Category: Statistics

BMC Glob Public Health. 2024 May 6;2(1):28. doi: 10.1186/s44263-024-00061-6.

ABSTRACT

BACKGROUND: Colorectal cancer (CRC) poses a significant public health challenge in Canada, with the Atlantic provinces bearing a particularly high burden. The implementation of population-based colon screening programs is aimed to address this concern. However, limited research exists on the effect of these programs especially in Canada. This study aimed to examine the impact of the first few years of the CRC screening programs in the Atlantic provinces of Canada by assessing changes in screening uptake, barriers, and predictors of screening among eligible populations.

METHODS: Employing a repeated cross-sectional design, this study analyzed data from a representative sample of 7614 respondents in 2010 and 6850 in 2017 from the Atlantic provinces aged 50-74 years, extracted from the Canadian Community Health Survey (CCHS). The outcomes measured were CRC screening rates, changes in predictors of screening uptake, and barriers to participation. Potential predictors examined included age, sex, income, education, smoking, and health status.

RESULTS: The proportion of adults aged 50-74 years who meet CRC screening requirements increased from 42% in 2010 to 54% in 2017 yet below the national target of 60%. New Brunswick reported the most significant increase in screening prevalence (18%, p < 0.05). Participation in fecal tests increased from 19.6 to 32.4%. Despite these improvements, disparities in screening participation remained, with lower uptake observed among individuals with lower income and education levels. Age (> 60 years, OR = 2.09, p < 0.01), the presence of multiple chronic health conditions (OR = 2.11, p < 0. 01), being female (OR = 1.21, p < 0.01), married status (OR = 1.21, p < 0.05), access to regular healthcare (OR = 1.91, p < 0.01), and nonsmoking status (OR = 2.55, p < 0.01) were identified as significant predictors of CRC screening uptake.

CONCLUSIONS: This study shows that while CRC screening uptake increased across the Atlantic provinces between 2010 and 2017, barriers to and disparities in screening participation persist. This highlights the need for targeted interventions to improve awareness, access, and screening uptake, particularly among disadvantaged groups, to promote equitable healthcare outcomes. Continued efforts should focus on reducing barriers to screening and leveraging available evidence to inform interventions aimed at mitigating the CRC burden in the region.

PMID:39681936 | DOI:10.1186/s44263-024-00061-6

BMC Glob Public Health. 2024 May 3;2(1):27. doi: 10.1186/s44263-024-00057-2.

ABSTRACT

BACKGROUND: Travel restrictions and border controls were used extensively during the COVID-19 pandemic. However, the processes for making robust evidence-based risk assessments of source countries to inform border control policies was in many cases very limited.

METHODS: Between April 2020 and February 2022, all international arrivals to New Zealand were required to spend 14 days in government-managed quarantine facilities and were tested at least twice. The infection rates among arrivals in the years 2020, 2021 and 2022 were respectively 6.3, 9.4 and 90.0 cases per thousand arrivals (487, 1064 and 1496 cases). Test results for all arrivals were linked with travel history, providing a large and comprehensive dataset on the number of SARS-CoV-2-positive and negative travellers from different countries over time. We developed a statistical model to predict the country-level infection risk based on infection rates among recent arrivals and reported cases in the country of origin. The model incorporates a country-level random effect to allow for the differences between the infection risk of the population of each country and that of travellers to New Zealand. A time dependent auto-regressive component of the model allows for short term correlation in infection rates.

RESULTS: A model selection and checking exercise found that the model was robust and reliable for forecasting arrival risk for 2 weeks ahead. We used the model to forecast the number of infected arrivals in future weeks and categorised countries according to their risk level. The model was implemented in R and was used by the New Zealand Ministry of Health to help inform border control policy during 2021.

CONCLUSIONS: A robust and practical forecasting tool was developed for forecasting infection risk among arriving passengers during a period of controlled borders during the COVID-19 pandemic. The model uses historical infection rates among arrivals and current infection rates in the source country to make separate risk predictions for arrivals from each country.

PMID:39681931 | DOI:10.1186/s44263-024-00057-2

BMC Glob Public Health. 2024 Jun 17;2(1):38. doi: 10.1186/s44263-024-00069-y.

ABSTRACT

BACKGROUND: Understanding how the COVID-19 pandemic evolved under control measures is crucial to tackle the SARS-CoV-2 virus spread. Laos, a country bordering China but with late occurrence and low burden of COVID-19 compared to its neighbouring countries, was used for a case study.

METHODS: A transmission model with disease reporting was proposed to investigate the impact of control measures on the SARS-CoV-2 virus spread in Laos from April 2021 to May 2022. It was assumed that the transmission rate changed with people’s behaviours, control measures and emerging variants; susceptibility decreased with vaccination and infection. Bayesian inference was used for model calibration to data of confirmed cases, deaths, and recoveries, and the deviance information criterion was used to select the best model variant.

RESULTS: Our model including Non-pharmaceutical interventions (NPIs), behaviour change, vaccination, and changing variants well explained the three waves in Laos. The Alpha variant was estimated to have a basic reproduction number of 1.55 (95% CrI: 1.47-1.64) and was replaced by the Delta variant from September 2021 which was 1.88 (95% CrI: 1.77-2.01) times more transmissible; the Delta variant was replaced by Omicron variant from March 2022 which was 3.33 (95% CrI: 2.84-3.74) times more transmissible. The Delta variant was the most severe with a case fatality rate of 1.05% (95% CrI: 0.96-1.15%) while the Alpha variant and Omicron variant were much milder. The ascertainment rate was low and variable: first decreasing from 13.2 to 1.8% by 23 May 2021, and then increasing to 23.4% by 15 March 2022. Counterfactual simulations indicated that vaccination played strong roles in reducing infections even under the emergence of immune escape variants while behaviour change delayed but might not flatten the peak of outbreaks.

CONCLUSIONS: The three waves of Laos’ epidemics were due to the invasion of more transmissible and immune escape variants that affected the herd immunity built via vaccination and infection. Even with immunity waning and the escape of new variants, vaccination was still the major contributor to control COVID-19 and combining behaviour changes and vaccination would best suppress future outbreaks of COVID-19.

PMID:39681927 | DOI:10.1186/s44263-024-00069-y

BMC Glob Public Health. 2024 Apr 12;2(1):24. doi: 10.1186/s44263-024-00055-4.

ABSTRACT

BACKGROUND: Prior research has reaffirmed lifestyle risk behaviors to cluster among adolescents. However, the lifestyle cluster effect on suicidal thoughts and behaviors (STBs) was unclear among adolescents in low- and middle-income countries (LMICs). No comparison of such associations was conducted across nations.

METHODS: Data from 45 LMICs were obtained from the Global School-based Student Health Survey (GSHS) between 2009 and 2019. Lifestyle behavior factors were collected through a structured questionnaire. Suicidal ideation, plan, and attempt were ascertained by three single-item questions. Lifestyle risk scores were calculated via a sufficient dimension reduction technique, and lifestyle risk clusters were constructed using a latent class analysis. Generalized linear mixed models with odds ratio (OR) and 95% confidence interval (CI) were used to estimate the lifestyle-STB associations.

RESULTS: A total of 229,041 adolescents were included in the final analysis. The weighted prevalence of suicidal ideation, plan, and attempt was 7.37%, 5.81%, and 4.59%, respectively. Compared with the favorable lifestyle group, the unfavorable group had 1.48-, 1.53-, and 3.11-fold greater odds of suicidal ideation (OR = 1.48, 95%CI: 1.30-1.69), plan (OR = 1.53, 95%CI 1.34-1.75), and attempt (OR = 3.11, 95%CI 2.64-3.65). Four clusters of lifestyle risk behaviors were identified, namely healthy lifestyles (H-L), insufficient intake of vegetables and fruit (V-F), frequent consumption of soft drinks and fast food (D-F), and tobacco smoking and alcohol drinking (S-A) clusters. Compared with H-L cluster, V-F cluster was associated with 43% and 42% higher odds of suicidal ideation and plan, followed by S-A cluster (26% for ideation and 20% for plan), but not significant in D-F cluster (P > 0.05). D-F cluster was associated with 2.85-fold increased odds of suicidal attempt, followed by V-F cluster (2.43-fold) and S-A cluster (1.18-fold).

CONCLUSIONS: Clustering of lifestyle risk behaviors is informative for risk stratification of STBs in resource-poor settings. Lifestyle-oriented suicide prevention efforts should be initiated among school-attending adolescents in LMICs.

PMID:39681898 | DOI:10.1186/s44263-024-00055-4

BMC Glob Public Health. 2024 Oct 3;2(1):67. doi: 10.1186/s44263-024-00098-7.

ABSTRACT

BACKGROUND: COVID-19 will not be the last pandemic of the twenty-first century. To better prepare for the next one, it is essential that we make honest appraisals of the utility of different responses to COVID. In this paper, we focus specifically on epidemiologic forecasting. Characterizing forecast efficacy over the history of the pandemic is challenging, especially given its significant spatial, temporal, and contextual variability. In this light, we introduce the Weighted Contextual Interval Score (WCIS), a new method for retrospective interval forecast evaluation.

METHODS: The central tenet of the WCIS is a direct incorporation of contextual utility into the evaluation. This necessitates a specific characterization of forecast efficacy depending on the use case for predictions, accomplished via defining a utility threshold parameter. This idea is generalized to probabilistic interval-form forecasts, which are the preferred prediction format for epidemiological modeling, as an extension of the existing Weighted Interval Score (WIS).

RESULTS: We apply the WCIS to two forecasting scenarios: facility-level hospitalizations for a single state, and state-level hospitalizations for the whole of the United States. We observe that an appropriately parameterized application of the WCIS captures both the relative quality and the overall frequency of useful forecasts. Since the WCIS represents the utility of predictions using contextual normalization, it is easily comparable across highly variable pandemic scenarios while remaining intuitively representative of the in-situ quality of individual forecasts.

CONCLUSIONS: The WCIS provides a pragmatic utility-based characterization of probabilistic predictions. This method is expressly intended to enable practitioners and policymakers who may not have expertise in forecasting but are nevertheless essential partners in epidemic response to use and provide insightful analysis of predictions. We note that the WCIS is intended specifically for retrospective forecast evaluation and should not be used as a minimized penalty in a competitive context as it lacks statistical propriety. Code and data used for our analysis are available at https://github.com/maximilian-marshall/wcis .

PMID:39681892 | DOI:10.1186/s44263-024-00098-7

Microb Cell Fact. 2024 Dec 17;23(1):330. doi: 10.1186/s12934-024-02600-0.

ABSTRACT

BACKGROUND: The main obstacle facing the utilization of microbial enzymes in industrial applications is the high cost of production substrates. As a result of the mentioned different wastes (coffee powder waste, dates nawah powder, molokhia stems, pea peels, lemon peels, and corn cobs) were investigated as low-cost nutritional substrates for the production of microbial β-galactosidase in this study. The purification of the enzyme and its kinetic and thermodynamics were investigated.

RESULTS: β-galactosidase was effectively produced by Aspergillus foetidus utilizing lemon peels and coffee powder waste by solid-state fermentation technique. The production yield was improved through Plackett-Burman Design declaring the significant effect of lemon peels and coffee waste powder, and beef extract quantities on A. foetidus β-galactosidase production. Followed by Central Composite Design investigating each factor with five levels resulting in 37363.1 U.ml^{– 1} production. The enzyme was fully purified by gel filtration technique through Sephadex G-150 giving one band with a molecular weight 40 KDa on SDS-PAGE gel. The maximal β-galactosidase activity was obtained at 50 °C with 0.4% ONPG. Cu²⁺, Fe²⁺, and Hg²⁺ showed severe inhibitory effect on pure enzyme activity. Energy required for enzyme activation (E_a) and denaturation (E_d) were determined to be 17.40, and 43.86 KJ.mol^{– 1}, respectively. Parameters reflecting β-galactosidase thermal stability at 40, 45, and 50 °C as T_1/2 and D-values values were determined to be 283.92, 209.43, and 168.56 min, and 943.34, 695.84, and 560.06 min, respectively.

PMID:39681866 | DOI:10.1186/s12934-024-02600-0

BMC Med Res Methodol. 2024 Dec 16;24(1):301. doi: 10.1186/s12874-024-02436-7.

ABSTRACT

BACKGROUND: Transitivity assumption is the cornerstone of network meta-analysis (NMA). Investigating the plausibility of transitivity can unveil the credibility of NMA results. The commonness of transitivity was examined based on study dissimilarities regarding several study-level aggregate clinical and methodological characteristics reported in the systematic reviews. The present study also demonstrated the disadvantages of using multiple statistical tests to assess transitivity and compared the conclusions drawn from multiple statistical tests with those from the approach of study dissimilarities for transitivity assessment.

METHODS: An empirical study was conducted using 209 published systematic reviews with NMA to create a database of study-level aggregate clinical and methodological characteristics found in the tracenma R package. For each systematic review, the network of the primary outcome was considered to create a dataset with extracted study-level aggregate clinical and methodological characteristics reported in the systematic review that may act as effect modifiers. Transitivity was evaluated by calculating study dissimilarities based on the extracted characteristics to provide a measure of overall dissimilarity within and between the observed treatment comparisons. Empirically driven thresholds of low dissimilarity were employed to determine the proportion of datasets with evidence of likely intransitivity. One-way ANOVA and chi-squared test were employed for each characteristic to investigate comparison dissimilarity at a significance level of 5%.

RESULTS: Study dissimilarities covered a wide range of possible values across the datasets. A ‘likely concerning’ extent of study dissimilarities, both intra-comparison and inter-comparison, dominated the analysed datasets. Using a higher dissimilarity threshold, a ‘likely concerning’ extent of study dissimilarities persisted for objective outcomes but decreased substantially for subjective outcomes. A likely intransitivity prevailed in all datasets; however, using a higher dissimilarity threshold resulted in few networks with transitivity for semi-objective and subjective outcomes. Statistical tests were feasible in 127 (61%) datasets, yielding conflicting conclusions with the approach of study dissimilarities in many datasets.

CONCLUSIONS: Study dissimilarity, manifested from variations in the effect modifiers’ distribution across the studies, should be expected and properly quantified. Measuring the overall study dissimilarity between observed comparisons and comparing it with a proper threshold can aid in determining whether concerns of likely intransitivity are warranted.

PMID:39681853 | DOI:10.1186/s12874-024-02436-7

BMC Palliat Care. 2024 Dec 16;23(1):283. doi: 10.1186/s12904-024-01615-z.

ABSTRACT

BACKGROUND: With an increased number of people living with multiple progressive diseases, online education courses have been created to address the growing need for competence in palliative care. However, there is limited knowledge about the form and content of these courses, or of participants’ experiences. This study aims to map the status, content, and evaluation of online palliative care courses in Sweden.

METHODS: This exploratory study used both quantitative and qualitative methods. The study process involved searching for online palliative care courses on the web and through contact with Swedish palliative care organisations, and then participating in these courses, surveying education providers, and analysing and validating responses. Quantitative data were analysed using descriptive statistics, while thematic analysis was applied to the free-text responses.

RESULTS: Nine online courses provided by five different organisations were mapped. These courses educated over 30 000 healthcare professionals, predominantly assistant nurses and registered nurses. There was a large discrepancy between the number of people who enrolled in and the number who completed the online courses. Shortcomings identified related to lack of systematic evaluation from the participants’ perspectives, if and how knowledge was integrated into clinical practice, and difficulties in making the courses sustainable.

CONCLUSION: Overarching and national systems for online education are needed. These would require sustainability considerations and guidelines for implementation, evaluation and follow-up of non-university-based online educational initiatives in palliative care. In addition, it is crucial for employers to support professionals undergoing such education, ensuring that they are given opportunities to share their feelings and discuss any challenging thoughts that arise during and after the course.

PMID:39681847 | DOI:10.1186/s12904-024-01615-z

BMC Public Health. 2024 Dec 16;24(1):3400. doi: 10.1186/s12889-024-20971-2.

ABSTRACT

BACKGROUND: Motivation levels for exercise vary widely among individuals and are influenced by various factors. This study aimed to compare exercise motivation levels and explore influencing factors among university students.

METHODS: A cross-sectional research design targeted university students aged range 18 to 32 years. Participants (n = 148) were selected via cluster random sampling. Motivation for exercise was determine by the Exercise Motivation Inventory (EMI-2). EMI-2 comprises fourteen different subscales of motivation, with each subscale containing three to four items. All items were rated on a scale of 0 to 5, with 0 indicating “not at all true for me” and 5 indicating “very true for me.” Statistical analyses included ANOVA and Pearson correlation coefficient to assess differences among demographic variables (year of study, age, gender, marital status, location, and family size) and relationships between motivational aspects.

RESULTS: The average exercise motivation level among all students was 166.94 ± 32.20. Fifth-year students exhibited the highest motivation 178.33 ± 30.37. No significant gender differences were found (p = 0.149). However, age (p = 0.024), location (p = 0.015), marital status (p = 0.050), and family size (p = 0.030) significantly influenced exercise motivation.

CONCLUSION: University students demonstrate inherent motivation for physical activity, with significant variations observed across demographic factors. These findings underscore the importance of tailored interventions to promote exercise and enhance student well-being. Further research, including longitudinal studies, is warranted to comprehensively understand exercise motivation dynamics in this population.

PMID:39681844 | DOI:10.1186/s12889-024-20971-2

BMC Prim Care. 2024 Dec 16;25(1):416. doi: 10.1186/s12875-024-02677-x.

ABSTRACT

BACKGROUND: Rural areas are increasingly moving back into the focus of social research, especially in the context of health care. As the shortage of general practitioners (GP) in rural areas is a significant challenge in Germany, there are several programs to counteract underuse effectively, acutely, and sustainably. One of those programs is ‘Beste Landpartie Allgemeinmedizin’ (BeLA), which was developed to strengthen primary care in rural areas and to sustainably promote young doctors to work as general practitioners in rural regions through didactical and financial support. The program includes an accompanying qualitative study exploring the motivational structures of medical students from a sociological perspective. For this study, the nexus of working in rural areas from the perspective of medical students with different forms of rural experiences was of interest.

METHODS: Qualitative interviews have been conducted at regular intervals on an ongoing basis since 2020 to investigate motivational retention effects during the program. The current 33 interviews were analysed using the sociological conceptual framework of spatial methods.

RESULTS: The images and experiences of working in rural areas condition medical education in various ways. In addition to general images of living and working in rural areas in a biographical dimension, the idea of working as a GP in rural areas includes images of specific medical competencies and is conditioned by different medical tasks. From such a perspective, the images and attributions of working in primary care in a rural region demonstrate particularities, challenges, and the potential attractiveness of working in rural regions.

DISCUSSION: The images and experiences of rural areas condition medical education in various ways and shape the expectations and the decision-making of possibly working in rural areas. The particularities, opportunities, and challenges of working in rural areas, which relate to both professional aspects and social life, are a major factor in the attractiveness of a potential rural practice. Didactical and educational curricula need to adapt the various attributions of working in rural areas.

PMID:39681841 | DOI:10.1186/s12875-024-02677-x