Category: Statistics

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2022 Mar;30(2):185-194. doi: 10.32687/0869-866X-2022-30-2-185-194.

ABSTRACT

The article presents current trends in reproductive demographic process economically developed countries. Today, the total fertility rate in all European countries is below the minimum required to ensure population reproduction in long term – 2.1 children per woman during her life. According statistic data, 4.167 million children were born in the EU in 2019 that corresponds to 9.3 births per 1000 of population. In the EU, 1.53 children went to one woman in 2019 (in 2018 – 1.54). The lowest total fertility rates in 2019 were registered in Malta (1.14), Spain (1.23) and Italy (1.27). In the United States, fall of rate of childless women with higher education disputes well-established observation of positive relationship between education and childlessness. The infertility affects approximately 8-12% of couples worldwide, at that in developed countries, up to 15% of all couples are infertile. In connection with the problem of birth rate reduction in developed countries, researchers highlight such problems as increasing of average age of mothers at delivery (30-35 years and older) and intervals between labors, development of subsidiary reproductive technologies, pregnancy outcomes, newborns health in short and long perspective. The global COVID-19 pandemic resulted in resources deficiency, complexities with medical services support related to reproductive health, risks for maternal and perinatal outcomes in pregnant women with COVID-19. However, actually still there is no complete picture of pandemic impact on global indices of reproductive demographic process.

PMID:35439373 | DOI:10.32687/0869-866X-2022-30-2-185-194

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2022 Mar;30(2):232-238. doi: 10.32687/0869-866X-2022-30-2-232-238.

ABSTRACT

The diseases of digestive apparatus significantly contribute into premature mortality of population. In the Republic of Buryatia, the diseases of digestive apparatus occupy third place in the structure of primary morbidity of population (6.7%) and fourth place in the structure of total mortality (6.6%). The purpose of the study is to establish characteristics of structure and dynamics of morbidity and mortality of population because of diseases of digestive apparatus in the Republic of Buryatia in 2009-2018. The analysis was based on data from state statistical reporting forms and official reports of the Territorial Authority of the Federal State Statistics Service in Republic of Buryatia for 2009-2018, reporting and accounting forms of medical organizations. The study was carried out using statistical, analytical methods, as well as elements of comparative analysis. The analysis testifies increasing of indicator of primary morbidity of diseases of digestive apparatus from 4051.0 to 4226.1 per 100 thousand of population and of mortality of diseases of digestive apparatus in the Republic of Buryatia from 60.6 to 62.5 per 100 thousand of population. The main causes of increasing of morbidity and mortality from diseases of digestive apparatus in the Republic of Buryatia are liver diseases, in particular liver fibrosis and cirrhosis because of alcoholization of population, undue diagnostics and treatment of liver pathology in the group “older than able-bodied age”.

PMID:35439381 | DOI:10.32687/0869-866X-2022-30-2-232-238

Arthritis Care Res (Hoboken). 2022 Apr 19. doi: 10.1002/acr.24897. Online ahead of print.

ABSTRACT

OBJECTIVE: Early diagnosis and tight control improve outcomes of rheumatoid arthritis (RA). However, it is not known whether establishing an Early Arthritis Clinic (EAC) is sustainable for national health systems. This analysis aims to compare effectiveness and costs of an EAC compared to patients followed as for standards of care.

METHODS: A retrospective study on administrative health databases of patients with a new diagnosis of RA was conducted: 430 patients followed in an EAC were enrolled, and 4 non-EAC controls were randomly matched for each of them. During two years of follow up, the mean healthcare costs (outpatient, inpatient, pharmaceutical and global) and 3 effectiveness measures (number and length of hospitalization and quality of care) of EAC and non-EAC were estimated. The incremental cost-effectiveness ratio was calculated as well as the cost-effectiveness acceptability curve.

RESULTS: The cohorts included patients with a mean age of 55.4 years and 1506 (70%) females. Mean pharmaceutical (2602 versus 1945 €) and outpatient (2447 versus 1778 €) costs were higher in the EAC cohort. Conversely, a higher rate of non-EAC patients had a low adherence to quality-of-care indicators. The expected number of hospitalizations and the length of stay were statistically significant higher in non-EAC versus EAC.

CONCLUSION: Despite an expected increase in outpatient costs (visits and diagnostic tests) and pharmaceutical costs, the reduction in terms of number and length of hospitalizations and the higher adherence to international quality of care guidelines support the effectiveness of the EAC model.

PMID:35439369 | DOI:10.1002/acr.24897

Dermatol Ther. 2022 Apr 19:e15524. doi: 10.1111/dth.15524. Online ahead of print.

ABSTRACT

BACKGROUND: Recent knowledge on the key role of interleukin (IL)23/17 axis in psoriasis pathogenesis, led to development of new biologic drugs. Risankizumab is a humanized immunoglobulin G1 monoclonal antibody specifically targeting IL23. Its efficacy and safety were showed by both clinical trials and real-life experiences. However, real life data on effectiveness and safety of risankizumab in patients who previously failed anti-IL17 are scant.

OBJECTIVES: To assess the efficacy and safety of risankizumab in patients who previously failed anti-IL17.

METHODS: A 52-week real-life retrospective study was performed to assess the long-term efficacy and safety of risankizumab in patients who previously failed anti-IL17.

RESULTS: A total of 39 patients (26 male,66.7%; mean age 50.5±13.7years) were enrolled. A statistically significant reduction of Psoriasis Area Severity Index (PASI) and Body Surface Area (BSA) was assessed at each follow-up (PASI at baseline vs week52: 13.7±5.8 vs 0.9±0.8,p<0.0001; BSA 21.9±14.6 vs 1.9±1.7,p<0.0001). Nail Psoriasis Severity Index improved as well, being statistically significative only at week16 and thereafter [9.3±4.7 at baseline, 4.1±2.4(p<0.01) at week16, 1.4±0.8(p<0.0001) at week52]. Treatment was discontinued for primary and secondary inefficacy in 1(2.6%) and 3(7.7%) patients, respectively. No cases of serious adverse events were assessed.

CONCLUSION: Our real-life study confirmed the efficacy and safety of risankizumab, suggesting it as a valuable therapeutic weapon among the armamentarium of biologics, also in psoriasis patients who previously failed anti-IL17 treatments.

PMID:35439341 | DOI:10.1111/dth.15524

Cancer. 2022 Apr 19. doi: 10.1002/cncr.34230. Online ahead of print.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitors (ICIs) can cause immune-related adverse events (irAEs) that range from mild to life-threatening. Age itself does not seem to be a predictor for the occurrence of irAEs. It is unknown whether frailty plays a role in the occurrence of irAEs. Therefore, the authors assessed whether irAEs and their sequelae occur more often in frail patients than in fit patients according to the Geriatric 8 (G8) assessment.

METHODS: Patients with melanoma aged 70 years and older who were about to start ICI therapy and were screened with the G8 assessment were enrolled in this prospective, observational study. Patients were classified by the G8 as either fit or frail. The primary outcome was the occurrence of grade ≥3 irAEs.

RESULTS: In total, 92 patients were included for statistical analyses, 26 (29%) of whom were classified as frail. Grade ≥3 irAEs occurred in 20% of patients. There was no significant difference in the occurrence of grade ≥3 irAEs between fit and frail patients (17% vs 27%; P = .26). Frail patients were admitted to the hospital because of irAEs significantly more often than fit patients (29% vs 54%; P = .02) and showed a trend toward increased length of hospitalization (5 vs 8 days; P = .06) and more frequent use of immunosuppressants or ICI discontinuation for irAEs (36% vs 58%; P = .06).

CONCLUSIONS: Although frailty appears to be unrelated to the occurrence of severe irAEs, it is an indicator of irAE-related adverse sequelae, such as hospital admission. Screening for frailty can be of added value in the shared decision-making process for older patients who qualify for ICI treatment.

PMID:35439334 | DOI:10.1002/cncr.34230

J Athl Train. 2022 Apr 1;57(4):352-359. doi: 10.4085/1062-6050-0330.21.

ABSTRACT

CONTEXT: Care-seeking behaviors for sport-related concussion (SRC) are not consistent across demographic subgroups. Not only may these differences stem from health inequities, but they can perpetuate disparities in care for SRCs.

OBJECTIVE: To determine whether racial differences existed in the care pathway from injury to SRC clinic of adolescent athletes.

DESIGN: Retrospective cohort study.

SETTING: Regional SRC center.

PATIENTS OR OTHER PARTICIPANTS: Of 582 total athletes, 96 (16.5%) Black and 486 (83.5%) White adolescent athletes were diagnosed with SRC and evaluated within 3 months at the SRC clinic.

MAIN OUTCOME MEASURE(S): Race was the defined exposure, dichotomized as Black or White. The 4 primary outcomes were (1) location of the first health system contact, (2) time from injury to the first health system contact, (3) time to the in-person SRC clinic visit, and (4) whether the athlete established care (>1 visit), was released immediately to an athletic trainer, or was lost to follow-up.

RESULTS: Black and White athletes mostly presented directly to the SRC clinic (61.5% versus 62.3%) at a median (interquartile range) of 3 (1-5) and 4 (1-8) days, respectively (P = .821). Similar proportions of Black and White athletes also first presented to the emergency department (30.2% and 27.2%) at a median of 0 (0-1) versus 0 (0-1) days, respectively (P = .941). Black athletes more frequently had care transferred to their athletic trainer than White athletes (39.6% versus 29.6%) and less frequently established care (56.3% versus 64.0%), respectively; however, these differences were not statistically significant (P = .138). Loss to follow-up was uncommon among Black (4.2%) and White (6.4%) athletes alike.

CONCLUSIONS: Within an established SRC referral network and multidisciplinary clinic, no racial disparities were observed in how athletes were initially managed or ultimately presented to the SRC clinic despite racial differences in school type and insurance coverage. The SRC center assimilation and affiliation with school systems may be helpful in improving access and providing equitable care across diverse patient demographics.

PMID:35439315 | DOI:10.4085/1062-6050-0330.21

J Athl Train. 2022 Apr 1;57(4):325-333. doi: 10.4085/1062-6050-0407.20.

ABSTRACT

CONTEXT: Return-to-activity (RTA) assessments are commonly administered after anterior cruciate ligament reconstruction (ACLR) to manage the patient’s postoperative progressions back to activity. To date, few data are available on the clinical utility of these assessments to predict patient outcomes such as secondary anterior cruciate ligament (ACL) injury once the athlete has returned to activity.

OBJECTIVE: To identify the measures of patient function at 6 months post-ACLR that best predict RTA and second ACL injury at a minimum of 2 years after ACLR.

DESIGN: Prospective cohort study.

SETTING: Laboratory.

PATIENTS OR OTHER PARTICIPANTS: A total of 234 patients with primary, unilateral ACLR completed functional assessments at approximately 6 months post-ACLR. Of these, 192 (82.1%) completed follow-up at ≥2 years post-ACLR.

MAIN OUTCOME MEASURE(S): The 6-month functional assessments consisted of patient-reported outcomes, isokinetic knee-flexor and -extensor strength, and single-legged hopping. We collected RTA and secondary ACL injury data at ≥2 years after ACLR.

RESULTS: Of the patients who were able to RTA (n = 155), 44 (28.4%) had a subsequent ACL injury, 24 (15.5%) to the ipsilateral graft ACL and 20 (12.9%) to the contralateral ACL. A greater proportion of females had a secondary injury to the contralateral ACL (15/24, 62.5%), whereas a greater proportion of males reinjured the ipsilateral ACL graft (15/20, 75.0%; P = .017). Greater knee-extension symmetry at 6 months increased the probability of reinjury (B = 0.016, P = .048). Among patients with RTA at <8 months, every 1% increase in quadriceps strength symmetry at 6 months increased the risk of reinjury by 2.1% (B = 0.021, P = .05). Among patients with RTA at >8 months, every month that RTA was delayed reduced the risk of reinjury by 28.4% (B = -0.284, P = .042). Descriptive statistics of patient function stratified between the early and delayed RTA groups can be found in the Supplemental Table (available online at http://dx.doi.org/10.4085/1062-6050-0407.20.S1).

CONCLUSIONS: Patients with more symmetric quadriceps strength at 6 months post-ACLR were more likely to experience another ACL rupture, especially those who returned to sport at <8 months after the index surgery. Clinicians should be cognizant that returning high-functioning patients to activity at <8 months post-ACLR may place them at an increased risk for reinjury.

PMID:35439312 | DOI:10.4085/1062-6050-0407.20

J Hered. 2022 Apr 19:esac014. doi: 10.1093/jhered/esac014. Online ahead of print.

ABSTRACT

Pouched lamprey (Geotria australis) or kanakana/piharau is a culturally and ecologically significant jawless fish that is distributed throughout Aotearoa New Zealand. Despite its importance, much remains unknown about historical relationships and gene flow between populations of this enigmatic species within New Zealand. To help inform management, we assembled a draft Geotria australis genome and completed the first comprehensive population genomics analysis of pouched lamprey within New Zealand using targeted gene sequencing (Cyt-b and COI) and restriction site-associated DNA sequencing (RADSeq) methods. Employing 16,000 genome-wide single nucleotide polymorphisms (SNPs) derived from RADSeq (n=186) and sequence data from Cyt-b (766 bp, n=94) and COI (589 bp, n=20), we reveal low levels of structure across 10 sampling locations spanning the species range within New Zealand. F-statistics, outlier analyses, and STRUCTURE suggest a single panmictic population, and Mantel and EEMS tests reveal no significant isolation by distance. This implies either ongoing gene flow among populations or recent shared ancestry among New Zealand pouched lamprey. We can now use the information gained from these genetic tools to assist managers with monitoring effective population size, managing potential diseases, and conservation measures such as artificial propagation programs. We further demonstrate the general utility of these genetic tools for acquiring information about elusive species.

PMID:35439308 | DOI:10.1093/jhered/esac014

PLoS One. 2022 Apr 19;17(4):e0262008. doi: 10.1371/journal.pone.0262008. eCollection 2022.

ABSTRACT

BACKGROUND: Climate change is expected to exacerbate diarrhoea outbreaks across the developing world, most notably in Sub-Saharan countries such as South Africa. In South Africa, diseases related to diarrhoea outbreak is a leading cause of morbidity and mortality. In this study, we modelled the impacts of climate change on diarrhoea with various machine learning (ML) methods to predict daily outbreak of diarrhoea cases in nine South African provinces.

METHODS: We applied two deep Learning DL techniques, Convolutional Neural Networks (CNNs) and Long-Short term Memory Networks (LSTMs); and a Support Vector Machine (SVM) to predict daily diarrhoea cases over the different South African provinces by incorporating climate information. Generative Adversarial Networks (GANs) was used to generate synthetic data which was used to augment the available data-set. Furthermore, Relevance Estimation and Value Calibration (REVAC) was used to tune the parameters of the ML methods to optimize the accuracy of their predictions. Sensitivity analysis was also performed to investigate the contribution of the different climate factors to the diarrhoea prediction method.

RESULTS: Our results showed that all three ML methods were appropriate for predicting daily diarrhoea cases with respect to the selected climate variables in each South African province. However, the level of accuracy for each method varied across different experiments, with the deep learning methods outperforming the SVM method. Among the deep learning techniques, the CNN method performed best when only real-world data-set was used, while the LSTM method outperformed the other methods when the real-world data-set was augmented with synthetic data. Across the provinces, the accuracy of all three ML methods improved by at least 30 percent when data augmentation was implemented. In addition, REVAC improved the accuracy of the CNN method by about 2.5% in each province. Our parameter sensitivity analysis revealed that the most influential climate variables to be considered when predicting outbreak of diarrhoea in South Africa were precipitation, humidity, evaporation and temperature conditions.

CONCLUSIONS: Overall, experiments indicated that the prediction capacity of our DL methods (Convolutional Neural Networks) was found to be superior (with statistical significance) in terms of prediction accuracy across most provinces. This study’s results have important implications for the development of automated early warning systems for diarrhoea (and related disease) outbreaks across the globe.

PMID:35439258 | DOI:10.1371/journal.pone.0262008

PLoS One. 2022 Apr 19;17(4):e0267292. doi: 10.1371/journal.pone.0267292. eCollection 2022.

ABSTRACT

BACKGROUND: Digital health technologies have been used to enhance adherence to TB medication, but the cost-effectiveness remains unclear.

METHODS: We used the real data from the study conducted from April 2014 to December 2020 in Morocco using a smart pillbox with a web-based medication monitoring system, called Medication Event Monitoring Systems (MEMS). Cost-effectiveness was evaluated using a decision analysis model including Markov model for Multi-drug resistant (MDR) TB from the health system perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER) per disability adjusted life-year (DALY) averted. Two-way sensitive analysis was done for the treatment success rate between MEMS and standard of care.

RESULTS: The average total per-patient health system costs for treating a new TB patient under MEMS versus standard of care were $398.70 and $155.70, respectively. The MEMS strategy would reduce the number of drug-susceptible TB cases by 0.17 and MDR-TB cases by 0.01 per patient over five years. The ICER of MEMS was $434/DALY averted relative to standard of care, and was most susceptible to the TB treatment success rate of both strategies followed by the managing cost of MEMS.

CONCLUSION: MEMS is considered cost-effective for managing infectious active TB in Morocco.

PMID:35439273 | DOI:10.1371/journal.pone.0267292