Tag: statistics

Eur J Health Econ. 2022 Feb 6. doi: 10.1007/s10198-022-01439-9. Online ahead of print.

ABSTRACT

The financing structure of the healthcare system and, particularly, the voluntary health insurance (VHI) constituent, has been a vital pillar in improving the overall quality of life. Consequently, this study aims to shed light on the effect of VHI on the population’s health and longevity in a sample of 26 European OECD countries. The methodology employed covers both hierarchical clustering and the novel dynamic panel threshold technique. First, the descriptive cluster analysis unveils a delimitation of the countries into four main groups with respect to a broad set of health status indicators. Second, the estimates show that VHI is a significant determinant of health and longevity. More specifically, we find that the relationship between variables is characterized by a threshold effect, whose estimated value is roughly 6.3% of the total healthcare financing. Also, the heterogeneity analysis unveils consistent differences regarding the impact of VHI on health and longevity for the supplementary and complementary types of VHI. Overall, results are strongly robust, the signs and the significance of the coefficients being preserved in the presence of several additional control factors. From a policy perspective, the study’s findings can be used nationwide to stimulate regulatory policies to encourage the achievement of a satisfactory level of private health insurance.

PMID:35124741 | DOI:10.1007/s10198-022-01439-9

Int Orthop. 2022 Feb 5. doi: 10.1007/s00264-022-05329-w. Online ahead of print.

ABSTRACT

BACKGROUND: Over the last 20 years, suprapatellar (SP) intramedullary nailing has gained considerable attention for treating tibia fractures and is believed to improve fracture alignments, decrease anterior knee pain, and facilitate intraoperative fluoroscopy. However, it is associated with various concerns, including the need to make another infrapatellar (IP) incision to remove the nail.

AIMS: This study was aimed at developing a new technique for the removal of SP tibial nails through an SP approach using a cannulated extraction system. The efficiency of the novel SP approach was compared to that of the traditional IP approach for the removal of SP tibial nails.

PATIENTS AND METHODS: This was a retrospective cohort study from a prospectively collected clinical registry. The data for 69 consecutive patients who received surgery to remove a previous SP intramedullary nail using an SP approach (n = 30, SP cohort) or an IP approach (n = 39, IP cohort) were analyzed. Intra-operative evaluations included intraoperative blood loss, operation time, and changes in the surgical procedures. At six months follow-up, post-operative Lysholm knee score, visual analog scale (VAS) score, and the active range of motion (ROM) of the affected knee and complications were assessed.

RESULTS: Patients in the SP cohort exhibited an increased post-operative Lysholm knee score (β, 2.6; 95% confidence interval [CI], 0.6 to 4.6; P = 0.012), decreased post-operative VAS score (β, – 0.7; 95% CI, – 1.1 to – 0.2; P = 0.004), and increased operation time (β, 9.8 minutes; 95% CI, 5.7 to 14.0 minutes; P < 0.001) compared with those treated with the IP approach after adjustment for baseline characteristics. There were no statistically significant differences in blood loss, post-operative ROM, or complications between the two cohorts.

CONCLUSIONS: Compared with the IP technique, the SP approach for the removal of an SP tibial nail was independently associated with an increased post-operative Lysholm knee score and decreased VAS score, although the surgery was longer in duration. The novel technique offers a reliable and minimally invasive option for the removal of an SP tibial nail.

PMID:35124710 | DOI:10.1007/s00264-022-05329-w

Knee Surg Sports Traumatol Arthrosc. 2022 Feb 6. doi: 10.1007/s00167-022-06887-7. Online ahead of print.

ABSTRACT

PURPOSE: To compare the long-term clinical efficacy provided by intra-articular injections of either Pure Platelet-rich Plasma (P-PRP) or sham saline to treat knee osteoarthritis (KOA).

METHODS: This prospective, parallel-group, double-blind, multi-center, sham-controlled randomized clinical trial recruited participants with KOA from orthopedic departments at nine public hospitals (five tertiary medical centers, four secondary medical units) starting January 1, 2014, with follow-up completed on February 28, 2021. Participants were randomly allocated to interventions in a 1:1 ratio. Data were analyzed from March 1, 2021, to July 15, 2021. Three sessions (1 every week) of P-PRP or sham saline injected by physicians. The primary outcome was the Western Ontario and McMaster Universities Arthritis Index (WOMAC) at 3, 6, 12, 24, 60 months of follow-up. Secondary outcomes included the International Knee Documentation Committee (IKDC) subjective score, visual analogue scale (VAS) score, intra-articular biochemical marker concentrations, cartilage volume, and adverse events. Laboratory of each hospital analyzed the content and quality of P-PRP.

RESULTS: 610 participants (59% women) with KOA who received three sessions of P-PRP (n = 308, mean age 53.91 years) or sham saline (n = 302, mean age 54.51 years) injections completed the trial. The mean platelet concentration in PRP is 4.3-fold (95% confidence interval 3.6-4.5) greater than that of whole blood. Both groups showed significant improvements in IKDC, WOMAC, and VAS scores at 1 month of follow-up. However, only the P-PRP group showed a sustained improvement in clinical outcome measurements at month 24 (P < 0.001). There were statistically significant differences between the P-PRP and sham saline groups in all clinical outcome measurements at each follow-up time point (P < 0.001). The benefit of P-PRP was clinically better in terms of WOMAC-pain, WOMAC-physical function and WOMAC-total at 6, 12, 24, and 60 months of follow-up. No clinically significant differences between treatments were documented in terms of WOMAC-stiffness at any follow-up. A clinically significant difference favoring P-PRP group against saline in terms of IKDC and VAS scores was documented at 6, 12, 24 and 60 months of follow-up. At 6 months after injection, TNF-α and IL-1β levels in synovial fluid were lower in the P-PRP group (P < 0.001). Tibiofemoral cartilage volume decreased by a mean value of 1171 mm³ in the P-PRP group and 2311 mm³ in the saline group over 60 months and the difference between the group was statistically significant (intergroup difference, 1140 mm³, 95% CI – 79 to 1320 mm³; P < 0.001).

CONCLUSIONS: In this randomized clinical trial of patients with KOA, P-PRP was superior to sham saline in treating KOA. P-PRP was effective for achieving at least 24 months of symptom relief and slowing the progress of KOA, with both P-PRP and saline being comparable in safety profiles.

PMID:35124707 | DOI:10.1007/s00167-022-06887-7

Clin Neurol Neurosurg. 2022 Feb 1;214:107150. doi: 10.1016/j.clineuro.2022.107150. Online ahead of print.

ABSTRACT

BACKGROUND: Spinocerebellar ataxia (SCA) presents different rates of functional decline depending on the type of ataxia.

OBJECTIVE: To compare the progression of disability, imbalance and severity of ataxia in patients with the three most common types of SCA in southern Brazil.

METHODS: 126 patients (31-SCA2, 58-SCA3 and 37-SCA10) were stratified into four groups based on disease duration. Progression rates were calculated in each group for ataxia severity (SARA), functioning (FIM-ADL and Lawton-IADL), and balance (Berg Balance Scale).

RESULTS: Differences across groups in terms of disease severity revealed a linear pattern of decline in SCA3, with a faster rate over time (p = 0.039) compared to SCA2 and SCA10. The pattern was nonlinear for SCA2 and SCA10, with a twofold faster rate in patients with up to seven years of disease compared to all other periods in SCA10 (p < 0.001) and to the longer follow up period in SCA2 (p = 0.049). Differences across groups regarding worsening of balance scores was significantly faster in SCA3 compared to SCA10 (p = 0.028) and SCA2 (p = 0.028). The rate of loss of independence of ADLs tended to diminish over time in the three types of ataxia and was faster in SCA3. Similarly, the rate for loss of independence (IADLs) was faster in SCA3 compared to SCA2 (p = 0.057) and significantly faster compared to SCA10 (p = 0.028).

CONCLUSION: The present findings suggest that the progression of the disease (severity/functioning/balance) varies according to the SCA subtype and the period in disease course. Progression is more linear and aggressive in patients with SCA3.

PMID:35123369 | DOI:10.1016/j.clineuro.2022.107150

Soc Sci Med. 2022 Jan 29;296:114755. doi: 10.1016/j.socscimed.2022.114755. Online ahead of print.

ABSTRACT

Black South Africans accounted for 6.2 out of 6.4 million people living with HIV in South Africa in 2012, highlighting extreme racial disparities in HIV infection. These racial disparities are the result of structural and historical factors, specifically, the racist policies which were facilitated by segregation before, during, and after Apartheid. First, we describe the theoretical context of how racist policies and segregation are linked to HIV prevalence. Next, using data from a 2012 national survey of South Africans (SABSSM IV) and Statistics South Africa (StatsSA), we describe the race-specific geospatial distribution of HIV in South Africa, provide empirical evidence for the impact of Apartheid on important risk factors for HIV infection, and describe the relationship between these risk factors and HIV within racial groups. Using multilevel logistic regression, we find that segregation increases the odds of HIV infection among Black South Africans, even after adjusting for many covariates which are sometimes blamed, in place of structural factors, for a higher HIV prevalence in Black South Africans. We found that the estimated odds of infection in the most segregated municipality was 1.95 (95% CI: 1.15, 3.32) times the odds of infection in the least segregated municipality for Black South Africans. In addition to segregation, we also find other covariates to be differentially associated with HIV infection depending on race, such as gender, age, and sexual behavior. We also find that the HIV infection odds ratio comparing Black and Coloured (i.e., multiple ethnic groups with mixed ancestries from Africa, Asia, and Europe) South Africans varies over space. These results continue to build evidence for the influence of structural and historical factors on the modern geospatial and demographic distribution of HIV.

PMID:35123373 | DOI:10.1016/j.socscimed.2022.114755

Drug Alcohol Depend. 2022 Jan 29;232:109336. doi: 10.1016/j.drugalcdep.2022.109336. Online ahead of print.

ABSTRACT

BACKGROUND: Research on the impact of Medicaid expansion on buprenorphine utilization has largely focused on the Medicaid program. Less is known about its associations with total buprenorphine utilization and non-Medicaid payers.

METHODS: Monthly prescription data (June 2013-May 2018) for proprietary and generic sublingual as well as buccal buprenorphine products were purchased from IQVIA®. Population-adjusted state-level utilization measures were constructed for Medicaid, commercial insurance, Medicare, cash, and total utilization. A difference-in-differences (DID) approach with population weights estimated the association between Medicaid expansion and buprenorphine utilization, while controlling for treatment capacity.

RESULTS: Monthly total buprenorphine prescriptions increased by 68% overall and increased 283% for Medicaid, 30% for commercial insurance, and 143% for Medicare. Cash prescriptions decreased by 10%. The DID estimate for Medicaid expansion was not statistically significant for total utilization (-19.780, 95% CI = -45.118, 5.558, p = .123). For Medicaid buprenorphine utilization, there was a significant increase of 27.120 prescriptions per 100,000 total state residents (95% CI = 9.458, 44.782, p = .003) in expansion states versus non-expansion states post-Medicaid expansion. Medicaid expansion had a negative effect on commercial insurance (DID estimate = -37.745, 95% CI = -62.946, -12.544, p = .004), cash utilization (DID estimate = -6.675, 95% CI = -12.627, -0.723, p = .029), and Medicare utilization (DID estimate = -1.855, 95% CI = -3.697, -0.013, p = .048).

DISCUSSION: The associations between Medicaid expansion and buprenorphine utilization varied across different types of payers, such that the overall impact of Medicaid expansion on buprenorphine utilization was not significant.

PMID:35123365 | DOI:10.1016/j.drugalcdep.2022.109336

J Colloid Interface Sci. 2022 Jan 25;615:50-58. doi: 10.1016/j.jcis.2022.01.141. Online ahead of print.

ABSTRACT

Nanoparticle tracking analysis (NTA) is a single particle tracking technique that in principle provides a more direct measure of particle size distribution compared to dynamic light scattering (DLS). Here, we demonstrate how statistical mixture distribution analysis can be used in combination with NTA to quantitatively characterize the amount and extent of particle binding in a mixture of nanomaterials. The combined approach is used to study the binding of gold nanoparticles to two types of phospholipid vesicles, those containing and lacking the model ion channel peptide gramicidin A. This model system serves as both a proof of concept for the method and a demonstration of the utility of the approach in studying nano-bio interactions. Two diffusional models (Stokes-Einstein and Kirkwood-Riseman) were compared in the determination of particle size, extent of binding, and nanoparticle:vesicle binding ratios for each vesicle type. The combination of NTA and statistical mixture distributions is shown to be a useful method for quantitative assessment of the extent of binding between particles and determination of binding ratios.

PMID:35123359 | DOI:10.1016/j.jcis.2022.01.141

Drug Alcohol Depend. 2022 Jan 29;232:109332. doi: 10.1016/j.drugalcdep.2022.109332. Online ahead of print.

ABSTRACT

BACKGROUND: This study examined associations of local cannabis retail outlet availability and neighborhood disadvantage with cannabis use and related risk factors among young adults.

METHODS: Data were from annual cross-sectional surveys administered from 2015 to 2019 to individuals ages 18-25 residing in Washington State (N = 10,009). As outcomes, this study assessed self-reported cannabis use at different margins/frequencies (any past year, at least monthly, at least weekly, at least daily) and perceived ease of access to cannabis and acceptability of cannabis use in the community. Cannabis retail outlet availability was defined as the presence of at least one retail outlet within a 1-kilometer road network buffer of one’s residence. Sensitivity analyses explored four other spatial metrics to define outlet availability (any outlet within 0.5-km, 2-km, and the census tract; and census tract density per 1000 residents). Census tract level disadvantage was a composite of five US census variables.

RESULTS: Adjusting for individual- and area-level covariates, living within 1-kilometer of at least one cannabis retail outlet was statistically significantly associated with any past year and at least monthly cannabis use as well as high perceived access to cannabis. Results using a 2-km buffer and census tract-level metrics for retail outlet availability showed similar findings. Neighborhood disadvantage was statistically significantly associated with at least weekly and at least daily cannabis use and with greater perceived acceptability of cannabis use.

CONCLUSIONS: Results may have implications for regulatory and prevention strategies to reduce the population burden of cannabis use and related harms.

PMID:35123361 | DOI:10.1016/j.drugalcdep.2022.109332

Poult Sci. 2022 Jan 8;101(4):101700. doi: 10.1016/j.psj.2022.101700. Online ahead of print.

ABSTRACT

Large White male turkey genetic lines (GL) comparison in performance and processing yields under the same conditions are rare in the literature. Two rearing experiments (EXP) were conducted to accomplish 2 objectives. The first objective was to test the effects of poult source and genetic lines on performance and processing yields. The second objective was to extract season and growth patterns when comparing both EXP common treatments. In EXP 1, male poults from 5 different sources were randomly assigned to 48 concrete: litter-covered floor pens. In EXP 2, male poults from 7 different genetic lines were randomly assigned to 48 concrete: litter-covered floor pens. For both EXP, the experimental design was a completely randomized block design with a one-factor arrangement. Both EXP were placed in the same house with the same management and nutrition in two separate seasons of the same year. Bird performance and carcass processing yield were analyzed in SAS 9.4 or JMP 15.1 in a mixed model. In EXP 1 no significant difference in BW or processing yield was observed. However, a similar GL from a commercial hatchery had an improved feed conversion ratio (FCR) over the same GL sourced directly from the genetic company hatchery. In EXP 2, statistical differences were observed in performance and breast meat yield depending on the GL. A season effect was observed when comparing the two EXP. Birds raised in the fall season had a 2 kg BW increase, on average, over their spring counterparts. This difference in BW can also be observed in a statistically higher breast meat yield by the birds raised in the fall over the ones raised in the spring. In conclusion, a comparison between GL resulted in effects due to genetic line, poult source, and rearing season on bird performance and carcass yield.

PMID:35123351 | DOI:10.1016/j.psj.2022.101700

Leg Med (Tokyo). 2022 Jan 31;56:102031. doi: 10.1016/j.legalmed.2022.102031. Online ahead of print.

ABSTRACT

After death human body is subject to the processes of autolysis and putrefaction. Notably, the changes in cadaver during decomposition complicate its forensic analysis and particularly the estimation of the post-mortem interval (PMI). The process and rate of decomposition is impacted by various intrinsic and extrinsic factors that vary across countries and regions. Studying the decomposition pattern in different regions in the world helps us to understand the process and improve the precision of the PMI estimation of decomposed bodies. With the aim to develop a taphonomic model of decomposition in the province of Barcelona (Catalonia, Spain), this study analyses the influence of several intrinsic and extrinsic factors in the pattern and rate of decomposition in this geographical area. Our statistical model concluded that the most significant factors affecting the decomposition pattern and rate are temperature and PMI. Nevertheless, there are other intrinsic factors such as cause, manner of death and underlying pathological conditions which also have an important role. Moreover, considering the various variables studied in this research, two predictive machine learning algorithms were developed as a probabilistic approach to estimate the PMI. Reliable classification results are obtained for three interval groups (1-2 days, 3-10 days, and > 10 days) and two interval groups (>1 week, < 1 week). Machine learning algorithm is a promising tool to gain objectivity in forensic PMI assessments. The results of this study could potentially assist further research in forensic taphonomy.

PMID:35123354 | DOI:10.1016/j.legalmed.2022.102031