Tag: statistics

J Ment Health Policy Econ. 2022 Mar 1;25(1):21-34.

ABSTRACT

BACKGROUND: Uncertainty around economic recovery from a pandemic, in addition to restrictions on mobility and socializing, can be isolating and stressful. While preventive measures, such as mask mandates, are expected to mitigate spread of the disease and lower concerns of future job loss, state- and local-level mandates could signal that infection rates are worse in the mandated areas and decrease consumer confidence and mobility. Thus, the association between mask mandates and psychological well-being is unclear.

AIMS OF THE STUDY: Twenty-five states in the United States implemented statewide mask mandates early in the pandemic. This study seeks to examine the effect of mask mandates on self-reported job loss expectation and mental health.

METHODS: This study analyzes U.S. Census Bureau’s Household Pulse Survey data, collected between April 23rd and July 21st, 2020. Using a panel subset of the data, fixed effects models are estimated to understand statewide mask mandate’s effect on psychological well-being over a twelve-week period while controlling for individual-level unobserved heterogeneity. All data are then state-aggregated, and fixed effects models are estimated to examine average differences in job loss expectation and mental health between mandate and non-mandate states.

RESULTS: In the individual-level panel data, job loss expectation was lower by 1.1 percentage point by the second week of a statewide mask mandate and by 1.6 percentage point by the third week, compared to average job loss expectation in states without a mask mandate and to the mandate states before the policy implementation. Average job loss expectation was 6.5 percentage point lower by the twelfth week in the five states that were the first to implement statewide mask mandates. Mental health status improved steadily from the fourth week on in states with a mask mandate. Analysis of state-aggregated data indicates considerable variability and lack of uniformity in mask mandates’ impact on job loss expectation and mental health status.

DISCUSSION: Local-level mandates, such as those at the county-level, could not be identified in these data. The impact of a mask mandate could be underestimated when only state-level mandates are considered, and local regulations are excluded. This is a limitation of this study.

IMPLICATIONS FOR HEALTH CARE PROVISION: The staggered state-by-state approach to implementing mask mandates and the considerable variability in enforcement of mask rules has possibly contributed to lack of uniformity and consistency in how mask mandates impact subjective psychological well-being.

IMPLICATIONS FOR HEALTH POLICIES: The lack of statistically significant impact of statewide mask mandates on the two outcome variables in the state-aggregated data, and on long-run job loss expectation in the individual-level panel data, could be indicative of the complexities of effective science communication regarding behavioral recommendations to promote overall well-being.

IMPLICATIONS FOR FURTHER RESEARCH: Multiple variants of SARS-CoV-2, the virus that causes COVID-19, has emerged around the world. Further research could more clearly assess the degree to which communicating public health implications of these variants has evolved, and whether it has elicited behavior change and affected psychological well-being.

PMID:35302051

J Ment Health Policy Econ. 2022 Mar 1;25(1):3-10.

ABSTRACT

BACKGROUND AND AIMS: We study the trajectory of depressive symptoms among US adults before, during, and after the 2008/2009 Great Recession.

METHODS: We use repeated cross-sectional surveys of the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. Mental health is assessed with the Patient Health Questionnaire-9 (PHQ-9), with the following categorization for depressive symptoms: none or mild (score 0-9), moderate or severe (score 10-27). A parallel time series was calculated from the Behavioral Risk Factor Surveillance System (BRFSS) on self-reported number of days with poor mental health.

RESULTS: NHANES data show a statistically significant increase in depressive symptoms from 2005/2006 to 2007/2008 (the beginning of the Great Recession), but there were no significant or consistent changes after 2007/2008. In particular, the deterioration in the adjusted predicted PHQ-9 scores occurred prior to the large increase in unemployment rate (2009/2010). As the macroeconomic situations improved and unemployment rates recovered, mental health did not return to the previous level. In the latest wave of NHANES (2017/2018), unemployment rates were at the lowest level over the analysis period; however, the adjusted predicted PHQ-9 scores were higher than that at the beginning of the Great Recession. Trends of PHQ-9 scores were similar across income groups – all groups had an increase in depressive symptoms after 2005/2006 and PHQ-9 scores were still high in 2017/2018 after controlling for sociodemographic status. Group with the lowest income had higher levels of depressive symptoms at every time point. BRFSS data shows no consistent changes in the number of days with poor mental health that parallel economic conditions.

DISCUSSION: Depressive symptoms at the population level did not match the economic cycle before, during and after the Great Recession. Future research is needed to better understand the lack of correlation between population mental health and macroeconomic conditions.

PMID:35302049

J Cachexia Sarcopenia Muscle. 2022 Mar 17. doi: 10.1002/jcsm.12952. Online ahead of print.

ABSTRACT

Low muscle mass is prevalent among patients with cancer and a predictor of adverse clinical outcomes. To counteract muscle loss, β-hydroxy β-methylbutyrate (HMB) supplementation has been proposed as a potential therapy for older adults and various diseases states. This systematic review aimed to investigate the effects and safety of HMB supplementation in relation to muscle mass and function and other clinical outcomes in patients with cancer. A systematic search of MEDLINE, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Scopus, ProQuest, and grey literature for reports published from inception to December 2021 was conducted. Included studies provided supplements containing any dose of HMB to adult patients with active cancer. A synthesis without meta-analysis was conducted using a vote-counting approach based solely on the direction of the effect (i.e. regardless of statistical significance). Risk of bias was assessed for each outcome domain, and evidence from higher-quality studies (i.e. those with either low or moderate risk of bias) was examined. Safety was evaluated using both lower-quality and higher-quality studies. Fifteen studies were included, in which six were randomized controlled trials in patients with various cancer types and treatments. Studies prescribed HMB combined with amino acids (73.3%), HMB in oral nutritional supplements (20.0%), or both supplement types (6.7%); Ca-HMB doses of 3.0 g/day were provided in 80.0% of the studies. Four studies had high risk of bias across all outcome domains. Considering the higher-quality studies, evidence of a beneficial effect of HMB supplementation was found in four of four studies for muscle mass, two of two for muscle function, three of three for hospitalization, and five of seven for survival. In contrast, no beneficial effects of HMB on quality of life or body weight was found in two of four and three of five studies, respectively. A limited number of higher-quality studies evaluating the impact of HMB on cancer therapy-related toxicity, inflammation, and tumour response were observed. No serious adverse effects directly related to the nutrition intervention were reported. Although limited, current evidence suggests that HMB supplementation has a beneficial effect on muscle mass and function in patients with cancer. Well-designed trials are needed to further explore the clinical benefit of HMB supplementation in this patient population.

PMID:35301826 | DOI:10.1002/jcsm.12952

J Clin Hypertens (Greenwich). 2022 Mar 17. doi: 10.1111/jch.14460. Online ahead of print.

ABSTRACT

Masked uncontrolled hypertension (MUCH) is at higher cardiovascular risk than controlled hypertension (CH). In previous studies, patients with MUCH were considered as a unique group though those receiving ≤2 drugs could be defined as having nonresistant MUCH (NRMUCH) and those receiving ≥3 drugs as having resistant MUCH (RMUCH). The aim of this study was to assess the prognostic value of NRMUCH and RMUCH detected by ambulatory blood pressure (BP) monitoring. Cardiovascular risk was evaluated in 738 treated hypertensive patients with normal clinic BP. Patients were classified as having CH or MUCH if daytime BP < or ≥ 135/85 mmHg, respectively, regardless of nighttime BP, or CH or MUCH if 24-h BP < or ≥ 130/80 mmHg, respectively, regardless of daytime or nighttime BP. By daytime or 24-h BP, the authors detected 523 (71%), 178 (24%), and 37 (5%) or 463 (63%), 231 (31%), and 44 (6%) patients with CH, NRMUCH, and RMUCH, respectively. During the follow-up (median 10 years), 148 events occurred. After adjustment for covariates, compared to CH, the hazard ratio (HR), 95% confidence interval (CI), for cardiovascular events was 1.81, 1.27-2.57, and 2.99, 1.73-5.16, in NRMUCH and RMUCH defined by daytime BP, respectively, and 1.58, 1.12-2.23, and 2.21, 1.27-3.82, in NRMUCH and RMUCH defined by 24-h BP, respectively. If RMUCH was compared with NRMUCH, the risk tended to be higher in RMUCH but did not attain statistical significance (P = .08 and P = .23 by daytime and 24-h BP thresholds, respectively). In conclusion, both NRMUCH and RMUCH are at increased cardiovascular risk than CH.

PMID:35301793 | DOI:10.1111/jch.14460

J Cachexia Sarcopenia Muscle. 2022 Mar 18. doi: 10.1002/jcsm.12967. Online ahead of print.

ABSTRACT

BACKGROUND: Chemotherapy-induced toxicities frequently occur in non-small cell lung cancer (NSCLC) patients treated with platinum-based chemotherapy. Low skeletal muscle mass (SMM) has been associated with a higher incidence of toxicities for several types of cancers and cytostatics. The aim of this study was to evaluate the association between skeletal muscle measures and chemotherapy-induced toxicity in a large cohort of NSCLC patients.

METHODS: A multicentre prospective follow-up study (PGxLUNG, NTR number NL5373610015) in NSCLC patients was conducted. Included were patients diagnosed with NSCLC (stage II-IV) treated with first-line platinum-based (cisplatin or carboplatin) chemotherapy of whom pretreatment imaging was available. Skeletal muscle area (SMA) segmentation was performed on abdominal imaging at the level of the third lumbar vertebra (L3). SMA at the level of L3 was corrected for squared height (m² ) to yield the lumbar skeletal muscle mass index (LSMI). Skeletal muscle density (SMD) was calculated as the mean Hounsfield Unit (HU) of the segmented SMA. SMM and SMD were categorized as low, intermediate, and high, based on LSMI and mean HU tertiles, respectively. Chemotherapy-induced toxicity was scored using CTCAE v4.03 and categorized into haematological (anaemia, leukocytopenia, neutropenia, and thrombocytopenia), non-haematological (nephrotoxicity, neurotoxicity, and esophagitis), and dose-limiting toxicity (DLT) (treatment switch, delay, de-escalation, discontinuation, or hospitalization). The relationship between SMM, SMD, and toxicities was assessed with logistic regression modelling taking into account potential confounders like gender and body mass index (BMI).

RESULTS: In total, 297 patients (male n = 167, median age 64 years) were included. Haematological toxicity grade 3/4 was experienced in 36.6% (n = 108) of the patients, 24.6% (n = 73) experienced any non-haematological toxicity grade ≥2, and 55.6% (n = 165) any DLT. Multivariate logistic regression analysis showed that low SMM (ORadj 2.41, 95% CI 1.31-4.45, P = 0.005) and age at diagnosis >65 years (ORadj 1.76, 95% CI 1.07-2.90, P = 0.025) were statistically significantly associated with overall haematological toxicity grade 3/4. No statistically significant associations were found between low SMM or low SMD and non-haematological toxicities. Low SMM (ORadj 2.23, 95% CI 1.23-4.04, P = 0.008) and high SMD (ORadj 0.41, 95% CI 0.23-0.74, P = 0.003) were statistically significantly associated with a higher respectively lower risk of DLT.

CONCLUSIONS: Non-small cell lung cancer patients with pretreatment low SMM are at significant higher risk for haematological toxicities grade 3/4 and DLT. NSCLC patients with high SMD are at significant lower risk for DLT. Further studies should be aimed to investigate whether platinum dosing based on skeletal muscle measurements and/or improvement of pretreatment SMM/SMD could reduce the risk of toxicity without compromising efficacy.

PMID:35301821 | DOI:10.1002/jcsm.12967

Health Soc Care Community. 2022 Mar 17. doi: 10.1111/hsc.13776. Online ahead of print.

ABSTRACT

Health and well-being are promoted when primary care teams partner with patients and provide care coordination to mitigate risks and promote optimal health. Identification of patients for care coordination is typically based on claim-driven risk assessments. Evidence shows that social determinants of health (SDOH) drive risk for adverse health outcomes but are omitted from existing risk tools. Missed opportunities for care coordination contribute to increased healthcare costs, poorer health outcomes and reduced patient well-being. To address the gap of risk-informed care coordination that includes SDOH, the aim of this project was to implement process improvement of a system’s care coordination program through refined patient selection and customised engagement in intensive care coordination. A non-randomised care coordination quality improvement project was conducted at a community health centre in 2020. Inclusion criteria (i.e. presence of risk attribution score, SDOH questionnaire completed) resulted in 540 patients being offered care coordination services; Patients having at least one month of care coordination were included in the analysis (N = 216). Analysis included the 216 patients that chose participation and the 324 patients that maintained usual care. Descriptive statistics were generated to distinguish patient demographics, frequency of care coordination contact, and specific SDOH insecurities for both the study and comparison groups. Paired t-tests were incorporated to evaluate statistical significance of the intervention group. Impact on well-being, SDOH barriers, appointment adherence and health outcomes were assessed in both conditions. Intervention condition patients reported improvement in well-being [feeling anxious (t = 4.051; p < 0.000)] and reduced SDOH barriers [food access (t = 4.662; p < 0.000); housing (t = 2.203; p = 0.008)] that were significantly different from the usual care condition in the expected directions. Care coordination based on factors including SDOH risks shows promise in improving patient well-being. Future research should refine this approach for comprehensive risk assessment to intervene and support patient health and well-being.

PMID:35301764 | DOI:10.1111/hsc.13776

J Adv Nurs. 2022 Mar 17. doi: 10.1111/jan.15198. Online ahead of print.

ABSTRACT

AIMS: To examine the effects of nursing deans/directors’ transformational leadership behaviours on academic workplace culture, faculty burnout and job satisfaction.

BACKGROUND: Transformational leadership is an imperative antecedent to organizational change, and employee well-being and performance. However, little has been espoused regarding the theoretical and empirical mechanisms by which transformational leaders improve the academic workplace culture and faculty retention.

DESIGN: A cross-sectional survey design was implemented.

METHODS: Nursing faculty employed in Canadian academic settings were invited to complete an anonymous online survey in May-July 2021. A total of 645 useable surveys were included in the analyses. Descriptive statistics and reliability estimates were performed. The moderated mediation model was tested using structural equation modelling in the Analysis of Moment software v24.0. Bootstrap method was used to estimate total, direct and indirect effects.

RESULT: The proposed study model was supported. Transformational leadership had both a strong direct effect on workplace culture and job satisfaction and an inverse direct effect on faculty burnout. While workplace culture mediated the effect of leadership on job satisfaction and burnout, the moderation effect of COVID-19 was not captured in the baseline model.

CONCLUSION: The findings provide an in-depth understanding of the factors that affect nursing faculty wellness, and evidence that supportive workplace culture can serve as an adaptive mechanism through which transformational leaders can improve retention. A transformational dean/director can proactively shape the nature of the academic work environment to mitigate the risks of burnout and improve satisfaction and ultimately faculty retention even during an unforeseen event, such as a pandemic.

IMPLICATION: Given the range of uncertainties associated with COVID-19, administrators should consider practicing transformational leadership behaviours as it is most likely to be effective, especially in times of uncertainty and chaos. In doing so, academic leaders can work towards equitable policies, plans and decisions and rebuild resources to address the immediate and long-term psychological and overall health impacts of COVID-19.

PMID:35301738 | DOI:10.1111/jan.15198

Br J Clin Pharmacol. 2022 Mar 17. doi: 10.1111/bcp.15319. Online ahead of print.

ABSTRACT

AIM: This Phase I, multicentre, open-label, non-randomised, parallel-group, two-part study aimed to evaluate the effect of mild to moderate hepatic impairment on the pharmacokinetics (PK), safety and tolerability of a single oral dose of risdiplam.

METHODS: Adult subjects (aged 18-70 years) with mild (Child-Pugh Class A; Part 1) or moderate (Child-Pugh Class B; Part 2) hepatic impairment were matched with subjects with normal hepatic function on sex, age, body mass index and smoking status. Each subject received a single oral dose of 5 mg risdiplam. Plasma concentrations of risdiplam and its metabolite M1 were measured, and PK parameters were compared. Adverse events, laboratory abnormalities, vital signs and electrocardiogram measurements were assessed.

RESULTS: After a single dose (5 mg) risdiplam, the risdiplam PK parameters area under the plasma concentration-time curve from time zero to infinity and maximum observed plasma concentration were approximately 20% and 5% lower, respectively, in subjects with mild hepatic impairment and approximately 8% and 20% higher, respectively, in subjects with moderate hepatic impairment compared with subjects with normal hepatic function. These differences were not statistically significant; all 90% confidence intervals for geometric least squares-means ratios spanned unity. No new risdiplam-related safety findings were observed in subjects with mild or moderate hepatic impairment.

CONCLUSION: Mild or moderate hepatic impairment did not have a clinically relevant impact on the PK of risdiplam. Therefore, no dose adjustment is required in patients with mild or moderate hepatic impairment when receiving risdiplam.

PMID:35301746 | DOI:10.1111/bcp.15319

J Community Psychol. 2022 Mar 18. doi: 10.1002/jcop.22841. Online ahead of print.

ABSTRACT

Recent years have witnessed a substantial increase in the interest in violence occurring at home or school, as well as in neighborhoods. Yet, there is no standardized instrument to measure community violence in Turkey. Thus, the present study aimed to adapt the Exposure to Recurring Community Violence Scale into Turkish and explore its psychometric properties. The sample consisted of 210 participants (57% were females) between 18 and 64 years (Mage = 38.33, SD = 10.67). For criterion-related validity, we evaluated the participants’ scores on the Brief Symptom Inventory (BSI), the Traumatic Life Events Form, the Relationship Quality Scale, and a Demographic Information Form. We performed all statistical analyses using the FACTOR and SPSS v.20 programs. Exploratory factor analysis revealed a 2-factor structure for the scale (victimization and witnessing), explaining 52% of the total variance. As expected, the witnessing and victimization scores were correlated with the subscales of the BSI, the number of traumatic life events, and the subscales of The Relationship Quality Scale. For reliability concerns, we calculated Cronbach’s α coefficients to be 0.79 for the victimization and 0.90 for the witnessing. Besides, the findings revealed acceptable psychometric properties for the Turkish version of the Exposure to Recurring Community Violence Scale. Thereby, we concluded that the scale can be used as a reliable and valid measure in the Turkish context. Overall, the scale will likely allow further research to scrutinize the risk factors and consequences of community violence.

PMID:35301721 | DOI:10.1002/jcop.22841

Br J Haematol. 2022 Mar 17. doi: 10.1111/bjh.18137. Online ahead of print.

ABSTRACT

The glycoprotein CD47 regulates antiphagocytic activity via signal regulatory protein alpha (SIRPa). This study investigated CD47 expression on Hodgkin and Reed-Sternberg (HRS) cells in the classical Hodgkin lymphoma (cHL) tumour microenvironment and its correlation with prognosis, programmed-death (PD) immune markers, and SIRPa⁺ leukocytes. We conducted immunohistochemistry with CD47 and SIRPa antibodies on diagnostic biopsies (tissue microarrays) from cHL patients from two cohorts (n = 178). In cohort I (n = 136) patients with high expression of CD47 on HRS cells (n = 48) had a significantly inferior event-free survival [hazard ratio (HR) = 5.57; 95% confidence interval (CI), 2.78-11.20; p < 0.001] and overall survival (OS) (HR = 8.54; 95% CI, 3.19-22.90; p < 0.001) compared with patients with low expression (n = 88). The survival results remained statistically significant in multivariable Cox regression adjusted for known prognostic factors. In cohort II (n = 42) high HRS cell CD47 expression also carried shorter event-free survival (EFS) (HR = 5.96; 95% CI, 1.20-29.59; p = 0.029) and OS (HR = 5.61; 95% CI, 0.58-54.15; p = 0.136), although it did not retain statistical significance in the multivariable analysis. Further, high CD47 expression did not correlate with SIRPa⁺ leukocytes or PD-1, PD-L1 and PD-L2 expression. This study provides a deeper understanding of the role of CD47 in cHL during an era of emerging CD47 therapies.

PMID:35301709 | DOI:10.1111/bjh.18137