Tag: statistics

Fam Pract. 2022 Nov 2:cmac122. doi: 10.1093/fampra/cmac122. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore consultation patterns, management practices, and costs of foot, ankle, and leg problems in Australian primary care.

STUDY DESIGN: We analyzed data from the Bettering the Evaluation and Care of Health program, April 2000 to March 2016. Foot, ankle, and leg problems were identified using the International Classification of Primary Care, Version 2 PLUS terminology. Data were summarized using descriptive statistics examining general practitioner (GP) and patient characteristics associated with a foot, ankle, or leg problem being managed. Cost to government was estimated by extracting fees for GP consultations, diagnostic imaging, and pathology services from the Medicare Benefits Schedule (MBS) database. Costs for prescription-only medicines were extracted from the Pharmaceutical Benefits Schedule and for nonprescribed medications, large banner discount pharmacy prices were used.

RESULTS: GPs recorded 1,568,100 patient encounters, at which 50,877 foot, ankle, or leg problems were managed at a rate of 3.24 (95% confidence intervals [CIs] 3.21-3.28) per 100 encounters. The management rate of foot, ankle, or leg problems was higher for certain patient characteristics (older, having a health care card, socioeconomically disadvantaged, non-Indigenous, and being English speaking) and GP characteristics (male sex, older age, and Australian graduate). The most frequently used management practice was the use of medications. The average cost (Australian dollars) per encounter was A$52, with the total annual cost estimated at A$256m.

CONCLUSIONS: Foot, ankle, and leg problems are frequently managed by GPs, and the costs associated with their management represent a substantial economic impact in Australian primary care.

PMID:36321909 | DOI:10.1093/fampra/cmac122

Global Spine J. 2022 Nov 2:21925682221138261. doi: 10.1177/21925682221138261. Online ahead of print.

ABSTRACT

STUDY DESIGN: Diagnostic accuracy study.

OBJECTIVES: Previous studies have reported the clinical application of the Vertebral Bone Quality (VBQ) scores for assessing bone density in operative lumbar spine patients. We aim to explore whether the method could be modified and applicable for patients undergoing cervical spine surgery.

METHODS: Adult patients receiving cervical spine surgery for degenerative diseases between September 2020 and March 2022 with non-contrast T1-weighted MRI and DEXA were included. Correlation between cervical VBQ scores and DEXA T-scores was analyzed using Pearson’s correlation. Student’s t test was used to present the discrepancy between the VBQ of patients with normal bone density (T ≥ -1.0) and patients with osteopenia/osteoporosis (T < -1.0). Statistical significance was set at P < .05.

RESULTS: Eighty-three patients (20 patients with T ≥ -1.0 vs 63 patients with T < -1.0 ) were included. Significant difference was found between the cervical VBQ between groups (2.99 ± .79 vs 3.80 ± .81, P < .001). Interclass correlation coefficient for inter-rater reliability was .82 (95% CI: .70-.93) and .91(95% CI: .84-.97) for intra-rater reliability. The area under the ROC curve was .78 (95% CI: .65-.90). The DEXA T-score of the femoral neck, total hip and the lowest DEXA T-score were found to be significantly correlated with the cervical VBQ score according to Pearson correlation analysis (P < .001).

CONCLUSIONS: This is the first study to apply the VBQ method to assess the bone density in preoperative cervical spine patients. Cervical VBQ scores were significantly correlated with DEXA T-score. With an overall accuracy of .78, the radiation-free and cost-effective method could be a potential tool for screening patients with osteopenia and osteoporosis before surgery.

PMID:36321883 | DOI:10.1177/21925682221138261

J Med Entomol. 2022 Nov 2:tjac166. doi: 10.1093/jme/tjac166. Online ahead of print.

ABSTRACT

Tick-borne diseases (TBDs) pose a significant risk to humans and represent one of the major factors influencing readiness within the United States’ military worldwide. Additionally, ticks and TBDs constitute major animal health problems leading to economic losses at multiple levels affecting low- and middle-income countries the hardest. Tick control is frequently hampered by issues ranging from acaricide resistance to lack of data on tick distribution and infection rates. We conducted a cross-sectional study to assess tick species distribution, host use, and rickettsial pathogen infection rate of ticks in different areas of the Uganda Cattle Corridor. We identified 4,425 hard ticks (Ixodida: Ixodidae) comprised of seven species by morphological characters with 3,315 ticks collected from four locations during the dry season and 1,110 ticks from one location during the wet season. Rickettsial pathogen prevalence was assessed in ticks collected from two districts to determine the minimum infection rate compared across seasons, village location, and tick species. We found statistically significant differences in the abundance and distribution of tick species among districts in the dry season, host animal species, and the proportion of rickettsial positive pools between villages. Seasonality, village location, and tick species do not affect the minimum infection rate of rickettsial pathogens of ticks in Uganda, but village location affects the proportion of positive tick pools. These results indicate geographical and seasonal differences among pathogen-harboring ticks contributing to our understanding of the current distribution of ticks and TBDs in Uganda.

PMID:36321534 | DOI:10.1093/jme/tjac166

Prim Health Care Res Dev. 2022 Nov 2;23:e66. doi: 10.1017/S1463423622000573.

ABSTRACT

OBJECTIVES: Symptom awareness campaigns have contributed to improved early detection of lung cancer. Previous research suggests that this may have been achieved partly by diagnosing lung cancer in those who were not experiencing symptoms of their cancer. This study aimed to explore the relationship between frequency of chest x-ray in the three years prior to diagnosis and stage at diagnosis.

SETTINGS: Lung cancer service in a UK teaching hospital.

PARTICIPANTS: Patients diagnosed with lung cancer between 2010 and 2013 were identified. The number of chest x-rays for each patient in the three years prior to diagnosis was recorded. Statistical analysis of chest x-ray frequency comparing patients with early- and late-stage disease was performed.

RESULTS: One-thousand seven-hundred fifty patients were included – 589 (33.7%) with stage I/II and 1,161 (66.3%) with stage III/IV disease. All patients had at least one chest x-ray in the six months prior to diagnosis. Those with early-stage disease had more chest x-rays in this period (1.32 vs 1.15 radiographs per patient, P = 0.009). In the period 36 months to six months prior to lung cancer diagnosis, this disparity was even greater (1.70 vs 0.92, radiographs per patient, P < 0.001).

CONCLUSIONS: Increased rates of chest x-ray are likely to contribute to earlier detection. Given the known symptom lead time many patients diagnosed through chest x-ray may not have been experiencing symptoms caused by their cancer. The number of chest x-rays performed could reflect patient and/or clinician behaviours in response to symptoms.

PMID:36321523 | DOI:10.1017/S1463423622000573

Asia Pac J Public Health. 2022 Nov 2:10105395221135407. doi: 10.1177/10105395221135407. Online ahead of print.

ABSTRACT

Evidence on the associations between built environment and overweight in children outside developed countries is scarce. We examined associations between access to local food and physical activity environments and overweight in 5- to 17-year-old Malaysians in two states with differing overweight levels. Information on children was measured in the National Health and Morbidity Survey 2015 and combined with Geographic Information System-derived data on local food and physical activity environments. Access to the built environment was measured by presence and distance from child’s residence. Complete data were available for 880 children. Access to local food outlets and parks was higher and associated with higher occurrence of overweight in children living in the state with higher overweight prevalence. When adjusted for sociodemographic factors, higher presence of and shorter distance to convenience stores and parks were associated with overweight. Both built environment and children’s sociodemographic backgrounds should be considered when planning interventions to curb the overweight epidemic in Malaysia.

PMID:36321506 | DOI:10.1177/10105395221135407

J Anim Ecol. 2022 Nov 2. doi: 10.1111/1365-2656.13832. Online ahead of print.

ABSTRACT

1. Uncovering the mechanisms behind animal space use patterns is of vital importance for predictive ecology, thus conservation and management of ecosystems. Movement is a core driver of those patterns so understanding how movement mechanisms give rise to space use patterns has become an increasingly active area of research. 2. This study focuses on a particular strand of research in this area, based around step selection analysis (SSA). SSA is a popular way of inferring drivers of movement decisions, but, perhaps less well-appreciated, it also parametrises a model of animal movement. Of key interest is that this model can be propagated forwards in time to predict the space use patterns over broader spatial and temporal scales than those that pertain to the proximate movement decisions of animals. 3. Here, we provide a guide for understanding and using the various existing techniques for scaling up step selection models to predict broad-scale space use patterns. We give practical guidance on when to use which technique, as well as specific examples together with code in R and Python. 4. By pulling together various disparate techniques into one place, and providing code and instructions in simple examples, we hope to highlight the importance of these techniques and make them accessible to a wider range of ecologists, ultimately helping expand the usefulness of step selection analysis.

PMID:36321473 | DOI:10.1111/1365-2656.13832

Pharm Stat. 2022 Nov 2. doi: 10.1002/pst.2271. Online ahead of print.

ABSTRACT

In randomized clinical trials, methods of pairwise comparisons such as the ‘Net Benefit’ or the ‘win ratio’ have recently gained much attention when interests lies in assessing the effect of a treatment as compared to a standard of care. Among other advantages, these methods are usually praised for delivering a treatment measure that can easily handle multiple outcomes of different nature, while keeping a meaningful interpretation for patients and clinicians. For time-to-event outcomes, a recent suggestion emerged in the literature for estimating these treatment measures by providing a natural handling of censored outcomes. However, this estimation procedure may lead to biased estimates when tails of survival functions cannot be reliably estimated using Kaplan-Meier estimators. The problem then extrapolates to the other outcomes incorporated in the pairwise comparison construction. In this work, we suggest to extend the procedure by the consideration of a hybrid survival function estimator that relies on an extreme value tail model through the Generalized Pareto distribution. We provide an estimator of treatment effect measures that notably improves on bias and remains easily apprehended for practical implementation. This is illustrated in an extensive simulation study as well as in an actual trial of a new cancer immunotherapy.

PMID:36321470 | DOI:10.1002/pst.2271

Med Phys. 2022 Nov 2. doi: 10.1002/mp.16029. Online ahead of print.

ABSTRACT

BACKGROUND: For proton therapy, a relative biological effectiveness (RBE) of 1.1 has broadly been applied clinically. However, as unexpected toxicities have been observed by the end of the proton tracks, variable RBE models have been proposed. Typically, the dose averaged linear energy transfer (LET_d ) has been used as an input variable for these models but the way the LET_d was defined, calculated or determined was not always consistent, potentially impacting the corresponding RBE value.

PURPOSE: This study compares consistently calculated LET_d with other quantities as input variables for a phenomenological RBE model and attempts to determine which quantity that can best predicts proton RBE. The comparison was performed within the frame of introducing a new model for the proton RBE.

METHODS: High-throughput experimental set-ups of in vitro cell survival studies for proton RBE determination are simulated using the SHIELD-HIT12A Monte Carlo particle transport code. Together with LET, z*² /β² , here called effective Q (Q_eff ), and Q are scored. Each quantity is calculated using the dose and track averaging methods, while the scoring includes all hadronic particles, all protons or only primaries. A phenomenological linear-quadratic based RBE model is subsequently applied to the in vitro data with the various beam quality descriptors used as input variables and the goodness of fit is determined and compared using a bootstrapping approach. Both linear and non-linear fit functions were tested.

RESULTS: Versions of Q_eff and Q outperform LET with a statistically significant margin, with the best non-linear and linear fit having a relative root-mean-square-error (RMSE) for RBE_2Gy ± one standard error of 1.55 ± 0.04 (Q_{eff, t, primary} ) and 2.84 ± 0.07 (Q_{eff, d, primary} ), respectively. For comparison, the corresponding best non-linear and linear fits for LET_{d, all protons} had a relative RMSE of 2.07 ± 0.06 and 3.39 ± 0.08, respectively. Applying Welch’s t-test for comparing the calculated RMSE of RBE_2Gy resulted in two-tailed p-values of <0.002 for all Q and Q_eff quantities compared to LET_{d, all protons} .

CONCLUSIONS: The study shows that Q or Q_eff could be better RBE descriptors that dose averaged LET. This article is protected by copyright. All rights reserved.

PMID:36321465 | DOI:10.1002/mp.16029

J Hum Nutr Diet. 2022 Nov 2. doi: 10.1111/jhn.13109. Online ahead of print.

ABSTRACT

BACKGROUND: Poor diet including inadequate vegetable intake is a leading risk factor for non-communicable disease. Culinary and nutrition education provided to trainee and practising health and education professionals is an emerging strategy to promote improved dietary intake, including vegetable consumption. We evaluated the impact and feasibility of an online culinary medicine and nutrition (CM/CN) short course for health, education and vegetable industry professionals. The course aimed to improve participants’ skills, and confidence to prepare vegetables, knowledge of evidence-based nutrition information, and recommendations for improving vegetable consumption and diet quality.

METHODS: A pre-post study consisting of two separate groups participating in two course rounds, recruited practising professionals (n = 30) working in health; community, adult and/or culinary education; and the vegetable industry. Evaluation assessed diet quality, vegetable consumption barriers, cooking and food skills confidence, nutrition knowledge and process measures.

RESULTS: Seventeen participants (68%) completed the program. Pre to post intervention statistically significant increases in vegetables (M1.3, SD2.2), fruit (M1.6, SD3.1), and breads and cereal (M1.1, SD1.7) intakes were observed. Statistically significant increases and large effect sizes for mean food skill confidence scores (M8.9, SD 15.4, Cohen’s d 0.56) and nutrition knowledge scores (M6.2, SD 15.4, Cohen’s d 0.83) were also observed pre to post intervention.

CONCLUSION: The short online course was feasible and improved diet quality, food skill confidence and nutrition knowledge. Online CM/CN education for practising professionals represents a promising area of research. Future research involving a larger study sample and more rigorous study design such as RCT is warranted. This article is protected by copyright. All rights reserved.

PMID:36321462 | DOI:10.1111/jhn.13109

Int J Technol Assess Health Care. 2022 Nov 2;38(1):e79. doi: 10.1017/S0266462322000605.

ABSTRACT

Advances in the digitization of health systems and expedited regulatory approvals of innovative treatments have led to increased potential for the use of real-world data (RWD) to generate real-world evidence (RWE) to complement evidence from clinical trials. However, health technology assessment (HTA) bodies and payers have concerns about the ability to generate RWE of sufficient quality to be pivotal evidence of relative treatment effectiveness. Consequently, there is a growing need for HTA bodies and payers to develop guidance for the industry and other stakeholders about the use of RWD/RWE to support access, reimbursement, and pricing. We therefore sought to (i) understand barriers to the use of RWD/RWE by HTA bodies and payers; (ii) review potential solutions in the form of published guidance; and (iii) review findings with selected HTA/payer bodies. Four themes considered key to shaping the generation of robust RWE for HTA bodies and payers were identified as: (i) data (availability, governance, and quality); (ii) methodology (design and analytics); (iii) trust (transparency and reproducibility); and (iv) policy and partnerships. A range of guidance documents were found from trusted sources that could address these themes. These were discussed with HTA experts. This commentary summarizes the potential guidance solutions available to help resolve issues faced by HTA decision-makers in the adoption of RWD/RWE. It shows that there is alignment among stakeholders about the areas that need improvement in the development of RWE and that the key priority to move forward is better collaboration to make data usable for multiple purposes.

PMID:36321447 | DOI:10.1017/S0266462322000605