Category: Statistics

JAMA Netw Open. 2024 Jun 3;7(6):e2419137. doi: 10.1001/jamanetworkopen.2024.19137.

ABSTRACT

IMPORTANCE: Transgender and gender-diverse (TGD) communities experience disproportionate levels of violence, yet due to limitations in measuring TGD identity, few state-representative estimates are available.

OBJECTIVE: To assess gender identity differences in experiences of violence among adults.

DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional data from the 2023 California Violence Experiences (CalVEX) survey, weighted to provide state-representative estimates, was used to assess associations between gender identity and past-year experiences of violence among adults 18 years and older. Data were analyzed from June to December 2023.

EXPOSURE: Gender identity (cisgender women, cisgender men, transgender women, transgender men, and nonbinary individuals).

MAIN OUTCOMES AND MEASURES: Experience of physical violence (including physical abuse and threat or use of a weapon), sexual violence (verbal sexual harassment, homophobic or transphobic slurs, cyber and physically aggressive sexual harassment, and forced sex), and intimate partner violence (IPV; emotional, physical, or sexual violence) using age-adjusted logistic regression.

RESULTS: In total 3560 individuals (weighted cumulative response rate, 5%) completed the 2023 CalVEX survey, with 1978 cisgender women, 1431 cisgender men, 35 transgender women, 52 transgender men, and 64 nonbinary respondents (mean [SD] age, 47.1 [17.5] years; 635 [17%] were Asian, 839 [37%] were Hispanic, and 1159 [37%] were White). Past-year physical violence was reported by 22 transgender men (43%), 9 transgender women (24%), and 9 nonbinary respondents (14%). Past-year sexual violence was reported by 23 transgender men (42%), 11 transgender women (14%), and 31 nonbinary respondents (56%). Compared with cisgender women, transgender women and transgender men had greater risk of past-year physical violence (any form) (transgender women adjusted incidence rate ratio [AIRR], 6.7; 95% CI, 2.5-18.2; transgender men AIRR, 9.7; 95% CI, 5.3-17.7), as well as past-year IPV (any form) (transgender women AIRR, 3.2; 95% CI, 1.3-8.0; transgender men AIRR, 6.7; 95% CI, 4.0-11.3). Relative to cisgender women, transgender men (AIRR, 3.0; 95% CI, 1.7-5.1) and nonbinary respondents (AIRR, 3.3; 95% CI, 2.1-5.2) had greater risk of past-year sexual violence (any form).

CONCLUSIONS AND RELEVANCE: In this survey study of adults in California, results showed that TGD individuals, especially transgender men, are at higher risk of experiencing all forms of violence relative to cisgender women. Results highlight the need for gender-affirming violence prevention and intervention services as well as policies that protect TGD individuals from discriminatory violence.

PMID:38916887 | DOI:10.1001/jamanetworkopen.2024.19137

Transl Vis Sci Technol. 2024 Jun 3;13(6):19. doi: 10.1167/tvst.13.6.19.

ABSTRACT

PURPOSE: We sought to develop and evaluate a practical framework that supports structurally enhanced perimetric examinations.

METHODS: Two perimetric strategies were compared: standard Zippy Estimation through Sequential Testing (ZEST) procedure, a traditional visual field test with population-based prior distributions, and structural-ZEST (S-ZEST), enhanced with individual optical coherence tomography data to determine the starting parameters. The integration and collection of data was facilitated by a bespoke application developed in Shiny R (R Studio). The test was implemented using the Open Perimetry Interface on the Compass perimeter (CentreVue-iCare, Italy). The strategies were evaluated via simulations and on 10 visually healthy participants. The usability of the application was assessed in a simulated environment with 10 test users.

RESULTS: In simulations, the S-ZEST improved test speed in patients with glaucoma. In the practical implementation, there was a statistically significant decrease in the testing time (approximately 26%) and in the number of presentations per test with S-ZEST (P < 0.001). The structure-function relationship was similar between the two strategies. The time taken for users to complete the sequence of actions on the application was 52.9 ± 11.5 seconds (mean ± standard deviation).

CONCLUSIONS: Structurally enhanced perimetric examination can significantly improve test time in healthy subjects and can be delivered through a user-friendly interface. Further testing will need to assess feasibility and performance of S-ZEST in patients with glaucoma.

TRANSLATIONAL RELEVANCE: We have developed a user-friendly web application based within the Shiny environment for R, which implements an automated extraction of optical coherence tomography data from raw files and performs real-time calculations of structural features to inform the perimetric strategy.

PMID:38916881 | DOI:10.1167/tvst.13.6.19

J Clin Neurophysiol. 2024 Jun 25. doi: 10.1097/WNP.0000000000001085. Online ahead of print.

ABSTRACT

INTRODUCTION: The prognostic significance of tailored resection guided with intraoperative electrocorticography (iECoG) in frontal lobe epilepsy surgery has not been fully elucidated.

OBJECTIVES: To analyze influence of preresection and postresection iECoG patterns on long-term seizure control of adults with frontal lobe epilepsy undergoing epilepsy surgery.

METHODS: We retrospectively analyzed 27 patients undergoing epilepsy surgery from two centers with preresection and postresection iECoG and reported clinical variables, preresection and postresection iECoG patterns, and outcome using the Engel Outcome Scale. Descriptive statistics, Kaplan-Meier, the logistic regression model, and analysis of variance tests were used.

RESULTS: Fifteen males (55.6%), a mean and mode follow-up after surgery of 43 (range 2-117) and 19 months, respectively. At 6 months, seizure frequency outcome according to Engel Scale was I 74.1% (20/27), II 7.4% (2/27), III 3.7% (1/27), and IV 14.8% (4/27). We found that 51.9% (14/27) and 40.8% (11/27) of patients without residual epileptiform discharges in postresective iECoG become seizure-free at 6 and 12 months of follow-up, respectively, compared with other postresective iECoG patterns.

CONCLUSIONS: Disregarding the presence of lack of residual epileptiform discharges (interictal epileptiform discharges) after resection, Engel I outcome was seen between 74.1% and 63% at 6- and 12-month postresection follow-up, suggesting the outcome might be in relation with other factors.

PMID:38916879 | DOI:10.1097/WNP.0000000000001085

J Nurs Educ. 2024 Jun 21:1-4. doi: 10.3928/01484834-20240422-05. Online ahead of print.

ABSTRACT

BACKGROUND: Social determinants of health (SDOH) cause significant burden on individuals living with acute and chronic disease. There are meaningful data to support screening for social needs, yet implementation limitations exist in the clinical setting. Incorporating SDOH education into nurse practitioner (NP) curriculum provides a framework for bringing these concepts into clinical practice. As NP education transitions from concept-based to competency-based instruction, NP programs across the nation are tasked with ensuring socially competent, practice-ready NPs.

METHOD: To help students understand the impact of SDOH in an applied way, a multisemester clinical and didactic dyad approach to SDOH competency was implemented.

RESULTS: NP students (N = 521) in three separate cohorts completed the SDOH project between 2019 and 2021. Statistically significant results (p > .001) demonstrated increased knowledge related to SDOH in the clinical setting.

CONCLUSION: Equipping NP students with SDOH competencies empowers them to optimize health, improve patient outcomes, and promote health equity. [J Nurs Educ. 2024;63(X):XXX-XXX.].

PMID:38916854 | DOI:10.3928/01484834-20240422-05

Ecohealth. 2024 Jun 25. doi: 10.1007/s10393-024-01684-9. Online ahead of print.

ABSTRACT

Climate and agricultural land-use change has increased the likelihood of infectious disease emergence and transmissions, but these drivers are often examined separately as combined effects are ignored. Further, seldom are the influence of climate and agricultural land use on emerging infectious diseases examined in a spatially explicit way at regional scales. Our objective in this study was to spatially examine the climate, agriculture, and socio-demographic factors related to agro-pastoralism, and especially the combined effects of these variables that can influence the prevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) in dromedary camels across northern Kenya. Our research questions focused on: (1) How MERS-CoV in dromedary camels has varied across geographic regions of northern Kenya, and (2) what climate, agriculture, and socio-demographic factors of agro-pastoralism were spatially related to the geographic variation of MERS-CoV cases in dromedary camels. To answer our questions, we analyzed the spatial distribution of historical cases based on serological evidence of MERS-CoV at the county level and applied spatial statistical analysis to examine the spatial relationships of the MERS-CoV cases between 2016 and 2018 to climate, agriculture, and socio-demographic factors of agro-pastoralism. Regional differences in MERS-CoV cases were spatially correlated with both social and environmental factors, and particularly ethno-religious camel practices, which highlight the complexity in the distribution of MERS-CoV in dromedary camels across Kenya.

PMID:38916836 | DOI:10.1007/s10393-024-01684-9

Breast Cancer Res Treat. 2024 Jun 25. doi: 10.1007/s10549-024-07309-7. Online ahead of print.

ABSTRACT

BACKGROUND: Despite lower chemotherapy use in older triple-negative breast cancer (TNBC) patients, their outcomes match younger counterparts. We compared outcomes in early-stage TNBC patients by age receiving chemotherapy at a major cancer center with a national TNBC database.

METHODS: Retrospective study using institutional data on stage I-III TNBC (ER/PR < 10%) women with neoadjuvant/adjuvant chemotherapy. Based on their ages at diagnosis, patients were stratified into four categories: ≤40, 41-59, 60-69, and ≥ 70 years. Demographic and clinical characteristics recorded included race, disease stage, ER/PR positivity, treatment regimen, lymphatic or vascular invasion (LVI), histologic grade, Ki-67 level, body mass index (BMI), and pathologic complete response (pCR) following neoadjuvant treatment and are summarized using descriptive statistics. The primary endpoints were overall survival (OS), disease-free survival (DFS), and distant disease-free survival (DDFS); all were estimated using the Kaplan-Meier method. Both univariate and multivariate (MV) Cox regressions were applied to evaluate the impact of important covariates on these time-to-event endpoints.

RESULTS: Of the 2336 patients studied, 492 (21.1%) were ≤ 40 years old, 1239 (53.1%) were 41-59, 461 (19.7%) were 60-69, and 144 (6.2%) were ≥ 70. In the univariate regression model of OS/DFS/DDFS, age ≥ 70 was significantly associated with worse OS (p = 0.0217); other factors associated with worse OS were non-anthracycline-based chemotherapy, higher tumor stage, and neoadjuvant chemotherapy. The multivariate Cox regression model, adjusted for race and stage, showed no significant effects of age on OS; however, patients ≥ 70 years old who received non-anthracycline treatment combinations had worse DFS (hazard ratio = 0.349 vs. 1.049, p = 0.0293) and DDFS (hazard ratio = 0.317 vs. 1.016, p = 0.0251) than patients ≤ 40 years old. DFS from MV model after adjusting for age, race, and disease stage, the hazard ratio between anthracycline + taxane treatments and anthracycline + other treatments in patients ≥ 70 years old was statistically significantly lower than in patients ≤ 40 years old (hazard ratios [HRs] = 0.349 vs. 1.049, p = 0.0293).

CONCLUSIONS: Our findings indicate that outcomes such as DFS are less favorable in older compared to younger patients with early-stage TNBC, primarily in those who did not receive an anthracycline based chemotherapy regimen.

PMID:38916821 | DOI:10.1007/s10549-024-07309-7

Adv Ther. 2024 Jun 25. doi: 10.1007/s12325-024-02917-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Chimeric antigen receptor T-cell (CAR T) therapies have transformed diffuse large B-cell lymphoma (DLBCL) treatment. It is important to better understand their use in Medicare Fee-for-Service (FFS) patients, who often differ from commercially insured populations in important ways.

METHODS: We analyzed Medicare FFS claims data, focusing on the utilization patterns across three CAR T products-lisocabtagene maraleucel (liso-cel), tisagenlecleucel (tisa-cel), and axicabtagene autoleucel (axi-cel)-which are indicated for the treatment of DLBCL. Our investigation covered the period from 2021 through 2022. This analysis spanned a 180-day period prior to CAR T procedure and extended to a 90-day post-CAR T. Utilization of healthcare services, healthcare spending, and comorbidities were assessed in the pre- and post-periods. Clinical trial and PPS-exempt center claims were removed from the analysis. Statistical comparisons between inpatient and outpatient cohorts were made using Wilcoxon’s rank-sum tests for continuous variables and Chi-square tests or Fisher’s exact tests for categorical variables.

RESULTS: Among the total 391 CAR T claims assessed, most of the CAR T therapies were administered in the inpatient setting (79%) compared to outpatient (21%). CAR T therapy in the inpatient setting received an average Medicare cost of US$498,723 ($276,138-$1,066,524), while the average Medicare cost for outpatient CAR T claims was $414,393 ($276,980-$849,878). There was a higher 3-month average post-period cost for those hospitals utilizing CAR T in the outpatient setting than the inpatient setting ($15,794 vs. $10,244). Despite the higher post-period cost, when looking at the CAR T procedure and pre- and post-periods as a single episode, beneficiaries receiving outpatient CAR T had less cost for the total episode of care ($587,908 vs. $529,188). Follow-up inpatient claims were also assessed post-CAR T procedure for 30 days. The rate of post-CAR T inpatient re-admission was significantly lower for beneficiaries receiving the index CAR T in the inpatient setting (21%) compared to outpatient CAR T (59%). Days between index CAR T discharge and IP admission were also significantly shorter for OP CAR T compared to IP CAR T (8.0 vs. 14.1 days, p < 0.0001). Additionally, IP CAR T had a longer ALOS on the admission claim (6.9 vs. 6.2 days).

CONCLUSION: CAR T therapy for the treatment of LBCL has become more common within the Medicare population, primarily in the inpatient setting. This study helps understand providers’ cost and associated patient care around CAR T administration. The data show that the average cost received by hospitals encompasses the expenses related to both the CAR T drug and the medical services delivered to patients.

PMID:38916811 | DOI:10.1007/s12325-024-02917-7

Environ Monit Assess. 2024 Jun 25;196(7):659. doi: 10.1007/s10661-024-12763-3.

ABSTRACT

First-ever measurements of particulate matter (PM_2.5, PM₁₀, and TSP) along with gaseous pollutants (CO, NO₂, and SO₂) were performed from June 2019 to April 2020 in Faisalabad, Metropolitan, Pakistan, to assess their seasonal variations; Summer 2019, Autumn 2019, Winter 2019-2020, and Spring 2020. Pollutant measurements were carried out at 30 locations with a 3-km grid distance from the Sitara Chemical Industry in District Faisalabad to Bhianwala, Sargodha Road, Tehsil Lalian, District Chiniot. ArcGIS 10.8 was used to interpolate pollutant concentrations using the inverse distance weightage method. PM_2.5, PM₁₀, and TSP concentrations were highest in summer, and lowest in autumn or winter. CO, NO₂, and SO₂ concentrations were highest in summer or spring and lowest in winter. Seasonal average NO₂ and SO₂ concentrations exceeded WHO annual air quality guide values. For all 4 seasons, some sites had better air quality than others. Even in these cleaner sites air quality index (AQI) was unhealthy for sensitive groups and the less good sites showed Very critical AQI (> 500). Dust-bound carbon and sulfur contents were higher in spring (64 mg g^-1) and summer (1.17 mg g^-1) and lower in autumn (55 mg g^-1) and winter (1.08 mg g^-1). Venous blood analysis of 20 individuals showed cadmium and lead concentrations higher than WHO permissible limits. Those individuals exposed to direct roadside pollution for longer periods because of their occupation tended to show higher Pb and Cd blood concentrations. It is concluded that air quality along the roadside is extremely poor and potentially damaging to the health of exposed workers.

PMID:38916809 | DOI:10.1007/s10661-024-12763-3

Obes Surg. 2024 Jun 25. doi: 10.1007/s11695-024-07302-5. Online ahead of print.

ABSTRACT

Several studies have indicated that miRNAs play crucial roles in adipogenesis, insulin resistance, and inflammatory pathways associated with obesity and change after metabolic bariatric surgery (MBS). This systematic review explores and maps the existing literature on how miRNAs are expressed and investigates the unique miRNAs with the effects after MBS. The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and EMBASE were searched from 2019 until February 2024. This SR found 825 miRNAs from 25 studies, identifying 507 unique ones not used twice in the same study. A total of 21 studies (84%) measured RNA before and after surgery. The miRNA used per study ranged from 1 to 146 miRNA types, with a median study sample size of just 27 patients per study, raising concerns about some conclusions’ robustness. From the 507 unique miRNAs, only 16 were consistently analyzed in 4 to 7 studies, which gave 77 different outcomes in relation to miRNA after MBS. MiRNA 122 and 122-5p were analyzed the most. Others were 106b-5p, 140-5p, 183-5p, 199b-5p, 20b-5p, 424-5p, 486-5p, 7-5p, 92a, 93-5p, 194-5p, 21-5p, 221, 320a, and 223-3p. A gap was observed in many studies, whereby the results were not the same, or there was no explanation for the effects after MBS was given within the same miRNA. Fifteen miRNAs were reported to have the same upward and downward trend, although not within the same study, and only 26.1% employed some form of statistical modeling to account for bias or confounding factors. Directions and effects in miRNA are visible, but still, inconsistent outcomes linked to the same miRNA after MBS, underscoring the need for clarity in miRNA-outcome relationships. Collaborative efforts, consensus-driven miRNA dictionaries, and larger, more rigorous studies are necessary to improve methodology designs and improve outcomes.

PMID:38916799 | DOI:10.1007/s11695-024-07302-5

Int J Stroke. 2024 Jun 25:17474930241266796. doi: 10.1177/17474930241266796. Online ahead of print.

ABSTRACT

BACKGROUND: Insulin resistance (IR) is of growing concern yet its association with white matter integrity remains controversial. We aimed to investigate the association between IR and white matter integrity in nondiabetic adults.

METHODS: This cross-sectional analysis was conducted based on the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study. A total of 1709 Nondiabetic community-dwelling adults with available diffusion weighted imaging based on brain magnetic resonance imaging and completed oral glucose tolerance test were included. IR was measured non-invasively by insulin sensitivity indices (ISI), including ISIcomposite and ISI_0,120, as well as homeostasis model assessment of insulin resistance (HOMA-IR). White matter microstructure abnormalities were identified by diffusion weighted imaging along with tract-based spatial statistics analysis to compare diffusion metrics between groups. The multivariable linear regression models were applied to measure the association between white matter microstructure abnormalities and IR.

RESULTS: A total of 1709 nondiabetic individuals with a mean age of 60.8±6.4 years and 53.5% female were included. We found that IR was associated with a significant increase in mean diffusivity, axial diffusivity, and radial diffusivity extensively in cerebral white matter in regions such as the anterior corona radiata, superior corona radiata, anterior limb of internal capsule, external capsule, and body of corpus callosum. The pattern of associations was more marked for ISIcomposite and ISI_0,120. However, the effect of insulin resistance on white matter integrity was attenuated after additionally adjustment for history of hypertension and cardiovascular disease and antihypertensive medication use.

CONCLUSION: Our findings indicate a significant association between IR and white matter microstructural abnormalities in nondiabetic middle-aged community residents, while these associations were greatly influenced by the history of hypertension and cardiovascular disease, and antihypertensive medication use. Further investigation is needed to clarify the role of IR in white matter integrity, whereas prophylactic strategies of maintaining a low IR status may ameliorate disturbances in white matter integrity.

PMID:38916129 | DOI:10.1177/17474930241266796