Category: Statistics

JAMA Health Forum. 2024 Jun 7;5(6):e241568. doi: 10.1001/jamahealthforum.2024.1568.

ABSTRACT

IMPORTANCE: The 2018 Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act was implemented to increase timely access to care by expanding veterans’ opportunities to receive Veterans Affairs (VA)-purchased care in the community (community care [CC]). Because health equity is a major VA priority, it is important to know whether Black and Hispanic veterans compared with White veterans experienced equitable access to primary care within the VA MISSION Act.

OBJECTIVE: To examine whether utilization of and wait times for primary care differed between Black and Hispanic veterans compared with White veterans in rural and urban areas after the implementation of the VA MISSION Act.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used VA and CC outpatient and consult data from the VA’s Corporate Data Warehouse for fiscal years 2021 to 2022 (October 1, 2020, to September 30, 2022). Separate fixed-effects multivariable models were run to predict CC utilization and wait times. Each model was run twice, once comparing Black and White veterans and then comparing Hispanic and White veterans. Adjusted risk ratios (ARRs) were calculated for Black and Hispanic veterans compared with White veterans within rurality status for both outcomes.

MAIN OUTCOMES AND MEASURES: VA and CC primary care utilization as measured by primary care visits (utilization cohort); VA and CC primary care access as measured by mean wait times (access cohort).

RESULTS: A total of 5 046 087 veterans (994 517 [19.7%] Black, 390 870 [7.7%] Hispanic, and 3 660 700 [72.6%] White individuals) used primary care from fiscal years 2021 to 2022. Utilization increased for all 3 racial and ethnicity groups, more so in CC than VA primary care. ARRs were significantly less than 1 regardless of rurality status, indicating Black and Hispanic veterans compared with White veterans were less likely to utilize CC for primary care. There were 468 246 primary care consultations during the study period. The overall mean (SD) wait time was 33.3 (32.4) days. Despite decreases in wait times over time, primary care wait times remained longer in CC than in VA. Black veterans compared with White veterans had significantly longer wait times in CC (ARRs >1) but significantly shorter wait times in VA (ARRS <1) regardless of rurality status in VA and CC. CC wait times for Hispanic veterans compared with White veterans were longer in rural areas only and in VA rural and urban areas (ARRs >1).

CONCLUSION AND RELEVANCE: The results of this cross-sectional study suggest that additional research should explore the determinants and implications of utilization differences among Black and Hispanic veterans compared with White veterans. Efforts to promote equitable primary care access for all veterans are needed so that policy changes can be more effective in ensuring timely access to care for all veterans.

PMID:38904952 | DOI:10.1001/jamahealthforum.2024.1568

Afr J Reprod Health. 2024 Apr 30;28(4):50-59. doi: 10.29063/ajrh2024/v28i4.6.

ABSTRACT

Healthcare workers have crafted and implemented several health policies and programs to attract men, but men still struggle to access SRH services. This study explored healthcare workers’ perceptions and views about the determinants of men’s sexual and reproductive health service utilization. This qualitative study employed a purposive sampling technique to select healthcare workers in urology clinics and those managing men diagnosed with SRH conditions outside urology clinics. Data were analyzed thematically. HCWs highlighted men’s lack of awareness due to inadequate community education and health campaigns, staff shortage, the unavailability of medicines and medical supplies, health system incapacity, personal factors, and cultural norms and beliefs as hindrances in using SRH services. Health policymakers and relevant stakeholders need to pay attention to the SRH needs of men. The ongoing awareness campaigns about the importance of SRH service utilization, including additional male nurses, can encourage men to engage more with such services.

PMID:38904935 | DOI:10.29063/ajrh2024/v28i4.6

J Endocrinol Invest. 2024 Jun 21. doi: 10.1007/s40618-024-02379-2. Online ahead of print.

ABSTRACT

BACKGROUND: People with metabolically healthy (MHO) and metabolically unhealthy obesity (MUO) differ for the presence or absence of cardio-metabolic complications, respectively.

OBJECTIVE: Based on these differences, we are interested in deepening whether these obesity phenotypes could be linked to changes in microbiota and metabolome profiles. In this respect, the overt role of microbiota taxa composition and relative metabolic profiles is not completely understood. At this aim, biochemical and nutritional parameters, fecal microbiota, metabolome and SCFA compositions were inspected in patients with MHO and MUO under a restrictive diet regimen with a daily intake ranging from 800 to 1200 kcal.

METHODS: Blood, fecal samples and food questionnaires were collected from healthy controls (HC), and an obese cohort composed of both MHO and MUO patients. Most impacting biochemical/anthropometric variables from an a priori sample stratification were detected by applying a robust statistics approach useful in lowering the background noise. Bacterial taxa and volatile metabolites were assessed by qPCR and gas chromatography coupled with mass spectrometry, respectively. A targeted GC-MS analyses on SCFAs was also performed.

RESULTS: Instructed to follow a controlled and restricted daily calorie intake, MHO and MUO patients showed differences in metabolic, gut microbial and volatilome signatures. Our data revealed higher quantities of specific pro-inflammatory taxa (i.e., Desulfovibrio and Prevotella genera) and lower quantities of Clostridium coccoides group in MUO subset. Higher abundances in alkane, ketone, aldehyde, and indole VOC classes together with a lower amount of butanoic acid marked the faecal MUO metabolome.

CONCLUSIONS: Compared to MHO, MUO subset symptom picture is featured by specific differences in gut pro-inflammatory taxa and metabolites that could have a role in the progression to metabolically unhealthy status and developing of obesity-related cardiometabolic diseases. The approach is suitable to better explain the crosstalk existing among dysmetabolism-related inflammation, nutrient intake, lifestyle, and gut dysbiosis.

PMID:38904913 | DOI:10.1007/s40618-024-02379-2

Matern Child Health J. 2024 Jun 21. doi: 10.1007/s10995-024-03936-0. Online ahead of print.

ABSTRACT

OBJECTIVE: Child neglect is a public health concern with negative consequences that impact children, families, and society. While neglect is involved with many pediatric hospitalizations, few studies explore characteristics associated with neglect types, social needs, and post-discharge care.

METHODS: Data on neglect type, sociodemographics, social needs, inpatient consultations, and post-discharge care were collected from the electronic medical record for children aged 0-5 years who were hospitalized with concern for neglect during 2016-2020. Frequencies and percentages were calculated to determine sample characteristics. The Chi-square Test for Independence was used to evaluate associations between neglect type and other variables.

RESULTS: The most common neglect types were inadequate nutrition (40%), inability to provide basic care (37%), intrauterine substance exposure (25%), combined types (23%), and inadequate medical care (10%). Common characteristics among neglect types included age less than 1 year, male sex, Hispanic ethnicity, public insurance, past involvement with Child Protective Services, and inpatient consultation services (social work, physical therapy, and occupational therapy), and post-discharge recommendations (primary care, physical therapy, and regional center). Neglect type groups varied by child medical history, social needs, and discharge recommendations. Statistically significant associations supported differences per neglect type.

CONCLUSIONS: Our findings highlight five specific types of neglect seen in an impoverished and ethnically diverse geographic region. Post-discharge care needs should focus on removing social barriers and optimizing resources, in particular mental health, to mitigate the risk of continued neglect. Future studies should focus on prevention strategies, tailored interventions, and improved resource allocations per neglect type and discharge location.

PMID:38904903 | DOI:10.1007/s10995-024-03936-0

Adv Ther. 2024 Jun 21. doi: 10.1007/s12325-024-02910-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Perimenopause is a time of transition in a woman’s life that links her reproductive years to the cessation of ovulation, or menopause. For many women, this time is characterized by a variety of physiological and lifestyle changes, including increasing irregularity in menstrual bleeding, frequency and severity of vasomotor symptoms, etc. Therapies evaluated specifically for the perimenopausal women are very limited. This study aimed to evaluate the effectiveness and safety of Amberen^® (a succinate-based non-hormonal supplement) combined with a Smart B^® (vitamin B) complex in women with typical (without complications) mild to moderate climacteric syndrome during perimenopause.

METHODS: Women up to 50 years of age, in perimenopause, with vasomotor and psychosomatic symptoms of the climacteric syndrome were enrolled for the study. The trial was randomized, double-blinded, placebo-controlled, comparative, and prospective.

RESULTS: A total of 106 participants were enrolled in the trial and, per protocol, 105 completed the trial. We observed statistically significant improvements in most of the Greene Climacteric Scale symptoms, State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS), and Well-being, Activity, and Mood (WAM) scores. The intervention was well tolerated with few adverse effects reported to be mild and transient.

CONCLUSION: The use of this dietary supplement is safe and eliminates or improves vasomotor and psychosomatic symptoms of climacteric symptoms in perimenopausal women: it improves sleep and cognitive abilities, lowers depression and anxiety, improves mood and well-being, and positively affects quality of life.

GOV IDENTIFIER: NCT03897738.

PMID:38904899 | DOI:10.1007/s12325-024-02910-0

Int J Clin Oncol. 2024 Jun 21. doi: 10.1007/s10147-024-02572-6. Online ahead of print.

ABSTRACT

BACKGROUND: Multidrug chemotherapy for Ewing sarcoma can lead to severe myelosuppression. We proposed two clinical questions (CQ): CQ #1, “Does primary prophylaxis with G-CSF benefit chemotherapy for Ewing sarcoma?” and CQ #2, “Does G-CSF-based intensified chemotherapy improve Ewing sarcoma treatment outcomes?”.

METHODS: A comprehensive literature search was conducted in PubMed, Cochrane Library, and Ichushi web databases, including English and Japanese articles published from 1990 to 2019. Two reviewers assessed the extracted papers and analyzed overall survival (OS), febrile neutropenia (FN) incidence, infection-related mortality, quality of life (QOL), and pain.

RESULTS: Twenty-five English and five Japanese articles were identified for CQ #1. After screening, a cohort study of vincristine, ifosfamide, doxorubicin, and etoposide chemotherapy with 851 patients was selected. Incidence of FN was 60.8% with G-CSF and 65.8% without; statistical tests were not conducted. Data on OS, infection-related mortality, QOL, or pain was unavailable. Consequently, CQ #1 was redefined as a future research question. As for CQ #2, we found two English and five Japanese papers, of which one high-quality randomized controlled trial on G-CSF use in intensified chemotherapy was included. This trial showed trends toward lower mortality and a significant increase in event-free survival for 2-week interval regimen with the G-CSF primary prophylactic use compared with 3-week interval.

CONCLUSION: This review indicated that G-CSF’s efficacy as primary prophylaxis in Ewing sarcoma, except in children, is uncertain despite its common use. This review tentatively endorses intensified chemotherapy with G-CSF primary prophylaxis for Ewing sarcoma.

PMID:38904887 | DOI:10.1007/s10147-024-02572-6

Environ Monit Assess. 2024 Jun 21;196(7):643. doi: 10.1007/s10661-024-12815-8.

ABSTRACT

Urban water systems are potential sources of secondary microplastics (MPs) as well as a distributor of MPs in the environment. In the present study, the presence of MPs in the urban water systems of the Tehran Metropolitan (Capital of Iran) was investigated. In addition, the probable relationship of MPs with different land uses (i.e., residential-commercial, forest, military, and highway) was assessed. The results showed that all parts of Tehran’s urban water system in the study area were contaminated with MPs (107.1 ± 39, 37.8 ± 10.5, 48.3 ± 3.1, 46.9 ± 5.6, 59.4 ± 26.5, 1.7, 2.0 ± 0.6, 7.9 ± 1, 1.8 ± 0.2 particles/liter at the residential, integrated, military, forest, highway runoffs, drinking water, groundwater, seasonal river, and the effluent of the wastewater treatment plants; respectively). However, significant differences were found between different land uses. As expected, the residential runoff had the highest rate of MPs pollution, with 107.1 ± 39 particles/liter. According to the obtained results and our estimation, more than five million MPs/day can enter into the water bodies and soil of the study area through the wastewater treatment plants. While there are significant differences in MPs in the different land uses, our findings suggest that residential areas and highways need further attention in controlling the spread of MPs in urban areas.

PMID:38904869 | DOI:10.1007/s10661-024-12815-8

Support Care Cancer. 2024 Jun 21;32(7):449. doi: 10.1007/s00520-024-08672-3.

ABSTRACT

PURPOSE: Patients on oral anticancer agent (OAA) therapies have the autonomy to manage their cancer treatments in home settings. However, patients may not have adequate knowledge, confidence, or ability to effectively manage OAA-related consequences, which can significantly impact their treatment and health outcomes. This study aims to identify the associations between medication beliefs, patient activation, and self-rated health (SRH) among oncology patients taking OAAs and explore the potential mediation effects of patient activation on the relationship between medication beliefs and SRH.

METHODS: A secondary data analysis was conducted on cross-sectional data from 114 patients who were diagnosed with breast, colorectal, lung, or prostate cancer. Patients completed a self-reported survey including items of SRH, Beliefs about Medicines Questionnaire (BMQ), and Patient Activation Measure (PAM-13). Descriptive statistics, bivariate correlation, hierarchical multiple linear regression, and mediation analysis were conducted.

RESULTS: The results indicate that patients taking OAAs have ambivalent attitudes toward medication. Both medication necessity (r = – 0.27) and concerns (r = – 0.21) were negatively associated with SRH, while patient activation was positively associated with SRH (r = 0.38). Patient activation had a negative association with medication concerns (r = – 0.36) and fully mediated the relationship between medication concerns and SRH in patients taking OAAs (indirect effect = – 0.154, 95% confidence interval, – 0.276 to – 0.060).

CONCLUSION: The findings highlight the significance of activating patients to better understand and manage their OAAs. It is crucial for oncology professionals to provide multifaceted interventions to promote patient activation with an effort to mitigate the negative impact of medication beliefs on patient-perceived health outcomes.

PMID:38904864 | DOI:10.1007/s00520-024-08672-3

Am J Physiol Heart Circ Physiol. 2024 Jun 21. doi: 10.1152/ajpheart.00766.2023. Online ahead of print.

ABSTRACT

Computational, or in-silico, models are an effective, non-invasive tool for investigating cardiovascular function. These models can be used in the analysis of experimental and clinical data to identify possible mechanisms of (ab)normal cardiovascular physiology. Recent advances in computing power and data management have led to innovative and complex modeling frameworks that simulate cardiovascular function across multiple scales. While commonly used in multiple disciplines, there is a lack of concise guidelines for the implementation of computer models in cardiovascular research. In line with recent calls for more reproducible research, it is imperative that scientists adhere to credible practices when developing and applying computational models to their research. The goal of this manuscript is to provide a consensus document that identifies best practices for in-silico computational modeling in cardiovascular research. These guidelines provide the necessary methods for mechanistic model development, model analysis, and formal model calibration using fundamentals from statistics. We outline rigorous practices for computational modeling in cardiovascular research and discuss its synergistic value to experimental and clinical data.

PMID:38904851 | DOI:10.1152/ajpheart.00766.2023

Int J Biometeorol. 2024 Jun 21. doi: 10.1007/s00484-024-02728-z. Online ahead of print.

ABSTRACT

BACKGROUND: PM_2.5 has been associated with various adverse health effects, particularly affecting lung function and chronic respiratory diseases. However, the genetic causality relationship between PM_2.5 exposure and lung function as well as chronic respiratory diseases remains poorly understood.

METHOD: We conducted a two-sample Mendelian randomization analysis to investigate the causal impact of PM_2.5 on lung function and chronic respiratory diseases. Instrumental variables were carefully selected, with significance thresholds (P < 5 × 10^{– 8}), and linkage disequilibrium with an r² value below 0.001. Additionally, SNPs with an F-statistic exceeding 10 were included to mitigate potential bias stemming from weak instrumental variables. The primary analytical approach employed the Inverse Variance Weighted method, supplemented by the Weighted Median, MR-Egger, Simple Model, and Weighted Model. Furthermore, pleiotropy and heterogeneity were evaluated through the MR-Egger intercept test and Cochrane’s Q test, with a sensitivity analysis conducted using the leave-one-out method.

RESULTS: Eight SNPs significantly associated with PM_2.5 exposure were identified as Instrumental variables. Mendelian randomization analysis revealed a significant causal association between PM_2.5 exposure and lung function (FEV), with an OR of 0.7284 (95% CI: 0.5799-0.9150). Similarly, PM_2.5 exposure demonstrated a substantial causal effect on asthma, with an OR of 1.5280 (95% CI: 1.0470-2.2299). However, no causal association was observed between PM_2.5 exposure and chronic obstructive pulmonary disease, with an OR of 1.5176 (95% CI: 0.8294-2.7768).

CONCLUSION: These findings emphasize the necessity for continued research efforts in environmental health to develop effective strategies for the prevention and management of chronic respiratory diseases.

PMID:38904841 | DOI:10.1007/s00484-024-02728-z