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Wan F, Li S, Lei Y, Wang M, Liu R, Hu K, Xia Y, Chen W. Two-step machine learning-assisted label-free surface-enhanced Raman spectroscopy for reliable prediction of dissolved furfural in transformer oil. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 321:124571. [PMID: 38950473 DOI: 10.1016/j.saa.2024.124571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/28/2024] [Accepted: 05/29/2024] [Indexed: 07/03/2024]
Abstract
Accurate detection of dissolved furfural in transformer oil is crucial for real-time monitoring of the aging state of transformer oil-paper insulation. While label-free surface-enhanced Raman spectroscopy (SERS) has demonstrated high sensitivity for dissolved furfural in transformer oil, challenges persist due to poor substrate consistency and low quantitative reliability. Herein, machine learning (ML) algorithms were employed in both substrate fabrication and spectral analysis of label-free SERS. Initially, a high-consistency Ag@Au substrate was prepared through a combination of experiments, particle swarm optimization-neural network (PSO-NN), and a hybrid strategy of particle swarm optimization and genetic algorithm (Hybrid PSO-GA). Notably, a two-step ML framework was proposed, whose operational mechanism is classification followed by quantification. The framework adopts a hierarchical modeling strategy, incorporating simple algorithms such as kernel support vector machine (Kernel-SVM), k-nearest neighbors (KNN), etc., to independently establish lightweight regression models on each cluster, which allows each model to focus more effectively on fitting the data within its cluster. The classification model achieved an accuracy of 100%, while the regression models exhibited an average correlation coefficient (R2) of 0.9953 and the root mean square errors (RMSE) consistently below 10-2. Thus, this ML framework emerges as a rapid and reliable method for detecting dissolved furfural in transformer oil, even in the presence of different interfering substances, which may also have potentiality for other complex mixture monitoring systems.
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Affiliation(s)
- Fu Wan
- State Key Laboratory of Power Transmission Equipment Technology, School of Electrical Engineering, Chongqing University, Chongqing 400044, China; National Innovation Center for Industry-Education Integration of Energy Storage Technology, School of Electrical Engineering, Chongqing University, Chongqing, 400044, China.
| | - Shufan Li
- State Key Laboratory of Power Transmission Equipment Technology, School of Electrical Engineering, Chongqing University, Chongqing 400044, China
| | - Yu Lei
- State Key Laboratory of Power Transmission Equipment Technology, School of Electrical Engineering, Chongqing University, Chongqing 400044, China
| | - Mingliang Wang
- State Key Laboratory of Power Transmission Equipment Technology, School of Electrical Engineering, Chongqing University, Chongqing 400044, China
| | - Ruiqi Liu
- State Key Laboratory of Power Transmission Equipment Technology, School of Electrical Engineering, Chongqing University, Chongqing 400044, China
| | - Kaida Hu
- State Key Laboratory of Power Transmission Equipment Technology, School of Electrical Engineering, Chongqing University, Chongqing 400044, China
| | - Yaoyang Xia
- State Key Laboratory of Power Transmission Equipment Technology, School of Electrical Engineering, Chongqing University, Chongqing 400044, China
| | - Weigen Chen
- State Key Laboratory of Power Transmission Equipment Technology, School of Electrical Engineering, Chongqing University, Chongqing 400044, China; National Innovation Center for Industry-Education Integration of Energy Storage Technology, School of Electrical Engineering, Chongqing University, Chongqing, 400044, China
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Levison JH, Fung V, Wilson A, Cheng D, Donelan K, Oreskovic NM, Samuels R, Silverman P, Batson J, Fathi A, Gamse S, Holland S, Becker JE, Freedberg KA, Iezzoni LI, Donohue A, Viron M, Lubarsky C, Keller T, Reichman JL, Bastien B, Ryan E, Tsai AC, Hsu J, Chau C, Krane D, Trieu HD, Wolfe J, Shellenberger K, Cella E, Bird B, Bartels S, Skotko BG. Predictors of COVID-19 infection and hospitalization in group homes for individuals with intellectual and/or developmental disabilities. Disabil Health J 2024; 17:101645. [PMID: 38879412 DOI: 10.1016/j.dhjo.2024.101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 05/16/2024] [Accepted: 05/31/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND More than seven million people with intellectual and/or developmental disabilities (ID/DD) live in the US and may face an elevated risk for COVID-19. OBJECTIVE To identify correlates of COVID-19 and related hospitalizations among people with ID/DD in group homes in Massachusetts. METHODS We collected data during March 1, 2020-June 30, 2020 (wave 1) and July 1, 2020-March 31, 2021 (wave 2) from the Massachusetts Department of Public Health and six organizations administering 206 group homes for 1035 residents with ID/DD. The main outcomes were COVID-19 infections and related hospitalizations. We fit multilevel Cox proportional hazards models to estimate associations with observed predictors and assess contextual home- and organizational-level effects. RESULTS Compared with Massachusetts residents, group home residents had a higher age-adjusted rate of COVID-19 in wave 1 (incidence rate ratio [IRR], 12.06; 95 % confidence interval [CI], 10.51-13.84) and wave 2 (IRR, 2.47; 95 % CI, 2.12-2.88) and a higher age-adjusted rate of COVID-19 hospitalizations in wave 1 (IRR, 17.64; 95 % CI, 12.59-24.70) and wave 2 (IRR, 4.95; 95 % CI, 3.23-7.60). COVID-19 infections and hospitalizations were more likely among residents aged 65+ and in group homes with 6+ resident beds and recent infection among staff and residents. CONCLUSIONS Aggressive efforts to decrease resident density, staff-to-resident ratios, and staff infections through efforts such as vaccination, in addition to ongoing access to personal protective equipment and COVID-19 testing, may reduce COVID-19 and related hospitalizations in people with ID/DD living in group homes.
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Affiliation(s)
- Julie H Levison
- Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Massachusetts General Hospital, Department of Medicine, 55 Fruit St, Gray 7-730, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Vicki Fung
- Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Anna Wilson
- Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA
| | - David Cheng
- Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Massachusetts General Hospital, Biostatistics Center, 50 Staniford Street, Suite 560, Boston, MA, 02114, USA
| | - Karen Donelan
- Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, 02453, USA
| | - Nicolas M Oreskovic
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Massachusetts General Hospital, Department of Pediatrics, Division of Medical Genetics and Metabolism, Down Syndrome Program, 125 Nashua Street, Suite 821, Boston, MA, 02114, USA
| | - Ronita Samuels
- Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA
| | - Paula Silverman
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Joey Batson
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Ahmed Fathi
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Stefanie Gamse
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Sibyl Holland
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Jessica E Becker
- NYU Grossman School of Medicine and NYU Langone Health, Department of Child and Adolescent Psychiatry, 550 First Avenue, New York, NY, 10016, USA
| | - Kenneth A Freedberg
- Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Massachusetts General Hospital, Department of Medicine, 55 Fruit St, Gray 7-730, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Lisa I Iezzoni
- Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Amy Donohue
- Advocates, Inc. 1881 Worcester Rd, Framingham, MA, 01701, USA
| | - Mark Viron
- Advocates, Inc. 1881 Worcester Rd, Framingham, MA, 01701, USA
| | - Carley Lubarsky
- Bay Cove Human Services, 66 Canal Street, Boston, MA, 02114, USA
| | - Terina Keller
- Bay Cove Human Services, 66 Canal Street, Boston, MA, 02114, USA
| | | | - Bettina Bastien
- Riverside Community Care, 270 Bridge Street, Suite 301, Dedham, MA, 02026, USA
| | - Elizabeth Ryan
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Alexander C Tsai
- Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - John Hsu
- Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Harvard Medical School, Department of Medicine, 25 Shattuck Street, Boston, MA, 02115, USA; Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Cindy Chau
- Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA
| | - David Krane
- Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA
| | - Hao D Trieu
- Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA
| | - Jessica Wolfe
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | | | - Elizabeth Cella
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Bruce Bird
- Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA
| | - Stephen Bartels
- Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Massachusetts General Hospital, Department of Medicine, 55 Fruit St, Gray 7-730, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Brian G Skotko
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Massachusetts General Hospital, Department of Pediatrics, Division of Medical Genetics and Metabolism, Down Syndrome Program, 125 Nashua Street, Suite 821, Boston, MA, 02114, USA
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Wilson T, James MT, Southern D, Har B, Graham MM, Brass N, Bainey K, Fedak PWM, Sajobi TT, Wilton SB. Hospital and Physician Variability in Revascularization Decisions and Outcomes for Patients With 3-Vessel and Left Main Coronary Artery Disease: A Population-Based Cohort Study. J Am Heart Assoc 2024:e035356. [PMID: 39248266 DOI: 10.1161/jaha.123.035356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/22/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Hospital- and physician-level variation for selection of percutaneous coronary intervention versus coronary artery bypass grafting (CABG) for patients with coronary artery disease has been associated with outcome differences. However, most studies excluded patients treated medically. METHODS AND RESULTS From 2010 to 2019, adults with 3-vessel or left main coronary artery disease at 3 hospitals (A, B, C) in Alberta, Canada, were categorized by treatment with medical therapy, percutaneous coronary intervention, or CABG. Multilevel regression models determined the proportion of variation in treatment attributable to patient, physician, and hospital factors, and survival models assessed outcomes including death and major adverse cardiovascular events over 5 years. Of 22 580 patients (mean age, 67 years; 80% men): 6677 (29%) received medical management, 9171 (41%) percutaneous coronary intervention, and 6732 (30%) CABG. Hospital factors accounted for 10.8% of treatment variation. In adjusted models (site A as reference), patients at sites B and C had 49% (95% CI, 44%-53%) and 43% (95% CI, 37%-49%) lower rates of medical therapy, respectively, and 31% (95% CI, 24%-38%) and 32% (95% CI, 24%-40%) lower rates of CABG. During 5.0 years median follow-up, 3287 (14.6%) patients died, with no intersite mortality differences. There were no between-site differences in acute coronary syndromes or stroke; patients at sites B and C had 24% lower risk (95% CI, 13%-34% and 11%-35%, respectively) of heart failure hospitalization. CONCLUSIONS Hospital-level variation in selection of percutaneous coronary intervention, CABG, or medical therapy for patients with complex coronary artery disease was not associated with differences in 5-year mortality rates. Research and quality improvement initiatives comparing revascularization practices should include medically managed patients.
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Affiliation(s)
- Todd Wilson
- Department of Medicine University of Calgary Alberta Canada
- Department of Community Health Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Matthew T James
- Department of Medicine University of Calgary Alberta Canada
- Department of Community Health Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Danielle Southern
- Centre for Health Informatics, Cumming School of Medicine University of Calgary Alberta Canada
| | - Bryan Har
- Department of Cardiac Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Michelle M Graham
- Mazankowski Alberta Heart Institute, University of Alberta Edmonton Canada
| | - Neil Brass
- CKHui Heart Centre University of Alberta Alberta Canada
| | - Kevin Bainey
- Mazankowski Alberta Heart Institute, University of Alberta Edmonton Canada
| | - Paul W M Fedak
- Department of Cardiac Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Stephen B Wilton
- Department of Community Health Sciences University of Calgary Alberta Canada
- Department of Cardiac Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
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Shah NH, Fellows JL, Polk DE. Adoption and Effect of Sealants for Occlusal Noncavitated Caries in a Large Dental Network in the USA. Caries Res 2024:1-11. [PMID: 39154643 DOI: 10.1159/000540884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024] Open
Abstract
INTRODUCTION Dental sealants applied to occlusal pit-and-fissure surfaces have been shown to prevent caries and arrest occlusal noncavitated carious lesions (NCCLs). The American Dental Association (ADA) recommends that oral healthcare providers apply sealants on occlusal NCCLs. Though the evidence is clear that sealants are effective, few studies have examined the adoption of the ADA guideline by dentists and the duration of protection provided by sealants in a large real-world setting. METHODS This study used observational electronic health record (EHR) data from a network of dental clinics to follow teeth over a 2 year time period from when they were diagnosed as having an occlusal NCCL until either they were treated with a restoration or the time period ended with no restoration. The objectives of the study were to determine: (1) the degree to which dentists adopted the guideline, (2) whether the duration of protection was different for teeth that received a sealant from teeth that did not receive a sealant, and (3) whether dentists' experience placing sealants was associated with the duration of protection. RESULTS Overall, there were 7,299 teeth in the sample. Of those, dentists restored 591 teeth and applied sealants on 164. The sealant application rate for eligible teeth was 2.2%. Sealant application was associated with provider, with 1.9% of providers placing more than half of the sealants. By the end of the observation period, the proportion of teeth progressing to restorations was 8.2% for teeth that had not received a sealant and 3.0% for teeth that had received one (RR = 0.37; 95% CI: 0.16-0.88; p = 0.02). Multilevel survival analysis showed that teeth that had not received a sealant were restored sooner than teeth that had received a sealant (aHR = 0.11; 95% CI: 0.03-0.36; p < 0.01). Overall, teeth that received a sealant had an 89% reduced hazard of restoration within 2 years compared with teeth that did not receive sealants. CONCLUSION This study found that by arresting decay, the presence of sealants led to fewer restorations and delayed restorations compared with teeth not receiving a sealant or restoration in the 2 years following diagnosis of occlusal NCCL in clinical settings.
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Affiliation(s)
- Nilesh H Shah
- Dental Public Health, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
| | - Jeffrey L Fellows
- Center for Health Research, Kaiser Permanente, Portland, Oregon, USA
| | - Deborah E Polk
- Dental Public Health, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
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Kurita T, Kuramitsu S, Ishii M, Takasaki A, Domei T, Matsuo H, Horie K, Ando H, Terai H, Kikuta Y, Ishihara T, Saigusa T, Sakamoto T, Suematsu N, Shiono Y, Asano T, Tsujita K, Masamura K, Doijiri T, Toyota F, Ogita M, Shiraishi J, Harada K, Isogai H, Anai R, Sonoda S, Yokoi H, Tanaka N, Dohi K. Impact of Antiplatelet Therapy on 5-Year Outcomes After Fractional Flow Reserve-Guided Deferral of Revascularization in Nonsignificant Obstructive Coronary Artery Disease. Circ Rep 2024; 6:313-321. [PMID: 39132333 PMCID: PMC11309776 DOI: 10.1253/circrep.cr-24-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 08/13/2024] Open
Abstract
Background Because the clinical benefit of antiplatelet therapy (APT) for patients with nonsignificant coronary artery disease (CAD) remains poorly understood, we evaluated it in patients after fractional flow reserve (FFR)-guided deferral of revascularization. Methods and Results From the J-CONFIRM (Long-Term Outcomes of Japanese Patients with Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry), we investigated 265 patients with deferred lesions who did not require APT for secondary prevention of cardiovascular disease. A 2-year landmark analysis assessed the relationship between APT at 2 years and 5-year major cardiac adverse events (MACE: composite of all-cause death, target vessel-related myocardial infarction, clinically driven target vessel revascularization). Of the 265 patients, 163 (61.5%) received APT. The 5-year MACE did not significantly differ between the APT and non-APT groups after adjustment for baseline clinical characteristics (9.2% vs. 6.9%, inverse probability weighted hazard ratio, 1.40 [95% confidence interval, 0.53-3.69]; P=0.49). There was a marginal interaction between the effect of APT on MACE and FFR values (< or ≥0.84) (P for interaction=0.066). Conclusions The 5-year outcomes after FFR-guided deferral of revascularization did not significantly differ between the APT and non-APT groups, suggesting that APT might not be a critical requirement for nonsignificant obstructive CAD patients not requiring APT for secondary prevention of cardiovascular disease.
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Affiliation(s)
- Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine Mie Japan
| | - Shoichi Kuramitsu
- Department of Cardiovascular Medicine, Sapporo Cardiovascular Clinic, Sapporo Heart Center Sapporo Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University Kumamoto Japan
| | - Akihiro Takasaki
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine Mie Japan
| | - Takenori Domei
- Department of Cardiology, Kokura Memorial Hospital Fukuoka Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center Gifu Japan
| | - Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital Sendai Japan
| | - Hirohiko Ando
- Department of Cardiology, Aichi Medical University Aichi Japan
| | - Hidenobu Terai
- Department of Cardiology, Kanazawa Cardiovascular Hospital Ishikawa Japan
| | - Yuetsu Kikuta
- Department of Cardiology, Fukuyama Cardiovascular Hospital Hiroshima Japan
| | | | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine Nagano Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Nobuhiro Suematsu
- Department of Cardiology, Saiseikai Fukuoka General Hospital Fukuoka Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan
| | - Taku Asano
- Department of Cardiology, St. Luke's International Hospital Tokyo Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University Kumamoto Japan
| | | | - Tatsuki Doijiri
- Department of Cardiology, Yamato Seiwa Hospital Kanagawa Japan
| | | | - Manabu Ogita
- Department of Cardiology, Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Jun Shiraishi
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital Kyoto Japan
| | - Ken Harada
- Department of Cardiology, Chubu Rosai Hospital Nagoya Japan
| | - Hiroyuki Isogai
- Department of Cardiology, Juntendo University Urayasu Hospital Chiba Japan
| | - Reo Anai
- The Second Department of Internal Medicine, University of Occupational and Environmental Health Japan School of Medicine Kitakyushu Japan
| | - Shinjo Sonoda
- Department of Cardiovascular Medicine, Saga University Saga Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital Fukuoka Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center Tokyo Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine Mie Japan
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Pérez A, Gómez D, Montoro J, Chorão P, Hernani R, Guerreiro M, Villalba M, Albert E, Carbonell-Asins JA, Hernández-Boluda JC, Navarro D, Solano C, Piñana JL. Are any specific respiratory viruses more severe than others in recipients of allogeneic stem cell transplantation? A focus on lower respiratory tract disease. Bone Marrow Transplant 2024; 59:1118-1126. [PMID: 38730040 DOI: 10.1038/s41409-024-02304-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
Abstract
In the general population, influenza virus, respiratory syncytial virus, and SARS-CoV-2 are considered the most severe community-acquired respiratory viruses (CARVs). However, allogeneic stem cell transplant (allo-SCT) recipients may also face severe courses from other CARVs. This retrospective study compared outcomes of various CARV lower respiratory tract diseases (LRTD) in 235 adult allo-SCT recipients, excluding co-infection episodes. We included 235 adults allo-SCT recipients experiencing 353 CARV LRTD consecutive episodes (130 rhinovirus, 63 respiratory syncytial virus, 43 influenza, 43 human parainfluenza virus, 23 human metapneumovirus, 19 Omicron SARS-CoV-2, 17 common coronavirus, 10 adenovirus and 5 human bocavirus) between December 2013 and June 2023. Day 100 overall survival ranged from 78% to 90% without significant differences among CARV types. Multivariable analysis of day 100 all-cause mortality identified corticosteroid use of >1 to <30 mg/d [Hazard ratio (HR) 2.45, p = 0.02) and ≥30 mg/d (HR 2.20, p = 0.015) along with absolute lymphocyte count <0.2 × 109/L (HR 5.82, p < 0.001) and number of CARV episodes as a continuous variable per one episode increase (HR 0.48, p = 0.001) as independent risk factors for all-cause mortality. Degree of immunosuppression, rather than intrinsic CARV virulence, has the most significant impact on mortality in allo-SCT recipients with CARV-LRTD.
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Affiliation(s)
- Ariadna Pérez
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Dolores Gómez
- Microbiology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan Montoro
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pedro Chorão
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rafael Hernani
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Marta Villalba
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Eliseo Albert
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
| | | | - Juan Carlos Hernández-Boluda
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
- Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Carlos Solano
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - José Luis Piñana
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain.
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Austin PC. The effect of number of clusters and magnitude of within-cluster homogeneity in outcomes on the performance of four variance estimators for a marginal multivariable Cox regression model fit to clustered data in the context of observational research. Stat Med 2024; 43:3264-3279. [PMID: 38822699 DOI: 10.1002/sim.10126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
Researchers often estimate the association between the hazard of a time-to-event outcome and the characteristics of individuals and the clusters in which individuals are nested. Lin and Wei's robust variance estimator is often used with a Cox regression model fit to clustered data. Recently, alternative variance estimators have been proposed: the Fay-Graubard estimator, the Kauermann-Carroll estimator, and the Mancl-DeRouen estimator. Using Monte Carlo simulations, we found that, when fitting a marginal Cox regression model with both individual-level and cluster-level covariates: (i) in the presence of weak to moderate within-cluster homogeneity of outcomes, the Lin-Wei variance estimator can result in estimates of the SE with moderate bias when the number of clusters is fewer than 20-30, while in the presence of strong within-cluster homogeneity, it can result in biased estimation even when the number of clusters is as large as 100; (ii) when the number of clusters was less than approximately 20, the Fay-Graubard variance estimator tended to result in estimates of SE with the lowest bias; (iii) when the number of clusters exceeded approximately 20, the Mancl-DeRouen estimator tended to result in estimated standard errors with the lowest bias; (iv) the Mancl-DeRouen estimator used with a t-distribution tended to result in 95% confidence that had the best performance of the estimators; (v) when the magnitude of within-cluster homogeneity in outcomes was strong or very strong, all methods resulted in confidence intervals with lower than advertised coverage rates even when the number of clusters was very large.
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Affiliation(s)
- Peter C Austin
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
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Yin S, Yang Y, Wang Q, Guo W, He Q, Yuan L, Si K. Association between Abortion and All-Cause and Cause-Specific Premature Mortality: A Prospective Cohort Study from the UK Biobank. HEALTH DATA SCIENCE 2024; 4:0147. [PMID: 39011272 PMCID: PMC11246836 DOI: 10.34133/hds.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/13/2024] [Indexed: 07/17/2024]
Abstract
Background: Concerns have been raised about the increasing prevalence of both spontaneous and induced abortions worldwide, yet their effect on premature mortality remains poorly understood. We aimed to examine the associations between abortion and all-cause and cause-specific premature mortality, and the potential effect modification by maternal characteristics. Methods: Women aged 39 to 71 years at baseline (2006 to 2010) with prior pregnancies were derived from the UK Biobank and categorized as no abortion history, spontaneous abortion alone, induced abortion alone, and both spontaneous and induced abortions. All-cause and cause-specific mortality were ascertained through linkage to death certificate data, with premature death defined as occurring before the age of 70. Results: Of the 225,049 ever gravid women, 43,418 (19.3%) reported spontaneous abortion alone, 27,135 (12.1%) reported induced abortion alone, and 10,448 (4.6%) reported both spontaneous and induced abortions. During a median of 14.4 years of follow-up, 5,353 deaths were recorded, including 3,314 cancer-related and 1,444 cardiovascular deaths. Compared with no abortion history, spontaneous abortion alone was associated with an increased risk of all-cause premature mortality (adjusted hazard ratio [aHR] 1.10, 95% confidence interval [CI] 1.02 to 1.17), and induced abortion alone was associated with increased risks of all-cause (aHR 1.12, 95% CI 1.04 to 1.22) and cardiovascular mortality (aHR 1.27, 95% CI 1.09 to 1.48). The aHRs for all-cause and cardiovascular mortality were higher for recurrent abortions, whether spontaneous or induced (P trend < 0.05). The increased risk of all-cause mortality associated with induced abortion was higher in women with hypertensive disorders of pregnancy than in those without (40% vs. 9%, P interaction = 0.045). Conclusions: Either spontaneous or induced abortion alone was associated with an increased risk of premature mortality, with induced abortion alone particularly linked to cardiovascular death. Future studies are encouraged to explore the underlying mechanisms.
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Affiliation(s)
- Shaohua Yin
- Department of Medical Engineering,
Peking University Third Hospital, Beijing, China
| | - Yingying Yang
- Clinical Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine,
Tongji University, Shanghai, China
| | - Qin Wang
- Department of Health Management,
Naval Medical University, Shanghai, China
| | - Wei Guo
- Department of Military Health Statistics,
Naval Medical University, Shanghai, China
| | - Qian He
- Department of Military Health Statistics,
Naval Medical University, Shanghai, China
| | - Lei Yuan
- Department of Health Management,
Naval Medical University, Shanghai, China
| | - Keyi Si
- Department of Environmental Health, School of Public Health,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
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9
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Frévent C, Ahmed MS, Dabo-Niang S, Genin M. A Shared-Frailty Spatial Scan Statistic Model for Time-to-Event Data. Biom J 2024; 66:e202300200. [PMID: 38988210 DOI: 10.1002/bimj.202300200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/24/2024] [Accepted: 05/04/2024] [Indexed: 07/12/2024]
Abstract
Spatial scan statistics are well-known methods widely used to detect spatial clusters of events. Furthermore, several spatial scan statistics models have been applied to the spatial analysis of time-to-event data. However, these models do not take account of potential correlations between the observations of individuals within the same spatial unit or potential spatial dependence between spatial units. To overcome this problem, we have developed a scan statistic based on a Cox model with shared frailty and that takes account of the spatial dependence between spatial units. In simulation studies, we found that (i) conventional models of spatial scan statistics for time-to-event data fail to maintain the type I error in the presence of a correlation between the observations of individuals within the same spatial unit and (ii) our model performed well in the presence of such correlation and spatial dependence. We have applied our method to epidemiological data and the detection of spatial clusters of mortality in patients with end-stage renal disease in northern France.
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Affiliation(s)
- Camille Frévent
- Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Université de Lille, Lille, France
| | - Mohamed-Salem Ahmed
- Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Université de Lille, Lille, France
- Alicante SARL, Lesquin, France
| | - Sophie Dabo-Niang
- CNRS, UMR 8524 - Laboratoire Paul Painlevé, Université de Lille, Lille, France
- MODAL team, INRIA Lille-Nord Europe, Villeneuve-d'Ascq, France
| | - Michaël Genin
- Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Université de Lille, Lille, France
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10
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Li Y, Menon G, Long JJ, Chen Y, Metoyer GT, Wu W, Crews DC, Purnell TS, Thorpe RJ, Hill CV, Szanton SL, Segev DL, McAdams-DeMarco MA. Neighborhood Racial and Ethnic Segregation and the Risk of Dementia in Older Adults Living with Kidney Failure. J Am Soc Nephrol 2024; 35:936-948. [PMID: 38671538 PMCID: PMC11230717 DOI: 10.1681/asn.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/22/2024] [Indexed: 04/28/2024] Open
Abstract
Key Points
Regardless of race and ethnicity, older adults with kidney failure residing in or receiving care at dialysis facilities located in high-segregation neighborhoods were at a 1.63-fold and 1.53-fold higher risk of dementia diagnosis, respectively.Older adults with kidney failure residing in minority-predominant high-segregation neighborhoods had a 2.19-fold higher risk of dementia diagnosis compared with White individuals in White-predominant neighborhoods.
Background
Dementia disproportionately affects older minoritized adults with kidney failure. To better understand the mechanism of this disparity, we studied the role of racial and ethnic segregation (segregation hereafter), i.e., a form of structural racism recently identified as a mechanism in numerous other health disparities.
Methods
We identified 901,065 older adults (aged ≥55 years) with kidney failure from 2003 to 2019 using the United States Renal Data System. We quantified dementia risk across tertiles of residential neighborhood segregation score using cause-specific hazard models, adjusting for individual- and neighborhood-level factors. We included an interaction term to quantify the differential effect of segregation on dementia diagnosis by race and ethnicity.
Results
We identified 79,851 older adults with kidney failure diagnosed with dementia between 2003 and 2019 (median follow-up: 2.2 years). Compared with those in low-segregation neighborhoods, older adults with kidney failure in high-segregation neighborhoods had a 1.63-fold (95% confidence interval [CI], 1.60 to 1.66) higher risk of dementia diagnosis, an association that differed by race and ethnicity (Asian: adjusted hazard ratio [aHR] = 1.26, 95% CI, 1.15 to 1.38; Black: aHR = 1.66, 95% CI, 1.61 to 1.71; Hispanic: aHR = 2.05, 95% CI, 1.93 to 2.18; White: aHR = 1.59, 95% CI, 1.55 to 1.64; P
interaction < 0.001). Notably, older Asian (aHR = 1.76; 95% CI, 1.64 to 1.89), Black (aHR = 2.65; 95% CI, 2.54 to 2.77), Hispanic (aHR = 2.15; 95% CI, 2.04 to 2.26), and White (aHR = 2.20; 95% CI, 2.09 to 2.31) adults with kidney failure residing in minority-predominant high-segregation neighborhoods had a higher risk of dementia diagnosis compared with older White adults with kidney failure in White-predominant high-segregation neighborhoods. Moreover, older adults with kidney failure receiving care at dialysis facilities located in high-segregation neighborhoods also experienced a higher risk of dementia diagnosis (aHR = 1.53; 95% CI, 1.50 to 1.56); this association differed by race and ethnicity (P
interaction < 0.001).
Conclusions
Residing in or receiving care at dialysis facilities located in high-segregation neighborhoods was associated with a higher risk of dementia diagnosis among older individuals with kidney failure, particularly minoritized individuals.
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Affiliation(s)
- Yiting Li
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Gayathri Menon
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Jane J Long
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Yusi Chen
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Garyn T Metoyer
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Wenbo Wu
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Deidra C Crews
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tanjala S Purnell
- Division of Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Roland J Thorpe
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Sarah L Szanton
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Mara A McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
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11
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Li J, Meng X, Shi FD, Jing J, Gu HQ, Jin A, Jiang Y, Li H, Johnston SC, Hankey GJ, Easton JD, Chang L, Shi P, Wang L, Zhuang X, Li H, Zang Y, Zhang J, Sun Z, Liu D, Li Y, Yang H, Zhao J, Yu W, Wang A, Pan Y, Lin J, Xie X, Jin WN, Li S, Niu S, Wang Y, Zhao X, Li Z, Liu L, Zheng H, Wang Y. Colchicine in patients with acute ischaemic stroke or transient ischaemic attack (CHANCE-3): multicentre, double blind, randomised, placebo controlled trial. BMJ 2024; 385:e079061. [PMID: 38925803 PMCID: PMC11200154 DOI: 10.1136/bmj-2023-079061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To assess the efficacy and safety of colchicine versus placebo on reducing the risk of subsequent stroke after high risk non-cardioembolic ischaemic stroke or transient ischaemic attack within the first three months of symptom onset (CHANCE-3). DESIGN Multicentre, double blind, randomised, placebo controlled trial. SETTING 244 hospitals in China between 11 August 2022 and 13 April 2023. PARTICIPANTS 8343 patients aged 40 years of age or older with a minor-to-moderate ischaemic stroke or transient ischaemic attack and a high sensitivity C-reactive protein ≥2 mg/L were enrolled. INTERVENTIONS Patients were randomly assigned 1:1 within 24 h of symptom onset to receive colchicine (0.5 mg twice daily on days 1-3, followed by 0.5 mg daily thereafter) or placebo for 90 days. MAIN OUTCOME MEASURES The primary efficacy outcome was any new stroke within 90 days after randomisation. The primary safety outcome was any serious adverse event during the treatment period. All efficacy and safety analyses were by intention to treat. RESULTS 4176 patients were assigned to the colchicine group and 4167 were assigned to the placebo group. Stroke occurred within 90 days in 264 patients (6.3%) in the colchicine group and 270 patients (6.5%) in the placebo group (hazard ratio 0.98 (95% confidence interval 0.83 to 1.16); P=0.79). Any serious adverse event was observed in 91 (2.2%) patients in the colchicine group and 88 (2.1%) in the placebo group (P=0.83). CONCLUSIONS The study did not provide evidence that low-dose colchicine could reduce the risk of subsequent stroke within 90 days as compared with placebo among patients with acute non-cardioembolic minor-to-moderate ischaemic stroke or transient ischaemic attack and a high sensitivity C-reactive protein ≥2 mg/L. TRIAL REGISTRATION ClinicalTrials.gov, NCT05439356.
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Affiliation(s)
- Jiejie Li
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fu-Dong Shi
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Jing
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong-Qiu Gu
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aoming Jin
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Graeme J Hankey
- Medical School, University of Western Australia, Perth, WA, Australia
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - J Donald Easton
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Liguo Chang
- Department of Neurology, Liaocheng Third People's Hospital, Shandong, China
| | - Penglai Shi
- Department of Neurology, Yantai Penglai Traditional Chinese Medicine Hospital, Shandong, China
| | - Lihua Wang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Xianbo Zhuang
- Department of Neurology, Liaocheng People's Hospital, Shandong, China
| | - Haitao Li
- Department of Neurology, The People's Hospital of Qihe County, Shandong, China
| | - Yingzhuo Zang
- Department of Neurology, Qinghe People's Hospital, Hebei, China
| | - Jianling Zhang
- Department of Neurology, The Fourth People's Hospital of Hengshui, Hebei, China
| | - Zengqiang Sun
- Department of Neurology, Zibo Municipal Hospital, Shandong, China
| | - Dongqi Liu
- Department of Neurology, Hejian People's Hospital, Hebei, China
| | - Ying Li
- Department of Neurology, Suixian Chinese Medicine Hospital, Henan, China
| | - Hongqin Yang
- Department of Neurology, Jiyuan Hospital of TCM, Henan, China
| | - Jinguo Zhao
- Department of Neurology, Weihai Wendeng District People's Hospital, Shandong, China
| | - Weiran Yu
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jinxi Lin
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuewei Xie
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei-Na Jin
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuya Li
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Siying Niu
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zixiao Li
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huaguang Zheng
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Clinical Center for Precision Medicine in Stroke, Capital Medical University, Beijing, China
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12
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Desmonde S, Dame J, Malateste K, David A, Amorissani-Folquet M, N'Gbeche S, Sylla M, Takassi E, Kouakou K, Tossa LB, Yonaba C, Leroy V. Disparities in access to Dolutegravir in West African children, adolescents and young adults aged 0-24 years living with HIV. A IeDEA Pediatric West African cohort analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.24.24307900. [PMID: 38826257 PMCID: PMC11142258 DOI: 10.1101/2024.05.24.24307900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Introduction We describe the 24-month incidence of Dolutegravir (DTG)-containing antiretroviral treatment (ART) initiation since its introduction in 2019 in the pediatric West African IeDEA cohorts. Methods We included all patients aged 0-24 years on ART, from nine clinics in Côte d'Ivoire (n=4), Ghana, Nigeria, Mali, Benin, and Burkina Faso. Baseline varied by clinic and was defined as date of first DTG prescription; patients were followed-up until database closure/death/loss to follow-up (LTFU, no visit ≥ 7 months), whichever came first. We computed the cumulative incidence function for DTG initiation; associated factors were explored in a shared frailty model, accounting for clinic heterogeneity. Results Since 2019, 3,350 patients were included; 49% were female;79% had been on ART ≥ 12 months. Median baseline age was 12.9 years (IQR: 9-17). Median follow-up was 14 months (IQR: 7-22). The overall cumulative incidence of DTG initiation reached 35.5% (95% CI: 33.7-37.2) and 56.4% (95% CI: 54.4-58.4) at 12 and 24 months, respectively. In univariate analyses, those aged <5 years and females were overall less likely to switch. Adjusted on ART line and available viral load (VL) at baseline, females >10 years were less likely to initiate DTG compared to males of the same age (aHR among 10-14 years: 0.62, 95% CI: 0.54-0.72; among ≥15 years: 0.43, 95% CI: 0.36-0.50), as were those with detectable VL (> 50 copies/mL) compared to those in viral suppression (aHR: 0.86, 95% CI: 0.77-0.97) and those on PIs compared to those on NNRTIs (aHR after 12 months of roll-out: 0.75, 95% CI: 0.65-0.86). Conclusion: Access to paediatric DTG was incomplete and unequitable in West African settings: children <5years, females ≥ 10 years and those with detectable viral load were least likely to access DTG. Maintained monitoring and support of treatment practices is required to better ensure universal and equal access. Key messages What is already known on this topic?: Dolutegravir (DTG)-based ART regimens are recommended as the preferred first-line ART regimens recommended by the World Health Organisation in all people living with HIV since 2018, with a note of caution for pregnant women, then confirmed in all children with approved DTG dosing and adolescents since 2019.Deployment of universal DTG access in adults in West Africa has faced challenges such as infrastructure challenges, and healthcare system disparities, and was hindered by initial perinatal safety concerns affecting greatly women of childbearing age.Specific data on access to DTG in children, adolescents and young adults in West Africa is limited.What this study adds ?: This study describes the dynamic of the DTG roll-out over the first 24 months and its correlates since 2019 in a large West African multicentric cohort of children, adolescents and youth.We observed a rapid scale-up of DTG among children, adolescents and young adults living with HIV in West Africa, despite the COVID-19 pandemic.However, DTG access after 24 months was incomplete and unequitable, with adolescent girls and young women being less likely to initiate DTG compared to males, as were those with a detectable viral load (> 50 copies/mL) compared to those in success.Younger children < 5 years were also less likely to initiate DTG, explained by the later approval of paediatric formulations and their low availability.How this study might affect research, practice or policy?: Maintained monitoring, training and updating guidance for healthcare workers is essential to ensure universal access to DTG, especially for females, for whom inequity begins age 10 years.Efforts to improve access to universal DTG in West Africa require multifaceted interventions including healthcare infrastructure improvement and facilitation of paediatric antiretroviral forecasting and planification.
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Okafor PC, Jimongkolkul N, Khongpradit A, Ahiwichai W, Homwong N. Enhancement of selectivity, 25-hydroxyvitamin D3 level, alkaline phosphatase activity and reproductive performance in gilts and primiparous sows using 14-epimer of 25-hydroxyvitamin D3. Vet Anim Sci 2024; 24:100352. [PMID: 38699218 PMCID: PMC11064612 DOI: 10.1016/j.vas.2024.100352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
Selecting breed-worthy gilts as sow replacements is essential for continuity of pig production cycle. Though vitamin D3 (VD3) is known to enhance reproductive performance of multiparous sows, there is still a knowledge gap on its impact in developing gilts and primiparous sows. This study was aimed to quantify plasma 25-hydroxyvitamin D3 (25(OH)D3), serum alkaline phosphatase (ALP), and examine the reproductive performance of primiparous sows fed diets supplemented with regular VD3, and its 25(OH)D3 epimers. The study sample comprised 10-week-old replacement gilts (50 % Landrace x 50 % Yorkshire, N = 180) assigned in a randomized complete block design to three treatments [2,000 IU/kg of VD3 (T1), 25 µg/kg of 14‑epi-25(OH)D3, half dose (T2), and 50 µg/kg of 25(OH)D3 (T3)] equilibrated to 2,000 IU/kg in base diets. Selections occurred at 22, 27 and 35 weeks of age, respectively. Plasma 25(OH)D3, serum alkaline phosphatase (ALP), bone structure and reproductive performance were analyzed. Dietary treatments influenced carpus (P = 0.023), fore view stance (P = 0.017), infantile vulva (P = 0.014), inverted (P = 0.048), and prominent teat (P < 0.001). Post-partum 25(OH)D3 concentration and ALP activity were elevated by day 25 (P < 0.001). Treatment diets also influenced total born (P < 0.001), born alive (P = 0.048), and still born (P = 0.049). Two factors affect circulating 25(OH)D3 and ALP activity: physiological changes in sows during lactation, and dietary 25(OH)D3 intake. 14‑epi-25(OH)D3 is a potent metabolite for improving maturation of reproductive organs in developing gilts. It also reduces still birth in primiparous sows.
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Affiliation(s)
- Prester C.John Okafor
- Department of Animal Science, Faculty of Agriculture at Kamphaeng Saen, Kasetsart University, Kamphaeng Saen Campus, Nakhon Pathom, Thailand
| | - Nattanit Jimongkolkul
- Department of Animal Science, Faculty of Agriculture at Kamphaeng Saen, Kasetsart University, Kamphaeng Saen Campus, Nakhon Pathom, Thailand
| | - Anchalee Khongpradit
- Department of Animal Science, Faculty of Agriculture at Kamphaeng Saen, Kasetsart University, Kamphaeng Saen Campus, Nakhon Pathom, Thailand
| | - Wunwinee Ahiwichai
- Department of Animal Science, Faculty of Agriculture at Kamphaeng Saen, Kasetsart University, Kamphaeng Saen Campus, Nakhon Pathom, Thailand
| | - Nitipong Homwong
- Department of Animal Science, Faculty of Agriculture at Kamphaeng Saen, Kasetsart University, Kamphaeng Saen Campus, Nakhon Pathom, Thailand
- National Swine Research and Training Center, Kasetsart University, Kamphaeng Saen Campus, Nakhon Pathom, Thailand
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14
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Wu W, Chen D, Ruan X, Wu G, Deng X, Lawrence W, Lin X, Li Z, Wang Y, Lin Z, Zhu S, Deng X, Lin Q, Hao C, Du Z, Wei J, Zhang W, Hao Y. Residential greenness and chronic obstructive pulmonary disease in a large cohort in southern China: Potential causal links, risk trajectories, and mediation pathways. J Adv Res 2024:S2090-1232(24)00214-5. [PMID: 38797475 DOI: 10.1016/j.jare.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Residential greenness may influence COPD mortality, but the causal links, risk trajectories, and mediation pathways between them remain poorly understood. OBJECTIVES We aim to comprehensively identify the potential causal links, characterize the dynamic progression of hospitalization or posthospital risk, and quantify mediation effects between greenness and COPD. METHODS This study was conducted using a community-based cohort enrolling individuals aged ≥ 18 years in southern China from January 1, 2009 to December 31, 2015. Greenness was characterized by normalized difference vegetation index (NDVI) around participants' residential addresses. We applied doubly robust Cox proportional hazards model, multi-state model, and multiple mediation method, to investigate the potential causal links, risk trajectories among baseline, COPD hospitalization, first readmission due to COPD or COPD-related complications, and all-cause death, as well as the multiple mediation pathways (particulate matter [PM], temperature, body mass index [BMI] and physical activity) connecting greenness exposure to COPD mortality. RESULTS Our final analysis included 581,785 participants (52.52% female; average age: 48.36 [Standard Deviation (SD): 17.56]). Each interquartile range (IQR: 0.06) increase in NDVI was associated with a reduced COPD mortality risk, yielding a hazard ratio (HR) of 0.88 (95 % CI: 0.81, 0.96). Furthermore, we observed per IQR (0.04) increase in NDVI was inversely associated with the risk of multiple transitions (baseline - COPD hospitalization, baseline - death, and readmission - death risks), especially a declined risk of all-cause death after readmission (HR = 0.66 [95 %CI: 0.44, 0.99]). Within the observed association between greenness and COPD mortality, three mediators were identified, namely PM, temperature, and BMI (HR for the total indirect effect: 0.773 [95 % CI: 0.703, 0.851]), with PM showing the highest mediating effect. CONCLUSIONS Our findings revealed greenness may be a beneficial factor for COPD morbidity, prognosis, and mortality. This protective effect is primarily attributed to the reduction in PM concentration.
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Affiliation(s)
- Wenjing Wu
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Dan Chen
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Xingling Ruan
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Gonghua Wu
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Xinlei Deng
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, USA
| | - Wayne Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Xiao Lin
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Zhiqiang Li
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Ying Wang
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Ziqiang Lin
- Department of Preventive Medicine, School of Basic Medicine and Public Health, Jinan University, Guangzhou, China
| | - Shuming Zhu
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Xueqing Deng
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Qiaoxuan Lin
- Guangzhou Health Technology Identification & Human Resources Assessment Center, Department of Statistics, China
| | - Chun Hao
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Zhicheng Du
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, USA.
| | - Wangjian Zhang
- Department of Medical Statistics, School of Public Health & Research Center for Health Information & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China.
| | - Yuantao Hao
- Peking University Center for Public Health and Epidemic Preparedness & Response, Peking, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Peking, China.
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Marangu-Boore D, Mwaniki P, Isaaka L, Njoroge T, Mumelo L, Kimego D, Adem A, Jowi E, Ithondeka A, Wanyama C, Agweyu A. Characteristics of children readmitted with severe pneumonia in Kenyan hospitals. BMC Public Health 2024; 24:1324. [PMID: 38755590 PMCID: PMC11097591 DOI: 10.1186/s12889-024-18651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Pneumonia is a leading cause of childhood morbidity and mortality. Hospital re-admission may signify missed opportunities for care or undiagnosed comorbidities. METHODS We conducted a retrospective cohort study including children aged ≥ 2 months-14 years hospitalised with severe pneumonia between 2013 and 2021 in a network of 20 primary referral hospitals in Kenya. Severe pneumonia was defined using the 2013 World Health Organization criteria, and re-admission was based on clinical documentation from individual patient case notes. We estimated the prevalence of re-admission, described clinical management practices, and modelled risk factors for re-admission and inpatient mortality. RESULTS Among 20,603 children diagnosed with severe pneumonia, 2,274 (11.0%, 95% CI 10.6-11.5) were readmitted. Re-admission was independently associated with age (12-59 months vs. 2-11 months: adjusted odds ratio (aOR) 1.70, 1.54-1.87; >5 years vs. 2-11 months: aOR 1.85, 1.55-2.22), malnutrition (weight-for-age-z-score (WAZ) <-3SD vs. WAZ> -2SD: aOR 2.05, 1.84-2.29); WAZ - 2 to -3 SD vs. WAZ> -2SD: aOR 1.37, 1.20-1.57), wheeze (aOR 1.17, 1.03-1.33) and presence of a concurrent neurological disorder (aOR 4.42, 1.70-11.48). Chest radiography was ordered more frequently among those readmitted (540/2,274 [23.7%] vs. 3,102/18,329 [16.9%], p < 0.001). Readmitted patients more frequently received second-line antibiotics (808/2,256 [35.8%] vs. 5,538/18,173 [30.5%], p < 0.001), TB medication (69/2,256 [3.1%] vs. 298/18,173 [1.6%], p < 0.001), salbutamol (530/2,256 [23.5%] vs. 3,707/18,173 [20.4%], p = 0.003), and prednisolone (157/2,256 [7.0%] vs. 764/18,173 [4.2%], p < 0.001). Inpatient mortality was 2,354/18,329 (12.8%) among children admitted with a first episode of severe pneumonia and 269/2,274 (11.8%) among those who were readmitted (adjusted hazard ratio (aHR) 0.93, 95% CI 0.82-1.07). Age (12-59 months vs. 2-11 months: aHR 0.62, 0.57-0.67), male sex (aHR 0.81, 0.75-0.88), malnutrition (WAZ <-3SD vs. WAZ >-2SD: aHR 1.87, 1.71-2.05); WAZ - 2 to -3 SD vs. WAZ >-2SD: aHR 1.46, 1.31-1.63), complete vaccination (aHR 0.74, 0.60-0.91), wheeze (aHR 0.87, 0.78-0.98) and anaemia (aHR 2.14, 1.89-2.43) were independently associated with mortality. CONCLUSIONS Children readmitted with severe pneumonia account for a substantial proportion of pneumonia hospitalisations and deaths. Further research is required to develop evidence-based approaches to screening, case management, and follow-up of children with severe pneumonia, prioritising those with underlying risk factors for readmission and mortality.
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Affiliation(s)
- Diana Marangu-Boore
- Paediatric Pulmonology Division, Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
| | - Paul Mwaniki
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Lynda Isaaka
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Teresiah Njoroge
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Livingstone Mumelo
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Dennis Kimego
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | | | - Conrad Wanyama
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ambrose Agweyu
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, Great Britain
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Kim Y, Kim HY. Turnover Rates and Factors Associated With Turnover: A Longitudinal Analysis of the Retention Period of Clinical Nurses in Korea Using National Data. Policy Polit Nurs Pract 2024; 25:83-93. [PMID: 38414406 DOI: 10.1177/15271544241231285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Many countries, including Korea, are struggling with a nursing workforce shortage. This study aimed to identify the actual turnover rate of Korean clinical nurses and the factors affecting the turnover rate, considering the time required for nurses to gain experience at their current medical institution. This longitudinal study followed up on a cohort consisting of all 107,682 nurses from January 1, 2017 to July 30, 2020. Differences in the distribution of retention and turnover according to the medical institutions' and nurses' characteristics were analyzed using the chi-square test. The hazard ratios (HRs) for turnover in each analysis interval were analyzed using multilevel Cox proportional-hazards analysis. The mean turnover rate was 10.0% within 1 year and 33.4% within 3.5 years. Several organizational characteristics (the type and ownership of the hospital, its location, and the bed-to-nurse ratio) and individual characteristics (gender, age, and clinical experience) were found to be associated with turnover risk. Among these factors, compared to hospitals with a bed-to-nurse ratio in general wards of 6.0 or more, those with a ratio of 3.5-3.9 had an HR for 1-year turnover of 0.81 (95% confidence interval [CI] = 0.67-0.98), and those with a ratio of 2.5-2.9 had an HR for 3.5-year turnover of 0.77 (95% CI = 0.66-0.90). The bed-to-nurse ratio is a condition that can be modified through collaboration between government policy-makers and medical institutions. To reduce nurse turnover and retain experienced nurses, appropriate staffing should be implemented.
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Affiliation(s)
- Yunmi Kim
- College of Nursing, Eulji University, Seongnam-si, Republic of Korea
| | - Hyun-Young Kim
- Department of Nursing, Jeonju University, Jeonju-si, Republic of Korea
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Chen S, Fu K, Cai Q, Feng Y, He H, Gao Y, Zhu Z, Jin D, Sheng J, Zhang C. Development of a risk-predicting score for hip preservation with bone grafting therapy for osteonecrosis. iScience 2024; 27:109332. [PMID: 38500832 PMCID: PMC10946322 DOI: 10.1016/j.isci.2024.109332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/02/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
Identification and differentiation of appropriate indications on hip preserving with bone grafting therapy remains a crucial challenge in the treatment of osteonecrosis of the femoral head (ONFH). A prospective cohort study on bone grafting therapy for ONFH aimed to evaluate hip survival rates, and to establish a risk scoring derived from potential risk factors (multivariable model) for hip preservation. Eight variables were identified to be strongly correlated with a decreased rate of hip survival post-therapy, and a comprehensive risk scoring was developed for predicting hip-preservation outcomes. The C-index stood at 0.72, and the areas under the receiver operating characteristics for the risk score's 5- and 10-year hip failure event predictions were 0.74 and 0.72, respectively. This risk score outperforms conventional methods in forecasting hip preservation. Bone grafting shows sustained benefits in treating ONFH when applied under the right indications. Furthermore, the risk scoring proves valuable as a decision-making tool, facilitating risk stratification for ONFH treatments in future.
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Affiliation(s)
- Shengbao Chen
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Kai Fu
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Qianying Cai
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Yong Feng
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Haiyan He
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Yun Gao
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Zhenzhong Zhu
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Dongxu Jin
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Jiagen Sheng
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
| | - Changqing Zhang
- Institute of Microsurgery on Extremities, and Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, National Center for Orthopaedics, Shanghai 200233, China
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Gebert P, Karsten MM, Hage AM, Dordevic AD, Grittner U. Statistical analysis plan for the PRO B study: open-label, superiority randomised controlled trial of alarm-based patient-reported outcome monitoring in patients with metastatic breast cancer. Trials 2024; 25:171. [PMID: 38448904 PMCID: PMC10918931 DOI: 10.1186/s13063-024-08025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND With an increasing collection of patient-reported outcomes (PROs) to measure health-related quality of life (HRQoL) in oncological patients, there is still a lack of standardised strategies on how to interpret and use these data in patient care. Prior research has shown support for the use of digital PRO monitoring together with alarm systems to notify clinicians when the PRO values are deteriorating. This system has demonstrated advantages in improving HRQoL and increasing survival rates among oncology patients. Hence, we designed the PRO B study, a superiority multi-centre randomised controlled trial, to investigate the effects of alarm-based monitoring in metastatic breast cancer patients in Germany. The study protocol for the PRO B study was published in September 2021, and this manuscript describes a formal statistical analysis plan (SAP) for the PRO B study to improve the transparency and quality of this trial. METHODS AND DESIGN The trial aimed to recruit 1000 patients with metastatic breast cancer. However, as of the completion of recruitment on June 15, 2023, we have successfully enrolled 924 patients from 52 breast cancer centres. Patients were 1:1 stratified randomised to the intervention and control groups. App-based PRO questionnaires are sent weekly to the intervention group and every 3 months to the control group. Only patients in the intervention group trigger an alarm if their PRO scores deteriorate, and they are subsequently contacted by the local care team within 48 h. The primary outcome is the fatigue score at 6 months, and secondary outcomes are other HRQoL and overall survival. Evaluation of the superiority of the intervention will be done using a linear mixed model with random intercepts for study centres. CONCLUSION This detailed SAP defines the main components of the statistical analysis for the PRO B study to assist the statistician and prevent bias in selecting analysis and reporting findings. Version 1 of the SAP was finalised on January 18, 2024. TRIAL REGISTRATION DRKS (German Clinical Trials Register) DRKS00024015 . Registered on February 15, 2021.
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Affiliation(s)
- Pimrapat Gebert
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
| | - Maria Margarete Karsten
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Anna Maria Hage
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Adam David Dordevic
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Ulrike Grittner
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
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19
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Kuenzig ME, Stukel TA, Carroll MW, Kaplan GG, Otley AR, Singh H, Bitton A, Fung SG, Spruin S, Coward S, Cui Y, Nugent Z, Griffiths AM, Mack DR, Jacobson K, Nguyen GC, Targownik LE, El-Matary W, Bernstein CN, Dummer TJB, Jones JL, Lix LM, Murthy SK, Peña-Sánchez JN, Nasiri S, Benchimol EI. Variation in the Care of Children with Inflammatory Bowel Disease Within and Across Canadian Provinces: A Multi-Province Population-Based Cohort Study. Clin Epidemiol 2024; 16:91-108. [PMID: 38374886 PMCID: PMC10875172 DOI: 10.2147/clep.s449183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/25/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose The incidence of childhood-onset inflammatory bowel disease (IBD) is rising. We described variation in health services utilization and need for surgery among children with IBD between six and 60 months following IBD diagnosis across Canadian pediatric centers and evaluated the associations between care provided at diagnosis at each center and the variation in these outcomes. Patients and Methods Using population-based deterministically-linked health administrative data from four Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario) we identified children diagnosed with IBD <16 years of age using validated algorithms. Children were assigned to a pediatric center of care using a hierarchical approach based on where they received their initial care. Outcomes included IBD-related hospitalizations, emergency department (ED) visits, and IBD-related abdominal surgery occurring between 6 and sixty months after diagnosis. Mixed-effects meta-analysis was used to pool results and examine the association between center-level care provision and outcomes. Results We identified 3784 incident cases of pediatric IBD, of whom 2937 (77.6%) were treated at pediatric centers. Almost a third (31.4%) of children had ≥1 IBD-related hospitalization and there were 0.66 hospitalizations per person during follow-up. More than half (55.8%) of children had ≥1 ED visit and there were 1.64 ED visits per person. Between-center heterogeneity was high for both outcomes; centers where more children visited the ED at diagnosis had more IBD-related hospitalizations and more ED visits during follow-up. Between-center heterogeneity was high for intestinal resection in Crohn's disease but not colectomy in ulcerative colitis. Conclusion There is variation in health services utilization among children with IBD and risk of undergoing intestinal resection in those with Crohn's disease, but not colectomy among children with ulcerative colitis, across Canadian pediatric tertiary-care centers. Improvements in clinical care pathways are needed to ensure all children have equitable and timely access to high quality care.
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Affiliation(s)
- M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (Sickkids), Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Therese A Stukel
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Matthew W Carroll
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Gilaad G Kaplan
- Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Anthony R Otley
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Harminder Singh
- Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Research Institute at CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Alain Bitton
- McGill University Health Centre, Division of Gastroenterology and Hepatology, Montreal, Québec, Canada
| | - Stephen G Fung
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Sarah Spruin
- ICES, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Stephanie Coward
- Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Yunsong Cui
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Zoann Nugent
- Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anne M Griffiths
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (Sickkids), Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - David R Mack
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevan Jacobson
- Department of Pediatrics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoffrey C Nguyen
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura E Targownik
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wael El-Matary
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Trevor J B Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer L Jones
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sanjay K Murthy
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Juan Nicolás Peña-Sánchez
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Soheila Nasiri
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (Sickkids), Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - On behalf of the Canadian Gastro-Intestinal Epidemiology Consortium
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (Sickkids), Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Research Institute at CancerCare Manitoba, Winnipeg, Manitoba, Canada
- McGill University Health Centre, Division of Gastroenterology and Hepatology, Montreal, Québec, Canada
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada
- CHEO Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Knapp SJ, Cole GS, Pincot DDA, Dilla-Ermita CJ, Bjornson M, Famula RA, Gordon TR, Harshman JM, Henry PM, Feldmann MJ. Transgressive segregation, hopeful monsters, and phenotypic selection drove rapid genetic gains and breakthroughs in predictive breeding for quantitative resistance to Macrophomina in strawberry. HORTICULTURE RESEARCH 2024; 11:uhad289. [PMID: 38487295 PMCID: PMC10939388 DOI: 10.1093/hr/uhad289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/17/2023] [Indexed: 03/17/2024]
Abstract
Two decades have passed since the strawberry (Fragaria x ananassa) disease caused by Macrophomina phaseolina, a necrotrophic soilborne fungal pathogen, began surfacing in California, Florida, and elsewhere. This disease has since become one of the most common causes of plant death and yield losses in strawberry. The Macrophomina problem emerged and expanded in the wake of the global phase-out of soil fumigation with methyl bromide and appears to have been aggravated by an increase in climate change-associated abiotic stresses. Here we show that sources of resistance to this pathogen are rare in gene banks and that the favorable alleles they carry are phenotypically unobvious. The latter were exposed by transgressive segregation and selection in populations phenotyped for resistance to Macrophomina under heat and drought stress. The genetic gains were immediate and dramatic. The frequency of highly resistant individuals increased from 1% in selection cycle 0 to 74% in selection cycle 2. Using GWAS and survival analysis, we found that phenotypic selection had increased the frequencies of favorable alleles among 10 loci associated with resistance and that favorable alleles had to be accumulated among four or more of these loci for an individual to acquire resistance. An unexpectedly straightforward solution to the Macrophomina disease resistance breeding problem emerged from our studies, which showed that highly resistant cultivars can be developed by genomic selection per se or marker-assisted stacking of favorable alleles among a comparatively small number of large-effect loci.
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Affiliation(s)
- Steven J Knapp
- Department of Plant Sciences, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Glenn S Cole
- Department of Plant Sciences, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Dominique D A Pincot
- Department of Plant Sciences, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Christine Jade Dilla-Ermita
- Department of Plant Sciences, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA
- Crop Improvement and Protection Research, USDA-ARS, 1636 E. Alisal Street, CA 93905, USA
| | - Marta Bjornson
- Department of Plant Sciences, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Randi A Famula
- Department of Plant Sciences, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Thomas R Gordon
- Department of Plant Pathology, University of California, One Shields Avenue, Davis, CA 95616, USA
| | - Julia M Harshman
- Department of Plant Sciences, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Peter M Henry
- Crop Improvement and Protection Research, USDA-ARS, 1636 E. Alisal Street, CA 93905, USA
| | - Mitchell J Feldmann
- Department of Plant Sciences, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA
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Nix HP, Meeker S, King CE, Andrew M, Davis IRC, Koto PS, Sim M, Murdoch J, Patriquin G, Theriault C, Reidy S, Rockwood M, Sampalli T, Searle SD, Rockwood K. Preventing Respiratory Viral Illness Invisibly (PRiVII): protocol for a pragmatic cluster randomized trial evaluating far-UVC light devices in long-term care facilities to reduce infections. Trials 2024; 25:88. [PMID: 38279184 PMCID: PMC10811883 DOI: 10.1186/s13063-024-07909-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/03/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Respiratory viral illness (RVI)-e.g., influenza, COVID-19-is a serious threat in long-term care (LTC) facilities. Standard infection control measures are suboptimal in LTC facilities because of residents' cognitive impairments, care needs, and susceptibility to loneliness and mental illness. Further, LTC residents living with high degrees of frailty who contract RVIs often develop the so-called atypical symptoms (e.g., delirium, worse mobility) instead of typical cough and fever, delaying infection diagnosis and treatment. Although far-UVC (222 nm) light devices have shown potent antiviral activity in vitro, clinical efficacy remains unproven. METHODS Following a study to assay acceptability at each site, this multicenter, double-blinded, cluster-randomized, placebo-controlled trial aims to assess whether far-UVC light devices impact the incidence of RVIs in LTC facilities. Neighborhoods within LTC facilities are randomized to receive far-UVC light devices (222 nm) or identical placebo light devices that emit only visible spectrum light (400-700 nm) in common areas. All residents are monitored for RVIs using both a standard screening protocol and a novel screening protocol that target atypical symptoms. The 3-year incidence of RVIs will be compared using intention-to-treat analysis. A cost-consequence analysis will follow. DISCUSSION This trial aims to inform decisions about whether to implement far-UVC light in LTC facilities for RVI prevention. The trial design features align with this pragmatic intent. Appropriate additional ethical protections have been implemented to mitigate participant vulnerabilities that arise from conducting this study. Knowledge dissemination will be supported through media engagement, peer-reviewed presentations, and publications. TRIAL REGISTRATION ClinicalTrials.gov NCT05084898. October 20, 2021.
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Affiliation(s)
- Hayden P Nix
- Geriatric Medicine Research, Halifax, NS, Canada.
- Department of Medicine, Dalhousie University, Halifax, NS, Canada.
| | | | - Caroline E King
- Research, Innovation and Discovery, Nova Scotia Health, Halifax, NS, Canada
| | - Melissa Andrew
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ian R C Davis
- Division of Infectious Diseases, Department of Medicine, Nova Scotia Health, Halifax, NS, Canada
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Prosper S Koto
- Research Methods Unit, Nova Scotia Health, Halifax, NS, Canada
| | - Meaghan Sim
- Research, Innovation and Discovery, Nova Scotia Health, Halifax, NS, Canada
| | - Jennifer Murdoch
- Research, Innovation and Discovery, Nova Scotia Health, Halifax, NS, Canada
| | - Glenn Patriquin
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, NS, Canada
| | - Chris Theriault
- Research Methods Unit, Nova Scotia Health, Halifax, NS, Canada
| | - Stephanie Reidy
- Geriatric Medicine Research, Halifax, NS, Canada
- Division of Rheumatology, Nova Scotia Health, Halifax, NS, Canada
| | | | - Tara Sampalli
- Research, Innovation and Discovery, Nova Scotia Health, Halifax, NS, Canada
| | - Samuel D Searle
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
- Medical Research Council Unit for Lifelong Health and Ageing at University College London, University College London, London, UK
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
- Frailty & Elder Care Network, Nova Scotia Health, Halifax, NS, Canada
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22
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Kageyama S, Ohashi T, Yoshida T, Kobayashi Y, Kojima A, Kobayashi D, Kojima T. Early mortality of emergency surgery for acute type A aortic dissection in octogenarians and nonagenarians: A multi-center retrospective study. J Thorac Cardiovasc Surg 2024; 167:65-75.e8. [PMID: 35277246 DOI: 10.1016/j.jtcvs.2022.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The clinical data on postoperative mortality and central nervous system (CNS) complications in older adults who underwent acute type A aortic dissection are limited. Thus, in this study we aimed to evaluate the association between age and early postoperative mortality and occurrence of CNS complications. METHODS This multicentric retrospective cohort study included 5 tertiary hospitals in Japan. All patients who underwent emergency surgery for acute type A aortic dissection between October 1998 and December 2019 were enrolled. The multilevel Cox proportional hazards model, which considered years as level 1, institutions as level 2, and surgeons as level 3, was used to evaluate the association between age and early postoperative hospital mortality and occurrence of CNS complications. RESULTS Of the 1037 patients, 227 (21.9%) were ≥80 years old and 810 (78.1%) were <80 years old. Overall, 134 patients (12.9%) died within 30 days postoperatively; among them, 42/227 (18.5%) and 92/810 (11.4%) were aged ≥80 and <80 years, respectively (hazard ratio [HR], 1.63; P = .0046). CNS complications within 30 days postoperatively occurred in 140/1037 (13.5%) patients; among them, 42/227 (18.5%) and 98/810 (12.1%) were aged ≥80 and <80 years, respectively (HR, 1.63; P = .011). In multivariate analysis, age ≥80 years was associated with mortality within 30 days postoperatively (adjusted HR, 2.37; 95% CI, 1.23-4.57; P = .01) but not with CNS complications (adjusted HR, 1.58; 95% CI, 0.93-2.69; P = .091). CONCLUSIONS The early postoperative mortality in older patients was approximately 50% higher than in the younger population. A thorough discussion regarding the surgical indications should be done.
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Affiliation(s)
- Soichiro Kageyama
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Takeki Ohashi
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Takeshi Yoshida
- Department of Cardiovascular Surgery, Matsubara Tokushukai Hospital, Matsubara-city, Osaka, Japan
| | - Yutaka Kobayashi
- Department of Cardiovascular Surgery, Uji Tokushukai Hospital, Makishima-cho, Uji-city, Kyoto, Japan
| | - Akinori Kojima
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Daiki Kobayashi
- Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu-shi, Aichi, Japan.
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23
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Gastmeier K, Gastmeier A, Schwab F, Herdegen T. The Use of Tetrahydrocannabinol Is Associated with an Increase in Survival Time in Palliative Cancer Patients: A Retrospective Multicenter Cohort Study. Med Cannabis Cannabinoids 2024; 7:59-67. [PMID: 38655402 PMCID: PMC11037891 DOI: 10.1159/000538311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/04/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Tetrahydrocannabinol (THC) is often prescribed for ambulatory palliative patients to improve sleep quality and appetite and to reduce anxiety, stress, and pain. However, it is not known if THC has also an effect on the mortality of these patients. Method The objective was the impact of THC on mortality of ambulatory palliative patients. For this purpose, data from the palliative treatment documentation from 5 ambulatory palliative care teams in Brandenburg, Germany were used for this analysis. Survival time was calculated for 3 groups of patients: (1) without THC; (2) with THC in a low dosage (≤4.7 mg per day); and (3) THC in higher doses (≥4.7 mg per day). The analysis was done for 2 cohorts of patients. Cohort 1: all patients with a survival time of at least 7 days after inclusion in specialized ambulatory palliative care (SAPC) and cohort 2: a subgroup of patients with a survival time between 7 and 100 days. Kaplan-Meier curves were created, and multivariate analysis was done to investigate the impact of THC on mortality. Results A total of 9,419 patients with a survival time of at least 7 days after inclusion in SAPC were included in the analysis (cohort 1). 7,085 among them had a survival time between 7 and 100 days (cohort 2). In both cohorts, survival time was significantly prolonged by THC, but only when the daily THC dose was above the median of 4.7 mg. Survival time was 15 days longer in cohort 2 (40 vs. 25 days), when more than 4.7 mg THC were prescribed per day. Conclusion Use of THC is associated with a significant increase in survival time in ambulatory palliative patients which survive longer than 7 days the initiation of THC prescription and which use of THC >4.7 mg/day.
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Affiliation(s)
- Knud Gastmeier
- Practice for Palliative Medicine Potsdam, Potsdam, Germany
| | - Anne Gastmeier
- Special Practice for Internal Medicine, Pneumology and General Medicine, Kleinmachnow, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Thomas Herdegen
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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24
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Zarghami A, Fuh‐Ngwa V, Claflin SB, van der Mei I, Ponsonby A, Broadley S, Simpson‐Yap S, Taylor BV. Changes in employment status over time in multiple sclerosis following a first episode of central nervous system demyelination, a Markov multistate model study. Eur J Neurol 2024; 31:e16016. [PMID: 37525323 PMCID: PMC11235915 DOI: 10.1111/ene.16016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND AND PURPOSE Understanding predictors of changes in employment status among people living with multiple sclerosis (MS) can assist health care providers to develop appropriate work retention/rehabilitation programs. We aimed to model longitudinal transitions of employment status in MS and estimate the probabilities of retaining employment status or losing or gaining employment over time in individuals with a first clinical diagnosis of central nervous system demyelination (FCD). METHODS This prospective cohort study comprised adults (aged 18-59 years) diagnosed with FCD (n = 237) who were followed for more than 11 years. At each review, participants were assigned to one of three states: unemployed, part-time, or full-time employed. A Markov multistate model was used to examine the rate of state-to-state transitions. RESULTS At the time of FCD, participants with full-time employment had an 89% chance of being in the same state over a 1-year period, but this decreased to 42% over the 10-year follow-up period. For unemployed participants, there was a 92% likelihood of remaining unemployed after 1 year, but this probability decreased to 53% over 10 years. Females, those who progressed to clinically definite MS, those with a higher relapse count, and those with a greater level of disability were at increased risk of transitioning to a deteriorated employment state. In addition, those who experienced clinically significant fatigue over the follow-up period were less likely to gain employment after being unemployed. CONCLUSIONS In our FCD cohort, we found a considerable rate of employment transition during the early years post-diagnosis. Over more than a decade of follow-up post-FCD, we found that females and individuals with a greater disability and a higher relapse count are at higher risk of losing employment.
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Affiliation(s)
- Amin Zarghami
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
| | - Valery Fuh‐Ngwa
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
| | - Suzi B. Claflin
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
| | - Ingrid van der Mei
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
| | - Anne‐Louise Ponsonby
- The Florey Institute of Neuroscience and Mental HealthThe University of MelbourneParkvilleVictoriaAustralia
- Murdoch Children's Research InstituteRoyal Children's Hospital, The University of MelbourneParkvilleVictoriaAustralia
| | - Simon Broadley
- Menzies Health Institute QueenslandGriffith UniversitySouthportQueenslandAustralia
| | - Steve Simpson‐Yap
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
- Melbourne School of Population and Global HealthThe University of MelbourneParkvilleVictoriaAustralia
| | - Bruce V. Taylor
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
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25
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Miller RJH, Gransar H, Rozanski A, Dey D, Al‐Mallah M, Chow BJW, Kaufmann PA, Cademartiri F, Maffei E, Han D, Slomka PJ, Berman DS. Simplified Approach to Predicting Obstructive Coronary Disease With Integration of Coronary Calcium: Development and External Validation. J Am Heart Assoc 2023; 12:e031601. [PMID: 38108259 PMCID: PMC10863788 DOI: 10.1161/jaha.123.031601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The Diamond-Forrester model was used extensively to predict obstructive coronary artery disease (CAD) but overestimates probability in current populations. Coronary artery calcium (CAC) is a useful marker of CAD, which is not routinely integrated with other features. We derived simple likelihood tables, integrating CAC with age, sex, and cardiac chest pain to predict obstructive CAD. METHODS AND RESULTS The training population included patients from 3 multinational sites (n=2055), with 2 sites for external testing (n=3321). We determined associations between age, sex, cardiac chest pain, and CAC with the presence of obstructive CAD, defined as any stenosis ≥50% on coronary computed tomography angiography. Prediction performance was assessed using area under the receiver-operating characteristic curves (AUCs) and compared with the CAD Consortium models with and without CAC, which require detailed calculations, and the updated Diamond-Forrester model. In external testing, the proposed likelihood tables had higher AUC (0.875 [95% CI, 0.862-0.889]) than the CAD Consortium clinical+CAC score (AUC, 0.868 [95% CI, 0.855-0.881]; P=0.030) and the updated Diamond-Forrester model (AUC, 0.679 [95% CI, 0.658-0.699]; P<0.001). The calibration for the likelihood tables was better than the CAD Consortium model (Brier score, 0.116 versus 0.121; P=0.005). CONCLUSIONS We have developed and externally validated simple likelihood tables to integrate CAC with age, sex, and cardiac chest pain, demonstrating improved prediction performance compared with other risk models. Our tool affords physicians with the opportunity to rapidly and easily integrate a small number of important features to estimate a patient's likelihood of obstructive CAD as an aid to clinical management.
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Affiliation(s)
- Robert J. H. Miller
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryAlbertaCanada
| | - Heidi Gransar
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
| | - Alan Rozanski
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
- Division of Cardiology and Department of MedicineMount Sinai Morningside HospitalMount Sinai Heart and the Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Damini Dey
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
| | - Mouaz Al‐Mallah
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | - Benjamin J. W. Chow
- Departments of Medicine (Cardiology and Nuclear Medicine) and RadiologyUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Philipp A. Kaufmann
- Department of Nuclear MedicineUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | | | - Erica Maffei
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) SYNLAB SDNNaplesItaly
| | - Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
| | - Piotr J. Slomka
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
| | - Daniel S. Berman
- Departments of Medicine (Division of Artificial Intelligence in Medicine)Imaging and Biomedical SciencesCedars‐Sinai Medical CenterLos AngelesCA
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26
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Tasfa Marine B, Mengistie DT. Application of parametric survival analysis to women patients with breast cancer at Jimma University Medical Center. BMC Cancer 2023; 23:1223. [PMID: 38087229 PMCID: PMC10714515 DOI: 10.1186/s12885-023-11685-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
Public health systems in both industrialized and undeveloped countries continue to struggle with the worldwide problem of breast cancer. In sub-Saharan African countries, notably Ethiopia, it is the form of cancer that strikes women the most commonly. Despite the extreme difficulties, the causes of mortality in Ethiopia have not yet been identified. In addition, little study has been done in this area. Therefore, the major objective of this analysis was to pinpoint the factors that were most responsible for the decreased life expectancy of breast cancer patients at the University of Jimma Medical Center. 552 women who had been treated for breast cancer at Jimma University Medical Center between October 2018 and December 2022 were included in this study, which used a retrospective cohort study design and five-year follow-up data. The most frequent and widely used test for comparing the probability of survival curves between several categorical independent variables was the log-rank test. Next, semi-parametric methods for multivariable analysis using the Cox proportional hazards model were used. Furthermore, a parametric strategy that includes fully parametric survival models better achieves the goal of the analysis. Among covariate, age of patient (ϕ = 254.06; 95% CI (3.95, 7.13), P-value = 0.000), patient live in urban (ϕ = 0.84; 95% CI (-0.35,-0.00), P-value = 0.047), preexisting comorbidity (ϕ = 2.46; 95% CI (0.39, 1.41), P-value = 0.001), overweight women cancer patient (ϕ = 0.05; 95% CI(-4.41,-1.57), P-value = 0.000, positive Axillary Node status cancer patient (ϕ = 0.04; 95% CI(-4.45,-1.88), P-value = 0.000), both surgery and chemotropic baseline treatment patient (ϕ = 0.53; 95% CI(-1.12,-0.16), P-value = 0.009) significantly affected the survival of women breast cancer. Age of breast cancer patient, patient education level, place of residence, marital status, pre-existing comorbidity, axillary node status, estrogen receptor, tumor size, body mass index at diagnosis, stage of cancer, and baseline treatment were found to have a significant effect on time to survive for women with breast cancer at the University of Jimma Medical Center, Oromia region, Ethiopia. However, the covariate histologic grade, number of positive lymph nodes involved, and type of hormone used were insignificant to the survival of breast cancer patients.
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Affiliation(s)
- Buzuneh Tasfa Marine
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
| | - Dagne Tesfaye Mengistie
- Department of Statistics, College of Natural and Computational Science, Jigjiga University, Jigjiga, Ethiopia
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27
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Zhou Y, Liu Y, Jiang L, Zhang R, Zhang H, Shi Q, Yang Z, Mao Y, Liu S, Yang Z, Ding J, Zhou Y, Ren B, He L, Zhao X, Li W, Li S, Liu D. Azvudine and nirmatrelvir-ritonavir in hospitalized patients with moderate-to-severe COVID-19: Emulation of a randomized target trial. J Med Virol 2023; 95:e29318. [PMID: 38112106 DOI: 10.1002/jmv.29318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/12/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023]
Abstract
To examine the effectiveness of azvudine and nirmatrelvir-ritonavir in treating hospitalized patients with moderate-to-severe COVID-19. We emulated a target trial with a multicenter retrospective cohort of hospitalized adults with moderate-to-severe COVID-19 without contraindications for azvudine or nirmatrelvir-ritonavir between December 01, 2022 and January 19, 2023 (during the Omicron BA.5.2 variant wave). Exposures included treatment with azvudine or nirmatrelvir-ritonavir for 5 days versus no antiviral treatment during hospitalization. Primary composite outcome (all-cause death and initiation of invasive mechanical ventilation), and their separate events were evaluated. Of the 1154 patients, 27.2% were severe cases. In the intent-to-treat analyses, azvudine reduced all-cause death (Hazard ratio [HR]: 0.31; 95% CI: 0.12-0.78), and its composite with invasive mechanical ventilation (HR: 0.47; 95% CI: 0.24-0.92). Nirmatrelvir-ritonavir reduced invasive mechanical ventilation (HR: 0.42; 95% CI: 0.17-1.05), and its composite with all-cause death (HR: 0.38; 95% CI: 0.18-0.81). The study did not identify credible subgroup effects. The per-protocol analyses and all sensitivity analyses confirmed the robustness of the findings. Both azvudine and nirmatrelvir-ritonavir improved the prognosis of hospitalized adults with moderate-to-severe COVID-19.
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Affiliation(s)
- Yiling Zhou
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Li Jiang
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Renqing Zhang
- Chengdu Public Health Clinical Medical Center, Chengdu, China
| | - Huohuo Zhang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qingyang Shi
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Zhirong Yang
- Department of Computational Biology and Health Informatics, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Yi Mao
- Chengdu Public Health Clinical Medical Center, Chengdu, China
| | - Sha Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhibo Yang
- Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jialin Ding
- Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yongzhao Zhou
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bi Ren
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Liping He
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Institute of Respiratory Health, West China Hospital, Sichuan University, Chengdu, China
- Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Chinese Evidence-Based Medicine Center, Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Institute of Respiratory Health, West China Hospital, Sichuan University, Chengdu, China
- Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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28
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Coulter DJ, Lloyd CD, Serin RC. Psychometric Properties of a Risk Tool Across Indigenous Māori and European Samples in Aotearoa New Zealand: Measurement Invariance, Discrimination, and Calibration for Predicting Criminal Recidivism. Assessment 2023; 30:2560-2579. [PMID: 36919226 PMCID: PMC10655698 DOI: 10.1177/10731911231153838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Due to recent legal cases highlighting a lack of cross-ethnicity validity research using correctional risk assessment tools, we evaluated psychometric properties of Dynamic Risk Assessment for Offender Re-entry (DRAOR) scores across Māori (n = 1,812) and New Zealand (NZ) European samples (n = 1,211) in Aotearoa NZ. Using routine administrative data, our analyses suggested scoring properties were invariant across ethnicity for 15 of 19 items. Discrimination properties were also equivalent, but we observed a higher recidivism base rate among Māori participants, consistent with official statistics. Consequently, calibration analyses using a fixed follow-up (N = 372) demonstrated higher predicted recidivism rates for Māori participants at each DRAOR score. This suggests that Māori participants with similar levels of DRAOR-assessed need factors as NZ European participants experienced relatively greater continued justice contact. DRAOR users should prioritize delivering quality case management to clients, recognizing that both case-specific and systemic factors may underlie differential base rates.
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Affiliation(s)
- Darcy J. Coulter
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Alphington, Victoria, Australia
| | - Caleb D. Lloyd
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Forensicare, Alphington, Victoria, Australia
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29
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Campbell SP, Kim CJ, Allkanjari A, Aksenov LI, Dionise ZR, Inouye BM, Lentz AC. Infection rates following urologic prosthetic revision without replacement of any device components compared to partial or complete device exchange: a single-center retrospective cohort study. Int J Impot Res 2023; 35:725-730. [PMID: 36151320 DOI: 10.1038/s41443-022-00616-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 11/09/2022]
Abstract
Urologic implant revision carries a higher infection risk than virgin implantation. Historically, exchanging device components at the time of revision was performed to reduce infection risk. We hypothesize that revision without replacement of any parts of the device may not be associated with increased infection risk. A single-center, retrospective cohort study was performed on patients undergoing urologic implant revision from 2000 to 2021. Revisions involving exchange of any/all device components (+CE) were compared to revisions without exchange of any components (-CE). The primary outcome was infection or erosion within 12 weeks of revision. Infection rates were compared using Fischer exact test. Infection-free survival (IFS) was compared with Kaplan-Meier (KM) log-rank test and Cox proportional hazards (CPH) model. 551 revisions were included, including 497 revisions with CE and 54 without CE. Among those with at least 12 weeks follow-up, no difference was seen in infection rates within 12 weeks of revision [-CE 3/39 (7.7%) vs. +CE 10/383 (2.6%)], p = 0.109). In addition, IFS was comparable between groups (log-rank test p = 0.22, HR for -CE 1.65 (0.65-4.21). Revision surgery for IPP or AUS without CE may not present an elevated risk of infection in the properly selected patient.
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Affiliation(s)
- Scott P Campbell
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Chris J Kim
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Armand Allkanjari
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Leonid I Aksenov
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Zachary R Dionise
- Division of Urology, Duke University Medical Center, Durham, NC, USA
| | - Brian M Inouye
- Division of Urology, Albany Medical Center, Albany, NY, USA
| | - Aaron C Lentz
- Division of Urology, Duke University Medical Center, Durham, NC, USA.
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Reddy RK, Howard JP, Ahmad Y, Shun-Shin MJ, Simader FA, Miyazawa AA, Saleh K, Naraen A, Samways JW, Katritsis G, Mohal JS, Kaza N, Porter B, Keene D, Linton NWF, Francis DP, Whinnett ZI, Luther V, Kanagaratnam P, Arnold AD. Catheter Ablation for Ventricular Tachycardia After MI: A Reconstructed Individual Patient Data Meta-analysis of Randomised Controlled Trials. Arrhythm Electrophysiol Rev 2023; 12:e26. [PMID: 38124803 PMCID: PMC10731517 DOI: 10.15420/aer.2023.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/24/2023] [Indexed: 12/23/2023] Open
Abstract
Background The prognostic impact of ventricular tachycardia (VT) catheter ablation is an important outstanding research question. We undertook a reconstructed individual patient data meta-analysis of randomised controlled trials comparing ablation to medical therapy in patients developing VT after MI. Methods We systematically identified all trials comparing catheter ablation to medical therapy in patients with VT and prior MI. The prespecified primary endpoint was reconstructed individual patient assessment of all-cause mortality. Prespecified secondary endpoints included trial-level assessment of all-cause mortality, VT recurrence or defibrillator shocks and all-cause hospitalisations. Prespecified subgroup analysis was performed for ablation approaches involving only substrate modification without VT activation mapping. Sensitivity analyses were performed depending on the proportion of patients with prior MI included. Results Eight trials, recruiting a total of 874 patients, were included. Of these 874 patients, 430 were randomised to catheter ablation and 444 were randomised to medical therapy. Catheter ablation reduced all-cause mortality compared with medical therapy when synthesising individual patient data (HR 0.63; 95% CI [0.41-0.96]; p=0.03), but not in trial-level analysis (RR 0.91; 95% CI [0.67-1.23]; p=0.53; I2=0%). Catheter ablation significantly reduced VT recurrence, defibrillator shocks and hospitalisations compared with medical therapy. Sensitivity analyses were consistent with the primary analyses. Conclusion In patients with postinfarct VT, catheter ablation reduces mortality.
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Affiliation(s)
- Rohin K Reddy
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - James P Howard
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale UniversityNew Haven, CT, US
| | | | | | | | - Keenan Saleh
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Akriti Naraen
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Jack W Samways
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - George Katritsis
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Jagdeep S Mohal
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Nandita Kaza
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Bradley Porter
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | | | - Darrel P Francis
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | | | - Vishal Luther
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | | | - Ahran D Arnold
- National Heart and Lung Institute, Imperial College LondonLondon, UK
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Klarenbeek SE, Aarts MJ, van den Heuvel MM, Prokop M, Tummers M, Schuurbiers-Siebers OCJ. Impact of time-to-treatment on survival for early-stage non-small cell lung cancer in The Netherlands-a nationwide observational cohort study. Transl Lung Cancer Res 2023; 12:2015-2029. [PMID: 38025812 PMCID: PMC10654436 DOI: 10.21037/tlcr-23-256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/29/2023] [Indexed: 12/01/2023]
Abstract
Background Varied outcomes on the relation between time-to-treatment and survival in early-stage non-small cell lung cancer (NSCLC) patients are reported. We examined this relation in a large multicentric retrospective cohort study and identified factors associated with extended time-to-treatment. Methods We included 9,536 patients with clinical stage I-II NSCLC, diagnosed and treated in 2014-2019, from the Netherlands Cancer Registry that includes nation-wide data. Time-to-treatment was defined as the number of days between first outpatient visit for suspected lung cancer and start of treatment. The effect of extended time-to-treatment beyond the first quartile and survival was studied with Cox proportional hazard regression. Analyses were stratified for stage and type of therapy. Time-to-treatment was adjusted for multiple covariates including performance status and socioeconomic status. Factors associated with treatment delay were identified by multilevel logistic regression. Results Median time-to-treatment was 47 days [interquartile range (IQR): 34-65] for stage I and 46 days (IQR: 34-62) for stage II. The first quartile extended to 33 days for both stages. Risk of death increased significantly with extended time-to-treatment for surgical treatment of clinical stage II patients [adjusted hazard ratio (aHR) >33 days: 1.36, 95% confidence intervals (CI): 1.09-1.70], but not in stage II patients treated with radiotherapy or in stage I patients. Causes of prolonged time-to-treatment were multifactorial including diagnostic tests, such as endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS). Conclusions Clinical stage II patients benefit from fast initiation of surgical treatment. Surprisingly this appears to be accounted for by patients who are clinically stage II but pathologically stage I. Further study is needed on characterizing these patients and the significance of lymph node- or distant micrometastasis in guiding time-to-treatment and treatment strategy.
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Affiliation(s)
- Sosse E. Klarenbeek
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mieke J. Aarts
- Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Michel M. van den Heuvel
- Department of Pulmonary Diseases, Radboud Institute for Molecular Life Sciences, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga C. J. Schuurbiers-Siebers
- Department of Pulmonary Diseases, Radboud Institute for Molecular Life Sciences, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Essuman MA, Storph RP, Ahinkorah BO, Budu E, Yaya S. Hygienic Disposal of Children's Stools Practices Among Women of Children With Diarrhoea in Sub-Saharan Africa. ENVIRONMENTAL HEALTH INSIGHTS 2023; 17:11786302231204764. [PMID: 37899844 PMCID: PMC10605691 DOI: 10.1177/11786302231204764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/13/2023] [Indexed: 10/31/2023]
Abstract
Background Diarrhoea stools contain infectious agents and pose a public health threat to children and members of the entire family when exposed to them. Therefore, their hygienic disposal is essential. Empirical data are needed to stir the needed public health interventions to encourage or enforce proper disposal practices to curb associated clinical issues. This study assessed the prevalence and correlates of hygienic stool disposal practices by mothers of children with diarrhoea in sub-Saharan Africa (SSA). Methods The Demographic and Health Surveys (DHS) data of 16 sub-Saharan African countries from 2015 to 2021 involving 22 590 mother-child pairs were analysed. Multilevel binary logistic analysis was conducted to assess the individual- and household-level factors associated with the hygienic disposal of stool practices by mothers of children with diarrhoea. The results were presented using adjusted odds ratios (AOR) and 95% confidence intervals (CI) at a statistical significance of P < .05. Results The overall prevalence of hygienic disposal of children's stools among women of children with diarrhoea was 49.01% (95% CI: 48.40-49.62) and ranged from 15.70% in Liberia to 86.6% in Rwanda. The practice of hygienic disposal of stools of children with diarrhoea was likely to increase among mothers who are working (AOR: 1.19; 95% CI: 1.09-1.30), those with partners with primary level of education (AOR: 1.18; 95% CI: 1.06-1.31), Muslims (AOR: 1.69; 95% CI: 1.49-1.91) and widowed/divorced (AOR: 8.94, 95% CI: 3.55-22.53). Again, mothers in the richer (AOR: 1.23; 95% CI: 1.08-1.39) wealth index had increased odds of disposing of stools hygienically compared to those in the poorest wealth index. Women who were 20 years and above, to who belonged to Traditional Religions (AOR: 0.57; 95% CI: 0.43-0.74), and those with unimproved sources of water (AOR: 0.89; 95% CI: 0.82-0.98) and toilet facilities (AOR: 0.63; 95% CI: 0.58-0.69) were less likely to dispose of child's diarrhoea stool hygienically than their counterparts. Conclusion The study reveals that the unhygienic disposal of the stool of children with diarrhoea is prevalent in SSA and requires a concerted effort to curb it. Sanitation practices such as educating mothers about hygienic disposal of children's stool and improving water and sanitation facilities are crucial in lowering the high prevalence of unhygienic disposal of the diarrhoeic stool of children. Additional country-level research is needed to assess children's defecation behaviours and the disposal of diarrhoeic stools using different methodologies.
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Affiliation(s)
- Mainprice Akuoko Essuman
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Central, Ghana
| | | | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Eugene Budu
- Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Zhu Y, Ren P, Doi SA, Furuya-Kanamori L, Lin L, Zhou X, Tao F, Xu C. Data extraction error in pharmaceutical versus non-pharmaceutical interventions for evidence synthesis: Study protocol for a crossover trial. Contemp Clin Trials Commun 2023; 35:101189. [PMID: 37520330 PMCID: PMC10374854 DOI: 10.1016/j.conctc.2023.101189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 07/09/2023] [Accepted: 07/15/2023] [Indexed: 08/01/2023] Open
Abstract
Background Data extraction is the foundation for research synthesis evidence, while data extraction errors frequently occur in the literature. An interesting phenomenon was observed that data extraction error tend to be more common in trials of pharmaceutical interventions compared to non-pharmaceutical ones. The elucidation of which would have implications for guidelines, practice, and policy. Methods and analyses We propose a crossover, multicenter, investigator-blinded trial to elucidate the potential variants on the data extraction error rates. Eligible 90 participants would be 2nd year or above post-graduate students (e.g., masters, doctoral program). Participants will be randomized to one of the two groups to complete pre-defined data extraction tasks: 1) group A will contain 10 randomized controlled trials (RCTs) of pharmaceutical interventions; 2) group B will contain 10 RCTs of non-pharmaceutical interventions. Participants who finish the data extraction would then be assigned to the alternative group for another round of data extraction after a 30 min washout period. Finally, those participants assigned to A or B group will be further 1:1 randomly matched based on a random-sequenced number for the double-checking process on the extracted data. The primary outcome will be the data extract error rates of the pharmaceutical intervention group and non-pharmaceutical group, before the double-checking process, in terms of the cell level, study level, and participant level. The secondary outcome will be the data error rates of the pharmaceutical intervention group and non-pharmaceutical group after the double-checking process, again, in terms of the cell level, study level, and participant level. A generalized linear mixed effects model (based on the above three levels) will be used to estimate the potential differences in the error rates, with a log link function for binomial data. Subgroup analyses will account for the experience of individuals on systematic reviews and the time used for the data extraction. Discussion This trial will provide useful evidence for further systematic review of data extraction practices, improved data extraction strategies, and better guidelines. Trial registration Chinese Clinical Trial Register Center (Identifier: ChiCTR2200062206).
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Affiliation(s)
- Yi Zhu
- MOE Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), No. 81 Meishan Road, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Anhui, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui, China
| | - Pengwei Ren
- Department of Clinical Research Center for Respiratory Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Suhail A.R. Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Lifeng Lin
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Xiaoqin Zhou
- Department of Clinical Research Management, West China Hospital, Sichuan University, China
| | - Fangbiao Tao
- MOE Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), No. 81 Meishan Road, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Anhui, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui, China
| | - Chang Xu
- MOE Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), No. 81 Meishan Road, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Anhui, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui, China
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Shou BL, Wilcox C, Florissi IS, Krishnan A, Kim BS, Keller SP, Whitman GJR, Uchino K, Bush EL, Cho SM. National Trends, Risk Factors, and Outcomes of Acute In-Hospital Stroke Following Lung Transplantation in the United States: Analysis of the United Network for Organ Sharing Registry. Chest 2023; 164:939-951. [PMID: 37054775 PMCID: PMC10567928 DOI: 10.1016/j.chest.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Lung transplantation (LTx) is the definitive treatment for end-stage lung failure. However, there have been no large, long-term studies on the impact of acute in-hospital stroke in this population. RESEARCH QUESTION What are the trends, risk factors, and outcomes of acute stroke in patients undergoing LTx in the United States? STUDY DESIGN AND METHODS We identified adult first-time isolated LTx recipients from the United Network for Organ Sharing database, which comprehensively captures every transplant in the United States, between May 2005 and December 2020. Stroke was defined as occurring at any time after LTx but prior to discharge. Multivariable logistic regression with stepwise feature elimination was used to identify risk factors for stroke. Freedom from death in patients with a stroke vs those without a stroke was evaluated with Kaplan-Meier analysis. Cox proportional hazards analysis was used to identify predictors of death at 24 months. RESULTS Of 28,564 patients (median age, 60 years; 60% male), 653 (2.3%) experienced an acute in-hospital stroke after LTx. Median follow-up was 1.2 (stroke) and 3.0 (non-stroke) years. Annual incidence of stroke increased (1.5% in 2005 to 2.4% in 2020; P for trend = .007), as did lung allocation score and utilization of post-LTx extracorporeal membrane oxygenation (P = .01 and P < .001, respectively). Compared with those without stroke, patients with stroke had lower survival at 1 month (84% vs 98%), 12 months (61% vs 88%), and 24 months (52% vs 80%) (log-rank test, P < .001 for all). In Cox analysis, acute stroke conferred a high hazard of mortality (hazard ratio, 3.01; 95% CI, 2.67-3.41). Post-LTx extracorporeal membrane oxygenation was the strongest risk factor for stroke (adjusted OR, 2.98; 95% CI, 2.19-4.06). INTERPRETATION Acute in-hospital stroke post-LTx has been increasing over time and is associated with markedly worse short- and long-term survival. As increasingly sicker patients undergo LTx as well as experience stroke, further research on stroke characteristics, prevention, and management strategies is warranted.
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Affiliation(s)
- Benjamin L Shou
- Division of Cardiac Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Christopher Wilcox
- Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD
| | - Isabella S Florissi
- Division of Cardiac Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Aravind Krishnan
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA
| | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Steven P Keller
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Glenn J R Whitman
- Division of Cardiac Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Ken Uchino
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Errol L Bush
- Division of General Thoracic Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sung-Min Cho
- Division of Cardiac Surgery, Johns Hopkins School of Medicine, Baltimore, MD; Division of Neurosciences Critical Care, Johns Hopkins School of Medicine, Baltimore, MD.
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de Wildt KK, van de Loo B, Linn AJ, Medlock SK, Groos SS, Ploegmakers KJ, Seppala LJ, Bosmans JE, Abu-Hanna A, van Weert JCM, van Schoor NM, van der Velde N. Effects of a clinical decision support system and patient portal for preventing medication-related falls in older fallers: Protocol of a cluster randomized controlled trial with embedded process and economic evaluations (ADFICE_IT). PLoS One 2023; 18:e0289385. [PMID: 37751429 PMCID: PMC10522018 DOI: 10.1371/journal.pone.0289385] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Falls are the leading cause of injury-related mortality and hospitalization among adults aged ≥ 65 years. An important modifiable fall-risk factor is use of fall-risk increasing drugs (FRIDs). However, deprescribing is not always attempted or performed successfully. The ADFICE_IT trial evaluates the combined use of a clinical decision support system (CDSS) and a patient portal for optimizing the deprescribing of FRIDs in older fallers. The intervention aims to optimize and enhance shared decision making (SDM) and consequently prevent injurious falls and reduce healthcare-related costs. METHODS A multicenter, cluster-randomized controlled trial with process evaluation will be conducted among hospitals in the Netherlands. We aim to include 856 individuals aged ≥ 65 years that visit the falls clinic due to a fall. The intervention comprises the combined use of a CDSS and a patient portal. The CDSS provides guideline-based advice with regard to deprescribing and an individual fall-risk estimation, as calculated by an embedded prediction model. The patient portal provides educational information and a summary of the patient's consultation. Hospitals in the control arm will provide care-as-usual. Fall-calendars will be used for measuring the time to first injurious fall (primary outcome) and secondary fall outcomes during one year. Other measurements will be conducted at baseline, 3, 6, and 12 months and include quality of life, cost-effectiveness, feasibility, and shared decision-making measures. Data will be analyzed according to the intention-to-treat principle. Difference in time to injurious fall between the intervention and control group will be analyzed using multilevel Cox regression. DISCUSSION The findings of this study will add valuable insights about how digital health informatics tools that target physicians and older adults can optimize deprescribing and support SDM. We expect the CDSS and patient portal to aid in deprescribing of FRIDs, resulting in a reduction in falls and related injuries. TRIAL REGISTRATION ClinicalTrials.gov NCT05449470 (7-7-2022).
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Affiliation(s)
- Kelly K. de Wildt
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Bob van de Loo
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
| | - Annemiek J. Linn
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephanie K. Medlock
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Department of Medical Informatics, Amsterdam, Netherlands
| | - Sara S. Groos
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Kim J. Ploegmakers
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Lotta J. Seppala
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Department of Medical Informatics, Amsterdam, Netherlands
| | - Julia C. M. van Weert
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Natasja M. van Schoor
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
| | - Nathalie van der Velde
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
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Antoun L, Middleton L, Smith P, Saridogan E, Cooper K, Brocklehurst P, McKinnon W, Bevan S, Woolley R, Jones L, Fullard J, Morgan M, Roberts T, Clark TJ. LAparoscopic Versus Abdominal hysterectomy (LAVA): protocol of a randomised controlled trial. BMJ Open 2023; 13:e070218. [PMID: 37669836 PMCID: PMC10481847 DOI: 10.1136/bmjopen-2022-070218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/27/2023] [Indexed: 09/07/2023] Open
Abstract
INTRODUCTION There is uncertainty about the advantages and disadvantages of laparoscopic hysterectomy compared with abdominal hysterectomy, particularly the relative rate of complications of the two procedures. While uptake of laparoscopic hysterectomy has been slow, the situation is changing with greater familiarity, better training, better equipment and increased proficiency in the technique. Thus, a large, robust, multicentre randomised controlled trial (RCT) is needed to compare contemporary laparoscopic hysterectomy with abdominal hysterectomy to determine the safest and most cost-effective technique. METHODS AND ANALYSIS A parallel, open, non-inferiority, multicentre, randomised controlled, expertise-based surgery trial with integrated health economic evaluation and an internal pilot with an embedded qualitative process evaluation. A within trial-based economic evaluation will explore the cost-effectiveness of laparoscopic hysterectomy compared with open abdominal hysterectomy. We will aim to recruit 3250 women requiring a hysterectomy for a benign gynaecological condition and who were suitable for either laparoscopic or open techniques. The primary outcome is major complications up to six completed weeks postsurgery and the key secondary outcome is time from surgery to resumption of usual activities using the personalised Patient-Reported Outcomes Measurement Information System Physical Function questionnaire. The principal outcome for the economic evaluation is to be cost per QALY at 12 months' postsurgery. A secondary analysis is to be undertaken to generate costs per major surgical complication avoided and costs per return to normal activities. ETHICS AND DISSEMINATION The study was approved by the West Midlands-Edgbaston Research Ethics Committee, 18 February 2021 (Ethics ref: 21/WM/0019). REC approval for the protocol version 2.0 dated 2 February 2021 was issued on 18 February 2021.We will present the findings in national and international conferences. We will also aim to publish the findings in high impact peer-reviewed journals. We will disseminate the completed paper to the Department of Health, the Scientific Advisory Committees of the RCOG, the Royal College of Nurses (RCN) and the BSGE. TRIAL REGISTRATION NUMBER ISRCTN14566195.
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Affiliation(s)
- Lina Antoun
- Department of Gynaecology, Birmingham Women's NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Lee Middleton
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Paul Smith
- Department of Gynaecology, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Ertan Saridogan
- Department of Gynaecology, University College London Hospitals, London, UK
| | - Kevin Cooper
- Aberdeen Royal Infirmary, Aberdeen, UK
- University of Aberdeen, Aberdeen, UK
| | | | | | | | - Rebecca Woolley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Laura Jones
- Public Health, Epidemiology & Biostatistics, University of Birmingham, Birmingham, UK
| | | | | | - Tracy Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - T Justin Clark
- Department of Gynaecology, Birmingham Women's NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
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Wright LK, Culp S, Gajarski RJ, Nandi D. Racial and socioeconomic disparities in status exceptions for pediatric heart transplant candidates under the current U.S. Pediatric Heart Allocation Policy. J Heart Lung Transplant 2023; 42:1233-1241. [PMID: 37088341 DOI: 10.1016/j.healun.2023.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND The 2016 revision of the US Pediatric Heart Allocation Policy developed stringent rules for priority status creating impetus for clinicians to seek status exceptions. We hypothesized there may be differential status exceptions based on race and socioeconomic status (SES) contributing to disparities in waitlist outcomes. METHODS The Scientific Registry for Transplant Recipients was queried for children listed for heart transplant from 2012 to 2020. Waitlist status & mortality with regards to race and neighborhood SES were stratified by listing before (Era 1) or after (Era 2) the policy change. RESULTS The use of both 1A and 1B exceptions (E) increased in Era 2. In Era 1, there was no association between patient race or neighborhood SES on use of 1A(E) or 1B(E) when controlling for age and diagnosis. In Era 2, neither race nor neighborhood SES were associated with 1A(E), but both were associated with 1B(E): non-Hispanic (NH) Black children and those from low- and middle-SES neighborhoods were significantly less likely to be listed 1B(E). In Era 1, there were no significant differences in waitlist mortality based on race at any waitlist status; in Era 2, NH Black children had higher waitlist mortality when initially listed 1B or 2. CONCLUSIONS Since the 2016 policy change, racial disparities in waitlist mortality have worsened among children initially listed with lower priority status. Unequal use of 1B exceptions, which lower waitlist mortality, may explain some of these disparities. Recently implemented standardized pediatric exception guidance has the potential to improve equity.
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Affiliation(s)
- Lydia K Wright
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio.
| | - Stacey Culp
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | | | - Deipanjan Nandi
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
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Villemure-Poliquin N, Costerousse O, Lessard Bonaventure P, Audet N, Lauzier F, Moore L, Zarychanski R, Turgeon AF. Tracheostomy versus prolonged intubation in moderate to severe traumatic brain injury: a multicentre retrospective cohort study. Can J Anaesth 2023; 70:1516-1526. [PMID: 37505417 PMCID: PMC10447593 DOI: 10.1007/s12630-023-02539-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/29/2023] [Accepted: 02/16/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE Tracheostomy is a surgical procedure that is commonly performed in patients admitted to the intensive care unit (ICU). It is frequently required in patients with moderate to severe traumatic brain injury (TBI), a subset of patients with prolonged altered state of consciousness that may require a long period of mechanical respiratory assistance. While many clinicians favour the use of early tracheostomy in TBI patients, the evidence in favour of this practice remains scarce. The aims of our study were to evaluate the potential clinical benefits of tracheostomy versus prolonged endotracheal intubation, as well as whether the timing of the procedure may influence outcome in patients with moderate to severe TBI. METHODS We conducted a retrospective multicentre cohort study based on data from the provincial integrated trauma system of Quebec (Québec Trauma Registry). The study population was selected from adult trauma patients hospitalized between 2013 and 2019. We included patients 16 yr and older with moderate to severe TBI (Glasgow Coma Scale score < 13) who required mechanical ventilation for 96 hr or longer. Our primary outcome was 30-day mortality. Secondary outcomes included hospital and ICU mortality, six-month mortality, duration of mechanical ventilation, ventilator-associated pneumonia, ICU and hospital length of stay as well as orientation of patients upon discharge from the hospital. We used propensity score covariate adjustment. To overcome the effect of immortal time bias, an extended Cox shared frailty model was used to compare mortality between groups. RESULTS From 2013 to 2019, 26,923 patients with TBI were registered in the Québec Trauma Registry. A total of 983 patients who required prolonged endotracheal intubation for 96 hr or more were included in the study, 374 of whom underwent a tracheostomy and 609 of whom remained intubated. We observed a reduction in 30-day mortality (adjusted hazard ratio, 0.33; 95% confidence interval, 0.21 to 0.53) associated with tracheostomy compared with prolonged endotracheal intubation. This effect was also seen in the ICU as well as at six months. Tracheostomy, when compared with prolonged endotracheal intubation, was associated with an increase in the duration of mechanical respiratory assistance without any increase in the length of stay. No effect on mortality was observed when comparing early vs late tracheostomy procedures. An early procedure was associated with a reduction in the duration of mechanical respiratory support as well as hospital and ICU length of stay. CONCLUSION In this multicentre cohort study, tracheostomy was associated with decreased mortality when compared with prolonged endotracheal intubation in patients with moderate to severe TBI. This effect does not appear to be modified by the timing of the procedure. Nevertheless, the generalization and application of these results remains limited by potential residual time-dependent indication bias.
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Affiliation(s)
- Noémie Villemure-Poliquin
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, QC, Canada
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, QC, Canada
| | - Olivier Costerousse
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, QC, Canada
| | - Paule Lessard Bonaventure
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, QC, Canada
- Division of Neurosurgery, Department of Surgery, CHU de Québec -Université Laval, Quebec City, QC, Canada
| | - Nathalie Audet
- Department of Ophthalmology and Otolaryngology - Head and Neck Surgery, Université Laval, Quebec City, QC, Canada
| | - François Lauzier
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, QC, Canada
- Department of Medicine, Université Laval, Quebec City, QC, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Lynne Moore
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, QC, Canada
- Department of Preventive and Social Medicine, Université Laval, Quebec City, QC, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Sections of Critical Care Medicine, of Hematology and of Medical Oncology, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, QC, Canada.
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada.
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Rydbeck D, Bock D, Haglind E, Angenete E, Onerup A. Survival in relation to time to start of curative treatment of colon cancer: A national register-based observational noninferiority study. Colorectal Dis 2023; 25:1613-1621. [PMID: 37317006 DOI: 10.1111/codi.16638] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/27/2023] [Accepted: 04/30/2023] [Indexed: 06/16/2023]
Abstract
AIM There are ample discussions regarding the timing of treatment, especially in the era after Covid that caused delay to treatment. The aim of this study was to determine whether a delayed start to curative treatment, within 29-56 days after a diagnosis of colon cancer, was noninferior to starting treatment within 28 days, with regard to all-cause mortality. METHOD This is a national register-based observational noninferiority study, with a noninferiority margin of hazard ratio (HR) 1.1, including all patients treated with curative intent for colon cancer in Sweden between 2008 and 2016. The primary outcome was all-cause mortality. Secondary outcomes were length of hospital stay, readmissions and reoperations within 1 year after surgery. Exclusion criteria were emergency surgery, disseminated disease at diagnosis, missing diagnosis date and treatment for another cancer 5 years before colon cancer diagnosis. RESULTS A total of 20 836 individuals were included. A period of 29-56 days from diagnosis to start of curative treatment was noninferior versus starting treatment within 28 days for the primary outcome of all-cause mortality (HR 0.95, 95% CI 0.89-1.00). Starting treatment within 29-56 days was associated with a shorter length of stay (average 9.2 vs. 10 days) but a higher risk of reoperation compared to within 28 days. Post hoc analyses demonstrated that surgical modality was driving survival rather than time to treatment. Overall survival was greater after laparoscopic surgery (HR 0.78, 95% CI 0.69-0.88). CONCLUSION For patients with colon cancer, a period of up to 56 days from diagnosis to the start of curative treatment did not lead to worse overall survival.
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Affiliation(s)
- Daniel Rydbeck
- Department of Surgery, SSORG-Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - David Bock
- Department of Surgery, SSORG-Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Haglind
- Department of Surgery, SSORG-Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Angenete
- Department of Surgery, SSORG-Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aron Onerup
- Department of Surgery, SSORG-Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Pediatric Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Bjørndal LD, Kendler KS, Reichborn-Kjennerud T, Ystrom E. Stressful life events increase the risk of major depressive episodes: A population-based twin study. Psychol Med 2023; 53:5194-5202. [PMID: 35920242 PMCID: PMC10476058 DOI: 10.1017/s0033291722002227] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Previous studies have found that stressful life events (SLEs) are associated with an increased risk of adult depression. However, many studies are observational in nature and limited by methodological issues, such as potential confounding by genetic factors. Genetically informative research, such as the co-twin control design, can strengthen causal inference in observational studies. Discrete-time survival analysis has several benefits and multilevel survival analysis can incorporate frailty terms (random effects) to estimate the components of the biometric model. In the current study, we investigated associations between SLEs and depression risk in a population-based twin sample (N = 2299). METHODS A co-twin control design was used to investigate the influence of the occurrence of SLEs on depression risk. The co-twin control design involves comparing patterns of associations in the full sample and within dizygotic (DZ) and monozygotic twins (MZ). Associations were modelled using discrete-time survival analysis with biometric frailty terms. Data from two time points were used in the analyses. Mean age at Wave 1 was 28 years and mean age at Wave 2 was 38 years. RESULTS SLE occurrence was associated with increased depression risk. Co-twin control analyses indicated that this association was at least in part due to the causal influence of SLE exposure on depression risk for event occurrence across all SLEs and for violent SLEs. A minor proportion of the total genetic risk of depression reflected genetic effects related to SLEs. CONCLUSIONS The results support previous research in implicating SLEs as important risk factors with probable causal influence on depression risk.
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Affiliation(s)
- Ludvig D. Bjørndal
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Kenneth S. Kendler
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Ted Reichborn-Kjennerud
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eivind Ystrom
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- School of Pharmacy, University of Oslo, Oslo, Norway
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Choi S, O’Grady MA, Cleland CM, Knopf E, Hong S, D’Aunno T, Bao Y, Ramsey KS, Neighbors CJ. Clinics Optimizing MEthadone Take-homes for opioid use disorder (COMET): Protocol for a stepped-wedge randomized trial to facilitate clinic level changes. PLoS One 2023; 18:e0286859. [PMID: 37294821 PMCID: PMC10256218 DOI: 10.1371/journal.pone.0286859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION Regulatory changes made during the COVID-19 public health emergency (PHE) that relaxed criteria for take-home dosing (THD) of methadone offer an opportunity to improve quality of care with a lifesaving treatment. There is a pressing need for research to study the long-term effects of the new PHE THD rules and to test data-driven interventions to promote more effective adoption by opioid treatment programs (OTPs). We propose a two-phase project to develop and test a multidimensional intervention for OTPs that leverages information from large State administrative data. METHODS AND ANALYSIS We propose a two-phased project to develop then test a multidimensional OTP intervention to address clinical decision making, regulatory confusion, legal liability concerns, capacity for clinical practice change, and financial barriers to THD. The intervention will include OTP THD specific dashboards drawn from multiple State databases. The approach will be informed by the Health Equity Implementation Framework (HEIF). In phase 1, we will employ an explanatory sequential mixed methods design to combine analysis of large state administrative databases-Medicaid, treatment registry, THD reporting-with qualitative interviews to develop and refine the intervention. In phase 2, we will conduct a stepped-wedge trial over three years with 36 OTPs randomized to 6 cohorts of a six-month clinic-level intervention. The trial will test intervention effects on OTP-level implementation outcomes and patient outcomes (1) THD use; 2) retention in care; and 3) adverse healthcare events). We will specifically examine intervention effects for Black and Latinx clients. A concurrent triangulation mixed methods design will be used: quantitative and qualitative data collection will occur concurrently and results will be integrated after analysis of each. We will employ generalized linear mixed models (GLMMs) in the analysis of stepped-wedge trials. The primary outcome will be weekly or greater THD. The semi-structured interviews will be transcribed and analyzed with Dedoose to identify key facilitators, barriers, and experiences according to HEIF constructs using directed content analysis. DISCUSSION This multi-phase, embedded mixed methods project addresses a critical need to support long-term practice changes in methadone treatment for opioid use disorder following systemic changes emerging from the PHE-particularly for Black and Latinx individuals with opioid use disorder. By combining findings from analyses of large administrative data with lessons gleaned from qualitative interviews of OTPs that were flexible with THD and those that were not, we will build and test the intervention to coach clinics to increase flexibility with THD. The findings will inform policy at the local and national level.
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Affiliation(s)
- Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Megan A. O’Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Charles M. Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Elizabeth Knopf
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Sueun Hong
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
- New York University Wagner School of Public Policy, New York, NY, United States of America
| | - Thomas D’Aunno
- New York University Wagner School of Public Policy, New York, NY, United States of America
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Kelly S. Ramsey
- New York State Office of Addiction Services and Supports (OASAS), New York, NY, United States of America
| | - Charles J. Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
- New York University Wagner School of Public Policy, New York, NY, United States of America
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Muluneh EK, Alemu M. Correlates of age at first birth among women in Ethiopia: use of multilevel survival analysis models. Pan Afr Med J 2023; 44:190. [PMID: 37484593 PMCID: PMC10362677 DOI: 10.11604/pamj.2023.44.190.36090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 04/06/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction the timing of birth of the first child has a direct relationship with fertility in general and health and future career including further education of a mother in particular. The objective of this study was to identify factors significantly associated with the time to the first birth among women in Ethiopia. Methods a cross-sectional study was conducted using data from the 2016 Ethiopian Demographic and Health Survey (EDHS). The study subjects were married women and men aged 15 to 49 in randomly selected households across Ethiopia and two stage stratified random sampling technique was used to select study subjects. Log logistic-Gamma shared frailty model was used to identify factors associated with the length of time spent until the first birth. Results the median age at first birth for women living in Ethiopia was 20 years, whereas the minimum and maximum ages at first birth were 11 and 49 years respectively. Age at first sex, age at first cohabitation, sex of household head, place of residence, religion, education level, contraceptive use and exposure to media were significant correlates of age at first birth of women in Ethiopia. Higher level of education was associated with increased age at first birth. Women who use contraceptive, women living in urban areas, women having exposure to media and female headed households had longer time to first birth compared to their counterparts. Conclusion the different regions of Ethiopia have significant differences in the age of women during their first birth. Most of the factors associated with the time to first child in this study were related to education of women. Investing in education and educating women plays critical roles in regulating fertility of a nation and health of women.
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Affiliation(s)
| | - Mahider Alemu
- Department of Statistics, Woldia University, Woldia, Ethiopia
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Kojima T, Yamauchi Y, Watanabe F, Ichiyanagi S, Kobayashi Y, Kaiho Y, Kasuya S, Urayama KY, Kuratani N, Suzuki Y. Epidemiology of adverse events attributed to airway management in paediatric anaesthesia: protocol for the prospective, multicentre, registry-based, cross-sectional Japan Pediatric Difficult Airway in Anesthesia study (J-PEDIA). BMJ Open 2023; 13:e067554. [PMID: 37068905 PMCID: PMC10111891 DOI: 10.1136/bmjopen-2022-067554] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Failure to secure an airway during general anaesthesia is a major cause of adverse events (AEs) in children. The safety of paediatric anaesthesia may be improved by identifying the incidence of AEs and their attributed risk factors. The aim of the current study is to obtain real-world data on the incidence of adverse peri-intubation events and assess their association with patient characteristics (including the prevalence of difficult airway features) and choice of anaesthesia management. These data can be used to develop a targeted education programme for anaesthesia providers towards quality improvement activities. METHODS AND ANALYSIS This prospective, multicentre, registry-based, cross-sectional study will be conducted in four tertiary care hospitals in Japan from June 2022 to May 2025. Children <18 years of age undergoing surgical and/or diagnostic test procedures under general anaesthesia or sedation by anaesthesiologists will be enrolled in this study. Data on patient characteristics, discipline of anaesthesia providers and methodology of airway management will be collected through a standardised verification system. The exposure of interest is the presence of difficult airway features defined based on the craniofacial appearance. The primary and secondary endpoints are all AEs associated with airway management and reduced peripheral capillary oxygen saturation values. Potential confounders are related to the failure to secure the airway and variations in the anaesthesia providers' levels, adjusted using hierarchical multivariable regression models with mixed effects. The sample size was calculated to be approximately 16 000 assuming a 99% probability of obtaining a 95% Wilson CI with±0.3% of the half-width for the 2.0% of the incidence of critical AEs. ETHICS AND DISSEMINATION The study protocol was approved by the Institutional Review Board at Aichi Children's Health and Medical Center (2021051). The results will be reported in a peer-reviewed journal and a relevant academic conference. TRIAL REGISTRATION NUMBER UMIN000047351.
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Affiliation(s)
- Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
- Division of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yusuke Yamauchi
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Fumio Watanabe
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Shogo Ichiyanagi
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Yasuma Kobayashi
- Children's Heart Center, Saitama Children's Medical Center, Saitama, Japan
| | - Yu Kaiho
- Department of Anesthesiology, Tohoku University Hospital, Sendai, Japan
| | - Shugo Kasuya
- Department of Critical Care and Anesthesiology, National Center for Child Health and Development, Setagaya-ku, Japan
| | | | | | - Yasuyuki Suzuki
- Department of Critical Care and Anesthesiology, National Center for Child Health and Development, Setagaya-ku, Japan
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Chaudhary S, Weigt SS, Ribeiro Neto ML, Benn BS, Pugashetti JV, Keith R, Chand A, Oh S, Kheir F, Ramalingam V, Solomon JJ, Harper R, Lasky JA, Oldham JM. Interstitial lung disease progression after genomic usual interstitial pneumonia testing. Eur Respir J 2023; 61:2201245. [PMID: 36549706 PMCID: PMC10288658 DOI: 10.1183/13993003.01245-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND A genomic classifier for usual interstitial pneumonia (gUIP) has been shown to predict histological UIP with high specificity, increasing diagnostic confidence for idiopathic pulmonary fibrosis (IPF). Whether those with positive gUIP classification exhibit a progressive, IPF-like phenotype remains unknown. METHODS A pooled, retrospective analysis of patients who underwent clinically indicated diagnostic bronchoscopy with gUIP testing at seven academic medical centres across the USA was performed. We assessed the association between gUIP classification and 18-month progression-free survival (PFS) using Cox proportional hazards regression. PFS was defined as the time from gUIP testing to death from any cause, lung transplant, ≥10% relative decline in forced vital capacity (FVC) or censoring at the time of last available FVC measure. Longitudinal change in FVC was then compared between gUIP classification groups using a joint regression model. RESULTS Of 238 consecutive patients who underwent gUIP testing, 192 had available follow-up data and were included in the analysis, including 104 with positive gUIP classification and 88 with negative classification. In multivariable analysis, positive gUIP classification was associated with reduced PFS (hazard ratio 1.58, 95% CI 0.86-2.92; p=0.14), but this did not reach statistical significance. Mean annual change in FVC was -101.8 mL (95% CI -142.7- -60.9 mL; p<0.001) for those with positive gUIP classification and -73.2 mL (95% CI -115.2- -31.1 mL; p<0.001) for those with negative classification (difference 28.7 mL, 95% CI -83.2-25.9 mL; p=0.30). CONCLUSIONS gUIP classification was not associated with differential rates of PFS or longitudinal FVC decline in a multicentre interstitial lung disease cohort undergoing bronchoscopy as part of the diagnostic evaluation.
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Affiliation(s)
- Sachin Chaudhary
- Division of Pulmonary and Critical Care Medicine, University of Arizona, Tucson, AZ, USA
| | - S Sam Weigt
- Division of Pulmonary and Critical Care Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Bryan S Benn
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Janelle Vu Pugashetti
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California at Davis, Sacramento, CA, USA
| | - Rebecca Keith
- Division of Pulmonary and Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Arista Chand
- Division of Pulmonary and Critical Care Medicine, University of Arizona, Tucson, AZ, USA
| | - Scott Oh
- Division of Pulmonary and Critical Care Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Fayez Kheir
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Vijaya Ramalingam
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Northeast Georgia Physicians Group
| | - Joshua J Solomon
- Division of Pulmonary and Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Richart Harper
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California at Davis, Sacramento, CA, USA
| | - Joseph A Lasky
- Division of Pulmonary and Critical Care Medicine, Tulane University, New Orleans, LA, USA
| | - Justin M Oldham
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
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Taylor M, Masood M, Mnatzaganian G. Differences in complete denture longevity and replacement in public and private dental services: A propensity score-matched analysis of subsidised dentures in adult Australians across 20 years. Community Dent Oral Epidemiol 2023; 51:318-326. [PMID: 35338502 DOI: 10.1111/cdoe.12744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/13/2021] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the differences in treatment outcomes for patients who received subsidized complete dentures in private dental clinics and in public dental clinics over 20 years in Victoria, Australia. METHODS Between 2000 and 2019, 187 227 complete dentures were provided to eligible public patients by the Victorian public dental system. Of these, approximately 52% were provided to public patients in private clinics through the voucher system. Of the 97 107 participants who received denture care in private clinics, 70 818 were matched 1:1 by propensity score (PS) quantiles with participants who received denture care in public clinics. The PS matching balanced the characteristics between these two groups. Subsequently, a conditional logistic regression model investigated the binary outcome of denture replacement whilst a conditional Poisson regression modelled the number of years to denture replacement. A frailty Cox regression after PS matching investigated denture survival over time. RESULTS Dentures provided in public clinics had a mean time to replacement of 5.5 years (SD: 34.0) and 25.9% were replaced during the observation period. In the first year of denture service, incidence rate per person year (IR) for complete denture replacement in public clinics was 0.04 (95% CI: 0.04-0.04). Dentures provided in private clinics had a mean time to replacement of 6.5 years (SD: 3.8) with 29.4% replaced during the observation period. In the first year of denture service, the IR for complete denture replacement in private clinics was 0.02 (95% CI: 0.02-0.02), which was less than half that of the public IR. Multivariate analyses found that although private dentures were more likely to be replaced during the observation period than those provided in the public sector (odds ratio [OR]: 1.31, 95% CI: 1.28-1.35, p < .001), they had greater longevity (incidence rate ratio [IRR]: 1.23, 95% CI: 1.23-1.24, p < .001). Longer longevity of private dentures was also supported by the frailty Cox regression showing that private dentures had a reduced hazard of denture replacement over time (better survival) in comparison to public dentures (hazard ratio [HR]: 0.94, 95% CI: 0.92-0.97, p < .001). Probabilistic sensitivity analysis supported the study findings. CONCLUSIONS Increased denture longevity, higher rates of denture replacement and lower rates of early denture replacement were associated with receiving denture care in private clinics as compared with dentures provided in the public sector.
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Affiliation(s)
- Marietta Taylor
- Department of Rural Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mohd Masood
- Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Institute of Dentistry, University of Turku, Turku, Finland
| | - George Mnatzaganian
- Department of Rural Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Cheng D, Fung V, Shah R, Goldberg S, Lee B, Song G, Doane J, Kingsley M, Henley P, Banthin C, Winickoff JP, Rigotti NA, Levy DE. Smoke-Free Policies and Resident Turnover: An Evaluation in Massachusetts Public Housing From 2009‒2018. Am J Prev Med 2023; 64:503-511. [PMID: 36635198 PMCID: PMC10033366 DOI: 10.1016/j.amepre.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/07/2022] [Accepted: 10/27/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Smoke-free policies (SFP) in multi-unit housing are a promising tool for reducing exposure to tobacco smoke among residents. Concerns about increased housing instability due to voluntary or involuntary transitions induced by SFPs have been a primary barrier to greater widespread adoption. The impact of SFP implementation on transitions out of public housing in federally funded public housing authorities in Massachusetts was evaluated. METHODS Tenancy data from the Department of Housing and Urban Development were used to determine the time from admission to transitioning out of public housing based on a cohort study design. Periods of exposure to SFPs were defined based on dates of SFP implementation at each PHA. Multi-level Cox regression models were fit to estimate the effects of SFPs on the hazard of transitioning, adjusting for household- and PHA-level characteristics. Analyses were conducted in 2021‒2022. RESULTS There were 44,705 households with a record of residence in Massachusetts PHAs over 2009‒2018. Over this period, despite increasing adoption of SFPs among the PHAs, rates of transition remained steady at around 5‒8 transitions per 1,000 household-months. There was no overall association between exposure to SFPs and transitions among the full sample (adjusted HR=0.99, 95% CI=0.95, 1.04, p=0.794). However, the association varied significantly by age group, race/ethnicity, timing of SFP adoption, and era of admission. CONCLUSIONS Adoption of SFPs in public housing had a minimal overall impact on turnover for households in Massachusetts, though disparities in the impact were observed between different demographic and PHA-level subgroups.
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Affiliation(s)
- David Cheng
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Vicki Fung
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Radhika Shah
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Sydney Goldberg
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Boram Lee
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Glory Song
- Office of Statistics and Evaluation, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Jacqueline Doane
- Massachusetts Tobacco Cessation and Prevention Program, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Melody Kingsley
- Office of Statistics and Evaluation, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Patricia Henley
- Massachusetts Tobacco Cessation and Prevention Program, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Christopher Banthin
- Public Health Advocacy Institute, Northeastern University School of Law, Boston, Massachusetts
| | - Jonathan P Winickoff
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Nancy A Rigotti
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas E Levy
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts
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Goungounga JA, Grafféo N, Charvat H, Giorgi R. Correcting for heterogeneity and non-comparability bias in multicenter clinical trials with a rescaled random-effect excess hazard model. Biom J 2023; 65:e2100210. [PMID: 36890623 DOI: 10.1002/bimj.202100210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/13/2022] [Accepted: 08/14/2022] [Indexed: 03/10/2023]
Abstract
In the presence of competing causes of event occurrence (e.g., death), the interest might not only be in the overall survival but also in the so-called net survival, that is, the hypothetical survival that would be observed if the disease under study were the only possible cause of death. Net survival estimation is commonly based on the excess hazard approach in which the hazard rate of individuals is assumed to be the sum of a disease-specific and expected hazard rate, supposed to be correctly approximated by the mortality rates obtained from general population life tables. However, this assumption might not be realistic if the study participants are not comparable with the general population. Also, the hierarchical structure of the data can induces a correlation between the outcomes of individuals coming from the same clusters (e.g., hospital, registry). We proposed an excess hazard model that corrects simultaneously for these two sources of bias, instead of dealing with them independently as before. We assessed the performance of this new model and compared it with three similar models, using extensive simulation study, as well as an application to breast cancer data from a multicenter clinical trial. The new model performed better than the others in terms of bias, root mean square error, and empirical coverage rate. The proposed approach might be useful to account simultaneously for the hierarchical structure of the data and the non-comparability bias in studies such as long-term multicenter clinical trials, when there is interest in the estimation of net survival.
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Affiliation(s)
- Juste A Goungounga
- INSERM, IRD, SESSTIM, ISSPAM, Aix Marseille University, Marseille, France.,Registre Bourguignon des Cancers Digestifs, Centre Hospitalier Universitaire de Dijon Bourgogne, Université de Bourgogne, Dijon, France.,Univ Rennes, CNRS, Inserm, Arènes-UMR 6051, RSMS-U 1309, Écoles Des Hautes Études en Santé Publique, Rennes, France
| | - Nathalie Grafféo
- INSERM, IRD, SESSTIM, ISSPAM, Aix Marseille University, Marseille, France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France.,Institut Paoli-Calmettes, Unité de Biostatistique et de Méthodologie, Marseille, France
| | - Hadrien Charvat
- Faculty of International Liberal Arts, Juntendo University, Bunkyo-ku, Tokyo, Japan.,Division of International Health Policy Research, Institute for Cancer Control, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Roch Giorgi
- APHM, INSERM, IRD, SESSTIM, ISSPAM, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Aix Marseille University, Marseille, France
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Hanff TC, Browne A, Dickey J, Gaines H, Harhay MO, Goodwin M, Selzman CH, Fang JC, Drakos SG, Stehlik J. Heart waitlist survival in adults with an intra-aortic balloon pump relative to other Status 2, Status 1, and inotrope Status 3 patients. J Heart Lung Transplant 2023; 42:368-376. [PMID: 36369224 PMCID: PMC9974555 DOI: 10.1016/j.healun.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Intra-aortic balloon pump (IABP) utilization has significantly outpaced other Status 2 eligibility criteria for heart transplant. The risk of waitlist mortality of IABP-supported patients relative to other Status 2 listed patients has not been described. METHODS We performed a retrospective analysis of all adult patients listed Status 2 for heart transplantation under the current U.S. allocation policy, using data from the United Network for Organ Sharing. Patients listed status 1 and status 3 for high-dose inotropes were included for reference. Mortality and waitlist decompensation were modeled as a function of time-varying status in cause-specific Cox survival models. RESULTS We identified 3638 Status 2 listings, of whom 1676 (46%) were Status 2 due to IABP. Relative to patients supported with IABP, status 2 patients with ventricular tachycardia/fibrillation [VT/VF] (HR 4.0, p < .001), right-or-biventricular assist device configurations (HR 2.3, p = .002), or temporary surgical left ventricular assist devices [LVAD] (HR 2.6, p = .003) had greater risk of waitlist mortality and decompensation. Other Status 2 subgroups had mortality comparable to IABP Status 2. Risk of waitlist mortality and decompensation for IABP Status 2 was similar to Status 3 patients listed for high-dose inotropes (HR 1.2, p = .27) and lower than Status 1 patients (HR 0.7, p = .002). CONCLUSIONS Waitlist mortality varies significantly by Status 2 eligibility criteria and is highest among patients listed for VT/VF, right-or-biVAD configurations, or temporary surgical LVADs. IABP-supported patients were among those with the lowest Status 2 waitlist mortality risk and comparable to Status 3 inotrope-supported patients.
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Affiliation(s)
- Thomas C Hanff
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Adeline Browne
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jacqueline Dickey
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Holly Gaines
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matt Goodwin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - James C Fang
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Stavros G Drakos
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Chen J, Zeng Y, Lau AK, Guo C, Wei X, Lin C, Huang B, Lao XQ. Chronic exposure to ambient PM 2.5/NO 2 and respiratory health in school children: A prospective cohort study in Hong Kong. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 252:114558. [PMID: 36696726 DOI: 10.1016/j.ecoenv.2023.114558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/08/2023] [Accepted: 01/15/2023] [Indexed: 06/17/2023]
Abstract
Despite increasing concerns about the detrimental effects of air pollution on respiratory health, limited evidence is available on these effects in the Hong Kong population, especially in children. In this prospective cohort study between 2012 and 2017, we aimed to investigate the associations between exposure to air pollution (concentrations of fine particulate matter [PM2.5] and nitrogen dioxide [NO2]) and respiratory health (lung function parameters and respiratory diseases and symptoms) in schoolchildren. We recruited 5612 schoolchildren aged 6-16 years in Hong Kong. We estimated the annual average concentrations of ambient PM2.5 and NO2 at each participant's address using spatiotemporal models. We conducted spirometry tests on all participants to measure their lung function parameters and used a self-administered questionnaire to collect information on their respiratory diseases and symptoms and a wide range of covariates. Linear mixed models were used to investigate the associations between exposure to air pollution and lung function. Mixed-effects logistic regression models with random effects were used to investigate the associations of exposure to air pollution with respiratory diseases and symptoms. In all of the participants, every 5-μg/m3 increase in the ambient PM2.5 concentration was associated with changes of - 13.90 ml (95 % confidence interval [CI]: -23.65 ml, -4.10 ml), - 4.20 ml (-15.60 ml, 7.15 ml), 27.20 ml/s (-3.95 ml/s, 58.35 ml/s), and - 19.80 ml/s (-38.35 ml/s, -1.25 ml/s) in forced expiratory volume in 1 s, forced vital capacity, peak expiratory flow, and maximal mid-expiratory flow, respectively. The corresponding lung function estimates for every 5-μg/m3 increase in the ambient NO2 concentration were - 2.70 ml (-6.05 ml, 0.60 ml), - 1.40 ml (-5.40 ml, 2.60 ml), - 6.60 ml/s (-19.75 ml/s, 6.55 ml/s), and - 3.05 ml/s (-11.10 ml/s, 5.00 ml/s), respectively. We did not observe significant associations between PM2.5/NO2 exposure and most respiratory diseases and symptoms. Stratified analyses by sex and age showed that the associations between exposure to air pollution and lung function parameters were stronger in male participants and older participants (11-14 year old group) than in female participants and younger participants (6-10 year old group), respectively. Our results suggest that chronic exposure to air pollution is detrimental to the respiratory health of schoolchildren, especially that of older boys. Our findings reinforce the importance of air pollution mitigation to protect schoolchildren's respiratory health.
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Affiliation(s)
- Jinjian Chen
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yiqian Zeng
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Alexis Kh Lau
- Division of Environment and Sustainability, the Hong Kong University of Science and Technology, Hong Kong, China; Department of Civil and Environmental Engineering, the Hong Kong University of Science and Technology, Hong Kong, China
| | - Cui Guo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Department of Urban Planning and Design, Faculty of Architecture, the University of Hong Kong, Hong Kong SAR
| | - Xianglin Wei
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Changqing Lin
- Division of Environment and Sustainability, the Hong Kong University of Science and Technology, Hong Kong, China
| | - Bo Huang
- Department of Geography and Resource Management, the Chinese University of Hong Kong, Hong Kong, China
| | - Xiang Qian Lao
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Department of Biomedical Sciences, the City University of Hong Kong, Hong Kong, China; School of Public Health, Zhengzhou University, Zhengzhou, China.
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50
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Moradhvaj, Samir KC. Differential impact of maternal education on under-five mortality in rural and urban India. Health Place 2023; 80:102987. [PMID: 36801652 DOI: 10.1016/j.healthplace.2023.102987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/15/2023] [Accepted: 02/02/2023] [Indexed: 02/20/2023]
Abstract
Under-five mortality rate (U5MR) differs by rural-urban place of residence and mother's education; however, the rural-urban gap in U5MR by mother's educational attainment is unclear in the existing literature. Using five rounds of the national family health surveys (NFHS I-V) conducted between 1992-93 and 2019-21 in India, this study estimated the main and interaction effects of rural-urban and maternal education on U5MR. The mixed effect Cox proportional hazard (MECPH) model was used to predict the risk of under-five mortality (U5M). The finding shows that unadjusted U5MR remained 50 per cent higher in rural areas than in urban areas across the surveys. Whereas, after controlling for demographic, socioeconomic, and maternal health care predictors of U5M, the MECPH regression results indicated that urban children had a higher risk of death than their rural counterparts in NFHS I-III. However, there are no significant rural-urban differences in the last two surveys (NFHS IV -V). In addition, increasing maternal education levels were associated with lower U5M in all surveys. Though, in recent years, primary education has had no significant effect. The U5M risk was additionally lower for urban children than rural children whose mothers had secondary and higher education by NFHS-III; however, this additional urban advantage was no longer significant in recent surveys. The higher impact of secondary education on U5MR in urban areas in the past may be attributed to poor socio-economic, healthcare conditions in rural areas. Overall, maternal education, particularly secondary education, remained a protective factor for U5M in both rural and urban areas, even after controlling for predictors. Therefore, there is a need to increase the focus on secondary education for girls for a further decline in U5M.
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Affiliation(s)
- Moradhvaj
- International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria; Vienna Institute of Demography of the Austrian Academy of Sciences, Vienna, Austria; Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria.
| | - K C Samir
- International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria; Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria; Asian Demographic Research Institute (ADRI) at Shanghai University, Shanghai, China.
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