Category: Statistics

Eur J Ageing. 2024 Mar 29;21(1):11. doi: 10.1007/s10433-024-00806-0.

ABSTRACT

Polypharmacy (PP) use is very common in older people and may lead to drug-drug interactions (DDIs) and anticholinergic burden (ACB) that may affect cognitive function. We aimed to determine the occurrence of PP, potential DDIs and ACB and their role in cognitive outcomes in an older population. Cross-sectional data from 636 community-dwelling adults (73.2 ± 6.0 SD, 58.6% women) participating in the NutBrain study (2019-2023) were analyzed. Participants were asked about their medication use, and data on potential DDIs and ACB were extracted. The associations of PP (≥ 5 drugs/day), potential DDIs, and ACB with mild cognitive impairment (MCI) and specific cognitive domains were assessed using logistic regression adjusted for confounders. Sex-stratified analysis was performed. Overall, 27.2% of the participants were exposed to PP, 42.3% to potential DDIs and 19% to cumulative ACB. Women were less exposed to PP and more exposed to ACB than men. In multivariate analysis, the odds of having MCI (24%) were three times higher in those with severe ACB (≥ 3) (OR 3.34, 95%CI 1.35-8.25). ACB was positively associated with poor executive function (OR 4.45, 95%CI 1.72-11.49) and specifically with the Frontal Assessment Battery and neuropsychological tests of phonological and semantic fluency. In sex-stratified analysis, ACB was statistically significantly associated with MCI and executive function in women and with memory in men. PP, potential DDIs and anticholinergics use are very common in community-dwelling older people. ACB exposure is associated with MCI, particularly with poor executive function. Clinicians are encouraged to be vigilant when prescribing anticholinergics.Trial registration: Trial registration number NCT04461951, date of registration July 7, 2020 (retrospectively registered, ClinicalTrials.gov).

PMID:38551689 | DOI:10.1007/s10433-024-00806-0

J Math Biol. 2024 Mar 29;88(5):51. doi: 10.1007/s00285-024-02073-0.

ABSTRACT

Communities are commonly not isolated but interact asymmetrically with each other, allowing the propagation of infectious diseases within the same community and between different communities. To reveal the impact of asymmetrical interactions and contact heterogeneity on disease transmission, we formulate a two-community SIR epidemic model, in which each community has its contact structure while communication between communities occurs through temporary commuters. We derive an explicit formula for the basic reproduction number $R_0$ , give an implicit equation for the final epidemic size z, and analyze the relationship between them. Unlike the typical positive correlation between $R_0$ and z in the classic SIR model, we find a negatively correlated relationship between counterparts of our model deviating from homogeneous populations. Moreover, we investigate the impact of asymmetric coupling mechanisms on $R_0$ . The results suggest that, in scenarios with restricted movement of susceptible individuals within a community, $R_0$ does not follow a simple monotonous relationship, indicating that an unbending decrease in the movement of susceptible individuals may increase $R_0$ . We further demonstrate that network contacts within communities have a greater effect on $R_0$ than casual contacts between communities. Finally, we develop an epidemic model without restriction on the movement of susceptible individuals, and the numerical simulations suggest that the increase in human flow between communities leads to a larger $R_0$ .

PMID:38551684 | DOI:10.1007/s00285-024-02073-0

J Hered. 2024 Mar 29:esae021. doi: 10.1093/jhered/esae021. Online ahead of print.

ABSTRACT

Rosalia funebris (RFUNE; Cerambycidae), the banded alder borer, is a longhorn beetle whose larvae feed on the wood of various economically and ecologically significant trees in western North America. Adults are short-lived and not known to consume plant material substantially. We sequenced, assembled and annotated the RFUNE genome using HiFi and RNASeq data. We documented genome architecture and gene content, focusing on genes putatively involved in plant feeding (phytophagy). Comparisons were made to the well-studied genome of the Asian longhorned beetle (AGLAB; Anoplophora glabripennis) and other Cerambycidae. The 814 Mb RFUNE genome assembly was distributed across 42 contigs, with an N50 of 30.18 Mb. Repetitive sequences comprised 60.27 % of the genome, and 99.0 % of expected single-copy orthologous genes were fully assembled. We identified 12657 genes, fewer than in the four other species studied, and 46.4 % fewer than for Aromia moschata (same subfamily as RFUNE). Of the 7258 orthogroups shared between RFUNE and AGLAB, 1461 had more copies in AGLAB and 1023 had more copies in RFUNE. We identified 240 genes in RFUNE that putatively arose via horizontal transfer events. The RFUNE genome encoded substantially fewer putative plant cell wall degrading enzymes than AGLAB, which may relate to the longer-lived plant-feeding adults of the latter species. The RFUNE genome provides new insights into cerambycid genome architecture and gene content and provides a new vantage point from which to study the evolution and genomic basis of phytophagy in beetles.

PMID:38551670 | DOI:10.1093/jhered/esae021

JMIR Med Educ. 2024 Mar 29;10:e55737. doi: 10.2196/55737.

ABSTRACT

BACKGROUND: Digital competence is listed as one of the key competences for lifelong learning and is increasing in importance not only in private life but also in professional life. There is consensus within the health care sector that digital competence (or digital literacy) is needed in various professional fields. However, it is still unclear what exactly the digital competence of health professionals should include and how it can be measured.

OBJECTIVE: This scoping review aims to provide an overview of the common definitions of digital literacy in scientific literature in the field of health care and the existing measurement instruments.

METHODS: Peer-reviewed scientific papers from the last 10 years (2013-2023) in English or German that deal with the digital competence of health care workers in both outpatient and inpatient care were included. The databases ScienceDirect, Scopus, PubMed, EBSCOhost, MEDLINE, OpenAIRE, ERIC, OAIster, Cochrane Library, CAMbase, APA PsycNet, and Psyndex were searched for literature. The review follows the JBI methodology for scoping reviews, and the description of the results is based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist.

RESULTS: The initial search identified 1682 papers, of which 46 (2.73%) were included in the synthesis. The review results show that there is a strong focus on technical skills and knowledge with regard to both the definitions of digital competence and the measurement tools. A wide range of competences were identified within the analyzed works and integrated into a validated competence model in the areas of technical, methodological, social, and personal competences. The measurement instruments mainly used self-assessment of skills and knowledge as an indicator of competence and differed greatly in their statistical quality.

CONCLUSIONS: The identified multitude of subcompetences illustrates the complexity of digital competence in health care, and existing measuring instruments are not yet able to reflect this complexity.

PMID:38551628 | DOI:10.2196/55737

Am Surg. 2024 Mar 29:31348241241657. doi: 10.1177/00031348241241657. Online ahead of print.

ABSTRACT

Gustilo type III open fractures involve extensive soft tissue damage and wound contamination that pose significant infection risks. The historical standard for antibiotic prophylaxis has been cefazolin and gentamicin. We conducted a retrospective cohort study of lower extremity type III open fractures treated with ceftriaxone alone for prophylaxis. Eighty-six patients were identified. Nearly all (98%) were managed with appropriate antibiotics, but only 55 (64%) received prophylaxis within 1 hour. Overall, there were 12 infections. This infection rate was not statistically different than the reported literature (14% vs 19%, P = .20). The infection rate between those who received antibiotics within 1 hour was not statistically different from those who got it beyond 1 hour (15% vs 13%, P = .98). In conclusion, the use of ceftriaxone as monotherapy for antibiotic prophylaxis in lower extremity type III open fractures is not statistically different than the use of historic prophylactic regimens.

PMID:38551626 | DOI:10.1177/00031348241241657

Am Surg. 2024 Mar 29:31348241241697. doi: 10.1177/00031348241241697. Online ahead of print.

ABSTRACT

INTRODUCTION: Rates of appropriate surgical treatment of colon cancer are historically worse in traditionally marginalized populations. We sought to examine which social determinants of health may be associated with longer time to appropriate operative intervention.

METHODS: The National Cancer Databank was queried for this retrospective study. Adult patients (18 to 90 years of age) diagnosed between 2004 and 2018 with single or primary, stage III colon cancer were included. Patient demographic variables included age at diagnosis, sex, ethnicity (Hispanic or non-Hispanic), comorbidity score, median household income, education status, rural/urban status, treatment facility type and location, and insurance status. Disease characteristics include stage (stage 3), primary site, surgical margins, tumor size, and number of nodes resected. Reported descriptive statistics include means and 95% confidence intervals for continuous variables and frequency and proportions for categorical variables. Univariate and multivariate analyses were performed.

RESULTS: A total of 134,601 individuals diagnosed with stage 3 colon cancer were included. Time to surgery in all cases had a mean of 26.4 ± 19.0 days. Multivariate analysis of time to surgery indicated that receiving surgery at a Community Cancer Program, Charlson-Deyo Score of 0, younger age, and non-Hispanic-White race/ethnicity are associated with decreased time to surgery (P < .001).

CONCLUSION: Patients who receive surgery at a Community Cancer Program, have fewer comorbidities, have lower household income, are younger, and receive surgery within 50 miles of their primary residence are more likely to have timely surgery.

PMID:38551594 | DOI:10.1177/00031348241241697

JAMA Health Forum. 2024 Mar 1;5(3):e240324. doi: 10.1001/jamahealthforum.2024.0324.

ABSTRACT

IMPORTANCE: While the Patient Protection and Affordable Care Act (ACA) helped make health insurance premiums more affordable with premium tax credits, ACA marketplace enrollees continue to face barriers to care.

OBJECTIVE: To investigate the effect of informational emails on plan switching and health care utilization.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted during the 2021 special enrollment period in California’s Affordable Care Act marketplace among households that reported receiving unemployment insurance and were enrolled in non-silver-tier plans. The trial targeted 42 470 households that became temporarily eligible for cost-sharing reduction (CSR) silver plans that covered 94% of medical costs (CSR silver 94 plans) as a result of the 2021 American Rescue Plan Act.

INTERVENTION: Households were randomized to either a no-email control group or to a treatment group receiving 2 informational emails encouraging households to switch to CSR plans.

MAIN OUTCOMES AND MEASURES: The primary outcome was the switch rate to a CSR silver plan by July 31, 2021. Secondary outcomes include various measures of health care utilization in the second half of 2021 (July 1, 2021, to December 31, 2021). Health care utilization was measured by rates of practitioner visits, emergency department visits, hospitalizations, and prescription fills.

RESULTS: Of the 42 470 households (head of household mean [SD], age, 41.4 [13.3] years; 51.7% male), 10 650 (25.1%) were in the control group and 31 820 (74.9%) were in the treatment group. The emails led to a statistically significant 3.1-percentage point (95% CI, 2.6-3.6 percentage points) increase in CSR silver 94 enrollment (a 74.8% relative increase) by July 31, 2021, and a 1.3-percentage point (95% CI, 0.2-2.4 percentage points) increase (a 2.3% relative increase) in practitioner visits by December 31, 2021. The emails had no detectable effect on prescription fills, emergency department visits, or hospitalizations.

CONCLUSIONS AND RELEVANCE: The results of this randomized clinical trial provide experimental evidence that, with access to more affordable health care, individuals are more likely to visit practitioners.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05891418.

PMID:38551588 | DOI:10.1001/jamahealthforum.2024.0324

Invest Ophthalmol Vis Sci. 2024 Mar 5;65(3):36. doi: 10.1167/iovs.65.3.36.

ABSTRACT

PURPOSE: Symptomatic vitreous opacifications, so-called floaters, are difficult to objectively assess majorly limiting the possibility of in vitro studies. Forward light scattering was found previously to be increased in eyes with symptomatic floaters. Using an objective setup to measure forward light scattering, we studied the effects of enzymatically digesting the components of the vitreous body on straylight to develop an in vitro model of vitreous opacifications.

METHODS: Fifty-seven porcine vitreous bodies were digested using hyaluronidase, collagenase, trypsin, and bromelain, as well as using a combination of hyaluronidase + collagenase and hyaluronidase + bromelain. A modified C-Quant setup was used to objectively assess forward light scattering.

RESULTS: Depletion of hyaluronic acid majorly increased vitreous straylight (mean increase 34.4 deg2/sr; P = 0.01), whereas primarily digesting the vitreous gel with collagenase or trypsin did not significantly affect straylight. When collagenase or bromelain is applied in hyaluronic acid depleted vitreous gels, the increase in forward light scattering is reversed partially.

CONCLUSIONS: The age-related loss of hyaluronic acid primarily drives the increase in vitreous gel straylight induced by conglomerates of collagen. This process can be reversed partially by digesting collagen. This in vitro model allows the objective quantification and statistical comparison of straylight burden caused by vitreous opacities and, thus, can serve as a first testing ground for pharmacological therapies, as demonstrated with bromelain.

PMID:38551585 | DOI:10.1167/iovs.65.3.36

JAMA Netw Open. 2024 Mar 4;7(3):e243215. doi: 10.1001/jamanetworkopen.2024.3215.

ABSTRACT

IMPORTANCE: Scientific publication is an important tool for knowledge dissemination and career advancement, but authors affiliated with institutions in low- and middle-income countries (LMICs) are historically underrepresented on publications.

OBJECTIVE: To assess the country income level distribution of author affiliations for publications resulting from National Cancer Institute (NCI)-supported extramural grants between 2015 and 2019, with international collaborating institutions exclusively in 1 or more LMICs.

DESIGN AND SETTING: This cross-sectional study assessed authorship on publications resulting from NCI-funded grants between October 1, 2015, and September 30, 2019. Grants with collaborators in LMICs were identified in the National Institutes of Health (NIH) Query/View/Report and linked to publications using Dimensions for NIH, published between 2011 and 2020. Statistical analysis was performed from May 2021 to July 2022.

MAIN OUTCOMES AND MEASURES: Author institutional affiliation was used to classify author country and related income level as defined by the World Bank. Relative citation ratio and Altmetric data from Dimensions for NIH were used to compare citation impact measures using the Wilcoxon rank sum test.

RESULTS: In this cross-sectional study, 159 grants were awarded to US institutions with collaborators in LMICs, and 5 grants were awarded directly to foreign institutions. These 164 grants resulted in 2428 publications, of which 1242 (51%) did not include any authors affiliated with an institution in an LMIC. In addition, 1884 (78%) and 2009 (83%) publications had a first or last author, respectively, affiliated with a high-income country (HIC). Publications with HIC-affiliated last authors also demonstrated greater citation impact compared with publications with LMIC-affiliated last authors as measured by relative citation ratios and Altmetric Attention Scores; publications with HIC-affiliated first authors also had higher Altmetric Attention Scores.

CONCLUSIONS AND RELEVANCE: This cross-sectional study suggests that LMIC-affiliated authors were underrepresented on publications resulting from NCI-funded grants involving LMICs. It is critical to promote equitable scientific participation by LMIC institutions in cancer research, including through current and planned programs led by the NCI.

PMID:38551565 | DOI:10.1001/jamanetworkopen.2024.3215

JAMA Netw Open. 2024 Mar 4;7(3):e244090. doi: 10.1001/jamanetworkopen.2024.4090.

ABSTRACT

IMPORTANCE: Limited evidence supports the performance of human papillomavirus (HPV) DNA testing as a primary screening method, followed by triage with visual inspection with acetic acid, in areas with limited health care resources, as suggested by the 2021 World Health Organization guidelines.

OBJECTIVE: To evaluate the performance of visual inspection with acetic acid and Lugol iodine as a triage method for detecting cervical precancerous lesions among HPV-positive women in 1 visit.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined the implementation of a government-led cervical cancer screening program conducted from January 1, 2016, to December 31, 2020, in Ordos City, China. Female residents, aged 35 to 64 years, who understood the screening procedures and voluntarily participated were included in the study. Women were excluded if they reported never having had sexual intercourse, were pregnant, had a hysterectomy, or had ever undergone treatment for cervical lesions. Statistical analysis was conducted from December 2022 to December 2023.

EXPOSURES: The program used the careHPV DNA assay as the primary screening method, and immediate triage was performed by visual inspection if HPV screening results were positive, with a 5-year screening interval. A colposcopy was performed for the women who had suspected cancer on visual inspection results or who were HPV positive and had abnormal visual inspection results, all in 1 visit.

MAIN OUTCOMES AND MEASURES: The rate of compliance with colposcopy and the detection rate of cervical intraepithelial neoplasia grade 2 or higher (CIN2+).

RESULTS: The study included 187 863 women (median age, 46 years [IQR, 40-52 years]) who participated in the program and had valid HPV test results. The overall prevalence of HPV positivity was 12.8% (24 070 of 187 863), and the adherence to triage with visual inspection among HPV-positive women was 93.9% (22 592 of 24 070). Among HPV-positive women, the rate of compliance with colposcopy was 65.6% (2714 of 4137), and the CIN2+ detection rate was 2.8% (643 of 22 592).

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that the implementation of HPV testing, visual inspection, and colposcopy within 1 visit may mitigate losses to follow-up, detect precancerous lesions, and hold significant implications for screening in comparable areas with limited health care resources.

PMID:38551562 | DOI:10.1001/jamanetworkopen.2024.4090