METHODS AND ANALYSIS: The research team will search the PubMed (Medline), Scopus, PsycINFO and Google Scholar databases for papers published between January 2000 and May 2024 using truncated and phrase-searched keywords and relevant subject headings. Cross-sectional studies, case series, case reports and cohort studies published in English will be included in the review. Review papers, commentaries, preprints, meeting abstracts, protocols and letters will be excluded. Two reviewers will screen the retrieved papers independently. Disagreements between two reviewers will be resolved by a third reviewer. Exposure will be different factors that initiate suicidal behaviours among medical students. The prevalence of suicidal behaviours (suicidal ideation, suicide plans and suicide attempts) in addition to the factors responsible, and types of suicide method will be extracted. Narrative synthesis and meta-analysis will be conducted and the findings will be summarised. For enhanced visualisation of the included studies, forest plots will be constructed. Heterogeneity among the studies will be assessed and sensitivity analysis will be conducted based on study quality. Included studies will be critically appraised using Joanna Briggs’s Institutional critical appraisal tools developed for different study designs.

ETHICS AND DISSEMINATION: The study will synthesise evidence extracted from published studies. As the review does not involve the collection of primary data, ethical approval will not be required. Findings will be disseminated orally (eg, conferences, webinars) and in writing (ie, journal paper).

PROSPERO REGISTRATION NUMBER: CDR 42023493595.

PMID:38964798 | DOI:10.1136/bmjopen-2023-083720

BMJ Open. 2024 Jul 4;14(7):e081645. doi: 10.1136/bmjopen-2023-081645.

ABSTRACT

OBJECTIVE: To describe the associations between patient-to-nurse staffing ratios and rates of mortality, process of care events and vital sign documentation.

DESIGN: Secondary analysis of data from the evaluating processes of care and outcomes of children in hospital (EPOCH) cluster-randomised trial.

SETTING: 22 hospitals caring for children in Canada, Europe and New Zealand.

PARTICIPANTS: Eligible hospitalised patients were aged>37 weeks and <18 years.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was all-cause hospital mortality. Secondary outcomes included five events reflecting the process of care, collected for all EPOCH patients; the frequency of documentation for each of eight vital signs on a random sample of patients; four measures describing nursing perceptions of care.

RESULTS: A total of 217 714 patient admissions accounting for 849 798 patient days over the course of the study were analysed. The overall mortality rate was 1.65/1000 patient discharges. The median (IQR) number of patients cared for by an individual nurse was 3.0 (2.8-3.6). Univariate Bayesian models estimating the rate ratio (RR) for the patient-to-nurse ratio and the probability that the RR was less than one found that a higher patient-to-nurse ratio was associated with fewer clinical deterioration events (RR=0.88, 95% credible interval (CrI) 0.77-1.03; P (RR<1)=95%) and late intensive care unit admissions (RR=0.76, 95% CrI 0.53-1.06; P (RR<1)=95%). In adjusted models, a higher patient-to-nurse ratio was associated with lower hospital mortality (OR=0.77, 95% CrI=0.57-1.00; P (OR<1)=98%). Nurses from hospitals with a higher patient-to-nurse ratio had lower ratings for their ability to influence care and reduced documentation of most individual vital signs and of the complete set of vital signs.

CONCLUSIONS: The data from this study challenge the assumption that lower patient-to-nurse ratios will improve the safety of paediatric care in contexts where ratios are low. The mechanism of these effects warrants further evaluation including factors, such as nursing skill mix, experience, education, work environment and physician staffing ratios.

TRIAL REGISTRATION NUMBER: EPOCH clinical trial registered on clinical trial.gov NCT01260831; post-results.

PMID:38964797 | DOI:10.1136/bmjopen-2023-081645