Tag: statistics

Mil Psychol. 2021 Apr 13;33(3):169-181. doi: 10.1080/08995605.2021.1897493. eCollection 2021.

ABSTRACT

Electronic Nicotine Delivery Systems (ENDS) are an increasingly popular form of a nicotine delivery device, particularly among young adults and adolescents. The health consequences of long-term ENDS use are not known. Two populations that warrant special consideration are members of the United States Military (service members) and US Veterans. In this narrative review of literature before December 2019, research on ENDS use in these two populations is described in relation to four themes relevant to ENDS use: Prevalence of ENDS use; perceptions of ENDS; correlates of ENDS use; and use of ENDS for smoking cessation. This narrative review summarized research findings in each of these four areas and identified areas for future research.

PMID:38536356 | PMC:PMC10013515 | DOI:10.1080/08995605.2021.1897493

Mil Psychol. 2020 Apr 3;32(3):223-236. doi: 10.1080/08995605.2020.1724594. eCollection 2020.

ABSTRACT

Identifying the optimal factor structure of posttraumatic stress disorder (PTSD) has recently been reinvigorated in literature due to the substantial changes to its diagnostic criteria in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Currently, six models of PTSD are supported in literature, but there is no consensus on the best-fitting factor structure. Additionally, the extant literature examining the relationship between PTSD symptom-grouping and AS in the latent level has been scarce. The present study’s objectives are two-fold: first, we aimed to identify the best-fitted model of PTSD by comparing the six empirically-supported models, and; second, we examined the relationship between the best-fitting model with anxiety sensitivity (AS). Utilizing a sample of 476 combat-exposed soldiers, the results suggest that both the anhedonia and hybrid models provide the best fit to the data, with the anhedonia model achieving slightly better fit indices. Further, the examination on the influence of AS to PTSD reveal that while there is a pattern of decreasing factor loadings and factor correlations when accounting for AS, the changes are not significant to alter the PTSD symptom-structure. Based on these results, our findings suggest further investigation on the possible mediating or moderating mechanisms by which AS may influence PTSD.

PMID:38536310 | PMC:PMC10013399 | DOI:10.1080/08995605.2020.1724594

Mil Psychol. 2021 Nov 24;34(2):129-146. doi: 10.1080/08995605.2021.1976544. eCollection 2022.

ABSTRACT

Suicide is the tenth leading cause of death in America. Particularly at risk, Veterans are 1.5 times more likely to die by suicide than non-Veterans, and the suicide rate among service members has risen over the last decade. In the present study, we (1) assessed risk factors for suicidal ideation, suicide attempts, and suicide death within and between Veterans and service members, (2) identified the most commonly studied and (3) the strongest risk factors for suicide-related outcomes among Veterans and service members, and (4) compared overall and risk factor-specific meta-analytic prediction of suicide-related outcomes in Veterans and service members, as determined in the present meta-analysis, to that of the general population. Authors harvested longitudinal effects predicting suicidal ideation, suicide attempts, or suicide deaths in Veterans or service members until May 1, 2020. Traumatic Brain Injury, substance/alcohol use disorders, prior Self-Injurious Thoughts and Behavior, PTSD, and depressive symptoms were among the most commonly studied risk factors. Anger/aggression was particularly strong risk factors, providing a source for future study and intervention efforts. When combined, risk factors conferred similar risk for suicide attempts and suicide death among Veterans, service members, and the general population. However, when analyzing p-values, factors conferred significantly more risk of suicidal ideation among Veterans and service members as compared to the general population. That is, p-values for risk factors were lower in an absolute sense but not necessarily to a statistically significant degree.

PMID:38536290 | PMC:PMC10013359 | DOI:10.1080/08995605.2021.1976544

J Med Internet Res. 2024 Mar 27;26:e49058. doi: 10.2196/49058.

ABSTRACT

BACKGROUND: During the first lockdown of the COVID-19 pandemic, an exponential increase in video consultations replacing in-person outpatient visits was observed in hospitals. Insight into patients’ experiences with this type of consultation is helpful for a broad, sustainable, and patient-centered implementation of video consultation.

OBJECTIVE: This study aims to examine patients’ experiences with video consultation during the COVID-19 pandemic and identify discriminative patient and consultation characteristics to determine when video consultation is most feasible.

METHODS: A cross-sectional survey study was conducted. Patients aged ≥18 years and scheduled for a video consultation at the outpatient clinic of a Dutch university medical center from August 2020 to December 2020 for all medical specialties were eligible. Patients’ experiences were explored through a study-specific survey using descriptive quantitative statistics. Open-ended questions were qualitatively analyzed and thematically categorized into appreciated aspects and aspects for improvement. Discriminative patient and consultation characteristics were identified using 3 distinctive survey items. Characteristics of patients who scored and those who did not score all 3 items positively were analyzed using binary logistic regression.

RESULTS: A total of 1054 patients were included in the analysis. Most patients (964/1054, 91.46%) were satisfied with their video consultation, with a mean overall grade of 8.6 (SD 1.3) of 10. In the qualitative analyses, 70.02% (738/1054) of the patients cited aspects they appreciated and 44.97% (474/1054) mentioned aspects for improvement during their consultation. Patients with better self-rated health reported a positive evaluation significantly more often (P=.001), which also held true for other medical specialties (vs surgical and nonsurgical specialties; P<.001).

CONCLUSIONS: Video consultation was perceived as highly satisfactory by patients during the COVID-19 pandemic, with the best experience reported by healthy participants and those undergoing their first consultation. Appreciated aspects are mainly at the individual professional level, organizational level, and innovation level itself. The aspects that were mentioned for improvement can be changed for the better.

PMID:38536236 | DOI:10.2196/49058

J Med Internet Res. 2024 Mar 27;26:e54287. doi: 10.2196/54287.

ABSTRACT

BACKGROUND: University attendance represents a transition period for students that often coincides with the emergence of mental health and substance use challenges. Digital interventions have been identified as a promising means of supporting students due to their scalability, adaptability, and acceptability. Minder is a mental health and substance use mobile app that was codeveloped with university students.

OBJECTIVE: This study aims to examine the effectiveness of the Minder mobile app in improving mental health and substance use outcomes in a general population of university students.

METHODS: A 2-arm, parallel-assignment, single-blinded, 30-day randomized controlled trial was used to evaluate Minder using intention-to-treat analysis. In total, 1489 participants were recruited and randomly assigned to the intervention (n=743, 49.9%) or waitlist control (n=746, 50.1%) condition. The Minder app delivers evidence-based content through an automated chatbot and connects participants with services and university social groups. Participants are also assigned a trained peer coach to support them. The primary outcomes were measured through in-app self-assessments and included changes in general anxiety symptomology, depressive symptomology, and alcohol consumption risk measured using the 7-item General Anxiety Disorder scale, 9-item Patient Health Questionnaire, and US Alcohol Use Disorders Identification Test-Consumption Scale, respectively, from baseline to 30-day follow-up. Secondary outcomes included measures related to changes in the frequency of substance use (cannabis, alcohol, opioids, and nonmedical stimulants) and mental well-being. Generalized linear mixed-effects models were used to examine each outcome.

RESULTS: In total, 79.3% (589/743) of participants in the intervention group and 83% (619/746) of participants in the control group completed the follow-up survey. The intervention group had significantly greater average reductions in anxiety symptoms measured using the 7-item General Anxiety Disorder scale (adjusted group mean difference=-0.85, 95% CI -1.27 to -0.42; P<.001; Cohen d=-0.17) and depressive symptoms measured using the 9-item Patient Health Questionnaire (adjusted group mean difference=-0.63, 95% CI -1.08 to -0.17; P=.007; Cohen d=-0.11). A reduction in the US Alcohol Use Disorders Identification Test-Consumption Scale score among intervention participants was also observed, but it was not significant (P=.23). Statistically significant differences in favor of the intervention group were found for mental well-being and reductions in the frequency of cannabis use and typical number of drinks consumed. A total of 77.1% (573/743) of participants in the intervention group accessed at least 1 app component during the study period.

CONCLUSIONS: In a general population sample of university students, the Minder app was effective in reducing symptoms of anxiety and depression, with provisional support for increasing mental well-being and reducing the frequency of cannabis and alcohol use. These findings highlight the potential ability of e-tools focused on prevention and early intervention to be integrated into existing university systems to support students’ needs.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05606601; https://clinicaltrials.gov/ct2/show/NCT05606601.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/49364.

PMID:38536225 | DOI:10.2196/54287

Microb Genom. 2024 Mar;10(3). doi: 10.1099/mgen.0.001214.

ABSTRACT

With emerging infectious disease outbreaks in human, domestic and wild animal populations on the rise, improvements in pathogen characterization and surveillance are paramount for the protection of human and animal health, as well as the conservation of ecologically and economically important wildlife. Genomics offers a range of suitable tools to meet these goals, with metagenomic sequencing facilitating the characterization of whole microbial communities associated with emerging and endemic disease outbreaks. Here, we use metagenomic sequencing in a case-control study to identify microbes in lung tissue associated with newly observed pneumonia-related fatalities in 34 white-tailed deer (Odocoileus virginianus) in Wisconsin, USA. We identified 20 bacterial species that occurred in more than a single individual. Of these, only Clostridium novyi was found to substantially differ (in number of detections) between case and control sample groups; however, this difference was not statistically significant. We also detected several bacterial species associated with pneumonia and/or other diseases in ruminants (Mycoplasma ovipneumoniae, Trueperella pyogenes, Pasteurella multocida, Anaplasma phagocytophilum, Fusobacterium necrophorum); however, these species did not substantially differ between case and control sample groups. On average, we detected a larger number of bacterial species in case samples than controls, supporting the potential role of polymicrobial infections in this system. Importantly, we did not detect DNA of viruses or fungi, suggesting that they are not significantly associated with pneumonia in this system. Together, these results highlight the utility of metagenomic sequencing for identifying disease-associated microbes. This preliminary list of microbes will help inform future research on pneumonia-associated fatalities of white-tailed deer.

PMID:38536208 | DOI:10.1099/mgen.0.001214

JMIR Infodemiology. 2024 Mar 27;4:e47770. doi: 10.2196/47770.

ABSTRACT

BACKGROUND: Social media posts by clinicians are not bound by the same rules as peer-reviewed publications, raising ethical concerns that have not been extensively characterized or quantified.

OBJECTIVE: We aim to develop a scale to assess ethical issues on medical social media (SoMe) and use it to determine the prevalence of these issues among posts with 3 different hashtags: #MedTwitter, #IRad, and #CardioTwitter.

METHODS: A scale was developed based on previous descriptions of professionalism and validated via semistructured cognitive interviewing with a sample of 11 clinicians and trainees, interrater agreement, and correlation of 100 posts. The final scale assessed social media posts in 6 domains. This was used to analyze 1500 Twitter posts, 500 each from the 3 hashtags. Analysis of posts was limited to original Twitter posts in English made by health care professionals in North America. The prevalence of potential issues was determined using descriptive statistics and compared across hashtags using the Fisher exact and χ² tests with Yates correction.

RESULTS: The final scale was considered reflective of potential ethical issues of SoMe by participants. There was good interrater agreement (Cohen κ=0.620, P<.01) and moderate to strong positive interrater correlation (=0.602, P<.001). The 6 scale domains showed minimal to no interrelation (Cronbach α=0.206). Ethical concerns across all hashtags had a prevalence of 1.5% or less except the conflict of interest concerns on #IRad, which had a prevalence of 3.6% (n=18). Compared to #MedTwitter, posts with specialty-specific hashtags had more patient privacy and conflict of interest concerns.

CONCLUSIONS: The SoMe professionalism scale we developed reliably reflects potential ethical issues. Ethical issues on SoMe are rare but important and vary in prevalence across medical communities.

PMID:38536206 | DOI:10.2196/47770

Hematol Oncol. 2024 Mar;42(2):e3253. doi: 10.1002/hon.3253.

ABSTRACT

Examination of central nervous system (CNS) involvement is not routine diagnostic practice in adult patients with acute myeloid leukemia (AML). Therefore, many asymptomatic patients with CNS involvement might go undetected. The effect of CNS involvement on the AML disease course is not well defined, with conflicting results regarding clinical outcome. This study aimed to determine the incidence of asymptomatic CNS involvement in AML estimated by multiparametric flow cytometry of cerebrospinal fluid (MFC-CSF) at diagnosis, the related potential risk factors, and prognosis. In total, 645 patients with de novo AML were screened; 183 (28.4%) of them fulfilled institutional practice for MFC-CSF analysis based on presence of CNS symptoms and/or clinical features. CNS symptoms and signs were observed in 8/183 (4.4%) patients, but most patients (175/183, 95.6%) were asymptomatic. In the asymptomatic group, 73/175 (41.7%) patients had positive or suspicious cerebrospinal fluid (CSF) findings categorized as CNS positive (CNS^pos) and 102/175 (58.3%) had normal CNS findings categorized as CNS negative (CNS^neg). The presence of leukemic blasts was confirmed in 81/183 (44.3%) patients; the total incidence of CNS involvement in the whole AML group was 12.6% (81/645). Compared with asymptomatic patients with CNS^neg, those with CNS^pos had a significantly higher frequency of lymphadenopathy, white blood cell count ≥30 × 10⁹/L, presence of the monocytic phenotype, and a high percentage of bone marrow (BM) blasts. The multivariate logistic regression model identified monocytic phenotype (p = 0.047) and high percentage of BM blasts (p = 0.042) as predictors for CNS^pos. CNS^pos did not affect overall survival in patients with AML. There was a higher incidence of CNS involvement in asymptomatic adult patients with de novo AML, emphasizing possible undervalued rates of CNS disease at diagnosis. Prospective studies should determine whether diagnostic lumbar puncture for MFC-CSF analysis and CNS prophylaxis could contribute to better selection and prognosis in this patient population.

PMID:38536200 | DOI:10.1002/hon.3253

JAMA Surg. 2024 Mar 27. doi: 10.1001/jamasurg.2024.0235. Online ahead of print.

ABSTRACT

IMPORTANCE: When considering nonoperative treatment in a patient with acute appendicitis, it is crucial to accurately rule out complicated appendicitis. The Atema score, also referred to as the Scoring System of Appendicitis Severity (SAS), has been designed to differentiate between uncomplicated and complicated appendicitis but has not been prospectively externally validated.

OBJECTIVE: To externally validate the SAS and, in case of failure, to develop an improved SAS (2.0) for estimating the probability of complicated appendicitis.

DESIGN, SETTING, AND PARTICIPANTS: This prospective study included adult patients who underwent operations for suspected acute appendicitis at 11 hospitals in the Netherlands between January 2020 and August 2021.

MAIN OUTCOMES AND MEASURES: Appendicitis severity was predicted according to the SAS in 795 patients and its sensitivity and negative predictive value (NPV) for complicated appendicitis were calculated. Since the predefined targets of 95% for both were not met, the SAS 2.0 was developed using the same cohort. This clinical prediction model was developed with multivariable regression using clinical, biochemical, and imaging findings. The SAS 2.0 was externally validated in a temporal validation cohort consisting of 565 patients.

RESULTS: In total, 1360 patients were included, 463 of whom (34.5%) had complicated appendicitis. Validation of the SAS resulted in a sensitivity of 83.6% (95% CI, 78.8-87.6) and an NPV of 85.0% (95% CI, 80.6-88.8), meaning that the predefined targets were not achieved. Therefore, the SAS 2.0 was developed, internally validated (C statistic, 0.87; 95% CI, 0.84-0.89), and subsequently externally validated (C statistic, 0.86; 95% CI, 0.82-0.89). The SAS 2.0 was designed to calculate a patient’s individual probability of having complicated appendicitis along with a 95% CI.

CONCLUSIONS AND RELEVANCE: In this study, external validation of the SAS fell short in accurately distinguishing complicated from uncomplicated appendicitis. The newly developed and externally validated SAS 2.0 was able to assess an individual patient’s probability of having complicated appendicitis with high accuracy in patients with acute appendicitis. Use of this patient-specific risk assessment tool can be helpful when considering and discussing nonoperative treatment of acute appendicitis with patients.

PMID:38536188 | DOI:10.1001/jamasurg.2024.0235

JAMA Netw Open. 2024 Mar 4;7(3):e243854. doi: 10.1001/jamanetworkopen.2024.3854.

ABSTRACT

IMPORTANCE: There is substantial interest in capturing cancer treatment tolerability from the patient’s perspective using patient-reported outcomes (PROs).

OBJECTIVE: To examine whether a PRO question, item 5 from the Functional Assessment of Cancer Therapy-General General Physical Wellbeing Scale (GP5), was associated with early treatment discontinuation (ETD) due to adverse events.

DESIGN, SETTING, AND PARTICIPANTS: This prospective survey study was conducted from February to April 2023. Among participants in the ECOG-ACRIN E1A11 trial (a phase 3, parallel design trial conducted between 2013 and 2019), patients with newly diagnosed multiple myeloma were randomized to receive bortezomib (VRd) or carfilzomib (KRd) plus lenalidomide and dexamethasone as induction therapy. The GP5 item was administered at baseline (pretreatment) and at 1 month, 2.8 months, and 5.5 months postbaseline. Eligible participants included patients with newly diagnosed multiple myeloma treated at community oncology practices or academic medical centers in the US.

EXPOSURES: GP5 response options were “very much,” “quite a bit,” “somewhat,” “a little bit,” and “not at all.” Responses at each assessment while undergoing treatment (1 month, 2.8 months, and 5.5 months) were categorized as high adverse event bother (ie, “very much,” and “quite a bit”) and low adverse event bother (ie, “somewhat,” “a little bit,” or “not at all”). In addition, change from baseline to each assessment while undergoing treatment was calculated and categorized as worsening by 1 response category and 2 or more response categories.

MAIN OUTCOME AND MEASURE: ETD due to adverse events (yes vs no) was analyzed using logistic regression adjusting for treatment group, performance status, gender, race, and disease stage.

RESULTS: Of the 1087 participants in the original trial, 1058 (mean [SD] age 64 [9] years; 531 receiving VrD [50.2%]; 527 receiving KRd [49.8%]) responded to item GP5 and were included in the secondary analysis. A small proportion (142 patients [13.4%]) discontinued treatment early due to AEs. For those with high adverse-effect bother, GP5 while undergoing treatment was associated with ETD at 1 month (adjusted odds ratio [aOR], 2.20; 95% CI, 1.25-3.89), 2.8 months (aOR, 3.41; 95% CI, 2.01-5.80), and 5.5 months (aOR, 4.66; 95% CI, 1.69-12.83). Worsening by 2 or more response categories on the GP5 was associated with ETD at 2.8 months (aOR, 3.02; 95% CI, 1.64-5.54) and 5.5 months (aOR, 5.49; 95% CI, 1.45-20.76).

CONCLUSIONS AND RELEVANCE: In this survey study of the E1A11 trial, worse GP5 response was associated with ETD. These findings suggest that simple assessment of adverse-effect bother while receiving treatment is an efficient way to indicate treatment tolerability and ETD risk.

PMID:38536173 | DOI:10.1001/jamanetworkopen.2024.3854