Category: Statistics

JAMA Netw Open. 2023 Aug 1;6(8):e2326905. doi: 10.1001/jamanetworkopen.2023.26905.

ABSTRACT

IMPORTANCE: Practice-level evidence is needed to clarify the value of population-based clinical decision support (CDS) tools in reducing racial and sex disparities in cardiovascular care.

OBJECTIVE: To evaluate the association between CDS tools and racial and sex disparities in the aspirin use, blood pressure control, cholesterol management, and smoking cessation (ABCS) care quality metrics among smaller primary care practices.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used practice-level data from the Agency for Healthcare Research and Quality-funded EvidenceNOW initiative. The national initiative from May 1, 2015, to April 30, 2021, spanned 12 US states and focused on improving cardiovascular preventive care by providing quality improvement support to smaller primary care practices. A total of 576 primary care practices in EvidenceNOW submitted both survey data and electronic health record (EHR)-derived ABCS data stratified by race and sex.

MAIN OUTCOMES AND MEASURES: Practice-level estimates of disparities between Black and White patients and between male and female patients were calculated as the difference in proportions of eligible patients within each practice meeting ABCS care quality metrics. The association between CDS tools (EHR prompts, standing orders, and clinical registries) and disparities was evaluated by multiply imputed multivariable models for each CDS tool, adjusted for practice rurality, ownership, and size.

RESULTS: Across the 576 practices included in the analysis, 219 (38.0%) had patient panels that were more than half White and 327 (56.8%) had panels that were more than half women. The proportion of White compared with Black patients meeting metrics for blood pressure (difference, 5.16% [95% CI, 4.29%-6.02%]; P < .001) and cholesterol management (difference, 1.49% [95% CI, 0.04%-2.93%] P = .04) was higher; the proportion of men meeting metrics for aspirin use (difference, 4.36% [95% CI, 3.34%-5.38%]; P < .001) and cholesterol management (difference, 3.88% [95% CI, 3.14%-4.63%]; P < .001) was higher compared with women. Conversely, the proportion of women meeting practice blood pressure control (difference, -1.80% [95% CI, -2.32% to -1.28%]; P < .001) and smoking cessation counseling (difference, -1.67% [95% CI, -2.38% to -0.95%]; P < .001) metrics was higher compared with men. Use of CDS tools was not associated with differences in race or sex disparities except for the smoking metric. Practices using CDS tools showed a higher proportion of men meeting the smoking counseling metric than women (coefficient, 3.82 [95% CI, 0.95-6.68]; P = .009).

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study suggest that practices using CDS tools had small disparities that were not statistically significant, but CDS tools were not associated with reductions in disparities. More research is needed on effective practice-level interventions to mitigate disparities.

PMID:37531106 | DOI:10.1001/jamanetworkopen.2023.26905

JAMA Netw Open. 2023 Aug 1;6(8):e2326910. doi: 10.1001/jamanetworkopen.2023.26910.

ABSTRACT

IMPORTANCE: The use of potentially inappropriate medications (PIMs) is widespread yet continues to receive little attention in outpatient services.

OBJECTIVE: To estimate the overall prevalence of PIM use in outpatient services.

DATA SOURCES: PubMed, Embase, and Web of Science were searched to identify relevant studies published from January 1, 1990, to November 21, 2022.

STUDY SELECTION: Observational studies that reported the prevalence of PIM use among older patients in outpatient services were screened.

DATA EXTRACTION AND SYNTHESIS: Two reviewers independently selected eligible articles, extracted data, and assessed the risk of bias. A random-effects meta-analysis was conducted to pool the prevalence estimates.

MAIN OUTCOMES AND MEASURES: The global patterns in the prevalence of PIM use among older patients in outpatient services were estimated, and the temporal trends and regional differences in PIM use were investigated.

RESULTS: A total of 94 articles with 132 prevalence estimates were analyzed, including nearly 371.2 million older participants from 17 countries. Overall, the pooled prevalence of PIM use was 36.7% (95% CI, 33.4%-40.0%). Africa had the highest prevalence of PIM use (47.0%; 95% CI, 34.7%-59.4%), followed by South America (46.9%; 95% CI, 35.1%-58.9%), Asia (37.2%; 95% CI, 32.4%-42.2%), Europe (35.0%; 95% CI, 28.5%-41.8%), North America (29.0%; 95% CI, 22.1%-36.3%), and Oceania (23.6%; 95% CI, 18.8%-28.8%). In addition, the prevalence of PIM use is highest in low-income areas. Use of PIMs among older patients has become increasingly prevalent in the past 2 decades.

CONCLUSIONS AND RELEVANCE: This study of patterns of PIM use by different groups, such as geographic regions and World Bank countries, suggests noticeable geographic environment and economic income differences in the burden of PIMs in outpatient services. Furthermore, the high prevalence trend in the past 2 decades indicates that the global burden of PIM use continues to be worthy of attention.

PMID:37531105 | DOI:10.1001/jamanetworkopen.2023.26910

J Pediatr Endocrinol Metab. 2023 Aug 3. doi: 10.1515/jpem-2023-0084. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of our study was the longitudinal assessment of bone health index (BHI) in short-statured children during growth hormone (GH) treatment to estimate changes in their bone health.

METHODS: 256 short-statured children (isolated GH deficiency (IGHD) n=121, multiple pituitary hormone deficiency (MPHD) n=49, intrauterine growth retardation (small for gestational age (SGA)) n=52, SHOX (short stature homeobox gene) deficiency n=9, Ullrich Turner syndrome (UTS) n=25) who started with GH between 2010 and 2018 were included. Annual bone ages (Greulich and Pyle, GP) and BHI were, retrospectively, analysed in consecutive radiographs of the left hand (BoneXpert software) from GH therapy start (T0) up to 10 years (T10) thereafter, with T max indicating the individual time point of the last available radiograph. The results are presented as the median (25 %/75 % interquartile ranges, IQR) and statistical analyses were performed using non-parametric tests as appropriate.

RESULTS: The BHI standard deviation scores (SDS) were reduced (-0.97, -1.8/-0.3) as bone ages were retarded (-1.6 years, -2.31/-0.97) in all patients before start of GH and were significantly lower in patients with growth hormone deficiency (GHD) (-1.04, -1.85/-0.56; n=170) compared to non-GHD patients (-0.79, -1.56/-0.01; n=86; p=0.022). BHI SDS increased to -0.17 (-1/0.58) after 1 year of GH (T1, 0.5-1.49, p<0.001) and to -0.20 (-1/-0.50, p<0.001) after 5.3 years (T max, 3.45/7.25).

CONCLUSIONS: BHI SDS are reduced in treatment-naive short-statured children regardless of their GH status, increase initially with GH treatment while plateauing thereafter, suggesting sustained improved bone health.

PMID:37531076 | DOI:10.1515/jpem-2023-0084

Environ Sci Pollut Res Int. 2023 Aug 2. doi: 10.1007/s11356-023-28523-8. Online ahead of print.

ABSTRACT

The goal is for governments and executives to make environmental protection and the preservation of natural resources a priority. The current research examines how green human resource management practices have altered environmental performance in China’s manufacturing sector. The survey used a trustworthy and valid questionnaire adapted from the literature to obtain the data. Random sampling method has been applied to collect data from manufacturers in China’s Guangdong Province. Workers in China’s industrial sector are the focus of this study, and each individual is treated as a separate unit of analysis. Three hundred of the 500 questionnaires were returned with sufficient data for statistical analysis. The predicted serial mediation model was analyzed using structural equation modeling (SEM) and the PROCESS model 4. The findings revealed that green HRM practices have a major impact on environmental performance and pro-environmental actions partially mediate the relationship between GHRM and environmental performance. In addition, higher education helped moderate the effect of green HRM on environmental outcomes. In terms of environmental performance, green recruitment, green selection, and green performance, green rewards via higher education has the greatest impact (p 0.01 significance level). Through an extension of the ability-motivation-opportunity theory, this study offers useful tips for policymakers, new and current organizations, and, in particular, manufacturing enterprises, on how to implement an incentive plan to promote environmentally friendly activities and product development, which in turn will increase customer loyalty.

PMID:37531058 | DOI:10.1007/s11356-023-28523-8

Environ Sci Pollut Res Int. 2023 Aug 2. doi: 10.1007/s11356-023-28934-7. Online ahead of print.

ABSTRACT

Recently, several urban areas are trying to mitigate the environmental impacts of traffic, where noise pollution is one of the main consequences. Thus, studying the determinants of traffic-related noise generation and developing a model that predicts the level of noise by controlling the influencing factors are crucial for transportation planning purposes. This research aims at utilizing the response surface method (RSM) to develop a robust statistical prediction model of traffic-related noise levels and optimize different traffic characteristics’ ranges to reduce the expected noise levels. The results indicate that the rate of L_eq increase is higher at traffic flow values less than the 1204 veh/h. The interaction effect of flow-speed and flow-heavy vehicle percentage pairs shows that L_eq has peak values around 45.8 km/h and 28.71%, respectively, with almost symmetric value distribution about those center points. The main effects study indicates a direct effect of traffic flow, speed, density, and traffic composition on roadside noise levels. The prediction model has good representativeness of observed noise levels by predicted noise levels as the model has a high coefficient of determination (R² = 95.87% and R² adj = 92.26%) with a significance level of 0.0036. Then, the research presents a methodology to perform an optimization of the roadside noise level by defining traffic characteristics that can keep the noise level below 65 dB(A) or minimize noise level. Decision-makers could use the proposed method to control the roadside noise level.

PMID:37531052 | DOI:10.1007/s11356-023-28934-7

Environ Sci Pollut Res Int. 2023 Aug 2. doi: 10.1007/s11356-023-28935-6. Online ahead of print.

ABSTRACT

Biochemical oxygen demand (BOD) is one of the most important parameters used for water quality assessment. Alternative methods are essential for accurately prediction of this parameter because the traditional method in predicting the BOD is time-consuming and it is inaccurate due to inconstancies in microbial multiplicity. In this study, the applicability of four hybrid neuro-fuzzy (ANFIS) methods, ANFIS with genetic algorithm (GA), ANFIS with particle swarm optimization (PSO), ANFIS with sine cosine algorithm (SCA), and ANFIS with marine predators algorithm (MPA), was investigated in predicting BOD using distinct input combinations such as potential of hydrogen (pH), dissolved oxygen (DO), electrical conductivity (EC), water temperature (WT), suspended solids (SS), chemical oxygen demand (COD), total nitrogen (TN), and total phosphorus (T-P) acquired from two river stations, Gongreung and Gyeongan, South Korea. The applicability of multi-variate adaptive regression spline (MARS) in determination of the best input combination was examined. The ANFIS-MPA was found to be the best model with the lowest root mean square error and mean absolute error and the highest determination coefficient. It improved the root mean square error of ANFIS-PSO, ANFIS-GA, and ANFIS-SCA models by 13.8%, 12.1%, and 6.3% for Gongreung Station and by 33%, 25%, and 6.3% for Gyeongan Station in the test stage, respectively.

PMID:37531049 | DOI:10.1007/s11356-023-28935-6

Updates Surg. 2023 Aug 2. doi: 10.1007/s13304-023-01619-z. Online ahead of print.

ABSTRACT

Robot-assisted transaxillary thyroidectomy is widely performed in Asian countries, although it is still under discussion in the Western World. However, there have been few studies reporting on the learning curve of robot-assisted transaxillary thyroidectomy. We used the cumulative sum (CUSUM) analysis to assess the learning curve of gasless robot-assisted transaxillary thyroidectomy at a third-level institution in Europe. We included all consecutive patients operated by a single surgeon without previous experience of robotic surgery from February 2012 to January 2023. The primary endpoint of the study was the learning curve extracted from the median operative time using the CUSUM method for the quantitative assessment. Overall, 583 patients were enrolled. The median operative time for thyroid lobectomy and total thyroidectomy was 70 and 90 min, respectively. The CUSUM analysis showed that the learning curve for thyroid lobectomy and total thyroidectomy is 66 and 56 cases, respectively. Moreover, the presence of thyroiditis resulted associated with shorter operative time for total thyroidectomy (p = 0.044), whereas no factors resulted associated with surgical complications. The learning curve for performing robotic transaxillary thyroid lobectomy for a surgeon without previous robotic experience is 66 cases. After that, 56 cases must be performed to acquire proficiency in robotic transaxillary total thyroidectomy. Training programs may reduce the slope of the learning curve.

PMID:37531041 | DOI:10.1007/s13304-023-01619-z

Eur Arch Paediatr Dent. 2023 Aug 2. doi: 10.1007/s40368-023-00826-x. Online ahead of print.

ABSTRACT

PURPOSE: The aims of this study were to: (1) examine the psychometric properties of the Greek version of JSE-HP and (2) explore empathy among Greek dental postgraduate students.

METHODS: The JSE-HP scale was translated into Greek using the back translation method. The questionnaire was given to 111 dental postgraduate students between November 2017 and February 2018. A random sample of 25% was retested to assess test-retest reliability. The reliability of the Greek version of JSE-HP was measured with Cronbach’s alpha (α) and Discrimination Indices (DIs). Exploratory Factor Analysis, with varimax rotation of the factorial axes, was used to examine the dimensionality and the factorial validity of the Greek version of the JSE-HP. Comparisons between groups of postgraduate students were performed as appropriate with the Kruskal-Wallis or the Mann-Whitney U test.

RESULTS: The response rate was 100%. The mean age was 28.9 years. The reliability, in the sense of internal consistency of the questionnaire was considered satisfactory (Cronbach’s alpha: 0.76, average DI: 0.33.) The test-retest reliability was satisfactory (Pearson’s r = 0.77, p < 0.001). Factor Analysis revealed 7 significant factors. No statistically significant differences in empathy scores were found among groups of postgraduate students.

CONCLUSIONS: The Greek version of the JSE-HP shows good psychometric properties. Empathy scores do not differ among Greek dental postgraduate students.

PMID:37531023 | DOI:10.1007/s40368-023-00826-x

J Racial Ethn Health Disparities. 2023 Aug 2. doi: 10.1007/s40615-023-01698-z. Online ahead of print.

ABSTRACT

A complex interplay of social, economic, and environmental factors drove the COVID-19 epidemic. Understanding these factors is crucial in explaining the racial disparities observed in COVID-19 deaths. This research investigated various hypotheses, including ecological, racial, demographic, economic, and political party factors, to determine their impact on COVID-19 deaths. The study utilized data from the National Center for Health Statistics (NCHS), specifically focusing on COVID-19 deaths categorized by race and Hispanic origin in US counties, with over 100 recorded deaths as of July 11, 2022.

METHOD: To analyze the data, the study employed partial least squares (PLS) as the statistical approach, considering the presence of multicollinearity in the county-level socioeconomic data. SmartPLS4 software was utilized to illustrate paths depicting variance and covariance and to conduct significance tests. The analysis encompassed overall COVID-19 deaths and deaths among White, Black, and Hispanic Americans, utilizing the same latent variables and paths.

RESULTS: The results revealed that the number of residents aged 65 years or older in a county was the most influential predictor of COVID-19 deaths, irrespective of race. Economic factors emerged as the second strongest predictors. However, when considering each racial group separately, distinct factors aligned with the five hypotheses emerged as significant contributors to COVID-19 deaths. Furthermore, the diagrams illustrating the relationships between these factors (covariates) varied among racial groups, indicating that the underlying social influences differed across races.

DISCUSSION: In light of these findings, it becomes evident that a “one-size-fits-all” approach to prevention strategies is suboptimal. Instead, targeted prevention efforts tailored to specific racial and social classes at high risk of COVID-19 death could have provided more precise messaging and necessitate direct engagement.

PMID:37531017 | DOI:10.1007/s40615-023-01698-z

Ultrasound J. 2023 Aug 2;15(1):33. doi: 10.1186/s13089-023-00331-8.

ABSTRACT

BACKGROUND: Measurement of the optic nerve sheath diameter (ONSD) via ultrasonography has been proposed as a non-invasive metric of intracranial pressure that may be employed during in-field patient triage. However, first responders are not typically trained to conduct sonographic exams and/or do not have access to an expensive ultrasound device. Therefore, for successful deployment of ONSD measurement in-field, we believe that first responders must have access to low-cost, portable ultrasound and be assisted by artificial intelligence (AI) systems that can automatically interpret the optic nerve sheath ultrasound scan. We examine the suitability of five commercially available, low-cost, portable ultrasound devices that can be combined with future artificial intelligence algorithms to reduce the training required for and cost of in-field optic nerve sheath diameter measurement. This paper is focused on the quality of the images generated by these low-cost probes. We report results of a clinician preference survey and compare with a lab analysis of three quantitative image quality metrics across devices. We also examine the suitability of the devices in a hypothetical far-forward deployment using operators unskilled in ultrasound, with the assumption of a future onboard AI video interpreter.

RESULTS: We find statistically significant differences in clinician ranking of the devices in the following categories: “Image Quality”, “Ease of Acquisition”, “Software”, and “Overall ONSD”. We show differences in signal-to-noise ratio, generalized contrast-to-noise ratio, point-spread function across the devices. These differences in image quality result in a statistically significant difference in manual ONSD measurement. Finally, we show that sufficiently wide transducers can capture the optic nerve sheath during blind (no visible B-mode) scans performed by operators unskilled in sonography.

CONCLUSIONS: Ultrasound of the optic nerve sheath has the potential to be a convenient, non-invasive, point-of-injury or triage measure for elevated intracranial pressure in cases of traumatic brain injury. When transducer width is sufficient, briefly trained operators may obtain video sequences of the optic nerve sheath without guidance. This data suggest that unskilled operators are able to achieve the images needed for AI interpretation. However, we also show that image quality differences between ultrasound probes may influence manual ONSD measurements.

PMID:37530991 | DOI:10.1186/s13089-023-00331-8