Tag: pubmed

Front Public Health. 2024 Dec 9;12:1479750. doi: 10.3389/fpubh.2024.1479750. eCollection 2024.

ABSTRACT

Diagnostic errors burden the United States healthcare system. Depending on how they are defined, between 40,000 and 4 million cases occur annually. Despite this striking statistic, and the potential benefits epidemiological approaches offer in identifying risk factors for sub-optimal diagnoses, diagnostic error remains an underprioritized epidemiolocal research topic. Magnifying the challenge are the array of forms and definitions of diagnostic errors, and limited sources of data documenting their occurrence. In this narrative review, we outline a framework for improving epidemiological applications in understanding risk factors for diagnostic error. This includes explicitly defining diagnostic error, specifying the hypothesis and research questions, consideration of systemic including social and economic factors, as well as the time-dependency of diagnosis relative to disease progression. Additional considerations for future epidemiological research on diagnostic errors include establishing standardized research databases, as well as identifying potential important sources of study bias.

PMID:39720799 | PMC:PMC11667112 | DOI:10.3389/fpubh.2024.1479750

Front Public Health. 2024 Dec 10;12:1410499. doi: 10.3389/fpubh.2024.1410499. eCollection 2024.

ABSTRACT

BACKGROUND: Although several studies have explored the association between breakfast consumption and suicidal behaviors among children and adolescents, such associations have been less frequently reported among adults and seniors.

METHOD: This population-based cross-sectional study was conducted in Hebei Province, China. A total of 21, 376 community residents aged 18 years and older were interviewed. This study evaluated the breakfast frequency per week (BFF), full breakfast frequency (FBF), suicidal ideation, suicide plans, and suicide attempts of the participants. Sociodemographic variables, living alone, and sleep quality were also measured.

RESULTS: The prevalence of suicidal ideation, plans, and attempts were 1.4, 0.3, and 0.2%, respectively. Compared to ≥6 days/week BFF, 2-3 days/week BFF was positively associated with suicidal ideation (OR = 1.93, p < 0.01), suicide plan (OR = 2.73, p < 0.05), and suicide attempts (OR = 3.46, p < 0.05). In addition, participants with 2-3 days/week FBF was also at higher risk of suicidal ideation (OR = 2.06, p < 0.001), comparing with never FBF.

CONCLUSION: The reported prevalence of suicidal ideation, plans, and attempts were lower compared to other countries. Lower breakfast frequency was positively associated with suicidal behaviors, and participants with 2-3 days/week of full breakfast consumption were also at a higher risk of suicidal ideation.

PMID:39720798 | PMC:PMC11667555 | DOI:10.3389/fpubh.2024.1410499

Front Public Health. 2024 Dec 10;12:1507672. doi: 10.3389/fpubh.2024.1507672. eCollection 2024.

ABSTRACT

BACKGROUND: This study aimed to describe the temporal trends in the age and sex burdens of lower respiratory infections (LRIs) in China and globally from 1990 to 2021 and to analyze their epidemiological characteristics to formulate corresponding strategies to control LRIs.

METHODS: This study utilized open data from the Global Burden of Disease (GBD) database from 1990 to 2021 to assess the burden of disease based on the prevalence, incidence, mortality, years lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of LRIs in China and globally. Moreover, a comprehensive comparative analysis of the epidemiological characteristics of LRIs in China and globally was conducted via the Joinpoint regression model, age-period-cohort model (APC model), and stratified analysis of the study method from multiple dimensions, such as age, sex, and period. Finally, we used an autoregressive integrated moving average (ARIMA) model to predict the disease burden in LRIs over the next 15 years.

RESULTS: From 1990 to 2021, China’s age-standardized incidence, deaths, and disability-adjusted life year (DALY) rates per 100,000 people decreased from 5,481.13 (95% CI: 5,149.05, 5,836.35) to 2,853.81 (95% CI: 2,663.94, 3,067.55), from 60.65 (95% CI. 52.96, 66.66) to 14.03 (95% CI: 11.68, 17) and from 3,128.39 (95% CI: 2,724.11, 3,579.57) to 347.67 (95% CI: 301.28, 402.94). The global age-standardized incidence, deaths, and DALY rates per 100,000 people, on the other hand, decreased from 6,373.17 (95% CI: 5,993.51, 6,746.04) to 4,283.61 (95% CI: 4,057.03, 4,524.89) and from 61.81 (95% CI: 56.66, 66.74) to 28.67 (95% CI: 25.92, 31.07) and from 3,472.9 (95% CI: 3,090.71, 3,872.11) to 1,168.8 (95% CI: 1,016.96, 1,336.95). The decline in the aforementioned indicators is greater in the female population than in the male population, and the decrease in China is more pronounced than the global trend. In China, the age-standardized incidence and mortality rates of LRIs showed an annual average percentage change (AAPC) of -2.12 (95% CI: -2.20, -2.03) and -4.77 (95% CI: -5.14, -4.39), respectively. Globally, the age-standardized incidence and mortality rates for LRIs decreased by -1.28 (95% CI: -1.37, -1.18) and -2.47 (95% CI: -2.61, -2.32). By 2036, the incidence of lower respiratory infections (LRI) among men and women in China is projected to decrease by 36.55 and 46.87%, respectively, while the mortality rates are expected to decline to 12.67% for men and increase by 71.85% for women. In comparison, the global decline in LRI incidence is lower than that observed in China, yet the reduction in mortality rates is greater globally than in China.

CONCLUSIONS: Age-standardized incidence, mortality and disability-adjusted life years (DALYs) decreased more in China than at the global level between 1990 and 2021. Compared with the previous period, the COVID-19 pandemic has led to a significant decrease in the disease burden of LRIs. As the population continues to age, the disease burden of LRIs in the old adult population will become a major new public health challenge.

PMID:39720797 | PMC:PMC11666531 | DOI:10.3389/fpubh.2024.1507672

Am J Lifestyle Med. 2024 Dec 22:15598276241308551. doi: 10.1177/15598276241308551. Online ahead of print.

ABSTRACT

Purpose: Physical activity and sedentary behavior have significant prognostic importance in survivors of breast cancer. However, not much is known about physical activity and sedentary behavior in the midwestern United States for patients who have breast cancer. This study provides patient-reported physical activity and sedentary behavior from a cohort of patients from the midwestern United States. Methods: A survey assessed physical activity and sedentary behavior from patients with all types of local or invasive breast cancer and ductal carcinoma in situ (DCIS). Demographic information and characteristics of participants’ breast cancer, including time since diagnosis, type of cancer, and remission status were gathered. Results: Data from 108 patients reveal diverse physical activity and sedentary behavior patterns. Seventeen individuals (15.9%) report not engaging in any form of physical activity and only 15.9% report meeting national guideline recommendations of greater than 150 minutes of moderate intensity-equivalent physical activity per week. A wide range of physical activity in minutes was reported across age, time since diagnosis, type of cancer and remission status, none of which was statistically significant. Participants report sitting or reclining an average of 6.1 hours (SD = 3.9) per day during a typical workday and 5.8 hours (SD = 3.8) on a typical non-workday. Conclusions: Our study provides information about physical activity and sedentary behavior in a cohort of midwestern patients with breast cancer and indicates that the majority of the patients could be at high risk for long-term adverse prognosis. Tailored lifestyle programs to enhance physical activity and decrease sedentary behavior are critical to improve outcomes. Our results indicate that clinicians should incorporate healthy lifestyle medicine recommendations for all patients living with breast cancer at any age or time since diagnosis, independent of cancer type or remission status.

PMID:39720786 | PMC:PMC11664562 | DOI:10.1177/15598276241308551

Phys Imaging Radiat Oncol. 2024 Dec 4;32:100684. doi: 10.1016/j.phro.2024.100684. eCollection 2024 Oct.

ABSTRACT

BACKGROUND AND PURPOSE: Segmentation imperfections (noise) in radiotherapy organ-at-risk segmentation naturally arise from specialist experience and image quality. Using clinical contours can result in sub-optimal convolutional neural network (CNN) training and performance, but manual curation is costly. We address the impact of simulated and clinical segmentation noise on CNN parotid gland (PG) segmentation performance and provide proof-of-concept for an easily implemented auto-curation countermeasure.

METHODS AND MATERIALS: The impact of segmentation imperfections was investigated by simulating noise in clean, high-quality segmentations. Curation efficacy was tested by removing lowest-scoring Dice similarity coefficient (DSC) cases early during CNN training, both in simulated (5-fold) and clinical (10-fold) settings, using our full radiotherapy clinical cohort (RTCC; N = 1750 individual PGs). Statistical significance was assessed using Bonferroni-corrected Wilcoxon signed-rank tests. Curation efficacies were evaluated using DSC and mean surface distance (MSD) on in-distribution and out-of-distribution data and visual inspection.

RESULTS: The curation step correctly removed median(range) 98(90-100)% of corrupted segmentations and restored the majority (1.2 %/1.3 %) of DSC lost from training with 30 % corrupted segmentations. This effect was masked when using typical (non-curated) validation data. In RTCC, 20 % curation showed improved model generalizability which significantly improved out-of-distribution DSC and MSD (p < 1.0e-12, p < 1.0e-6). Improved consistency was observed in particularly the medial and anterior lobes.

CONCLUSIONS: Up to 30% case removal, the curation benefit outweighed the training variance lost through curation. Considering the notable ease of implementation, high sensitivity in simulations and performance gains already at lower curation fractions, as a conservative middle ground, we recommend 15% curation of training cases when training CNNs using clinical PG contours.

PMID:39720784 | PMC:PMC11667007 | DOI:10.1016/j.phro.2024.100684

Pharmgenomics Pers Med. 2024 Dec 20;17:551-561. doi: 10.2147/PGPM.S482289. eCollection 2024.

ABSTRACT

PURPOSE: Atorvastatin is commonly used to treat dyslipidemia; however, individual responses vary considerably. This study endeavors to evaluate the relationship between polymorphisms in the coding sequence (CDS) of SLCO1B1 gene and blood lipid levels before and after atorvastatin treatment among the Chinese Han adults with dyslipidemia.

PATIENTS AND METHODS: A total of 165 Chinese Han adults undergoing atorvastatin therapy were enrolled in this study and followed up quarterly. The complete CDS of the SLCO1B1 gene was sequenced to detect polymorphisms. Statistical analysis was utilized to assess the impacts of sex, age, body mass index (BMI), and polymorphisms on blood lipid levels before and after atorvastatin treatment.

RESULTS: Fourteen polymorphisms were identified in the SLCO1B1 CDS. Among them, four polymorphisms had mutant alleles present in over 20 patients. No polymorphism was found to correlate with blood lipid levels before treatment; in contrast, age, sex, and BMI did show correlations (P<0.05). Notably, females had higher baseline blood lipid levels than males, indicating that sex had a more significant impact on baseline levels than age and BMI. The polymorphism rs2306283 was significantly correlated with the efficacy of atorvastatin (P<0.05), whereas age, sex, and BMI were not. Carriers of the rs2306283 AA allele experienced a substantially greater reduction in total cholesterol (TC) and triglyceride (TG) levels after atorvastatin treatment. The other polymorphisms did not demonstrate any significant impact on atorvastatin’s efficacy.

CONCLUSION: This study delved into the intricate genetic structure of polymorphisms in SLCO1B1 CDS and their roles in lipid metabolism and atorvastatin’s efficacy among Chinese Han adults with dyslipidemia. The findings underscore the crucial role of the rs2306283 polymorphism in the response to atorvastatin’s efficacy, highlighting the significance of pharmacogenomics in personalized medicine. It is thus advisable to consider genetic testing for SLCO1B1 variants to optimize atorvastatin therapy.

PMID:39720770 | PMC:PMC11668066 | DOI:10.2147/PGPM.S482289

Am J Prev Cardiol. 2024 Nov 23;21:100895. doi: 10.1016/j.ajpc.2024.100895. eCollection 2025 Mar.

ABSTRACT

BACKGROUND: Lipoprotein(a) [Lp(a)] is a low-density lipoprotein variant with atherogenic, thrombogenic, and pro-inflammatory properties that may have numerous pathologic effects, including dyslipidemia. Screening for Lp(a) is clinically significant, due to its causal role in atherosclerotic cardiovascular disease (ASCVD). Among clinicians, however, there remains a general lack of both clinical awareness of Lp(a) and adequate tools to track Lp(a) testing in patients.

OBJECTIVE: To study factors affecting Lp(a) screening by: i) determining the effectiveness of messaging providers at a large community health system about Lp(a) screening and measuring the subsequent percentage of Lp(a) tests requested; and ii) by determining the percentage of patients who obtained Lp(a) testing after being advised by the provider.

METHODS: From December 2022 through March 2023, messages detailing the need for Lp(a) screening were sent via the Epic EHR™ to providers of patients meeting criteria for Lp(a) testing in advance of scheduled patient appointments. In this prospective study, providers were randomized into 2 groups: those receiving the pre-appointment message (Group 1) and those not receiving the pre-appointment message (Group 2).

RESULTS: Sending pre-appointment messages correlated with more Lp(a) orders (16.6 % v. 4.7 %, P < 0.001) and consequently with more tests performed (10.2 % v. 3.7 %, p < 0.001). Among provider types, nurse practitioners and physician assistants had the highest number of Lp(a) results per order (Z = 16.40, P < 0.001), achieving 30.8-39.1 % more test results, even if they did not receive the pre-appointment message. Distribution of Lp(a) values in patients was 59.7 % ≤ 29 mg/dL; 9.7 % > 29 and < 50mg/dL; and 30.6 % ≥ 50 mg/dL.

CONCLUSION: Providers who received pre-appointment messages via an EHR were associated with requesting more tests and consequently receiving more Lp(a) results, compared with providers who did not receive messages.

PMID:39720768 | PMC:PMC11666892 | DOI:10.1016/j.ajpc.2024.100895

Am J Prev Cardiol. 2024 Nov 29;21:100899. doi: 10.1016/j.ajpc.2024.100899. eCollection 2025 Mar.

ABSTRACT

AIMS: To investigate the association between body mass index (BMI) at acute myocardial infarction (AMI) and all-cause as well as cause-specific long-term mortality.

METHODS: The analysis was based on 10,651 hospitalized AMI patients (age 25-84 years) recorded by the population-based Myocardial Infarction Registry Augsburg between 2000 and 2017. The median follow-up time was 6.7 years [IQR: 3.5-10.0)]. Cause-specific mortality was obtained by evaluating the death certificates. In multivariable-adjusted COX regression models using cubic splines for the variable BMI, the association between BMI and cause-specific mortality (all-cause, cardiovascular, ischemic heart diseases, cancer) was investigated. Additionally, a subgroup analysis in three age groups was performed for all-cause mortality.

RESULTS: Overall, there was a statistically significant U-shaped association between BMI at AMI and long-term mortality with the lowest hazard ratios (HR) found for BMI values between 25 and 30 kg/m². For cancer mortality, higher BMI values > 30 kg/m² were not associated with higher mortality. In patients aged <60 years, there was a significant association between BMI values >35 kg/m² and increased all-cause mortality; this association was missing in 60 to 84 years old patients. For all groups and for each specific cause of mortality, lower BMI (<25kg/m²) values were significantly associated with higher mortality.

CONCLUSIONS: Overall, a lower BMI – and also a high BMI in patients younger than 60 years – seem to be a risk factors for increased all-cause mortality after AMI. A BMI in a mid-range between 25 and 30 kg/m² is favorable in terms of long-term survival after AMI.

PMID:39720766 | PMC:PMC11665372 | DOI:10.1016/j.ajpc.2024.100899

Healthc Technol Lett. 2024 Nov 25;11(6):318-326. doi: 10.1049/htl2.12099. eCollection 2024 Dec.

ABSTRACT

Accurate intra-operative Remaining Surgery Duration (RSD) predictions allow for anaesthetists to more accurately decide when to administer anaesthetic agents and drugs, as well as to notify hospital staff to send in the next patient. Therefore, RSD plays an important role in improved patient care and minimising surgical theatre costs via efficient scheduling. In endoscopic pituitary surgery, it is uniquely challenging due to variable workflow sequences with a selection of optional steps contributing to high variability in surgery duration. This article presents PitRSDNet for predicting RSD during pituitary surgery, a spatio-temporal neural network model that learns from historical data focusing on workflow sequences. PitRSDNet integrates workflow knowledge into RSD prediction in two forms: (1) multi-task learning for concurrently predicting step and RSD; and (2) incorporating prior steps as context in temporal learning and inference. PitRSDNet is trained and evaluated on a new endoscopic pituitary surgery dataset with 88 videos to show competitive performance improvements over previous statistical and machine learning methods. The findings also highlight how PitRSDNet improves RSD precision on outlier cases utilising the knowledge of prior steps.

PMID:39720757 | PMC:PMC11665798 | DOI:10.1049/htl2.12099

J Health Popul Nutr. 2024 Dec 24;43(1):225. doi: 10.1186/s41043-024-00692-3.

ABSTRACT

BACKGROUND: Foodborne illness is a significant public health concern, particularly in developing countries like Bangladesh. Young adults, aged 18-26 (including undergraduates and recent graduates), are especially vulnerable to the onset of unhealthy eating habits and nutritional imbalances as they begin living independently, often away from their families. This research aims to identify the risk factors associated with the knowledge, attitudes, and practices related to safe food handling among residential university students. By understanding these factors, the study seeks to inform strategies to improve food safety behaviors in this at-risk population.

METHODS: A standardized questionnaire was administered through a simple random sampling survey of 250 students at Jahangirnagar University to collect primary data on food safety practices, attitudes, and knowledge. Descriptive statistics and the chi-square test were used to examine associations between the responses and predictor variables. To further assess the statistical significance and strength of these relationships, logistic regression analyses were performed. These methods provided a comprehensive evaluation of the factors influencing safe food handling behaviors among the students.

RESULTS: The survey found that most participants were from rural areas (44.4%) and female students (65.2%). Multicollinearity issues were not detected, and predictor factors explained 53.8% (Nagelkerke R-square: 0.538) of the variation in food poisoning incidents. Overall, 57.6% of students reported being prone to food poisoning. Risk factors for food poisoning included being in the third year of study (OR: 3.493, CI: 0.394-30.972), consuming food during a blackout based on its appearance or scent (OR: 4.824, CI: 0.690-33.715), and believing food should be refrigerated for five to seven days (OR: 2.309, CI: 0.318-16.778). Conversely, students who stored raw meat or fish on the middle shelf (OR: 0.078, CI: 0.012-0.511) and those who thought leftover food should be kept in the fridge for more than seven days (OR: 0.034, CI: 0.002-0.626) were less likely to experience food poisoning. These findings highlight behaviors that influence foodborne illness risk among students.

CONCLUSIONS: This study found that while students in Bangladesh demonstrate a strong understanding of food handling, there has been insufficient focus on food safety education in the country. Based on these findings, the authors recommend enhancing awareness of key food safety risks and integrating this knowledge into both short- and long-term initiatives. To ensure lasting improvements in food safety, sustained and effective interventions are essential. These efforts will accelerate progress toward achieving the sustainable development goals related to public health in Bangladesh.

PMID:39719654 | DOI:10.1186/s41043-024-00692-3