Category: Statistics

J Pharm Policy Pract. 2022 Aug 17;15(1):48. doi: 10.1186/s40545-022-00448-6.

ABSTRACT

BACKGROUND: Human immunodeficiency virus and acquired immunodeficiency syndrome had created enormous challenges worldwide, and continues to be the world’s serious health and development challenges. Globally, at the end 2017, there were 1.8 million children (< 15 years) living with HIV. The survival of HIV-positive children treated with ART depends on a variety of factors, which might vary greatly with economic, socio-demographic, behavioral risk, and health factors. This study aimed to assess survival status and predictors of mortality among HIV-positive children on antiretroviral therapy at East Gojjam Zone Public hospitals, Northwest Ethiopia.

METHODS: An institution-based retrospective cohort study was conducted in selected hospitals of the East Gojjam zone, Northwest Ethiopia, among < 15-year-old children who were newly enrolled in HIV care clinic from January 1st, 2014 to December 31, 2018. Data were collected from patient charts from March 1 to 22, 2019 using a standardized checklist. Data were analyzed by SPSS version 24. A Kaplan-Meier curve and log-rank test were used to estimate the survival time and compare survival curves between variables. Multivariable Cox proportional-hazards model was fitted to identify predictors of survival status taking p-value < 0.05 as statistically significant.

RESULT: In this study, a total of 251 HIV-positive children on ART were followed up for a total of 60 months, with a mean survival time of 55.54 (± 0.83) (95% CI: 53.90-57.17) months. The overall mortality incidence rate in the cohort during the 626 Child-Year-Observation (CYO) was 2.56/100 CYO. The overall estimated survival probability after starting ART was 0.90 at 60 months of follow-up. In this study age < 5 years, Hgb < 10 gm/dl, CD4 count below threshold, cotrimoxazole preventive therapy, and subnormal weight for height were statistically significant predictors of survival status (P < 0.05).

CONCLUSION AND RECOMMENDATION: Age, hemoglobin level, CD4 count, weight for height, and not taking cotrimoxazole preventive therapy were independent predictors of mortality. Therefore, concerned stakeholders should focus on the above-mentioned predictors of mortality and nutritional interventions to enhance the survival of HIV-infected children on antiretroviral therapy.

PMID:35978382 | DOI:10.1186/s40545-022-00448-6

Trials. 2022 Aug 17;23(1):677. doi: 10.1186/s13063-022-06522-3.

ABSTRACT

BACKGROUND: Approximately 75,000 people fracture a hip each year in the UK. This painful injury can be devastating-with a high associated mortality rate-and survivors likely to be more dependent and less mobile. Pain relief at the scene of injury is known to be inadequate. Intravenous morphine is usually given by paramedics, but opioids are less effective for dynamic pain and can cause serious side effects, including nausea, constipation, delirium and respiratory depression. These may delay surgery, require further treatment and worsen patient outcomes. We completed a feasibility study of paramedic-provided fascia iliaca compartment block (FICB), testing the intervention, trial methods and data collection. The study (RAPID) demonstrated that a full trial was feasible. In this subsequent study, we aim to test safety, clinical and cost-effectiveness of paramedic-provided FICB as pain relief to patients with suspected hip fracture in the prehospital environment.

METHODS: We will conduct a pragmatic multi-centre individually randomised parallel-group trial, with a 1:1 allocation between usual care (control) and FICB (intervention). Hospital clinicians in five sites (paired ambulance services and receiving hospitals) in England and Wales will train 220 paramedics to administer FICB. The primary outcome is change in pain score from pre-randomisation to arrival at the emergency department. One thousand four hundred patients are required to find a clinically important difference between trial arms in the primary outcome (standardised statistical effect ~ 0.2; 90% power, 5% significance). We will use NHS Digital (England) and the SAIL (Secure Anonymised Information Linkage) databank (Wales) to follow up patient outcomes using routine anonymised linked data in an efficient study design, and questionnaires to capture patient-reported outcomes at 1 and 4 months. Secondary outcomes include mortality, length of hospital stay, job cycle time, prehospital medications including morphine, presence of hip fracture, satisfaction, mobility, and NHS costs. We will assess safety by monitoring serious adverse events (SAEs).

DISCUSSION: The trial will help to determine whether paramedic administered FICB is a safe, clinically and cost-effective treatment for suspected hip fracture in the pre-hospital setting. Impact will be shown if and when clinical guidelines either recommend or reject the use of FICB in routine practice in this context.

TRIAL REGISTRATION: ISRCTN15831813 . Registered on 22 September 2021.

PMID:35978361 | DOI:10.1186/s13063-022-06522-3

BMC Musculoskelet Disord. 2022 Aug 17;23(1):786. doi: 10.1186/s12891-022-05736-5.

ABSTRACT

INTRODUCTION: Investigations of the relationship between waist circumference (WC) and bone mineral density (BMD) have inconsistent and incomprehensive results. We explored the association between WC and BMD at various sites in a large-scale population-based study.

METHODS: We screened 5337 participants from National Health and Nutrition Examination Survey (NHANES) database. BMD was measured using dual-energy X-ray absorptiometry at various skeletal sites. The associations of WC with BMD were evaluated by weighted multivariable logistic regression models and conducted subgroup analyses for gender, age, and BMI. A weighted generalized additive model and a smooth curve fitting were performed to address non-linearity.

RESULTS: Adjustments for all confounders, in males, WC was negatively correlated to BMD in different age and BMI groups (all the p < 0.05), except for in the lowest BMI group; in females, overall trends of relationships between WC and BMD were negative. However, statistical differences were insignificant in some cases. Additionally, every 1 cm increase in WC for individuals of all ages with normal BMI (18.5 ≤ BMI < 25) was associated with decrease in BMD at each skeletal site, as was the case for men with BMI ≥ 25 kg/m². For women, the negative association of WC with BMD was evident at the lumbar spine in the youngest age group (8 ≤ Age ≤ 18) with normal BMI.

CONCLUSIONS: The nonlinear associations between WC and BMD at various skeletal sites are gender-, age- and BMI-specific in the NHANES (2006-2006).

PMID:35978347 | DOI:10.1186/s12891-022-05736-5

BMC Public Health. 2022 Aug 17;22(1):1564. doi: 10.1186/s12889-022-13925-z.

ABSTRACT

BACKGROUND: Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD studies undertaken across Europe and to comprehensively review the methodological design choices and assumption parameters that have been made to calculate years of life lost (YLL) and years lived with disability (YLD) in these studies.

METHODS: We searched EMBASE, MEDLINE, Cochrane Central, Google Scholar, and Web of Science, and the grey literature supplemented by handsearching, for BoD studies. We included injury BoD studies that quantified the BoD expressed in YLL, YLD, and disability-adjusted life years (DALY) in countries within the European Region between early-1990 and mid-2021.

RESULTS: We retrieved 2,914 results of which 48 performed an injury-specific BoD assessment. Single-country independent and Global Burden of Disease (GBD)-linked injury BoD studies were performed in 11 European countries. Approximately 79% of injury BoD studies reported the BoD by external cause-of-injury. Most independent studies used the incidence-based approach to calculate YLDs. About half of the injury disease burden studies applied disability weights (DWs) developed by the GBD study. Almost all independent injury studies have determined YLL using national life tables.

CONCLUSIONS: Considerable methodological variation across independent injury BoD assessments was observed; differences were mainly apparent in the design choices and assumption parameters towards injury YLD calculations, implementation of DWs, and the choice of life table for YLL calculations. Development and use of guidelines for performing and reporting of injury BoD studies is crucial to enhance transparency and comparability of injury BoD estimates across Europe and beyond.

PMID:35978333 | DOI:10.1186/s12889-022-13925-z

BMC Oral Health. 2022 Aug 17;22(1):357. doi: 10.1186/s12903-022-02390-0.

ABSTRACT

BACKGROUND: There have been no reports on the impact of different reciprocating angles on retreatment performance of reciprocating files. This ex-vivo study compared the efficiency of three reciprocating systems in removing MTA-type sealer-based filling materials and investigated the influence of different reciprocating angles on their retreatment ability.

METHODS: 140 root-canals were instrumented to a 35 apical size and filled with an MTA-type sealer and gutta-percha cones. Samples were scanned by micro-computed-tomography and the root-canals fillings volumes were measured. Samples were divided into 7 groups according to the reciprocating angles at which the WaveOne-Gold (WOG), Reciproc-Blue (RB) and R-Motion (RM) systems were reciprocated to remove the root-canals’ fillings. The WOG-150/30, WOG-90/30, RB-150/30, RB-90/30, RM-150/30 and RM-90/30 groups in which the systems were reciprocated at 150/30 and 90/30 (counterclockwise/clockwise) angles. In the RB-270/30 group the RB system was reciprocated at 270/30 angles. Samples were re-scanned and the remaining filling materials’ (RFMs) volumes were measured. The percentage of the RFMs volume and its mean value for each group were calculated and data were statistically analysed at 0.05 significance level.

RESULTS: The WOG system resulted in less RFMs (2.24%) when reciprocated at 90/30 angles compared to that resulted from the 150/30 angles (4.96%) [P = 0.002]. The RB system reciprocated at 90/30 angles resulted in less RFMs (2.67%) compared to that resulted from the 270/30 angles (6.64%) [P = 0.001]. The RFMs after using RM system reciprocated at 90/30 (6.02%) and 150/30 (7.61%) were greater than those of WOG (2.24 and 4.96%) and RB (2.67 and 4.34%) reciprocated at the same angles (P < 0.05). The longest time required to remove the filling materials was recorded with the RB-270/30 group (6.06 min) [P = 0.00]. The times required when the WOG, RB and RM files reciprocated at 90/30 angles (3.59, 3 and 3.05 mins, respectively) were shorter than those when files were reciprocated at 150/30 angles (5.25, 4.98 and 3.67 min, respectively) [P < 0.05].

CONCLUSIONS: The WOG and RB systems removed more MTA-type sealer-based root-canals fillings than the RM system. Lower counterclockwise reciprocating angles improve the retreatment ability of reciprocating systems, especially the WOG system and can reduce the time required for retreatment procedures.

PMID:35978330 | DOI:10.1186/s12903-022-02390-0

BMC Health Serv Res. 2022 Aug 17;22(1):1048. doi: 10.1186/s12913-022-08374-8.

ABSTRACT

BACKGROUND: The current pandemic situation led to deep changes not only in social relationships, but also on clinical care and access to healthcare facilities. The authors aimed to understand whether this context affected the main characteristics of psychiatric hospitalizations, measured by admissions in a portuguese acute psychiatric ward.

METHODS: Retrospective data collection of all patients admitted in Centro Hospitalar Psiquiátrico de Lisboa, in two different time periods: pre-COVID-19 (march 11th, 2019 to march 10th, 2020, n = 1845) and COVID-19 (march 11th, 2020 to march 10th, 2021, n = 1278); comparing the number of total admissions, compulsory ones, age, sex, median days of admission, median days to readmission and diagnosis at discharge. Distribution of disorders in both groups, as well as in compulsory admissions were also evaluated. The same comparisons were evaluated in the 15-25-year-old patient group.

RESULTS: Statistical significance was found regarding total number of admissions (reduction of around 30.7%), as well as compulsory ones (reduction of 14%, although the relative frequency had increased), days of admission and distribution between admissions (with lower reductions regarding dementias, schizophrenia and affective disorders, while substance use disorders and intellectual disabilities presented reductions of over 50%), with no differences between gender, median age, previous admissions or readmissions. Distribution between compulsory admissions did not present differences before and during COVID periods. For patients between 15 and 25 years of age, statistical significance was found regarding total number of compulsory ones (94 versus 44, p-value = 0.01), and in all groups of diagnoses (all with p-value = 0.001).

CONCLUSIONS: While there was a general reduction in the overall number of patients admitted, in the most severe conditions (compulsory admissions and schizophrenia diagnosis) did not present such a reduction. Difficulties in social, clinical and family networks can explain the reduction of the time to readmission. Future research could show whether there is a rebound increase number of admissions in the other diagnoses.

TRIAL REGISTRATION: The current study was approved by the hospital’s scientific and ethics committees (CCP number 0060/2021 and CES 09/2021).

PMID:35978322 | DOI:10.1186/s12913-022-08374-8

Int J Equity Health. 2022 Aug 17;21(1):112. doi: 10.1186/s12939-022-01704-6.

ABSTRACT

BACKGROUND: The significant increase in access to oncological medicines through court cases suggests that constitutional guarantees of integral and universal care in the Brazilian public health system are uncertain.

METHODS: A retrospective observational study was conducted to analyze data from lawsuits requesting oncological medicines from 2014 to 2020 in the State of Goiás, Brazil, in state and federal courts. Sociodemographic, medical, and legal variables were statistically examined using descriptive, association, and correlation methods.

RESULTS: Women brought more than half (54%) of the 301 processes analyzed. The most frequent age group was over 55 years, with income below 3 × the minimum wage (total about USD$600/month), and their cases were promoted through the public minister and public defender’s offices. The most requested medications, not on official public health system lists, were indicated for multiple myeloma and brain cancer.

CONCLUSIONS: Improved quality of life, frequently used as a justification, could be conceptually confused with increased survival. Finally, judicialization itself indicates that individual health needs arise even with properly defined and adequately implemented public policies. These needs should be considered for the adequate provisioning of services by the state to ensure the right to health.

PMID:35978319 | DOI:10.1186/s12939-022-01704-6

BMC Public Health. 2022 Aug 17;22(1):1566. doi: 10.1186/s12889-022-13979-z.

ABSTRACT

BACKGROUND: Supportive family or peer behaviors positively impact smoking cessation in people with mental health problems who smoke. However, the limited understanding of the pathways through which family or peer factors impact quitting limits the development of effective support interventions. This study examined pathways through which family or peer views on tobacco use, family or peer smoking status, and rules against smoking in the home influenced quitting in adults with mental health problems who smoke.

METHODS: We used data from the Population Assessment of Tobacco and Health Study, a national longitudinal survey. Baseline data were collected in 2015, and follow-up data in 2016. We included adults’ current smokers who had experienced two or more mental health symptoms in the past year (unweighted n = 4201). Structural equation modeling was used to test the relationships between family and peer factors, mediating factors, and smoking cessation.

RESULTS: We found that having family or peers with negative views on tobacco use had a positive indirect effect on smoking cessation, mediated through the individual’s intention to quit (regression coefficient: 0.19) and the use of evidence-based approaches during their past year quit attempt (regression coefficient: 0.32). Having rules against smoking in the home (regression coefficient: 0.33) and having non-smoking family members or peers (regression coefficient: 0.11) had a positive indirect effect on smoking cessation, mediated through smoking behaviors (regression coefficient: 0.36). All paths were statistically significant (p < 0.01). The model explained 20% of the variability in smoking outcomes.

CONCLUSION: Family or peer-based cessation interventions that systematically increase intentions to quit and monitor smoking behavior may be able to assess the efficacy of family and peer support on quitting in people with mental health problems who smoke.

PMID:35978318 | DOI:10.1186/s12889-022-13979-z

BMC Ophthalmol. 2022 Aug 17;22(1):346. doi: 10.1186/s12886-022-02571-z.

ABSTRACT

BACKGROUND: Diabetic retinopathy (DR) is a common complication of diabetes mellitus (DM). Systemic inflammation is intimately associated with DR. The neutrophil-to-lymphocyte ratio (NLR) index is a relatively new indicator of inflammation.

METHODS: This cross-sectional study was carried out among adults with DM based on the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2016. NLR was presented as absolute neutrophil counts/ absolute lymphocyte counts. The relationship of NLR levels to DR was analyzed using multivariable logistic regression.

RESULTS: There were 2772 eligible subjects extracted from the NHANES. In the multivariate analysis, NLR was related to the risk of DR after adjustment for potential confounders. The association between NLR levels and DR was nonlinear, with an inflection point of 4.778. Compared with the baseline values, NLR was not statistically significant on the right side of the inflection point (1.000, 0.914 to 1.094, 0.9974) but was positively associated with DR on the left side (1.236, 1.132 to 1.349, < 0.0001).

CONCLUSIONS: NLR reflects systemic inflammation that may increase the risk of DR. NLR positively correlates with DR when its value is less than 4.778.

PMID:35978314 | DOI:10.1186/s12886-022-02571-z

BMC Infect Dis. 2022 Aug 17;22(1):694. doi: 10.1186/s12879-022-07664-0.

ABSTRACT

COVID-19 has had a substantial impact globally. It spreads readily, particularly in enclosed and crowded spaces, such as public transport carriages, yet there are limited studies on how this risk can be reduced. We developed a tool for exploring the potential impacts of mitigation strategies on public transport networks, called the Systems Analytics for Epidemiology in Transport (SAfE Transport). SAfE Transport combines an agent-based transit assignment model, a community-wide transmission model, and a transit disease spread model to support strategic and operational decision-making. For this simulated COVID-19 case study, the transit disease spread model incorporates both direct (person-to-person) and fomite (person-to-surface-to-person) transmission modes. We determine the probable impact of wearing face masks on trains over a seven day simulation horizon, showing substantial and statistically significant reductions in new cases when passenger mask wearing proportions are greater than 80%. The higher the level of mask coverage, the greater the reduction in the number of new infections. Also, the higher levels of mask coverage result in an earlier reduction in disease spread risk. These results can be used by decision makers to guide policy on face mask use for public transport networks.

PMID:35978312 | DOI:10.1186/s12879-022-07664-0