Clin Chem. 2022 Nov 1:hvac155. doi: 10.1093/clinchem/hvac155. Online ahead of print.
NO ABSTRACT
PMID:36316167 | DOI:10.1093/clinchem/hvac155
Br J Gen Pract. 2022 Sep 30:BJGP.2022.0271. doi: 10.3399/BJGP.2022.0271. Online ahead of print.
ABSTRACT
BACKGROUND: GPs and patients value continuity of care. Ethnic differences in continuity could contribute to inequalities in experience and outcomes.
AIM: To describe relational continuity of care in general practice by ethnicity and long-term conditions.
DESIGN AND SETTING: In total, 381 474 patients in England were included from a random sample from the Clinical Practice Research Datalink (January 2016 to December 2019).
METHOD: Face-to-face, telephone, and online consultations with a GP were included. Continuity, measured by the Usual Provider of Care and Bice-Boxerman indices, was calculated for patients with ≥3 consultations. Ethnicity was taken from the GP record or linked Hospital Episode Statistics data, and long-term conditions were counted at baseline. Multilevel regression models were used to describe continuity by ethnicity sequentially adjusted for: a) the number of consultations, follow-up time, age, sex, and practice-level random intercept; b) socioeconomic deprivation in the patient’s residential area; and c) long-term conditions.
RESULTS: On full adjustment, 5 of 10 ethnic minority groups (Bangladeshi, Pakistani, Black African, Black Caribbean, and any other Black background) had lower continuity of care compared with White patients. Continuity was lower for patients in more deprived areas and younger patients but this did not account for ethnic differences in continuity. Differences by ethnicity were also seen in patients with ≥2 long-term conditions.
CONCLUSION: Ethnic minority identity and socioeconomic deprivation have additive associations with lower continuity of care. Structural factors affecting demand for, and supply of, GPs should be assessed for their contribution to ethnic inequalities in relational continuity and other care quality domains.
PMID:36316161 | DOI:10.3399/BJGP.2022.0271
Br J Gen Pract. 2022 Jul 22:BJGP.2022.0118. doi: 10.3399/BJGP.2022.0118. Online ahead of print.
ABSTRACT
BACKGROUND: It is unclear how engaging in physical activity after long periods of inactivity provides expected health benefits.
AIM: To determine whether physically inactive primary care patients reduce their mortality risk by increasing physical activity, even in low doses.
DESIGN AND SETTING: Prospective cohort of 3357 physically inactive patients attending 11 Spanish public primary healthcare centres.
METHOD: Change in physical activity was repeatedly measured during patients’ participation in the ‘Experimental Program for Physical Activity Promotion’ clinical trial between 2003 and 2006, using the ‘7-day Physical Activity Recall’. Mortality to 31 December 2018 (312 deaths) was recorded from national statistics, and survival time from the end of the clinical trial analysed using proportional hazard models.
RESULTS: After 46 191 person-years of follow-up, compared with individuals who remained physically inactive, the mortality rates of those who achieved the minimum recommendations of 150- 300 min/ week of moderate- or 75-150 min/ week of vigorous-intensity exercise was reduced by 45% (adjusted hazard ratio [aHR] 0.55; 95% confidence interval [95% CI] = 0.41 to 0.74); those who did not meet these recommendations but increased physical activity in low doses, that is, 50 min/week of moderate physical activity, showed a 31% reduced mortality (aHR 0.69, 95% CI = 0.51 to 0.93); and, those who surpassed the recommendation saw a 49% reduction in mortality (aHR 0.51, 95% CI = 0.32 to 0.81). The inverse association between increased physical activity and mortality follows a continuous curvilinear dose-response relationship.
CONCLUSION: Physically inactive primary care patients reduced their risk of mortality by increasing physical activity, even in doses below recommended levels. Greater reduction was achieved through meeting physical activity recommendations or adopting levels of physical activity higher than those recommended.
PMID:36316160 | DOI:10.3399/BJGP.2022.0118
Neuroradiol J. 2022 Oct 31:19714009221114445. doi: 10.1177/19714009221114445. Online ahead of print.
ABSTRACT
PURPOSE: The purpose is to determine the inter-rater reliability in grading ASPECTS score, between emergency medicine physician at first contact and radiologist among patients with acute ischemic stroke.
MATERIALS AND METHODS: We conducted a prospective analysis of 765 acute ischemic stroke cases referred to the Department of Radiodiagnosis in a rural-based hospital in South India, during January 2017 to October 2021. Non-contrast computed tomography (NCCT) scans of the brain were performed using GE Bright Speed Elite 128 Slice CT Scanner. ASPECTS score was calculated separately by an emergency medicine physician and radiologist. Inter-rater reliability for total and dichotomized ASPECTS (≥6 and <6) scores were assessed using statistical analysis (ICC and Cohen ĸ coefficients) on SPSS software (v17.0).
RESULTS: Inter-rater agreement for total and dichotomized ASPECTS was substantial (ICC 0.79 and Cohen ĸ 0.68) between the emergency physician and the radiologist. Mean difference in ASPECTS between the two readers was only 0.15 with standard deviation of 1.58. No proportionality bias was detected. The Bland-Altman plot was constructed to demonstrate the distribution of ASPECTS differences between the two readers.
CONCLUSION: Substantial inter-rater agreement was noted in grading ASPECTS between emergency medicine physician at first contact and radiologist, thereby confirming its robustness even in a rural setting.
PMID:36316159 | DOI:10.1177/19714009221114445
J Epidemiol Community Health. 2022 Oct 31:jech-2022-219521. doi: 10.1136/jech-2022-219521. Online ahead of print.
ABSTRACT
BACKGROUND: It is not known how differences in COVID-19 deaths by migration background in the Netherlands evolved throughout the pandemic, especially after introduction of COVID-19 prevention measures targeted at populations with a migration background (in the second wave). We investigated associations between migration background and COVID-19 deaths across first wave of the pandemic, interwave period and second wave in the Netherlands.
METHODS: We obtained multiple registry data from Statistics Netherlands spanning from 1 March 2020 to 14 March 2021 comprising 17.4 million inhabitants. We estimated incidence rate ratios for COVID-19 deaths by migration background using Poisson regression models and adjusted for relevant sociodemographic factors.
RESULTS: Populations with a migration background, especially those with Turkish, Moroccan and Surinamese background, exhibited higher risk of COVID-19 deaths than the Dutch origin population throughout the study periods. The elevated risk of COVID-19 deaths among populations with a migration background (as compared with Dutch origin population) was around 30% higher in the second wave than in the first wave.
CONCLUSIONS: Differences in COVID-19 deaths by migration background persisted in the second wave despite introduction of COVID-19 prevention measures targeted at populations with a migration background in the second wave. Research on explanatory mechanisms and novel prevention measures are needed to address the ongoing differences in COVID-19 deaths by migration background.
PMID:36316152 | DOI:10.1136/jech-2022-219521
Glob Health Sci Pract. 2022 Oct 31;10(5):e2200072. doi: 10.9745/GHSP-D-22-00072. Print 2022 Oct 31.
ABSTRACT
BACKGROUND: There is limited research on how digital health technologies (DHTs) are used to promote access to care for patients with noncommunicable diseases (NCDs), particularly in low- and middle-income countries (LMICs). We describe the use of DHTs in pharmaceutical industry-led access programs aimed at improving access to NCD care in LMICs.
METHODS: The Access Observatory is the largest publicly available repository containing detailed information about pharmaceutical industry-led access programs targeting NCDs. The repository includes 101 access program reports submitted by 19 pharmaceutical companies. From each report, we extracted data relating to geographic location, disease area, beneficiary population, use of DHTs, partnerships, strategies, and activities. Data were analyzed descriptively using SAS Statistical Software and categorized according to the World Health Organization Digital Health Classification Framework.
RESULTS: A total of 43 access programs (42.6%) included DHTs. The majority of programs using DHTs were clustered across sub-Saharan Africa (72.1%) and targeted cancer (60.5%) followed by metabolic disorders (39.5%). The applied DHTs mostly related to program strategies on health service strengthening (74.4%) and community awareness (41.9%) and were largely directed toward health providers, followed by data services and clients. Only a few DHTs were used for health system management. To promote access, most DHTs focused on improving data collection, management, and use (51.1%); building health provider capacity through training (37.2%); and providing targeted patient information (34.8%).
CONCLUSION: The range of DHTs applied by the pharmaceutical industry offers opportunities for more effective access to NCD care. Transparent reporting on DHT use and its contributions to access programs’ achievements may reduce duplicative and redundant efforts and provide learnings for private and public stakeholders that may contribute to greater access to NCD care in LMICs.
PMID:36316151 | DOI:10.9745/GHSP-D-22-00072
eNeuro. 2022 Oct 31:ENEURO.0144-22.2022. doi: 10.1523/ENEURO.0144-22.2022. Online ahead of print.
ABSTRACT
A central question in neuroscience is how sensory inputs are transformed into percepts. At this point, it is clear that this process is strongly influenced by prior knowledge of the sensory environment. Bayesian ideal observer models provide a key link between data and theory that can help researchers evaluate how prior knowledge is represented and integrated with incoming sensory information. However, the statistical prior employed by a Bayesian observer cannot be measured directly, and must instead be inferred from behavioral measurements. Here we review the general problem of inferring priors from psychophysical data, and the simple solution that follows from assuming a prior that is a Gaussian probability distribution. As our understanding of sensory processing advances, however, there is an increasing need for methods to flexibly recover the shape of Bayesian priors that are not well-approximated by elementary functions. To address this issue, we describe a novel approach that applies to arbitrary prior shapes, which we parameterize using mixtures of Gaussian distributions. After incorporating a simple approximation, this method produces an analytical solution for psychophysical quantities that can be numerically optimized to recover the shapes of Bayesian priors. This approach offers advantages in flexibility, while still providing an analytical framework for many scenarios. We provide a MATLAB toolbox implementing key computations described herein.Significance statementModels in neuroscience provide an essential tool for developing and testing hypotheses about how the brain works. Here, we review the canonical application of Bayesian ideal observer models for understanding sensory processing. We present a new mathematical generalization that will allow these models to be used for deeper investigations into how prior knowledge influences perception. We also provide a software toolkit for implementing the described models.
PMID:36316119 | DOI:10.1523/ENEURO.0144-22.2022
Thorax. 2022 Oct 31:thoraxjnl-2022-219039. doi: 10.1136/thorax-2022-219039. Online ahead of print.
ABSTRACT
OBJECTIVE: Little is known about how lower respiratory tract infections (LRTIs) before chronic obstructive pulmonary disease (COPD) are associated with future exacerbations and mortality. We investigated this association in patients with COPD in England.
METHODS: Clinical Practice Research Datalink Aurum, Hospital Episode Statistics and Office of National Statistics data were used. Start of follow-up was patient’s first ever COPD diagnosis date and a 1-year baseline period prior to start of follow-up was used to find mild LRTIs (general practice (GP) events/no antibiotics), moderate LRTIs (GP events+antibiotics) and severe LRTIs (hospitalised). Patients were categorised as having: none, 1 mild only, 2+ mild only, 1 moderate, 2+ moderate and 1+ severe. Negative binomial regression modelled the association between baseline LRTIs and subsequent COPD exacerbations and Cox proportional hazard regression was used to investigate mortality.
RESULTS: In 215 234 patients with COPD, increasing frequency and severity of mild and moderate LRTIs were associated with increased rates of subsequent exacerbations compared with no recorded LRTIs (1 mild adjusted IRR 1.16, 95% CI 1.14 to 1.18, 2+ mild IRR 1.51, 95% CI 1.46 to 1.55, 1 moderate IRR 1.81, 95% CI 1.78 to 1.85, 2+ moderate IRR 2.55, 95% CI 2.48 to 2.63). Patients with 1+ severe LRTI (vs no baseline LRTIs) also showed an increased rate of future exacerbations (adjusted IRR 1.75, 95% CI, 1.70 to 1.80). This pattern of association was similar for risk of all-cause and COPD-related mortality; however, patients with 1+ severe LRTIs had the highest risk of all-cause and COPD mortality.
CONCLUSION: Increasing frequency and severity of LRTIs prior to COPD diagnosis were associated with increasing rates of subsequent exacerbations, and increasing risk of all-cause and COPD-related mortality.
PMID:36316117 | DOI:10.1136/thorax-2022-219039
Emerg Med J. 2022 Oct 31:emermed-2021-211160. doi: 10.1136/emermed-2021-211160. Online ahead of print.
ABSTRACT
BACKGROUND: Airway management is challenging in trauma patients because of the fear of worsening cervical spinal cord damage. Video-integrated and optic-integrated devices and intubation laryngeal mask airways have been proposed as alternatives to direct laryngoscopy with the Macintosh laryngoscope (MAC). We performed a meta-analysis to clarify which devices cause less cervical movement during airway management.
METHODS: We searched MEDLINE, Cochrane Central, Embase and LILACS from inception to January 2022. We selected randomised controlled trials comparing alternative devices with the MAC for cervical movement from C0 to C5 in adult patients, evaluated by radiological examination. Additionally, cervical spine immobilisation (CSI) techniques were evaluated. We used the Cochrane Risk of Bias Tool to evaluate the risk of bias, and the principles of the Grading of Recommendations, Assessment, Development, and Evaluations system to assess the quality of the body of evidence.
RESULTS: Twenty-one studies (530 patients) were included. Alternative devices caused statistically significantly less cervical movement than MAC during laryngoscopy with mean differences of -3.43 (95% CI -4.93 to -1.92) at C0-C1, -3.19 (-4.04 to -2.35) at C1-C2, -1.35 (-2.19 to -0.51) at C2-C3, and -2.61 (-3.62 to -1.60) at C3-C4; and during intubation: -3.60 (-5.08 to -2.12) at C0-C1, -2.38 (-3.17 to -1.58) at C1-C2, -1.20 (-2.09 to -0.31) at C2-C3. The Airtraq and the Intubation Laryngeal Mask Airway caused statistically significant less movement than MAC restricted to some cervical segments, as well as CSI. Heterogeneity was low to moderate in most results. The quality of the body of evidence was ‘low’ and ‘very low’.
CONCLUSIONS: Compared with the MAC, alternative devices caused less movement during laryngoscopy (C0-C4) and intubation (C0-C3). Due to the high risk of bias and the very low grade of evidence of the studies, further research is necessary to clarify the benefit of each device and to determine the efficacy of cervical immobilisation during airway management.
PMID:36316103 | DOI:10.1136/emermed-2021-211160
BMJ Open. 2022 Oct 31;12(10):e060136. doi: 10.1136/bmjopen-2021-060136.
ABSTRACT
INTRODUCTION: Mechanical thrombectomy (MT) using stent retrievers or a direct aspiration first-pass technique has proven to yield better results over intravenous thrombolysis in treating acute ischaemic stroke caused by large vessel occlusion (LVO). However, the treatment of intracranial atherosclerotic stenosis-related LVO remains unclear and has been a critical problem in daily clinical practice, as it can cause a relatively high failure rate for MT. Whether direct angioplasty and/or stenting is clinically feasible and shows advantage in reducing delay to revascularisation with better functional outcome compared with MT with rescue angioplasty and/or stenting remains unclear. This study seeks to provide direct and practical clinical evidence for clinicians.
METHODS AND ANALYSIS: The main databases of PubMed, the Cochrane library, Embase and Web of Science will be screened for related studies published after1 January 2015. Primary outcomes include successful recanalisation and 90-day favourable outcome. Secondary outcomes include puncture to revascularisation time, vascular complication (perforation, dissection and vasospasm), intracerebral haemorrhage, hospital-related complications and 90-day mortality. The Newcastle-Ottawa Scale will be adopted to assess risk bias of observational studies. The I 2 statistic will be used to assess heterogeneity.
ETHICS AND DISSEMINATION: No primary data of patients are needed. Therefore, ethics approval is unnecessary. The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.
PROSPERO REGISTRATION NUMBER: CRD42021268061.
PMID:36316082 | DOI:10.1136/bmjopen-2021-060136