JAMA Netw Open. 2024 May 1;7(5):e2413874. doi: 10.1001/jamanetworkopen.2024.13874.
NO ABSTRACT
PMID:38814646 | DOI:10.1001/jamanetworkopen.2024.13874
Tag: statistics
JAMA Netw Open. 2024 May 1;7(5):e2413869. doi: 10.1001/jamanetworkopen.2024.13869.
ABSTRACT
IMPORTANCE: Cigarette smoking is a primary risk factor for chronic lower respiratory disease (CLRD) and is associated with worse symptoms among people with CLRD. It is important to evaluate the economic outcomes of smoking in this population.
OBJECTIVE: To estimate smoking prevalence and cigarette smoking-attributable health care expenditures (SAHEs) for adults with CLRD in the US.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the 2014-2018 and 2020 National Health Interview Surveys (NHIS) and the 2020 Medical Expenditure Panel Survey. The final study population, stratified by age 35 to 64 years and 65 years or older, was extracted from the 2014-2018 NHIS data. The data analysis was performed between February 1 and March 31, 2024.
EXPOSURES: Cigarette smoking, as classified into 4 categories: current smokers, former smokers who quit less than 15 years ago, former smokers who quit 15 or more years ago, and never smokers.
MAIN OUTCOMES AND MEASURES: Smoking-attributable health care expenditures were assessed using a prevalence-based annual cost approach. Econometric models for the association between cigarette smoking and health care utilization were estimated for 4 types of health care services: inpatient care, emergency department visits, physician visits, and home health visits.
RESULTS: In the 2014-2018 NHIS study sample of 13 017 adults, 7400 (weighted 62.4%) were aged 35 to 64 years, 5617 (weighted 37.6%) were 65 years or older, and 8239 (weighted 61.9%) were female. In 2020, among 11 211 222 adults aged 35 to 64 with CLRD, 3 508 504 (31.3%) were current smokers and 3 496 790 (31.2%) were former smokers. Total SAHEs in 2020 for this age group were $13.6 billion, averaging $2752 per current smoker and $1083 per former smoker. In 2020, 7 561 909 adults aged 65 years or older had CLRD, with 1 451 033 (19.2%) being current smokers and 4 104 904 (54.3%) being former smokers. Total SAHEs in 2020 for the older age group were $5.3 billion, averaging $1704 per current smoker and $682 per former smoker. In sum, SAHEs for adults with CLRD aged 35 years or older amounted to $18.9 billion in 2020.
CONCLUSIONS AND RELEVANCE: In this cross-sectional study of adults with CLRD, cigarette smoking was associated with a substantial health care burden. The higher per-person SAHEs for current smokers compared with former smokers suggest potential cost savings of developing targeted smoking cessation interventions for this population.
PMID:38814643 | DOI:10.1001/jamanetworkopen.2024.13869
JAMA Netw Open. 2024 May 1;7(5):e2413878. doi: 10.1001/jamanetworkopen.2024.13878.
ABSTRACT
IMPORTANCE: The decision for surgical vs nonsurgical treatment for hip fracture can be complicated among community-dwelling people living with dementia.
OBJECTIVE: To compare outcomes of community-dwelling people living with dementia treated surgically and nonsurgically for hip fracture.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study undertook a population-based analysis of national Medicare fee-for-service data. Participants included community-dwelling Medicare beneficiaries with dementia and an inpatient claim for hip fracture from January 1, 2017, to June 30, 2018. Analyses were conducted from November 10, 2022, to October 17, 2023.
EXPOSURE: Surgical vs nonsurgical treatment for hip fracture.
MAIN OUTCOMES AND MEASURES: The primary outcome was mortality within 30, 90, and 180 days. Secondary outcomes consisted of selected post-acute care services.
RESULTS: Of 56 209 patients identified with hip fracture (73.0% women; mean [SD] age, 86.4 [7.0] years), 33 142 (59.0%) were treated surgically and 23 067 (41.0%) were treated nonsurgically. Among patients treated surgically, 73.3% had a fracture of the femoral head and neck and 40.2% had moderate to severe dementia (MSD). Among patients with MSD and femoral head and neck fracture, 180-day mortality was 31.8% (surgical treatment) vs 45.7% (nonsurgical treatment). For patients with MSD treated surgically vs nonsurgically, the unadjusted odds ratio (OR) of 180-day mortality was 0.56 (95% CI, 0.49-0.62; P < .001) and the adjusted OR was 0.59 (95% CI, 0.53-0.66; P < .001). Among patients with mild dementia and femoral head and neck fracture, 180-day mortality was 26.5% (surgical treatment) vs 34.9% (nonsurgical treatment). For patients with mild dementia who were treated surgically vs nonsurgically for femoral head and neck fracture, the unadjusted OR of 180-day mortality was 0.67 (95% CI, 0.60-0.76; P < .001) and the adjusted OR was 0.71 (95% CI, 0.63-0.79; P < .001). For patients with femoral head and neck fracture, there was no difference in admission to a nursing home within 180 days when treated surgically vs nonsurgically.
CONCLUSIONS AND RELEVANCE: In this cohort study of community-dwelling patients with dementia and fracture of the femoral head and neck, patients with MSD and mild dementia treated surgically experienced lower odds of death compared with patients treated nonsurgically. Although avoiding nursing home admission is important to persons living with dementia, being treated surgically for hip fracture did not necessarily confer a benefit in that regard. These data can help inform discussions around values and goals with patients and caregivers when determining the optimal treatment approach.
PMID:38814642 | DOI:10.1001/jamanetworkopen.2024.13878
JAMA Netw Open. 2024 May 1;7(5):e2413884. doi: 10.1001/jamanetworkopen.2024.13884.
ABSTRACT
IMPORTANCE: Although new parents’ mental health is known to decline, less is known about changes in therapy attendance, especially among military service members.
OBJECTIVE: To investigate changes in therapy attendance among new parents and by parental leave length.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study of US Army and Navy service members from January 1, 2013, to December 31, 2019, compared parents’ monthly therapy attendance with matched nonparents’ across childbirth and compared mothers’ weekly therapy attendance before vs after returning to work. Eligible monthly sample members included service members with first births from January 1, 2014, to December 31, 2017, and 12 months of data before to 24 months after birth and nonparents with 36 months of data. Eligible weekly sample members included mothers with first births from January 1, 2013, to June 30, 2019, and data from 12 months before to 6 months after birth and nonparents with 18 months of data. Data analysis was performed from July 1, 2023, to January 15, 2024.
EXPOSURE: Those exposed to parenthood had no prior children, acquired a dependent younger than 1 year, and, for mothers, had an inpatient birth. Unexposed matches did not add a dependent younger than 1 year.
MAIN OUTCOMES AND MEASURES: Monthly counts of mental health therapy sessions and any therapy sessions (weekly).
RESULTS: The monthly sample included 15 554 193 person-month observations, representing 321 200 parents and matches, including 10 193 mothers (3.2%; mean [SD] age, 25.0 [4.9] years), 50 865 nonmother matches (15.8%; mean [SD] age, 25.0 [5.0] years), 43 365 fathers (13.5%; mean [SD] age, 26.4 [4.8] years), and 216 777 nonfather matches (67.5%; mean [SD] age, 26.4 [4.8] years). The weekly sample included 17 464 mothers. Mothers went to 0.0712 fewer sessions at 1 month post partum (95% CI, -0.0846 to -0.0579) compared with 10 months before birth. Fathers went to 0.0154 fewer sessions in the month of birth (95% CI, -0.0194 to -0.0114) compared with 10 months before. Parents with preexisting treatment needs had larger decreases in treatment. Weekly therapy attendance increased by 0.555 percentage points (95% CI, 0.257-0.852) when mothers returned to work from 6 weeks of leave and 0.953 percentage points (95% CI, 0.610-1.297) after 12 weeks of leave.
CONCLUSIONS AND RELEVANCE: In this cohort study of new parents, therapy attendance decreased around childbirth, especially among parents with prior mental health needs and mothers with longer maternity leaves. These findings suggest that more accessible treatment, including home visits or telehealth appointments, is needed.
PMID:38814641 | DOI:10.1001/jamanetworkopen.2024.13884
Chem Biodivers. 2024 May 30:e202400523. doi: 10.1002/cbdv.202400523. Online ahead of print.
ABSTRACT
Cold-pressed Camelina oil is a traditional oil registered as a traditional food in Poland. Camelina oil has health-promoting properties and high oxidative stability. This may be due to the presence of various bioactive antioxidant compounds such as carotenoids, sterols and polyphenols. Bioactive compounds content in Camelina oil depends mainly on the varieties and on the conditions under which the crop was grown therefore the aim of the research was to analyse antioxidant bioactive compounds in oil from different cultivars of Camelina sativa seeds and to determine their relationship with oil parameters.
PMID:38814629 | DOI:10.1002/cbdv.202400523
JAMA Ophthalmol. 2024 May 30. doi: 10.1001/jamaophthalmol.2024.1712. Online ahead of print.
ABSTRACT
IMPORTANCE: Fluoroquinolone use has been associated with increased risk of uveitis and retinal detachment in noninterventional studies, but the findings have been conflicting and causality is unclear.
OBJECTIVE: To estimate the association of systemic fluoroquinolone use with acute uveitis or retinal detachment, using multiple analyses and multiple databases to increase the robustness of results.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Clinical Practice Research Datalink Aurum and GOLD UK primary care records databases, which were linked to hospital admissions data. Adults prescribed a fluoroquinolone or a comparator antibiotic, cephalosporin, between April 1997 and December 2019 were included. Adults with uveitis or retinal detachment were analyzed in a separate self-controlled case series. Data analysis was performed from May 2022 to May 2023.
EXPOSURES: Systemic fluoroquinolone or comparator antibiotic.
MAIN OUTCOMES AND MEASURES: The primary outcome was a diagnosis of acute uveitis or retinal detachment. Hazard ratios (HRs) were estimated in the cohort study for the association of fluoroquinolone prescription with either uveitis or retinal detachment, using stabilized inverse probability of treatment weighted Cox regression. Rate ratios (RRs) were estimated in the self-controlled case series, using conditional Poisson regression. Estimates were pooled across databases using fixed-effects meta-analysis.
RESULTS: In total, 3 001 256 individuals in Aurum (1 893 561 women [63.1%]; median [IQR] age, 51 [35-68] years) and 434 754 in GOLD (276 259 women [63.5%]; median [IQR] age, 53 [37-70] years) were included in the cohort study. For uveitis, the pooled adjusted HRs (aHRs) for use of fluoroquinolone vs cephalosporin were 0.91 (95% CI, 0.72-1.14) at first treatment episode and 1.07 (95% CI, 0.92-1.25) over all treatment episodes. For retinal detachment, the pooled aHRs were 1.37 (95% CI, 0.80-2.36) at first treatment episode and 1.18 (95% CI, 0.84-1.65) over all treatment episodes. In the self-controlled case series, for uveitis, the pooled adjusted RRs (aRRs) for fluoroquinolone use vs nonuse were 1.13 (95% CI, 0.97-1.31) for 1 to 29 days of exposure, 1.16 (95% CI, 1.00-1.34) for 30 to 59 days, and 0.98 (95% CI, 0.74-1.31) for 60 days for longer. For retinal detachment, pooled aRRs for fluoroquinolone use vs nonuse were 1.15 (95% CI, 0.86-1.54) for 1 to 29 days of exposure, 0.94 (95% CI, 0.69-1.30) for 30 to 59 days, and 1.03 (95% CI, 0.59-1.78) for 60 days or longer.
CONCLUSIONS AND RELEVANCE: These findings do not support an association of systemic fluoroquinolone use with substantively increased risk of uveitis or retinal detachment. Although an association cannot be completely ruled out, these findings indicate that any absolute increase in risk would be small and, hence, of limited clinical importance.
PMID:38814618 | DOI:10.1001/jamaophthalmol.2024.1712
Altern Ther Health Med. 2024 May 24:AT10198. Online ahead of print.
ABSTRACT
OBJECTIVE: This study aimed to evaluate the effectiveness of personalized nursing care in postoperative supplementary surgery for cervical intraepithelial neoplasia grade III (CIN III) patients with positive or high-grade CIN margins after cold knife conization at the Fourth Hospital of Hebei Medical University in Shijiazhuang, China. The primary objective was to assess the impact of personalized nursing intervention on postoperative outcomes, including psychological well-being, self-care ability, quality of life, and postoperative complications.
METHODS: A total of 106 patients undergoing additional surgery after CIN III cold knife conization at the Fourth Hospital of Hebei Medical University from January 2020 to April 2023 were randomly allocated into an observation group (n=53) and a control group (n=53) using a random number table method. Detailed information on the randomization process, including stratification factors and blinding procedures, is provided. The observation group received personalized nursing intervention, while the control group received routine nursing. The retreatment methods, including repeat cold knife conization, total hysterectomy, and radical cervical cancer surgery, were analyzed using appropriate statistical methods. Statistical software was employed for data analysis.
RESULTS: Pathological results post-cold knife conization revealed positive margins in 76 cases and pathological upgrades in 30 cases. The consistency rate between post-cold knife conization and post-retreatment pathological results was 75.47%. After the intervention, the observation group exhibited significantly lower SAS and SDS scores and significantly higher ESCA and WHO QOL-100 scores compared to the control group (P < .05), indicating improved psychological well-being and quality of life. The total incidence of postoperative complications in the observation group was 5.66%, significantly lower than in the control group (P < .05).
CONCLUSION: Personalized nursing care in postoperative supplementary surgery for CIN III patients with positive or high-grade CIN margins at the Fourth Hospital of Hebei Medical University improves psychological well-being, self-care ability, quality of life, and reduces postoperative complications. The findings underscore the importance of tailored nursing interventions in enhancing patient outcomes. The inclusion of detailed patient demographics and methodological transparency enhances the generalizability and reliability of the study findings beyond the study setting.
PMID:38814609
Altern Ther Health Med. 2024 May 24:AT8215. Online ahead of print.
ABSTRACT
OBJECTIVE: To investigate the effects of sacubitril valsartan sodium combined with levosimendan on improving cardiac and renal functions in patients with CRS.
METHODS: 90 patients with the cardiorenal syndrome who were hospitalized in our hospital from February 2020 to February 2022 were selected and divided into two groups, the control group, and the joint group, according to both single and double number methods, with 45 cases in each group. Patients who met the diagnostic criteria for CRS, were older than 18 years of age, had NYHA class II to IV, and had stage 1 or 2 chronic kidney disease were included in the study. Patients with severe hypersensitivity to the drugs used in this test, haemodynamic instability, combined hyperthyroidism, malignancy, severe pulmonary hypertension, cardiogenic shock, malignant arrhythmias and pregnant women were excluded. Among them, the control group was treated with sacubitril valsartan sodium alone, and the joint group was treated with levosimendan supplemented with the treatment method of the control group. The treatment effect, the improvement of cardiac and renal function, and the incidence of adverse reactions were compared between the two groups of CRS patients, and the prognostic effect was followed up 6 months after treatment.
RESULTS: The total effective rate of treatment in the joint group was 95.56%, which was significantly higher than that in the control group of 80.00%, and the difference was statistically significant by using χ2 test (P < .05). After treatment, LVEF, LVEDD, and NT-proBNP levels in both groups were significantly improved compared with those before treatment (P < .05), and the improvement effect of each index in the joint group was more significant than that in the control group (P < .05). After treatment, the levels of SCr, BUN, and UA in both groups were significantly lower than those before treatment (P < .05), and the levels of each index in the joint group were significantly lower than those in the control group, statistical analyses showed significant differences (P < .05) using t test. The incidence of adverse effects such as tachycardia, premature ventricular contractions, heart failure, and myocardial ischaemia was 22.22% in the combined group, which was significantly lower than 42.22% in the control group, and the difference in the total incidence between the two groups was statistically significant by χ2 test (P < .05). One case of malignant arrhythmia and five cases of recurrence of heart failure occurred 6 months after surgery in the combined group, which were significantly lower than the eight and twelve cases in the control group.
CONCLUSION: Sacubitril valsartan sodium combined with levosimendan can significantly improve the therapeutic effect of CRS, with significant improvement in cardiac and renal function of CRS patients, and its incidence of adverse effects and long-term prognostic effects are lower than those of sacubitril valsartan sodium alone. This combination therapy offers a promising new direction for CRS management, warranting further investigation in larger, multicenter trials.
PMID:38814606
Altern Ther Health Med. 2024 May 24:AT10873. Online ahead of print.
ABSTRACT
OBJECTIVE: This study aims to evaluate the efficacy of integrating nursing early warning systems with doula-assisted childbirth nursing on natural childbirth rates and associated outcomes.
METHODS: A total of 150 women who underwent childbirth in the obstetrics and gynecology department of our hospital between September 2021 and March 2023 were enrolled as participants. They were randomly allocated into either the observation group or the control group, each comprising 75 individuals. The control group received standard nursing care, while the observation group received nursing early warning systems combined with doula-assisted childbirth nursing. Comparison between the two groups included modes of childbirth, the intensity of childbirth pain, neonatal Apgar scores, the incidence of postpartum hemorrhage, duration of the first and second stages of labor, and maternal satisfaction with nursing care.
RESULTS: Our findings indicated a higher natural childbirth rate in the observation group compared to the control group (P < .05). Furthermore, the SAS score of the observation group post-nursing was significantly lower than that of the control group. Additionally, neonates in the observation group exhibited higher Apgar scores compared to those in the control group. Moreover, mothers who underwent natural childbirth in the observation group experienced lower childbirth pain scores and reduced postpartum hemorrhage incidence (P < .05). The duration of both the first and second stages of childbirth was shorter in the observation group than in the control group. Furthermore, overall satisfaction with care was significantly higher in the observation group than in the control group, with a statistically significant difference (P < .05).
CONCLUSIONS: This study underscores the effectiveness of implementing nursing early warning systems combined with doula-assisted nursing in enhancing maternal satisfaction, reducing postpartum hemorrhage, and improving maternal well-being and neonatal outcomes. The findings advocate for the widespread adoption of this intervention in clinical practice.
PMID:38814602
Altern Ther Health Med. 2024 May 24:AT9027. Online ahead of print.
ABSTRACT
OBJECTIVE: Our aim was to analyze the risk factors of hypertensive disorders of pregnancy (HDP) and explore its influence on fetal risk factors, infant’s blood cells and markers of inflammation.
METHODS: A total of 123 patients with HDP were in the HDP group, and 121 healthy pregnant women were selected as the control group. The general clinical data of the participants were recorded. Statistics of maternal and infant outcomes, delivery methods, routine blood lab results and coagulation factors of the newborn were recorded. Univariate analysis and multi-factor analysis were used to explore the risk factors for HDP.
RESULTS: The overall incidence of poor maternal outcomes in the HDP group was higher than in the control group. The incidence of premature delivery; postpartum hemorrhage; coagulopathy; placental abruption; heart failure and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome was significantly higher in the HDP group than in the control group (P < .05). The cesarean section rate in the HDP group was significantly higher than in the control group (P < .05). The overall incidence of poor outcomes in fetuses and newborns in the HDP group was higher than in the control group. The incidence of infant low birth weight, intraventricular hemorrhage (IVH), neonatal respiratory distress syndrome (NRDS), asphyxia and all-cause neonatal death were higher than in the control group (P < .05). The incidence of small gestational age (SGA), fetal distress and intrauterine death in the HDP group were higher than in the control group (P < .05). In the HDP group, neonatal white blood cells (WBC), neutrophils (NEUT) and platelets (PLT) were significantly lower than in the control group (P < .05), while hemoglobin (Hgb) and hematocrit (Hct) were higher (P < .05).
CONCLUSIONS: HDP endangers the health of mother and infant; Age, body mass index (BMI) (>24 kg/m2), parity, history of hypertension, family history of hypertension and other factors may be involved in the occurrence and development of HDP.
PMID:38814595