Tag: statistics

Br J Gen Pract. 2022 Jul 22:BJGP.2022.0118. doi: 10.3399/BJGP.2022.0118. Online ahead of print.

ABSTRACT

BACKGROUND: It is unclear how engaging in physical activity after long periods of inactivity provides expected health benefits.

AIM: To determine whether physically inactive primary care patients reduce their mortality risk by increasing physical activity, even in low doses.

DESIGN AND SETTING: Prospective cohort of 3357 physically inactive patients attending 11 Spanish public primary healthcare centres.

METHOD: Change in physical activity was repeatedly measured during patients’ participation in the ‘Experimental Program for Physical Activity Promotion’ clinical trial between 2003 and 2006, using the ‘7-day Physical Activity Recall’. Mortality to 31 December 2018 (312 deaths) was recorded from national statistics, and survival time from the end of the clinical trial analysed using proportional hazard models.

RESULTS: After 46 191 person-years of follow-up, compared with individuals who remained physically inactive, the mortality rates of those who achieved the minimum recommendations of 150- 300 min/ week of moderate- or 75-150 min/ week of vigorous-intensity exercise was reduced by 45% (adjusted hazard ratio [aHR] 0.55; 95% confidence interval [95% CI] = 0.41 to 0.74); those who did not meet these recommendations but increased physical activity in low doses, that is, 50 min/week of moderate physical activity, showed a 31% reduced mortality (aHR 0.69, 95% CI = 0.51 to 0.93); and, those who surpassed the recommendation saw a 49% reduction in mortality (aHR 0.51, 95% CI = 0.32 to 0.81). The inverse association between increased physical activity and mortality follows a continuous curvilinear dose-response relationship.

CONCLUSION: Physically inactive primary care patients reduced their risk of mortality by increasing physical activity, even in doses below recommended levels. Greater reduction was achieved through meeting physical activity recommendations or adopting levels of physical activity higher than those recommended.

PMID:36316160 | DOI:10.3399/BJGP.2022.0118

Neuroradiol J. 2022 Oct 31:19714009221114445. doi: 10.1177/19714009221114445. Online ahead of print.

ABSTRACT

PURPOSE: The purpose is to determine the inter-rater reliability in grading ASPECTS score, between emergency medicine physician at first contact and radiologist among patients with acute ischemic stroke.

MATERIALS AND METHODS: We conducted a prospective analysis of 765 acute ischemic stroke cases referred to the Department of Radiodiagnosis in a rural-based hospital in South India, during January 2017 to October 2021. Non-contrast computed tomography (NCCT) scans of the brain were performed using GE Bright Speed Elite 128 Slice CT Scanner. ASPECTS score was calculated separately by an emergency medicine physician and radiologist. Inter-rater reliability for total and dichotomized ASPECTS (≥6 and <6) scores were assessed using statistical analysis (ICC and Cohen ĸ coefficients) on SPSS software (v17.0).

RESULTS: Inter-rater agreement for total and dichotomized ASPECTS was substantial (ICC 0.79 and Cohen ĸ 0.68) between the emergency physician and the radiologist. Mean difference in ASPECTS between the two readers was only 0.15 with standard deviation of 1.58. No proportionality bias was detected. The Bland-Altman plot was constructed to demonstrate the distribution of ASPECTS differences between the two readers.

CONCLUSION: Substantial inter-rater agreement was noted in grading ASPECTS between emergency medicine physician at first contact and radiologist, thereby confirming its robustness even in a rural setting.

PMID:36316159 | DOI:10.1177/19714009221114445

J Epidemiol Community Health. 2022 Oct 31:jech-2022-219521. doi: 10.1136/jech-2022-219521. Online ahead of print.

ABSTRACT

BACKGROUND: It is not known how differences in COVID-19 deaths by migration background in the Netherlands evolved throughout the pandemic, especially after introduction of COVID-19 prevention measures targeted at populations with a migration background (in the second wave). We investigated associations between migration background and COVID-19 deaths across first wave of the pandemic, interwave period and second wave in the Netherlands.

METHODS: We obtained multiple registry data from Statistics Netherlands spanning from 1 March 2020 to 14 March 2021 comprising 17.4 million inhabitants. We estimated incidence rate ratios for COVID-19 deaths by migration background using Poisson regression models and adjusted for relevant sociodemographic factors.

RESULTS: Populations with a migration background, especially those with Turkish, Moroccan and Surinamese background, exhibited higher risk of COVID-19 deaths than the Dutch origin population throughout the study periods. The elevated risk of COVID-19 deaths among populations with a migration background (as compared with Dutch origin population) was around 30% higher in the second wave than in the first wave.

CONCLUSIONS: Differences in COVID-19 deaths by migration background persisted in the second wave despite introduction of COVID-19 prevention measures targeted at populations with a migration background in the second wave. Research on explanatory mechanisms and novel prevention measures are needed to address the ongoing differences in COVID-19 deaths by migration background.

PMID:36316152 | DOI:10.1136/jech-2022-219521

Glob Health Sci Pract. 2022 Oct 31;10(5):e2200072. doi: 10.9745/GHSP-D-22-00072. Print 2022 Oct 31.

ABSTRACT

BACKGROUND: There is limited research on how digital health technologies (DHTs) are used to promote access to care for patients with noncommunicable diseases (NCDs), particularly in low- and middle-income countries (LMICs). We describe the use of DHTs in pharmaceutical industry-led access programs aimed at improving access to NCD care in LMICs.

METHODS: The Access Observatory is the largest publicly available repository containing detailed information about pharmaceutical industry-led access programs targeting NCDs. The repository includes 101 access program reports submitted by 19 pharmaceutical companies. From each report, we extracted data relating to geographic location, disease area, beneficiary population, use of DHTs, partnerships, strategies, and activities. Data were analyzed descriptively using SAS Statistical Software and categorized according to the World Health Organization Digital Health Classification Framework.

RESULTS: A total of 43 access programs (42.6%) included DHTs. The majority of programs using DHTs were clustered across sub-Saharan Africa (72.1%) and targeted cancer (60.5%) followed by metabolic disorders (39.5%). The applied DHTs mostly related to program strategies on health service strengthening (74.4%) and community awareness (41.9%) and were largely directed toward health providers, followed by data services and clients. Only a few DHTs were used for health system management. To promote access, most DHTs focused on improving data collection, management, and use (51.1%); building health provider capacity through training (37.2%); and providing targeted patient information (34.8%).

CONCLUSION: The range of DHTs applied by the pharmaceutical industry offers opportunities for more effective access to NCD care. Transparent reporting on DHT use and its contributions to access programs’ achievements may reduce duplicative and redundant efforts and provide learnings for private and public stakeholders that may contribute to greater access to NCD care in LMICs.

PMID:36316151 | DOI:10.9745/GHSP-D-22-00072

eNeuro. 2022 Oct 31:ENEURO.0144-22.2022. doi: 10.1523/ENEURO.0144-22.2022. Online ahead of print.

ABSTRACT

A central question in neuroscience is how sensory inputs are transformed into percepts. At this point, it is clear that this process is strongly influenced by prior knowledge of the sensory environment. Bayesian ideal observer models provide a key link between data and theory that can help researchers evaluate how prior knowledge is represented and integrated with incoming sensory information. However, the statistical prior employed by a Bayesian observer cannot be measured directly, and must instead be inferred from behavioral measurements. Here we review the general problem of inferring priors from psychophysical data, and the simple solution that follows from assuming a prior that is a Gaussian probability distribution. As our understanding of sensory processing advances, however, there is an increasing need for methods to flexibly recover the shape of Bayesian priors that are not well-approximated by elementary functions. To address this issue, we describe a novel approach that applies to arbitrary prior shapes, which we parameterize using mixtures of Gaussian distributions. After incorporating a simple approximation, this method produces an analytical solution for psychophysical quantities that can be numerically optimized to recover the shapes of Bayesian priors. This approach offers advantages in flexibility, while still providing an analytical framework for many scenarios. We provide a MATLAB toolbox implementing key computations described herein.Significance statementModels in neuroscience provide an essential tool for developing and testing hypotheses about how the brain works. Here, we review the canonical application of Bayesian ideal observer models for understanding sensory processing. We present a new mathematical generalization that will allow these models to be used for deeper investigations into how prior knowledge influences perception. We also provide a software toolkit for implementing the described models.

PMID:36316119 | DOI:10.1523/ENEURO.0144-22.2022

Thorax. 2022 Oct 31:thoraxjnl-2022-219039. doi: 10.1136/thorax-2022-219039. Online ahead of print.

ABSTRACT

OBJECTIVE: Little is known about how lower respiratory tract infections (LRTIs) before chronic obstructive pulmonary disease (COPD) are associated with future exacerbations and mortality. We investigated this association in patients with COPD in England.

METHODS: Clinical Practice Research Datalink Aurum, Hospital Episode Statistics and Office of National Statistics data were used. Start of follow-up was patient’s first ever COPD diagnosis date and a 1-year baseline period prior to start of follow-up was used to find mild LRTIs (general practice (GP) events/no antibiotics), moderate LRTIs (GP events+antibiotics) and severe LRTIs (hospitalised). Patients were categorised as having: none, 1 mild only, 2+ mild only, 1 moderate, 2+ moderate and 1+ severe. Negative binomial regression modelled the association between baseline LRTIs and subsequent COPD exacerbations and Cox proportional hazard regression was used to investigate mortality.

RESULTS: In 215 234 patients with COPD, increasing frequency and severity of mild and moderate LRTIs were associated with increased rates of subsequent exacerbations compared with no recorded LRTIs (1 mild adjusted IRR 1.16, 95% CI 1.14 to 1.18, 2+ mild IRR 1.51, 95% CI 1.46 to 1.55, 1 moderate IRR 1.81, 95% CI 1.78 to 1.85, 2+ moderate IRR 2.55, 95% CI 2.48 to 2.63). Patients with 1+ severe LRTI (vs no baseline LRTIs) also showed an increased rate of future exacerbations (adjusted IRR 1.75, 95% CI, 1.70 to 1.80). This pattern of association was similar for risk of all-cause and COPD-related mortality; however, patients with 1+ severe LRTIs had the highest risk of all-cause and COPD mortality.

CONCLUSION: Increasing frequency and severity of LRTIs prior to COPD diagnosis were associated with increasing rates of subsequent exacerbations, and increasing risk of all-cause and COPD-related mortality.

PMID:36316117 | DOI:10.1136/thorax-2022-219039

Emerg Med J. 2022 Oct 31:emermed-2021-211160. doi: 10.1136/emermed-2021-211160. Online ahead of print.

ABSTRACT

BACKGROUND: Airway management is challenging in trauma patients because of the fear of worsening cervical spinal cord damage. Video-integrated and optic-integrated devices and intubation laryngeal mask airways have been proposed as alternatives to direct laryngoscopy with the Macintosh laryngoscope (MAC). We performed a meta-analysis to clarify which devices cause less cervical movement during airway management.

METHODS: We searched MEDLINE, Cochrane Central, Embase and LILACS from inception to January 2022. We selected randomised controlled trials comparing alternative devices with the MAC for cervical movement from C0 to C5 in adult patients, evaluated by radiological examination. Additionally, cervical spine immobilisation (CSI) techniques were evaluated. We used the Cochrane Risk of Bias Tool to evaluate the risk of bias, and the principles of the Grading of Recommendations, Assessment, Development, and Evaluations system to assess the quality of the body of evidence.

RESULTS: Twenty-one studies (530 patients) were included. Alternative devices caused statistically significantly less cervical movement than MAC during laryngoscopy with mean differences of -3.43 (95% CI -4.93 to -1.92) at C0-C1, -3.19 (-4.04 to -2.35) at C1-C2, -1.35 (-2.19 to -0.51) at C2-C3, and -2.61 (-3.62 to -1.60) at C3-C4; and during intubation: -3.60 (-5.08 to -2.12) at C0-C1, -2.38 (-3.17 to -1.58) at C1-C2, -1.20 (-2.09 to -0.31) at C2-C3. The Airtraq and the Intubation Laryngeal Mask Airway caused statistically significant less movement than MAC restricted to some cervical segments, as well as CSI. Heterogeneity was low to moderate in most results. The quality of the body of evidence was ‘low’ and ‘very low’.

CONCLUSIONS: Compared with the MAC, alternative devices caused less movement during laryngoscopy (C0-C4) and intubation (C0-C3). Due to the high risk of bias and the very low grade of evidence of the studies, further research is necessary to clarify the benefit of each device and to determine the efficacy of cervical immobilisation during airway management.

PMID:36316103 | DOI:10.1136/emermed-2021-211160

BMJ Open. 2022 Oct 31;12(10):e060136. doi: 10.1136/bmjopen-2021-060136.

ABSTRACT

INTRODUCTION: Mechanical thrombectomy (MT) using stent retrievers or a direct aspiration first-pass technique has proven to yield better results over intravenous thrombolysis in treating acute ischaemic stroke caused by large vessel occlusion (LVO). However, the treatment of intracranial atherosclerotic stenosis-related LVO remains unclear and has been a critical problem in daily clinical practice, as it can cause a relatively high failure rate for MT. Whether direct angioplasty and/or stenting is clinically feasible and shows advantage in reducing delay to revascularisation with better functional outcome compared with MT with rescue angioplasty and/or stenting remains unclear. This study seeks to provide direct and practical clinical evidence for clinicians.

METHODS AND ANALYSIS: The main databases of PubMed, the Cochrane library, Embase and Web of Science will be screened for related studies published after1 January 2015. Primary outcomes include successful recanalisation and 90-day favourable outcome. Secondary outcomes include puncture to revascularisation time, vascular complication (perforation, dissection and vasospasm), intracerebral haemorrhage, hospital-related complications and 90-day mortality. The Newcastle-Ottawa Scale will be adopted to assess risk bias of observational studies. The I ² statistic will be used to assess heterogeneity.

ETHICS AND DISSEMINATION: No primary data of patients are needed. Therefore, ethics approval is unnecessary. The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER: CRD42021268061.

PMID:36316082 | DOI:10.1136/bmjopen-2021-060136

BMJ Open. 2022 Oct 31;12(10):e067468. doi: 10.1136/bmjopen-2022-067468.

ABSTRACT

INTRODUCTION: Medication non-initiation, or primary non-adherence, is a persistent public health problem that increases the risk of adverse clinical outcomes. The initial medication adherence (IMA) intervention is a complex multidisciplinary intervention to improve adherence to cardiovascular and diabetes treatments in primary care by empowering the patient and promoting informed prescriptions based on shared decision-making. This paper presents the development and implementation strategy of the IMA intervention and the process evaluation protocol embedded in a cluster randomised controlled trial (the IMA-cRCT) to understand and interpret the outcomes of the trial and comprehend the extent of implementation and fidelity, the active mechanisms of the IMA intervention and in what context the intervention is implemented and works.

METHODS AND ANALYSIS: We present the protocol for a mixed-methods process evaluation including quantitative and qualitative methods to measure implementation and fidelity and to explore the active mechanisms and the interactions between the intervention, participants and its context. The process evaluation will be conducted in primary care centres and community pharmacies from the IMA-cRCT, and participants include healthcare professionals (general practitioners, nurses and community pharmacists) as well as patients. Quantitative data collection methods include data extraction from the intervention operative records, patient clinical records and participant feedback questionnaires, whereas qualitative data collection involves semistructured interviews, focus groups and field diaries. Quantitative and qualitative data will be analysed separately and triangulated to produce deeper insights and robust results.

ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Research Ethics Comittee (CEIm) at IDIAP Jordi Gol (codeCEIm 21/051 P). Findings will be disseminated through publications and conferences, as well as presentations to healthcare professionals and stakeholders from healthcare organisations.

TRIAL REGISTRATION NUMBER: NCT05026775.

PMID:36316078 | DOI:10.1136/bmjopen-2022-067468

BMJ Open. 2022 Oct 31;12(10):e060242. doi: 10.1136/bmjopen-2021-060242.

ABSTRACT

INTRODUCTION AND AIM: Low socioeconomic position (SEP) has been shown to be strongly associated with impaired lung cancer survival. Barriers related to receiving recommended treatment among patients with lung cancer with low SEP may include adverse health behaviour and limited physical and psychosocial resources influencing the ability to react on high-risk symptoms and to navigate the healthcare system. To address the underlying factors that drive both decisions of treatment, adherence to treatment and follow-up in vulnerable patients with lung cancer, we developed the Navigate intervention. The aim of this randomised controlled trial is to investigate the effect of the intervention on survival (primary outcome), lung cancer treatment adherence, health-related quality of life and other psychosocial outcomes as well as health costs and process evaluation (secondary outcomes) in a study population of vulnerable patients with lung cancer.

METHODS AND ANALYSIS: This two-armed multicentre randomised trial will recruit patients from five lung cancer clinics in Denmark identified as vulnerable according to a screening instrument with nine clinical and patient-reported vulnerability criteria developed for the study. We will enrol 518 vulnerable patients >18 years old diagnosed with non-small cell lung cancer at all stages with a performance status <2. Participants will be randomly allocated to either standard treatment and intervention or standard treatment alone. The Navigate intervention is based on principles from motivational interviewing and includes three components of nurse navigation, systematic monitoring of patient-reported outcomes (PROs) and physical exercise in a person-centred delivery model. Data will be collected at baseline and 3, 6, 12 months after randomisation using questionnaires, clinical data and physical function tests.

ETHICS AND DISSEMINATION: Ethics Committee, Region Zealand (SJ-884/EMN-2020-37380) and the Data Protection Agency in Region Zealand (REG-080-2021) approved the trial. Participants will provide written informed consent. Results will be reported in peer-reviewed journals.

TRIAL REGISTRATION NUMBER: NCT05053997.

PMID:36316074 | DOI:10.1136/bmjopen-2021-060242