Category: Statistics

J Nutr Health Aging. 2024 Dec 19;29(2):100454. doi: 10.1016/j.jnha.2024.100454. Online ahead of print.

ABSTRACT

OBJECTIVES: Nutritional status, as one of the core characteristics of frailty, the impact of its changes on clinical outcomes in older patients following transcatheter aortic valve replacement (TAVR) remains unclear.

DESIGN: A retrospective cohort study.

SETTING: This study included a total of 781 patients who underwent TAVR at West China Hospital between 2012 and 2022.

METHOD: The average age of the patients was 72.6 years, with a mean follow-up period of 2.2 years. All patients were followed for at least one year, and their nutritional status was assessed using the Controlling Nutritional Status (CONUT) score both before TAVR and six months post-TAVR. Based on post-TAVR changes in nutritional status, patients with normal nutritional status pre-TAVR were categorized into Non-malnutrition and New malnutrition groups, while patients with malnutrition pre-TAVR were categorized into Malnutrition regression and Malnutrition persistence groups.

RESULT: The New malnutrition group experienced higher cumulative incidences of all-cause mortality (20.5% vs. 2.4%, P = 0.002), MACE (25.5% vs. 23.7%, P = 0.001), and readmissions for heart failure (13.1% vs. 7.3%, P = 0.027) compared to the Non-malnutrition group. Conversely, the Malnutrition regression group showed a lower cumulative incidence of all-cause mortality (3.1% vs. 18.0%, P = 0.016) compared to the Malnutrition persistence group, although no statistically significant differences were observed in MACE (14.7% vs. 28.5%, P = 0.087) and readmissions for heart failure (7.0% vs. 8.3%, P = 0.551).

CONCLUSION: Our study indicates that deterioration in nutritional status after TAVR is associated with poorer clinical outcomes, whereas improvement is associated with better outcomes.

PMID:39705747 | DOI:10.1016/j.jnha.2024.100454

J Nutr Health Aging. 2024 Dec 19;29(2):100455. doi: 10.1016/j.jnha.2024.100455. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of the study was to investigate associations between risk of malnutrition and risk of rehospitalisation and death in older hospital patients, and whether the possible associations were modified by age, gender, comorbidity or Ambulatory Care Sensitive Conditions (ACSCs).

DESIGN: Prospective cohort study.

SETTING: Somatic hospital in Western Norway.

PARTICIPANTS: 9,768 hospital admissions for patients aged ≥65 years.

MEASUREMENTS: Information on the risk of malnutrition was based on nutritional risk screening data from 34 point prevalence surveys conducted between 2008 and 2018. Risk of malnutrition was assessed using Nutritional Risk Screening 2002 (NRS 2002) during the initial hospital admission. Outcomes and possible effect modifiers were obtained from the hospital’s patient administration systems. The short-term outcome was the length of initial hospital stay. Long-term outcomes included total number of days in hospital, number of hospital stays and risk of death within one year following nutritional risk screening. Statistical analysis involved negative binomial and Cox regression models with adjustment for age, sex and number of diagnoses at time of nutritional risk screening.

RESULTS: Overall, 34% of the patients were classified as being at risk of malnutrition. A higher proportion of the initial admissions were related to ACSCs for patients at risk of malnutrition than for those not at risk. Risk of malnutrition was associated with longer initial hospital stay (adjusted hazard ratio (95% confidence intervals) 1.31 (1.25, 1.37)), more days in hospital (adjusted risk ratio 1.25 (1.18, 1.32)) and a higher risk of having more than two hospital admissions the year following nutritional risk screening (adjusted risk ratio 1.16 (1.07, 1.26)). Patients at risk of malnutrition also had an increased risk of death within one year (adjusted hazard ratio 2.45 (2.25, 2.67)). All associations were more pronounced in the ’65-69′ and ’70-79′ age groups compared to the 80+ years age group, and in patients with fewer than four diagnoses compared to patients with four or more diagnoses. No significant interaction was detected between sex and risk of malnutrition with regard to patient outcomes.

CONCLUSION: Older patients at risk of malnutrition have a higher risk of rehospitalisation and death during the first year after nutritional risk screening compared with those not at risk. Among patients at risk of malnutrition, the initial hospital admissions were more often due to ACSCs. The impact of the risk of malnutrition on outcomes appears stronger in patients aged 65-79 years and in patients with less comorbidity. These findings underline the importance of nutritional risk screening and subsequent nutritional support in all groups of older patients.

PMID:39705746 | DOI:10.1016/j.jnha.2024.100455

Eur J Oncol Nurs. 2024 Dec 8;74:102757. doi: 10.1016/j.ejon.2024.102757. Online ahead of print.

ABSTRACT

PURPOSE: Lymphoma survivors who have received curative intent treatment are currently followed up at defined time points in medical and nurse-led clinics often indefinitely. The follow up protocol is often at the discretion of the treating physician. The aim of the study was to explore the clinical, biochemical and radiological presentation of patients with Diffuse Large B-cell Lymphoma (DLBCL) and Hodgkin Lymphoma (HL) treated with curative intent at the point of recurrence from first remission, and to understand if recurrence was detected at scheduled follow up.

METHODS: A cross-sectional study of patients with DLBCL & HL on surveillance was carried out. Statistical analysis was performed to describe the clinical, biochemical and radiological characteristics of patients with DLBCL and HL at recurrence and to estimate the time to reoccurrence using the Kaplan-Meier estimator.

RESULTS: There was a substantial number of patients with DLBCL & HL treated with curative intent on surveillance programmes (N = 226). Small numbers of this patient group relapsed (13%) with most of these occurring within 5 years of achieving remission (73%). In all cases relapse was detected at an unscheduled appointment, most often initiated by a patient reported symptom (97%).

CONCLUSION: The evidence for a benefit of routine follow-up, particularly beyond 5 years, for detecting relapse is unsupported. However, the multiple survivorship benefits of routine follow-up visits must also be considered. A personalised follow up Lymphoma pathway with direct access, provision of an end of treatment care plan, and signposting to survivorship services is recommended.

PMID:39705731 | DOI:10.1016/j.ejon.2024.102757

J Chem Theory Comput. 2024 Dec 20. doi: 10.1021/acs.jctc.4c01214. Online ahead of print.

ABSTRACT

The light-harvesting complex II (LHCII) in green plants exhibits highly efficient excitation energy transfer (EET). A comprehensive understanding of the EET mechanism in LHCII requires quantum chemical, molecular dynamics (MD), and statistical mechanics calculations that can adequately describe pigment molecules in heterogeneous environments. Herein, we develop MD simulation parameters that accurately reproduce the quantum mechanical/molecular mechanical energies of both the ground and excited states of all chlorophyll (Chl) molecules in membrane embedded LHCII. The present simulations reveal that Chl a molecules reside in more inhomogeneous environments than Chl b molecules. We also find a narrow gap between the exciton energy levels of Chl a and Chl b. In addition, we investigate the nature of the exciton states of Chl molecules, such as delocalization, and analyze the optical spectra of LHCII, which align with experimental results. Thus, the MD simulation parameters developed in this study successfully reproduce the excitonic and optical properties of the Chl molecules in LHCII, validating their effectiveness.

PMID:39705720 | DOI:10.1021/acs.jctc.4c01214

ACS Appl Bio Mater. 2024 Dec 20. doi: 10.1021/acsabm.4c01497. Online ahead of print.

ABSTRACT

Skin wounds are extremely frequent injuries related to many etiologies. They are a burden on healthcare systems worldwide. Skin dressings are the most popular therapy, and collagen is the most commonly used biomaterial, although new sources of collagen have been studied, especially spongin-like from marine sponges (SPG), as a promising source due to a similar composition to vertebrates and the ability to function as a cell-matrix adhesion framework. Despite evidence showing the positive effects of SPG for tissue healing, the effects of skin dressings manufactured are still limited. In this context, this study aimed at investigating the effects of collagen skin dressings in an experimental model of skin wounds in rats. For this purpose, SEM, FTIR, cell viability, morphological and morphometric aspects, collagen deposition, and immunostaining of TGF-β and FGF were evaluated. The results demonstrated micro- and macropores on the rough surface, peak characteristics of collagen, and no cytotoxicity for the skin dressing. Also, the control group (CG) after 5 and 10 days exhibited an intense inflammatory process and the presence of granulation tissue, while the treated group (TG) exhibited re-epithelialization after 10 days. The evaluation of granulation tissue and neoepithelial length had an intragroup statistical difference (p = 0.0216) and no intergroup difference. Birefringence demonstrated an organized mesh arranged in a network pattern, presenting type I and type III collagen fibers in all groups. Moreover, in the morphometric evaluation, there were no statistical differences in intergroups or time points for the different types of collagen evaluated. In conclusion, these findings may indicate that the dressing has not exacerbated the inflammatory process and may allow faster healing. However, further studies using a critical wound healing injury model should be used, associated with longer experimental periods of evaluation, to further investigate the effects of these promising therapeutic approaches throughout the skin repair process.

PMID:39705707 | DOI:10.1021/acsabm.4c01497

JMIR Res Protoc. 2024 Dec 20;13:e63399. doi: 10.2196/63399.

ABSTRACT

BACKGROUND: Caregiver-involved treatments for adolescents with alcohol use disorder and co-occurring disorders (AUD+CODs) are associated with the best treatment outcomes. Understanding what caregiving practices during treatment improve core adolescent treatment targets may facilitate the refinement and scalability of caregiver-involved interventions. Caregiving is dynamic, varying by context, affect, and adolescent behavior. Caregiver-involved treatments seek to change momentary interactions between caregivers and their adolescents. Accordingly, this protocol outlines a dyadic ecological momentary assessment (EMA) study to examine caregiving practices during AUD+CODs treatment and their associations with adolescent core treatment targets (eg, alcohol craving and use, motivation to reduce or stop drinking, and internalizing and externalizing symptoms).

OBJECTIVE: This paper aims to describe the methods for examining momentary caregiving practices and adolescent core treatment targets during adolescent outpatient AUD+CODs treatment.

METHODS: We will recruit 75 caregiver-adolescent dyads from outpatient mental health clinics providing AUD+CODs treatment. Eligible families will have an adolescent who (1) is aged between 13 and 18 years; (2) meets the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for AUD; (3) is enrolled in outpatient treatment at the time of recruitment; and (4) has a legal guardian willing to participate in the study. Caregivers and adolescents will complete an eligibility screening, followed by a baseline assessment during or as close as possible to the second week of treatment. During the baseline assessment, caregivers and adolescents will receive formal training in EMA procedures. Next, caregivers and adolescents will complete a 15-week EMA burst design consisting of three 21-day EMA periods with 3-week breaks between periods. Throughout the study, participants will also complete weekly reports regarding the skills learned or practiced during therapy. The three overarching aims to the proposed study are as follows: (1) examine momentary caregiving practices (eg, support, monitoring, substance use communication quality) and their associations with core treatment targets, (2) examine how these associations change throughout treatment, and (3) examine whether a caregiver report of learning or practicing parenting- or family-focused behaviors in treatment sessions is associated with changes in the use of caregiving practices in daily life.

RESULTS: The proposed study was informed by a pilot study assessing the feasibility and acceptability of dyadic EMA during adolescent AUD+COD treatment. Some benchmarks were met during this study (eg, ≥80% caregiver retention rate), although most benchmarks were not (eg, adolescent [772/1622, 47.6%] and caregiver [1331/1881, 70.76%] random prompt compliance was below the ≥80% target). Data collection is anticipated to begin in December of 2024. The proposed study is designed to be completed over 3 years.

CONCLUSIONS: Examining momentary caregiving practices using EMA has important implications for refining and scaling caregiver-involved interventions for AUD+CODs so that families who would benefit from caregiver-involved treatments can have access to them.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/63399.

PMID:39705699 | DOI:10.2196/63399

JMIR Res Protoc. 2024 Dec 20;13:e51493. doi: 10.2196/51493.

ABSTRACT

BACKGROUND: Mortality statistics are vital for health policy development, epidemiological research, and health care service planning. A robust surveillance system is essential for obtaining vital information such as cause of death (CoD) information.

OBJECTIVE: This study aims to develop a comprehensive model to strengthen the CoD information in the selected study sites. The specific objectives are (1) to identify the best practices and challenges in the functioning of the Civil Registration and Vital Statistics (CRVS) system with respect to mortality statistics and CoD information; (2) to develop and implement interventions to strengthen the CoD information; (3) to evaluate the quality improvement of the Medical Certification of Cause of Death (MCCD); and (4) to improve the CoD information at the population level through verbal autopsy for noninstitutional deaths in the selected study sites.

METHODS: An uncontrolled, before-after, mixed method study will be conducted in 3 blocks located in the districts of 3 states (Madhya Pradesh, Uttar Pradesh, and Odisha) in India. A baseline assessment to identify the best practices and challenges in the functioning of the CRVS system, along with a quality assessment of the MCCD, will be conducted. An intervention informed by existing literature and the baseline assessment will be developed and implemented in the study sites. The major components of intervention will include a Training of Trainers workshop, orientation of stakeholders in the functioning of the CRVS system, training of physicians and medical officers in the MCCD, and training of community health workers in World Health Organization Verbal Autopsy 2022 instrument. Postintervention evaluation will be carried out to assess the impact made by the intervention on the availability and quality improvement of CoD information in the selected study sites. The outcome will be measured in terms of the quality improvement of the MCCD and the availability of CoD information at population level through verbal autopsy in the selected study sites.

RESULTS: The project has been funded, and regulatory approval has been obtained from the Institutional Ethics Committee. The data collection process began in May 2023. The duration of the study will be for 24 months.

CONCLUSIONS: Our study is expected to provide a valuable contribution toward strengthening CoD information, which could be helpful for policy making and further research. The intervention model will be developed in collaboration with the existing functionaries of the health and CRVS systems in the selected study sites that are engaged in reporting and recording CoD information; this will ensure sustainability and provide lessons for upscaling, with the aim to improve the reporting of CoD information in the country.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/51493.

PMID:39705697 | DOI:10.2196/51493

J Med Internet Res. 2024 Dec 20;26:e57774. doi: 10.2196/57774.

ABSTRACT

BACKGROUND: Despite the increasing popularity of mobile health (mHealth) technologies, little is known about which types of mHealth system engagement might affect the maintenance of antiretroviral therapy among people with HIV and substance use disorders.

OBJECTIVE: This study aimed to use longitudinal and detailed system logs and weekly survey data to test a mediation model, where mHealth engagement indicators were treated as predictors, substance use and confidence in HIV management were treated as joint mediators, and antiretroviral therapy adherence was treated as the outcome. We further distinguished the initiation and intensity of system engagement by mode (expression vs reception) and by communication levels (intraindividual vs dyadic vs network).

METHODS: Tailored for people with HIV living with substance use disorders, the mHealth app was distributed among 208 participants aged >18 years from 2 US health clinics. Supervised by medical professionals, participants received weekly surveys through the app to report their health status and medication adherence data. System use was passively collected through the app, operationalized as transformed click-level data, aggregated weekly, and connected to survey responses with a 7-day lagged window. Using the weekly check-in record provided by participants as the unit of analysis (N=681), linear regression and structure equation models with cluster-robust SEs were used for analyses, controlling within-person autocorrelation and group-level error correlations. Racial groups were examined as moderators in the structure equation models.

RESULTS: We found that (1) intensity, not initiation, of system use; (2) dyadic message expression and reception; and (3) network expression positively predicted medication adherence through joint mediators (substance use and confidence in HIV management). However, intraindividual reception (ie, rereading saved entries for personal motivation) negatively predicts medication adherence through joint mediators. We also found Black participants have distinct usage patterns, suggesting the need to tailor mHealth interventions for this subgroup.

CONCLUSIONS: These findings highlight the importance of considering the intensity of system engagement, rather than initiation alone, when designing mHealth interventions for people with HIV and tailoring these systems to Black communities.

PMID:39705693 | DOI:10.2196/57774

J Med Internet Res. 2024 Dec 20;26:e60944. doi: 10.2196/60944.

ABSTRACT

BACKGROUND: Previous studies have shown that electrocardiographic (ECG) alarms have high sensitivity and low specificity, have underreported adverse events, and may cause neonatal intensive care unit (NICU) staff fatigue or alarm ignoring. Moreover, prolonged noise stimuli in hospitalized neonates can disrupt neonatal development.

OBJECTIVE: The aim of the study is to conduct a nationwide, multicenter, large-sample cross-sectional survey to identify current practices and investigate the decision-making requirements of health care providers regarding ECG alarms.

METHODS: We conducted a nationwide, cross-sectional survey of NICU staff working in grade III level A hospitals in 27 Chinese provinces to investigate current clinical practices, perceptions, decision-making processes, and decision-support requirements for clinical ECG alarms. A comparative analysis was conducted on the results using the chi-square, Kruskal-Wallis, or Mann-Whitney U tests.

RESULTS: In total, 1019 respondents participated in this study. NICU staff reported experiencing a significant number of nuisance alarms and negative perceptions as well as practices regarding ECG alarms. Compared to nurses, physicians had more negative perceptions. Individuals with higher education levels and job titles had more negative perceptions of alarm systems than those with lower education levels and job titles. The mean difficulty score for decision-making about ECG alarms was 2.96 (SD 0.27) of 5. A total of 62.32% (n=635) respondents reported difficulty in resetting or modifying alarm parameters. Intelligent module-assisted decision support systems were perceived as the most popular form of decision support.

CONCLUSIONS: This study highlights the negative perceptions and strong decision-making requirements of NICU staff related to ECG alarm handling. Health care policy makers must draw attention to the decision-making requirements and provide adequate decision support in different forms.

PMID:39705688 | DOI:10.2196/60944

J Med Internet Res. 2024 Dec 20;26:e63054. doi: 10.2196/63054.

ABSTRACT

BACKGROUND: Health education and promotion are recognized as effective strategies for fostering healthy ageing, reducing the disease burden, and addressing health inequalities, particularly when delivered through digital media. Primary care workers are often regarded as the key providers of these interventions. Despite the strong practical significance and substantial individual demand, the use of digital media for delivering health promotion practices was not widespread in China. One of the main challenges identified is the providers’ inadequate capacities. However, little is known about the digital capacity for health promotion among primary care workers.

OBJECTIVE: This study aimed to investigate the levels of digital capacity for health promotion and its associated factors among community health workers.

METHODS: A total of 1346 community health workers were recruited from across 47 communities in Shanghai, China, through cluster-stratified random sampling. The digital capacity for health promotion was measured using the revised version of the Digital Capabilities Framework. Web-based questionnaires were distributed to collect data from March 20 to March 29, 2024. Data were analyzed using descriptive statistics, independent t tests, one-way ANOVA, and linear hierarchical regression using Stata MP (version 17.0; StataCorp).

RESULTS: We included 1199 participants. Among them, 47.5% (570/1199) had high digital media use for more than 19.6 hours per week, whereas 31.8% (381/1199) demonstrated high digital media trust. The average level of digital capacity for health promotion was 16.71 (SD 2.94) out of 25 points. Demographics, digital media usage-related characteristics, perceived usefulness and usability, attitudes, and behaviors were significant predictors of the capacities, explaining 44.4% of the total variance. Master’s degree or above (β=.077; P=.013), perceived usability (β=.235; P<.001), attitudes toward digital media health promotion (β=.095; P=.002), and past digital media health promotion practices (β=.377; P<.001) had significantly positive associations with digital capacities for health promotion. However, senior (β=-.076; P=.008) or median (β=-.074; P=.01) titles had a significant negative association with capacity levels.

CONCLUSIONS: A digitally capable workforce is required for primary health care systems to take full advantage of digital media health promotion. Therefore, solutions are necessary to achieve enhanced capacities among health professionals, including public health policy making, community empowerment, and individual practices.

PMID:39705686 | DOI:10.2196/63054