Tag: statistics

BMC Health Serv Res. 2021 Mar 17;21(1):237. doi: 10.1186/s12913-021-06248-z.

ABSTRACT

BACKGROUND: Many studies suggest that patient satisfaction is significantly negatively correlated with the waiting time. A well-designed healthcare system should not keep patients waiting too long for an appointment and consultation. However, in China, patients spend notable time waiting, and the actual time spent on diagnosis and treatment in the consulting room is comparatively less.

METHODS: We developed an artificial intelligence (AI)-assisted module and name it XIAO YI. It could help outpatients automatically order imaging examinations or laboratory tests based on their chief complaints. Thus, outpatients could get examined or tested before they went to see the doctor. People who saw the doctor in the traditional way were allocated to the conventional group, and those who used XIAO YI were assigned to the AI-assisted group. We conducted a retrospective cohort study from August 1, 2019 to January 31, 2020. Propensity score matching was used to balance the confounding factor between the two groups. And waiting time was defined as the time from registration to preparation for laboratory tests or imaging examinations. The total cost included the registration fee, test fee, examination fee, and drug fee. We used Wilcoxon rank-sum test to compare the differences in time and cost. The statistical significance level was set at 0.05 for two sides.

RESULTS: Twelve thousand and three hundred forty-two visits were recruited, consisting of 6171 visits in the conventional group and 6171 visits in the AI-assisted group. The median waiting time was 0.38 (interquartile range: 0.20, 1.33) hours for the AI-assisted group compared with 1.97 (0.76, 3.48) hours for the conventional group (p < 0.05). The total cost was 335.97 (interquartile range: 244.80, 437.60) CNY (Chinese Yuan) for the AI-assisted group and 364.58 (249.70, 497.76) CNY for the conventional group (p < 0.05).

CONCLUSIONS: Using XIAO YI can significantly reduce the waiting time of patients, and thus, improve the outpatient service process of hospitals.

PMID:33731096 | DOI:10.1186/s12913-021-06248-z

Health Qual Life Outcomes. 2021 Mar 17;19(1):92. doi: 10.1186/s12955-021-01740-w.

ABSTRACT

BACKGROUND: Research on quality of life (QOL) with Parkinson’s disease (PD) has examined direct influencing factors, not mediators. The study aim was to explore whether PD severity and poor cognitive function may decrease physical and mental QOL by reducing activities of daily living (ADL) and increasing depression in sequence.

METHODS: We conducted a cross-sectional questionnaire study of 150 PD hospital patients in China. PD severity, cognitive function, ADL, depression, and QOL were evaluated. We used structural equation modeling to analyze the mediating effects of ADL and depression on the association between PD severity/cognition and the physical health and mental health component summary scores measured by the SF36 quality of life instrument.

RESULTS: There was a significant mediating effect of PD severity on physical health via ADL and depression (95% CI: – 0.669, – 0.026), and a significant direct effect (p < 0.001). The mediating effect of PD severity on mental health via ADL and depression was significant (95% CI: – 2.135, – 0.726), but there was no direct effect (p = 0.548). There was a significant mediating effect of cognitive function on physical health via ADL and depression (95% CI: 0.025, 0.219) and a significant direct effect (p < 0.001). The mediating effect of cognitive function on mental health via ADL and depression was significant (95% CI: 0.256, 0.645), but there was no direct effect (p = 0.313). The physical health models showed a partial mediation, and the mental health models showed a complete mediation, of ADL and depression.

CONCLUSIONS: PD severity and cognitive function increase depression by reducing ADL, leading to lower QOL, and directly or indirectly affect physical health and mental health through different pathways.

PMID:33731129 | DOI:10.1186/s12955-021-01740-w

BMC Oral Health. 2021 Mar 17;21(1):124. doi: 10.1186/s12903-021-01491-6.

ABSTRACT

BACKGROUND: The present study aimed at investigating the prevalence of Apical periodontitis in a Moroccan Adult subpopulation with a non-surgical root canal treatment and to assess associated risk factors including endodontic treatment quality, periodontal health status, coronal restoration cavity design and quality.

METHODS: A total of 358 endodontically treated teeth were evaluated after more than 1-year period in a Moroccan subpopulation according to predetermined criteria. Studied parameters were assessed clinically and radiographically. The association between coronal restoration quality, cavity design, periodontal status, root canal filling quality, coronal restoration related features, presence or absence of the opposing dentition and the periapical status was determined. Data were analyzed using chi-square test, odds ratio and logistic regression.

RESULTS: The present study revealed that gingival health, coronal restoration with CL II cavity design, and root canal filling quality influenced periapical status of endodontically treated teeth. Multivariate analysis showed that this association was statistically significant for gingival inflammation (95% CI 1.08-3.91, OR 2.05, p = 0.02), inadequate coronal restoration (95% CI 1.16-4.04, OR 2.16, p = 0.01), inadequate root canal filling length and homogeneity (95% CI 1.24-3.01, OR 1.93, P = 0.004), (95% CI 1.41-4.44, OR 2.50, p = 0.002) respectively.

CONCLUSIONS: The present study revealed that inadequate coronal restorations especially with large proximal margins (CL II cavity design) and gingival inflammation increased the risk of apical periodontitis in endodontically treated teeth. Prevalence of Apical periodontitis in the present study was 72.1%.

PMID:33731077 | DOI:10.1186/s12903-021-01491-6

BMC Public Health. 2021 Mar 17;21(1):525. doi: 10.1186/s12889-021-10599-x.

ABSTRACT

BACKGROUND: Despite the common restrictive abortion laws, abortion remains widespread in sub-Saharan Africa (SSA) countries. Women still utilize abortion services and put their lives and health at risk because abortion can only be procured illegally in private facilities such as mid-level or small patent medicine store that may be manned by unskilled providers or through a non-medicated approach. The objective of this study was to investigate the prevalence of abortion, the reasons women had abortions, median years to first abortion after sexual debut and examine the factors of time to first abortion among women of reproductive age in the Republic of Congo.

METHODS: We used data from the most recent Republic of Congo Demographic and Health Survey (DHS). A total sample of 3622 women aged 15-49 years was analyzed. We estimated the overall prevalence of abortion and median years to first abortion. Furthermore, we examined the factors of time to first abortion after sexual debut using multivariable Cox regression and reported the estimates using adjusted Hazard Ratio (aHR) and 95% confidence intervals (CI). Statistical significance was determined at p < 0.05.

RESULTS: The prevalence of abortion was 60.0% and median years of time to first abortion after sexual debut was 9.0. The prominent reasons for abortion were due to too short birth interval (23.8%), lack of money (21.0%) and that husband/partner did not need a child at that time (14.0%). Women’s age and region were notable factors in timing to first abortion. Furthermore, women from poorer, middle, richer and richest households had 34, 67, 86 and 94% higher risk of abortion respectively, when compared with women from poorest households (all p < 0.05). Women currently in union/living with a man and formerly in union had 41 and 29% reduction in the risk of abortion respectively, when compared with those never in union (all p < 0.05). In addition, women with primary and secondary+ education had 42 and 76% higher risk of abortion respectively, when compared with women with no formal education (all p < 0.05).

CONCLUSION: There was high prevalence of abortion with short years at first abortion. Abortion was associated with women’s characteristics. There is need for unwanted pregnancy prevention intervention and the improvement in pregnancy care to reduce adverse pregnancy outcomes among women.

PMID:33731079 | DOI:10.1186/s12889-021-10599-x

BMC Oral Health. 2021 Mar 17;21(1):128. doi: 10.1186/s12903-021-01503-5.

ABSTRACT

BACKGROUND: Epidemiological data is providing vital indicators for organizing the financial resources related to a particular type of trauma, estimating expenses and training of dental practioners and ambulatory medical staff for collaboration with a certain pattern of patients. Knowing the etiology and epidemiology of a certain pathology is significant for approaching its means of prevention.

METHODS: A 10-year retrospective statistical analysis of 1007 patients with maxillofacial fractures treated in a University Clinic of Oral and Maxillofacial Surgery in Romania was performed. The data were extracted from patients’ medical records. Statistical analysis was performed. A value of p < 0.05 was considered statistically significant.

RESULTS: The incidence of maxillofacial fractures was high among patients in the 20-29 age group (35.9%). Male patients (90.57%, M:F = 9.6:1), having a low level of education (46.60%) and living in urban areas (53.50%) were more affected. The main cause of maxillofacial fractures was interpersonal violence (59.37%), both in the mandibular and midface topographic regions (p = 0.001, p = 0.002). In urban areas, fractures caused by interpersonal violence and road traffic accidents were predominant, while in rural areas, most of the fractures were due to interpersonal violence, domestic accidents, work accidents and animal attacks (p = 0.001).

CONCLUSIONS: Interpersonal violence is the main cause of maxillofacial fractures having epidemic proportions. Male patients aged 20-29 years with a low level of education represent the major risk category. Considering the wide area of interpersonal aggression, both the medical staff in the hospital and in the dental offices must be educated in order to collaborate with possible violent patients. Dentists must be prepared to work on a post-traumatic dento-periodontal field. Taking all measures to prevent inter-human aggression is imperative and will lead to a major decrease in maxillofacial fractures and an overall increase of oral health in a population.

PMID:33731083 | DOI:10.1186/s12903-021-01503-5

BMC Public Health. 2021 Mar 17;21(1):519. doi: 10.1186/s12889-021-10567-5.

ABSTRACT

BACKGROUND: Avoidable mortality is considered as a potential indicator of the influences of public health policies and healthcare quality on population health. This study aimed to examine the trend in avoidable mortality and its influence on rising life expectancy (LE) and declining gender gap in LE (GGLE) in Sweden.

METHODS: We extracted data on causes of death by age, sex, and year from national registry from 1997 to 2018. The UK Office for National Statistics definition was used to divide causes of death into five mutually exclusive categories: amenable, preventable, amenable & preventable, ischemic heart disease (IHD), and non-avoidable causes. We applied Joinpoint regression to analyse temporal trends in age-standardized mortality rates. The Arriaga method was applied to decompose changes in LE and GGLE by age group and causes of death.

RESULTS: Average annual reductions in avoidable vs. non-avoidable mortality were 2.6% (95% CI:2.5, 2.7) vs. 1.4% (95% CI:1.3, 1.5) in men, and 1.6% (95% CI:1.4, 1.9) vs. 0.9% (95% CI:0.7, 1.0) in women over the study period. LE in men rose by 4.1 years between 1997 and 2018 (from 72.8 to 76.9 years), of which 2.4 years (59.3%) were attributable to reductions in avoidable mortality. Corresponding LE gain was 2.3 years in women (from 78.0 in 1997 to 80.3 in 2018) and avoidable mortality accounted for 1.0 year (45.6%) of this gain. Between 1997 and 2018, the GGLE narrowed by 1.9 years, of which 1.4 years (77.7%) were attributable to avoidable causes. Among avoidable causes, while preventable causes had the largest contribution to the GGLE, IHD had the greatest contributions to LE gains and the narrowing GGLE.

CONCLUSIONS: Our findings showed that avoidable causes had a substantial contribution to gain in LE with more profound gain in men than in women, resulting in narrowing the GGLE. Lower pace of reductions in preventable than amenable mortality highlights the need for improving the effectiveness of inter-sectoral health policies aimed at behavioural changes.

PMID:33731076 | DOI:10.1186/s12889-021-10567-5

AIDS. 2021 Mar 16. doi: 10.1097/QAD.0000000000002883. Online ahead of print.

ABSTRACT

OBJECTIVE: Efficacy and safety of long-acting (LA) cabotegravir (CAB) and rilpivirine (RPV) dosed intramuscularly every 4 or 8 weeks has been demonstrated in three Phase 3 trials. Here, factors associated with virologic failure at Week 48 were evaluated post hoc.

DESIGN AND METHODS: Data from 1039 adults naive to CAB+RPV LA were pooled in a multivariable analysis to examine the influence of baseline viral and participant factors, dosing regimen, and drug concentrations on confirmed virologic failure (CVF) occurrence using a logistic regression model. In a separate model, baseline factors statistically associated with CVF were further evaluated to understand CVF risk when present alone or in combination.

RESULTS: Overall, 1.25% (n = 13/1039) of participants experienced CVF. Proviral RPV resistance-associated mutations (RAMs), HIV-1 subtype A6/A1, higher body mass index (BMI, associated with Week 8 CAB trough concentration), and lower Week 8 RPV trough concentrations were significantly associated (p < 0.05) with increased odds of CVF (all except RPV trough are knowable at baseline). Few participants (0.4%) with zero or 1 baseline factor had CVF. Only a combination of ≥2 baseline factors (observed in 3.4%; n = 35/1039) was associated with increased CVF risk (25.7%, n = 9/35).

CONCLUSIONS: CVF is an infrequent multifactorial event, with a rate of ∼1% in the LA arms across Phase 3 studies (FLAIR, ATLAS, and ATLAS-2 M) through Week 48. Presence of ≥2 of proviral RPV RAMs, HIV-1 subtype A6/A1, and/or BMI ≥30 kg/m2 was associated with increased CVF risk. These findings support the use of CAB+RPV LA in routine clinical practice.

PMID:33730748 | DOI:10.1097/QAD.0000000000002883

Int J Biostat. 2021 Jan 18. doi: 10.1515/ijb-2020-0059. Online ahead of print.

ABSTRACT

In allometric studies, the joint distribution of the log-transformed morphometric variables is typically symmetric and with heavy tails. Moreover, in the bivariate case, it is customary to explain the morphometric variation of these variables by fitting a convenient line, as for example the first principal component (PC). To account for all these peculiarities, we propose the use of multiple scaled symmetric (MSS) distributions. These distributions have the advantage to be directly defined in the PC space, the kind of symmetry involved is less restrictive than the commonly considered elliptical symmetry, the behavior of the tails can vary across PCs, and their first PC is less sensitive to outliers. In the family of MSS distributions, we also propose the multiple scaled shifted exponential normal distribution, equivalent of the multivariate shifted exponential normal distribution in the MSS framework. For the sake of parsimony, we also allow the parameter governing the leptokurtosis on each PC, in the considered MSS distributions, to be tied across PCs. From an inferential point of view, we describe an EM algorithm to estimate the parameters by maximum likelihood, we illustrate how to compute standard errors of the obtained estimates, and we give statistical tests and confidence intervals for the parameters. We use artificial and real allometric data to appreciate the advantages of the MSS distributions over well-known elliptically symmetric distributions and to compare the robustness of the line from our models with respect to the lines fitted by well-established robust and non-robust methods available in the literature.

PMID:33730771 | DOI:10.1515/ijb-2020-0059

Oncology. 2021 Mar 17:1-8. doi: 10.1159/000514404. Online ahead of print.

ABSTRACT

BACKGROUND: Biliary tract cancer (BTC) is associated with poor prognosis because of its aggressive and heterogeneous nature. Programmed death ligand 1 (PD-L1) has been considered a novel biomarker for prognosis and response of immune checkpoint inhibitors in various tumors. However, there are limited data reporting on the role of PD-L1 in advanced BTC patients.

PATIENTS AND METHODS: We analyzed 186 patients with advanced BTC who received palliative gemcitabine and platinum between May 2010 and December 2019. All patients were evaluated for PD-L1 expression by combined positive score positivity.

RESULTS: Of the 186 patients, the primary tumor location was intrahepatic cholangiocarcinoma (IHCC) in 72 (38.7%), extrahepatic cholangiocarcinoma (EHCC) in 90 (48.4%), and gallbladder (GB) cancer in 24 (12.9%). Among all the patients, 53 (28.5%) had PD-L1 positivity. The median overall survival (OS) of patients with PD-L1 positivity or negativity was 12.1 and 15.4 months, respectively. The median progression-free survival (PFS) in patients with PD-L1 positivity or negativity was 5.7 and 7.1 months, respectively. OS and PFS were not statistically different between groups. In subgroup analysis, EHCC patients with PD-L1 negativity had more favorable OS (17.2 vs. 11.6 months, p = 0.002) and PFS (7.8 vs. 5.4 months, p = 0.005) than those who were PD-L1-positive. However, this finding was not reproduced in patients with IHCC or GB cancer.

CONCLUSION: This study demonstrated that PD-L1 expression might be a novel prognostic biomarker in patients with EHCC but not in patients with IHCC or GB cancer.

PMID:33730723 | DOI:10.1159/000514404

Dermatology. 2021 Mar 17:1-8. doi: 10.1159/000514503. Online ahead of print.

ABSTRACT

BACKGROUND: A growing body of evidence links various biomarkers to atopic dermatitis (AD). Still, little is known about the association of specific biomarkers to disease characteristics and severity in AD.

OBJECTIVE: To explore the relationship between various immunological markers in the serum and disease severity in a hospital cohort of AD patients.

METHODS: Outpatients with AD referred to the Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark, were divided into groups based on disease severity (SCORAD). Serum levels of a preselected panel of immunoinflammatory biomarkers were tested for association with disease characteristics. Two machine learning models were developed to predict SCORAD from the measured biomarkers.

RESULTS: A total of 160 patients with AD were included; 53 (33.1%) with mild, 73 (45.6%) with moderate, and 34 (21.3%) with severe disease. Mean age was 29.2 years (range 6-70 years) and 84 (52.5%) were females. Numerous biomarkers showed a statistically significant correlation with SCORAD, with the strongest correlations seen for CCL17/thymus and activation-regulated chemokine (chemokine ligand-17/TARC) and CCL27/cutaneous T cell-attracting-chemokine (CTACK; Spearman R of 0.50 and 0.43, respectively, p < 0.001). Extrinsic AD patients were more likely to have higher mean SCORAD (p < 0.001), CCL17 (p < 0.001), CCL26/eotaxin-3 (p < 0.001), and eosinophil count (p < 0.001) than intrinsic AD patients. Predictive models for SCORAD identified CCL17, CCL27, serum total IgE, IL-33, and IL-5 as the most important predictors for SCORAD, but with weaker associations than single cytokines.

CONCLUSIONS: Specific immunoinflammatory biomarkers in the serum, mainly of the Th2 pathway, are correlated with disease severity in patients with AD. Predictive models identified biomarkers associated with disease severity but this finding warrants further investigation.

PMID:33730733 | DOI:10.1159/000514503