Category: Statistics

Malar J. 2022 Jun 7;21(1):175. doi: 10.1186/s12936-022-04175-w.

ABSTRACT

BACKGROUND: The collection and utilization of surveillance data is essential in monitoring progress towards achieving malaria elimination, in the timely response to increases in malaria case numbers and in the assessment of programme functioning. This paper describes the surveillance activities used by the malaria elimination task force (METF) programme which operates in eastern Myanmar, and provides an analysis of data collected from weekly surveillance, case investigations, and monitoring and evaluation of programme performance.

METHODS: This retrospective analysis was conducted using data collected from a network of 1250 malaria posts operational between 2014 and 2021. To investigate changes in data completeness, malaria post performance, malaria case numbers, and the demographic details of malaria cases, summary statistics were used to compare data collected over space and time.

RESULTS: In the first 3 years of the METF programme, improvements in data transmission routes resulted in a 18.9% reduction in late reporting, allowing for near real-time analysis of data collected at the malaria posts. In 2020, travel restrictions were in place across Karen State in response to COVID-19, and from February 2021 the military coup in Myanmar resulted in widescale population displacement. However, over that period there has been no decline in malaria post attendance, and the majority of consultations continue to occur within 48 h of fever onset. Case investigations found that 43.8% of cases travelled away from their resident village in the 3 weeks prior to diagnosis and 36.3% reported never using a bed net whilst sleeping in their resident village, which increased to 72.2% when sleeping away from their resident village. Malaria post assessments performed in 82.3% of the METF malaria posts found malaria posts generally performed to a high standard.

CONCLUSIONS: Surveillance data collected by the METF programme demonstrate that despite significant changes in the context in which the programme operates, malaria posts have remained accessible and continue to provide early diagnosis and treatment contributing to an 89.3% decrease in Plasmodium falciparum incidence between 2014 and 2021.

PMID:35672747 | DOI:10.1186/s12936-022-04175-w

BMC Infect Dis. 2022 Jun 7;22(1):525. doi: 10.1186/s12879-022-07499-9.

ABSTRACT

BACKGROUND: Guizhou is located in the southwest of China with high multidrug-resistant tuberculosis (MDR-TB) epidemic. To fight this disease, Guizhou provincial authorities have made efforts to establish MDR-TB service system and perform the strategies for active case finding since 2014. The expanded case finding starting from 2019 and COVID-19 pandemic may affect the cases distribution. Thus, this study aims to analyze MDR-TB epidemic status from 2014 to 2020 for the first time in Guizhou in order to guide control strategies.

METHODS: Data of notified MDR-TB cases were extracted from the National TB Surveillance System correspond to population information for each county of Guizhou from 2014 to 2020. The percentage change was calculated to quantify the change of cases from 2014 to 2020. Time trend and seasonality of case series were analyzed by a seasonal autoregressive integrated moving average (SARIMA) model. Spatial-temporal distribution at county-level was explored by spatial autocorrelation analysis and spatial-temporal scan statistic.

RESULTS: Guizhou has 9 prefectures and 88 counties. In this study, 1,666 notified MDR-TB cases were included from 2014-2020. The number of cases increased yearly. Between 2014 and 2019, the percentage increase ranged from 6.7 to 21.0%. From 2019 to 2020, the percentage increase was 62.1%. The seasonal trend illustrated that most cases were observed during the autumn with the trough in February. Only in 2020, a peak admission was observed in June. This may be caused by COVID-19 pandemic restrictions being lifted until May 2020. The spatial-temporal heterogeneity revealed that over the years, most MDR-TB cases stably aggregated over four prefectures in the northwest, covering Bijie, Guiyang, Liupanshui and Zunyi. Three prefectures (Anshun, Tongren and Qiandongnan) only exhibited case clusters in 2020.

CONCLUSION: This study identified the upward trend with seasonality and spatial-temporal clusters of MDR-TB cases in Guizhou from 2014 to 2020. The fast rising of cases and different distribution from the past in 2020 were affected by the expanded case finding from 2019 and COVID-19. The results suggest that control efforts should target at high-risk periods and areas by prioritizing resources allocation to increase cases detection capacity and better access to treatment.

PMID:35672746 | DOI:10.1186/s12879-022-07499-9

BMC Med Inform Decis Mak. 2022 Jun 7;22(1):151. doi: 10.1186/s12911-022-01893-8.

ABSTRACT

BACKGROUND: In many hospitals, operating theatres are not used to their full potential due to the dynamic nature of demand and the complexity of theatre scheduling. Theatre inefficiencies may lead to access block and delays in treating patients requiring critical care. This study aims to employ operating theatre data to provide decision support for improved theatre management.

METHOD: Historical observations are used to predict long-term daily surgery caseload in various levels of granularity, from emergency versus elective surgeries to clinical specialty-level demands. A statistical modelling and a machine learning-based approach are developed to estimate daily surgery demand. The statistical model predicts daily demands based on historical observations through weekly rolling windows and calendar variables. The machine learning approach, based on regression algorithms, learns from a combination of temporal and sequential features. A de-identified data extract of elective and emergency surgeries at a major 783-bed metropolitan hospital over four years was used. The first three years of data were used as historical observations for training the models. The models were then evaluated on the final year of data.

RESULTS: Daily counts of overall surgery at a hospital-level could be predicted with approximately 90% accuracy, though smaller subgroups of daily demands by medical specialty are less predictable. Predictions were generated on a daily basis a year in advance with consistent predictive performance across the forecast horizon.

CONCLUSION: Predicting operating theatre demand is a viable component in theatre management, enabling hospitals to provide services as efficiently and effectively as possible to obtain the best health outcomes. Due to its consistent predictive performance over various forecasting ranges, this approach can inform both short-term staffing choices as well as long-term strategic planning.

PMID:35672729 | DOI:10.1186/s12911-022-01893-8

BMC Nurs. 2022 Jun 6;21(1):144. doi: 10.1186/s12912-022-00916-z.

ABSTRACT

BACKGROUND: Even though evidence based practice (EBP) is being considered as a critical element in improving the quality of health services and achieving excellence in patient care, there is currently little knowledge of how EBP relates to nursing and midwifery in Malawi. This paper is a report of a study describing EBP knowledge, attitudes, and use of registered nurse-midwives practicing in central hospitals across Malawi.

METHODS: The descriptive, cross-sectional research design was conducted with a randomly selected sample of 183 nurse-midwives (response rate of 87.9%). The study used a paper version questionnaire to collect the data. The data were analysed using both descriptive and inferential statistics in the Statistical Product and Service Solutions version 23. Descriptive statistics were calculated to summarise overall knowledge levels, attitudes, and use of nurse-midwives as percentages based on their scores on the assessment scale (1 to 7 Likert scale) in the EBP questionnaire. Non-parametric Mann-Whitney and Kruskal-Wallis tests were carried out to compare evidence-based practice scores based on demographics. Pearson’s correlation (r) and stepwise regression analysis were further performed to analyse the relationship between the knowledge, attitude and use of nurse-midwives on the overall EBP of nurse-midwives.

RESULTS: The average scores (mean±SD) of evidence-based practice amongst nurse-midwives were 78.7 ± 19.6 for attitude, 70.6 ± 15.1 for knowledge levels, 57.8 ± 23 for use, and 68.9 ± 14.2 for the overall EBP. Higher educational qualification was associated with higher scores in knowledge levels (P = 0.02). Research experience was associated with higher scores in nursing use (P = 0.005), and higher overall evidence-based practice were associated with both research experience (P = 0.035) and educational qualification (P = 0.004). Nurse-midwives attitude was affected by clinical experience (P = 0.006) and the hospital where nurse-midwives worked (P = 0.016). There was no significant difference in the EBP scores of nurse-midwives based on gender and/or their administrative roles in their respective central hospitals.

CONCLUSION: It is important to develop the knowledge or skills of nurse midwives in order to enhance evidence-based practice amongst nurse-midwives in Malawian hospitals. The results can be used by nurse managers, nurse educators, policy makers at the Ministry of Health and Nurses and Midwives Council of Malawi to enhance implementation of EBP.

PMID:35672731 | DOI:10.1186/s12912-022-00916-z

BMC Womens Health. 2022 Jun 7;22(1):214. doi: 10.1186/s12905-022-01804-z.

ABSTRACT

BACKGROUND: Despite the high prevalence of mental health issues among young mothers, their subsequent needs for mental health care support does not correlate with their access and use of services. The purpose of this study, grounded in the experiences of young mothers living in Ontario, Canada, was to describe their experiences of using mental health services during the perinatal period, and to identify the attributes of services and professionals that influenced their decision to engage with mental health services.

METHODS: As the qualitative component of a sequential explanatory mixed methods study, the principles of qualitative description informed sampling, data collection, and analysis decisions. In-depth, semi-structured interviews were conducted with a purposeful sample of 29 young mothers (≤ 21 years) who met diagnostic criteria for at least one psychiatric disorder, and who were ≥ 2 months postpartum. Interview data were triangulated with data from ecomaps and a sub-set of demographic data for this purposeful sample from the survey conducted in the quantitative study component. Qualitative data were analyzed using both conventional content analysis and reflexive thematic analysis; the subset of survey data extracted for these 29 participants were analyzed using descriptive statistics.

RESULTS: Young mothers identified the need to have at least one individual, either an informal social support or formal service provider who they could talk to about their mental health. Among participants deciding to seek professional mental health support, their hesitancy to access services was grounded in past negative experiences or fears of being judged, being medicated, not being seen as an active partner in care decisions or experiencing increased child protection involvement. Participants identified organizational and provider attributes of those delivering mental health care that they perceived influenced their use of or engagement with services.

CONCLUSION: Organizations or health/social care professionals providing mental health services to young pregnant or parenting mothers are recommended to implement trauma-and violence-informed care. This approach prioritizes the emotional and physical safety of individuals within the care environment. Applying this lens in service delivery also aligns with the needs of young mothers, including that they are actively listened to, treated with respect, and genuinely engaged as active partners in making decisions about their care and treatment.

PMID:35672725 | DOI:10.1186/s12905-022-01804-z

BMC Public Health. 2022 Jun 7;22(1):1137. doi: 10.1186/s12889-022-13535-9.

ABSTRACT

BACKGROUND: Reduced meat consumption benefits human and planetary health. Modelling studies have demonstrated the significant health and environmental gains that could be achieved through fiscal measures targeting meat. Adding other interventions may enhance the effect of a fiscal measure. The current study aimed to examine the effect of higher meat prices, an information nudge and a combination of both measures on meat purchases in a three-dimensional virtual supermarket.

METHODS: A parallel designed randomised controlled trial with four conditions was performed. Participants (≥ 18 years) were randomly assigned to the control condition or one of the experimental conditions: a 30% price increase for meat (‘Price condition’), an information nudge about the environmental impact of meat production and consumers’ role in that regard (‘Information nudge condition’) or a combination of both (‘Combination condition’). Participants were asked to shop for their household for one week. The primary outcome was the difference in the total amount of meat purchased in grams per household per week.

RESULTS: Between 22 June 2020 and 28 August 2020, participants were recruited and randomly assigned to the control and experimental conditions. The final sample included 533 participants. In the ‘Combination condition’, – 386 g (95% CI: – 579, – 193) meat was purchased compared with the ‘Control condition’. Compared to the ‘Control condition’ less meat was purchased in the ‘Price condition’ (- 144 g (95%CI: – 331, 43)), although not statistically significant, whereas a similar amount of meat was purchased in the ‘Information nudge condition’ (1 g (95%CI: – 188, 189)).

CONCLUSION: Achieving the most pronounced effects on reduced meat purchases will require a policy mixture of pricing and informational nudging. Less meat is purchased in a virtual supermarket after raising the meat price by 30% combined with an information nudge. The results could be used to design evidence-based policy measures to reduce meat purchases.

TRIAL REGISTRATION: The trial was registered in the Netherlands Trial Register identifier NL8628 . Registered on 18/05/2020. ICTRP Search Portal (who.int) NTR (trialregister.nl).

PMID:35672726 | DOI:10.1186/s12889-022-13535-9

BMC Musculoskelet Disord. 2022 Jun 7;23(1):549. doi: 10.1186/s12891-022-05489-1.

ABSTRACT

BACKGROUND: Postural control is associated with fall risk. Patients with rheumatoid arthritis (RA) have a higher risk to fall than healthy subjects. The objective of this study was to identify associations between variables of postural control with prospective falls in patients with RA.

METHODS: For the baseline, the balance performance of 289 men and women with RA, ages 24-85 years, was evaluated by SPPB, FICSIT-4 and Romberg tests. Postural sway for Romberg, semitandem, tandem and one-leg stands were measured with the Leonardo Mechanograph®. Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ) and the Activity-specific Balance Confidence Scale (ABC-scale). Falls were reported in quarterly reports over a year. Univariate and multiple logistic regression analysis were used to explore any associations with falling. Receiver-operating characteristics were determined, and the area under the curve is reported.

RESULTS: A total of 238 subjects completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. Age (OR = 1.04, CI 1.01-1.07), HAQ (OR = 1.62, 1.1-2.38), FICSIT-4 scoring 0-4 (OR = 2.38, 1.13-5.0), and one-leg standing (OR = 2.14, 1.06-4.31) showed significant associations with falls. With regard to the SPPB and ABC-scale, no statistically significant associations with falls were found. The quartiles containing the worst results of medio-lateral sway of Romberg (OR = 2.63, CI 1.03-6.69), total sway of semitandem (OR = 3.07, CI 1.10-8.57) and tandem (OR = 2.86, CI 1.06-7.69), and area of sway of semitandem (OR = 2.80, CI 1.11-7.08) stands were associated with falls.

CONCLUSIONS: The assessment of a one-leg stand seems to be a good screening tool to discriminate between high and low risk of falls in RA patients in clinical practice. A low FICSIT-4 score and several sway parameters are important predictors of falls.

TRIAL REGISTRATION: The study has been registered at the German Clinical Trials Register and the WHO International Clinical Trials Registry Platform (ICTRP) since 16 March 2017 ( DRKS00011873 ).

PMID:35672724 | DOI:10.1186/s12891-022-05489-1

Telemed J E Health. 2022 Jun 7. doi: 10.1089/tmj.2022.0118. Online ahead of print.

ABSTRACT

Background: The widespread use of telemedicine systems and medical information networks has made telemedicine one of the current trends in health care. The purpose of this article is to propose a community health intervention with remote monitoring and teleconsultation during COVID-19 for the prevention and control of COVID-19 at the rural level. Methods: In this intervention study, a randomized group of 1,500 community residents was selected. A questionnaire with acceptable validity and reliability was used to collect data. The study was conducted with the test group itself as a control, and the questionnaire was completed again 6 months after the health intervention through remote monitoring. The extent of the effect of the remote monitoring intervention on community health during COVID-19 was measured. The data were entered into SPSS 26, and the data were analyzed using the K-S normality test, t-test, and chi-square test. Results: After 6 months of the intervention, the differences in mean scores of the test group were statistically significant (p < 0.05) in cognition, perceived benefits, self-efficacy, and behavioral outcomes, with a substantial increase in mean scores for all variables. Conclusions: The application of remote monitoring during COVID-19 in rural communities can influence the health perception, benefit perception, self-efficacy, and behavior of community residents, thus effectively preventing and controlling the spread of COVID-19 in rural communities. It reduces medical barriers for rural areas while meeting.

PMID:35671521 | DOI:10.1089/tmj.2022.0118

ACS Appl Bio Mater. 2022 Jun 7. doi: 10.1021/acsabm.2c00119. Online ahead of print.

ABSTRACT

Transparent yttria-stabilized zirconia (YSZ) ceramics are promising for cranial window applications because of their good mechanical and optical properties as well as biocompatibility. YSZ discs with different yttria concentrations were either processed via current-activated pressure-assisted densification (CAPAD) using commercial nanoparticles or densified via spark plasma sintering (SPS) using pyrolysis-synthesized nanoparticles in-house. This study provided critical results to screen composition, processing, microstructure, and cytocompatibility of transparent YSZ discs for cranial window applications. CAPAD-processed YSZ discs with 6 or 8 mol % yttria (6YSZ and 8YSZ) and SPS-densified YSZ discs with 4 mol % yttria (4YSZ_P) showed 200-350 nm polycrystalline grains containing 20-30 nm crystallite domains. SPS-densified YSZ discs with 8 mol % yttria (8YSZ_P) showed larger polycrystalline grains of 819 ± 155 nm with 29 ± 5 nm crystallite domains. CAPAD-processed YSZ discs with 3 mol % yttria (3YSZ) showed 39 ± 9 nm grains. Bone-marrow-derived stem cells (BMSCs) on the polished YSZ discs showed statistically higher spreading areas than those on the unpolished YSZ discs of the same compositions. Generally, polished 8YSZ, 4YSZ_P, and 8YSZ_P discs and unpolished 8YSZ_R, 4YSZ_PR, and 8YSZ_PR discs had lower average cell adhesion densities than other YSZ discs under direct contact conditions. Under indirect contact conditions, all the YSZ disc groups showed similar average cell adhesion densities to the Cell-only control. The groups of polished 4YSZ_P and 8YSZ_P discs, unpolished 4YSZ_PR and 8YSZ_PR discs, and particle control of 8YSZ_Pnp showed higher Y³⁺ ion concentrations than other groups. No mineral deposition was detected on the polished YSZ discs after cell culture. Considering multiple factors such as cytocompatibility, cell adhesion density, Y³⁺ ion release, mineral deposition, and optical transparency collectively, 8YSZ may be the best candidate for the cranial window applications. Further studies are needed to evaluate the long-term transparency and biocompatibility of YSZ discs.

PMID:35671525 | DOI:10.1021/acsabm.2c00119

Telemed J E Health. 2022 Jun 7. doi: 10.1089/tmj.2022.0138. Online ahead of print.

ABSTRACT

Aim: To investigate factors influencing delayed or forgone care due to the coronavirus pandemic and examine patterns in overall virtual care use and virtual care related to the coronavirus pandemic. Methods: The cross-sectional study used the 2020 National Center for Health Statistics, National Health Interview Survey. Individuals (17,586) who responded to delayed or forgone care questions were included. A generalized linear model estimated prevalence ratios (PRs) for delayed care, forgone care, and virtual care. Results: Approximately 26.5% of participants reported either having delayed (23.6%) or forgone care (15.7%). Females showed 1.29 (95% confidence interval [CI] 1.20-1.38; p ≤ 0.000) and 1.29 (95% CI 1.17-1.48; p ≤ 0.000) times greater risk of delayed and forgone care than males, respectively. Being insured and having chronic conditions were associated with more delayed and forgone care. About 32.5% of adults reported 1 year of virtual care, and of these, 83.6% were related to the coronavirus pandemic. Patterns of virtual care use of 1 year and the one related to the coronavirus pandemic varied. In the coronavirus pandemic-related virtual care, adults of 85 years old or above had a lower likelihood (PR 0.87, 95% CI 0.77-1.00; p = 0.043) of receiving virtual care. Low education attainment and nonmetro areas showed less virtual care usage. Conclusions: The coronavirus pandemic greatly affected health care. While virtual care significantly increased, historically underserved populations, such as older adults, rural residents, and those with low education attainment, experienced disparities in virtual care use. The findings provide important implications for sustained health care in a rapidly changing public health landscape.

PMID:35671515 | DOI:10.1089/tmj.2022.0138