Category: Statistics

J Environ Manage. 2023 Aug 1;339:117856. doi: 10.1016/j.jenvman.2023.117856. Epub 2023 Apr 5.

ABSTRACT

With increasing human impacts on the ecosystem in natural protected areas, there is an urgent need to undertake an assessment of ecological carrying capacity taken as a benchmark for assessing regional sustainability. Based on satellite remote sensing and socio-economic statistical data from 2000 to 2019, this study distinguished the controlling factors for the spatial and temporal patterns of ecological carrying capacity in the Qilian Mountain National Park, one of the 10 pilot national parks in China. The ecological carrying capacity index (ECCI) was developed by using the Driver-Pressure-State-Impact-Response framework and a comprehensive weight method. The results showed that the multiyear averaged ECCI was low in the south and west but was high in central and eastern regions. The spatial distribution of the ECCI was constrained by soil resources, ecosystem quality, land use/cover and water environment. At the regional scale, the ECCI decreased from 2000 to 2014, especially in Tianzhu, where farmland expansion and severe droughts reduced habitat quality and ecosystem function. However, the ECCI increased significantly from 2014 to 2019, which was attributed to a warm moist climate and the implementation of eco-environmental protection policies. Forest and grassland coverage, soil and water conservation, waste water treatment amount and terrestrial water reserves accounted for 35%, 26%, 20% and 8%, respectively, of the temporal variability in the ECCI. Concurrent with national park development, the ECCI is predicted to increase in most areas from 2020 to 2029 by back-propagation artificial neural networks, except for Sunan, Shandan and Menyuan, possibly owing to increasing conflicts between humans and the environment. The findings of this study provide evidence about the effectiveness of government policies in promoting regional sustainability by altering ecosystem composition and function. In addition, the dominant drivers for the temporal variability of ecological carrying capacity varied in space according to stepwise regression analysis, calling for region-specific management strategies in mountain protected areas and their surroundings.

PMID:37129968 | DOI:10.1016/j.jenvman.2023.117856

Nurse Educ. 2023 Apr 28. doi: 10.1097/NNE.0000000000001432. Online ahead of print.

ABSTRACT

BACKGROUND: Several definitions and guiding principles for nursing academic-practice partnerships exist.

PROBLEM: There remains a gap between academic-practice partnership definitions and practical operational models, thereby limiting schools of nursing ability to engage in productive partnerships. This article describes the development and validation of a novel Operational Model for Nursing Academic-Practice Partnerships.

APPROACH: An email survey of all nursing faculty (n = 228) identified quantity and types of faculty-led academic-practice partnerships. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed via thematic analysis conducted by 2 members of the project team and validated by the full project team.

OUTCOMES: The Operational Model for Academic-Practice Partnerships was created and is comprised of 8 partnership strategies: innovation, embedded faculty, joint appointment, consultant, independent practice, volunteer, scholarship, and clinical site development.

CONCLUSION: We offer this model as a framework to structure the development, implementation, and evaluation of academic-practice partnerships at nursing schools.

PMID:37129964 | DOI:10.1097/NNE.0000000000001432

Biometrics. 2023 May 2. doi: 10.1111/biom.13872. Online ahead of print.

ABSTRACT

Q-learning has been one of the most commonly used methods for optimizing dynamic treatment regimes (DTRs) in multi-stage decision making. Right-censored survival outcome poses a significant challenge to Q-Learning due to its reliance on parametric models for counterfactual estimation which are subject to misspecification and sensitive to missing covariates. In this paper we propose an imputation-based Q-learning (IQ-learning) where flexible nonparametric or semiparametric models are employed to estimate optimal treatment rules for each stage and then weighted hot-deck multiple imputation (MI) and direct-draw MI are used to predict optimal potential survival times. Missing data are handled using inverse probability weighting and MI, and the non-random treatment assignment among the observed is accounted for using a propensity-score approach. We investigate the performance of IQ-learning via extensive simulations and show that it is more robust to model misspecification than existing Q-Learning methods, imputes only plausible potential survival times contrary to parametric models, and provides more flexibility in terms of baseline hazard shape. Using IQ-learning we developed an optimal DTR for leukemia treatment based on a randomized trial with observational follow-up that motivated this study. This article is protected by copyright. All rights reserved.

PMID:37129942 | DOI:10.1111/biom.13872

J Med Internet Res. 2023 May 2;25:e44840. doi: 10.2196/44840.

ABSTRACT

BACKGROUND: Randomized controlled trials on text message interventions for smoking cessation have shown they are effective and recommended for tobacco control. However, the effectiveness in real-world settings is largely unknown, especially in low- and middle-income countries.

OBJECTIVE: This study aimed to provide real-world evidence about the utilization and effectiveness of a message-based tobacco cessation program (mCessation) in China.

METHODS: From May 2021 to September 2022, 16,746 people from the general population participated in the mCessation program provided by the World Health Organization. All participants received text messages on smoking cessation via instant messaging for 6 months, and they were also required to report smoking status. We randomly selected 2500 participants and interviewed them by telephone to determine the 7-day point prevalence abstinence rate at 6 months. Descriptive statistics were used to analyze population characteristics and abstinence rate. Logistic regression analysis was performed to explore risk factors for the abstinence rate.

RESULTS: Among the 2500 participants, the mean age was 35 years, and most (2407/2500, 96.20%) were male. The prevalence of tobacco dependence and light degree of tobacco dependence were 85.70% (2142/2500) and 89.10% (2228/2500), respectively. For respondents (953/2500, 38.10%), the 7-day point prevalence abstinence rate at 6 months was 21.90% (209/953). Participants older than 40 years or with tobacco dependence had significantly higher abstinence rates than those who were younger than 30 years old (odds ratio [OR] 1.77, 95% CI 1.06-3.29) or without dependence (OR 1.64, 95% CI 1.08-2.51), respectively. However, married people or heavily dependent smokers tended to find it more difficult to successfully quit smoking compared with unmarried people (OR 0.57, 95% CI 0.34-0.93) or lightly dependent smokers (OR 0.16, 95% CI 0.02-0.98), respectively.

CONCLUSIONS: In a real-world setting, mCessation China was generally acceptable to men and lightly dependent smokers, and it could help 1 in 5 smokers aged 18 years to 67 years quit smoking. However, strategies to increase awareness of young and married adults may improve implementation and abstinence rates.

PMID:37129934 | DOI:10.2196/44840

J Acquir Immune Defic Syndr. 2023 May 1. doi: 10.1097/QAI.0000000000003214. Online ahead of print.

ABSTRACT

BACKGROUND: Racial and ethnic disparities in antiretroviral therapy (ART) adherence and sustained viral suppression (SVS) have been documented among women with HIV. We examined factors that may account for these racial/ethnic differences among women to inform interventions that increase health equity.

METHODS: We used data from the 2015-2019 cycles of the Medical Monitoring Project, a probability sample of U.S. adults with diagnosed HIV. Using logistic regression with predicted marginal means, we calculated weighted prevalence differences (PDs) of ART adherence and SVS among Black, Hispanic/Latina, and White women taking ART. Using modeling with forward stepwise selection, we adjusted PDs for selected variables, including social determinants of health (SDOH) factors, to examine whether magnitude of PDs was attenuated by their inclusion. We assessed relative changes between unadjusted and adjusted PDs.

RESULTS: After adjusting for poverty, transportation needs, health literacy, and gap in health insurance/coverage, the Black-White PD in adherence decreased by 11% (-16.0% to -14.2%). After adjusting for adherence, poverty, type of health insurance, and gap in health insurance/coverage, the Black-White PD in SVS reduced 37% (-7.9% to -5.0%) and was no longer statistically different. The Hispanic/Latina-White PD in adherence reduced 24% (-12.7% to -9.6%) after adjusting for poverty, health literacy and transportation needs. The unadjusted Hispanic/Latina-White PD in SVS was not significantly different.

CONCLUSION: Racial/ethnic disparities in HIV outcomes among women taking ART were substantially reduced after accounting for SDOH and other factors, although differences remained. Structural interventions to improve SDOH are needed to improve health equity for women with HIV.

PMID:37129907 | DOI:10.1097/QAI.0000000000003214

JAMA Netw Open. 2023 May 1;6(5):e2310894. doi: 10.1001/jamanetworkopen.2023.10894.

ABSTRACT

IMPORTANCE: It is unknown whether olanzapine combined with triplet antemetic therapy is effective for all patients undergoing highly emetogenic chemotherapy. A secondary analysis of randomized clinical trials using olanzapine may provide insight into the effectiveness of olanzapine for chemotherapy-induced nausea and vomiting (CINV), including cisplatin.

OBJECTIVE: To examine the add-on effect of olanzapine according to risk factors for CINV.

DESIGN, SETTING, AND PARTICIPANTS: This preplanned secondary analysis evaluated results of the J-FORCE trial, a large double-blind, placebo-controlled phase 3 randomized clinical trial conducted in Japan from February 9, 2017, to July 18, 2018. Participants were enrolled from 26 participating hospitals across Japan and included patients aged 20 to 75 years who had a malignant tumor and were cisplatin-naive. The efficacy analysis population of the J-FORCE trial was analyzed according to allocation adjustment factors (sex [male or female], age [≥55 years or <55 years], and cisplatin dose [≥70 mg/m2 or <70 mg/m2]) and patient-related risk factors (history of motion sickness, drinking habit [defined as alcoholic drinks consumption in excess of occasional drinking], and history of morning sickness during pregnancy). Statistical analysis was performed from February 18 to April 18, 2020.

INTERVENTIONS: Patients were randomized 1:1 to receive 5 mg of olanzapine or placebo combined with standard triplet antiemetic therapy.

MAIN OUTCOMES AND MEASURES: The primary end point was complete response (CR, defined as no vomiting and no use of rescue medication) in the delayed phase (24-120 hours after cisplatin-based chemotherapy administration). Secondary end points were CR, complete control, and total control in the acute, delayed, and overall phases for 6 CINV risk factors as well as time to treatment failure. The CR point estimates and 95% CIs of the differences between groups were calculated, and a Mantel-Haenszel test was performed.

RESULTS: Of the 705 patients (mean [SD] age, 63.0 [9.2] years; 471 males [66.8%]) included in the efficacy analysis population; 581 patients (82.4%) were 55 years or older, and 526 (74.6%) were treated with a cisplatin dose of 70 mg/m2 or more. Risk difference (RD) for a CR in the delayed phase was significantly greater in the olanzapine group than the placebo group in males (RD, 12.6% [95% CI, 5.0%-20.1%]; P = .001); in females (RD, 14.5% [95% CI, 2.2%-26.3%]; P = .02); in those 55 years or older (RD, 11.1% [95% CI, 3.9%-18.2%]; P = .003) or younger than 55 years (RD, 23.6% [95% CI, 7.3%-38.3%]; P = .005); for a cisplatin dose of 70 mg/m2 or more (RD, 13.5% [95% CI, 5.9%-21.0%]; P < .001); for those without a history of motion sickness (RD, 13.9% [95% CI, 6.9%-20.6%]; P < .001); for those with a drinking habit (RD, 14.9% [95% CI, 6.1%-23.4%]; P = .001) or without a drinking habit (RD, 12.0% [95% CI, 2.5%-21.3%]; P = .01); and for those with a history of morning sickness during pregnancy (RD, 27.2% [9.7%-42.6%]; P = .002). In other subgroups, a delayed CR was higher in the olanzapine group than the placebo group, although not significantly higher.

CONCLUSIONS AND RELEVANCE: Results of this study suggest a benefit of using 5 mg of olanzapine plus triplet antiemetic therapy to counter CINV regardless of the presence or absence of risk factors.

TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry Identifier: UMIN000024676.

PMID:37129897 | DOI:10.1001/jamanetworkopen.2023.10894

JAMA Netw Open. 2023 May 1;6(5):e2311086. doi: 10.1001/jamanetworkopen.2023.11086.

ABSTRACT

IMPORTANCE: Professional motorsport drivers are regularly exposed to biomechanical forces comparable with those experienced by contact and collision sport athletes, and little is known about the potential short-term and long-term neurologic sequelae.

OBJECTIVE: To determine whether cumulative impact exposure is associated with oculomotor functioning in motorsport drivers from the INDYCAR professional open-wheel automobile racing series.

DESIGN, SETTING, AND PARTICIPANTS: This is a longitudinal retrospective cohort study conducted across 3 racing seasons (2017-2019). Statistical analyses were conducted in November 2021. Data were retrieved from a secondary care setting associated with the INDYCAR series. INDYCAR series drivers who participated in 3 professional level racing seasons and were involved in at least 1 contact incident (ie, crash) in 2 of the 3 seasons were included in the study.

EXPOSURE: Cumulative acceleration and deceleration forces and total contact incidents (ie, crashes) measured via accident data recorder third generation chassis and ear accelerometers.

MAIN OUTCOMES AND MEASURES: Postseries oculomotor performance, including predictive saccades, vergence smooth pursuit, and optokinetic nystagmus, was measured annually with a head-mounted, clinical eye tracking system (Neurolign Dx 100).

RESULTS: Thirteen drivers (mean [SD] age, 29.36 [7.82] years; all men) sustained median resultant acceleration forces of 38.15 g (observed range, 12.01-93.05 g; 95% CI, 30.62-65.81 g) across 81 crashes. A 2-way multivariate analysis of variance did not reveal a statistically significant association between ear and chassis average resultant g forces, total number of contact incidents, and racing season assessed (F9,12 = 0.955; P = .54; Wilks Λ = 0.44).

CONCLUSIONS AND RELEVANCE: In this cohort study of professional drivers from the INDYCAR series, there were no statistically significant associations among cumulative impact exposure, racing season assessed, and oculomotor performance. Longitudinal studies across racing seasons using multidimensional examination modalities (eg, neurocognitive testing, advanced imaging, biomarkers, and physical examination) are critical to understand potential neurological and neurobehavioral sequelae and long-term consequences of cumulative impact exposure.

PMID:37129896 | DOI:10.1001/jamanetworkopen.2023.11086

JAMA Netw Open. 2023 May 1;6(5):e2311189. doi: 10.1001/jamanetworkopen.2023.11189.

ABSTRACT

IMPORTANCE: There are few robust evaluations of disease-specific question prompt sheets (QPS) in patient-physician communication among patients with advanced cancer.

OBJECTIVE: To compare the patient perception of helpfulness, global evaluation, and preference for the QPS vs a general information sheet (GIS), and to examine the effect of the QPS on participants’ anxiety, participants’ speaking time, number of questions asked, and length of the clinical encounter.

DESIGN, SETTING, AND PARTICIPANTS: This controlled, double-blind randomized clinical trial was conducted at an outpatient palliative and supportive care clinic in a cancer center in the US. Eligible patients were 18 years or older, had a cancer diagnosis, and were undergoing their first outpatient consultation visit with a palliative care physician from September 1, 2017, to May 31, 2019. Data analysis used a modified intention-to-treat design. Data were analyzed from May 18 to June 27, 2022.

INTERVENTION: QPS, a 25-item list of questions developed by expert palliative care clinicians using a Delphi process and tested among ambulatory advanced cancer patients. The control was GIS, generic information material given routinely to patients seen at the supportive care clinic.

MAIN OUTCOMES AND MEASURES: The main outcome was patient perception of helpfulness. Secondary outcomes included global evaluation and preference of QPS compared with GIS immediately after the encounter.

RESULTS: A total of 130 patients (mean [SD] age, 58.6 [13.3] years; 79 [60.8%] female) were randomized to receive either QPS (67 patients [51.5%]) or GIS (63 patients [48.5%]). Patients considered QPS and GIS equally helpful, with no statistically significant difference (mean [SD] helpfulness score, 7.2 [2.3] points vs 7.1 [2.7] points; P = .79). The QPS group, compared with the GIS group, had a higher global positive view of the material (mean [SD] global perception score, 7.1 [1.3] vs 6.5 [1.7]; P = .03) and felt it prompted them more to generate new questions (mean [SD] rating, 7.0 [2.9] vs 5.3 [3.5]; P = .005). Of 47 patients asked their preference between the items, more participants preferred the QPS to the GIS in communicating with their physicians (24 patients [51.1%] vs 7 patients [14.9%]; P = .01) at the 4-week follow-up. No significant differences between the QPS and GIS groups were observed regarding participant anxiety, speaking time, number of questions asked, or consultation length (eg, mean [SD] anxiety rating, 2.3 [3.7] vs 1.6 [2.7]; P = .19).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, participants perceived both QPS and GIS as equally helpful, but they had a more positive global view of and preferred the QPS. QPS facilitated generation of new questions without increasing patient anxiety nor prolonging the consultation. The findings provide support for increased adoption and integration of QPS into routine oncologic care.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03287492.

PMID:37129892 | DOI:10.1001/jamanetworkopen.2023.11189

J Psychosoc Nurs Ment Health Serv. 2023 May;61(5):11-16. doi: 10.3928/02793695-20230417-03. Epub 2023 May 1.

ABSTRACT

Anxiety disorders are among the most common mental health conditions affecting pediatric populations. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, recommends objective measurement of pediatric anxiety for evaluation of symptomatology and treatment response. The objective of the current review was to summarize recommendations and resources for measuring pediatric anxiety, and to quantify and characterize use of outcome measures for generalized anxiety in pediatric psychiatry. These findings represent an essential step toward understanding how and to what extent anxiety rating scales are used in pediatric psychiatry and where quality improvement initiatives may be needed. Education, training, and further research are warranted to optimize use of measurement-based care for generalized anxiety in pediatric psychiatry settings and to determine which scales are optimal for use in this context. [Journal of Psychosocial Nursing and Mental Health Services, 61(5), 11-16.].

PMID:37129880 | DOI:10.3928/02793695-20230417-03

Drugs Aging. 2023 May 2. doi: 10.1007/s40266-023-01024-6. Online ahead of print.

ABSTRACT

BACKGROUND: The aging of our societies leads to a higher prevalence of multimorbidity and therefore polypharmacy, which often results in inappropriate drug treatment. To address this issue, numerous listing approaches, such as the Fit fOR The Aged (FORTA) list have been developed. FORTA’s positive impact on the quality of medications and relevant clinical outcomes has been shown. Based on new emerging evidence and experiences with the existing FORTA lists, we aimed to update the FORTA lists in several European countries/regions.

METHODS: Two-step Delphi consensus procedures were conducted in Poland, UK/Ireland, Italy, Spain, the Nordic countries, The Netherlands and France. The existing European FORTA lists served as survey proposals.

RESULTS: Thirty-two experts agreed to take part in this study (return rate: 96.9%). The country/region-specific overall consensus for all items and participants after the first round was > 90%. FORTA lists from six participating countries, plus the FORTA list for the German-speaking countries, were collated into the new EURO-FORTA List, which now contains 267 items aligned to 27 indications. Three items were added to the EURO-FORTA List, and no drugs were deleted. Eight FORTA items were relabeled, and 96.9% of the labels remained unchanged.

CONCLUSION: In this study, seven new country/region specific FORTA lists, as well as a new overarching EURO-FORTA List, were developed. An overall increase in the mean consensus coefficient and increases for all disease-specific mean consensus coefficients show a wider consensus among participants. The new lists have the potential to improve drug therapy in older people internationally.

PMID:37129833 | DOI:10.1007/s40266-023-01024-6