Tag: statistics

Folia Med Cracov. 2023 Apr 30;63(1):5-17. doi: 10.24425/fmc.2023.145426.

ABSTRACT

B a c k g r o u n d: Due to current increased life expectancy, the quality of life (QoL) of senior patients is gaining in importance. The aims of this study were: to estimate QoL in a group of patients, aged above 64 years, that is cared for by general practitioners (GPs) in Krakow, Poland, and to find relation- ships between elements of QoL and the results of comprehensive geriatric assessment (CGA) and other important medical and social factors. M e t h o d s: We designed a cross-sectional, questionnaire study among patients who attended GPs’ surgeries from April 2018 to April 2019. To examine the patients, we used the Euro-Quality of Life Questionnaire (EQ-5D-5L) and eight scales forming CGA: the Activities of Daily Living, the Instrumental Activities of Daily Living, Mini-Mental State Examination, Geriatric Depression Scale, Timed Up and Go Test, Mini Nutritional Assessment, Clinical Frailty Scale and Athens Insomnia Scale. R e s u l t s: The lowest QoL was observed in dimensions of pain/discomfort and mobility, where 70% and 52% of patients, respectively, reported problems in these areas. Only 91 (21%) respondents had highest results in all five dimensions of QoL. The average score in the Visual Analogue Scale (VAS) of the EQ-5D-5L (representing self-rated health on a given day) was 62.36 ± 18.98 points. Statistically significant relationships were observed between QoL and age, physical activity and multimorbidity (in all cases p <0.001). The results of QoL were correlated with every aspect of CGA, while the strongest relationship was noticed between scores in the EQ-5D-5L VAS scale and scales assessing depression and frailty (p <0.001; r = -0.57 both).

PMID:37406273 | DOI:10.24425/fmc.2023.145426

Am J Public Health. 2023 Aug;113(8):893-903. doi: 10.2105/AJPH.2023.307324.

ABSTRACT

Objectives. To estimate impacts of COVID-19 infections and social and economic sequelae on mental and self-rated health among Latinx immigrant housecleaners in New York City. Methods. From March to June 2021, we conducted a follow-up study with 74% retention of 402 housecleaners initially surveyed before the pandemic between August 2019 and February 2020. We measured rates of self-reported COVID-19 infections, COVID-19 antibodies, and pandemic-related social and economic sequelae and examined predictors of mental and self-rated health changes using logistic regression models. Results. Fifty-three percent reported COVID-19 infections, consistent with the rate demonstrating COVID-19 antibodies. During shutdown of nonessential services, from March 22 to June 8, 2020, 29% worked as housecleaners, although this was not associated with higher COVID-19 infection rates. COVID-19-related stigma at work, lost earnings owing to COVID-19 infections, housing insecurity, food insecurity, and unsafe homes, including experiencing intimate partner verbal abuse, were statistically associated with changes in mental or self-rated health compared with prepandemic measures. Conclusions. The disproportionate impact and virtually nonexistent safety net housecleaners experienced during the first year of the pandemic highlight the importance of inclusive stopgap measures to mitigate economic insecurity and its sequelae. (Am J Public Health. 2023;113(8):893-903. https://doi.org/10.2105/AJPH.2023.307324).

PMID:37406262 | DOI:10.2105/AJPH.2023.307324

Pediatr Infect Dis J. 2023 Jul 4. doi: 10.1097/INF.0000000000004032. Online ahead of print.

ABSTRACT

BACKGROUND: Respiratory syncytial virus (RSV) is a common cause of acute respiratory tract infection in children, including in Thailand. We conducted this study to evaluate the economic and clinical outcomes of patients <2 years old with RSV infection at a tertiary teaching hospital in Thailand.

METHODS: This was a retrospective cohort study during 2014-2021. To be eligible, patients had to report at least 1 positive RSV test and were <2 years old. Descriptive statistics were used to describe baseline characteristics, healthcare resource utilization, direct medical costs (1 US dollars [USD] = 31.98 Thai Baht) and clinical outcomes.

RESULTS: Among 1370 RSV-positive patients, 49.9% of the patients (n = 683) were hospitalized at or within 3 days of RSV diagnosis with a median length of stay of 6 days (interquartile range [IQR]: 4-9 days), 38.8% were diagnosed with RSV-related respiratory complications (n = 532) and 1.5% died during the hospitalization episode (n = 20). A total of 22.5% of hospitalized patients (n = 154) received critical care during the hospitalization episode. The median cost of each RSV episode was USD539 (IQR: USD167-USD2106) and was higher among hospitalized patients (median: USD2112; IQR: USD1379-USD3182) compared with nonhospitalized patients (median: USD167; IQR: USD112-USD276).

CONCLUSIONS: RSV infection represents a potentially important contributor to healthcare resource use and medical costs among children <2 years old in Thailand. Coupled with epidemiologic data, findings from our study will be useful to illustrate the overall economic burden associated with RSV infection among children in Thailand.

PMID:37406252 | DOI:10.1097/INF.0000000000004032

Health Aff (Millwood). 2023 Jul;42(7):1002-1010. doi: 10.1377/hlthaff.2022.01672.

ABSTRACT

During the 2022 open enrollment period in California’s Affordable Care Act Marketplace, we tested two interventions designed to reduce choice errors among low-income households enrolled in bronze plans that were eligible for zero-premium cost-sharing reduction (CSR) silver plans with more generous benefits. A randomized controlled trial nudge intervention used letter and email reminders to encourage consumers to switch plans, and a quasi-experimental crosswalk intervention automatically enrolled eligible households from bronze plans into zero-premium CSR silver plans with the same insurers and provider networks. The nudge intervention led to a statistically significant 2.3-percentage-point (26 percent) increase in CSR silver plan take-up relative to the control group, but nearly 90 percent of households remained in nonsilver plans. The automatic crosswalk intervention resulted in an 83.0-percentage-point (822 percent) increase in CSR silver plan take-up compared with the control group, with more than 90 percent of households enrolled in CSR silver plans. Our findings can inform health policy debates on the relative effectiveness of different approaches to reducing choice errors among low-income households in the Affordable Care Act Marketplaces.

PMID:37406241 | DOI:10.1377/hlthaff.2022.01672

Health Aff (Millwood). 2023 Jul;42(7):928-936. doi: 10.1377/hlthaff.2022.00844.

ABSTRACT

Several Centers for Medicare and Medicaid Services (CMS) programs aim to transform how health care is delivered by adjusting Medicare inpatient hospital payments through a system of rewards and penalties based on performance on measures of quality. These programs are the Hospital Readmissions Reduction Program, the Hospital Value-Based Purchasing Program, and the Hospital-Acquired Condition Reduction Program. We analyzed value-based program penalty results for various groups of hospitals across these three programs and assessed the impact of patient and community health equity risk factors on hospital penalties. We found statistically significant positive relationships between hospital penalties and several factors that affect hospital performance but that hospitals cannot control-namely, medical complexity (as measured by Hierarchical Condition Categories scores), uncompensated care, and the portion of hospital catchment area populations who live alone. Moreover, these environmental conditions can be worse for hospitals that operate in areas with historically underserved populations. This suggests that the CMS programs might not adequately account for health equity factors at the community level. Refinements to these programs (including an explicit incorporation of patient and community health equity risk factors) and continued monitoring will help ensure that the programs work as intended in a fair and equitable fashion.

PMID:37406232 | DOI:10.1377/hlthaff.2022.00844

Prehosp Emerg Care. 2023 Jul 5:1-15. doi: 10.1080/10903127.2023.2232453. Online ahead of print.

ABSTRACT

Background and AimHelicopter EMS (HEMS) is a well-established mode of rapid transportation for patients with need for time-sensitive interventions, especially in patients with significant traumatic injuries. Traditionally in the setting of trauma, HEMS is often considered appropriate when used for patients with “severe” injury as defined by Injury Severity Score (ISS) >15. This may be overly conservative, and patients with a lower ISS may benefit from HEMS-associated speed or care quality. Our objective was to perform a meta-analysis of trauma HEMS transports to evaluate for possible mortality benefit in injured cases defined by an ISS score >8, lower than the customary ISS cutoff of >15.MethodsA broad search of the literature was performed including PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials, and Google Scholar from the years 1970 to 2022. The gray literature and reference lists of included publications were also examined. We included studies with the outcome of mortality in HEMS vs control in trauma transports from scene of injury for patients (adult or pediatric) with ISS > 8.ResultsNine eligible studies were used in the final analysis: six in the primary analysis and three in sensitivity analysis due to patient overlap. All studies reported statistically significant survival benefit in HEMS compared to control group. The minimum survival odds ratio (OR) benefit observed was OR 1.15 (95% CI 1.06-1.25) and maximum was OR 2.04 (95% CI 1.18-3.57). Risk of bias tool (ROBINS-I) application yielded moderate to low risk of bias, mainly due to the observational nature of the studies included.ConclusionsThere was a statistically significant survival benefit in patients with ISS > 8 when HEMS was used over traditional ground ambulance transportation, although novel and more inclusive trauma triage criteria may be more appropriate in the future to guide HEMS utilization decision-making. Restricting HEMS to trauma patients with ISS >15 likely misses survival benefit that could be afforded to the subset of trauma patients with serious injury.

PMID:37406174 | DOI:10.1080/10903127.2023.2232453

Pest Manag Sci. 2023 Jul 5. doi: 10.1002/ps.7639. Online ahead of print.

ABSTRACT

BACKGROUND: In Spain, citrus pruning is usually done by hand, although mechanized pruning is gradually being introduced as a cheaper alternative. The pruning strategy affects the pattern and intensity of sprouting, and the canopy characteristics, and therefore could affect pest control. In this study, the effect of three pruning strategies on the incidence of key citrus pests was analysed: manual, mechanized (with hedging and topping) and no pruning. In a commercial clementine orchard, sprouting, pest density and fruit damage were evaluated along three seasons.

RESULTS: Outside the canopy, mechanically pruned trees had a significantly higher number of shoots, and more shoots were attacked by aphids (cotton aphid, Aphis gossypii, and spirea aphid, A. spiraecola) in comparison with manual or non-pruning strategies. Inside the canopy not statistically significant differences were found between strategies. Regarding the pest level of two-spotted spider mite, Tetranychus urticae, and California red scale, Aonidiella aurantii, in general, no significant differences were found between pruning strategies, and in some cases mechanized pruning resulted in a lower level of these pests and fruit damage than manual pruning.

CONCLUSION: The density of aphids, which are pests associated with sprouting, was affected by the pruning strategy. On the contrary, the density of T. urticae and A. aurantii and the level of damaged fruits were not affected. This article is protected by copyright. All rights reserved.

PMID:37406173 | DOI:10.1002/ps.7639

Anesthesiology. 2023 Jul 5. doi: 10.1097/ALN.0000000000004675. Online ahead of print.

ABSTRACT

BACKGROUND: Insured patients who receive out-of-network care may receive a “balance bill” for the difference between the practitioner’s charge and their insurer’s contracted rate. In 2017, California banned balance billing for anesthesia care. We examined the association between California’s law and subsequent payments for anesthesia care. We hypothesized that following the law’s implementation, there would be no change in-network payment amounts, and that out-of-network payment amounts and the portion of claims occurring out-of-network would decline.

METHODS: We used average, quarterly, California county-level payment data (2013-2020) derived from a claims database of commercially-insured patients. Using a difference-in-differences approach, we estimated the change in payment amounts for intraoperative/intrapartum anesthesia care, along with the portion of claims occurring out-of-network, following the law’s implementation. The comparison group was office visit payments, expected to be unaffected by the law. We prespecified that we would refer to differences of ≥10% as policy significant.

RESULTS: Our sample consisted of 43,728 procedure code-county-quarter-network combinations aggregated from 4,599,936 claims. The law’s implementation was associated with a significant 13.6% decline in payments for out-of-network anesthesia care (95%CI -16.5 to -10.6%; p<0.001), translating to an average $108 decrease across all procedures (95%CI -$149 to -$64). There was a statistically significant 3.0% increase in payments for in-network anesthesia care (95%CI 0.9 to 5.1%; p=0.007), translating to an average $87 increase (95%CI $64 to $110), which may be notable in some circumstances but did not meet our threshold for identifying a change as policy significant. There was a non-statistically significant increase in the portion of claims occurring out-of-network (10.0%, 95%CI -4.1 to 24.2%, p=0.155).

CONCLUSIONS: California’s balance billing law was associated with significant declines in out-of-network anesthesia payments in the first three years following implementation. There were mixed statistical and policy significant results for in-network payments and the proportion of out-of-network claims.

PMID:37406154 | DOI:10.1097/ALN.0000000000004675

AIDS Educ Prev. 2023 Jul;35(Supplement A):39-51. doi: 10.1521/aeap.2023.35.suppA.39.

ABSTRACT

Gender-based violence (GBV) is a complex issue deeply rooted in social structures, making its eradication challenging. GBV increases the risk of HIV transmission and is a barrier to HIV testing, care, and treatment. Quality clinical services for GBV, which includes the provision of HIV postexposure prophylaxis (PEP), vary, and service delivery data are lacking. We describe GBV clinical service delivery in 15 countries supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention. Through a descriptive statistical analysis of PEPFAR Monitoring, Evaluation, and Reporting (MER) data, we found a 252% increase in individuals receiving GBV clinical services, from 158,691 in 2017 to 558,251 in 2021. PEP completion was lowest (15%) among 15-19-year-olds. Understanding GBV service delivery is important for policy makers, program managers, and providers to guide interventions to improve the quality of service delivery and contribute to HIV epidemic control.

PMID:37406144 | DOI:10.1521/aeap.2023.35.suppA.39

Sci Transl Med. 2023 Jul 5;15(703):eadh0004. doi: 10.1126/scitranslmed.adh0004. Epub 2023 Jul 5.

ABSTRACT

Broadly neutralizing antibodies (bNAbs) may provide an alternative to standard antiretroviral treatment (ART) for controlling HIV-1 replication and may have immunotherapeutic effects against HIV-1 reservoirs. We conducted a prospective clinical trial with two HIV-1 bNAbs (VRC01LS and 10-1074) in children (n = 25) who had previously initiated small-molecule ART treatment before 7 days of age and who continued treatment for at least 96 weeks. Both bNAbs were dosed intravenously every 4 weeks, overlapping with ART for at least 8 weeks and then continued for up to 24 weeks or until detectable viremia of HIV-1 RNA rose above 400 copies per milliliter in the absence of ART. Eleven (44%) children maintained HIV-1 RNA below 400 copies per milliliter through 24 weeks of bNAb-only treatment; 14 (56%) had detectable viremia above 400 copies per milliliter at a median of 4 weeks. Archived HIV-1 provirus susceptible to 10-1074, lower birth HIV-1 DNA reservoir in peripheral blood mononuclear cells, sustained viral suppression throughout early life, and combined negative qualitative HIV-1 DNA polymerase chain reaction and negative HIV-1 serology at entry were associated with maintaining suppression on bNAbs alone. This proof-of-concept study suggests that bNAbs may represent a promising treatment modality for infants and children living with HIV-1. Future studies using newer bNAb combinations with greater breadth and potency are warranted.

PMID:37406137 | DOI:10.1126/scitranslmed.adh0004