Category: Statistics

Am J Crit Care. 2024 Nov 1;33(6):462-466. doi: 10.4037/ajcc2024422.

ABSTRACT

BACKGROUND: Social constructs like race can affect how patients are perceived and impact care. This study investigated whether mentions of race in notes for critically ill patients differed according to patients’ race.

METHODS: This retrospective cohort study included intensive care unit notes for adults (≥18 years old) admitted to any of 6 intensive care units at University of California, San Francisco, from 2012 through 2020. Notes were linked to National Provider Identifier records to obtain note writer characteristics. Logistic regression analysis with robust SEs clustered on note writers was adjusted for patient-, note- and clinician-level characteristics. Any race or ethnicity mention was the outcome of interest.

RESULTS: Among 5573 patients with 292 457 notes by 9742 unique note writers, 3225 patients (57.9%) self-reported their race as White, 997 (17.9%) as Asian, 860 (15.4%) as Latinx, and 491 (8.8%) as Black. Note writers documented race/ethnicity for 20.8% of Black, 10.9% of Latinx, 9.1% of White, and 4.4% of Asian patients. Black patients were more likely than White patients to have race mentioned in notes (adjusted odds ratio, 2.05 [95% CI, 1.49-2.82]).

CONCLUSIONS: Black patients were more than twice as likely as White patients to have race mentioned in notes. Note language containing information on social constructs has consequences for clinicians and patients reading notes and for algorithms trained on clinical notes.

PMID:39482093 | DOI:10.4037/ajcc2024422

Am J Crit Care. 2024 Nov 1;33(6):446-454. doi: 10.4037/ajcc2024898.

ABSTRACT

BACKGROUND: Various social determinants of health have been established as significant risk factors for COVID-19 transmission, prevalence, incidence, and mortality. Area deprivation index (ADI, a composite score made up of educational, housing, and poverty markers) is an accepted multidimensional social determinants of health measure. Little is known about how structural social determinants of health before hospitalization, including ADI, may affect mortality related to COVID-19 in critically ill patients.

OBJECTIVES: To examine the association of ADI with intensive care unit (ICU) mortality in patients with COVID-19 and compare its predictive power with that of clinical factors.

METHODS: This was a retrospective cohort study of critically ill adults with COVID-19 in 3 hospitals within a single health system. Multivariable logistic regression models (adjusted for demographic and clinical variables) were used to examine the association of ADI with ICU mortality.

RESULTS: Data from 1784 patients hospitalized from 2020 to 2022 were analyzed. In multivariable models, no association was found between national ADI and ICU mortality. Notable factors associated with ICU mortality included treatment year, age, van Walraven weighted score, invasive mechanical ventilation, and body mass index.

CONCLUSION: In this study, clinical factors were more predictive of mortality than ADI and other social determinants of health. The influence of ADI may be most relevant before hospital admission. These findings could serve as a foundation for shaping targeted public health strategies and hospital interventions, enhancing care delivery, and potentially contributing to better outcomes in future pandemics.

PMID:39482088 | DOI:10.4037/ajcc2024898

Am J Crit Care. 2024 Nov 1;33(6):468-472. doi: 10.4037/ajcc2024174.

ABSTRACT

BACKGROUND: Supporting the sleep health of surrogate decision-makers of patients in the intensive care unit is a research priority. However, few studies have approached sleep health as a multidimensional construct, instead focusing on 1 or 2 dimensions in isolation.

OBJECTIVE: To holistically examine the sleep health (satisfaction, timing, efficiency, duration) of surrogate decision-makers of critically ill patients.

METHODS: This secondary analysis involved surrogate decision-makers of incapacitated intensive care unit patients at a tertiary medical center in northeastern Ohio (n = 19). Sleep-health data were captured by means of a subjective scale (satisfaction) and objectively (timing, efficiency, duration) by means of a wrist-worn accelerometer (Actiwatch Spectrum Plus; Philips Respironics). Upon enrollment, participants completed the satisfaction scale and wore the Actiwatch Spectrum Plus for 3 consecutive days. Descriptive statistics of the study variables were evaluated.

RESULTS: A minority (15%) of the sample reported poor sleep satisfaction. Sleep timing variables were comparable to those found in other adult studies. Participants averaged approximately 6 hours of sleep per day with an average sleep efficiency of 83.7%.

CONCLUSIONS: Despite adequate satisfaction scores, intensive care unit surrogate decision-makers’ sleep duration is inadequate and sleep efficiency is suboptimal. Sleep-health interventions may be needed in this at-risk population. Future research should consider the impact of surrogate decision-maker sleep health on their capacity to serve in the surrogate decision-maker role.

PMID:39482083 | DOI:10.4037/ajcc2024174

Zhonghua Nei Ke Za Zhi. 2024 Nov 1;63(11):1087-1095. doi: 10.3760/cma.j.cn112138-20240410-00231.

ABSTRACT

Objective: To investigate the correlation between impulse oscillometry system examination indicators and conventional pulmonary ventilation function. Methods: The pulmonary ventilation function data of 10 883 patients from January 1, 2020 to December 31, 2022 at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were included. The one-second rate [ratio of forced expiratory volume in the first second (FEV₁) to forced vital capacity (FVC)] measured as a percentage of the predicted value was ≥92% for the control group (n=3 478) and <92% for the pulmonary obstruction group (n=7 405). The obstruction group was subdivided into five groups according to the degree of pulmonary dysfunction: mild group (n=3 938),moderate group (n=1 142),oderate-severe group (n=917),severe group (n=737),and extremely severe group (n=671). Conventional pulmonary ventilatory function FVC, FEV₁, one-second rate, and forced expired flow at 50% of FVC (MEF50%), forced expired flow at 75% FVC (MEF25%), maximal mid-expiratory flow (MMEF), peak expiratory flow (PEF), and pulsed oscillation pulmonary function test were detected in both groups of patients. Impedance at 5 Hz (Z5) means total respiratory resistance, resistance at 5 Hz (R5) means total airway resistance, reactance at 5 Hz (X5) indicates the elastic recoil of the peripheral airways, and resistance at 20 Hz (R20) represents resistance of the central airways. R5-R20 reflects resistance in the small airways. Additionally, peripheral resistance (Rp), respiratory resonance frequency (Frex), and area under the reactance curve (Ax) were also measured. Correlation between the indicators of the two groups and the sensitivity and specificity of the impulse oscillometry system parameters for the diagnosis of obstructive pulmonary ventilation dysfunction were analyzed. Results: Pulmonary function force expiratory volume in the first second as a percentage of predicted value (FEV₁%Pre) [80.10 (54.95,97.10)%],one-second rate [62.43(48.67, 67.02)%],MEF50% [1.33 (0.62,1.97)L/s],MEF25% [0.28 (0.17,0.41)L/s], MMEF [0.85 (0.43,1.29)L/s],and PEF [5.64 (3.73,7.50)]L/s in the obstruction group were significantly lower than those in the control group (P<0.05). The differences within the subgroups of the obstruction group were also significant (P<0.05). Pulsed oscillation Z5 [0.42 (0.33,0.55)kPa·L^-1·s^-1],Rp [0.25 (0.20,0.45)kPa·L^-1·s^-1], R5 [0.39 (0.31,0.49)kPa·L^-1·s^-1], R20 [0.28 (0.24,0.34)kPa·L^-1·s^-1], R5-R20 [0.09 (0.05,0.17)kPa·L^-1·s^-1],Frex [16.32 (13.07,20.84)Hz], and Ax [0.67 (0.28,1.64)] indices in the obstruction group were significantly higher than those in the control group. X5 [-0.14 (-0.23, -0.10)kPa·L^-1·s^-1] was significantly lower than that in the control group (P<0.05). Z5, Rp, X5, R5, R5-R20, Frex, and Ax were statistically significant between different degrees of obstruction in the obstruction group (P<0.05). The impulse oscillometry system parameters Z5, Rp, R5, R20, R5-20, Frex, and Ax were negatively correlated with the indices of conventional pulmonary ventilation (r=-0.21-0.68, P<0.05), and the parameter X5 was positively correlated with the indices of conventional pulmonary ventilation (r=0.41-0.68, P<0.05). The pulsed oscillation pulmonary function test parameters X5 (58.60%-95.68%) and Ax (57.08%-98.06%) presented the best sensitivity; X5 (86.29%-98.82%), Frex (86.69%-94.71%), and Ax (88.10%-98.53%) displayed the best specificity; and R20 presented the worst sensitivity and specificity. The sensitivity and specificity were slightly better in female patients than in male patients. Conclusion: The technical parameters of the impulse oscillometry system showed significant correlation with relevant indices of conventional pulmonary ventilation function detection. These well reflect the changes of different degrees of pulmonary ventilation function and have greater significance for reference in evaluating the degree of pulmonary function impairment.

PMID:39482072 | DOI:10.3760/cma.j.cn112138-20240410-00231

Taiwan J Obstet Gynecol. 2024 Nov;63(6):900-903. doi: 10.1016/j.tjog.2024.09.008.

ABSTRACT

OBJECTIVES: Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disease affecting both genders in reproductive age. In this study, we aimed to investigate the relation between FMF and pregnancy on both maternal and fetal aspects.

MATERIAL AND METHODS: In this retrospective, single-center, descriptive study we analysed total of 95 pregnancies of 40 FMF patients. Clinical and demographic data were obtained from patients’ records. To prevent recall bias, only the last pregnancy of each patient was evaluated for disease activity and use or revision of medications during pregnancy.

RESULTS: The median age of the patients at diagnosis was 22 and the first pregnancy age was 26 years. The median duration of FMF at last pregnancy was 8 (0-23) years. Eight (20%) patients had at least 1 pregnancy via assisted reproductive techniques (IVF), while 34 (85%) patients had at least 1 spontaneous pregnancy. While 32 patients were in remission (80%) before pregnancy, 8 were clinically active (20%). Improvement in clinical course and attack frequency during pregnancy was observed in 23 patients (57.5%), stable course in 10 (25.0%), and worsening in 7 (17.5%). The rate of live birth was 70.0%, abortus was 28.9%, preterm labor was 8.1%, pre-eclampsia was 5.0%, and only 1 achondroplasia as congenital fetal abnormality was observed.

CONCLUSION: FMF did not constitute a contraindication for pregnancy. The most important obstetric problems, complications, and negative fetal outcomes in the course of pregnancy are increased IVF requirement, abortion, and cesarean rates. There is no increase in the risk of congenital malformations due to FMF itself or use of colchicine.

PMID:39482000 | DOI:10.1016/j.tjog.2024.09.008

Taiwan J Obstet Gynecol. 2024 Nov;63(6):887-891. doi: 10.1016/j.tjog.2024.05.026.

ABSTRACT

OBJECTIVE: In this study, we aimed to evaluate the factors associated with insufficient cervical ripening in a controlled-release dinoprostone vaginal delivery system (Propess).

MATERIALS AND METHODS: This retrospective cohort study included 103 pregnant women who used Propess for labor induction. The outcomes were the factors associated with insufficient cervical ripening, defined as a Bishop score ≤6 on the morning after Propess administration.

RESULTS: Forty-nine participants had insufficient cervical ripening, and 54 had sufficient cervical ripening. Univariate analysis of these two groups showed that maternal age ≥35 years, early-term delivery (gestational age between 37 and 38 weeks), and Bishop scores at insertion ≤1 were significantly higher in the insufficient cervical ripening group. Multivariate logistic analysis showed that maternal age ≥35 years (adjusted odds ratio: 3.08, 95% confidence interval: 1.29-7.36, p = 0.011) and early-term delivery (adjusted odds ratio: 3.17, 95% confidence interval: 1.23-8.20, p = 0.017) were independent factors associated with poor Propess efficacy. Parity, pre-pregnancy body mass index, body mass index at delivery, and indications for labor induction were not associated with insufficient cervical ripening.

CONCLUSIONS: In our study, older maternal age and early-term delivery were independent predictors of insufficient cervical ripening with Propess. More effective delivery management can be achieved by considering induction protocols tailored to individual maternal factors for patients with factors associated with poor Propess efficacy.

PMID:39481997 | DOI:10.1016/j.tjog.2024.05.026

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