Category: Statistics

JAMA Netw Open. 2024 Aug 1;7(8):e2425627. doi: 10.1001/jamanetworkopen.2024.25627.

ABSTRACT

IMPORTANCE: Reduced institutional postacute care has been associated with savings in alternative payment models. However, organizations may avoid voluntary participation if participation could threaten their own revenues.

OBJECTIVE: To characterize the association between hospital-skilled nursing facility (SNF) integration and participation in Medicare’s Bundled Payments for Care Improvement Advanced (BPCI-A) program.

DESIGN, SETTING, AND PARTICIPANTS: This is a cross-sectional analysis of hospital participation in BPCI-A beginning with its launch in 2018. Each SNF-integrated hospital was matched with 2 nonintegrated hospitals for each of 4 episode-specific analyses. Fifteen hospital-level variables were used for matching: beds, case mix index, days, area SNF beds, metropolitan location, ownership, region, system membership, and teaching status. Hospitals were also matched on episode-specific volume, target price, and the interaction of target price and case mix. Episode-specific logistic models were estimated regressing hospital participation on integration and the previously listed variables. The marginal effect of integration on participation was then calculated. Analysis took place from August 2022 to May 2024.

EXPOSURE: Hospital-SNF integration, as defined by common ownership and referral patterns and identified using cost reports, Medicare claims, and Provider Enrollment, Chain, and Ownership System records. Additional sources included records of target prices and participation, the Area Health Resources File, and the Compendium of US Health Systems.

MAIN OUTCOMES AND MEASURES: Participation in BPCI-A.

RESULTS: In total, 1524 hospitals met criteria for inclusion in the hip and femur (HFP) analysis, 1825 were included in the major joint replacement of the lower extremity (MJRLE) analysis, 2018 were included in the sepsis analysis, and 1564, were included in the stroke-specific analysis. Across episodes, 191 HFP-eligible hospitals (12.5% of HFP-eligible hospitals), 302 MJRLE-eligible hospitals (16.5%), 327 sepsis-eligible hospitals (16.2%), and 185 sepsis-eligible hospitals (11.8%) were SNF integrated. In total, 79 hospitals (5.2%) participated in the HFP episode, 128 (7.0%) participated in the MJRLE episode, 204 (10.1%) participated in the sepsis episode, and 141 (9.0%) participated in the stroke episode. Integration was associated with a 4.7-percentage point decrease (95% CI, 2.4 to 6.9 percentage points) in participation in the MJRLE episode. There was no association between integration and participation for HFP (0.5-percentage point increase in participation moving from nonintegrated to integrated; 95% CI, -2.9 to 3.8 percentage points), sepsis (1.0-percentage point increase; 95% CI, -2.2 to 4.2 percentage points), and stroke (0.3-percentage point decrease; 95% CI, -3.1 to 3.8 percentage points).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, there was an uneven association between hospital-SNF integration and participation in Medicare’s BPCI-A program. Other factors may be more consistent determinants of selection into voluntary payment reform.

PMID:39150712 | DOI:10.1001/jamanetworkopen.2024.25627

JAMA Netw Open. 2024 Aug 1;7(8):e2427691. doi: 10.1001/jamanetworkopen.2024.27691.

ABSTRACT

IMPORTANCE: Delirium is common among older hospitalized adults. In addition to presenting immediate management issues, delirium can increase the long-term risk of dementia, institutionalization, and mortality. Delirium is associated with disrupted sleep, and prior studies suggest that some specific sleep-promoting agents may reduce delirium.

OBJECTIVE: To evaluate the orexin receptor antagonist suvorexant for reducing delirium in older adults at high risk for delirium after hospitalization.

DESIGN, SETTING, AND PARTICIPANTS: This double-blind, placebo-controlled, phase 3 randomized clinical trial was conducted at 50 hospitals in Japan between October 22, 2020, and December 23, 2022. The study population included Japanese adults aged 65 to 90 years who were at high risk for delirium (mild cognitive impairment or mild dementia, history of delirium at prior hospitalization, or both) and had been hospitalized for acute disease or elective surgery. Data analysis was performed between January 23 and March 13, 2023.

INTERVENTION: Participants were randomized 1:1 to suvorexant (15 mg) or placebo taken at bedtime for up to 7 days while in the hospital.

MAIN OUTCOMES AND MEASURES: Delirium, the primary end point, was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria while participants were hospitalized. The treatment difference in the proportion of participants with delirium was analyzed.

RESULTS: This study included 203 participants: 101 were treated with suvorexant (mean [SD] age, 81.5 [4.5]; years; 52 men [51.5%] and 49 women [48.5%]) and 102 received placebo (mean [SD] age, 82.0 [4.9] years; 45 men [44.1%] and 57 women [55.9%]). There were 17 participants with delirium (16.8%) in the suvorexant group compared with 27 (26.5%) in the placebo group (difference, -8.7% [95% CI, -20.1% to 2.6%]; P = .13). Adverse events were similar between the 2 groups.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of suvorexant in older adults at high risk for delirium after hospitalization, fewer participants taking suvorexant had delirium compared with placebo, but the difference was not statistically significant. Further studies are needed to determine whether suvorexant may be useful for reducing delirium, particularly delirium with a hyperactive component, in this population.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04571944.

PMID:39150711 | DOI:10.1001/jamanetworkopen.2024.27691

JAMA Netw Open. 2024 Aug 1;7(8):e2428261. doi: 10.1001/jamanetworkopen.2024.28261.

ABSTRACT

IMPORTANCE: The digital phenomenon termed technoference refers to interruptions in routine social interactions due to technology use. Technoference may negatively affect parents’ attention to cues necessary for supporting children’s mental health.

OBJECTIVE: To explore whether there are directional prospective associations between perceived parental technoference and emerging adolescents’ mental health symptoms (anxiety, depression, inattention, and hyperactivity).

DESIGN, SETTING, AND PARTICIPANTS: This cohort study assessed a general population of mothers and emerging adolescents in Calgary, Alberta, Canada. Women were recruited during pregnancy between May 3, 2008, and December 13, 2010, with convenience sampling and repeated follow-up; eligible women were 18 years or older, spoke English, had a gestational age of at least 24 weeks, and received local prenatal care. Data collection for the present study took place when emerging adolescents were aged 9 (May 20 to July 15, 2020), 10 (March 4 to April 30, 2021), and 11 (November 22, 2021, to January 17, 2022) years. Mothers provided consent for their child to participate, and emerging adolescents provided assent. Data were analyzed from December 1 to 31, 2023, using random-intercept cross-lagged panel models.

EXPOSURE: Perceived parental technoference.

MAIN OUTCOMES AND MEASURES: Emerging adolescents completed questionnaires about their perception of parental technoference and their mental health symptoms (depression, anxiety, hyperactivity, and inattention) at the 3 study times. This study did not rely on statistical significance, but instead on the magnitude of effect sizes to determine meaningful effects.

RESULTS: Participants included 1303 emerging adolescents (mean [SD] age, 9.7 [0.8] years at time 1; of the 1028 reporting information, 529 [51.5%] were girls). Cross-sectional associations indicated correlations between perceptions of parental technoference and emerging adolescents’ mental health (r range, 0.17-0.19). Higher levels of anxiety at 9 and 10 years of age were prospectively associated with higher parental technoference scores at 10 (β = 0.11 [95% CI, -0.05 to 0.26]) and 11 (β = 0.12 [95% CI, 0.001-0.24]) years of age, with small magnitudes of effect size. Higher parental technoference scores at 9 and 10 years of age were prospectively associated with higher hyperactivity at 10 (β = 0.07 [95% CI, -0.07 to 0.22]) and 11 (β = 0.11 [95% CI, -0.02 to 0.24]) years of age and inattention at 11 years of age (β = 0.12 [95% CI, 0.001-0.24]), with small magnitudes of effect size. No gender differences were identified.

CONCLUSIONS AND RELEVANCE: In this 3-wave longitudinal birth cohort study, perceived parental technoference was associated with emerging adolescents’ mental health. The findings speak to the need to discuss digital technology use and mental health with parents and emerging adolescents as a part of routine care.

PMID:39150710 | DOI:10.1001/jamanetworkopen.2024.28261

JAMA Netw Open. 2024 Aug 1;7(8):e2428444. doi: 10.1001/jamanetworkopen.2024.28444.

ABSTRACT

IMPORTANCE: Abiraterone acetate and enzalutamide are recommended as preferred treatments for metastatic castration-resistant prostate cancer (mCRPC), but differences in their relative efficacy are unclear due to a lack of head-to-head clinical trials. Clear guidance is needed for making informed mCRPC therapeutic choices.

OBJECTIVE: To compare clinical outcomes in patients with mCRPC treated with abiraterone acetate or enzalutamide.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, multicenter cohort study included patients with mCRPC in the US Department of Veterans Affairs health care system who initiated treatment with abiraterone acetate or enzalutamide between January 1, 2014, and October 30, 2022.

EXPOSURES: Abiraterone acetate or enzalutamide.

MAIN OUTCOMES AND MEASURES: The study used inverse probability of treatment weighting to balance baseline characteristics between patients initiating abiraterone acetate or enzalutamide and evaluated restricted mean survival time (RMST) differences in overall survival (OS), prostate cancer-specific survival (PCS), time to next treatment switching or death (TTS), and time to prostate-specific antigen (PSA) response (TTR) at different time points after treatment initiation.

RESULTS: The study included 5779 patients (median age, 74.42 years [IQR, 68.94-82.14 years]). Median follow-up was between 38 and 60 months. Patients initiating enzalutamide on average had longer OS than those initiating abiraterone acetate, with RMSTs of 24.29 months (95% CI, 23.58-24.99 months) and 23.38 months (95% CI, 22.85-23.92 months), respectively, and a difference in RMST of 0.90 months (95% CI, 0.02-1.79 months) at 4 years. Similarly, TTS and TTR were improved in patients initiating enzalutamide, with an RMST at 4 years of 1.95 months (95% CI, 0.92-2.99 months) longer for TTS and 3.57 months (95% CI, 1.76-5.38 months) shorter for TTR. For PCS, the RMST at 2 years was 0.48 months (95% CI, 0.01-0.95 months) longer. An examination of subgroups identified that enzalutamide initiation was associated with longer RMST in OS among patients without prior docetaxel treatment (1.14 months; 95% CI, 0.19-2.10 months) and in those with PSA doubling time of 3 months or longer (2.23 months; 95% CI, 0.81-3.66 months) but not among patients with prior docetaxel (-0.25 months; 95% CI, -2.59 to 2.09 months) or with PSA doubling time of less than 3 months (0.05 months; 95% CI, -1.05 to 1.15 months).

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with mCRPC, initiation of enzalutamide was associated with small but statistically significant improvements in OS, PCS, TTS, and TTR compared with initiation of abiraterone acetate. The improvements were more prominent in short-term outcomes, including TTS and TTR, and in patient subgroups without prior docetaxel or with PSA doubling time longer than 3 months.

PMID:39150709 | DOI:10.1001/jamanetworkopen.2024.28444

JAMA Netw Open. 2024 Aug 1;7(8):e2428680. doi: 10.1001/jamanetworkopen.2024.28680.

ABSTRACT

IMPORTANCE: Households with children and minoritized racial and ethnic groups experience a disproportionate burden of food hardship. During the COVID-19 pandemic, the US federal government implemented emergency allotments in the Supplemental Nutrition Assistance Program (SNAP), increasing the amount of food purchasing assistance received by many participating households.

OBJECTIVE: To examine the association of implementing emergency allotments in SNAP with food hardship among households with children overall and for households with Black, Hispanic, and White children by comparing income-eligible households that did and did not participate in SNAP.

DESIGN, SETTING, AND PARTICIPANTS: This ecologic cross-sectional study used 2016-2022 National Survey of Children’s Health data and a difference-in-differences approach to compare changes in the risk of food hardship from before implementation of emergency allotments in SNAP (2016-2019) to during implementation (2020-2022). Households with children younger than 18 years and incomes 130% or less of the federal poverty level (FPL) in all 50 states and Washington, DC, were included.

EXPOSURE: Implementation of emergency allotments in SNAP.

MAIN OUTCOME AND MEASURES: The primary outcome was caregiver report of household food hardship during the past 12 months.

RESULTS: Of 44 753 households with incomes 130% or less of the FPL, a weighted 23.4% had Black children, 56.7% had White children, and 19.9% had children of other races. More than one-third of households (37.8%) had Hispanic children, and 31.8% had young children aged 0 to 5 years. The percentage of households that experienced food hardship decreased from 2016 to 2021 (from 62.9% to 48.2% among SNAP-participating households and from 44.3% to 38.9% among income-eligible nonparticipating households) but increased in 2022 (to 58.0% among SNAP-participating households and to 47.5% among nonparticipating households). Adjusting for confounders, implementing emergency allotments in SNAP was associated with a decreased risk of food hardship among SNAP-participating compared with nonparticipating households (risk ratio [RR], 0.88; 95% CI, 0.81-0.96). Implementing emergency allotments in SNAP was associated with a decreased risk of food hardship among SNAP-participating households with Hispanic (RR, 0.86; 95% CI, 0.72-1.02) and White (RR, 0.85; 95% CI, 0.76-0.94) children compared with nonparticipating households but not among households with Black children (RR, 1.04; 95% CI, 0.87-1.23).

CONCLUSIONS AND RELEVANCE: In this ecologic cross-sectional study, implementing emergency allotments in SNAP was associated with a decreased risk of food hardship among households with children. Efforts are needed to ensure that all populations benefit from economic policies.

PMID:39150708 | DOI:10.1001/jamanetworkopen.2024.28680

Eur J Cancer Prev. 2024 Jul 31. doi: 10.1097/CEJ.0000000000000913. Online ahead of print.

ABSTRACT

Considering that carbohydrates play an important role in supplying the body with energy and exhibit diverse mechanisms that can either prevent or stimulate cancer, we hypothesize that the quality of carbohydrate intake may be associated with cancer risk, including lung cancer. This hospital-based case-control study was conducted on 135 newly diagnosed lung cancer patients, and 237 healthy age- and sex-matched hospitalized controls. We used a valid and reliable 148-item Food Frequency Questionnaire to collect the dietary intake of subjects. Multivariate logistic regression was used to estimate the association between carbohydrate quality indices and the odds of lung cancer. After adjustment for confounding variables, the high glycemic index appears to be an increased risk factor for lung cancer [odds ratio (OR) = 2.51, 95% confidence interval (CI): 1.28-4.91]. No statistically significant association was found between glycemic load and lung cancer (OR = 2.51, 95% CI: 0.98-6.43). In contrast, the carbohydrate quality index (OR = 0.23, 95% CI: 0.11-0.48) and low-carbohydrate diet score (OR = 0.17, 95% CI: 0.08-0.36), were associated with a decrease in the risk of lung cancer. In summary, our study showed that a high glycemic index is a risk factor for lung cancer, however carbohydrate quality index and low-carbohydrate diet score is a dietary approach to reduce the risk of lung cancer.

PMID:39150686 | DOI:10.1097/CEJ.0000000000000913

J Gen Intern Med. 2024 Aug 16. doi: 10.1007/s11606-024-09005-0. Online ahead of print.

NO ABSTRACT

PMID:39150679 | DOI:10.1007/s11606-024-09005-0

Dermatol Ther (Heidelb). 2024 Aug 16. doi: 10.1007/s13555-024-01251-8. Online ahead of print.

ABSTRACT

INTRODUCTION: This pilot study investigated the effects of a 12-week administration of a nutritional supplement containing special collagen peptides on the structural and molecular properties of the collagen fiber network in the human skin. For the assessments, the suction blister method and electron microscopical comparisons were used.

METHODS: Three suction blisters were generated on the inner forearm of each test subject before and after the 12-week administration of the nutritional supplement. High-resolution scanning electron microscopy (SEM) was employed to meticulously investigate the structural characteristics of the skin’s collagen network, including the length and diameter of collagen fibers within the suction blister roof. Furthermore, the analysis included immunohistochemistry and fluorescence light microscopy to study hyaluronic acid within the extracellular matrix. Additional assessments encompassed changes in various epidermal parameters. Nine female participants within the age range of 43.7-61.8 years (mean: 52.5 ± 5.9 years) completed the study in accordance with the study protocol.

RESULTS: Compared with baseline, the 12-week supplementation regimen led to a statistically significant average increase in the collagen fiber network size of 34.56% (p < 0.0001). Additionally, collagen fiber cross-linking and fiber length were substantially increased. The ingestion of the supplement also resulted in an 18.08% elevation in epidermal hyaluronic acid concentration (p < 0.0001). No adverse events were recorded during the study.

CONCLUSION: Using an innovative approach, this study demonstrated the ability of a targeted nutritional supplement to effectively restore the ultrastructural integrity of the dermal collagen network, which is typically disrupted by the natural aging process of the skin. These findings not only corroborate existing data regarding the positive effects of oral collagen peptides on skin structure and function but also contribute to our understanding of ultrastructural morphological aspects of changes in the skin’s collagen network. Supplementation can induce regeneration of the collagen fiber network in the human skin.

TRIAL REGISTRATION NUMBER: German Clinical Trials Register, DRKS-ID DRKS00034161- Date of registration: 06.05.2024, retrospectively registered.

PMID:39150674 | DOI:10.1007/s13555-024-01251-8

Environ Sci Pollut Res Int. 2024 Aug 16. doi: 10.1007/s11356-024-34654-3. Online ahead of print.

ABSTRACT

In this paper, it is aimed, for the first time, at deriving simple models, leveraging the trend analysis in order to estimate the future greenhouse gas emissions associated with coal combustion. Due to the expectations of becoming the center of global economic development in the future, BRICS-T (Brazil, the Russian Federation, India, China, South Africa, and Turkiye) countries are adopted as cases in the study. Following the models’ derivation, their statistical validations and estimating accuracies are also tested through various metrics. In addition, the future greenhouse gas emissions associated with coal combustion are estimated by the derived models. The results demonstrate that the derived models can be successfully used as a tool for estimating the greenhouse gas emissions associated with coal combustions with accuracy ranges from at least 90% to almost 98%. Moreover, the estimating results show that the total amount of greenhouse gas emissions associated with coal combustions in the relevant countries and in the world will increase to 14 BtCO_2eq and 19 BtCO_2eq by 2035, with an annual growth of 2.39% and 1.71%, respectively. In summary, the current study’s findings affirm the usefulness of trend analysis in deriving models to estimate greenhouse gas emissions associated with coal combustion.

PMID:39150668 | DOI:10.1007/s11356-024-34654-3

J Interv Card Electrophysiol. 2024 Aug 16. doi: 10.1007/s10840-024-01857-0. Online ahead of print.

ABSTRACT

BACKGROUND: We sought to evaluate the anatomic and functional lesion development over time at different atrial sites immediately following delivery of pulsed field ablation (PFA).

METHODS: Using a porcine model, PFA ablations were performed in the superior vena cava (SVC), right atrial lateral wall (RA), left atrial appendage (LAA), and right superior pulmonary vein (RSPV) using four different PFA profiles. Mapping was done sequentially in 5-20-min increments up to 280-min post lesion delivery for low voltage area (LVA) assessment and conduction velocity. Lesion characteristics were noted with voltage mapping immediately post ablation and at the serial time points.

RESULTS: In 9 animals, 33 sites were ablated. None of the four different profiles across all sites showed any statistical difference on acute lesion formation or persistence. Higher tissue contact was observed in the SVC and RSPV and lower tissue contact was observed in the LAA and RA locations. Higher contact areas were noted to have higher density electroanatomic low voltage area (LVA) (12/14 vs 5/18, p = 0.01) and larger lesions on gross pathology (2 /14 vs 6/16, p = 0.01) compared to lower contact areas. Lesion regression occurred in 16/33 sites. Sustained lesions were significantly more prevalent in higher versus lower contact sites (65% vs 38%, p = 0.037).

CONCLUSION: The development of significant and durable lesions for PFA in a porcine model appears to be dependent on tissue proximity and contact.

PMID:39150656 | DOI:10.1007/s10840-024-01857-0