Category: Statistics

Rheumatology (Oxford). 2024 Dec 19:keae690. doi: 10.1093/rheumatology/keae690. Online ahead of print.

ABSTRACT

OBJECTIVES: Salivary gland ultrasound (SGUS) has an interest in primary Sjögren’s disease (pSD) for diagnosis, but the evolution of parenchymal lesions over time is unknown. The objective of this study was to assess the severity of ultrasound abnormalities in relation to pSD duration from the time of buccal dryness onset.

METHODS: In this cross-sectional international multicentre study, patients with pSD according to the 2002 or 2016 ACR/EULAR classification criteria were included. Parenchymal abnormalities were classified according to the semiquantitative score as defined by OMERACT. Patients were separated into 4 groups (Group A: < 5 years, Group B: 5-9 years, Group C: 10-20 years, and Group D: > 20 years from the onset of buccal dryness). The association between disease duration groups and SGUS lesions was quantified in terms of odds ratios and 95% confidence intervals.

RESULTS: A total of 247 patients were consecutively included between May 2019 and February 2022. Eighty-nine percent of patients had a focus score ≥1/4 mm2, and 85% had positive anti-Ro/SSA. pSD duration was associated with a pathological OMERACT score (score 2 or 3): OR for 5-year duration: 1.23 [95% CI 1.04; 1.47], p= 0.0383). Considering each US item, the only statistical association with pSD duration was found regarding the presence of hyperechoic bands (25% or more): OR for five-year duration 1.18 [95% CI 1.03; 1.36], p= 0.038), independent of an older age.

CONCLUSION: pSD duration was associated with the presence of hyperechoic bands, but not with hypoechoic areas, suggesting a progressive fibro-adipose evolution.

PMID:39700419 | DOI:10.1093/rheumatology/keae690

G3 (Bethesda). 2024 Dec 19:jkae280. doi: 10.1093/g3journal/jkae280. Online ahead of print.

ABSTRACT

Amplicon panels using genotyping by sequencing methods are now common, but have focused on characterizing SNP markers. We investigate how microhaplotype (MH) discovery within a recently developed Pacific oyster (Magallana gigas) amplicon panel could increase the statistical power for relationship assignment. Trios (offspring and two parents) from three populations in a newly established breeding program were genotyped on a 592 locus panel. After processing, 92% of retained amplicons contained polymorphic MH variants and 85% of monomorphic SNP markers contained MH variation. The increased allelic richness resulted in substantially improved power for relationship assignment with much lower estimated false positive rates. No substantive differences in assignment accuracy occurred between SNP and MH datasets, but using MHs increased the separation in log-likelihood values between true parents and highly related potential parents (aunts and uncles). A high number of Mendelian incompatibilities among trios were observed, likely due to null alleles. Further development of a MH panel, including removing loci with high rates of null alleles, would enable high-throughput genotyping by reducing panel size and therefore cost for Pacific oyster research and breeding programs.

PMID:39700397 | DOI:10.1093/g3journal/jkae280

J Glob Health. 2024 Dec 20;14:04246. doi: 10.7189/jogh.14.04246.

ABSTRACT

BACKGROUND: Postpartum family planning (PPFP) is an essential component of birth care that helps avert maternal and newborn health hazards by preventing short-spaced births. Many Asian and African studies found PPFP counselling during antenatal care (ANC) and postnatal care (PNC) effective in increasing PPFP uptake. Studies in Bangladesh, however, provided limited evidence of the feasibility and effectiveness of integrating PPFP in maternal health services. The national action plan integrated PPFP services (counseling and providing methods) in maternal health care and immunisation programmes. However, no study has examined the availability of PPFP counselling, an essential component of PPFP, in maternity care points and its effectiveness in increasing PPFP initiation. We explore the prevalence and correlates of PPFP counselling during ANC and PNC and investigate whether PPFP counselling during ANC and PNC increases PPFP initiation.

METHODS: We used nationally representative data from the 2017-18 Bangladesh Demographic and Health Survey to analyse whether women having the last live birth in the past three years received PPFP counselling during ANC or PNC visits. We included women’s other characteristics as covariates in a multivariable logistic regression. Finally, we analysed the 12-month PPFP initiation by PPFP counselling during ANC and PNC visits. The PPFP initiation analysis used self-reported contraceptive calendar data, a life table technique, and a proportional hazards model.

RESULTS: The prevalence of PPFP counselling was 12% during ANC and 22% during PNC. Women with higher education, higher birth order, upper household wealth quintiles, and living in the Khulna division compared to Chattogram (i.e. the division with the lowest PPFP counselling prevalence) were more likely to receive PPFP counselling during ANC and PNC. Three-fourths of the women initiated FP within 12 months postpartum. PPFP initiation was higher for women receiving PPFP counselling during PNC than those who did not receive it during PNC. We did not find evidence of increased PPFP initiation among women receiving PPFP counselling during ANC.

CONCLUSIONS: The higher PPFP initiation among women receiving PPFP counselling during PNC is encouraging. Although we did not find evidence supporting increased PPFP initiation among women receiving PPFP counselling during ANC, further investigation on the quality of PPFP counselling during ANC may guide this necessary intervention’s implementation and scale-up.

PMID:39700387 | DOI:10.7189/jogh.14.04246

J Glob Health. 2024 Dec 20;14:05037. doi: 10.7189/jogh.14.05037.

ABSTRACT

BACKGROUND: While countries’ coronavirus disease 2019 (COVID-19) emergency contingency and response plans aimed to prevent and control the spread of the virus, they also caused major disruptions to health services. We assessed the effects of COVID-19 on coverage and inequalities in select maternal, newborn, and child health services in Burkina Faso.

METHODS: We analysed data from two cross-sectional household surveys conducted in two provinces, one rural and one urban. The first survey of 3375 households was conducted immediately before the pandemic (February to March 2020) and the second survey in the same areas two years after the pandemic (May to June 2022) using a similar methodology. We compared the coverage of maternal, newborn, and child health interventions and care-seeking between the two surveys to assess the effects of the pandemic on maternal, newborn, and child health services.

RESULTS: Our findings did not show significant disruptions in coverage of antenatal service, postnatal care for mothers and babies, child routine vaccination, and care-seeking for sick children during the pandemic. However, there was a dramatic drop of the number of women (23 percentage points) accompanied by their partners for delivery as well as the number of caesarean-section deliveries in urban areas. The shortage of health staff, facility congestion, fear of getting COVID-19 after a caesarean-section admission, and prioritisation of critical health services such as emergency caesarean-section to the detriment of elective cases may explain the decline of caesarean-section rates.

CONCLUSIONS: COVID-19 did not cause major reversals in the coverage of maternal, newborn, and child health services in Burkina Faso, except for caesarean sections. We also saw no substantial increases in service coverage. In the absence of a counterfactual, we could not attribute the stagnation to the pandemic. However, the very low proportion of women reporting disruption in care-seeking suggests some resilience of the health systems to mitigate the negative impacts of the pandemic.

PMID:39700386 | DOI:10.7189/jogh.14.05037

J Glob Health. 2024 Dec 20;14:05034. doi: 10.7189/jogh.14.05034.

ABSTRACT

BACKGROUND: The World Health Organization declared that coronavirus disease 2019 (COVID-19) constitutes an international public health emergency, which has strained health resources. In this study, we aimed to understand medical students’ willingness to join the workforce fighting against the COVID-19 pandemic and identify factors associated with their decisions.

METHODS: We conducted a nationwide cross-sectional study using the Wen-Juan-Xing platform and a pre-designed questionnaire from 23 March to 19 April 2021. We conducted logistic regression analyses to identify the determinants associated with the willingness.

RESULTS: Among the 5022 medical students, the majority (n = 4289, 85.40%) expressed willingness to work on the COVID-19 frontline. Logistic regression indicated that medical students’ willingness to work on the COVID-19 frontline in China was associated with gender, region, reason for choosing medicine, having medical workers in the family, students whose family members, relatives or friends experienced COVID-19, and professional attitude. Females (odds ratio (OR) = 1.305; 95% confidence interval (CI) = 1.100-1.549; P = 0.0023), medical students from urban areas (OR = 1.295; 95% CI = 1.089-1.539; P = 0.0034), medical students whose choice of a medical career was their desire (OR = 1.579; 95% CI = 1.290-1.933; P < 0.0001), medical students whose parents or relatives are medical workers (OR = 1.266; 95% CI = 1.066-1.505; P = 0.0073), medical students whose family members, relatives, or friends have never been infected with COVID-19 (OR = 4.567; 95% CI = 3.002-6.947; P < 0.0001), and medical students with undisturbed of professional attitudes (OR = 4.280; 95% CI = 3.241-5.654; P < 0.0001) showed increased willingness to work on the COVID-19 frontline compared with their counterparts.

CONCLUSIONS: Medical students demonstrated a strong willingness to contribute to COVID-19 work during the pandemic in China. The findings may provide valuable information for emergency management so that policymakers can maintain sufficient health resources and provide quality health care in similar health emergencies in the future.

PMID:39700384 | DOI:10.7189/jogh.14.05034

J Med Internet Res. 2024 Dec 19;26:e57786. doi: 10.2196/57786.

ABSTRACT

BACKGROUND: The status of the digitalization of companies and institutions is usually measured using maturity models. However, the concept of maturity in general practice is currently unclear, and herewith we examine the question of how maturity can be measured. There is a lack of empirical work on the dimensions and subcategories of digital maturity that provide information on the assessment framework.

OBJECTIVE: The aim of the study was to answer the question of how many and which dimensions and subcategories describe digital maturity in general practice.

METHODS: An explorative, qualitative research design based on semistructured expert interviews was used to investigate the dimensions of digital maturity. Twenty experts from various areas of the health care sector (care providers, interest groups, health care industry, and patient organizations) were interviewed. The interviews were analyzed based on a content-structuring analysis according to Kuckartz and Rädiker using MAXQDA software (VERBI GmbH).

RESULTS: In total, 6 dimensions with a total of 26 subcategories were identified. Of these, 4 dimensions with a total of 16 subcategories (1) digitally supported processes, (2) practice staff, (3) organizational structures and rules, and (4) technical infrastructure and were deductively linked to digital maturity. In addition to the use of digital solutions, digital maturity included, for example, individual, organizational, and technical capabilities and resources of the medical practice. The 2 further dimensions, (5) benefits and outcomes and (6) external framework conditions of the medical practice, were identified inductively with a total of 10 subcategories. Digital maturity was associated with the beneficial use of digitalization, for example, with efficiency benefits for the practice, and external framework conditions were associated with influencing factors such as the local patient situation in the medical practice.

CONCLUSIONS: The results indicate that digital maturity is a multidimensional construct that is associated with many dimensions and variables. It is a holistic approach with human, organizational, and technical factors and concerns the way digitalization is used to shape patient care and processes. Furthermore, it is related to the maturity of the organizational environment as well as the benefits of a digitalized medical practice; however, this still needs to be confirmed. To measure the level of digital maturity in outpatient care as accurately as possible, maturity models should therefore be multilayered and take external influencing factors into account. Future research should statistically validate the identified dimensions. At the same time, correlations and dependencies between the measurement dimensions and their subcategories should be analyzed.

PMID:39699948 | DOI:10.2196/57786

J Surg Oncol. 2024 Dec 19. doi: 10.1002/jso.28046. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: The tumor-associated stroma is an essential compartment in breast cancer, and collagen fiber organization in the stroma has been reported to be correlated with prognosis. In this study, we sought to evaluate collagen fiber characteristics in relation to pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer patients.

METHODS: A total of 388 breast cancer patients receiving NAC were enrolled. The stroma type was manually assessed on pretreatment hematoxylin and eosin (HE)-stained slides, and the collagen fiber features were quantified by a computer tool. The relationship between syndecan-1 expression and collagen fibers and its correlation with treatment efficacy were detected by immunohistochemistry.

RESULTS: The pCR rate of patients with collagen-dominant stroma was lower than that of patients with lymphocyte-dominant stroma (19.6% vs. 40.0%, p = 0.001). Patients who achieved pCR had straighter and less dense fibers in pretreatment biopsied tissue than non-pCR patients (p = 0.031, p = 0.044). Additionally, the pCR group had greater syndecans-1 expression on the tumor epithelium than the non-pCR group (p < 0.001), while there was no statistically significant difference in the stroma (p = 0.333). Collagen fiber density was the only factor associated with pCR after correction for other clinicopathological variables in triple-negative breast cancer (TNBC) patients (OR 0.466, 95% CI 0.227-0.956, p = 0.037); patients with lower fiber density had a greater pCR rate (37.5% vs. 12.5%, p = 0.021).

CONCLUSIONS: Collagen fiber density was associated with pCR in patients with breast cancer, and it could be a potential candidate for discriminating between responders and nonresponders for TNBC patients receiving NAC.

PMID:39699940 | DOI:10.1002/jso.28046

JAMA Otolaryngol Head Neck Surg. 2024 Dec 19. doi: 10.1001/jamaoto.2024.4373. Online ahead of print.

ABSTRACT

INTRODUCTION: Mild sleep-disordered breathing (mSDB) in children is associated with both neurobehavioral morbidity and reduced quality of life (QOL). However, the association between symptom burden and QOL with executive function is not well understood, and it is not known whether QOL and symptom burden may help identify children with neurocognitive dysfunction.

OBJECTIVE: To assess associations among executive function, QOL, and symptom burden in children with mSDB.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was a secondary analysis of the multicenter Pediatric Adenotonsillectomy Trial for Snoring, which included children aged 3 to 12 years randomized to watchful waiting or adenotonsillectomy for mSDB (snoring and an obstructive apnea-hypopnea index <3) between June 29, 2016, and February 1, 2021. The data for this report were analyzed between December 22, 2020, and October 3, 2024.

EXPOSURE: Pediatric mSDB.

MAIN OUTCOMES AND MEASURES: Quality of life was assessed using the Obstructive Sleep Apnea-18 (OSA-18), and symptom burden was assessed using the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder Scale (PSQ-SRBD). Executive function, including self-control and working memory, was measured using the Behavior Rating Inventory of Executive Function Global Executive Composite (BRIEF GEC), and inhibitory control and sustained attention were measured by the GoNoGo vigilance test. Partial Pearson correlations and multiple linear regression models were used to assess the associations among QOL, symptoms, and executive function.

RESULTS: The sample included 459 children (mean [SD] age, 6.1 [2.3] years; 230 female [50.1%]). Moderate correlations were found between the BRIEF GEC and the PSQ-SRBD and OSA-18 (r = 0.58 [95% CI, 0.51-0.64] and 0.59 [95% CI, 0.52-0.64], respectively). After adjusting for age, sex, race and ethnicity, body mass index percentile, household income, maternal education, attention-deficit/hyperactivity disorder, test characteristics, and disease severity, both OSA-18 and PSQ-SRBD scores were associated with the BRIEF GEC (β = 0.41 [95% CI, 0.36-0.47] and 3.66 [95% CI, 3.17-4.15], respectively). In the fully adjusted model, PSQ-SRBD was also associated with GoNoGo inhibitory control (β = -0.04 [95% CI, -0.08 to -0.01]) and sustained attention (β = -0.05 [95% CI, -0.10 to -0.01]).

CONCLUSIONS AND RELEVANCE: In this study, disease-specific QOL and symptom burden were associated with executive function in children with mSDB. These findings may be useful in identifying those children who are at risk for neurocognitive dysfunction.

PMID:39699925 | DOI:10.1001/jamaoto.2024.4373

JAMA Oncol. 2024 Dec 19. doi: 10.1001/jamaoncol.2024.5403. Online ahead of print.

ABSTRACT

IMPORTANCE: Most patients with locally advanced hepatocellular carcinoma (HCC) recur within the liver following systemic therapy.

OBJECTIVE: To determine whether stereotactic body radiation therapy (SBRT) improves outcomes in patients with locally advanced HCC compared with sorafenib alone.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter phase 3 randomized clinical trial randomized patients with HCC 1:1 to sorafenib or SBRT followed by sorafenib, stratified by performance status, liver function, degree of metastases, and macrovascular invasion. Eligible patients had HCC unsuitable for or refractory to standard local-regional therapies and were candidates for first-line systemic therapy. Data were collected from April 2013 to March 2021, and data were analyzed from July 2022 to August 2023.

INTERVENTION: Personalized SBRT, 27.5 to 50 Gy in 5 fractions.

MAIN OUTCOMES AND MEASURES: The primary end point was overall survival (OS). Secondary end points were progression-free survival (PFS), adverse events, and quality of life.

RESULTS: Of 193 patients randomized, 177 were eligible. Accrual was stopped early due to a change in standard-of-care systemic therapy. Of 177 included patients, 150 (84.7%) were male, and the median (IQR) age was 66 (60-72) years. Macrovascular invasion was seen in 131 (74.0%). As of July 1, 2022, the median OS was 12.3 months (90% CI, 10.6-14.3) with sorafenib vs 15.8 months (90% CI, 11.4-19.2) following SBRT and sorafenib (hazard ratio [HR], 0.77; 90% CI, 0.59-1.01; 1-sided P = .06). Adjusting for stratification factors, OS was improved with SBRT (HR, 0.72; 95% CI, 0.52-0.99; 2-sided P = .04). Median PFS was improved from 5.5 months (95% CI, 3.4-6.3) with sorafenib to 9.2 months (95% CI, 7.5-11.9) with SBRT and sorafenib (HR, 0.55; 95% CI, 0.40-0.75; 2-sided P < .001). Treatment-related grade 3 or higher adverse events were seen in 37 of 88 (42%) and 39 of 83 (47%) of patients treated with sorafenib vs SBRT and sorafenib, respectively (P = .52). There were 2 treatment-related deaths in the sorafenib group (death not otherwise specified and liver failure) and 1 in the SBRT and sorafenib group (lung infection). At 6 months, improved quality of life was seen in 2 of 20 (10%) and 6 of 17 (35%) of patients treated with sorafenib and SBRT and sorafenib, respectively.

CONCLUSIONS AND RELEVANCE: In this phase 3 randomized clinical trial, among patients with locally advanced HCC, SBRT was associated with a clinically important but not statistically significant improved overall survival compared with sorafenib alone.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01730937.

PMID:39699905 | DOI:10.1001/jamaoncol.2024.5403

JAMA Netw Open. 2024 Dec 2;7(12):e2450489. doi: 10.1001/jamanetworkopen.2024.50489.

ABSTRACT

IMPORTANCE: Little is known about the nature of change in goals of care (GOC) over time among adolescents and younger adult (AYA) patients aged 12 to 39 years with cancer near the end of life. Understanding how GOC evolve may guide clinicians in supporting AYA patients in making end-of-life decisions.

OBJECTIVE: To assess frequency, timing, and evolution of documented GOC among AYA patients with cancer in the last 90 days of life.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included a retrospective review of medical records from the Dana-Farber Cancer Institute, Kaiser Permanente Northern California, and Kaiser Permanente Southern California of AYA patients with cancer who were 12 to 39 years of age at death and who died between January 1, 2003, and December 31, 2019. Data were analyzed from July 1, 2023, through April 30, 2024.

EXPOSURES: Stage IV cancer or stage I-III cancer with new metastasis or recurrence.

MAIN OUTCOME AND MEASURES: The primary outcome was documented GOC discussions, categorized by timing before death as initial (>60 days), middle (31-60 days), or late (≤30 days). Goals were classified as palliative, nonpalliative, undecided, or not discussed. Subgroup analysis according to race and ethnicity were also performed.

RESULTS: Among 1929 AYA patients with a mean (SD) age at cancer diagnosis of 28 (8) years, 1049 (54.5%) were female; 5 (0.3%) were American Indian or Alaska Native, 227 (11.8%) were Asian, 157 (8.1%) were Black or African American, 14 (0.7%) were Native Hawaiian or Other Pacific Islander, 1184 (61.4%) were White, 11 (0.6%) were of more than 1 race, 38 (2.0%) were categorized as other race, 293 (15.2%) were without documented race, 514 (26.6%) were Hispanic or Latino, 762 (39.5%) were not Hispanic or Latino, and 653 (33.9%) had no documented ethnicity. Few AYA patients had palliative goals documented in the initial period (139 [7.2%]), increasing to 331 (17.2%) in the middle period and 1113 (57.7%) in the late period. In total, 393 patients (20.4%) transitioned from documented nonpalliative goals in the initial or middle periods to palliative goals by the late period. Many patients had no documented GOC discussion until close to death (initial, 1364 [70.7%]; middle, 969 [50.2%]; and late, 322 [16.7%]). Among the 1929 patients, non-White patients were disproportionately represented among those not having documented GOC discussions (Black, 30 of 157 [19.1%]; Asian, 45 of 227 [19.8%]; and other or undocumented race, 80 of 361 [22.2%]) compared with White patients (167 of 1184 [14.1%]) (P < .001) as were Hispanic or Latino patients (116 of 514 [22.6%]) compared with non-Hispanic patients (93 of 762 [12.2%]) (P < .001) and individuals with no ethnicity documented (113 of 653 [17.3%]) (P < .001).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of AYA patients who died of cancer, palliative goals were rarely documented before the last month of life, highlighting the need for timely and ongoing GOC discussions.

PMID:39699897 | DOI:10.1001/jamanetworkopen.2024.50489