Category: Statistics

Demography. 2021 May 28:9335177. doi: 10.1215/00703370-9335177. Online ahead of print.

ABSTRACT

Previous research has shown that childbearing is associated with short-term improvements in women’s subjective well-being but that these effects depend on the timing and quantum of the birth as well as on the parents’ education and socioeconomic status. These studies did not address whether and, if so, how this effect varies according to the mode of conception. This represents an important knowledge gap, given that conceptions through medically assisted reproduction (MAR) have been increasing rapidly in recent decades, exceeding 5% of live births in some European countries. Drawing on nine waves (2009/2010-2017/2018) of the UK Household Longitudinal Study, we use distributed fixed-effects linear regression models to examine changes in women’s mental health before, during, and after natural and MAR conceptions. The results show that the mental health of women who conceived naturally improved around the time of conception and then gradually returned to baseline levels; comparatively, the mental health of women who conceived through MAR declined in the year before pregnancy and then gradually recovered. The findings also indicate that women’s happiness decreased both two years and one year before an MAR conception and then increased above the baseline in the year of pregnancy. We further show that the deterioration in mental health and subjective well-being before an MAR conception affects both partners, which could be part of a longer process in which the partners potentially suffer from stress related not solely to the MAR treatments themselves but also to the experience of subfertility.

PMID:34047787 | DOI:10.1215/00703370-9335177

JAMA Netw Open. 2021 May 3;4(5):e2111858. doi: 10.1001/jamanetworkopen.2021.11858.

ABSTRACT

IMPORTANCE: The Comprehensive Care for Joint Replacement (CJR) model is Medicare’s mandatory bundled payment reform to improve quality and spending for beneficiaries who need total hip replacement (THR) or total knee replacement (TKR), yet it does not account for sociodemographic risk factors such as race/ethnicity and income. Results of this study could be the basis for a Medicare payment reform that addresses inequities in joint replacement care.

OBJECTIVE: To examine the association of the CJR model with racial/ethnic and socioeconomic disparities in the use of elective THR and TKR among older Medicare beneficiaries after accounting for the population of patients who were at risk or eligible for these surgical procedures.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used the 2013 to 2017 national Medicare data and multivariable logistic regressions with triple-differences estimation. Medicare beneficiaries who were aged 65 to 99 years, entitled to Medicare, alive at the end of the calendar year, and residing either in the 67 metropolitan statistical areas (MSAs) mandated to participate in the CJR model or in the 104 control MSAs were identified. A subset of Medicare beneficiaries with a diagnosis of arthritis underwent THR or TKR. Data were analyzed from March to December 2020.

EXPOSURES: Implementation of the CJR model in 2016.

MAIN OUTCOMES AND MEASURES: Outcomes were separate binary indicators for whether a beneficiary underwent THR or TKR. Key independent variables were MSA treatment status, pre- or post-CJR model implementation phase, combination of race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic beneficiaries) and dual eligibility, and their interactions. Logistic regression models were used to control for patient characteristics, MSA fixed effects, and time trends.

RESULTS: The 2013 cohort included 4 447 205 Medicare beneficiaries, of which 2 025 357 (45.5%) resided in MSAs with the CJR model. The cohort’s mean (SD) age was 77.18 (7.95) years, and it was composed of 2 951 140 female (66.4%), 3 928 432 non-Hispanic White (88.3%), and 657 073 dually eligible (14.8%) beneficiaries. Before the CJR model implementation, rates were highest among non-Hispanic White non-dual-eligible beneficiaries at 1.25% (95% CI, 1.24%-1.26%) for THR use and 2.28% (95% CI, 2.26%-2.29%) for TKR use in MSAs with CJR model. Compared with MSAs without the CJR model and the analogous race/ethnicity and dual-eligibility group, the CJR model was associated with a 0.10 (95% CI, 0.05-0.15; P < .001) percentage-point increase in TKR use for non-Hispanic White non-dual-eligible beneficiaries, a 0.11 (95% CI, 0.004-0.21; P = .04) percentage-point increase for non-Hispanic White dual-eligible beneficiaries, a 0.15 (95% CI, -0.29 to -0.01; P = .04) percentage-point decrease for non-Hispanic Black non-dual-eligible beneficiaries, and a 0.18 (95% CI, -0.34 to -0.01; P = .03) percentage-point decrease for non-Hispanic Black dual-eligible beneficiaries. These CJR model-associated changes in TKR use were 0.25 (95% CI, -0.40 to -0.10; P = .001) percentage points lower for non-Hispanic Black non-dual-eligible beneficiaries and 0.27 (95% CI, -0.45 to -0.10; P = .002) percentage points lower for non-Hispanic Black dual-eligible beneficiaries compared with the model-associated changes for non-Hispanic White non-dual-eligible beneficiaries. No association was found between the CJR model and a widening of the THR use gap among race/ethnicity and dual eligibility groups.

CONCLUSIONS AND RELEVANCE: Results of this study indicate that the CJR model was associated with a modest increase in the already substantial difference in TKR use among non-Hispanic Black vs non-Hispanic White beneficiaries; no difference was found for THR. These findings support the widespread concern that payment reform has the potential to exacerbate disparities in access to joint replacement care.

PMID:34047790 | DOI:10.1001/jamanetworkopen.2021.11858

Indian Pediatr. 2021 May 28:S097475591600333. Online ahead of print.

ABSTRACT

AIM: To compare effectiveness, safety and tolerance of two colon cleansing regimens using polyethylene glycol 4000 (PEG) in children.

METHODS: Prospective, randomized, open clinical trial carried out in 129 children, 3 to 18 years old undergoing colonoscopy. Patients were randomized into two groups, 64 children received PEG with electrolyte (50 mL/kg) and oral bisacodyl (PEG+B) group or 65 other children received PEG with electrolyte (70 mL/kg) and glycerol enema (PEG+G) group.

RESULTS: Both regimens showed a good colon cleansing effectiveness with the percentage of successful cleansing being 93.8% for PEG+B regimen and 89.1% for PEG+G regimen (P=0.510). There was no statistically significant difference between the pre-regimen and post-regimen laboratory values. The rates of nausea (65.6% vs 31.3%; P<0.001) and bloating (50% vs 17.2%; P<0.001) of PEG+G group were significantly higher than that of PEG+B group.

CONCLUSION: Both regimens had good efficacy and safety for clon cleansing in children. The tolerance of PEG+B regimen was better.

PMID:34047716

Indian Pediatr. 2021 May 28:S097475591600337. Online ahead of print.

ABSTRACT

Durations of any event, such as duration of hospitalization, has an annoying feature of highly skewed distribution and incomplete values due to dropouts and limited follow-up. The usual methods of statistical analysis are, therefore, not applicable. The method of survival analysis is a nonparametric method and is designed to overcome these problems. Survival is a generic term and is used for any time-to-event data. The entire survival pattern at different points in time is studied by the Kaplan-Meier method under certain conditions. Log-rank method is used to compare survival pattern in two or more groups. Hazard is the rate of occurrence of an event per unit of time and studied by Cox method. The concept of survival and all these methods of survival analysis are briefly discussed in this short note in a nonmathematical format for medical audience.

PMID:34047720

JAMA Intern Med. 2021 May 28. doi: 10.1001/jamainternmed.2021.1974. Online ahead of print.

ABSTRACT

IMPORTANCE: Patient reviews of health care experiences are increasingly used for public reporting and alternative payment models. Critics have argued that this incentivizes physicians to provide more care, including low-value care, undermining efforts to reduce wasteful practices.

OBJECTIVE: To assess associations between rates of low-value service provision to a primary care professional (PCP) patient panel and patients’ ratings of their health care experiences.

DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study used Medicare fee-for-service claims from January 1, 2007, to December 31, 2014, for a random 20% sample of beneficiaries to identify beneficiaries for whom each of 8 low-value services could be ordered but would be considered unnecessary. The study also used health care experience reports from independently sampled beneficiaries who responded to the 2010-2015 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare fee-for-service survey. Statistical analysis was performed from January 1, 2019, to December 9, 2020.

MAIN OUTCOMES AND MEASURES: The main outcomes were health care experience ratings from Medicare beneficiaries who responded to the CAHPS survey from 2 domains, namely “Your Health Care in the Last 6 Months” (overall health care, office wait time, timely access to nonurgent care, and timely access to urgent care) and “Your Personal Doctor” (overall personal physician and a composite score for interactions with personal physician). Beneficiaries in both samples were attributed to the PCP with whom they had the most spending. For each PCP, a composite score of low-value service exposure was constructed using the 20% sample; this score represented the adjusted relative propensity of the PCP patient panel to receive low-value care. The association between low-value service exposure and health care experience ratings reported by the CAHPS respondents in the PCP patient panel was estimated using regression analysis.

RESULTS: The final sample had 100 743 PCPs, with a mean of approximately 258 patients per PCP. Only 1 notable association was found; more low-value care exposure was associated with more frequent reports of having to wait more than 15 minutes after the scheduled time of an appointment (a mean of 0.448 points lower CAHPS score on a 10-point scale for PCP patient panels who received the most low-value care vs the least low-value care). Although some other associations were statistically significant, their magnitudes were substantially smaller than those typically considered meaningful in other CAHPS literature and were inconsistent in direction across levels of low-value service exposure.

CONCLUSIONS AND RELEVANCE: This quality improvement study found that more low-value care exposure for a PCP patient panel was not associated with more favorable patient ratings of their health care experiences.

PMID:34047761 | DOI:10.1001/jamainternmed.2021.1974

Arch Environ Occup Health. 2021 May 28:1-13. doi: 10.1080/19338244.2021.1931796. Online ahead of print.

ABSTRACT

Among health care professionals, dentists are more prone to infection due to their direct contact with blood and saliva. This study highlights the level of compliance with infection control measures among dental students; and linked this to their knowledge and attitudes regarding infection control measures and proper vaccinations. The study is a multi-centre analytical cross-sectional survey. The sample size was 969 clinical years’ students from governmental and private dental colleges in Sudan and Saudi Arabia. A pre-coded, pre-tested, and anonymous questionnaire consisted of seven categories of knowledge, attitude, awareness, and practices, including 40 questions, was answered. The study has linked knowledge, attitude, and practice in dental clinics with possible COVID-19 transmission in dental clinics. The results showed that the use of some Personal Protective Equipment was low in Sudan and moderate in Saudi Arabia (statistically significant, p < 0.001). Moderate percentage of Hepatitis B vaccination status, with low percentage of Post HBV serology, was reported (p < 0.001). The percentages of major causes of percutaneous and/or eye exposure/injury, for examples, were as follows: anesthesia (33.3-62.7%, p 0.006) and suture needle (17.5-39.4%, p 0.037). In conclusion, dental students in the present study had good knowledge and positive attitudes regarding infection control in general, but showed moderate compliance with the recommended infection control guidelines.

PMID:34047677 | DOI:10.1080/19338244.2021.1931796

Parasite. 2021;28:46. doi: 10.1051/parasite/2021042. Epub 2021 May 27.

ABSTRACT

Dicrocoelium dendriticum is a trematode that infects ruminant livestock and requires two different intermediate hosts to complete its lifecycle. Modelling the spatial distribution of this parasite can help to improve its management in higher risk regions. The aim of this research was to assess the constraints of using historical data sets when modelling the spatial distribution of helminth parasites in ruminants. A parasitological data set provided by CREMOPAR (Napoli, Italy) and covering most of Italy was used in this paper. A baseline model (Random Forest, VECMAP^®) using the entire data set was first used to determine the minimal number of data points needed to build a stable model. Then, annual distribution models were computed and compared with the baseline model. The best prediction rate and statistical output were obtained for 2012 and the worst for 2016, even though the sample size of the former was significantly smaller than the latter. We discuss how this may be explained by the fact that in 2012, the samples were more evenly geographically distributed, whilst in 2016 most of the data were strongly clustered. It is concluded that the spatial distribution of the input data appears to be more important than the actual sample size when computing species distribution models. This is often a major issue when using historical data to develop spatial models. Such data sets often include sampling biases and large geographical gaps. If this bias is not corrected, the spatial distribution model outputs may display the sampling effort rather than the real species distribution.

PMID:34047693 | DOI:10.1051/parasite/2021042

JMIR Res Protoc. 2021 May 28;10(5):e26110. doi: 10.2196/26110.

ABSTRACT

BACKGROUND: Due to their ability to collect person-generated health data, digital tools and connected health devices may hold great utility in disease prevention, chronic disease self-monitoring and self-tracking, as well as in tailoring information and educational content to fit individual needs. Facilitators and barriers to the use of digital health technologies vary across demographics, including sex. The “femtech” market is growing rapidly, and women are some of the largest adopters of digital health technologies.

OBJECTIVE: This paper aims to provide the background and methods for conducting a scoping review on the use of person-generated health data from connected devices in women’s health. The objectives of the scoping review are to identify the various contexts of digital technologies in women’s health and to consolidate women’s views on the usability and acceptability of the devices.

METHODS: Searches were conducted in the following databases: Medline, Embase, APA PsycInfo, CINAHL Complete, and Web of Science Core Collection. We included articles from January 2015 to February 2020. Screening of articles was done independently by at least two authors in two stages. Data charting is being conducted in duplicate. Results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist.

RESULTS: Our search identified 9102 articles after deduplication. As of November 2020, the full-text screening stage is almost complete and data charting is in progress. The scoping review is expected to be completed by Fall 2021.

CONCLUSIONS: This scoping review will broadly map the literature regarding the contexts and acceptability of digital health tools for women. The results from this review will be useful in guiding future digital health and women’s health research.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26110.

PMID:34047708 | DOI:10.2196/26110

J Matern Fetal Neonatal Med. 2021 May 27:1-5. doi: 10.1080/14767058.2021.1909560. Online ahead of print.

ABSTRACT

OBJECTIVE: Assess women’s perceptions of the impact of COVID-19 on their health care and well-being, access to and satisfaction with medical care due to the changes in delivery of care triggered by the pandemic.

METHODS: An online survey of women having health care appointments in the outpatient facilities across all divisions of a Department of Obstetrics and Gynecology at a tertiary care referral center in North Central Florida. Patients had outpatient appointments that were scheduled, canceled or rescheduled, in person or by telemedicine, between 11 March 2020 and 11 May 2020, a time during which a COVID-19 stay-at-home order was enacted across our state. A total of 6,697 visits were planned. Patients with multiple visits were unified, leaving 6,044 unique patients to whom the survey was emailed between 20 July 2020 and 31 July 2020. The survey was closed on 21 August 2020. Analyses were focused on simple descriptive statistics to assess frequency of responses. Analyses of variance and chi-square analyses were conducted to compare outcomes when all cells were ≥ 10, based on sub-specialty and insurance status; otherwise, frequencies were examined for the entire sample only. Missing data were excluded listwise.

RESULTS: A total of 6044 patients were contacted. Completed surveys numbered 1,083 yielding a response rate of 17.9%. The most common sub-specialty visit was gynecology (56.7%) followed by obstetrics (31.5%,), pelvic floor disorders (4.8%), gynecological oncology (2.9%,), and reproductive endocrinology (0.5%). A substantial percentage of women had visits canceled (19.2%), rescheduled (32.8%) or changed (42.1%) to telemedicine. In our patient population, 32.6% were worried about visiting the clinic and 48.1% were worried about visiting the hospital. COVID-19 triggered changes were perceived to have a negative impact by 26.1% of respondents. Refusal of future telemedicine visits was by 17.2%, however, 75.2% would prefer to use both in-person and telemedicine visits.

CONCLUSION: During the initial COVID-19 surge with lockdown, the majority of survey respondents were following public health precautions. However, there were significant concerns amongst women related to obstetric and gynecologic medical appointments scheduled during that period. During pandemics, natural disasters and similar extreme circumstances, digital communication and telemedicine have the potential to play a critical role in providing reassurance and care. Nevertheless, given the concerns expressed by survey respondents, communication and messaging tools are needed to increase comfort and ensure equity with the rapidly changing methods of care delivery.

PMID:34044744 | DOI:10.1080/14767058.2021.1909560

J Refract Surg. 2021 May;37(5):331-336. doi: 10.3928/1081597X-20210204-01. Epub 2021 May 1.

ABSTRACT

PURPOSE: To assess enlargement of the clear corneal incision site and functional outcome in patients with cataract, following the use of two preloaded intraocular lens (IOL) injectors.

METHODS: In this prospective, randomized, intraindividual comparative clinical study, 58 paired-eyes were randomly assigned for implantation with two preloaded injectors: AutonoMe with a Clareon IOL (Alcon Laboratories, Inc) and iSert with a Vivinex IOL (Hoya). The size of the corneal incision, 2 mm for the iSert and 2.2 mm for the AutonoMe, was measured before and after phacoemulsification and after IOL implantation. Patients were examined 3 months after surgery to assess keratometry, subjective refraction, and visual acuity.

RESULTS: The incision enlargement was 0.20 ± 0.10 mm for the AutonoMe and 0.29 ± 0.10 mm for the iSert, with a statistically significant difference (P < .05). The final wound size after IOL implantation was 2.41 mm for the AutonoMe and 2.35 mm for the iSert. The mean absolute surgically induced astigmatism (SIA) was 0.50 ± 0.25 diopters (D) in the iSert eyes and 0.45 ± 0.20 D in the AutonoMe eyes (P > .05). The 3-month postoperative uncorrected and corrected distance visual acuity (UDVA and CDVA) were similar in both groups, with a UDVA of 0.10 and 0.12 logMAR and CDVA of -0.04 and -0.03 logMAR, respectively for the AutonoMe and iSert.

CONCLUSIONS: The iSert injector caused more enlargement of the corneal wound during IOL implantation compared to the AutonoMe. Despite the initially different incision sizes, the final incision size and functional outcomes were similar in both groups. [J Refract Surg. 2021;37(5):331-336.].

PMID:34044690 | DOI:10.3928/1081597X-20210204-01