Category: Statistics

JMIR Mhealth Uhealth. 2022 Sep 20;10(9):e35851. doi: 10.2196/35851.

ABSTRACT

BACKGROUND: Hematological malignancies (HMs) are a heterogeneous group of cancers representing a significant cause of morbidity and mortality. The chronification of HMs and the increasing use of smartphones may lead patients to seek their current unmet needs through mobile health apps.

OBJECTIVE: The goal of this review was to identify and assess the quality of smartphone apps aimed at patients diagnosed with HMs.

METHODS: A systematic search of apps that were aimed at patients diagnosed with HMs, accessed from a Spain IP address, and were available on the iOS (App Store) and Android (Google Play) platforms was conducted in November 2021. The search terms used were “hematology,” “blood cancer,” “leukemia,” “lymphoma,” and “myeloma” apps in English, Spanish, or both languages. The identified apps were downloaded and analyzed independently by 2 reviewers. Information about general app characteristics was collected. The Mobile Application Rating Scale (MARS) was used to assess quality. The resulting parameter of the analyses, the mean score of the apps, was compared by Student t test.

RESULTS: Overall, 18 apps were identified; 7 were available on Android, 5 were available on iOS, and 6 were available on both platforms. All included apps were free; 3 were published in 2021, and among the apps published before 2021, only 6 were updated in 2021. Most (16/18, 89%) of the apps were aimed at patients with leukemia or lymphoma (16). The primary purposes of the apps were to provide general information about the condition (16/18, 89%) and monitor symptoms and clinical parameters (11/18, 61%). Health care professionals contributed to the development of 50% (9/18) of apps; 6 were owned and supported by scientific societies, and 3 were developed with the participation of health care professionals. The mean MARS score for the overall quality of the apps was 3.1 (SD 1.0). The engagement and aesthetics subscales were the lowest rated subscales, with only 44% (8/18) and 67% (12/18), respectively, of the apps obtaining acceptable scores. None of the included apps proved clinical efficacy through clinical trials in patients with HMs. Statistically significant differences were found in the MARS scores between operating systems (+1.0, P=.003) in favor of iOS apps. The participation of health care professionals in the development of the apps did not have a statistically significant impact on the MARS scores.

CONCLUSIONS: This systematic search and evaluation identified few acceptable quality mobile apps for patients with HMs. Current and future apps for patients with HMs should provide evidence-based valuable information, improve user engagement, incorporate functions according to patient preferences, and generate evidence regarding the efficacy of app use by patients with HMs.

PMID:36125860 | DOI:10.2196/35851

J Med Internet Res. 2022 Sep 20;24(9):e33720. doi: 10.2196/33720.

ABSTRACT

BACKGROUND: A Trusted Research Environment (TRE; also known as a Safe Haven) is an environment supported by trained staff and agreed processes (principles and standards), providing access to data for research while protecting patient confidentiality. Accessing sensitive data without compromising the privacy and security of the data is a complex process.

OBJECTIVE: This paper presents the security measures, administrative procedures, and technical approaches adopted by TREs.

METHODS: We contacted 73 TRE operators, 22 (30%) of whom, in the United Kingdom and internationally, agreed to be interviewed remotely under a nondisclosure agreement and to complete a questionnaire about their TRE.

RESULTS: We observed many similar processes and standards that TREs follow to adhere to the Seven Safes principles. The security processes and TRE capabilities for supporting observational studies using classical statistical methods were mature, and the requirements were well understood. However, we identified limitations in the security measures and capabilities of TREs to support “next-generation” requirements such as wide ranges of data types, ability to develop artificial intelligence algorithms and software within the environment, handling of big data, and timely import and export of data.

CONCLUSIONS: We found a lack of software or other automation tools to support the community and limited knowledge of how to meet the next-generation requirements from the research community. Disclosure control for exporting artificial intelligence algorithms and software was found to be particularly challenging, and there is a clear need for additional controls to support this capability within TREs.

PMID:36125859 | DOI:10.2196/33720

JMIR Perioper Med. 2022 Sep 20;5(1):e39617. doi: 10.2196/39617.

ABSTRACT

BACKGROUND: Tonsillectomy is a common pediatric surgical procedure performed in North America. Caregivers experience complex challenges in preparing for their child’s surgery and coordinating care at home and, consequently, could benefit from access to educational resources. A previous feasibility study of Tonsil-Text-To-Me, an automated SMS text messaging service that sends 15 time-sensitive activity reminders, links to nutrition and hydration tips, pain management strategies, and guidance on monitoring for complications, showed promising results, with high levels of caregiver satisfaction and engagement.

OBJECTIVE: This study aimed to pilot-test Tonsil-Text-To-Me in a real-world context to determine whether and how it might improve perioperative experiences and outcomes for caregivers and patients.

METHODS: Caregivers of children aged 3 to 14 years undergoing tonsillectomy were included. Data from a historical control group and an intervention group with the same study parameters (eg, eligibility criteria and surgery team) were compared. Measures included the Parenting Self-Agency Measure, General Health Questionnaire-12, Parents’ Postoperative Pain Measure, Client Satisfaction Questionnaire-8, and engagement analytics, as well as analgesic consumption, pain, child activity level, and health service use. Data were collected on the day before surgery, 3 days after surgery, and 14 days after surgery. Participants in the intervention group received texts starting 2 weeks before surgery up to the eighth day after surgery. Descriptive and inferential statistics were used.

RESULTS: In total, 51 caregivers (n=32, 63% control; n=19, 37% intervention) who were predominately women (49/51, 96%), White (48/51, 94%), and employed (42/51, 82%) participated. Intervention group caregivers had a statistically significant positive difference in Parenting Self-Agency Measure scores (P=.001). The mean postoperative pain scores were higher for the control group (mean 10.0, SD 3.1) than for the intervention group (mean 8.5, SD 3.7), both of which were still above the 6/15 threshold for clinically significant pain; however, the difference was not statistically significant (t₃₉=1.446; P=.16). Other positive but nonsignificant trends for the intervention group compared with the control group were observed for the highest level of pain (t₃₉=0.882; P=.38), emergency department visits (χ²₂=1.3; P=.52; Cramer V=0.19), and other measures. Engagement with resources linked in the texts was moderate, with all but 1 being clicked on for viewing at least once by 79% (15/19) of the participants. Participants rated the intervention as highly satisfactory across all 8 dimensions of the Client Satisfaction Questionnaire (mean 29.4, SD 3.2; out of a possible value of 32.0).

CONCLUSIONS: This cohort study with a historical control group found that Tonsil-Text-To-Me had a positive impact on caregivers’ perioperative care experience. The small sample size and unclear impacts of COVID-19 on the study design should be considered when interpreting the results. Controlled trials with larger sample sizes for evaluating SMS text messaging interventions aimed to support caregivers of children undergoing tonsillectomy surgery are warranted.

PMID:36125849 | DOI:10.2196/39617

Nurs Open. 2022 Sep 20. doi: 10.1002/nop2.1344. Online ahead of print.

ABSTRACT

AIM: This descriptive-analytical correlational study was carried out to examine moral awareness and its relationship with moral sensitivity among Iranian nursing students.

DESIGN: A descriptive-analytical correlational study.

METHODS: The present descriptive-analytical study was performed among 140 Iranian nursing students. The data collection tool was a three-part questionnaire including (1) Demographic Information Questionnaire, (2) Nurses’ Awareness about the Iranian Nursing Code of Ethics by Mohajjel Aghdam and (3) Moral Sensitivity Questionnaire (MSQ) by Kim Lutzen. The data collected from these questionnaires were analysed in SPSS-26 using descriptive and inferential statistics.

RESULTS: The mean moral awareness (29.42 ± 4.01) was good, and the mean moral sensitivity (135.05 ± 18.79) was moderate among the students. A significant positive correlation was observed between the total score of moral awareness and moral sensitivity (r = .22, p = .009) in the nursing students.

PMID:36125847 | DOI:10.1002/nop2.1344

J Med Internet Res. 2022 Sep 20;24(9):e37757. doi: 10.2196/37757.

ABSTRACT

BACKGROUND: Internet and social media platforms offer insights into the lived experiences of survivors of cancer and their caregivers; however, the volume of narrative data available is often cumbersome for thorough analysis. Survivors of gynecological cancer have unique needs, such as those related to a genetic predisposition to future cancers, impact of cancer on sexual health, the advanced stage at which many are diagnosed, and the influx of new therapeutic approaches.

OBJECTIVE: This study aimed to present a unique methodology to leverage large amounts of data from internet-based platforms for mixed methods analysis. We analyzed discussion board posts made by survivors of gynecological cancer on the American Cancer Society website with a particular interest in evaluating the psychosocial aspects of survivorship.

METHODS: All posts from the ovarian, uterine, and gynecological cancers (other than ovarian and uterine) discussion boards on the American Cancer Society Cancer Survivors Network were included. Posts were web scraped using Python and organized by psychosocial themes described in the Quality of Cancer Survivorship Care Framework. Keywords related to each theme were generated and verified. Keywords identified posts related to the predetermined psychosocial themes. Quantitative analysis was completed using Python and R Foundation for Statistical Computing packages. Qualitative analysis was completed on a subset of posts as a proof of concept. Themes discovered through latent Dirichlet allocation (LDA), an unsupervised topic modeling technique, were assessed and compared with the predetermined themes of interest.

RESULTS: A total of 125,498 posts made by 6436 survivors of gynecological cancer and caregivers between July 2000 and February 2020 were evaluated. Of the 125,489 posts, 23,458 (18.69%) were related to the psychosocial experience of cancer and were included in the mixed methods psychosocial analysis. Quantitative analysis (23,458 posts) revealed that survivors across all gynecological cancer discussion boards most frequently discussed the role of friends and family in care, as well as fatigue, the effect of cancer on interpersonal relationships, and health insurance status. Words related to psychosocial aspects of survivorship most often used in posts included “family,” “hope,” and “help.” Qualitative analysis (20 of the 23,458 posts) similarly demonstrated that survivors frequently discussed coping strategies, distress and worry, the role of family and caregivers in their cancer care, and the toll of managing financial and insurance concerns. Using LDA, we discovered 8 themes, none of which were directly related to psychosocial aspects of survivorship. Of the 56 keywords identified by LDA, 2 (4%), “sleep” and “work,” were included in the keyword list that we independently devised.

CONCLUSIONS: Web-based discussion platforms offer a great opportunity to learn about patient experiences of survivorship. Our novel methodology expedites the quantitative and qualitative analyses of such robust data, which may be used for additional patient populations.

PMID:36125848 | DOI:10.2196/37757

Curr Rheumatol Rev. 2022 Sep 20. doi: 10.2174/1573397118666220920104900. Online ahead of print.

ABSTRACT

BACKGROUND: Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by joint inflammation and destruction.

OBJECTIVE: Establish the association between Porphyromonas gingivalis (P. gingivalis) infection, body mass index (BMI), joint involvement, and serum adipokines in first-degree relatives (FDR) of patients with rheumatoid arthritis (RA).

METHODS: The cross-sectional study evaluated 124 FDR and 124 healthy controls (HC). The clinical examination included joint and radiographic evaluation and calculation of BMI. Serum adipokine levels were measured (leptin, vaspin, adiponectin, resistin, and adipsin), as were the erythrocyte sedimentation rate, C-reactive protein, and anti-citrullinated protein antibodies. Investigations were performed to detect P. gingivalis, and anti-P. gingivalis antibodies. Statistical analyses were performed to confirm associations.

RESULTS: Leptin levels in FDR were associated with BMI >25 (OR, 2.64; 95%CI, 1.17-5.97; P=0.019), radiographic damage (Simple Erosion Narrowing Score [SENS])/hands, total SENS, and joint space narrowing in feet (P=0.037, 0.026, 0.020, respectively). FDR had more tender joints (P=0.018); this finding was associated with high levels of leptin and resistin and low levels of adipsin (P=0.040, 0.040, and 0.019, respectively). The presence of P. gingivalis was related to FDR, low levels of adipsin, resistin, adiponectin, and a trend toward higher levels of leptin (P=0.002, 0.001, 0.003, and 0.060, respectively), whereas anti-P. gingivalis antibodies were related to low levels of adipsin (P=0.001).

CONCLUSION: In FDR, serum adipokine levels were associated with overweight, presence of P. gingivalis. Adipokine levels were also associated with joint involvement. Hence, adipokines may be involved in the pathogenesis of RA in FDR and warrant further investigation.

PMID:36125832 | DOI:10.2174/1573397118666220920104900

Curr Rheumatol Rev. 2022 Aug 21. doi: 10.2174/1573397118666220821143041. Online ahead of print.

ABSTRACT

OBJECTIVE: Low Back Pain (LBP) is the most common musculoskeletal disorder, particularly among working adults It is one of the most prevalent complaints among students. Medical students, are among those who are most exposed to this condition; due to stress, numerous hours of studying , and the sedentary lifestyle. The aim of our study was to determine the prevalence and the associated factors of LBP among the students of Tunis Faculty of Medicine and to assess its impact on student life. Methods This was a cross-sectional study carried out on the students of Tunis Faculty of Medicine. Data were collected through an online self-administered questionnaire. Sociodemographic, personal, and lifestyle characteristics were collected. LBP was assessed using the Nordic Musculoskeletal Health Questionnaire and Its impact using the Oswestry Disability Index (ODI).

RESULTS: One hundred and forty-eight students were included. The mean age was 22.9 ± 2.3 years [19.64-38.21]. The sex ratio was 0.29. According to the Nordic questionnaire, the point, annual and lifetime prevalence of LBP were 37.8%, 80.4%, and 90.5% respectively. The mean ODI score was 10.32± 8.48 % [0-32]. The ODI score was minimal in 87.3% and moderate in 12.7% of cases. The associated factors with LBP were: young age (p = 0.015), spending more than 4 hours in a sitting position (p = 0.059), second cycle of medical studies (p= 0.006), low screen projection in the amphitheater (p= 0.029) and poor layout of the amphitheatres (p= 0.000). The feeling of depression was significantly higher among LBP students (p= 0.018). In the multivariate analysis, the factors that remained statistically significant were the second cycle of medical studies (OR= 3.41), feeling of depression (OR = 3.7) and the belief in the responsibility of the poor layout of the amphitheaters in the genesis or maintenance of LBP (OR = 7.66).

CONCLUSION: LBP in medical students is multifactorial across both personal and college-life domains.

PMID:36125829 | DOI:10.2174/1573397118666220821143041

Endocr Metab Immune Disord Drug Targets. 2022 Aug 23. doi: 10.2174/1871530322666220823155956. Online ahead of print.

ABSTRACT

AIMS: The pandemic of coronavirus disease 2019 (COVID-19), has emerged as a dire health problem, causing a massive crisis for global health.

BACKGROUND: Most commonly reported clinical manifestations are fever, fatigue and dry cough. Interestingly, a small percentage of patients experience GI symptoms with the most common being anorexia, diarrhea, nausea and vomiting. We aimed to investigate a comparable study of COVID-19 patients with or without gastrointestinal patients (GI).

METHODS: Collective data of clinical manifestations and laboratory reports of patients admitted in Razi Hospital, Ahvaz, Khuzestan, Iran, during two weeks were analyzed.

RESULTS: Our results showed that GI symptoms are not statistically significant criteria to be predictive or prognostic factors in the COVID-19 patients despite they are probably related to acute or non-acute phase of the disease. Moreover, non-specific GI symptoms seem to be as a result of cytokine storm occurred during the disease.

CONCLUSION: Therefore, our results did not support GI tract involvement as a common route of COVID-19 infection. Maybe future research will shed light on why and how the gastrointestinal system became infected by COVID-19.

PMID:36125828 | DOI:10.2174/1871530322666220823155956

JAMA Netw Open. 2022 Sep 1;5(9):e2232556. doi: 10.1001/jamanetworkopen.2022.32556.

ABSTRACT

IMPORTANCE: Environmental disasters, such as the Flint, Michigan, water crisis, are potentially traumatic events (PTEs) that may precipitate long-term psychiatric disorders. The water crisis was associated with acute elevations in mental health problems in the Flint community, but long-term psychiatric sequelae have not yet been evaluated using standardized diagnostic measures.

OBJECTIVE: To investigate the prevalence of and factors associated with current presumptive diagnostic-level major depression and posttraumatic stress disorder (PTSD) among Flint residents 5 years after the onset of the crisis.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a household probability sample of 1970 adults living in Flint, Michigan, during the crisis were surveyed about their crisis experiences, their psychological symptoms 5 years later, and their access to and use of mental health services in the intervening years. Analyses were weighted to produce population-representative estimates.

MAIN OUTCOMES AND MEASURES: Presumptive Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) diagnostic-level past-year major depression and PTSD.

RESULTS: Among 1970 respondents, 1061 of 1946 reporting sex (54.5%) were women; 1043 of 1951 reporting race (53.5%) were Black or African American and 829 (42.5%) were White; and 1895 of 1946 reporting ethnicity (97.4%) were non-Hispanic. Overall, 435 (22.1%) met DSM-5 criteria for presumptive past-year depression, 480 (24.4%) for presumptive past-year PTSD, and 276 (14.0%) for both disorders. Residents who believed that their or their family’s health was harmed by contaminated water (eg, risk ratio [RR] for depression: 2.23; 95% CI, 1.80-2.76), who had low confidence in public-official information (eg, RR for PTSD, 1.44; 95% CI, 1.16-1.78), who had previous exposure to PTEs (eg, RR for both disorders: 5.06; 95% CI, 2.99-8.58), or who reported low social support (eg, RR for PTSD, 2.58; 95% CI, 1.94-3.43) had significantly higher risk for depression, PTSD, and comorbidity. PTEs involving prior physical or sexual assault were especially potent risk factors (eg, both disorders: RR, 7.30; 95% CI, 4.30-12.42). Only 685 respondents (34.8%) were ever offered mental health services to assist with water-crisis-related psychiatric symptoms; most (543 [79.3%]) who were offered services utilized them.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of psychiatric disorder in Flint, Michigan, presumptive depression and PTSD were highly prevalent 5 years after the onset of the water crisis. These findings suggest that public-works environmental disasters have large-scale, long-term psychological sequelae. The Flint community may require expanded mental health services to meet continued psychiatric need. National disaster preparedness and response programs should consider psychiatric outcomes.

PMID:36125808 | DOI:10.1001/jamanetworkopen.2022.32556

Dermatitis. 2022 Sep 21. doi: 10.1097/DER.0000000000000943. Online ahead of print.

ABSTRACT

BACKGROUND: Allergic contact dermatitis (ACD) remains a public health issue worldwide, despite regulations intended to minimize sensitization. With up-to-date knowledge about which chemicals continue to have high allergenicity, the government/industry can refocus their efforts to be most effective.

OBJECTIVE: We reviewed updated data showing common allergens that elicit ACD to determine the progress in reducing sensitization to inform public health policy, government regulation, and industry standards.

METHODS: We compiled data from the North American Contact Dermatitis Group showing patch test results from 1984 to 2016 for 153 compounds. Using these data, we analyzed the trends over time of positive test reactions to determine whether they are increasing or decreasing.

RESULTS: Of the 47 compounds with sufficient data to analyze, 23 had a decreasing proportion of positive patch test results over the whole period. An additional 5 had a decreasing proportion over a shorter period. Finally, 4 had an increasing proportion over any period: compositae mix, methylchloroisothiazolinone/methylisothiazolinone, nickel sulfate, and thimerosal mix.

CONCLUSIONS: The data strongly indicate decreasing and increasing frequency trends and challenge us to seek explanations, which are not yet clear. It is hoped that these data can be valuable in informing public health policy, government, and industry.

PMID:36125806 | DOI:10.1097/DER.0000000000000943