Tag: statistics

PM R. 2022 Jun 21. doi: 10.1002/pmrj.12866. Online ahead of print.

ABSTRACT

INTRODUCTION: There are an increasing number of individuals with long-term symptoms of coronavirus-19 disease (COVID-19); however, the prognosis for recovery of physical function and fatigue after COVID-19 is uncertain. Here we report the changes in functional recovery between 1- and 6-months after hospitalization of adults hospitalized for COVID-19 and explore the baseline factors associated with physical function recovery.

METHODS: A prospective cohort study was performed of adult COVID-19 survivors 1-month and 6-months after hospital discharge. Participants completed standardized telephone interviews assessing three outcome domains: basic and instrumental activities of daily living (ADLs) performance, fatigue, and general physical function (Health Assessment Questionnaire [HAQ]). Statistical analysis included t-tests for continuous measures and chi-square or Fisher’s Exact tests for categorical measures.

RESULTS: The age of participants (n = 92) ranged from 22 to 95 (54.3 ± 17.2) years. Across outcome domains, a majority (63-67%) of participants developed new ADL impairment, fatigue, or worsening HAQ severity by 1 month. Of those, 50-79% partially or fully recovered by 6 months, but 21-50% did not recover at least partially. Fifteen to 30% developed new impairment between 1-and 6-months. For those without any improvement in ADL impairments at 6 months, lower socioeconomic status was significantly more common (p = 0.01) and age ≥ 65 (p = 0.06), trending towards being more common.

CONCLUSIONS: In our cohort, a substantial proportion of the participants who developed new ADL impairment, worsening fatigue, or HAQ severity after hospitalization for COVID-19 did not recover at least partially by 6-months after discharge. Evaluating functional status one month after discharge may be important in understanding functional prognosis and recovery after hospitalization for COVID-19. This article is protected by copyright. All rights reserved.

PMID:35726518 | DOI:10.1002/pmrj.12866

J Med Econ. 2022 Jun 21:1-22. doi: 10.1080/13696998.2022.2090734. Online ahead of print.

ABSTRACT

OBJECTIVE: Accurate and up-to-date figures of the cost of community-acquired pneumonia (CAP) hospitalization are needed to understand the associated economic burden for public health decision makers. Recent estimates are lacking, and previously published estimates differ markedly. Our objective was to estimate the current mean cost to the NHS for adult CAP hospitalization.

METHODS: All CAP hospitalizations in 2019 for those aged >18 years were identified from English Hospital Episode Statistics (HES). Each hospitalization was mapped to the tariff cost paid to the care provider within the NHS, including critical care costs and accounting for length of stay and complexity of the case. Mean hospitalization costs were estimated in total and in individuals with defined underlying comorbidities.

RESULTS: A mean cost of £3,904 was estimated for 187,251 CAP admissions providing a total cost of approximately £731 million per annum. The mean cost was £3,402 excluding critical care costs, and £11,654 for critical care episodes in the 4.4% of admissions receiving this care. Groups at high risk of CAP had higher mean costs ranging from £4,458 for people with diabetes to £5,215 with heart disease for those <65 years and £4,356 with heart disease to £4,751 with liver disease in those aged >65 years who comprised 74.3% admissions overall.

CONCLUSION: This estimate of the cost of hospitalization for CAP from the total population and in those with certain underlying comorbidities will allow a valid understanding of the cost-benefit of vaccination and evidence-based prioritization of pneumococcal vaccination to those at highest risk.

PMID:35726515 | DOI:10.1080/13696998.2022.2090734

J Cosmet Dermatol. 2022 Jun 21. doi: 10.1111/jocd.15173. Online ahead of print.

ABSTRACT

BACKGROUND: Management of multiple recalcitrant common warts represents a therapeutic challenge. Both oral isotretinoin and acitretin have shown a promising efficacy in the treatment of various types of warts. However, a comparative study of the two medicines in wart treatment hasn’t yet been conducted.

OBJECTIVE: The aim of this study was to assess the efficacy and adverse effects of oral isotretinoin versus acitretin in the treatment of multiple recalcitrant common warts.

METHODS: This study was conducted on 75 adult male patients with recalcitrant multiple common warts. The patients were randomly assigned to 3 groups: group 1(30 patients) received oral isotretinoin, group 2 (30 patients) received acitretin and group 3 received oral placebo (15 patients). The treatment was given daily until complete clearance or for a maximum of 3 months.

RESULTS: Complete clearance of the treated lesions was observed in 18 patients (60%) of the isotretinoin group, in 22 patients (73.3%) of the acitretin group and in 0 patients (0%) of the placebo group. A statistically significant difference was observed in the therapeutic response between the treatment groups and the placebo group was observed. Adverse effects of the used drugs were mild and transient.

CONCLUSION: Oral isotretinoin and acitretin are promising effective modalities with minimal side effects for the treatment male patients with multiple recalcitrant common warts with a relative superiority of acitretin.

PMID:35726506 | DOI:10.1111/jocd.15173

J Public Health Dent. 2022 Mar;82 Suppl 1:53-62. doi: 10.1111/jphd.12520.

ABSTRACT

OBJECTIVE: There is a lack of diversity in the dental workforce. Efforts to enhance underrepresented minority (URM) recruitment and retention within dental school exist, but little effort has been made to track URM providers through education and practice. This study assesses the status of workforce diversity in the dental specialties and the predictors of URM dentist specialization.

METHODS: The primary data used were a 2012 national sample survey of Hispanic/Latino (H/L), Black, or American Indian/Alaska Native (AI/AN) dentists in the US, supplemented by publicly available workforce data. Descriptive and multivariate statistical analyses were performed to describe the demographic composition of URM clinical general and specialist dentists and analyze changes in proportions of URMs specializing among age cohorts, differences in specific type of specialization, and racial concordance between specialists and their patients.

RESULTS: The pathway continues to winnow with fewer URM dentists in specialty practice. Among all URM clinical dentists being first in his/her family to obtain a college degree, having a strong desire to work in his/her own cultural community or joining a loan repayment program due to debt load independently predicted lower odds of specialization. Alternatively, being initially foreign trained as a dentist and valuing professional training were independently predictive of higher odds of specialization.

CONCLUSION: The lack of diversity within the dental specialties is a critical flaw in our education and care delivery systems demanding clear actions toward improving the pathway into residency programs for URM students.

PMID:35726471 | DOI:10.1111/jphd.12520

J Public Health Dent. 2022 Mar;82 Suppl 1:114-122. doi: 10.1111/jphd.12516.

ABSTRACT

OBJECTIVES: The objective of this study was to assess the current efforts to move dental school curriculum beyond diversity and inclusion toward an anti-racism approach to racial equity.

METHODS: In this cross-sectional study, an electronic Qualtrics survey was sent to 67 Dental School Associate Deans/Deans of Academic Affairs and 15 Dental Public Health (DPH) Residency Program Directors. Survey topics included oral health equity, Critical Race Theory (CRT), racism and the physiologic impacts of racism on oral health. Descriptive statistics were used to demonstrate frequencies.

RESULTS: Overall response rate was 31.7% (DPH = 6, predoctoral Dental = 20). The majority of respondents that answered the question stated that the educational program offered instruction in oral health equity (96.2%), racism (75%), and the physiologic impacts of racism on oral health (83.3%). Only 17.4% of the respondents stated that the educational program offered instruction in CRT. The main barriers to providing the instruction was limited faculty trained in the topics to offer the instruction or there was limited time to offer additional content in the curriculum.

CONCLUSIONS: Findings demonstrate that oral health equity, racism and the physiologic impacts of racism are being discussed in dental education to some extent, but there is limited instruction in CRT. More robust efforts are needed to ensure dental students and DPH residents are competent in providing anti-racist and unbiased health care; there should be an incorporation of anti-racism standards in the Commission on Dental Accreditation (CODA)’s predoctoral and Advanced Education Program standards.

PMID:35726460 | DOI:10.1111/jphd.12516

J Public Health Dent. 2022 Mar;82 Suppl 1:89-102. doi: 10.1111/jphd.12522.

ABSTRACT

OBJECTIVES: Addressing inequities in oral health care requires identification of which populations are experiencing performance gaps and the extent of those gaps. This study used Dental Quality Alliance (DQA) measures to examine variations in quality by race and ethnicity.

METHODS: We used eligibility and claims data for 2018 for children aged <21 years for state Medicaid/CHIP programs available through the Transformed Medicaid Statistical Information System. For a subset of states with sufficient data quality, we calculated DQA measures of utilization of services, oral evaluation, and topical fluoride. The measures were stratified by race and ethnicity, age, sex, geographic location, and language. We used bivariate logistic regression to analyze relative disparities.

RESULTS: Variations in measure scores were noted between racial and ethnic groups. Measure scores were typically lower for non-Hispanic black and American Indian/Alaskan Native children and higher for non-Hispanic Asian and Hispanic children compared with non-Hispanic white children. There also was variation in the patterns of disparities between states. More than two-thirds of states had insufficient race and ethnicity data (>10% missing) to reliably report stratified measure scores.

CONCLUSIONS: Because disparities vary by state, each Medicaid/CHIP program should evaluate variations in care quality in the context of the population it serves. A critical first step is to improve collection of race and ethnicity. These measurements can be used to set improvement goals that not only raise quality of care for the population overall but also close gaps in performance between racial and ethnic groups.

PMID:35726463 | DOI:10.1111/jphd.12522

J Hypertens. 2022 Jun 21. doi: 10.1097/HJH.0000000000003172. Online ahead of print.

ABSTRACT

BACKGROUND: Little is known whether children’s sodium intake is affected by the national salt reduction programme in the United Kingdom (UK), particularly in relation to socioeconomic groups. We aimed to assess the trend of sodium intake among children from different socioeconomic backgrounds in the UK, from 2008-2009 to 2018-2019.

METHODS: Repeated cross-sectional analyses of data from the National Diet and Nutrition Survey in children aged 4-18 years. Sodium intake was estimated from a 4-day dietary record in years 2008-2009 to 2018-2019 and 24-h urine collection (2008-2009 to 2011-2012 only). Socioeconomic status was based on parental occupation and equivalized household income.

RESULTS: We included 6281 children (age 11.0 ± 4.3 years, 51.3% boys). In 2008-2009 to 2011-2012, the mean sodium intake was 2342.4 ± 60.0 mg/day as measured by 24-h urinary sodium excretion, and was 2053.1 ± 18.2 mg/day by dietary records. From 2008-2009 to 2018-2019, the sodium intake as assessed by dietary records decreased by 15, 9 and 12% in children from routine and manual occupation families, intermediate occupation families and higher managerial, administrative and professional occupation families, respectively. On the basis of dietary records, the sodium intake of children from families in routine and manual occupations was 109.6 ± 23.1 mg/day (P < 0.001) higher than those from higher managerial, administrative and professional occupation families in 2008-2009 to 2011-2012. Sodium intake measured by 24-h urine collection during the same period also showed a difference between occupation groups, but it was not statistically significant. The occupational differences in sodium intake became smaller over time and were no longer significant in 2016-2017 to 2018-2019. Similar findings were found for household income.

CONCLUSION: Sodium intake as assessed by dietary records decreased over the 10-year period from 2008-2009 to 2018-2019 in children from all socioeconomic groups, particularly in those from lower socioeconomic backgrounds. These findings suggest that the national salt reduction programme could potentially help reduce health inequality related to sodium intake in children.

PMID:35726456 | DOI:10.1097/HJH.0000000000003172

Diabetes Obes Metab. 2022 Jun 21. doi: 10.1111/dom.14802. Online ahead of print.

ABSTRACT

AIMS: To compare the risk of cardiovascular outcomes with long-acting insulin analogues versus Neutral Protamine Hagedorn (NPH) insulin among patients with type 2 diabetes.

MATERIALS AND METHODS: We conducted a population-based retrospective cohort study, using the United Kingdom Clinical Practice Research Datalink Aurum, linked with hospitalization and vital statistics data. Patients with type 2 diabetes who initiated basal insulin treatment between 2002-2018 were included in the study. Exposure was defined as current use of long-acting insulin analogues or NPH insulin, defined using a time-varying approach. The primary outcome was major adverse cardiovascular events (MACE, composite endpoint of myocardial infarction [MI], ischemic stroke, and cardiovascular death). We used a marginal structural Cox proportional hazards model to estimate the hazard ratio (HR) and 95% confidence interval (CI) for MACE with current use of long-acting insulin analogues versus NPH insulin, and by long-acting insulin molecule in secondary analyses.

RESULTS: Our cohort included 57 334 patients. A total of 3494 MACE events occurred over a mean follow-up of 1.6 years (incidence rate: 37.4, 95% CI: 36.2 to 38.7 per 1000 person-years). Long-acting insulin analogues were associated with a decreased risk of MACE compared to NPH insulin (HR: 0.89, 95% CI: 0.83 to 0.96).

CONCLUSIONS: Current use of long-acting insulin analogues is associated with a modestly reduced risk of MACE compared to current use of NPH insulin among patients with type 2 diabetes. This study can have important implications for drug plan managers and guideline writing committees for recommendations of insulin treatment for type 2 diabetes. This article is protected by copyright. All rights reserved.

PMID:35726454 | DOI:10.1111/dom.14802

J Cosmet Dermatol. 2022 Jun;21(6):2577-2580. doi: 10.1111/jocd.14475. Epub 2021 Sep 28.

ABSTRACT

BACKGROUND: The significance of tumor thickness is not clear in the prognosis of basal cell carcinoma. We aimed to identify the relationship between the tumor thickness and aggressive histopathological growth pattern in BCC.

METHODS: We retrospectively reviewed 85 primary BCCs of 82 patients. A total of 78 (91.7%) tumor slides were available for review, 7 (8.2%) missing slides in archive could not to be re-evaluated. We recorded the histological subtype, ulceration, perineural invasion, and the tumor thickness. Tumors with infiltrative, micronodular, morpheaform and basosquamous features were classified as having an aggressive growth pattern.

RESULTS: The aggressive growth pattern was determined in 21 (26.9%) tumors with a mean tumor thickness of 2.19 ± 0.71 mm (range, 0.9-3.40). The non-aggressive growth pattern was detected in 57 (73%) tumors and the mean tumor thickness was 1.76 ± 0.87 mm (range 0.50-4.40 mm). There was a statistically significant difference in the mean tumor thickness between the tumors with aggressive growth pattern and non-aggressive growth pattern (p = 0.033).

CONCLUSION: Tumor thickness might have positive correlation with aggressive histological pattern. Measuring and reporting tumor thickness may be a more practical way to determine the pathological risk for BCC.

PMID:35726442 | DOI:10.1111/jocd.14475

Lifetime Data Anal. 2022 Jun 20. doi: 10.1007/s10985-022-09561-9. Online ahead of print.

ABSTRACT

Studies of chronic disease often involve modeling the relationship between marker processes and disease onset or progression. The Cox regression model is perhaps the most common and convenient approach to analysis in this setting. In most cohort studies, however, biospecimens and biomarker values are only measured intermittently (e.g. at clinic visits) so Cox models often treat biomarker values as fixed at their most recently observed values, until they are updated at the next visit. We consider the implications of this convention on the limiting values of regression coefficient estimators when the marker values themselves impact the intensity for clinic visits. A joint multistate model is described for the marker-failure-visit process which can be fitted to mitigate this bias and an expectation-maximization algorithm is developed. An application to data from a registry of patients with psoriatic arthritis is given for illustration.

PMID:35725841 | DOI:10.1007/s10985-022-09561-9