Tag: statistics

Trans R Soc Trop Med Hyg. 2022 Oct 11:trac093. doi: 10.1093/trstmh/trac093. Online ahead of print.

ABSTRACT

BACKGROUND: Geographical overlap of human visceral leishmaniasis (HVL) and HIV infection favors occurrences of HVL/HIV coinfection. The increasing numbers of cases of HVL/HIV coinfection are a worldwide concern and knowledge of the factors involved can help in developing preventive measures.

METHODS: We aimed to identify spatial patterns and describe the epidemiological profile of HVL/HIV coinfection in Brazil from 2007 to 2015. This was an ecological study, in which thematic maps were created through geoprocessing tools, based on secondary data obtained from open-access platforms, to identify priority areas for interventions for controlling HLV/HIV coinfection, using the TerraView 4.2.2 software.

RESULTS: We found spatial autocorrelations between the HVL/HIV rates of neighboring municipalities according to the global Moran index (0.10; p<0.01). The highest HVL/HIV rate was in the central-western region. Among the epidemiological characteristics according to the regions, an increasing trend in the annual variation rate was observed, with positive values over the years and statistical significance (p<0.05) in the North with 1.62 (95% CI 0.57 to 2.69; p=0.02) and Northeast with 6.41 (95% CI 2.60 to 10.37; p=0.006). Similarly, increasing trends were observed in the states of Maranhão with 21.34 (95% CI 13.99 to 9.16; p<0.001) and Sergipe with 5.44 (95% CI 0.61 to 10.50; p=0.04).

CONCLUSIONS: Our results showed spatial overlap between occurrences of HVL and HIV with spatial patterns of HVL/HIV coinfection, thus revealing that the numbers of cases reported are increasing. Identifying areas with higher coinfection indices contributes to applying interventions and control measures among targeted populations, to prevent new cases.

PMID:36219448 | DOI:10.1093/trstmh/trac093

JAMA. 2022 Oct 11;328(14):1445-1455. doi: 10.1001/jama.2022.16303.

ABSTRACT

IMPORTANCE: Anxiety in children and adolescents is associated with impaired functioning, educational underachievement, and future mental health conditions.

OBJECTIVE: To review the evidence on screening for anxiety in children and adolescents to inform the US Preventive Services Task Force.

DATA SOURCES: PubMed, Cochrane Library, PsycINFO, CINAHL, and trial registries through July 19, 2021; references, experts, and surveillance through June 1, 2022.

STUDY SELECTION: English-language, randomized clinical trials (RCTs) of screening; diagnostic test accuracy studies; RCTs of cognitive behavioral therapy (CBT) or US Food and Drug Administration-approved pharmacotherapy; RCTs, observational studies, and systematic reviews reporting harms.

DATA EXTRACTION AND SYNTHESIS: Two reviewers assessed titles/abstracts, full-text articles, and study quality and extracted data; when at least 3 similar studies were available, meta-analyses were conducted.

MAIN OUTCOMES AND MEASURES: Test accuracy, symptoms, response, remission, loss of diagnosis, all-cause mortality, functioning, suicide-related symptoms or events, adverse events.

RESULTS: Thirty-nine studies (N = 6065) were included. No study reported on the direct benefits or harms of screening on health outcomes. Ten studies (n = 3260) reported the sensitivity of screening instruments, ranging from 0.34 to 1.00, with specificity ranging from 0.47 to 0.99. Twenty-nine RCTs (n = 2805) reported on treatment: 22 on CBT, 6 on pharmacotherapy, and 1 on CBT, sertraline, and CBT plus sertraline. CBT was associated with gains on several pooled measures of symptom improvement (magnitude of change varied by outcome measure), response (pooled relative risk [RR], 1.89 [95% CI, 1.17 to 3.05]; n = 606; 6 studies), remission (RR, 2.68 [95% CI, 1.48 to 4.88]; n = 321; 4 studies), and loss of diagnosis (RR range, 3.02-3.09) when compared with usual care or wait-list controls. The evidence on functioning for CBT was mixed. Pharmacotherapy, when compared with placebo, was associated with gains on 2 pooled measures of symptom improvement-mean difference (Pediatric Anxiety Rating Scale mean difference, -4.0 [95% CI, -5.5 to -2.5]; n = 726; 5 studies; and Clinical Global Impression-Severity scale mean difference, -0.84 [95% CI, -1.13 to -0.55]; n = 550; 4 studies) and response (RR, 2.11 [95% CI, 1.58 to 2.98]; n = 370; 5 studies)-but was mixed on measures of functioning. Eleven RCTs (n = 1293) reported harms of anxiety treatments. Suicide-related harms were rare, and the differences were not statistically significantly different.

CONCLUSIONS AND RELEVANCE: Indirect evidence suggested that some screening instruments were reasonably accurate. CBT and pharmacotherapy were associated with benefits; no statistically significant association with harms was reported.

PMID:36219404 | DOI:10.1001/jama.2022.16303

J Digit Imaging. 2022 Oct 11. doi: 10.1007/s10278-022-00700-0. Online ahead of print.

ABSTRACT

The manual segmentation of muscles on magnetic resonance images is the gold standard procedure to reconstruct muscle volumes from medical imaging data and extract critical information for clinical and research purposes. (Semi)automatic methods have been proposed to expedite the otherwise lengthy process. These, however, rely on manual segmentations. Nonetheless, the repeatability of manual muscle volume segmentations performed on clinical MRI data has not been thoroughly assessed. When conducted, volumetric assessments often disregard the hip muscles. Therefore, one trained operator performed repeated manual segmentations (n = 3) of the iliopsoas (n = 34) and gluteus medius (n = 40) muscles on coronal T1-weighted MRI scans, acquired on 1.5 T scanners on a clinical population of patients elected for hip replacement surgery. Reconstructed muscle volumes were divided in sub-volumes and compared in terms of volume variance (normalized variance of volumes – nVV), shape (Jaccard Index-JI) and surface similarity (maximal Hausdorff distance-HD), to quantify intra-operator repeatability. One-way repeated measures ANOVA (or equivalent) tests with Bonferroni corrections for multiple comparisons were conducted to assess statistical significance. For both muscles, repeated manual segmentations were highly similar to one another (nVV: 2-6%, JI > 0.78, HD < 15 mm). However, shape and surface similarity were significantly lower when muscle extremities were included in the segmentations (e.g., iliopsoas: HD -12.06 to 14.42 mm, P < 0.05). Our findings show that the manual segmentation of hip muscle volumes on clinical MRI scans provides repeatable results over time. Nonetheless, extreme care should be taken in the segmentation of muscle extremities.

PMID:36219348 | DOI:10.1007/s10278-022-00700-0

JAMA. 2022 Oct 11. doi: 10.1001/jama.2022.16310. Online ahead of print.

ABSTRACT

IMPORTANCE: Depression, suicidal ideation, and self-harm behaviors in youth are associated with functional impairment and suicide.

OBJECTIVE: To review the evidence on screening for depression or suicide risk in children and adolescents to inform the US Preventive Services Task Force (USPSTF).

DATA SOURCES: PubMed, Cochrane Library, PsycINFO, CINAHL, and trial registries through July 19, 2021; references, experts, and surveillance through June 1, 2022.

STUDY SELECTION: English-language, randomized clinical trials (RCTs) of screening for depression or suicide risk; diagnostic test accuracy studies; RCTs of psychotherapy and first-line pharmacotherapy; RCTs, observational studies, and systematic reviews reporting harms.

DATA EXTRACTION AND SYNTHESIS: Two reviewers assessed titles/abstracts, full-text articles, and study quality and extracted data; when at least 3 similar studies were available, meta-analyses were conducted.

MAIN OUTCOMES AND MEASURES: Test accuracy, symptoms, response, remission, loss of diagnosis, mortality, functioning, suicide-related events, and adverse events.

RESULTS: Twenty-one studies (N = 5433) were included for depression and 19 studies (N = 6290) for suicide risk. For depression, no studies reported on the direct effects of screening on health outcomes, and 7 studies (n = 3281) reported sensitivity of screening instruments ranging from 0.59 to 0.94 and specificity from 0.38 to 0.96. Depression treatment with psychotherapy was associated with improved symptoms (Beck Depression Inventory pooled standardized mean difference, -0.58 [95% CI, -0.83 to -0.34]; n = 471; 4 studies; and Hamilton Depression Scale pooled mean difference, -2.25 [95% CI, -4.09 to -0.41]; n = 262; 3 studies) clinical response (3 studies with statistically significant results using varying thresholds), and loss of diagnosis (relative risk, 1.73 [95% CI, 1.00 to 3.00; n = 395; 4 studies). Pharmacotherapy was associated with improvement on symptoms (Children’s Depression Rating Scale-Revised mean difference, -3.76 [95% CI, -5.95 to -1.57; n = 793; 3 studies), remission (relative risk, 1.20 [95% CI, 1.00 to 1.45]; n = 793; 3 studies) and functioning (Children’s Global Assessment Scale pooled mean difference, 2.60 (95% CI, 0.78 to 4.42; n = 793; 3 studies). Other outcomes were not statistically significantly different. Differences in suicide-related outcomes and adverse events for pharmacotherapy when compared with placebo were not statistically significant. For suicide risk, no studies reported on the direct benefits of screening on health outcomes, and 2 RCTs (n = 2675) reported no harms of screening. One study (n = 581) reported on sensitivity of screening, ranging from 0.87 to 0.91; specificity was 0.60. Sixteen RCTs (n = 3034) reported on suicide risk interventions. Interventions were associated with lower scores for the Beck Hopelessness Scale (pooled mean difference, -2.35 [95% CI, -4.06 to -0.65]; n = 644; 4 RCTs). Findings for other suicide-related outcomes were mixed or not statistically significantly different.

CONCLUSION AND RELEVANCE: Indirect evidence suggested that some screening instruments were reasonably accurate for detecting depression. Psychotherapy and pharmacotherapy were associated with some benefits and no statistically significant harms for depression, but the evidence was limited for suicide risk screening instruments and interventions.

PMID:36219399 | DOI:10.1001/jama.2022.16310

Eur J Clin Microbiol Infect Dis. 2022 Oct 11. doi: 10.1007/s10096-022-04506-4. Online ahead of print.

ABSTRACT

To better understand the progression of severe fever with thrombocytopenia syndrome (SFTS), identify early predictors of mortality, and improve the cure rate, the present study aimed to analyze the demographic feature, clinical characteristics, and laboratory parameters of patients with SFTS and to explore the risk factors associated with fatal outcome. We retrospectively analyzed demographic feature, clinical characteristics, and laboratory parameters of 216 laboratory-confirmed SFTS patients in Shandong province between January 2015 and December 2019. Univariate analysis was used to assess the relevance between these factors and fatal outcome. Factors with P < 0.05 in univariate analysis were further analyzed using multivariable logistic regression analysis to identify the independent risk factors for mortality of SFTS. Age, five complications (including CNS symptoms, pulmonary infection, heart failure, arrhythmia, and bleeding events), and ten abnormal laboratory parameters (including serum viral load, blood platelet, ALT, AST, LDH, CK, CK-MB, Cr, serum Ca²⁺, and APTT) were statistically significant by univariate analysis. These factors were further analyzed by multivariable logistic regression analysis, and the results indicated that coma, pulmonary infection, high viral load, and prolonged APTT were associated with fatal outcome in SFTS patients. Our study identified four independent risk factors associated with fatal outcome for SFTS patients. The results were hoped to provide help for active treatment of SFTS. However, the identification of risk factors is not absolutely associated with fatal outcome. Patients’ risk should be assessed by dynamic observation of the changes in risk factor indicators.

PMID:36219345 | DOI:10.1007/s10096-022-04506-4

Infect Dis Ther. 2022 Oct 10. doi: 10.1007/s40121-022-00699-5. Online ahead of print.

ABSTRACT

INTRODUCTION: A 13-valent pneumococcal conjugate vaccine (PCV13) was licensed to protect against emerging Streptococcus pneumoniae serotypes. Healthcare services, including routine childhood immunizations, were disrupted as a result of coronavirus disease 2019 (COVID-19). This study compared PCV13 routine vaccination completion and adherence among US infants before and during the COVID-19 pandemic and the relationship between primary and booster dose completion and adherence.

METHODS: Retrospective data from Optum’s de-identified Clinformatics^® Data Mart were used to create three cohorts using data collected between January 2017 and December 2020: cohort 1 (C1), pre-COVID; cohort 2 (C2), cross-COVID; and cohort 3 (C3), during COVID. Study endpoints were completion and adherence to the primary PCV13 series (analyzed using univariate logistic regression) and completion of and adherence to the booster dose (analyzed descriptively).

RESULTS: The analysis included 142,853 infants in C1, 27,211 infants in C2, and 53,306 infants in C3. Among infants with at least 8 months of follow-up from birth, three-primary-dose completion (receipt of all three doses within 8 months after birth) and adherence (receipt of doses at recommended times) were significantly higher before (C1 and C2) versus during (C3) COVID-19 (odds ratio [OR] 1.12 [95% confidence interval [CI] 1.07, 1.16] and OR 1.10 [95% CI 1.05, 1.15], respectively). A significantly higher percentage of infants received a booster dose before versus during COVID-19 (83.2% vs. 80.2%; OR 1.23; 95% CI 1.17, 1.29); similarly, booster dose adherence was higher before than during COVID-19 (51.2% vs. 47.4%; OR 1.17; 95% CI 1.13, 1.21). The odds of booster dose completion were 8.26 (95% CI 7.92, 8.60) and 7.90 (95% CI 7.14, 8.74) times as likely in infants who completed all three primary doses than in infants who did not complete primary doses before COVID-19 and during COVID-19, respectively.

CONCLUSIONS: PCV13 full completion was lower during the COVID-19 pandemic compared with pre-pandemic (79.0% vs. 77.1%).

PMID:36219342 | DOI:10.1007/s40121-022-00699-5

Hormones (Athens). 2022 Oct 11. doi: 10.1007/s42000-022-00400-y. Online ahead of print.

ABSTRACT

PURPOSE: The purpose was to evaluate the association between medication adherence and health-related quality of life (HRQoL) of patients with diabetes.

METHODS: In this cross-sectional study, a total of 518 patients were recruited from the outpatient departments of different general public and private hospitals in Greece during the COVID-19 pandemic using a consecutive sampling method. HRQoL was assessed with the EQ-5D-5L instrument and medication adherence with the corresponding subscale of the Adherence Starts with Knowledge 20 questionnaire. The relationship between HRQoL and adherence was explored by employing Spearman’s correlations and multiple binary logistic and linear stepwise regressions using robust standard errors.

RESULTS: A total of 15.1 and 1.9% of the patients reported that they had taken a medicine either more or less often than prescribed in the last month and week, respectively. Statistically significant but modest correlations of medication non-adherence with the EQ-5D index (rho = – 0.223), EQ-VAS (rho = – 0.230), and all the HRQoL domains (rho ranging from 0.211, for pain/discomfort, to 0.136, for mobility issues) were found. These significant associations persisted even after controlling for several other known potential factors of HRQoL in the multivariable analyses, except for the mobility and anxiety/depression dimensions.

CONCLUSION: Medication non-adherence appears to be independently associated with lower HRQoL and health levels in patients with diabetes. It is crucial to plan interventions to enhance medication adherence not only to obtain greater value from the available resources, but also to improve HRQoL of patients with diabetes.

PMID:36219341 | DOI:10.1007/s42000-022-00400-y

Behav Res Methods. 2022 Oct 11. doi: 10.3758/s13428-022-01837-0. Online ahead of print.

ABSTRACT

In a wide variety of cognitive domains, participants have access to several alternative strategies to perform a particular task and, on each trial, one specific strategy is selected and executed. Determining how many strategies are used by a participant as well as their identification at a trial level is a challenging problem for researchers. In the current paper, we propose a new method – the non-parametric mixture model – to efficiently disentangle hidden strategies in cognitive psychological data, based on observed response times. The developed method derived from standard hidden Markov modeling. Importantly, we used a model-free approach where a particular shape of a response time distribution does not need to be assumed. This has the considerable advantage of avoiding potentially unreliable results when an inappropriate response time distribution is assumed. Through three simulation studies and two applications to real data, we repeatedly demonstrated that the non-parametric mixture model is able to reliably recover hidden strategies present in the data as well as to accurately estimate the number of concurrent strategies. The results also showed that this new method is more efficient than a standard parametric approach. The non-parametric mixture model is therefore a useful statistical tool for strategy identification that can be applied in many areas of cognitive psychology. To this end, practical guidelines are provided for researchers wishing to apply the non-parametric mixture models on their own data set.

PMID:36219308 | DOI:10.3758/s13428-022-01837-0

Curr Microbiol. 2022 Oct 11;79(12):354. doi: 10.1007/s00284-022-03062-6.

ABSTRACT

Clostridioides difficile is the main pathogen responsible for antibiotic-associated diarrhea in adults. Besides its challenging diagnosis, C. difficile infection (CDI) causes substantial morbidity and mortality. Commercially, there are assays with different targets and performances in sensitivity and specificity. The objectives of this study were to: (1) evaluate the prevalence and seasonal variability of CDI rates at a tertiary hospital in southern Brazil over 12 years and (2) determine the impact of using a two-step algorithm test in the laboratory diagnosis. Between January 2007 and May 2019, fecal samples from 2275 patients were analyzed in a cross-sectional study. Four commercial tests were adopted for the diagnosis of CDI, the immunochromatographic test for toxin A from 2007 to 2010; the enzyme-linked immunosorbent assay method for toxins A and B from 2011 to March 2017; and the rapid enzyme immunoassay (EIA) for GDH and toxins A and B, associated with a Polymerase Chain Reaction (PCR) for the toxin B gene from June 2017 to 2019. The annual prevalence was 8.7% from 2007 to March 2017, increasing between June 2017 and 2019 to 14.7% when the C. diff Quik Chek Complete + GeneXpert C. difficile (two-step algorithm) test was adopted. The number of samples (691) and percentage of CDI cases (10.5%) were higher in winter, but the difference has no statistical significance (P > 0.05). An accurate diagnosis and adequate knowledge of the local seasonality of CDI allow the effective implementation of prevention and control strategies for nosocomial CDI, in addition to effective treatment for patients.

PMID:36219324 | DOI:10.1007/s00284-022-03062-6

J Gen Intern Med. 2022 Oct 11. doi: 10.1007/s11606-022-07791-z. Online ahead of print.

ABSTRACT

BACKGROUND: Patient empowerment through pharmacological self-management is a common strategy in some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure.

OBJECTIVE: This study aimed to assess self-monitoring plus self-titration of antihypertensive medication versus usual care for reducing systolic blood pressure (SBP) at 12 months in poorly controlled hypertensive patients.

DESIGN: The ADAMPA study was a pragmatic, controlled, randomized, non-masked clinical trial with two parallel arms in Valencia, Spain.

PARTICIPANTS: Hypertensive patients older than 40 years, with SBP over 145 mmHg and/or diastolic blood pressure (DBP) over 90 mmHg, were recruited from July 2017 to June 2018.

INTERVENTION: Participants were randomized 1:1 to usual care versus an individualized, pre-arranged plan based on self-monitoring plus self-titration.

MAIN MEASURE: The primary outcome was the adjusted mean difference (AMD) in SBP between groups at 12 months.

KEY RESULTS: Primary outcome data were available for 312 patients (intervention n=156, control n=156) of the 366 who were initially recruited. The AMD in SBP at 12 months (main analysis) was -2.9 mmHg (95% CI, -5.9 to 0.1, p=0.061), while the AMD in DBP was -1.9 mmHg (95% CI, -3.7 to 0.0, p=0.052). The results of the subgroup analysis were consistent with these for the main outcome measures. More patients in the intervention group achieved good blood pressure control (<140/90 mmHg) at 12 months than in the control group (55.8% vs 42.3%, difference 13.5%, 95% CI, 2.5 to 24.5%, p=0.017). At 12 months, no differences were observed in behavior, quality of life, use of health services, or adverse events.

CONCLUSION: Self-monitoring plus self-titration of antihypertensive medication based on an individualized pre-arranged plan used in primary care may be a promising strategy for reducing blood pressure at 12 months compared to usual care, without increasing healthcare utilization or adverse events.

TRIAL REGISTRATION: EudraCT, number 2016-003986-25 (registered 17 March 2017) and clinicaltrials.gov , NCT03242785.

PMID:36219303 | DOI:10.1007/s11606-022-07791-z