Category: Statistics

Implement Sci. 2022 Jul 29;17(1):51. doi: 10.1186/s13012-022-01218-3.

ABSTRACT

BACKGROUND: Interventions are often adapted; some adaptations may provoke more favorable outcomes, whereas some may not. A better understanding of the adaptations and their intended goals may elucidate which adaptations produce better outcomes. Improved methods are needed to better capture and characterize the impact of intervention adaptations.

METHODS: We used multiple data collection and analytic methods to characterize adaptations made by practices participating in a hybrid effectiveness-implementation study of a complex, multicomponent diabetes intervention. Data collection methods to identify adaptations included interviews, observations, and facilitator sessions resulting in transcripts, templated notes, and field notes. Adaptations gleaned from these sources were reduced and combined; then, their components were cataloged according to the framework for reporting adaptations and modifications to evidence-based interventions (FRAME). Analytic methods to characterize adaptations included a co-occurrence table, statistically based k-means clustering, and a taxonomic analysis.

RESULTS: We found that (1) different data collection methods elicited more overall adaptations, (2) multiple data collection methods provided understanding of the components of and reasons for adaptation, and (3) analytic methods revealed ways that adaptation components cluster together in unique patterns producing adaptation “types.” These types may be useful for understanding how the “who, what, how, and why” of adaptations may fit together and for analyzing with outcome data to determine if the adaptations produce more favorable outcomes rather than by adaptation components individually.

CONCLUSION: Adaptations were prevalent and discoverable through different methods. Enhancing methods to describe adaptations may better illuminate what works in providing improved intervention fit within context.

TRIAL REGISTRATION: This trial is registered on clinicaltrials.gov under Trial number NCT03590041 , posted July 18, 2018.

PMID:35906602 | DOI:10.1186/s13012-022-01218-3

BMC Musculoskelet Disord. 2022 Jul 30;23(1):729. doi: 10.1186/s12891-022-05618-w.

ABSTRACT

BACKGROUND: Restriction in foot and ankle joint range of motion, such as an ankle equinus, has been associated with increased plantar pressure and its complications. However, previous research is limited by its scope of measures and study populations. The aim of this study was to investigate the relationship between foot and ankle joint range of motion on barefoot plantar pressures during walking in healthy older adults.

METHODS: This cross-sectional study recruited 49 older adults. Participants underwent measures of foot (first metatarsophalangeal dorsiflexion range of motion, and navicular drop and drift) and ankle joint range of motion, foot posture, body mass index, and plantar pressure during barefoot walking. Spearman Rank Order Correlations were used to explore the relationship between foot and ankle measures, body mass index, and plantar pressure, with significant correlations explored in a hierarchical regression analysis. A Mann-Whitney U test was performed to compare plantar pressure values between those with and without ankle equinus per region of the foot.

RESULTS: Mean (SD) age and BMI were 72.4 years (5.2) and 29.8 kg/m² (5.9) respectively. A total of 32 of the 49 participants (65%) identified as female sex. Mean (SD) ankle joint range of motion was 32.7 (6.4) degrees with 17/49 (34.7%) participants classified as having an ankle equinus (defined as < 30 degrees of ankle joint dorsiflexion range of motion). We found that an ankle equinus predicted a statistically significant amount of peak forefoot plantar pressure (p = 0.03). Participants with an ankle equinus displayed significantly higher forefoot peak pressure 677.8 kPa (589.9 to 810.4) compared to those with no equinus 565.58 kPa (447.3 to 651.2), p = 0.02. A statistically significant correlation was found between body mass index and midfoot peak pressure (p < 0.01) and pressure-time integral (p < 0.01). No other significant correlations were found.

CONCLUSION: Clinicians should consider screening for an ankle equinus and body mass index as a simple way to identify which healthy older adults may be at risk of pressure-related complications in the mid- and forefoot.

PMID:35906599 | DOI:10.1186/s12891-022-05618-w

BMC Health Serv Res. 2022 Jul 29;22(1):971. doi: 10.1186/s12913-022-08351-1.

ABSTRACT

BACKGROUND: Opioid substitution treatment (OST) populations are aging and have increased mortality and somatic morbidity compared to general populations internationally. While OST patients have poor self-rated physical health and unmet healthcare needs, documented healthcare utilization has been sparsely investigated. The aim of this study was to assess registered healthcare utilization for somatic conditions in a sample of Swedish OST patients, and compare healthcare utilization among OST patients with and without use of on-site primary healthcare (PHC).

METHODS: Patients in OST in Malmö, Sweden, were recruited for a survey study conducted in 2017-2018. Survey data were compared with comprehensive patient records from specialized and primary care during one year prior to study inclusion (total n = 190). All patient records were examined for healthcare utilization, source of healthcare (PHC, emergency care and secondary care), and documented diagnoses and symptoms. Factors associated with healthcare utilization were analyzed by using logistic regression analysis. Patients with and without on-site PHC were compared by using descriptive statistics and Chi-2 test.

RESULTS: A total of 88% of the sample had been in direct or indirect contact with somatic healthcare during one year (PHC 66%; emergency care 28%; secondary care 67%). The most prevalent somatic diagnoses were infectious diseases (39%) and symptom diagnoses (37%). Respiratory, dermatological and musculoskeletal diagnoses, and trauma/intoxication were documented in 21-26% of the sample, respectively. PHC utilization was associated with older age and being born in Sweden. Among patients with on-site PHC (n = 25), the number utilizing secondary care was 84%, and certain diagnostic codes were more frequent in this group.

CONCLUSION: OST patients are seemingly underserved as regards their physical health. Since increased OST access decreases opioid overdose fatalities, the life expectancy among OST patients is likely to increase and thereby also increases the risk of age-related conditions. Thus, easily accessible physical healthcare is of great importance in this group. On-site PHC might be a way to establish healthcare contact with OST patients, especially for non-acute conditions, although further research is needed.

PMID:35906595 | DOI:10.1186/s12913-022-08351-1

Cardiovasc Diabetol. 2022 Jul 29;21(1):142. doi: 10.1186/s12933-022-01576-8.

ABSTRACT

BACKGROUND: Premature coronary artery disease (PCAD) has become more common in recent years and is often associated with poor outcomes. Triglyceride-glucose (TyG) index is a simple and reliable surrogate for insulin resistance (IR) and is an independent predictor of cardiovascular prognosis. However, the prognostic value of the TyG index in patients with PCAD remains uncertain. Thus, this study aimed to investigate the prognostic value and predictive performance of the TyG index in patients with PCAD.

METHODS: A total of 526 young subjects (male < 45 years, female < 55 years) with angiographically proven CAD from January 2013 to December 2018 were included consecutively in this study. Their clinical and laboratory parameters were collected, and the TyG index was calculated as [Formula: see text]. The follow-up time after discharge was 40-112 months (median, 68 months; interquartile range, 49‒83 months). The primary endpoint was the occurrence of the major adverse cardiovascular events (MACE), defined as the composite of all-cause death, non-fatal myocardial infarction (MI), coronary artery revascularization, and non-fatal stroke.

RESULTS: The TyG index was significantly associated with traditional cardiovascular risk factors and the Gensini score (GS). Kaplan-Meier survival (MACE-free) curves by tertiles of the TyG index showed statistically significant differences (log-rank test, p = 0.001). In the fully adjusted Cox regression model, the Hazard ratio (95% CI) of MACE was 2.17 (1.15-4.06) in tertile 3 and 1.45 (1.11-1.91) for per SD increase in the TyG index. Time-dependent ROC analyses of the TyG for prediction of MACE showed the area under the curves (AUC) reached 0.631 at 3 years, 0.643 at 6 years, and 0.710 at 9 years. Furthermore, adding TyG index to existing risk prediction model could improve outcome prediction [C-statistic increased from 0.715 to 0.719, p = 0.007; continuous net reclassification improvement (NRI) = 0.101, p = 0.362; integrated discrimination improvement (IDI) = 0.011, p = 0.017].

CONCLUSION: The TyG index is an independent predictor of MACE in patients with PCAD, suggesting that the TyG index has important clinical implications for risk stratification and early intervention of PCAD.

PMID:35906587 | DOI:10.1186/s12933-022-01576-8

BMC Public Health. 2022 Jul 29;22(1):1445. doi: 10.1186/s12889-022-13852-z.

ABSTRACT

BACKGROUND: Internet search volume reflects the level of Internet users’ risk perception during public health events. The Internet search volume index model, an algorithm of concentration of Internet users, and statistical analysis of popular topics on Weibo are used to analyze the effects of time, space, and space-time interaction. We conducted in-depth research on the characteristics of the spatial and temporal distribution of Internet users’ risk perceptions of public health events and the associated influential factors.

METHODS: We analyzed the spatiotemporal distribution characteristics of Internet users’ risk perception after the Wuhan “city closing” order during the coronavirus disease 2019 (COVID-19) pandemic. We established five linear regression models according to different time periods and analyzed factors influencing Internet users’ risk perception by employing a Poisson and spatial distribution and topic modeling analysis.

RESULTS: Economy, education, health, and the degree of information disclosure affect Internet users’ risk perception significantly. Internet users’ risk perception conforms to the exponential distribution law in time and has periodic characteristics and stability trends. Additionally, Internet users’ average arrival rate dropped from week 1 to week 8 after the “city closing.” Internet users’ risk perception has a uniform distribution in space, economic and social development level distribution consistency, spatial agglomeration, and other characteristics. The results of the time-space interaction show that after 8 weeks of COVID-19, Internet search hot topics have become more stable, and Internet users’ information demand structure has become more rational.

CONCLUSIONS: The Internet search cycle of the COVID-19 event is synchronized with the evolution cycle of the epidemic. The physical risk of Internet users is at the top of the risk structure, focusing on the strong concern about the government’s ability to control COVID-19 and its future trend. The government should strengthen network management; seize the risk control focus of key time nodes, regional locations, and information content of online communication; actively adjust the information content supply; effectively control the rebound of Internet users’ risk perception; establish a data-driven, risk-aware intelligence system for internet users; and guide people to actively face and overcome the potential risks and threats of COVID-19.

PMID:35906584 | DOI:10.1186/s12889-022-13852-z

J Craniofac Surg. 2022 Jul 28. doi: 10.1097/SCS.0000000000008753. Online ahead of print.

ABSTRACT

BACKGROUND: “Double eyelid” blepharoplasty is one of the most common cosmetic operations among Asian populations. Some patients might present with concomitant mild to moderate blepharoptosis, even though they choose initially to undergo blepharoplasty for cosmetic reasons.

OBJECTIVE: Using nonincisional double eyelid surgery without ptosis correction tends to produce unsatisfactory results. We introduce our modified suture method for the simultaneous correction of blepharoptosis during double eyelid blepharoplasty.

MATERIALS AND METHODS: We carried out a retrospective review on 13 patients who underwent simultaneous nonincisional ptosis correction and double eyelid surgery, using a single-knot continuous technique, from January 2017 to December 2019. A superior tarsal (Müller’s) muscle tagging suture was utilized to achieve an accurate tucking during surgery and create a double upper lid fold simultaneously.

RESULTS: The mean patient age was 31.8 years (range=23-54), and 9 patients (69%) were female. The mean marginal reflex distance 1 increased from 2.46±0.36 mm preoperatively to 4.07±0.61 mm postoperatively with a statistically significant difference. Most patients showed favorable results with an average of 10.8 months of follow-up and minimal complications.

CONCLUSIONS: This simultaneous double eyelid blepharoplasty technique using a single-knot, continuous, nonincisional technique is relatively easy and effective, with minimal downtime and few postoperative complications, and avoids scarring for patients with mild to moderate blepharoptosis.

PMID:35905501 | DOI:10.1097/SCS.0000000000008753

Can Urol Assoc J. 2022 Aug;16(8):273-278. doi: 10.5489/cuaj.7974.

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has caused many residency programs to pivot from traditional face-to-face to virtual teaching. The objective of this study was to assess the state of virtual education in Canadian urology programs and gauge interest in a national virtual curriculum.

METHODS: An electronic 15-item survey was distributed to all 13 Canadian urology programs’ directors and administrative assistants for circulation to residents. Data collection took place over six weeks from September to November 2020. A mixed-methods approach was used, including descriptive statistics and an inductive thematic analysis of responses to open-ended questions.

RESULTS: Eleven program directors and 32 residents from all four geographic areas (Atlantic, Ontario, Quebec, Western [MB, AB, BC]) responded to the survey. Overall, 95.3% of respondents indicated a role for virtual education in their program during the pandemic. Most respondents (74.4%) believe there is a significant or very significant role for a virtual national urology curriculum. All program directors indicated they are at least somewhat likely to require resident participation in such a curriculum. Most (90.6%) resident respondents indicated they believe such a curriculum will be at least somewhat important to their learning. Commonly described benefits include exposure to subspecialties, expertise at other institutions, and standardization of teaching. Commonly described barriers include difficulty with engagement, time zone differences, and lack of dedicated time for attendance.

CONCLUSIONS: During the COVID-19 pandemic, virtual education has become well-integrated in Canadian urology programs. This study highlights interest in the development of a national virtual urology curriculum and puts forth some key considerations to ensure its success.

PMID:35905483 | DOI:10.5489/cuaj.7974

J Clin Rheumatol. 2022 Jul 29. doi: 10.1097/RHU.0000000000001884. Online ahead of print.

ABSTRACT

OBJECTIVE: Cardiovascular disease is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). Hypertension (HTN) and nondipping are modifiable risk factors for cardiovascular disease. Limited studies are available for childhood-onset SLE (cSLE). We aimed to assess ambulatory blood pressure monitoring (ABPM) pattern in cSLE patients with normal office blood pressure.

METHODS: This cross-sectional single-center study enrolled 25 patients with cSLE, normal office blood pressure and normal renal function. We performed 24-hour ABPM and echocardiography to assess end-organ damage. Descriptive statistics were obtained, and comparison of variables using Fisher exact test, t test, and Mann-Whitney U test was performed to identify potential risk factors for nondipping.

RESULTS: Of the 25 patients, 22 were women; the median age was 18 years (interquartile range, 16-20 years). Median SLE duration was 4.2 years (interquartile range, 2.9-8.1 years); 18 patients had a history of lupus nephritis (LN). Four patients, 3 of whom had LN, had masked HTN. Fourteen patients (56%) were nondipping. The majority of patients without LN (71%) had a nondipping profile. Echocardiography was done for 15 patients. Left ventricular mass index, relative wall thickness, and ejection fraction were normal in all patients. Ambulatory blood pressure monitoring results led to changes in therapy in 5 patients.

CONCLUSION: Our data provide evidence of high prevalence of nondipping and masked HTN in patients with cSLE, even in patients without LN. Identifying ABPM abnormalities in these patients could potentially improve outcomes.

PMID:35905479 | DOI:10.1097/RHU.0000000000001884

Ann Fam Med. 2022 Apr 1;20(20 Suppl 1). doi: 10.1370/afm.20.s1.3139.

ABSTRACT

CONTEXT: Although chronic pain and high-risk alcohol use are prevalent in primary care and associated with more severe pain and functional impairment, current approaches address them separately and often neglect risky alcohol use among those with chronic pain. Treatments tailored to patient preferences increase utilization, yet little is known about patient treatment preferences for chronic pain and high-risk alcohol use.

OBJECTIVE: Describe treatment barriers and preferences of primary care patients with chronic musculoskeletal pain and past-year alcohol use and test for differences based on alcohol use (no risk, low risk, high risk).

STUDY DESIGN: Chart review and patient survey.

SETTING: VA primary care clinics. Inclusion criteria: ≥ 18 years old, past year VA primary care visit, chronic musculoskeletal condition, past year alcohol use. Exclusion criteria: psychotic or neurocognitive disorder diagnosis. Eligible participants were identified via chart review and mailed a survey packet.

POPULATION STUDIED: Participants (N = 371) were primarily White (74.7%) male (88.4%) veterans.

MAIN AND SECONDARY OUTCOME MEASURES: Readiness to change, alcohol treatment barriers, pain-alcohol beliefs, attitudes toward behavioral health and medical treatment, and treatment preferences were assessed.

RESULTS: Chi-square tests revealed statistically significant preferences for: face-to-face (70.3% preferred), individual (68.7% preferred), VA primary care, (69.2% preferred), and chronic pain focus (38.4% preferred). Patients with high-risk alcohol use reported more readiness to change alcohol use, stronger pain-alcohol beliefs, and more favorable attitudes toward behavioral health treatment than those with low- or no-risk alcohol use.

CONCLUSIONS: Primary care patients with chronic musculoskeletal pain and alcohol use showed clear preferences for individual, face-to-face behavioral health treatment focused on chronic pain in a VA primary care clinic. Those with co-occurring high-risk alcohol use may experience differences in treatment barriers that may impede treatment engagement (i.e., stronger pain-alcohol beliefs), and in other cases, may facilitate treatment engagement (i.e., more readiness to change, more favorable treatment attitudes) compared to those with low- or no-risk alcohol use. Incorporating patient perspectives may help clinicians provide optimal behavioral health treatment for chronic pain and/or hazardous alcohol use in primary care.

PMID:35905462 | DOI:10.1370/afm.20.s1.3139

Ann Fam Med. 2022 Apr 1;20(20 Suppl 1). doi: 10.1370/afm.20.s1.2881.

ABSTRACT

CONTEXT: Primary care providers can ask men about intimate partner violence (IPV) perpetration or victimization using validated questions, yet physicians feel unprepared to screen men for IPV. Few studies examine men’s physical IPV categories of perpetration-only, both perpetration and victimization, and victimization-only, or their associations with technology-facilitated abuse (TFA).

OBJECTIVE: Assess (1) prevalence of men’s physical IPV and (2) associations of physical IPV with demographics, children, health services use, self-reported physical or mental health diagnoses, substance use problems, and TFA.

STUDY DESIGN: Survey with survey-weighted descriptive statistics and multinomial logistic regression.

SETTING: Community-based nationally representative sample of U.S. men using IPSOS KnowledgePanel August-September 2014.

POPULATION STUDIED: 2,889 men age 18-35 with response rate 47% (1346/2889). Inclusion criteria “ever in a romantic relationship” yielded analysis sample 1074 men.

OUTCOME MEASURE: Physical IPV categories: perpetration-only, both perpetration and victimization, and victimization-only.

RESULTS: Among young U.S. men, physical IPV was reported by 2.5% perpetration only, 16.7% both perpetration and victimization, and 10.0% victimization only. Multivariate analyses showed physical IPV perpetration-only associated with primary care use (AOR 0.25, 95%CI 0.09-0.70), chronic pain (AOR 6.92, 95%CI 1.74-27.55), and prescription opioid misuse (AOR 2.31, 95%CI 1.53-3.47); IPV both perpetration and victimization associated with belief that children who do not witness parental IPV are still harmed (AOR 0.59, 95%CI 0.43-0.82), primary care use (AOR 0.54, 95%CI 0.31-0.94), alcohol misuse (AOR 1.08, 95%CI 1.01-1.15), prescription opioid misuse (AOR 1.58, 95%CI 1.09-2.29), TFA delivered only (AOR 3.64, 95%CI 1.23-10.80), TFA both delivered and received (AOR 6.08, 95%CI 3.32-11.13), TFA received only (AOR 4.95, 95%CI 1.54-15.91); IPV victimization-only associated with mental healthcare visits (AOR 2.34, 95%CI 1.19-4.64), TFA both delivered and received (AOR 2.31, 95%CI 1.16-4.58), and TFA received only (AOR 5.26, 95%CI 2.24-12.38).

CONCLUSIONS: Among young U.S. men, physical IPV was reported by 1 in 40 for perpetration only, 1 in 6 for both perpetration and victimization, and 1 in 10 for victimization only. Primary care physicians can consider assessing physical IPV among male patients. Limitations include self-report and no context for IPV.

PMID:35905460 | DOI:10.1370/afm.20.s1.2881