Category: Statistics

JMIR Res Protoc. 2023 Aug 15;12:e45917. doi: 10.2196/45917.

ABSTRACT

BACKGROUND: Intimate partner violence (IPV) disproportionately affects people in low-and middle-income countries (LMICs), such as Nepal. Women experiencing IPV are at higher risk of developing depression, anxiety, and posttraumatic stress disorder. The shortage of trained frontline health care providers, coupled with stigma related to IPV and mental health disorders, fuels low service uptake among women experiencing IPV. The Domestic Violence Intervention (DeVI) combines the Problem Management Plus counseling program developed by the World Health Organization with a violence prevention component.

OBJECTIVE: This study aims to implement and evaluate the feasibility, acceptability, and effectiveness of DeVI in addressing psychological distress and enabling the secondary prevention of violence for women experiencing IPV.

METHODS: A parallel cluster-randomized trial will be conducted across 8 districts in Madhesh Province in Nepal, involving 24 health care facilities. The study will include women aged 18-49 years who are either nonpregnant or in their first trimester, have experienced IPV within the past 12 months, have a 12-item General Health Questionnaire (GHQ-12) score of 3 or more (indicating current mental health issues), and have lived with their husbands or in-laws for at least 6 months. A total sample size of 912 was estimated at 80% power and α<.05 statistical significance level to detect a 15% absolute risk reduction in the IPV frequency and a 50% reduction in the GHQ-12 score in the intervention arm. The health care facilities will be randomly assigned to either the intervention or the control arm in a 1:1 ratio. Women visiting the health care facilities in the intervention and control arms will be recruited into the respective arms. In total, 38 participants from each health care facility will be included in the trial to meet the desired sample size. Eligible participants allocated to either arm will be assessed at baseline and follow-up visits after 6, 17, and 52 weeks after baseline.

RESULTS: This study received funding in 2019. As of December 29, 2022, over 50% of eligible women had been recruited from both intervention and control sites. In total, 269 eligible women have been enrolled in the intervention arm and 309 eligible women in the control arm. The trial is currently in the recruitment phase. Data collection is expected to be completed by December 2023, after which data analysis will begin.

CONCLUSIONS: If the intervention proves effective, it will provide evidence of how nonspecialist mental health care providers can address the harmful effects of IPV in resource-constrained settings with a high burden of IPV, such as Nepal. The study findings could also contribute evidence for integrating similar services into routine health programs in LMICs to prevent IPV and manage mental health problems among women experiencing IPV.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05426863; https://clinicaltrials.gov/ct2/show/NCT05426863.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45917.

PMID:37581909 | DOI:10.2196/45917

Curr Environ Health Rep. 2023 Aug 15. doi: 10.1007/s40572-023-00406-7. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: The volume of public health environmental justice (EJ) research produced by academic institutions increased through 2022. However, the methods used for evaluating EJ in exposure science and epidemiologic studies have not been catalogued. Here, we completed a scoping review of EJ studies published in 19 environmental science and epidemiologic journals from 2018 to 2021 to summarize research types, frameworks, and methods.

RECENT FINDINGS: We identified 402 articles that included populations with health disparities as a part of EJ research question and met other inclusion criteria. Most studies (60%) evaluated EJ questions related to socioeconomic status (SES) or race/ethnicity. EJ studies took place in 69 countries, led by the US (n = 246 [61%]). Only 50% of studies explicitly described a theoretical EJ framework in the background, methods, or discussion and just 10% explicitly stated a framework in all three sections. Among exposure studies, the most common area-level exposure was air pollution (40%), whereas chemicals predominated personal exposure studies (35%). Overall, the most common method used for exposure-only EJ analyses was main effect regression modeling (50%); for epidemiologic studies the most common method was effect modification (58%), where an analysis evaluated a health disparity variable as an effect modifier. Based on the results of this scoping review, current methods in public health EJ studies could be bolstered by integrating expertise from other fields (e.g., sociology), conducting community-based participatory research and intervention studies, and using more rigorous, theory-based, and solution-oriented statistical research methods.

PMID:37581863 | DOI:10.1007/s40572-023-00406-7

Adv Health Sci Educ Theory Pract. 2023 Aug 15. doi: 10.1007/s10459-023-10273-4. Online ahead of print.

ABSTRACT

The maldistribution of family physicians challenges equitable primary care access in Canada. The Theory of Social Attachment suggests that preferential selection and distributed training interventions have potential in influencing physician disposition. However, evaluations of these approaches have focused predominantly on rural underservedness, with little research considering physician disposition in other underserved communities. Accordingly, this study investigated the association between the locations from which medical graduates apply to medical school, their undergraduate preclerkship, clerkship, residency experiences, and practice as indexed across an array of markers of underservedness. We built association models concerning the practice location of 347 family physicians who graduated from McMaster University’s MD Program between 2010 and 2015. Postal code data of medical graduates’ residence during secondary school, pre-clerkship, clerkship, residency and eventual practice locations were coded according to five Statistics Canada indices related to primary care underservedness: relative rurality, employment rate, proportion of visible minorities, proportion of Indigenous peoples, and neighbourhood socioeconomic status. Univariate and multivariable logistic regression models were then developed for each dependent variable (i.e., practice location expressed in terms of each index). Residency training locations were significantly associated with practice locations across all indices. The place of secondary school education also yielded significant relationships to practice location when indexed by employment rate and relative rurality. Education interventions that leverage residency training locations may be particularly influential in promoting family physician practice location. The findings are interpreted with respect to how investment in education policies can promote physician practice in underserved communities.

PMID:37581856 | DOI:10.1007/s10459-023-10273-4

Neuroinformatics. 2023 Aug 15. doi: 10.1007/s12021-023-09639-1. Online ahead of print.

ABSTRACT

Resting-state functional magnetic resonance imaging (rs-fMRI) is a non-invasive imaging technique widely used in neuroscience to understand the functional connectivity of the human brain. While rs-fMRI multi-site data can help to understand the inner working of the brain, the data acquisition and processing of this data has many challenges. One of the challenges is the variability of the data associated with different acquisitions sites, and different MRI machines vendors. Other factors such as population heterogeneity among different sites, with variables such as age and gender of the subjects, must also be considered. Given that most of the machine-learning models are developed using these rs-fMRI multi-site data sets, the intrinsic confounding effects can adversely affect the generalizability and reliability of these computational methods, as well as the imposition of upper limits on the classification scores. This work aims to identify the phenotypic and imaging variables producing the confounding effects, as well as to control these effects. Our goal is to maximize the classification scores obtained from the machine learning analysis of the Autism Brain Imaging Data Exchange (ABIDE) rs-fMRI multi-site data. To achieve this goal, we propose novel methods of stratification to produce homogeneous sub-samples of the 17 ABIDE sites, as well as the generation of new features from the static functional connectivity values, using multiple linear regression models, ComBat harmonization models, and normalization methods. The main results obtained with our statistical models and methods are an accuracy of 76.4%, sensitivity of 82.9%, and specificity of 77.0%, which are 8.8%, 20.5%, and 7.5% above the baseline classification scores obtained from the machine learning analysis of the static functional connectivity computed from the ABIDE rs-fMRI multi-site data.

PMID:37581850 | DOI:10.1007/s12021-023-09639-1

J Neurovirol. 2023 Aug 15. doi: 10.1007/s13365-023-01165-9. Online ahead of print.

ABSTRACT

Encephalitis is a central nervous system disorder, often caused by infectious agents or aberrant immune responses. We investigated causes, comorbidities, costs, and outcomes of encephalitis in a population-based cohort. ICD-10 codes corresponding to encephalitis were used to identify health services records for all adults from 2004 to 2019. Data were cross-validated for identified diagnoses based on laboratory confirmation using univariate and multivariate statistical analyses. We identified persons with a diagnosis of encephalitis and abnormal cerebrospinal fluid (CSF) results (n = 581) in whom viral genome was detected (n = 315) in a population of 3.2 million adults from 2004 to 2019. Viral genome-positive CSF samples included HSV-1 (n = 133), VZV (n = 116), HSV-2 (n = 34), enterovirus (n = 4), EBV (n = 5), and CMV (n = 3) with the remaining viruses included JCV (n = 12) and HHV-6 (n = 1). The mean Charlson Comorbidity Index (2.0) and mortality rate (37.6%) were significantly higher in the CSF viral genome-negative encephalitis group although the mean costs of care were significantly higher for the CSF viral genome-positive group. Cumulative incidence rates showed increased CSF VZV detection in persons with encephalitis, which predominated in persons over 65 years with a higher mean Charlson index. We detected HSV-2 and VZV more frequently in CSF from encephalitis cases with greater material-social deprivation. The mean costs of care were significantly greater for HSV-1 encephalitis group. Encephalitis remains an important cause of neurological disability and death with a viral etiology in 54.2% of affected adults accompanied by substantial costs of care and mortality. Virus-associated encephalitis is evolving with increased VZV detection, especially in older persons.

PMID:37581843 | DOI:10.1007/s13365-023-01165-9

Adv Exp Med Biol. 2023;1425:619-628. doi: 10.1007/978-3-031-31986-0_60.

ABSTRACT

OBJECTIVE: Aphasia is a serious consequence of stroke resulting in difficulties in using language for communication with negative effects on patients’ quality of life. The use of non-invasive repetitive transcranial magnetic stimulation (rTMS) is a novel approach in aphasia therapy, based on the knowledge gained by functional imaging technics of the brain.

AIM: This review evaluates the effectiveness of rTMS on aphasia therapy according to the results of English language studies that have been published in the databases PubMed/Medline, Scopus, and Web of Science from 2011 to 2021.

RESULTS: Twenty-seven studies were included in the review with 672 participants. The studies mainly concern the application of inhibitory rTMS on the right inferior frontal gyrus (rIFG) in the subacute and chronic phase, as well as excitatory rTMS of the unaffected language areas of the left cerebral hemisphere in the chronic phase after stroke. Most of the studies concluded that there was statistically significant improvement in various parameters of language including confrontation naming, repetition, and aphasia quotient. Three studies published results that doubt the effectiveness of rTMS.

CONCLUSION: rTMS is a safe therapeutic method for aphasia treatment in the subacute and chronic phases after stroke. Its effectiveness is immediate as well as distant with a gradually decreasing therapeutic effect. Moreover, rTMS may supplement speech and language therapy as a priming factor. The most recognized method at this point in time is the application of suppressive rTMS on the right inferior frontal gyrus in combination with speech and language therapy.

PMID:37581835 | DOI:10.1007/978-3-031-31986-0_60

Adv Exp Med Biol. 2023;1425:535-543. doi: 10.1007/978-3-031-31986-0_52.

ABSTRACT

INTRODUCTION: The social isolation (lockdown) used worldwide as a measure to effectively prevent the infection of COVID-19 has been shown to be responsible for the high prevalence of depression, anxiety, insomnia, and post-traumatic stress symptoms. The aim of this study was to investigate the physical activity habits and sleep disorders in the nursing staff.

METHODOLOGY: This is a multicenter cross-sectional correlational study. The study population consisted of nurses and nursing assistants. Data were collected using the Greek version of the Pittsburgh Sleep Quality Index, the Fear of the COVID-19, and the Physical exercise questionnaire of the American College of Sports Medicine. Statistical analysis of data was done with IBM SPSS v. 22.0.

RESULTS: A total of 1710 nursing personnel aged 42.3 ± 9.1 years were included. At the beginning of the COVID-19 pandemic, 190 (11.1%) participants were physically active, and 2 years after the beginning of the COVID-19 pandemic, active were 130 (7.6%) participants. Both at the beginning and two years after the beginning of the pandemic, the sleep dimensions that scored higher were subjective sleep quality (1.98 ± 0.2 vs. 1.98 ± 0.3), sleep onset latency (1.89 ± 1.5 vs. 1.64 ± 1.6), and sleep duration (1.55 ± 0.9 vs. 1.65 ± 0.8). The total sleep score was 8.64 ± 3.1 at the beginning of the pandemic and 8.11 ± 3.7 two years after the beginning of the pandemic.

CONCLUSIONS: Nurses and nurses’ assistants had less physical activity habits, slept less, and had more sleep disorders 2 years after the beginning of the pandemic in relation to the beginning of the pandemic.

PMID:37581827 | DOI:10.1007/978-3-031-31986-0_52

Adv Exp Med Biol. 2023;1425:491-500. doi: 10.1007/978-3-031-31986-0_48.

ABSTRACT

The present study aimed to determine gender differences in the hand grip strength (HGS) and to examine the relations between HGS, anthropometric characteristics, and physical activity (PA) in Greek young adults. A cross-sectional observational study of 276 students (21.5 ± 4.1 years, 122 men, 154 women) was conducted at the University of Patras, Greece. HGS was assessed via a hand-held grip strength dynamometer; body composition was determined by bioelectrical impedance analysis; and calf, mid-arm, and waist circumferences with inelastic tape. PA was assessed with the modified Baecke Questionnaire for Habitual Physical Activity (mBQHPA). The mean of HGS was 37.15 ± 11.2 kg. Men had significantly (p < 0.001) greater HGS than women. Statistically large correlation was detected between HGS and muscle mass (r = 0.73; p ≤ 0.001), gender (r = 0.6; p ≤ 0.001), mid-arm (r = 0.74; p ≤ 0.001), and calf circumference (r = 0.69; p ≤ 0.001). Results show that fat mass was a risk factor associated with HGS, found using regression analyses in both genders. However, PA was a significant associated factor only for women participants (ΟR = 0.77; 95% confidence interval [CI]: 0.17-1.38; p ≤ 0.05). In summary, the HGS of Greek physiotherapy students was associated with muscle mass, gender, mid-arm, and calf circumference.

PMID:37581823 | DOI:10.1007/978-3-031-31986-0_48

Adv Exp Med Biol. 2023;1425:429-435. doi: 10.1007/978-3-031-31986-0_41.

ABSTRACT

INTRODUCTION: Chronic diseases represent a huge challenge for the health systems globally due to the rapidly increasing number of patients and their long-term need for healthcare. The purpose of this study was to investigate the needs of patients suffering from chronic diseases.

METHODOLOGY: This is a cross-sectional study. The study population consisted of 840 adults with chronic diseases. The data collection was done with an improvised needs survey questionnaire, which included 56 questions. Statistical analyses were performed using IBM SPSS Statistics for Windows, v.25.0, statistical significance being considered at p < 0.05.

RESULTS: The main diseases of the patients were chronic renal failure (22.6%), multiple sclerosis (19%), cancer (19%), diabetes mellitus (7.1%), dementia (6%), and chronic obstructive pulmonary disease (6%). The majority of patients (82.1%) were sick for more than 24 months. Patients seek information from health professionals (4.07 ± 1.4), feel tired (4.05 ± 1.4), have to share their feelings with other family members (4.01 ± 1.4), feel anxious about the future (3.94 ± 1.3), and feel out of control (3.80 ± 1.5).

CONCLUSIONS: Patients with chronic diseases suffer from numerous physical, mental, emotional, and cognitive problems. Paying attention to the unmet needs of patients could have beneficial effects on both patients and their caregivers.

PMID:37581816 | DOI:10.1007/978-3-031-31986-0_41

Adv Exp Med Biol. 2023;1425:401-415. doi: 10.1007/978-3-031-31986-0_39.

ABSTRACT

INTRODUCTION: Medical cannabis has been used to relieve the symptoms of people with various chronic diseases. Despite of this, it has been stigmatized, even after its legalization in many countries.

AIM: The purpose of this study was to investigate the quality of life of patients receiving medical cannabis.

MATERIAL AND METHOD: One hundred patients receiving medical cannabis were given (a) a socio-demographic and clinical questionnaire, and (b) the SF-36 Health Survey scale for assessing quality of life.

RESULTS: The majority of our patients who received medical cannabis to treat their neurological disorders (58%) reported decrease in their symptoms (96%), better energy and vitality (68%), ability to perform their professional duties (88%), and an improvement in sleeping and appetite (79% and 71%, respectively) after receiving medical cannabis. Our participants exhibited very few restrictions in activities due to emotional difficulties, a moderate general health status as well as moderate vitality and energy. Participants, who reported a longer period of receiving medical cannabis, reported statistically significant more energy and vitality (p = 0.000), but also better mental (p = 0.000) and general health status (p = 0.001). Furthermore, the majority of patients have disclosed medical cannabis use to their family members (85%) and enjoyed their support (93%), but they haven’t revealed their medication treatment to their social environment (81%).

CONCLUSIONS: Appropriate knowledge could significantly help health professionals in the field of planning and implementation of personalized nursing care in order to achieve optimal therapeutic outcomes.

PMID:37581814 | DOI:10.1007/978-3-031-31986-0_39