Tag: statistics

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

J Clin Psychol. 2022 Oct 12. doi: 10.1002/jclp.23450. Online ahead of print.

ABSTRACT

OBJECTIVE: Nonsuicidal self-injury (NSSI) frequently functions to regulate shame-based emotions and cognitions in the context of interpersonal stress. The present study sought to examine how sleep quality (SQ) may influence this process in a laboratory setting.

METHODS: Participants included 72 adults (M_age = 24.28; 36 with a lifetime history of NSSI) who completed a self-report measure of prior month SQ and engaged in a modified Trier social stress task (TSST). State shame ratings were collected immediately before and following the TSST, as well as 5 min post-TSST, to allow for the measurement of shame reactivity and recovery.

RESULTS: No significant results emerged for NSSI history and SQ as statistical predictors of shame reactivity. However, NSSI history was significantly associated with heightened shame intensity during the recovery period of the task, and this was moderated by SQ. Simple slopes analyses revealed a conditional effect whereby poorer SQ (1SD above the mean) was associated with greater intensity of shame during recovery, but only for those with a history of NSSI.

CONCLUSION: Poor SQ may contribute to worrisome emotional responses to daytime stressors in those at risk for NSSI.

PMID:36223526 | DOI:10.1002/jclp.23450

J Public Health Manag Pract. 2022 Oct 12. doi: 10.1097/PHH.0000000000001659. Online ahead of print.

ABSTRACT

CONTEXT: Big Cities Health Coalition member health departments (BCHC HDs) serve more than 61 million people across their jurisdictions, nearly 20% of the US population. As such, they have particular challenges and opportunities in how they do their work. This article focuses on BCHC HDs that participated in the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) and describes workplace perceptions, training needs, COVID-19 efforts, and well-being.

OBJECTIVE: To describe key characteristics of the governmental public health workforce among BCHC HDs, including demographics, perceptions, and needs.

DESIGN: Using a subsample of data from the 2021 PH WINS that included 29 BCHC HDs, descriptive statistics on many of the topics covered by the 2021 PH WINS were analyzed and compared with the 2017 PH WINS.

SETTING: Twenty-nine BCHC HDs in cities across the United States.

PARTICIPANTS: In total, 7922 of 29 661 staff members (response rate of 27%) from participating BCHC HDs.

RESULTS: Most BCHC HD respondents self-identified as a woman (76%, 95% confidence interval [CI]: 75%-77%), and as Black, Indigenous, and people of color (69%, 95% CI: 68%-70%), similar to findings from the 2017 PH WINS (75%, 95% CI: 74%-76%; 67%, 95% CI: 66%-69%, respectively). Most respondents believe that their organization prioritizes diversity, equity, and inclusion (70%, 95% CI: 69%-72%). Thirty percent (95% CI: 29%-32%) intend to leave their organizations within 1 year, and 18% (95% CI: 17%-19%) plan to retire within 5 years. Staff connect their work with agency goals and priorities (86%, 95% CI: 85%-87%) and are determined to give their best effort every day (91%, 95% CI: 90%-91%).

CONCLUSION: As the need for an all-encompassing focus on COVID-19 lessons, BCHC HDs should continue to focus on prioritizing staff retention, enhancing communication between senior staff and employees, and fostering an environment where innovation and creativity are rewarded.

PMID:36223507 | DOI:10.1097/PHH.0000000000001659

J Public Health Manag Pract. 2022 Oct 11. doi: 10.1097/PHH.0000000000001633. Online ahead of print.

ABSTRACT

OBJECTIVE: In response to calls to achieve racial equity, racism has been declared as a public health crisis. Diversity, equity, and inclusion (DEI) is an approach public health organizations are pursuing to address racial inequities in health. However, public health workforce perceptions about organizational commitment to DEI have not yet been assessed. Using a nationally representative survey of public health practitioners, we examine how perceptions about supervisors’ and managers’ commitment to DEI and their ability to support a diverse workforce relate to perceptions of organizational culture around DEI.

METHODS: Data from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) to examine the relationship between public health employees’ perceptions about their organization’s commitment to DEI and factors related to those perceptions. PH WINS received 44 732 responses (35% response rate). We calculated descriptive statistics and constructed a logistic regression model to assess these relationships.

RESULTS: Findings show that most public health employees perceive that their organizations are committed to DEI; however, perceptions about commitment to DEI vary by race, ethnicity, gender identity, and organizational setting. Across all settings, White respondents were more likely to agree with the statement, “My organization prioritizes diversity, equity, and inclusion” (range, 70%-75%), than Black/African American (range, 55%-65%) and Hispanic/Latino respondents (range, 62.5%-72.5%). Perception that supervisors worked well with individuals with diverse backgrounds had an adjusted odds ratio (AOR) of 5.37 (P < .001); organizational satisfaction had an AOR of 4.45 (P < .001). Compared with White staff, all other racial and ethnic groups had lower AOR of reporting their organizations prioritized DEI, with Black/African American staff being the lowest (AOR = 0.55), followed by Hispanic/Latino staff (AOR = 0.71) and all other staff (AOR = 0.82).

CONCLUSIONS: These differences suggest that there are opportunities for organizational DEI commitment to marginalized public health staff to further support DEI and racial equity efforts. Building a diverse public health workforce pipeline will not be sufficient to achieve health equity if staff perceive that their organization does not prioritize DEI.

PMID:36223514 | DOI:10.1097/PHH.0000000000001633

J Chem Inf Model. 2022 Oct 12. doi: 10.1021/acs.jcim.2c00977. Online ahead of print.

ABSTRACT

Ester hydrolysis is of wide biomedical interest, spanning from the green synthesis of pharmaceuticals to biomaterials’ development. Existing peptide-based catalysts exhibit low catalytic efficiency compared to natural enzymes, due to the conformational heterogeneity of peptides. Moreover, there is lack of understanding of the correlation between the primary sequence and catalytic function. For this purpose, we statistically analyzed 22 EC 3.1 hydrolases with known catalytic triads, characterized by unique and well-defined mechanisms. The aim was to identify patterns at the sequence level that will better inform the creation of short peptides containing important information for catalysis, based on the catalytic triad, oxyanion holes and the triad residues microenvironments. Moreover, fragmentation schemes of the primary sequence of selected enzymes alongside the study of their amino acid frequencies, composition, and physicochemical properties are proposed. The results showed highly conserved catalytic sites with distinct positional patterns and chemical microenvironments that favor catalysis and revealed variations in catalytic site composition that could be useful for the design of minimalistic catalysts.

PMID:36223497 | DOI:10.1021/acs.jcim.2c00977

Sci Adv. 2022 Oct 14;8(41):eabo6872. doi: 10.1126/sciadv.abo6872. Epub 2022 Oct 12.

ABSTRACT

Planning for adaptation to climate change requires accurate climate projections. Recent studies have shown that the uncertainty in global mean surface temperature projections can be considerably reduced using historical observations. However, the transposition of these new results to the local scale is not yet available. Here, we adapt an innovative statistical method that combines the latest generation of climate model simulations, global observations, and local observations to reduce uncertainty in local temperature projections. By taking advantage of the tight links between local and global temperature, we can derive the local implications of global constraints. The model uncertainty is reduced by 30% up to 70% at any location worldwide, allowing to substantially improve the quantification of risks associated with future climate change. A rigorous evaluation of these results within a perfect model framework indicates a robust skill, leading to a high confidence in our constrained climate projections.

PMID:36223474 | DOI:10.1126/sciadv.abo6872

PLoS One. 2022 Oct 12;17(10):e0275933. doi: 10.1371/journal.pone.0275933. eCollection 2022.

ABSTRACT

BACKGROUND: Antenatal care (ANC) is imperative to decreasing adverse pregnancy outcomes and their related maternal mortality. However, in sub-Saharan Africa, increases in ANC coverage have not correlated well with improved maternal and fetal outcomes suggesting the quality of ANC received could be the missing link. This study assessed ANC quality and its effect on adverse pregnancy outcomes among women who delivered at Komfo Anokye Teaching Hospital.

METHODS: A cross-sectional study was conducted among women who delivered at Komfo Anokye Teaching Hospital within the study period. Women were selected through systematic sampling and interviewed using a pretested structured questionnaire as well as review of their medical records. Data were collected on their sociodemographic and reproductive characteristics, care provided during ANC and delivery outcomes. Categorical variables were compared using the χ2 test. Factors associated with quality of ANC and adverse pregnancy outcomes were assessed using univariate and multivariate logistic regression to generate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Statistical analyses were performed using SPSS and GraphPad Prism. P-values of < 0.05 were considered statistically significant.

RESULTS: 950 women were recruited into the study with mean age of 30.39±5.57 years. Less than one-tenth (7.6%) of the women received good quality ANC, 63.4% had average quality ANC, and 29.0% received poor quality ANC. Increasing educational level and initiating ANC in the first trimester [aOR 0.2; 95%CI 0.08-0.68; p<0.001] increased the odds of receiving good quality ANC while being unemployed decreased the odds of receiving good quality ANC [aOR 0.3; 95% CI 0.12-0.65; p = 0.003]. Receiving poor and average quality of ANC were significantly associated with increased likelihood of developing anaemia during pregnancy, preeclampsia with severe features or delivering a low birth weight baby.

CONCLUSION: Most women did not receive good quality ANC. High quality ANC should be provided while the women are encouraged to comply with the recommendations during ANC.

PMID:36223426 | DOI:10.1371/journal.pone.0275933