Tag: statistics

PLoS One. 2023 Feb 3;18(2):e0280614. doi: 10.1371/journal.pone.0280614. eCollection 2023.

ABSTRACT

BACKGROUND: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in young people from Catalonia (Spain) who travelled to Menorca (Spain) in summer 2021. This outbreak appeared when governments relaxed Covid-19 preventive measures: the mask usage and the opening of nightlife. It was related to a super-disseminating mass event: Sant Joan festivities in Ciutadella. The aim of this article is to describe an outbreak of COVID-19 in young people aged 17-19 years from Catalonia travelling to Menorca.

METHODS: This is an observational study of a COVID-19 outbreak. The study population comprised Catalonian youth aged 17-19 years who travelled to Menorca from 15 June to 10 July. Epidemiological descriptive indicators were obtained. Descriptive and geographical statistics were carried out. Bivariate Moran’s I test was used to identify spatial autocorrelation between the place of residence and deprivation. The outbreak control method was based on identifying and stopping chains of transmission by implementing the test-trace-isolate-quarantine (TTIQ) strategy.

RESULTS: We identified 515 confirmed cases infected in Menorca, 296 (57.5%) in girls and 219 (42.5%) in boys, with a total of 2,280 close contacts. Of them, 245 (10.7%) were confirmed as cases. The cases were diagnosed between 15 June and 10 July. None of the persons with confirmed infection died or required hospitalisation. The attack rate was 27.2%. There was an inverse relationship between deprivation and number of confirmed cases (p<0.005), there were clusters of confirmed cases in the most socioeconomic favoured areas.

DISCUSSION: The outbreak is related with young people from socioeconomic favoured areas who travelled to Menorca in summer 2021. Failure to comply with preventive measures in binge-drinking events and during holidays may have favoured SARS-CoV-2 transmission. The interauthority coordination and establishment of a clear line of leadership allowed continuous communication between institutions, which were key to managing this complex COVID-19 outbreak.

PMID:36735702 | DOI:10.1371/journal.pone.0280614

Aust Endod J. 2023 Feb 3. doi: 10.1111/aej.12737. Online ahead of print.

ABSTRACT

This study aimed to perform an analysis of obtaining apical patency indexes during endodontic treatments considering gender, age, pulpoperiradicular diagnosis and canal/tooth (n. 639/383). Following previous clinical procedures, a thin K-File (No. 20, 15, 10 or 08) was used to achieve apical patency. These specific data and some demographic and clinical information were submitted to the statistical analysis (p < 0.05). Significant statistical differences were not identified considering gender (p = 0.156) and age (p = 0.793). However, in 14.6% of the canals of vital teeth and 14.1% of the canals of necrotic teeth without periapical lesions, apical patency could not be achieved, which occurred in only 7% of the canals of necrotic teeth with periradicular disease (p = 0.009). Considering canal/tooth, apical patency was more challenging to obtain in canals of posterior teeth (p = 0.000). The pulpoperiapical diagnosis and canal/tooth significantly influenced the obtaining of apical patency.

PMID:36735354 | DOI:10.1111/aej.12737

JMIR Res Protoc. 2023 Feb 3;12:e41416. doi: 10.2196/41416.

ABSTRACT

BACKGROUND: Parkinson’s can impact people’s speech, cognition, pragmatics, and language, significantly affecting their conversations with others. The speech and language therapy approach called communication partner training (CPT) is effective for a range of communication difficulties. However, speech and language therapy interventions for people with Parkinson’s predominantly focus on impairments, with little provision of CPT for this population. Better Conversations is a CPT approach that involves working with a dyad (the person with the communication difficulty and a conversation partner [CP]) to build conversation skills. It is effective at reducing barriers to conversation, and for some, it significantly increases targeted facilitatory strategies. Some approaches to CPT have been adapted to be delivered via telehealth. This can maximize ecological validity and convenience. Furthermore, telehealth is widely accepted as a delivery method for other interventions for Parkinson’s. This study presents the protocol for a pilot feasibility study of a Better Conversations CPT delivered via telehealth to people living with Parkinson’s and their CPs, called Better Conversations with Parkinson’s (BCP).

OBJECTIVE: The primary aim is to evaluate the feasibility of the BCP program delivered via telehealth with a treatment group from a collaborating National Health Service (NHS) site to establish for a main trial whether BCP can be delivered as intended in an NHS setting. The aim is to establish: (1) the acceptability of the program for people living with Parkinson’s, family members, and speech and language therapists (SLTs); (2) the feasibility of delivering the BCP program; (3) the recruitment and retention rates; (4) a sample size calculation; and (5) the most appropriate primary outcome measure.

METHODS: Ethical approval for this study was obtained from London-Central Research Ethics Committee (reference: 22/LO/0332). This case-series feasibility pilot study will recruit 10-12 dyads to ensure 10 complete data sets. Participants will be recruited by a collaborating NHS site located in England. Participants will be involved for 16 weeks (weeks 1-2 preintervention measures, weeks 3-8 intervention, weeks 10-12 postintervention measures, week 16 follow-up interview). Quantitative and qualitative methods will be used to analyze the study data. Speech, communication, and quality of life assessment data will be analyzed statistically to determine a suitably sensitive outcome measure. Descriptive statistics will be used to report on recruitment, attendance, and attrition. Finally, acceptability and feasibility will be evaluated using participant feedback, interviews, and the reflective diary and feedback of the SLT administering the therapy (by the research assistant who is the first author). This data will be analyzed using descriptive statistics and reflexive thematic analysis.

RESULTS: This study was approved for funding from Parkinson’s UK. Study recruitment commenced in July 2022. The results of the data analysis are expected to be available by September 2024.

CONCLUSIONS: Insights from this study will provide valuable information about the acceptability and feasibility of a remotely delivered Better Conversations CPT approach for people living with Parkinson’s and their CPs. An outcome of this study will be a manualized BCP program coproduced by people living with Parkinson’s, their families, and a group of expert SLTs. The study results will guide the next stages of intervention development.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/41416.

PMID:36735301 | DOI:10.2196/41416

JMIR Public Health Surveill. 2023 Feb 3;9:e42190. doi: 10.2196/42190.

ABSTRACT

BACKGROUND: Managing hypertension (HT) and diabetes mellitus (DM) is crucial to preventing cardiovascular diseases. Few studies have investigated the incidence and risk of cardiovascular diseases or mortality in uncontrolled HT or DM in the Asian population. Epidemiological studies of cardiovascular disease should be conducted with continuous consideration of the changing disease risk profiles, lifestyles, and socioeconomic status over time.

OBJECTIVE: We aimed to examine the association of uncontrolled HT or DM with the incidence of cardiovascular events or deaths from any cause.

METHODS: This population-based retrospective study was conducted using data from the Korean National Health Insurance Service-National Health Screening Cohort, including patients aged 40-79 years who participated in national screening from 2002 to 2003 and were followed up until 2015. The health screening period from 2002 to 2013 was stratified into 6 index periods in 2-year cycles, and the follow-up period from 2004 to 2015 was stratified accordingly into 6 subsequent 2-year periods. The incidence rates and hazard ratio (HR) for major adverse cardiovascular events (MACE) and death from any cause were estimated according to HT or DM control status. Extended Cox models with time-dependent variables updated every 2 years, including sociodemographic characteristics, blood pressure (BP), fasting blood glucose (FBG), medication prescription, and adherence, were used.

RESULTS: Among the total cohort of 440,249 patients, 155,765 (35.38%) were in the uncontrolled HT or DM group. More than 60% of the patients with HT or DM who were prescribed medications did not achieve the target BP or FBG. The incidence of MACE was 10.8-15.5 and 9.6-13.3 per 1000 person-years in the uncontrolled DM and uncontrolled HT groups, respectively, and increased with age. In the uncontrolled HT and DM group, the incidence of MACE was high (15.2-17.5 per 1000 person-years) at a relatively young age and showed no age-related trend. Adjusted HR for MACE were 1.28 (95% CI 1.23-1.32) for the uncontrolled DM group, 1.32 (95% CI 1.29-1.35) for the uncontrolled HT group, and 1.54 (95% CI 1.47-1.60) for the uncontrolled HT and DM group. Adjusted HR for death from any cause were 1.05 (95% CI 1.01-1.10) for the uncontrolled DM group, 1.13 (95% CI 1.10-1.16) for the uncontrolled HT group, and 1.17 (95% CI 1.12-1.23) for the uncontrolled HT and DM group.

CONCLUSIONS: This up-to-date evidence of cardiovascular epidemiology in South Korea serves as the basis for planning public health policies to prevent cardiovascular diseases. The high uncontrolled rates of HT or DM, regardless of medication prescription, have led us to suggest the need for a novel system for effective BP or glycemic control, such as a community-wide management program using mobile health technology.

PMID:36735297 | DOI:10.2196/42190

J Med Internet Res. 2023 Feb 3;25:e41532. doi: 10.2196/41532.

ABSTRACT

BACKGROUND: Internet-based cognitive behavioral therapy (iCBT) services for common mental health disorders have been found to be effective. There is a need for strategies that improve implementation in routine practice. One-size-fits-all strategies are likely to be ineffective. Tailored implementation is considered as a promising approach. The self-guided integrated theory-based Framework for intervention tailoring strategies toolkit (ItFits-toolkit) supports local implementers in developing tailored implementation strategies. Tailoring involves identifying local barriers; matching selected barriers to implementation strategies; developing an actionable work plan; and applying, monitoring, and adapting where necessary.

OBJECTIVE: This study aimed to compare the effectiveness of the ItFits-toolkit with implementation-as-usual (IAU) in implementing iCBT services in 12 routine mental health care organizations in 9 countries in Europe and Australia.

METHODS: A stepped-wedge cluster randomized trial design with repeated measures was applied. The trial period lasted 30 months. The primary outcome was the normalization of iCBT delivery by service providers (therapists, referrers, IT developers, and administrators), which was measured with the Normalization Measure Development as a proxy for implementation success. A 3-level linear mixed-effects modeling was applied to estimate the effects. iCBT service uptake (referral and treatment completion rates) and implementation effort (hours) were used as secondary outcomes. The perceived satisfaction (Client Satisfaction Questionnaire), usability (System Usability Scale), and impact of the ItFits-toolkit by implementers were used to assess the acceptability of the ItFits-toolkit.

RESULTS: In total, 456 mental health service providers were included in this study. Compared with IAU, the ItFits-toolkit had a small positive statistically significant effect on normalization levels in service providers (mean 0.09, SD 0.04; P=.02; Cohen d=0.12). The uptake of iCBT by patients was similar to that of IAU. Implementers did not spend more time on implementation work when using the ItFits-toolkit and generally regarded the ItFits-toolkit as usable and were satisfied with it.

CONCLUSIONS: The ItFits-toolkit performed better than the usual implementation activities in implementing iCBT services in routine practice. There is practical utility in the ItFits-toolkit for supporting implementers in developing and applying effective tailored implementation strategies. However, the effect on normalization levels among mental health service providers was small. These findings warrant modesty regarding the effectiveness of self-guided tailored implementation of iCBT services in routine practice.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-020-04686-4.

PMID:36735287 | DOI:10.2196/41532

JAMA Netw Open. 2023 Feb 1;6(2):e2254006. doi: 10.1001/jamanetworkopen.2022.54006.

ABSTRACT

IMPORTANCE: Electronic clinical decision support systems apply clinical guidelines in real time and offer a new approach to improve referral and utilization of low vision rehabilitation (LVR) care.

OBJECTIVE: To characterize patients and factors associated with LVR service utilization with and without the use of an electronic health record (EHR) clinical decision support system (CDSS) alert.

DESIGN, SETTING, AND PARTICIPANTS: Quality improvement study using EHR data to compare patients who did and did not utilize LVR service after referral between November 6, 2017, and October 5, 2019, (primary) and to assess overall service utilization rate from September 1, 2016, to April 2, 2021, regardless of referral status (secondary). Participants in the primary analysis were patients at a large ophthalmology department in an academic medical center in the US who received an LVR referral recommendation from their ophthalmologist according to the CDSS alert. The secondary analysis included patients with best documented visual acuity (BDVA) worse than 20/40 before, during, and after the CDSS implementation. Data were analyzed from August 2021 to April 2022.

EXPOSURES: Number and locations of referral recommendations for LVR service according to the CDSS alert in the primary analysis; active CDSS implementation in the secondary analysis.

MAIN OUTCOMES AND MEASURES: LVR service utilization rate was defined as the number of patients who accessed service among those who were referred (primary) and among those with BDVA worse than 20/40 (secondary). EHR data on patient demographics (age, sex, race, ethnicity) and ophthalmology encounter characteristics (numbers of referral recommendations, encounter location, and BDVA) were extracted.

RESULTS: Of the 429 patients (median [IQR] age, 71 [53 to 83] years; 233 female [54%]) who received a CDSS-based referral recommendation, 184 (42.9%) utilized LVR service. Compared with nonusers of LVR, users were more likely to have received at least 2 referral recommendations (12.5% vs 6.1%; χ21 = 5.29; P = .02) and at an ophthalmology location with onsite LVR service (87.5% vs 78.0%; χ21 = 6.50; P = .01). Onsite LVR service (odds ratio, 2.06; 95% CI, 1.18-3.61) persisted as the only statistically significant factor after adjusting for patient demographics and other referral characteristics. Among patients whose BDVA was worse than 20/40 before, during, and after the CDSS implementation regardless of referral status, the LVR service utilization rate was 6.1%, 13.8%, and 7.5%, respectively.

CONCLUSIONS AND RELEVANCE: In this quality improvement study, ophthalmologist referral recommendations and onsite LVR services at the location where patients receive other ophthalmic care were significantly associated with service utilization. Ophthalmology CDSSs are promising tools to apply clinical guidelines in real time to improve connection to care.

PMID:36735257 | DOI:10.1001/jamanetworkopen.2022.54006

JAMA Netw Open. 2023 Feb 1;6(2):e2254669. doi: 10.1001/jamanetworkopen.2022.54669.

ABSTRACT

IMPORTANCE: Anthracyclines increase the risk for congestive heart failure (CHF); however, long-term cumulative incidence and risk factors for CHF after anthracycline therapy are not well defined in population-based studies.

OBJECTIVE: To compare the long-term cumulative incidence of CHF in patients with breast cancer or lymphoma treated with anthracycline therapy compared with healthy controls from the same community.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective population-based case-control study included data from the Rochester Epidemiology Project. Participants included residents of Olmsted County, Minnesota, diagnosed with breast cancer or lymphoma from January 1985 through December 2010 matched for age, sex, and comorbidities with healthy controls, with a final ratio of 1 case to 1.5 controls. Statistical analysis was performed between July 2017 and February 2022.

EXPOSURES: Cancer treatment and CHF risk factors.

MAIN OUTCOMES AND MEASURES: The main outcome was new-onset CHF, as defined by the modified Framingham criteria. Cox proportional hazards regression was used to estimate hazard ratios (HRs) to compare the risk of CHF in participants with cancer vs controls, adjusted for age, sex, diabetes, hypertension, hyperlipidemia, coronary artery disease, obesity, and smoking history.

RESULTS: A total of 2196 individuals were included, with 812 patients with cancer and 1384 participants without cancer. The mean (SD) age was 52.62 (14.56) years and 1704 participants (78%) were female. Median (IQR) follow-up was 8.6 (5.2-13.4) years in the case group vs 12.5 (8.7-17.5) years in the control group. Overall, patients with cancer had higher risk of CHF compared with the control cohort even after adjusting for age, sex, diabetes, hypertension, coronary artery disease, hyperlipidemia, obesity, and smoking status (HR, 2.86 [95% CI, 1.90-4.32]; P < .001). After adjusting for the same variables, CHF risk was greater for patients with cancer receiving anthracycline (HR, 3.25 [95% CI, 2.11-5.00]; P < .001) and was attenuated and lost statistical significance for patients with cancer not receiving anthracyclines (HR, 1.78 [95% CI, 0.83-3.81]; P = .14). Higher cumulative incidence for patients treated with anthracyclines vs comparator cohort was observed at 1 year (1.81% vs 0.09%), 5 years (2.91% vs 0.79%), 10 years (5.36% vs 1.74%), 15 years (7.42% vs 3.18%), and 20 years (10.75% vs 4.98%) (P < .001). There were no significant differences in risk of CHF for patients receiving anthracycline at a dose of less than 180 mg/m2 compared with those at a dose of 180 to 250 mg/m2 (HR, 0.54 [95% CI, 0.19-1.51]) or at a dose of more than 250 mg/m2 (HR, 1.23 [95% CI, 0.52-2.91]). At diagnosis, age was an independent risk factor associated with CHF (HR per 10 years, 2.77 [95% CI, 1.99-3.86]; P < .001).

CONCLUSIONS AND RELEVANCE: In this retrospective population-based case-control study, anthracyclines were associated with an increased risk of CHF early during follow-up, and the increased risk persisted over time. The cumulative incidence of CHF in patients with breast cancer or lymphoma treated with anthracyclines at 15 years was more than 2-fold that of the control group.

PMID:36735254 | DOI:10.1001/jamanetworkopen.2022.54669

CMAJ Open. 2022 Dec 20;10(4):E1067-E1078. doi: 10.9778/cmajo.20210319. Print 2022 Oct-Dec.

ABSTRACT

BACKGROUND: With an aging population in Ontario, ophthalmologists provide most of their care to older adults, which has prominent human resource implications. In this study, we sought to investigate the supply and demographic characteristics of Ontario’s ophthalmologists.

METHODS: In this retrospective, population-based analysis, we evaluated cohort demographics, including sex and career stage, of Ontario’s ophthalmologists from 2010 to 2019, which we reported using descriptive statistics. Similarly, we detailed ophthalmologist supply within different areas of care using descriptive statistics.

RESULTS: Over the study period, a median of 464 ophthalmologists were practising in Ontario each year. The proportion of female ophthalmologists increased from 18.7% in 2010 to 24.1% in 2019. The proportion of late-career ophthalmologists (aged > 55 yr) significantly increased by 6.4% over the study period and constituted 45.3% of the workforce in 2019. Comprehensive cataract surgery was the most common area of care. Although the number of ophthalmologists per 100 000 people remained stable over the study period (3.27 ophthalmologists/100 000 people in 2019), the number of ophthalmologists per 100 000 people aged 65 years and older fell by 18.4% from 2010 to 2019. The greatest supply reduction was among moderate-volume comprehensive cataract surgeons (-20.2% overall and -35.4% relative to the population aged ≥ 65 yr).

INTERPRETATION: Between 2010 and 2019, the overall number of ophthalmologists in Ontario remained stable; however, we observed declines in the number of ophthalmologists per 100 000 people aged 65 years and older for most areas of care. Nearly half of the ophthalmology workforce is now older than 55 years and female representation is increasing.

PMID:36735225 | DOI:10.9778/cmajo.20210319

CMAJ Open. 2022 Dec 13;10(4):E1059-E1066. doi: 10.9778/cmajo.20210185. Print 2022 Oct-Dec.

ABSTRACT

BACKGROUND: Choosing Wisely is a high-profile campaign seeking to reduce the use of low-value care. We investigated the impact of a Choosing Wisely Canada recommendation against using a combination of angiotensin-converting-enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) for the management of hypertension, heart failure or diabetic nephropathy on population-level use of these medications in British Columbia, Canada.

METHODS: We identified all people (any age) who were continuously registered with BC’s Medical Service Plan between 2010 and 2017 with the targeted conditions. Using prescription claims data and an interrupted time-series analysis, we estimated the number of people on combination therapy per month, the proportion of days covered (PDC) by combination therapy per month and proportion of all combination prescriptions started per month in the 2 years before and after the introduction of the recommendation on Oct. 29, 2014.

RESULTS: Of 1 104 593 people (mean age 65 yr, standard deviation 16 yr) in our study cohort, 4.6% were exposed to combination therapy, largely prescribed by family physicians (84%). The number of people on combination therapy and the PDC were declining before the recommendation, but the proportion of combination prescriptions started in the 2 years before the recommendation was increasing. After the recommendation, we observed no statistically significant changes in any outcome. The pre-existing downward trend of the monthly number of people decelerated (16.8, 95% confidence interval [CI] 14.0 to 19.5) and the proportion of prescriptions started increased (0.13%, 95% CI 0.08% to 0.18%).

INTERPRETATION: The Choosing Wisely Canada recommendation against using a combination of ACE inhibitors and ARBs was not associated with reduced combination therapy use in the targeted conditions. The observed pre-existing declines in this practice questions the process of selecting recommendations, and the optimal implementation and value of Choosing Wisely campaigns without other reinforcing interventions.

PMID:36735223 | DOI:10.9778/cmajo.20210185

J Endocrinol Invest. 2023 Feb 3. doi: 10.1007/s40618-023-02021-7. Online ahead of print.

ABSTRACT

PURPOSE: To study sexual function and distress in women with functional hypothalamic amenorrhea (FHA) compared to women with FHA and an underlying polycystic ovary syndrome (PCOS)-phenotype, considering also their psychometric variables. As a secondary aim, we explored the relationship between sexual functioning and hormonal milieu in these women.

METHODS: This is a retrospective cross-sectional study conducted on 36 women with typical FHA and 43 women with FHA + PCOS-phenotype. The following validated psychometric questionnaires were administered: Female Sexual Functional Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Attitude Test (BAT), Bulimia Investigation Test (BITE), State Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Multidimensional Perfectionism Scale (MPS). Available hormones to formulate FHA diagnosis in the standard routine were considered.

RESULTS: Women with typical FHA reported a significantly lower FSFI total score than women with FHA + PCOS-phenotype (95% CI for median 16-21.3 vs. 21.1-24.1, p = 0.002), whereas the FSDS-R score was similar in the two groups (95% CI for median 6-16 vs. 6-16.3). No statistically significant differences were evident in body attitude, state and trait anxiety, depression, bulimic risk, and perfectionism between the two groups, confirming the two FHA groups were superimposable from a psychometric perspective. State anxiety correlated negatively with the FSFI total score in both typical FHA (rho: – 0.33, p = 0.05) and FHA + PCOS-phenotype (rho: – 0.40, p = 0.009). In the entire study population, a positive correlation was found between luteinizing hormone, androstenedione, and 17ß-estradiol and the total FSFI score (rho: 0.28, p = 0.01; rho: 0.27, p = 0.01, rho: 0.27, p = 0.01, respectively).

CONCLUSION: Women with FHA showed a very high rate of sexual symptoms as part of their condition, but those with a typical diagnosis displayed a more severe sexual impairment as compared with the FHA + PCOS-phenotype, in spite of a similar psychometric profile. Sexual distress was equally present in both groups (approximately 4 out of 10 women). Further studies should be designed to investigate the potential role of sex hormones, mainly LH-driven androstenedione, in influencing women’s sexual functioning.

PMID:36735200 | DOI:10.1007/s40618-023-02021-7