Tag: statistics

J Sleep Res. 2022 Oct 12:e13729. doi: 10.1111/jsr.13729. Online ahead of print.

ABSTRACT

Patients with obstructive sleep apnea (OSA) show autonomic, mood, cognitive, and breathing dysfunctions that are linked to increased morbidity and mortality, which can be improved with early screening and intervention. The gold standard and other available methods for OSA diagnosis are complex, require whole-night data, and have significant wait periods that potentially delay intervention. Our aim was to examine whether using faster and less complicated machine learning models, including support vector machine (SVM) and random forest (RF), with brain diffusion tensor imaging (DTI) data can classify OSA from healthy controls. We collected two DTI series from 59 patients with OSA [age: 50.2 ± 9.9 years; body mass index (BMI): 31.5 ± 5.6 kg/m² ; apnea-hypopnea index (AHI): 34.1 ± 21.2 events/h 23 female] and 96 controls (age: 51.8 ± 9.7 years; BMI: 26.2 ± 4.1 kg/m² ; 51 female) using a 3.0-T magnetic resonance imaging scanner. Using DTI data, mean diffusivity maps were calculated from each series, realigned and averaged, normalised to a common space, and used to conduct cross-validation for model training and selection and to predict OSA. The RF model showed 0.73 OSA and controls classification accuracy and 0.85 area under the curve (AUC) value on the receiver-operator curve. Cross-validation showed the RF model with comparable fitting over SVM for OSA and control data (SVM; accuracy, 0.77; AUC, 0.84). The RF ML model performs similar to SVM, indicating the comparable statistical fitness to DTI data. The findings indicate that RF model has similar AUC and accuracy over SVM, and either model can be used as a faster OSA screening tool for subjects having brain DTI data.

PMID:36223645 | DOI:10.1111/jsr.13729

J Infect Dev Ctries. 2022 Sep 30;16(9):1500-1505. doi: 10.3855/jidc.14145.

ABSTRACT

INTRODUCTION: Viral load measurement is an important gold standard for monitoring anti-retroviral treatment among people living with human immunodeficiency virus. The optimal use of the viral load results for guiding antiretroviral therapy depends on timely availability of the results at the clinic. The objective of the current study was to evaluate the turnaround time and utilization of viral load results in the clinical decision process.

METHODOLOGY: This was a retrospective cohort study which involved patients receiving cART from 1 August 2018 to 31 January 2017 at three clinics in Tanzania. Data was extracted from patient files at the clinics and relevant records were kept at the viral load determining laboratory. The data were analysed with the Statistical Package for Social Sciences version 20.

RESULTS: 445 subjects had a viral load in test results and 88% had a viral load of > 1,000 copies/mL. The median duration on the current regimen was five years. Median time between the clinics receiving the results and communicating them to the patients was 40 days. Shorter turnaround time was observed for patients with virological failure (p = 0.003). A higher prevalence of virological failure was found in patients monitored at the Kilimanjaro Christian Medical Centre (KCMC) compared to the two primary health clinics (p = 0.04).

CONCLUSIONS: The median viral load turnaround time was longer than stipulated by the national Tanzanian guidelines. Interventions that may reduce viral load turn-around-time, including point of care viral load testing, are needed to optimise monitoring of anti-retroviral therapy.

PMID:36223627 | DOI:10.3855/jidc.14145

J Infect Dev Ctries. 2022 Sep 30;16(9):1490-1499. doi: 10.3855/jidc.16570.

ABSTRACT

INTRODUCTION: The objective was to analyze the prevalence trend, spatial distribution, and TB-HIV co-infection-associated factors in an endemic scenario for TB in Northeastern Brazil.

METHODS: An ecological and temporal series study was conducted based on secondary data obtained from the Brazilian Notifiable Diseases Information System between January 2008 and December 2019. The prevalence rates were determined for each year and the average for the period. Prais-Winsten regressions were used for temporal variation analysis, scanning techniques were used to detect spatial clusters, and the Poisson regression model was used to explore the factors associated with the outcome.

RESULTS: A total of 947 TB cases were reported, of which 501 (52.9%) underwent HIV testing, and of these, 73 were positive. The average prevalence was 20.0%, ranging from 1.5% in 2018 to 44.4% in 2009. A decreasing trend was found. Sixty-seven cases (92%) were geocoded, and two statistically significant (p < 0.005) high relative risk (RR) spatial clusters were detected. Statistically significant associations (p < 0.05) between the co-infection and variables such as male gender, living in the urban area, entry due to relapse, and case closure due to loss to follow-up were evidenced, and these variables constituted risk factors.

CONCLUSIONS: A decreasing prevalence of TB-HIV co-infection has been found, as well as a heterogeneous spatial distribution with the formation of spatial clusters in urban areas characterized by socio-spatial inequalities associated with clinical-epidemiological factors. Such findings provide subsidies for rethinking health care activities and improving public policies for vulnerable populations.

PMID:36223626 | DOI:10.3855/jidc.16570

J Infect Dev Ctries. 2022 Sep 30;16(9):1424-1431. doi: 10.3855/jidc.16650.

ABSTRACT

INTRODUCTION: The aim of the study was to determine the survival probability of critically ill patients with COVID-19 infection who needed mechanical ventilation and to determine the efficacy of Tocilizumab use.

METHODOLOGY: The study was designed as a retrospective analysis of consecutive patients older than 18 years, treated in an intensive care unit. The criteria for admission to the intensive care unit was severe respiratory failure requiring mechanical ventilation. All patients received corticosteroid therapy (methylprednisolone 1-2 mg/kg). Tocilizumab was used at a dose of 8 mg/kg in patients with a severe form of the disease (onset, or developed ARDS), followed by cytokine storm (IL-6 ≥ 40 ng/L and CRP ≥ 50 mg/L).

RESULTS: 88 patients were included in the study. Intrahospital mortality was 48.86%. No statistically significant difference was observed between patients with and without tocilizumab therapy. In the group of patients in whom this therapy was applied, the values of intrahospital survival were 45.7%, while in the group without this therapy the probability of intrahospital survival was only 0.93%. The probability of survival in the group with noninvasive mechanical ventilation (NIV) was 94.7%, while in the group with invasive mechanical ventilation (IMV) 0.78%. The duration of symptoms before hospitalization (RR-1.088 CI 1.025-1.155, p < 0.05), as well as the duration of IMV (RR-0.906 CI 0.841-0.976, p < 0.05), were shown to be an independent predictor of poor outcome.

CONCLUSIONS: The mortality of patients with the most severe form of respiratory failure caused by COVID-19 infection remains high. Independent predictors of poor outcomes were needed for invasive mechanical ventilation and the duration of symptoms before hospitalization or late initiation of appropriate therapy.

PMID:36223617 | DOI:10.3855/jidc.16650

Eur J Public Health. 2022 Oct 12:ckac145. doi: 10.1093/eurpub/ckac145. Online ahead of print.

ABSTRACT

BACKGROUND: While a lot has been written about Sweden’s COVID-19 control strategy, less is known about Swedish residents’ media use during the pandemic and trust in and perceived agreement among key stakeholders commenting in the media.

METHODS: Eight online, nationwide surveys were fielded between March and August 2020, during the first wave of the coronavirus pandemic in Sweden, with 8146 responses. Questions were asked on media usage, perceived tone of media, trust in key pandemic stakeholder groups commenting in the media (politicians, journalists, government officials, doctors/healthcare professionals and researchers) and perceived agreement among these key stakeholders about how the pandemic was handled in Sweden.

RESULTS: Using five or more information sources was associated with increased perceived alarmism in the media. Women and those with tertiary education were more likely to trust key pandemic actors. Trust in doctors/healthcare professionals and researchers remained high over the course of the study, trust in politicians and journalists was relatively low throughout the study period, with a slight increase in April 2020. Trust in key stakeholders was strongly associated with perceived agreement among the key stakeholders.

CONCLUSIONS: Our results show that trust in stakeholders was strongly associated with perceived consistency of messages from those stakeholders. The inverse also holds: perceived conflicting messages among stakeholders was associated with low trust in them. Taken together, this could point to the importance of building trust before a crisis. Trust-building efforts could be targeted to men and those with lower educational attainment, as they had lower trust in key stakeholders.

PMID:36223605 | DOI:10.1093/eurpub/ckac145

J Infect Dev Ctries. 2022 Sep 30;16(9):1413-1416. doi: 10.3855/jidc.15545.

ABSTRACT

INTRODUCTION: The goal of this study was to evaluate the side effects of application of the Pfizer BioNTech vaccine on the workers at a Mexican hospital.

METHODOLOGY: A cross-sectional study was carried out, in which 1351 workers from a tertiary care center in the Mexican southeast were included. Sociodemographic data, comorbidities, and side effects after the Pfizer BioNTech vaccine were obtained through an online survey. The variables were analyzed through descriptive statistics. The presence or absence of side effects was analyzed through the Chi-square test or t-test, as appropriate. The result was considered statistically significant at p < 0.05.

RESULTS: A total of 1351 health workers participated in the online survey. The mean age was 37.8 ± 10.9 years and 56.4% were women. Among them, 8.2% suffered from high blood pressure. In addition, 76.7% manifested pain in the application area. The presence of side effects was associated with the female gender (p < 0.01). Side effects were more prevalent in younger age (37.2 ± 10.7) than older age (41.5 ± 10.8) (p < 0.01). There was no association with the presence of comorbidities (p > 0.05).

CONCLUSIONS: The data suggest that pain in the application area is the most frequent side effect among workers in a Mexican hospital who received the Pfizer BioNTech vaccine against COVID-19. In addition, we observed sialorrhea as a side effect in the studied population and this had not previously been reported. The highest number of adverse events occurred between 24 to 72 hours after application.

PMID:36223615 | DOI:10.3855/jidc.15545

Am J Public Health. 2022 Nov;112(11):1630-1639. doi: 10.2105/AJPH.2022.307027.

ABSTRACT

Objectives. To estimate whether state Medicaid expansions’ relationships to breast, cervical, and colorectal cancer screening differ by race/ethnicity. Methods. Analyses conducted in 2021 used 2011-2016 and 2018-2019 Behavioral Risk Factor Surveillance System data on adults aged 40 to 64 years with household incomes below 400% of the federal poverty guideline (FPG; n = 537 250). Triple-difference analyses compared cancer screening in Medicaid expansion versus nonexpansion states, before versus after expansion, among people with incomes above versus below the eligibility cutoff (138% FPG). Race/ethnicity and ethnicity-by-language interaction terms tested for effect modification. Results. Associations between Medicaid expansions and cancer screening were significant for past-2-year mammograms and past-5-year colorectal screening. Effect modification analyses showed elevated mammography among non-Hispanic Asian women (+9.0 percentage points; 95% confidence interval [CI] = 3.2, 14.8) and Hispanic women (+6.0 percentage points; 95% CI = 2.0, 10.1), and Papanicolaou tests among Hispanic women (+4.2 percentage points; 95% CI = 0.1, 8.2). Findings were not limited to English- or Spanish-speaking respondents and were robust to insurance status controls. Conclusions. Medicaid expansions yielded statistically significant increases in income-eligible Asian and Hispanic women’s mammography and Hispanic women’s Pap testing relative to non-Hispanic White women. Neither language proficiency nor insurance status explained these findings. (Am J Public Health. 2022;112(11):1630-1639. https://doi.org/10.2105/AJPH.2022.307027).

PMID:36223588 | DOI:10.2105/AJPH.2022.307027

JCO Oncol Pract. 2022 Oct 12:OP2200291. doi: 10.1200/OP.22.00291. Online ahead of print.

ABSTRACT

PURPOSE: CNS metastases are associated with decreased survival and quality of life for patients with metastatic breast cancer (MBC). Team-based care can optimize outcomes. IMPACT the Brain is a care coordination program that aims to improve access to team-based care for patients with MBC and CNS metastases.

MATERIALS AND METHODS: Patients with MBC and CNS metastases were eligible for enrollment in this care coordination program. A team of specialists supported a dedicated program coordinator who provided navigation, education, specialty referral, and clinical trial screening. A unique intake form developed for the program created personalized, coordinated, and expedited specialty referrals. Patient-reported outcomes and caregiver burden assessments were collected on a voluntary basis throughout enrollment. Data were analyzed using descriptive statistics.

RESULTS: Sixty patients were referred, and 53 were enrolled (88%). The median time to program enrollment was 1 day (range, 0-11) and to first visit was 5 days (range, 0-25). On the basis of the program intake form, 47 referrals were made across six specialties, most commonly physical medicine and rehabilitation (n = 10), radiation oncology (n = 10), and neuropsychology (n = 10). Nineteen patients (36%) consented to enroll in clinical trials.

CONCLUSION: A tailored team-based care coordination program for patients with MBC and CNS metastases is feasible. Use of a unique intake screening form by a dedicated program coordinator resulted in faster time to first patient visit, enabled access to subspecialist care, and supported enrollment in clinical trials. Future research should focus on intervention development using PRO data collected in this care coordination program.

PMID:36223556 | DOI:10.1200/OP.22.00291

Eur J Prosthodont Restor Dent. 2022 Oct 12. doi: 10.1922/EJPRD_2446Cevlik08. Online ahead of print.

ABSTRACT

INTRODUCTION: This research investigated the topographical features and phase transformation of high-translucent monolithic zirconia after different surface conditioning methods.

METHODS: Zirconia slabs were divided into six groups according to surface treatment method. Group I: etched with hydrofluoric acid (HF); Group II: etched with an experimental acid solution (EAS); Group III: melt-etched with ammonium hydrogen difluoride (AHD); Group IV: air abrasion (AB); Group V: etched with EAS after air abrasion (AB+EAS); Group VI: melt-etched with AHD after air abrasion (AB+AHD). Surface topographies of specimens were documented by scanning electron microscopy (SEM). Tetragonal-to-monoclinic phase transformation was detected by X-ray diffraction and surface evaluation of zirconia specimens; surface roughness and contact angle measurements were performed. The data were statistically analyzed by the Kruskal- Wallis test and post hoc tests (P⟨0.05).

RESULTS: The acid-etched zirconia groups (Group I, II, and III) showed the lowest contact angle and surface roughness values (P⟨0.05), while the air abrasion groups (Group IV, V, VI) showed the highest. The SEM images also supported these results.

CONCLUSION: Within the limitations of this in vitro study, treating the monolithic zirconia surfaces with EAS or AHD after air abrasion may be recommended to alter the zirconia surfaces.

PMID:36223544 | DOI:10.1922/EJPRD_2446Cevlik08

Med Care. 2022 Oct 12. doi: 10.1097/MLR.0000000000001785. Online ahead of print.

ABSTRACT

BACKGROUND: The Center for Medicare and Medicaid Innovation revised the comprehensive Care for Joint Replacement (CJR) program, a mandatory 90-day bundled payment for lower extremity joint replacement, in December 2017, retaining 34 of the original 67 metropolitan statistical areas with higher volume and historic episode payments.

OBJECTIVES: We describe differences in costs, quality, and patient selection between hospitals that continued to participate compared with those that withdrew from CJR before and after the implementation of CJR.

RESEARCH DESIGN: We used a triple difference approach to compare the magnitude of the policy effect for elective admissions between hospitals that were retained in the CJR revision or not, before and after the implementation of CJR, and compared with hospitals in nonparticipant metropolitan statistical areas.

SUBJECTS: 694,275 Medicare beneficiaries undergoing elective lower extremity joint replacement from January 1, 2013 to August 31, 2017.

MEASURES: The treatment effect heterogeneity of CJR.

RESULTS: Hospitals retained in the CJR policy revision had a greater reduction in 90-day episode-of-care cost compared with those that were allowed to discontinue (-$846, 95% CI: -$1,338, -$435) and had greater cost reductions in the more recent year (2017). We also found evidence that retained CJR hospitals disproportionately reduced treating patients who were older than 85 years.

CONCLUSIONS: Hospitals that continued to participate in CJR after the policy revision achieved a greater cost reduction. However, the cost reductions were partly attributed to avoiding potential higher-cost patients, suggesting that a bundled payment policy might induce disparities in care delivery.

PMID:36223537 | DOI:10.1097/MLR.0000000000001785