Tag: pubmed

Subst Abuse Treat Prev Policy. 2022 May 18;17(1):38. doi: 10.1186/s13011-022-00469-z.

ABSTRACT

BACKGROUND: Certificate-of-need (CON) laws in place in most US states require healthcare providers to prove to a state board that their proposed services are necessary in order to be allowed to open or expand. While CON laws most commonly target hospital and nursing home beds, many states require CONs for other types of healthcare providers and services. As of 2020, 23 states retain CON laws specifically for substance use treatment, requiring providers to prove their “economic necessity” before opening or expanding. In contrast to the extensive academic literature on how hospital and nursing home CON laws affect costs and access, substance use CON laws are essentially unstudied.

METHODS: Using 2002-19 data on substance use treatment facilities from the Substance Abuse and Mental Health Services Administration’s National Survey of Substance Abuse Treatment Services, we measure the effect of CON laws on access to substance use treatment. Using fixed-effects analysis of states enacting and repealing substance use CON laws, we measure how CON laws affect the number of substance use treament facilities and beds per capita in a state.

RESULTS: We find that CON laws have no statistically significant effect on the number of facilities, beds, or clients and no significant effect on the acceptance of Medicare. However, they reduce the acceptance of private insurance by a statistically significant 6.0%.

CONCLUSIONS: Policy makers may wish to reconsider whether substance use CON laws are promoting their goals.

PMID:35585635 | DOI:10.1186/s13011-022-00469-z

Health Qual Life Outcomes. 2022 May 18;20(1):79. doi: 10.1186/s12955-022-01980-4.

ABSTRACT

BACKGROUND: Health-related quality of life (HRQoL) is important in determining surgical success, particularly from the patients’ perspective.

AIMS: To identify predictors for HRQoL outcome after cardiac surgery in order to identify potentially modifiable factors where interventions to improve patient outcomes could be targeted.

METHODS: Electronic databases (including MEDLINE, CINAHL, Embase) were searched between January 2001 and December 2020 for studies determining predictors of HRQoL (using a recognised and validated tool) in adult patients undergoing cardiac surgery. Data extraction and quality assessments were undertaken and data was summarised using descriptive statistics and narrative synthesis, as appropriate.

RESULTS: Overall, 3924 papers were screened with 41 papers included in the review. Considerable methodological heterogeneity between studies was observed. Most were single-centre (75.6%) prospective observational studies (73.2%) conducted in patients undergoing coronary artery bypass graft (CABG) (n = 51.2%) using a version of the SF-36 (n = 63.4%). Overall, 103 independent predictors (62 pre-operative, five intra-operative and 36 post-operative) were identified, where 34 (33.0%) were reported in more than one study. Potential pre-operative modifiable predictors include alcohol use, BMI/weight, depression, pre-operative quality of life and smoking while in the post-operative period pain and strategies to reduce post-operative complications and intensive care and hospital length of stay are potential therapeutic targets.

CONCLUSION: Despite a lack of consistency across studies, several potentially modifiable predictors were identified that could be targeted in interventions to improve patient or treatment outcomes. This may contribute to delivering more person-centred care involving shared decision-making to improve patient HRQoL after cardiac surgery.

PMID:35585633 | DOI:10.1186/s12955-022-01980-4

BMC Womens Health. 2022 May 18;22(1):181. doi: 10.1186/s12905-022-01769-z.

ABSTRACT

BACKGROUND: Family planning is a low-cost, high-impact public health and development strategy to improve child and maternal health. However, there is a lack of evidence on modern contraceptive use and determinants in sub-Saharan Africa. Hence, this study aimed at determining the pooled prevalence and determinants of modern contraceptive utilization among married women of sub-Saharan Africa.

METHODS: Thirty-six sub-Saharan African countries’ demographic and health survey (DHS) data were used for pooled analysis. A total weighted sample of 322,525 married women was included. Cross tabulations and summary statistics were done using STATA version 14 software. The pooled prevalence of modern contraceptive utilization with a 95% Confidence Interval (CI) was reported. Multilevel regression analysis was used to identify the determinants of modern contraceptive use among married women. Four models were fitted to select the best-fitted model using the Likelihood Ratio (LLR) and Deviance test. Finally, the model with the highest LLR and the smallest deviance was selected as the best-fitted model.

RESULTS: The pooled estimate of modern contraception use in sub-Saharan African countries was 18.36% [95% CI: 18.24, 18.48], with highest in Lesotho (59.79%) and the lowest in Chad (5.04%). The odds of modern contraception utilization were high among women living in East Africa [AOR = 1.47 (1.40, 1.54)], urban areas [AOR = 1.18 (1.14, 1.24)], and women with primary [AOR = 1.49 (1.44, 1.55)] and secondary and above educational level [AOR = 1.66 (1.58, 1.74)]. Moreover, husbands with primary educational level [AOR = 1.38 (1.33, 1.42)], middle [AOR = 1.17, (1.14, 1.21)], rich wealth status [AOR = 1.29 (1.25, 1.34)], media exposure [AOR = 1.25 (1.22, 1.29)], and postnatal care (PNC) utilization [AOR = 1.25 (1.22, 1.29)] had higher odds of modern contraceptive utilization compared with their counter parts. Furthermore, deliver at health facility [AOR = 1.74 (1.69, 1.79)] and birth order 2-4 [AOR = 1.36 (1.31, 1.41)] had higher odds of modern contraceptive utilization. On the other hand, women living in Central [AOR = 0.23 (0.22, 0.24)], Western regions [AOR = 0.46 (0.40, 0.54)], women who decided with husband [AOR = 0.90 (0.87, 0.93)], and decisions by husband alone [AOR = 0.73 (0.71, 0.75)] decreased the odds of modern contraceptive utilization.

CONCLUSION: The uptake of modern contraception in sub-Saharan Africa is low. Modern contraceptive utilization is affected by different factors. More attention needs to be given to rural residents, illiterate women, and communities with low wealth status.

PMID:35585626 | DOI:10.1186/s12905-022-01769-z

BMC Med Inform Decis Mak. 2022 May 18;22(1):137. doi: 10.1186/s12911-022-01859-w.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is a serious complication after cardiac surgery. We derived and internally validated a Machine Learning preoperative model to predict cardiac surgery-associated AKI of any severity and compared its performance with parametric statistical models.

METHODS: We conducted a retrospective study of adult patients who underwent major cardiac surgery requiring cardiopulmonary bypass between November 1st, 2009 and March 31st, 2015. AKI was defined according to the KDIGO criteria as stage 1 or greater, within 7 days of surgery. We randomly split the cohort into derivation and validation datasets. We developed three AKI risk models: (1) a hybrid machine learning (ML) algorithm, using Random Forests for variable selection, followed by high performance logistic regression; (2) a traditional logistic regression model and (3) an enhanced logistic regression model with 500 bootstraps, with backward variable selection. For each model, we assigned risk scores to each of the retained covariate and assessed model discrimination (C statistic) and calibration (Hosmer-Lemeshow goodness-of-fit test) in the validation datasets.

RESULTS: Of 6522 included patients, 1760 (27.0%) developed AKI. The best performance was achieved by the hybrid ML algorithm to predict AKI of any severity. The ML and enhanced statistical models remained robust after internal validation (C statistic = 0.75; Hosmer-Lemeshow p = 0.804, and AUC = 0.74, Hosmer-Lemeshow p = 0.347, respectively).

CONCLUSIONS: We demonstrated that a hybrid ML model provides higher accuracy without sacrificing parsimony, computational efficiency, or interpretability, when compared with parametric statistical models. This score-based model can easily be used at the bedside to identify high-risk patients who may benefit from intensive perioperative monitoring and personalized management strategies.

PMID:35585624 | DOI:10.1186/s12911-022-01859-w

Genome Biol. 2022 May 18;23(1):118. doi: 10.1186/s13059-022-02684-0.

ABSTRACT

BACKGROUND: Spatial transcriptomics are a set of new technologies that profile gene expression on tissues with spatial localization information. With technological advances, recent spatial transcriptomics data are often in the form of sparse counts with an excessive amount of zero values.

RESULTS: We perform a comprehensive analysis on 20 spatial transcriptomics datasets collected from 11 distinct technologies to characterize the distributional properties of the expression count data and understand the statistical nature of the zero values. Across datasets, we show that a substantial fraction of genes displays overdispersion and/or zero inflation that cannot be accounted for by a Poisson model, with genes displaying overdispersion substantially overlapped with genes displaying zero inflation. In addition, we find that either the Poisson or the negative binomial model is sufficient for modeling the majority of genes across most spatial transcriptomics technologies. We further show major sources of overdispersion and zero inflation in spatial transcriptomics including gene expression heterogeneity across tissue locations and spatial distribution of cell types. In particular, when we focus on a relatively homogeneous set of tissue locations or control for cell type compositions, the number of detected overdispersed and/or zero-inflated genes is substantially reduced, and a simple Poisson model is often sufficient to fit the gene expression data there.

CONCLUSIONS: Our study provides the first comprehensive evidence that excessive zeros in spatial transcriptomics are not due to zero inflation, supporting the use of count models without a zero inflation component for modeling spatial transcriptomics.

PMID:35585605 | DOI:10.1186/s13059-022-02684-0

Diabetol Metab Syndr. 2022 May 18;14(1):74. doi: 10.1186/s13098-022-00844-7.

ABSTRACT

BACKGROUND: Elevated lipids in umbilical cord blood affect fetal programming, leading to a higher risk of developing cardiovascular disease in later life. However, the causes of changes in the lipid profile of umbilical cord blood are not clear yet. This study aimed for the first time to determine the association of asprosin concentration with TAG, TC, HDL-C, LDL-C concentrations and TAG/HDL-C, TC/HDL-C, LDL-C/HDL-C and non-HDL-C/HDL-C ratio in umbilical cord blood as well as newborn anthropometric indices. This cross-sectional study was based on 450 mother- newborn pairs of a birth cohort study in Sabzevar, Iran. Multiple linear regression was used to estimate the association of lipid concentration and lipid ratios as well as birth weight (BW), birth length (BL), head circumference (HC) and chest circumference (CC) with asprosin in cord blood samples controlled for the relevant covariates.

RESULT: In fully adjusted models, each 1 ng/mL increase in asprosin was associated with 0.19 (95% CI 0.06, 0.31, P < 0.01), 0.19 (95% CI 0.10, 0.29, P < 0.01), 0.17 (95% CI 0.09, 0.25, P < 0.01), 0.17 (95% CI 0.09, 0.25, P < 0.01), 0.01 (95% CI 0.00, 0.013, P < 0.01), 0.01 (95% CI 0.01, 0.01, P < 0.01), 0.01 (95% CI 0.01, 0.01, P < 0.01) and 0.01 (95% CI 0.01, 0.01, P < 0.01) increase in TAG, TC, LDL-C, TAG/HDL-C, TC/HDL-C, LDL-C/HDL-C and non-HDL-C/HDL-C ratio respectively. Moreover, higher asprosin levels was positively associated with newborn BW, BL, HC and CC; however, these associations were not statistically significant.

CONCLUSION: Overall, our findings support the positive association between cord asprosin concentration and the development of atherogenic lipid profile in newborns. Further studies are needed to confirm the findings of this study in other populations.

PMID:35585615 | DOI:10.1186/s13098-022-00844-7

BMC Oral Health. 2022 May 18;22(1):183. doi: 10.1186/s12903-022-02218-x.

ABSTRACT

OBJECTIVES: To evaluate the risk factors and risk indicators associated with early childhood caries in South Africa.

DESIGN: A systematic review of aetiology was performed. From 1366 papers found, 23 studies met the eligibility criteria and were included. All study designs were included. Healthy children under six who live in South Africa were eligible for the study. The study was registered with PROSPERO, registration number CRD42020216455.

DATA EXTRACTION: Eligible studies were selected, and data extracted independently by two reviewers. Published data on socio-economic status, dietary factors, oral hygiene knowledge and practices, breastfeeding and bottle-feeding practices, oral bacterial flora and other risk indicators were collected. Two authors appraised the studies independently using the Joanna Briggs Critical Appraisal tools.

DATA ANALYSIS: Heterogeneity was assessed using the I² statistics, and due to heterogeneity, extracted data were mostly presented narratively.

RESULTS: Meta-analysis was performed using random-effects models and concluded that parents of children who had a tertiary education had a 1.77 [1.22-2.57] odds of experiencing dental caries compared to the children of parents with a secondary education. However, the unclear risk of bias of most included cross-sectional studies precluded definitive conclusions.

CONCLUSIONS: More high-quality cohort studies need to be performed to evaluate actual risk factors for ECC in a South African setting. Parental/caregiver oral educational knowledge needs promoting before the emergence of their children’s teeth. The social determinants of health need to be incorporated in future studies, and suitable targeted interventions need to be developed and implemented to mitigate early childhood caries in South Africa.

PMID:35585594 | DOI:10.1186/s12903-022-02218-x

BMC Health Serv Res. 2022 May 18;22(1):670. doi: 10.1186/s12913-022-07984-6.

ABSTRACT

BACKGROUND: In the last two decades, cesarean section (CS) deliveries in India have increased by six-fold and created economic hardship for families and households. Although several schemes and policies under the National Health Mission (NHM) have reduced the inequality in the use of maternal care services in India, the distributive effect of public health subsidies on CS deliveries remains unclear. In this context, this paper examines the usage patterns of CS delivery and estimates the share of public health subsidies on CS deliveries among mothers by different background characteristics in India.

DATA: Data from the fourth round of the National Family Health Survey (NFHS-4) was used for the study. Out-of-pocket (OOP) payment for CS delivery was used as a dependent variable and was analyzed by level of care that is, primary (PHC, UHC, other) and secondary (government/municipal, rural hospital). Descriptive statistics, binary logistic regression, benefit incidence analysis, concentration curve and concentration index were used for the analysis.

RESULTS: A strong economic gradient was observed in the utilization of CS delivery from public health facilities. Among mothers using any public health facility, 23% from the richest quintile did not pay for CS delivery compared to 13% from the poorest quintile. The use of the public subsidy among mothers using any type of public health facility for CS delivery was pro-rich in nature; 9% in the poorest quintile, 16.1% in the poorer, 24.5% in the middle, 27.5% among richer and 23% in the richest quintile. The pattern of utilization and distribution of public subsidy was similar across the primary and secondary health facilities but the magnitude varied. The findings from the benefit-incidence analysis are supported by those obtained from the inequality analysis. The concentration index of CS was 0.124 for public health centers and 0.291 for private health centers. The extent of inequality in the use of CS delivery in public health centers was highest in the state of Mizoram (0.436), followed by Assam (0.336), and the lowest in Tamil Nadu (0.060), followed by Kerala (0.066).

CONCLUSION: The utilization of CS services from public health centers in India is pro-rich. Periodically monitoring and evaluating of the cash incentive schemes for CS delivery and generating awareness among the poor would increase the use of CS delivery services in public health centers and reduce the inequality in CS delivery in India.

PMID:35585584 | DOI:10.1186/s12913-022-07984-6

BMC Oral Health. 2022 May 18;22(1):184. doi: 10.1186/s12903-022-02181-7.

ABSTRACT

BACKGROUND: Oral lichen planus (OLP) is an immune-mediated inflammatory chronic disease of the oral mucosa, with different patterns of clinical manifestations which range from keratotic manifestations (K-OLP) to predominantly non-keratotic lesions (nK-OLP). The aim of the study was to analyze the differences in the clinical, psychological profile and symptoms between Italian patients of the North and Central-South with K-OLP and nK-OLP.

METHODS: 270 K-OLP and 270 nK-OLP patients were recruited in 15 Italian universities. The Numeric Rating Scale (NRS), Total Pain Rating Index (T-PRI), Hamilton Rating Scales for Depression and for Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were administered.

RESULTS: The Central-South K-OLP (CS-K-OLP) patients reported a higher frequency of pain/burning compared with the K-OLP patients of the North (N-K-OLP) with higher scores in the NRS and T-PRI (p value < 0.001**). The CS-K-OLP and the CS-nK-OLP patients showed higher scores in the HAM-D, HAM-A, PSQI and ESS compared with the Northern patients (p value < 0.001**). Multivariate logistic regression revealed that the NRS and T-PRI showed the greatest increase in the R2 value for the CS-K-OLP (DR2 = 9.6%; p value < 0.001**; DR2 = 9.7% p value < 0.001**; respectively) and that the oral symptoms (globus, itching and intraoral foreign body sensation) and PSQI showed the greatest increase in the R2 value for the CS-nK-OLP (DR2 = 5.6%; p value < 0.001**; DR2 = 4.5% p value < 0.001** respectively).

CONCLUSIONS: Pain and mood disorders are predominant in patients with OLP in the Central-South of Italy. Clinicians should consider that the geographical living area may explain the differences in oral symptoms and psychological profile in OLP.

PMID:35585582 | DOI:10.1186/s12903-022-02181-7

BMC Cancer. 2022 May 18;22(1):559. doi: 10.1186/s12885-022-09660-8.

ABSTRACT

BACKGROUND: Whether pioglitazone may affect breast cancer risk in female diabetes patients is not conclusive and has not been investigated in the Asian populations.

METHODS: The reimbursement database of Taiwan’s National Health Insurance was used to enroll an unmatched cohort and a propensity score-matched cohort of ever users and never users of pioglitazone in female patients with newly diagnosed type 2 diabetes during 1999-2008. The patients were alive on January 1, 2009 and were followed up for breast cancer incidence until December 31, 2011. Cox regression was used to estimate hazard ratios for ever users and tertiles of cumulative duration of pioglitazone therapy versus never users, and for cumulative duration of pioglitazone therapy treated as a continuous variable. Three models were created for the unmatched cohort and the matched cohort, respectively: 1) without adjustment for covariates; 2) after adjustment for covariates that differed with statistical significance (P-value < 0.05) between ever users and never users; and 3) after adjustment for all covariates.

RESULTS: There were 174,233 never users and 6926 ever users in the unmatched cohort; and 6926 never users and 6926 ever users in the matched cohort. After a median follow-up of 2.8 years, the numbers of incident breast cancer were 1044 in never users and 35 in ever users in the unmatched cohort and were 41 and 35, respectively, in the matched cohort. Hazard ratios suggested a null association between pioglitazone and breast cancer in all three models in either the unmatched cohort or the matched cohort. The overall hazard ratio after adjustment for all covariates was 0.758 (95% confidence interval: 0.539-1.065) in the unmatched cohort and was 0.824 (95% confidence interval: 0.524-1.296) in the matched cohort. None of the hazard ratios for the tertiles of cumulative duration of pioglitazone therapy and for the cumulative duration being treated as a continuous variable were statistically significant.

CONCLUSIONS: This study suggests a null association between pioglitazone and breast cancer risk in female patients with type 2 diabetes mellitus. However, because of the small breast cancer cases and the limited follow-up time, further studies are warranted to confirm our findings.

PMID:35585577 | DOI:10.1186/s12885-022-09660-8