Category: Statistics

PLoS One. 2024 Aug 23;19(8):e0309175. doi: 10.1371/journal.pone.0309175. eCollection 2024.

ABSTRACT

AIM: In this review, we investigated how Machine Learning (ML) was utilized to predict all-cause somatic hospital admissions and readmissions in adults.

METHODS: We searched eight databases (PubMed, Embase, Web of Science, CINAHL, ProQuest, OpenGrey, WorldCat, and MedNar) from their inception date to October 2023, and included records that predicted all-cause somatic hospital admissions and readmissions of adults using ML methodology. We used the CHARMS checklist for data extraction, PROBAST for bias and applicability assessment, and TRIPOD for reporting quality.

RESULTS: We screened 7,543 studies of which 163 full-text records were read and 116 met the review inclusion criteria. Among these, 45 predicted admission, 70 predicted readmission, and one study predicted both. There was a substantial variety in the types of datasets, algorithms, features, data preprocessing steps, evaluation, and validation methods. The most used types of features were demographics, diagnoses, vital signs, and laboratory tests. Area Under the ROC curve (AUC) was the most used evaluation metric. Models trained using boosting tree-based algorithms often performed better compared to others. ML algorithms commonly outperformed traditional regression techniques. Sixteen studies used Natural language processing (NLP) of clinical notes for prediction, all studies yielded good results. The overall adherence to reporting quality was poor in the review studies. Only five percent of models were implemented in clinical practice. The most frequently inadequately addressed methodological aspects were: providing model interpretations on the individual patient level, full code availability, performing external validation, calibrating models, and handling class imbalance.

CONCLUSION: This review has identified considerable concerns regarding methodological issues and reporting quality in studies investigating ML to predict hospitalizations. To ensure the acceptability of these models in clinical settings, it is crucial to improve the quality of future studies.

PMID:39178283 | DOI:10.1371/journal.pone.0309175

PLoS One. 2024 Aug 23;19(8):e0309442. doi: 10.1371/journal.pone.0309442. eCollection 2024.

ABSTRACT

The livestock sector contributes almost 11% of Pakistan’s GDP and is crucial to 35 million people’s livelihoods. Ticks are a major economic threat, as over 80% of livestock, such as bovines, are tick-infested with Hyalomma and Rhipicephalus tick species. Hyalomma anatolicum and Rhipicephalus microplus are the most common tick species collected from livestock, transmitting primarily anaplasmosis, babesiosis, and theileriosis. We aimed to identify the geographical distribution of these two tick species and hot spot areas where the risk of these diseases being transmitted by these ticks is high. Following the PRISMA guideline, two authors conducted an independent review of literature sourced from various databases. We screened 326 research articles published between January 1, 1990, and December 31, 2023, focused on identifying the tick species at the district level. Thirty studies from 75 districts, representing 49.3% of the country’s total area, detected at least one tick species through collection from animals. R. microplus was present in 81% (n = 61) and H. anatolicum in 82% (n = 62) of these sampled districts. We employed spatial and conventional statistical methods with Geographic Information Systems (GIS) after mapping the weighted distribution of both ticks (the number of ticks per standard unit of sampling effort). We identified northwestern and northcentral regions of the country as hotspots with the highest tick distribution, which aligned with the documented high prevalence of anaplasmosis, babesiosis, Crimean-Congo hemorrhagic fever (CCHF), and theileriosis in these regions. This underscores the urgent need for robust tick control measures in these districts to safeguard animal health and boost the livestock economy.

PMID:39178282 | DOI:10.1371/journal.pone.0309442

PLoS One. 2024 Aug 23;19(8):e0305978. doi: 10.1371/journal.pone.0305978. eCollection 2024.

ABSTRACT

Studies taking a person-centred statistical approach when examining young peoples` psychological experiences in sport is scarce. The main aim of the present study was to examine the relationships between young football players’ psychological health resources and the psychological quality of their football-specific experiences. Data for this cross-sectional study was collected as part of the [BLINDED] arm of the larger Promoting Adolescence Physical Activity (PAPA) multi-centre project [1]. The sample consisted of young [BLINDED] male (n = 814), female (n = 576), grassroots football players between the ages of 10 and 15 years (M = 12.5 years, SD = 1.1 years). We performed a latent profile analysis using Mplus 8.4 using a robust maximum likelihood estimator (MLR). Players with the most resourceful psychological health profile experienced more coach social support (mean = 4.38) than did those with a less well-off resourceful profile (mean = 3.79) and those with the least well-off profile (mean = 3.28). Players with the most resourceful profile also felt a stronger sense of unity among their teammates and they enjoyed football more than those least well off (mean = 4.43 vrs. mean = 3.12 and mean = 4.74 vrs 3.50. respectively). Parallel between-profile differences were also found for the players’ general health resources including perceived life satisfaction, general health and family affluence as covariates. Findings suggest that variations in young players’ psychological health profiles and their general health resources play a role in the quality of their football-specific psychological experiences.

PMID:39178278 | DOI:10.1371/journal.pone.0305978

Rev Esc Enferm USP. 2024 Aug 16;58:e20240078. doi: 10.1590/1980-220X-REEUSP-2024-0078en. eCollection 2024.

ABSTRACT

OBJECTIVE: To investigate the repercussions of COVID-19 on the length of breastfeeding and analyze the associated factors in Belo Horizonte, Minas Gerais, Brazil.

METHOD: This is an epidemiological, prospective cohort study. Data were collected from medical records and through telephone interviews. Women who weaned were estimated using Kaplan-Meier survival analysis. The log-rank test was used to verify differences between groups, analyzing weaning time, according to sociodemographic and clinical characteristics. The values of hazard ratio and 95% confidence intervals were estimated using Cox regression analysis.

RESULTS: A total of 1,729 women participated in the study. During the COVID-19 pandemic, brown women and women undergoing cesarean section were more likely to stop breastfeeding.

CONCLUSION: The birth route and mothers’ ethnic characteristics were associated with early weaning during the COVID-19 pandemic. Such findings are important to guide the assistance of the multidisciplinary team, especially nursing, during the post-pandemic period and in future epidemiological scenarios.

PMID:39178020 | DOI:10.1590/1980-220X-REEUSP-2024-0078en

Prim Care Companion CNS Disord. 2024 Aug 13;26(4):24m03724. doi: 10.4088/PCC.24m03724.

ABSTRACT

Objective: To analyze contemporary trends of dementia and dementia-related mortality in the United States between 1999 and 2020 categorized by demographic and regional attributes.

Methods: A retrospective cohort analysis was conducted using mortality data from individuals aged 35 years to ≥85 years, where dementia/Alzheimer disease was recorded as a contributing or underlying cause of death. Data were extracted from the US Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research database for the years 1999-2020. Mortality rates adjusted for age due to dementia (annual age-adjusted mortality rate [AAMR]) per 10,000 individuals in the United States were categorized by gender, racial and ethnic groups, and geographic regions.

Results: Results revealed 6,601,680 deaths related to dementia between 1999 and 2020. Among these, 85.5% were non-Hispanic (NH) white, 8% NH black, 4.34% Hispanic or Latino, 1.6% NH Asian or Pacific Islander, and 0.3% NH American Indian or Alaska Native adults. The overall AAMR was 17.49, with women experiencing a higher AAMR of 18.19 compared to men (16.05). Ethnic disparities were evident, with NH black adults having the highest AAMR (18.23), followed by NH white (18.09) and Hispanic adults (12.7). Over the study period, the overall AAMR increased from 10.86 in 1999 to 21.42 in 2020, with a notable 18.4% rise in the AAMR from 1999 to 2001. From 2001 to 2020, the average percent change of the AAMR was 1.0%. This upward trend in mortality was observed for both men and women and across all ethnicities.

Conclusions: The study spanning 1999-2020 revealed concerning trends in dementia-related mortality in the United States. There is a critical need for targeted health care policy initiatives aimed at mitigating the increasing dementia burden.

Prim Care Companion CNS Disord 2024;26(4):24m03724.

Author affiliations are listed at the end of this article.

PMID:39178013 | DOI:10.4088/PCC.24m03724

JAMA Netw Open. 2024 Aug 1;7(8):e2429792. doi: 10.1001/jamanetworkopen.2024.29792.

NO ABSTRACT

PMID:39178002 | DOI:10.1001/jamanetworkopen.2024.29792

JAMA Netw Open. 2024 Aug 1;7(8):e2429645. doi: 10.1001/jamanetworkopen.2024.29645.

ABSTRACT

IMPORTANCE: Decisions about whether to stop colorectal cancer (CRC) screening tests in older adults can be difficult and may benefit from shared decision-making (SDM).

OBJECTIVE: To evaluate the effect of physician training in SDM and electronic previsit reminders (intervention) vs reminders only (comparator) on receipt of the patient-preferred approach to CRC screening and on overall CRC screening rates of older adults at 12 months.

DESIGN, SETTING, AND PARTICIPANTS: This was a secondary analysis of the Promoting Informed Decisions About Colorectal Cancer Screening in Older Adults (PRIMED) cluster randomized clinical trial. In the PRIMED trial, primary care physicians (PCPs) from 36 primary care practices in Massachusetts and Maine were enrolled between May 1 and August 30, 2019, and were randomized to the intervention group or the comparator group. Patients aged 76 to 85 years who were overdue for CRC screening and did not have a prior diagnosis of CRC enrolled between October 21, 2019, and April 8, 2021. Data analysis was performed between May 24, 2022, and May 10, 2023.

INTERVENTIONS: Primary care physicians in the intervention group completed an SDM training course and received previsit reminders of patients eligible for CRC testing discussion, whereas PCPs in the comparator group received reminders only.

MAIN OUTCOMES AND MEASURES: The primary outcome was concordance, or the percentage of patients who received their preferred screening approach. Postvisit surveys were administered to assess patient preference for testing, and electronic health record review was used to assess CRC testing at 12 months. Heterogeneity of treatment effect analyses examined interaction between study groups and different factors on concordance rates.

RESULTS: This study included 59 physicians and 466 older adults. Physicians had a mean (SD) age of 52.7 (9.4) years and a mean (SD) of 21.6 (10.2) years in practice; 30 (50.8%) were women and 16 (27.1%) reported prior training in SDM. Patients had a mean (SD) age of 80.3 (2.8) years; 249 (53.4%) were women and 238 (51.1%) reported excellent or very good overall health. Patients preferred stool-based tests (161 [34.5%]), followed by colonoscopy (116 [24.8%]) or no further screening (97 [20.8%]); 75 (16.1%) were not sure. The distribution of patient preferences was similar across groups (P = .36). At 12 months, test uptake was also similar for both the intervention group (29 [12.3%] for colonoscopy, 62 [26.3%] for stool-based tests, and 145 [61.4%] for no testing) and the comparator group (32 [13.9%] for colonoscopy, 35 [15.2%] for stool-based tests, and 163 [70.9%] for no testing; P = .08). Approximately half of patients in the intervention group received their preferred approach vs the comparator group (115 of 226 [50.9%] vs 103 of 223 [46.2%]; P = .47). Heterogeneity of treatment effect analyses found significantly higher rates with the intervention vs the comparator for patients with a strong intention to follow through with the preferred approach (adjusted odds ratio [AOR], 1.79 [95% CI, 1.11-2.89]; P = .02, P = .05 for interaction) and for patients who reported more than 5 minutes (AOR, 3.27 [95% CI, 1.25-8.59]; P = .02, P = .05 for interaction) of discussion with their PCP regarding screening. Higher rates were also observed among patients who reported 2 to 5 minutes of discussion with their PCP, although this finding was not significant (AOR, 1.89 [95% CI, 0.93-3.84]; P = .08, P = .05 for interaction).

CONCLUSIONS AND RELEVANCE: In this secondary analysis of a cluster randomized clinical trial, approximately half of older patients received their preferred approach to CRC screening. Physician training in SDM did not result in higher concordance rates overall but may have benefitted some subgroups. Future work to refine and evaluate clinical decision support (in the form of an electronic advisory or reminder) as well as focused SDM skills training for PCPs may promote high-quality, preference-concordant decisions about CRC testing for older adults.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03959696.

PMID:39178001 | DOI:10.1001/jamanetworkopen.2024.29645

JAMA Netw Open. 2024 Aug 1;7(8):e2429764. doi: 10.1001/jamanetworkopen.2024.29764.

ABSTRACT

IMPORTANCE: Hypertension in middle-aged adults (35-50 years) is associated with poorer health outcomes in late life. Understanding how hypertension varies by race and ethnicity across levels of neighborhood disadvantage may allow for better characterization of persistent disparities.

OBJECTIVE: To evaluate spatial patterns of hypertension diagnosis and treatment by neighborhood socioeconomic position and racial and ethnic composition.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study of middle-aged adults in Cuyahoga County, Ohio, who encountered primary care in 2019, geocoded electronic health record data were linked to the area deprivation index (ADI), a neighborhood disadvantage measure, at the US Census Block Group level (ie, neighborhood). Neighborhoods were stratified by ADI quintiles, with the highest quintile indicating the most disadvantage. Data were analyzed between August 7, 2023, and June 1, 2024.

EXPOSURE: Essential hypertension.

MAIN OUTCOMES AND MEASURES: The primary outcome was a clinician diagnosis of essential hypertension. Spatial analysis was used to characterize neighborhood-level patterns of hypertension prevalence and treatment. Interaction analysis was used to compare hypertension prevalence by racial and ethnic group within similar ADI quintiles.

RESULTS: A total of 56 387 adults (median [IQR] age, 43.1 [39.1-46.9] years; 59.8% female) across 1157 neighborhoods, which comprised 3.4% Asian, 31.1% Black, 5.5% Hispanic, and 60.0% White patients, were analyzed. A gradient of hypertension prevalence across ADI quintiles was observed, with the highest vs lowest ADI quintile neighborhoods having a higher hypertension rate (50.7% vs 25.5%) and a lower treatment rate (61.3% vs 64.5%). Of the 315 neighborhoods with predominantly Black (>75%) patient populations, 200 (63%) had a hypertension rate greater than 35% combined with a treatment rate of less than 70%; only 31 of 263 neighborhoods (11.8%) comprising 5% or less Black patient populations met this same criterion. Compared with a spatial model without covariates, inclusion of ADI and percentage of Black patients accounted for 91% of variation in hypertension diagnosis prevalence among men and 98% among women. Men had a higher prevalence of hypertension than women across race and ADI quintiles, but the association of ADI and hypertension risk was stronger in women. Sex prevalence differences were smallest between Black men and women, particularly in the highest ADI quintile (1689 [60.0%] and 2592 [56.0%], respectively).

CONCLUSIONS AND RELEVANCE: These findings show an association between neighborhood deprivation and hypertension prevalence, with disparities observed particularly among Black patients, emphasizing a need for structural interventions to improve community health.

PMID:39177999 | DOI:10.1001/jamanetworkopen.2024.29764

JAMA Health Forum. 2024 Aug 2;5(8):e242614. doi: 10.1001/jamahealthforum.2024.2614.

ABSTRACT

IMPORTANCE: Enrollee cost-sharing and health insurance premiums have grown alongside rising hospital prices. To control prices and price growth, the Oregon State Employee plan instituted a cap on hospital facility payments in October 2019 that was found to reduce hospital prices. Yet the program’s association with out-of-pocket spending and use among enrollees is unknown.

OBJECTIVE: To assess the association of the Oregon State Employee Plan’s hospital payment cap with out-of-pocket spending and changes in service use among state employees enrolled in higher cost-sharing plans.

DESIGN, SETTING, AND PARTICIPANTS: Using data from the Oregon All Payer All Claims database (January 2014 to December 2021), a difference-in-differences analysis was conducted to examine the association of Oregon’s hospital payment cap with enrollee out-of-pocket spending and service use. The main analysis focused on the outpatient setting, where there were significant declines in hospital prices. Changes in a subpopulation of employees enrolled in higher cost-sharing plans were also examined.

MAIN OUTCOMES AND MEASURES: The primary outcome was outpatient out-of-pocket spending per procedure, which included the copayment, coinsurance, and/or deductible paid at the point of service. Changes in service use were also examined by counting the number of outpatient procedures received per enrollee per year.

RESULTS: The outpatient sample included 1 094 083 procedures from 92 523 Oregon educators and 4 510 342 procedures from 473 621 control enrollees. During the period before implementation, Oregon educators had higher out-of-pocket spending per outpatient procedure than the control group ($69.26 vs $41.87). The hospital payment cap was associated with a $6.60, or 9.5%, reduction in out-of-pocket spending per procedure (95% CI, -12.7 to -0.5) and a 0.24, or 4.8%, increase in the number of outpatient procedures received per enrollee per year (95% CI, 0.09-0.39) among those in higher cost-sharing plans. Enrollees receiving outpatient services from October 2019 through December 2021 saved an estimated $1.8 million. However, savings for the state were $10.3 million less than they would have been absent increases in service use.

CONCLUSIONS AND RELEVANCE: The study findings suggest that enrollees may benefit from reduced out-of-pocket spending due to hospital price regulations, but states should be mindful that price regulations may inadvertently increase health care service use.

PMID:39177983 | DOI:10.1001/jamahealthforum.2024.2614

JAMA Health Forum. 2024 Aug 2;5(8):e242640. doi: 10.1001/jamahealthforum.2024.2640.

ABSTRACT

IMPORTANCE: By expanding health insurance to millions of people in the US, the Patient Protection and Affordable Care Act (ACA) may have important health, economic, and social welfare implications for people with criminal legal involvement-a population with disproportionately high morbidity and mortality rates.

OBJECTIVE: To scope the literature for studies assessing the association of any provision of the ACA with 5 types of outcomes, including insurance coverage rates, access to care, health outcomes, costs of care, and social welfare outcomes among people with criminal legal involvement.

EVIDENCE REVIEW: The literature search included results from PubMed, CINAHL Complete, APA Psycinfo, Embase, Social Science Database, and Web of Science and was conducted to include articles from January 1, 2014, through December 31, 2023. Only original empirical studies were included, but there were no restrictions on study design.

FINDINGS: Of the 3538 studies initially identified for potential inclusion, the final sample included 19 studies. These 19 studies differed substantially in their definition of criminal legal involvement and units of analysis. The studies also varied with respect to study design, but difference-in-differences methods were used in 10 of the included studies. With respect to outcomes, 100 unique outcomes were identified across the 19 studies, with at least 1 in all 5 outcome categories determined prior to the literature search. Health insurance coverage and access to care were the most frequently studied outcomes. Results for the other 3 outcome categories were mixed, potentially due to heterogeneous definitions of populations, interventions, and outcomes and to limitations in the availability of individual-level datasets that link incarceration data with health-related data.

CONCLUSIONS AND RELEVANCE: In this scoping review, the ACA was associated with an increase in insurance coverage and a decrease in recidivism rates among people with criminal legal involvement. Future research and data collection are needed to understand more fully health and nonhealth outcomes among people with criminal legal involvement related to the ACA and other health insurance policies-as well as the mechanisms underlying these relationships.

PMID:39177982 | DOI:10.1001/jamahealthforum.2024.2640