Tag: statistics

J Manag Care Spec Pharm. 2022 Nov;28(11):1321-1330. doi: 10.18553/jmcp.2022.28.11.1321.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) imposes substantial health care and economic burden on health care systems and patients. Previous studies failed to examine health care resource utilization (HCRU) and costs among patients with incident AF and potential disparity with regard to geographic location. OBJECTIVES: To examine HCRU and costs among patients with incident AF compared with patients without AF and examine whether a geographic disparity exists. METHODS: This was a retrospective cohort study. We selected patients with AF and patients without AF from IBM/Watson MarketScan Research Databases 2014-2019. HCRU and costs were collected 12 months following an AF index date. We used 2-part models with bootstrapping to obtain the marginal estimates and CIs. Rural status was identified based on Metropolitan Statistical Area. We adjusted for age, sex, plan type, US region, and comorbidities. RESULTS: Among 156,732 patients with AF and 3,398,490 patients without AF, patients with AF had 9.04 (95% CI = 8.96-9.12) more outpatient visits, 0.82 (95% CI = 0.81-0.83) more emergency department (ED) visits, 0.33 (95% CI = 0.33-0.34) more inpatient admission, and $15,095 (95% CI = 14,871-15,324) higher total costs, compared with patients without AF. Among patients with AF, rural patients had 1.99 fewer (95% CI = -2.26 to -1.71) outpatient visits and 0.05 (95% CI = 0.02-0.08) more ED visits than urban patients. Overall, rural patients with AF had decreased total costs compared with urban patients (mean = $751; 95% CI = -1,227 to -228). CONCLUSIONS: Incident AF was associated with substantial burden of health care resources and an economic burden, and the burden was not equally distributed across patients in urban vs rural settings. DISCLOSURES: Dr Hansen reports grants from the National Science Foundation during the conduct of the study.

PMID:36282926 | DOI:10.18553/jmcp.2022.28.11.1321

J Manag Care Spec Pharm. 2022 Nov;28(11):1213-1218. doi: 10.18553/jmcp.2022.28.11.1213.

ABSTRACT

BACKGROUND: Early after the onset of the COVID-19 pandemic, concerns were raised that the use of psoriasis treatments, particularly biologic therapies because of their immunosuppressant effects, could be associated with a poor prognosis in the case of COVID-19 infection. OBJECTIVE: To examine changes in adherence to systematic biologic therapies for psoriasis after the onset of the COVID-19 pandemic. METHODS: Using IQVIA medical and pharmacy claims data from January 1, 2018, to October 31, 2020, we identified patients aged 18 years or older who had a diagnosis of plaque psoriasis in 2018 and who received systemic biologic therapies for psoriasis, including both provider-administered and pharmacy-dispensed therapies. We calculated the incidence of 14-day gaps without therapy per 1,000 study participants for each 30-day interval. We constructed interrupted time series analyses to test changes in the incidence of outcomes after the pandemic declaration. RESULTS: The sample included 15,890 study participants: 45.4% were female and 15.2% were aged 65 years or older. For patients using biologic therapies dispensed from the pharmacy, there was a 13.1% decrease in the incidence of 14-day gaps without biologic therapy immediately after pandemic declaration, from 92.4 gaps per 1,000 patients to 80.2 gaps per 1,000 patients, but this decrease was not statistically significant. However, for patients using provider-administered therapies, the incidence of 14-day gaps without biologic therapy increased by 55.1% after pandemic declaration, from 29.0 gaps per 1,000 patients to 44.9 gaps per 1,000 patients (P < 0.01). CONCLUSIONS: Following the onset of the COVID-19 pandemic, we found an increased incidence of gaps in biologic therapy for psoriasis among users of provider-administered treatments but not among users of pharmacy-dispensed therapies. DISCLOSURES: Dr Hernandez reports personal fees from Bristol Myers Squibb and personal fees from Pfizer outside the submitted work. Dr Hernandez is funded by the National Heart, Lung and Blood Institute (grant K01HL142847). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The statements, findings, conclusions, views, and opinions expressed in this publication are based on data obtained under license from IQVIA as part of the IQVIA Institute’s Human Data Science Research Collaborative.

PMID:36282925 | DOI:10.18553/jmcp.2022.28.11.1213

Gut. 2022 Sep 5:gutjnl-2022-328188. doi: 10.1136/gutjnl-2022-328188. Online ahead of print.

NO ABSTRACT

PMID:36282906 | DOI:10.1136/gutjnl-2022-328188

Aesthet Surg J. 2022 Oct 25:sjac273. doi: 10.1093/asj/sjac273. Online ahead of print.

ABSTRACT

BACKGROUND: The main disadvantages of wearing a compression garment following abdominoplasty are the increase in intra-abdominal pressure and risk of venous stasis. On the one hand, the wearing of garments may increase the risk of venous thromboembolism. On the other hand, it may be beneficial in decreasing edema formation after surgery.

OBJECTIVES: To evaluate the effectiveness of compression garments in reducing subcutaneous edema after abdominoplasty.

METHODS: Thirty-two women aged from 19 to 50 years were selected and randomly allocated to either the garment (n = 16) or no-garment (n = 16) group. All patients underwent abdominoplasty and received 10 sessions of manual lymphatic drainage during the postoperative period. Postoperative edema formation was assessed by perimetry and bioimpedance, and seroma formation was assessed by ultrasound. The statistical tests included Student’s t test, mixed linear models, analysis of variance with repeated measures, and the Kolmogorov-Smirnov test, which were performed at a significance level α of 0.05 (p ≤ 0.05).

RESULTS: The no-garment group showed a trend toward lower mean waist circumference (WC) at 29 days following abdominoplasty and significantly lower WC after postoperative day 35 compared to values from the garment group (p < 0.001). The mean total body water was slightly lower in the no-garment group than in the garment group 7 days after surgery (p = 0.05).

CONCLUSIONS: Patients who did not wear a compression garment after abdominoplasty showed less subcutaneous edema formation after 24 days of surgery than those who wore the garment.

PMID:36282895 | DOI:10.1093/asj/sjac273

PLoS One. 2022 Oct 25;17(10):e0276444. doi: 10.1371/journal.pone.0276444. eCollection 2022.

ABSTRACT

To examine the effectiveness of a play-based intervention for improving social play skills of typically-developing playmates of children with ADHD. Children (5-11 years) were randomised to an intervention (n = 15) or waitlisted control group (n = 14). The Test of Playfulness was scored by a blinded rater. Between-group statistics compared the change of the intervention (10-week intervention) and waitlisted control (10-week wait) groups. Change in the intervention group following intervention was significantly greater than the change in the waitlisted control group. When combining data from the groups, playmates’ (n = 29) mean ToP scores improved significantly following intervention, with a large effect pre- to post-intervention and pre-intervention to follow-up. Typically-developing playmates of children with ADHD benefited from participation in a peer-mediated intervention.

PMID:36282854 | DOI:10.1371/journal.pone.0276444

Integr Environ Assess Manag. 2022 Oct 25. doi: 10.1002/ieam.4704. Online ahead of print.

ABSTRACT

The process of producing information about dynamic land use/land cover and ecosystem health in a short time with high accuracy and low cost is important. This information is one of the basic data used for sustainable land management. For this purpose, remote sensing technologies are generally used, and sampling points are mostly assigned. Determination of the optimum number of sampling points using the I-Tree Canopy Tool was the main focus of this study. The I-Tree Canopy Tool classifies land cover, revealing the effects of tree cover on ecosystem services, such as carbon sequestration and storage, temperature regulation, air pollutant filtering, and air quality improvement, with numerical data. It is used since it is practical, open source, and user-friendly. This software works based on sampling point assignment, but it is unclear how many sampling points should be assigned. Therefore, determining the optimum number of sample points by statistical methods will increase the effectiveness of this tool and will guide users. For this purpose, reference data were created for comparison. Then, 31 I-Tree Canopy reports were created with 100-point increments up to 3100. The data obtained from the reports were compared with the reference data, and statistical analysis based on Gaussian and a second-order polynomial fit was performed. At the end of the analysis, the following results were obtained; the results of this study showed that the optimum number of sample points for a 1-ha area is 760±32 from the comparison of the real area and I-Tree Canopy results. Similar results from the Gaussian fit of annually sequestered and stored carbon and CO₂ amounts in trees and the reduction of air pollution in grams were obtained as 714±16. Therefore, we may conclude that the sample points taken more than 800 will not create a statistically significant difference. This article is protected by copyright. All rights reserved. Integr Environ Assess Manag 2022;00:0-0. © 2022 SETAC.

PMID:36281815 | DOI:10.1002/ieam.4704

Brain. 2022 Oct 25:awac285. doi: 10.1093/brain/awac285. Online ahead of print.

ABSTRACT

Repetitive transcranial magnetic stimulation (rTMS) is emerging as a non-invasive therapeutic strategy in the battle against Alzheimer’s disease. Alzheimer’s disease patients primarily show alterations of the default mode network for which the precuneus is a key node. Here, we hypothesized that targeting the precuneus with TMS represents a promising strategy to slow down cognitive and functional decline in Alzheimer’s disease patients. We performed a randomized, double-blind, sham-controlled, phase 2, 24-week trial to determine the safety and efficacy of precuneus stimulation in patients with mild-to-moderate Alzheimer’s disease. Fifty Alzheimer’s disease patients were randomly assigned in a 1:1 ratio to either receive precuneus or sham rTMS (mean age 73.7 years; 52% female). The trial included a 24-week treatment, with a 2-week intensive course in which rTMS (or sham) was applied daily five times per week, followed by a 22-week maintenance phase in which stimulation was applied once weekly. The Clinical Dementia Rating Scale-Sum of Boxes was selected as the primary outcome measure, in which post-treatment scores were compared to baseline. Secondary outcomes included score changes in the Alzheimer’s Disease Assessment Scale-Cognitive Subscale, Mini-Mental State Examination and Alzheimer’s Disease Cooperative Study-Activities of Daily Living scale. Moreover, single-pulse TMS in combination with EEG was used to assess neurophysiological changes in precuneus cortical excitability and oscillatory activity. Our findings show that patients that received precuneus repetitive magnetic stimulation presented a stable performance of the Clinical Dementia Rating Scale-Sum of Boxes score, whereas patients treated with sham showed a worsening of their score. Compared with the sham stimulation, patients in the precuneus stimulation group also showed also significantly better performances for the secondary outcome measures, including the Alzheimer’s Disease Assessment Scale-Cognitive Subscale, Mini-Mental State Examination and Alzheimer’s Disease Cooperative Study-Activities of Daily Living scale. Neurophysiological results showed that precuneus cortical excitability remained unchanged after 24 weeks in the precuneus stimulation group, whereas it was significantly reduced in the sham group. Finally, we found an enhancement of local gamma oscillations in the group treated with precuneus stimulation but not in patients treated with sham. We conclude that 24 weeks of precuneus rTMS may slow down cognitive and functional decline in Alzheimer’s disease. Repetitive TMS targeting the default mode network could represent a novel therapeutic approach in Alzheimer’s disease patients.

PMID:36281767 | DOI:10.1093/brain/awac285

Circ Heart Fail. 2022 Oct 25:e009651. doi: 10.1161/CIRCHEARTFAILURE.122.009651. Online ahead of print.

ABSTRACT

BACKGROUND: Food environment factors contribute to cardiovascular disease, but their effect on population-level heart failure (HF) mortality is unclear.

METHODS: We utilized the National Vital Statistics System and USDA Food Environment Atlas to collect HF mortality rates (MR) and 2 county food environment indices: (1) food insecurity percentage (FI%) and (2) food environment index (FEI), a scaled index (0-10, 10 best) incorporating FI% and access to healthy food. We used linear regression to estimate the association between food environment and HF MR RESULTS: Mean county FI% and FEI were 13% and 7.8 in 2956 included counties. Counties with FI% above the national median had significantly higher HF MR (30.7 versus 26.7 per 100 000; P<0.001) compared with FI% below the national median. Counties with HF MR above the national median had higher FI%, lower FEI, lower density of grocery stores, poorer access to stores among older adults, and lower Supplemental Nutrition Assistance Program participation rate (P<0.001 for all). Lower county FI% (β=-1.3% per 1% decrease) and higher county FEI (β=-3.6% per 1-unit increase in FEI) were significantly associated with lower HF MR after adjustment for county demographic, socioeconomic, and health factors. This association was stronger for HF MR compared with non-HF cardiovascular disease MR and all-cause MR The relationship between food environment and HF MR was stronger in counties with the highest income inequity and poverty rate.

CONCLUSIONS: Healthier food environment is significantly associated with lower HF mortality at the county level. This reinforces the role of food security on cardiovascular outcomes.

PMID:36281754 | DOI:10.1161/CIRCHEARTFAILURE.122.009651

Crit Rev Toxicol. 2022 Oct 25:1-47. doi: 10.1080/10408444.2022.2118107. Online ahead of print.

ABSTRACT

Hunters Point Naval Shipyard in San Francisco, California was deemed a Superfund site by the USEPA in 1989 due to chemical and radiological contamination resulting from U.S. Navy operations from 1939 to 1974. During characterization and remediation efforts, over 50,000 radiological soil samples and 19,000 air samples were collected. This risk assessment, conducted in accordance with federal guidelines, represents the first comprehensive evaluation of past, present, and future health risks associated with radionuclides present at the site. The assessment indicated that before site remediation, most radionuclide soil concentrations were at or near local background concentrations. Had such low remedial goals not been established, significant remediation of surface soils would not have been necessary to protect human health. The pre-remediation lifetime incremental cancer morbidity risks for on-site workers and theoretical on-site residents due to radionuclide contamination were found to be 1.3 × 10^-6 and 3.2 × 10^-6, respectively. The post-remediation risks to future on-site residents were found to be 6.3 × 10^-8 (without durable cover) and 3.7 × 10^-8 (with durable cover), while post-remediation risks to on-site workers were found to be 2.6 × 10^-8 (without durable cover) and 1.6 × 10^-8 (with durable cover). Risk estimates for all scenarios were found to be significantly below the acceptable risk of 3 × 10^-4 approved by regulatory agencies. Upwind and downwind air samples collected during remediation indicate that remediation activities never posed a measurable risk to off-site residents. This risk assessment emphasizes the importance of establishing clear and scientifically rigorous soil remedial goals at sites as well as understanding local radionuclide background concentrations.

PMID:36281736 | DOI:10.1080/10408444.2022.2118107

Physiol Res. 2022 Oct 13. Online ahead of print.

ABSTRACT

The impact of atrial fibrillation and atrial tachycardias (AF/AT), and their optimal treatment strategy in PH patients is still being discussed. The goal of this study was to evaluate the effect of AF/AT termination on the hemodynamic parameters in PH patients. We compared patients with pre-capillary pulmonary hypertension (PH group), left ventricular heart failure (LV-HF group), and a Control group. A repeated right heart catheterization was performed during the catheter ablation (CA) procedure. The first measurement was done in arrhythmia, the second after the sinus rhythm (SR) was restored. High frequency atrial stimulation was used to simulate AT in patients without arrhythmia presence at the time of the CA. The variation of pressure parameters in PH patients did not differ significantly from the Controls. There was a significant increase in the right ventricle pressure after the SR restoration in the LV-HF group compared to the Controls and PH group (+4 vs. -2 vs. -3 mmHg, p < 0.05). The cardiac index (CI) variation was not significant when compared between the study groups. An increase of the CI after the SR restoration was found in those patients with AF (+0.31 l/min/m(2) [IQR 0.18; 0.58]) in contrast to those patients with organized AT/high frequency atrial stimulation (-0.09 l/min/m(2), [IQR – 0.45; 0.19]). This difference was statistically significant (p < 0.05). The acute hemodynamic response to arrhythmia termination was not significantly different in the PH patients when compared to the Controls. In contrast to AT/high frequency stimulation, the restoration of SR in AF patients leads to an increased CI, irrespective of the presence or absence of PH.

PMID:36281725