Category: Statistics

Healthc Policy. 2024 Feb;19(3):78-95. doi: 10.12927/hcpol.2024.27281.

ABSTRACT

BACKGROUND: Rural persons with dementia face medical services gaps. This study compares the health service utilization of rural and urban community-dwelling individuals with incident dementia.

METHODS: This study used a repeated annual cross-sectional cohort design spanning a period from 2000 to 2019 analyzing age-adjusted rates for 20 indicators of service use and mortality one year after diagnosis in Quebec administrative databases.

RESULTS: Of 237,259 persons, 20.1% were rural. Most rural persons had more emergency department visits and hospitalizations, shorter stays, less alternate level of care and fewer family physicians’ and cognition specialists’ visits. All groups had similar long-term care and mortality rates.

CONCLUSION: Policy implications of these disparities are discussed.

PMID:38721736 | DOI:10.12927/hcpol.2024.27281

J Adv Nurs. 2024 May 9. doi: 10.1111/jan.16222. Online ahead of print.

ABSTRACT

AIM(S): To investigate spillover effects of organizational support for patient and workplace safety on safety outcomes and to examine the mediating role of safety compliance in these relationships.

DESIGN: A cross-sectional, correlational survey design.

METHODS: This study analysed data from 1255 nurses in 34 Korean hospitals. A structured questionnaire was used including items from the Hospital Survey on Patient Safety Culture and Safety Compliance scales. Data were collected between February and June 2022. We employed structural equation modelling (SEM) for analysis with a significance level set at 0.05.

RESULTS: Organizational support for patient and workplace safety showed direct impacts on patient and workplace safety outcomes. Findings supported our hypotheses regarding spillover effects, as organizational support for patient safety was related to enhanced workplace safety and organizational support for workplace safety was associated with improved patient safety. SEM analysis showed safety compliance’s mediating role. When the distribution of serial indirect effects was examined, three out of eight indirect pathways were statistically significant.

CONCLUSION: Improving organizational support for patient safety can lead to better workplace safety outcome, and enhancing support for workplace safety can result in better patient safety outcome. Given this mutually beneficial relationship, healthcare organizations should simultaneously promote safety in both areas rather than focusing on just one.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Study results highlight the need to recognize the interconnected nature of patient and workplace safety in order to achieve better overall safety outcomes.

IMPACT: This study shows that organizational safety efforts for patients and workers are interconnected and mutually beneficial. The study’s results have both theoretical and practical implications in demonstrating that organizational support for both patient and workplace safety plays a strong role in promoting nurses’ safety compliance and improving overall safety outcomes.

REPORTING METHOD: STROBE checklist.

PATIENT CONTRIBUTION: No patient or public contribution.

PMID:38721722 | DOI:10.1111/jan.16222

Arterioscler Thromb Vasc Biol. 2024 May 9. doi: 10.1161/ATVBAHA.124.320764. Online ahead of print.

ABSTRACT

BACKGROUND: While it has been hypothesized that high plaque stress and strain may be related to plaque rupture, its direct verification using in vivo coronary plaque rupture data and full 3-dimensional fluid-structure interaction models is lacking in the current literature due to difficulty in obtaining in vivo plaque rupture imaging data from patients with acute coronary syndrome. This case-control study aims to use high-resolution optical coherence tomography-verified in vivo plaque rupture data and 3-dimensional fluid-structure interaction models to seek direct evidence for the high plaque stress/strain hypothesis.

METHODS: In vivo coronary plaque optical coherence tomography data (5 ruptured plaques, 5 no-rupture plaques) were acquired from patients using a protocol approved by the local institutional review board with informed consent obtained. The ruptured caps were reconstructed to their prerupture morphology using neighboring plaque cap and vessel geometries. Optical coherence tomography-based 3-dimensional fluid-structure interaction models were constructed to obtain plaque stress, strain, and flow shear stress data for comparative analysis. The rank-sum test in the nonparametric test was used for statistical analysis.

RESULTS: Our results showed that the average maximum cap stress and strain values of ruptured plaques were 142% (457.70 versus 189.22 kPa; P=0.0278) and 48% (0.2267 versus 0.1527 kPa; P=0.0476) higher than that for no-rupture plaques, respectively. The mean values of maximum flow shear stresses for ruptured and no-rupture plaques were 145.02 dyn/cm² and 81.92 dyn/cm² (P=0.1111), respectively. However, the flow shear stress difference was not statistically significant.

CONCLUSIONS: This preliminary case-control study showed that the ruptured plaque group had higher mean maximum stress and strain values. Due to our small study size, larger scale studies are needed to further validate our findings.

PMID:38721707 | DOI:10.1161/ATVBAHA.124.320764

Int J Gynaecol Obstet. 2024 May 9. doi: 10.1002/ijgo.15574. Online ahead of print.

ABSTRACT

OBJECTIVE: Obesity and maternal age are increasing among pregnant patients. The understood effect of body mass index (BMI), advanced maternal age (AMA), and second stage of labor on obstetric anal sphincter injury (OASIS) at delivery is varied. The objective of this study was to assess whether incorporating BMI, second stage of labor length, and AMA into a model for predicting OASIS among forceps-assisted vaginal deliveries (FAVD) had a higher predictivity value compared to models without these additions.

METHOD: This was an IRB-approved retrospective cohort study of singleton gestations who underwent a FAVD between 2017 and 2021. The primary outcome was prediction of OASIS via established models versus models including the addition of new predictive factors.

RESULTS: A total of 979 patients met inclusionary criteria and were included in the final analysis. 20.4% of patients had an OASIS laceration, 11.3% of neonates had NICU admissions, 23.7% had a composite all neonatal outcome, and 8% had a composite subgaleal/cephalohematoma outcome. Comparisons of known factors that predict OASIS (nulliparity, race, episiotomy status) to known factors with additional predictors (BMI, AMA, and length of second stage in labor) were explored. After comparing each model’s AUC to one another (a total of 3 comparisons made), there was no statistically significant difference between the models (all P > 0.62).

CONCLUSION: Including BMI, AMA, and second stage of labor length does not improve the predictivity of OASIS in patients with successful FAVD. These factors should not impact a provider’s decision to perform a FAVD when solely considering increased odds of OASIS.

PMID:38721705 | DOI:10.1002/ijgo.15574

Prim Health Care Res Dev. 2024 May 9;25:e28. doi: 10.1017/S1463423624000136.

ABSTRACT

AIM: To identify and quantify general practitioner (GP) preferences related to service attributes of clinical consultations, including telehealth consultations, in Australia.

BACKGROUND: GPs have been increasingly using telehealth to deliver patient care since the onset of the 2019 coronavirus disease (COVID-19) pandemic. GP preferences for telehealth service models will play an important role in the uptake and sustainability of telehealth services post-pandemic.

METHODS: An online survey was used to ask GPs general telehealth questions and have them complete a discrete choice experiment (DCE). The DCE elicited GP preferences for various service attributes of telehealth (telephone and videoconference) consultations. The DCE investigated five service attributes, including consultation mode, consultation purpose, consultation length, quality of care and rapport, and patient co-payment. Participants were presented with eight choice sets, each containing three options to choose from. Descriptive statistics was used, and mixed logit models were used to estimate and analyse the DCE data.

FINDINGS: A total of 60 GPs fully completed the survey. Previous telehealth experiences impacted direct preferences towards telehealth consultations across clinical presentations, although in-person modes were generally favoured (in approximately 70% of all scenarios). The DCE results lacked statistical significance which demonstrated undiscernible differences between GP preferences for some service attributes. However, it was found that GPs prefer to provide a consultation with good quality care and rapport (P < 002). GPs would also prefer to provide care to their patients rather than decline a consultation due to consultation mode, length or purpose (P < 0.0001). Based on the findings, GPs value the ability to provide high-quality care and develop rapport during a clinical consultation. This highlights the importance of recognising value-based care for future policy reforms, to ensure continued adoption and sustainability of GP telehealth services in Australia.

PMID:38721700 | DOI:10.1017/S1463423624000136

Dev Med Child Neurol. 2024 May 9. doi: 10.1111/dmcn.15948. Online ahead of print.

ABSTRACT

Observational studies have a critical role in disability research, providing the opportunity to address a range of research questions. Over the past decades, there have been substantial shifts and developments in statistical methods for observational studies, most notably for causal inference. In this review, we provide an overview of modern design and analysis concepts critical for observational studies, drawing examples from the field of disability research and highlighting the challenges in this field, to inform the readership on important statistical considerations for their studies.

PMID:38721699 | DOI:10.1111/dmcn.15948

Prim Health Care Res Dev. 2024 May 9;25:e27. doi: 10.1017/S146342362400015X.

ABSTRACT

AIM: The study assessed mothers, children and adolescents’ health (MCAH) outcomes in the context of a Primary Health Care (PHC) project and associated costs in two protracted long-term refugee camps, along the Thai-Myanmar border.

BACKGROUND: Myanmar refugees settled in Thailand nearly 40 years ago, in a string of camps along the border, where they fully depend on external support for health and social services. Between 2000 and 2018, a single international NGO has been implementing an integrated PHC project.

METHODS: This retrospective study looked at the trends of MCAH indicators of mortality and morbidity and compared them to the sustainable development goals (SDGs) indicators. A review of programme documents explored and triangulated the evolution and changing context of the PHC services, and associated project costs were analysed. To verify changes over time, interviews with 12 key informants were conducted.

FINDINGS: While maternal mortality (SDG3.1) remained high at 126.5/100,000 live births, child mortality (SDG 3.2) and infectious diseases in children under 5 (SDG 3.3) fell by 69% and by up to 92%, respectively. Maternal anaemia decreased by 30%; and more than 90% of pregnant women attended four or more antenatal care visits, whereas 80% delivered by a skilled birth attendant; caesarean section rates rose but remained low at an average of 3.7%; the adolescent (15-19 years) birth rate peaked at 188 per 1000 in 2015 but declined to 89/1000 in 2018 (SDG 3.7).

CONCLUSION: Comprehensive PHC delivery, with improved health provider competence in MCAH care, together with secured funding is an appropriate strategy to bring MCAH indicators to acceptable levels. However, inequities due to confinement in camps, fragmentation of specific health services, prevent fulfilment of the 2030 SDG Agenda to ‘Leave no one behind’. Costs per birth was 115 EURO in 2018; however, MCAH expenditure requires further exploration over a longer period.

PMID:38721695 | DOI:10.1017/S146342362400015X

J Sex Med. 2024 May 9:qdae052. doi: 10.1093/jsxmed/qdae052. Online ahead of print.

ABSTRACT

BACKGROUND: Intravesical instillation of hyaluronic acid (HA) has been associated with reduced sexual dysfunction in participants with recurrent urinary tract infections (rUTIs), but the efficacy of an oral treatment has never been investigated.

AIM: To investigate the efficacy of an oral preparation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C in improving sexual and urinary symptoms in a cohort of reproductive-age participants with rUTI.

METHODS: In a monocentric randomized crossover pilot trial, participants with rUTI who were referred to our institute between March 2022 and April 2023 were randomized 1:1 in 2 groups: intervention vs control. All participants had an oral preparation of cranberry, D-mannose, propolis extract, turmeric, and Boswellia twice a day for 3 months. The intervention group also included an oral preparation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C once a day for 3 months. Crossover of treatment occurred at 3 months for an additional 3 months. At baseline and 3 and 6 months, participants were evaluated clinically and with the International Prostate Symptom Score (IPSS) and Female Sexual Function Index (FSFI). Descriptive statistics and logistic regression models tested the impact of the intervention on urinary and sexual symptoms at each follow-up assessment.

OUTCOMES: Improvement in sexual and urinary symptoms as measured by the FSFI and IPSS.

RESULTS: Overall, 27 (54%) participants had an FSFI score <26.5 at enrollment. At 3 months, FSFI scores were higher in the intervention group vs control (P < .001), but IPSS scores were lower (P = .03). After crossover of treatment, FSFI and IPSS scores remained stable in the intervention group. However, after crossover, the control group showed a significant improvement in IPSS and FSFI scores (all P < .01) vs the 3-month assessment. At last follow-up, urinary and sexual symptoms were comparable between groups. In logistic regression analyses, the intervention group was associated with early improvement in sexual symptoms (odds ratio, 3.9; P = .04) and urinary symptoms (odds ratio, 5.1; P = .01) after accounting for clinical confounders.

CLINICAL IMPLICATIONS: Combination treatment with HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C is effective if started immediately or even after a few months from symptoms in participants with rUTI.

STRENGTHS AND LIMITATIONS: The main limitation is the lack of long-term follow-up.

CONCLUSION: The oral formulation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C could be an effective therapy against urinary and sexual distress in participants with rUTI (NCT06268483; ClinicalTrials.gov).

PMID:38721680 | DOI:10.1093/jsxmed/qdae052

Trans R Soc Trop Med Hyg. 2024 May 9:trae032. doi: 10.1093/trstmh/trae032. Online ahead of print.

ABSTRACT

BACKGROUND: Haemophagocytic lymphohistiocytosis (HLH) is a rare complication of dengue fever with potentially life-threatening consequences and high mortality. Therefore, this study aims to investigate the prevalence, management and outcome of HLH in dengue fever.

METHODS: The major electronic databases, including PubMed, ScienceDirect and Ovid SP, were searched from inception until 31 January 2024 to identify relevant studies. Pooled prevalence and mortality were calculated using the random-effects generic inverse variance model with a 95% CI. All the statistical analysis was conducted using R programming.

RESULTS: A total of nine studies with 157 patients with HLH, 576 patients with severe dengue and 5081 patients with dengue fever were included in this meta-analysis. The prevalence of HLH in severe dengue (22.1%, 95% CI 8.07 to 48.0%) was significantly higher than the prevalence in dengue fever (3.12%, 95% CI 0.37 to 21.9%). The prevalence of HLH in severe dengue was higher in the paediatric population (22.8%, 95% CI 3.9 to 68.4%) compared with the adult population (19.0%, 95% CI 3.0 to 63.9%). The overall mortality rate was 20.2% (95% CI 9.7 to 37.2%).

CONCLUSION: The prevalence of dengue-associated HLH was low in patients with dengue fever but is significantly higher in patients with severe dengue and a high mortality rate.

PMID:38721675 | DOI:10.1093/trstmh/trae032

J Glob Health. 2024 May 10;14:04085. doi: 10.7189/jogh.14.04085.

ABSTRACT

BACKGROUND: Postnatal care (PNC) utilisation within 24 hours of delivery is a critical component of health care services for mothers and newborns. While substantial geographic variations in various health outcomes have been documented in India, there remains a lack of understanding regarding PNC utilisation and underlying factors accounting for these geographic variations. In this study, we aimed to partition and explain the variation in PNC utilisation across multiple geographic levels in India.

METHODS: Using India’s 5th National Family Health Survey (2019-21), we conducted four-level logistic regression analyses to partition the total geographic variation in PNC utilisation by state, district, and cluster levels, and to quantify how much of theses variations are explained by a set of 12 demographic, socioeconomic, and pregnancy-related factors. We also conducted analyses stratified by selected states/union territories.

RESULTS: Among 149 622 mother-newborn pairs, 82.29% of mothers and 84.92% of newborns were reported to have received PNC within 24 hours of delivery. In the null model, more than half (56.64%) of the total geographic variation in mother’s PNC utilisation was attributed to clusters, followed by 26.06% to states/union territories, and 17.30% to districts. Almost 30% of the between-state variation in mother’s PNC utilisation was explained by the demographic, socioeconomic, and pregnancy-related factors (i.e. state level variance reduced from 0.486 (95% confidence interval (CI) = 0.238, 0.735) to 0.320 (95% CI = 0.152, 0.488)). We observed consistent results for newborn’s PNC utilisation. State-specific analyses showed substantial geographic variation attributed to clusters across all selected states/union territories.

CONCLUSIONS: Our findings highlight the consistently large cluster variation in PNC utilisation that remains unexplained by compositional effects. Future studies should explore contextual drivers of cluster variation in PNC utilisation to inform and design interventions aimed to improve maternal and child health.

PMID:38721673 | DOI:10.7189/jogh.14.04085