Tag: statistics

JMIR Form Res. 2023 Aug 10;7:e47798. doi: 10.2196/47798.

ABSTRACT

BACKGROUND: As the use of social media becomes more widespread, its impact on health cannot be ignored. However, limited research has been conducted on the relationship between social media and suicide. Little is known about individuals’ vulnerable to suicide, especially when social media suicide information is extremely prevalent.

OBJECTIVE: This study aims to identify the characteristics underlying individuals’ vulnerability to suicide brought about by an increase in suicide-related tweets, thereby contributing to public health.

METHODS: A case-only design was used to investigate vulnerability to suicide using individual data of people who died by suicide and tweet data from January 1, 2011, through December 31, 2014. Mortality data were obtained from Japanese government statistics, and tweet data were provided by a commercial service. Tweet data identified the days when suicide-related tweets surged, and the date-keyed merging was performed by considering 3 and 7 lag days. For the merged data set for analysis, the logistic regression model was fitted with one of the personal characteristics of interest as a dependent variable and the dichotomous exposure variable. This analysis was performed to estimate the interaction between the surges in suicide-related tweets and personal characteristics of the suicide victims as case-only odds ratios (ORs) with 95% CIs. For the sensitivity analysis, unexpected deaths other than suicide were considered.

RESULTS: During the study period, there were 159,490 suicides and 115,072 unexpected deaths, and the number of suicide-related tweets was 2,804,999. Following the 3-day lag of a highly tweeted day, there were significant interactions for those who were aged 40 years or younger (OR 1.09, 95% CI 1.03-1.15), male (OR 1.12, 95% CI 1.07-1.18), divorced (OR 1.11, 95% CI 1.03 1.19), unemployed (OR 1.12, 95% CI 1.02-1.22), and living in urban areas (OR 1.26, 95% CI 1.17 1.35). By contrast, widowed individuals had significantly lower interactions (OR 0.83, 95% CI 0.77-0.89). Except for unemployment, significant relationships were also observed for the 7-day lag. For the sensitivity analysis, no significant interactions were observed for other unexpected deaths in the 3-day lag, and only the widowed had a significantly larger interaction than those who were married (OR 1.08, 95% CI 1.02-1.15) in the 7-day lag.

CONCLUSIONS: This study revealed the interactions of personal characteristics associated with susceptibility to suicide-related tweets. In addition, a few significant relationships were observed in the sensitivity analysis, suggesting that such an interaction is specific to suicide deaths. In other words, individuals with these characteristics, such as being young, male, unemployed, and divorced, may be vulnerable to surges in suicide-related tweets. Thus, minimizing public health strain by identifying people who are vulnerable and susceptible to a surge in suicide-related information on the internet is necessary.

PMID:37561553 | DOI:10.2196/47798

JMIR Med Educ. 2023 Aug 10;9:e44361. doi: 10.2196/44361.

ABSTRACT

BACKGROUND: The VSTEP Examination Suite is a collection of evidence-based standardized assessments for persons after stroke. It was developed by an interdisciplinary team in collaboration with clinician users. It consists of 5 standardized assessments: 2 performance-based tests using the Kinect camera (Microsoft Corp) to collect kinematics (5-Time Sit-to-Stand and 4-Square Test); 2 additional performance-based tests (10-Meter Walk Test and 6-Minute Walk Test); and 1 patient-reported outcome measure, the Activities-Specific Balance Confidence Scale.

OBJECTIVE: This study aimed to describe the development of the VSTEP Examination Suite and its evaluation as an educational tool by physical therapy students and faculty to determine its usefulness and usability.

METHODS: A total of 6 students from a Doctor of Physical Therapy program in the United States and 6 faculty members who teach standardized assessments in different physical therapy programs from the United States and Israel were recruited by convenience sampling to participate in the study. They interacted with the system using a talk-aloud procedure either in pairs or individually. The transcripts of the sessions were coded deductively (by 3 investigators) with a priori categories of usability and usefulness, and comments were labeled as negative or positive. The frequencies of the deductive themes of usefulness and usability were tested for differences between faculty and students using a Wilcoxon rank sum test. A second round of inductive coding was performed by 3 investigators guided by theories of technology adoption, clinical reasoning, and education.

RESULTS: The faculty members’ and students’ positive useful comments ranged from 83% (10/12) to 100%. There were no significant differences in usefulness comments between students and faculty. Regarding usability, faculty and students had the lowest frequency of positive comments for the 10-Meter Walk Test (5/10, 50%). Students also reported a high frequency of negative comments on the 4-Square Test (9/21, 43%). Students had a statistically significantly higher number of negative usability comments compared with faculty (W=5.7; P=.02), specifically for the 5-Time Sit-to-Stand (W=5.3; P=.02). Themes emerged related to variable knowledge about the standardized tests, value as a teaching and learning tool, technology being consistent with clinical reasoning in addition to ensuring reliability, expert-to-novice clinical reasoning (students), and usability.

CONCLUSIONS: The VSTEP Examination Suite was found to be useful by both faculty and students. Reasons for perceived usefulness had some overlap, but there were also differences based on role and experience. Usability testing revealed opportunities for technology refinement. The development of the technology by interdisciplinary teams and testing with multiple types of users may increase adoption.

PMID:37561552 | DOI:10.2196/44361

J Exp Psychol Learn Mem Cogn. 2023 Aug 10. doi: 10.1037/xlm0001270. Online ahead of print.

ABSTRACT

Linguistic phenomena (e.g., words and syntactic structure) co-occur with a wide variety of meanings. These systematic correlations can help readers to interpret a text and create predictions about upcoming material. However, to what extent these correlations influence discourse processing is still unknown. We address this question by examining whether clause type serves as a cue for discourse relations. We found that the co-occurrence of gerund-free adjuncts and specific discourse relations found in natural language is also reflected in readers’ offline expectations for discourse relations. However, we also found that clause structure did not facilitate the online processing of these discourse relations, nor that readers have a preference for these relations in a paraphrase selection task. The present research extends previous research on discourse relation processing, which mostly focused on lexical cues, by examining the role of non-semantic cues. We show that readers are aware of correlations between clause structure and discourse relations in natural language, but that, unlike what has been found for lexical cues, this information does not seem to influence online processing and discourse interpretation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37561516 | DOI:10.1037/xlm0001270

Transl Vis Sci Technol. 2023 Aug 1;12(8):8. doi: 10.1167/tvst.12.8.8.

ABSTRACT

PURPOSE: The genetic architecture of corneal dysfunction remains poorly understood. Epidemiological and clinical evidence suggests a relationship between corneal structural features and anthropometric measures. We used global and local genetic similarity analysis to identify genomic features that may underlie structural corneal dysfunction.

METHODS: We assembled genome-wide association study summary statistics for corneal features (central corneal thickness, corneal hysteresis [CH], corneal resistance factor [CRF], and the 3 mm index of keratometry) and anthropometric traits (body mass index, weight, and height) in Europeans. We calculated global genetic correlations (rg) between traits using linkage disequilibrium (LD) score regression and local genetic covariance using ρ-HESS, which partitions the genome and performs regression with LD regions. Finally, we identified genes located within regions of significant genetic covariance and analyzed patterns of tissue expression and pathway enrichment.

RESULTS: Global LD score regression revealed significant negative correlations between height and both CH (rg = -0.12; P = 2.0 × 10-7) and CRF (rg = -0.11; P = 6.9 × 10-7). Local analysis revealed 68 genomic regions exhibiting significant local genetic covariance between CRF and height, containing 2874 unique genes. Pathway analysis of genes in regions with significant local rg revealed enrichment among signaling pathways with known keratoconus associations, including cadherin and Wnt signaling, as well as enrichment of genes modulated by copper and zinc ions.

CONCLUSIONS: Corneal biophysical parameters and height share a common genomic architecture, which may facilitate identification of disease-associated genes and therapies for corneal ectasias.

TRANSLATIONAL RELEVANCE: Local genetic covariance analysis enables the identification of associated genes and therapeutic targets for corneal ectatic disease.

PMID:37561511 | DOI:10.1167/tvst.12.8.8

Psychol Methods. 2023 Aug 10. doi: 10.1037/met0000591. Online ahead of print.

ABSTRACT

Decades of published methodological research have shown the chi-square test of model fit performs inconsistently and unreliably as a determinant of structural equation model (SEM) fit. Likewise, SEM indices of model fit, such as comparative fit index (CFI) and root-mean-square error of approximation (RMSEA) also perform inconsistently and unreliably. Despite rather unreliable ways to statistically assess model fit, researchers commonly rely on these methods for lack of a suitable inferential alternative. Marcoulides and Yuan (2017) have proposed the first inferential test of SEM fit in many years: an equivalence test adaptation of the RMSEA and CFI indices (i.e., RMSEA_t and CFI_t). However, the ability of this equivalence testing approach to accurately judge acceptable and unacceptable model fit has not been empirically tested. This fully crossed Monte Carlo simulation evaluated the accuracy of equivalence testing combining many of the same independent variable (IV) conditions used in previous fit index simulation studies, including sample size (N = 100-1,000), model specification (correctly specified or misspecified), model type (confirmatory factor analysis [CFA], path analysis, or SEM), number of variables analyzed (low or high), data distribution (normal or skewed), and missing data (none, 10%, or 25%). Results show equivalence testing performs rather inconsistently and unreliably across IV conditions, with acceptable or unacceptable RMSEA_t and CFIt model fit index values often being contingent on complex interactions among conditions. Proportional z-tests and logistic regression analyses indicated that equivalence tests of model fit are problematic under multiple conditions, especially those where models are mildly misspecified. Recommendations for researchers are offered, but with the provision that they be used with caution until more research and development is available. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37561492 | DOI:10.1037/met0000591

Psychol Methods. 2023 Aug 10. doi: 10.1037/met0000551. Online ahead of print.

ABSTRACT

With the rising popularity of intensive longitudinal research, the modeling techniques for such data are increasingly focused on individual differences. Here we present mixture multilevel vector-autoregressive modeling, which extends multilevel vector-autoregressive modeling by including a mixture, to identify individuals with similar traits and dynamic processes. This exploratory model identifies mixture components, where each component refers to individuals with similarities in means (expressing traits), autoregressions, and cross-regressions (expressing dynamics), while allowing for some interindividual differences in these attributes. Key issues in modeling are discussed, where the issue of centering predictors is examined in a small simulation study. The proposed model is validated in a simulation study and used to analyze the affective data from the COGITO study. These data consist of samples for two different age groups of over 100 individuals each who were measured for about 100 days. We demonstrate the advantage of exploratory identifying mixture components by analyzing these heterogeneous samples jointly. The model identifies three distinct components, and we provide an interpretation for each component motivated by developmental psychology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37561488 | DOI:10.1037/met0000551

Am J Orthopsychiatry. 2023 Aug 10. doi: 10.1037/ort0000693. Online ahead of print.

ABSTRACT

Research has shown links between homelessness and criminal legal involvement in military veterans. The present study aimed to determine the magnitude and directionality of this association by investigating the incidence of, and factors associated with, homelessness preceding criminal arrest among veterans. Data on incarcerated veterans (N = 1,602) were analyzed from the 2016 Survey of Prison Inmates conducted by the U.S. Bureau of Justice Statistics. In this survey, 27% of incarcerated veterans reported homelessness 12 months before criminal arrest. In multivariable logistic regression analyses, higher odds of experiencing homelessness preceding criminal arrest were associated with younger age, non-White race, substance use disorder (with or without serious mental illness [SMI]), history of previous arrests, parental history of incarceration, and history of homelessness before age 18. These factors were found to be the same for nonveterans, as were rates of homelessness before arrest. However, incarcerated veterans were more likely to have mental disorders, including SMI, posttraumatic stress disorder (PTSD), and personality disorders. In contrast, incarcerated nonveterans were more likely to have a criminal history, including past arrests, parental incarceration, and juvenile detention. Although policymakers may be aware that some veterans they serve are at risk of criminal legal involvement, these national data reveal the magnitude and directionality of this problem: more than one in four incarcerated veterans experienced homelessness before criminal arrest. Identifying characteristics of veterans who experienced homelessness before criminal arrest directly informs service providers of demographic, historical, and clinical factors to evaluate and address to prevent criminal legal involvement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37561476 | DOI:10.1037/ort0000693

JAMA Netw Open. 2023 Aug 1;6(8):e2328159. doi: 10.1001/jamanetworkopen.2023.28159.

ABSTRACT

IMPORTANCE: There are known risks of using opioids for extended periods. However, less is known about the long-term trajectories of opioid use following initiation.

OBJECTIVE: To identify 5-year trajectories of prescription opioid use, and to examine the characteristics of each trajectory group.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study conducted in New South Wales, Australia, linked national pharmaceutical claims data to 10 national and state data sets to determine sociodemographic characteristics, clinical characteristics, drug use, and health services use. The cohort included adult residents (aged ≥18 years) of New South Wales who initiated a prescription opioid between July 1, 2003, and December 31, 2018. Statistical analyses were conducted from February to September 2022.

EXPOSURE: Dispensing of a prescription opioid, with no evidence of opioid dispensing in the preceding 365 days, identified from pharmaceutical claims data.

MAIN OUTCOMES AND MEASURES: The main outcome was the trajectories of monthly opioid use over 60 months from opioid initiation. Group-based trajectory modeling was used to classify these trajectories. Linked health care data sets were used to examine characteristics of individuals in different trajectory groups.

RESULTS: Among 3 474 490 individuals who initiated a prescription opioid (1 831 230 females [52.7%]; mean [SD] age, 49.7 [19.3] years), 5 trajectories of long-term opioid use were identified: very low use (75.4%), low use (16.6%), moderate decreasing to low use (2.6%), low increasing to moderate use (2.6%), and sustained use (2.8%). Compared with individuals in the very low use trajectory group, those in the sustained use trajectory group were older (age ≥65 years: 22.0% vs 58.4%); had more comorbidities, including cancer (4.1% vs 22.2%); had increased health services contact, including hospital admissions (36.9% vs 51.6%); had higher use of psychotropic (16.4% vs 42.4%) and other analgesic drugs (22.9% vs 47.3%) prior to opioid initiation, and were initiated on stronger opioids (20.0% vs 50.2%).

CONCLUSIONS AND RELEVANCE: Results of this cohort study suggest that most individuals commencing treatment with prescription opioids had relatively low and time-limited exposure to opioids over a 5-year period. The small proportion of individuals with sustained or increasing use was older with more comorbidities and use of psychotropic and other analgesic drugs, likely reflecting a higher prevalence of pain and treatment needs in these individuals.

PMID:37561463 | DOI:10.1001/jamanetworkopen.2023.28159

JAMA Netw Open. 2023 Aug 1;6(8):e2328343. doi: 10.1001/jamanetworkopen.2023.28343.

ABSTRACT

IMPORTANCE: In 2018, Medicare removed total knee arthroplasty from the list of inpatient-only procedures, resulting in a new pool of patients eligible for outpatient total knee arthroplasty. How this change was associated with the characteristics of patients undergoing outpatient knee arthroplasty at hospital-owned surgery centers (HOSCs) vs freestanding ambulatory surgery centers (FASCs) is unknown.

OBJECTIVES: To describe the characteristics of patients undergoing outpatient, elective total and partial knee arthroplasty in 2017 and 2018 and to compare the cohorts receiving treatment at FASCs and HOSCs.

DESIGN, SETTING, AND PARTICIPANTS: This observational retrospective cohort study included 5657 patients having elective, outpatient partial and total knee arthroplasty in the Florida and Wisconsin State Ambulatory Surgery Databases in 2017 and 2018. Prior admissions were identified in the State Inpatient Database. Statistical analysis was performed from March to June 2022.

MAIN OUTCOMES AND MEASURES: Characteristics of patients undergoing surgery at a FASC vs a HOSC in 2017 and 2018 were compared.

RESULTS: A total of 5657 patients (mean [SD] age, 64.2 [9.9] years; 2907 women [51.4%]) were included in the study. Outpatient knee arthroplasties increased from 1910 in 2017 to 3747 in 2018 and were associated with an increase in total knee arthroplasties (474 in 2017 vs 2065 in 2018). The influx of patients undergoing outpatient knee arthroplasty was associated with an amplification of differences between the patients treated at FASCs and the patients treated at HOSCs. Patients with private payer insurance seen at FASCs increased from 63.4% in 2017 (550 of 867) to 72.7% in 2018 (1272 of 1749) (P < .001), while the percentage of patients with private payer insurance seen at HOSCs increased, but to a lesser extent (41.6% [427 of 1027] in 2017 vs 46.4% [625 of 1346] in 2018; P < .001). In 2017, the percentages of White patients seen at FASCs and HOSCs were similar (85.0% [737 of 867] vs 88.2% [906 of 1027], respectively); in 2018, the percentage of White patients seen at FASCs had increased and was significantly different from the percentage of White patients seen at HOSCs (90.6% [1585 of 1749] vs 87.9% [1183 of 1346]; P = .01). Both types of facilities saw an increase from 2017 to 2018 in the percentage of patients from communities of low social vulnerability, but this increase was greater for FASCs (FASCs: 6.7% [58 of 867] in 2017 vs 33.9% [593 of 1749] in 2018; HOSCs: 7.6% [78 of 1027] in 2017 vs 21.2% [285 of 1346] in 2018). Finally, while FASCs and HOSCs had cared for a similar portion of patients with prior admissions in 2017 (7.8% [68 of 867] vs 9.4% [97 of 1027], respectively; P = .25), in 2018, FASCs cared for fewer patients with prior admissions than HOSCs (4.0% [70 of 1749] vs 8.1% [109 of 1346]; P < .001).

CONCLUSIONS: This study suggests that the increase in the number of patients undergoing outpatient knee arthroplasty in 2018 corresponded to FASCs treating a greater share of patients who were White, covered by private payer insurance, and healthier. These findings raise a concern that as more operations transition to the outpatient setting, variability in access to FASCs may increase, leaving hospital-owned centers to bear a greater share of the burden of caring for more vulnerable patients with more severe illness.

PMID:37561458 | DOI:10.1001/jamanetworkopen.2023.28343

Br J Radiol. 2023 Aug 10:20230143. doi: 10.1259/bjr.20230143. Online ahead of print.

ABSTRACT

OBJECTIVE: To validate selection criteria for sublobar resection in patients with lung cancer with respect to recurrence, and to investigate predictors for recurrence in patients for whom the criteria are not suitable.

METHODS: Patients who underwent sublobar resection for lung cancer between July 2010 and December 2018 were retrospectively included. The criteria for curative sublobar resection were consolidation-to-tumor ratio ≤0.50 and size ≤3.0 cm in tumors with a ground-glass opacity (GGO) component (GGO group), and size of ≤2.0 cm and volume doubling time ≥400 days in solid tumors (solid group). Cox regression was used to identify predictors for time-to-recurrence (TTR) in tumors outside of these criteria (non-curative group).

RESULTS: Out of 530 patients, 353 were classified into the GGO group and 177 into the solid group. In the GGO group, the 2-year recurrence rates in curative and non-curative groups were 2.1 and 7.7%, respectively (p = 0.054). In the solid group, the 2-year recurrence rates in curative and non-curative groups were 0.0 and 28.6%, respectively (p = 0.03). Predictors of 2-year TTR after non-curative sublobar resection were pathological nodal metastasis (hazard ratio [HR], 6.63; p = 0.02) and lymphovascular invasion (LVI; HR, 3.28; p = 0.03) in the GGO group, and LVI (HR, 4.37; p < 0.001) and fibrosis (HR, 3.18; p = 0.006) in the solid group.

CONCLUSION: The current patient selection criteria for sublobar resection are satisfactory. LVI was a predictor for recurrence after non-curative resection.

ADVANCES IN KNOWLEDGE: This result supports selection criteria of patients for sublobar resection. LVI may help predict recurrence after non-curative sublobar resection.

PMID:37561432 | DOI:10.1259/bjr.20230143