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Wu T, Dong S, Yang L, Qiu H, Qiu H, Mellor D, Chen J, Xu Y. Investigation of the pharmacological treatment patterns of Chinese patients with major depressive disorder under real-world settings using multi-channel sequence analysis. Front Psychiatry 2023; 14:1089504. [PMID: 37091706 PMCID: PMC10115953 DOI: 10.3389/fpsyt.2023.1089504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Background Despite many treatment guidelines available now, the treatment patterns of major depressive disorder (MDD) in China haven't been well-understood due to complexity and diversity. Aim To describe pharmacological treatment patterns of MDD patients in real-world settings using electronic health records from a major psychiatric hospital in China. Methods MDD patients (18-65 years, ICD-10: F32.x, F33.x) newly initiated single antidepressant (AD) in 2015 were enrolled, the date of first AD prescription during the study period was defined as index date, and eligible patients were followed up to 1 year. Treatment patterns were revealed and analyzed using multi-channel sequence analysis (MCSA), considering patients' chronological sequences (in days) of AD prescription, cumulative treatment step(s), and polypharmacy usage during the follow-up. Results This study (n = 5,003) identified four types of MDD treatment patterns. The first type (1-time treatment) represents the largest proportion of patients (73.6%, n = 3,686), followed by the second type (6-month consistent treatment) and third type (long-term, consistent treatment) collectively accounted for 20.6% (n = 1,031) of patients, by contrast the last type (long-term, inconsistent treatment) made up the rest 5.7% (n = 286) of patients while exhibiting the most complicated treatments patterns. The choice of AD was dominated by selective serotonin reuptake inhibitors (SSRIs), while treatment duration spent in polypharmacy spanned at 2.8%, 16.4%, 2.0%, and 36.5% over the four types, respectively. Conclusion Treatment patterns reflecting real-world pharmacological treatment practices of MDD in China were revealed using MCSA. The observed discrepancies between real-world practice and treatment guidelines provided additional insights in improving the clinical management of MDD.
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Affiliation(s)
- Tao Wu
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Beijing, China
| | - Sijia Dong
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Shanghai, China
| | - Lu Yang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Qiu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Qiu
- Global Epidemiology, Office of Chief Medical Officer, Johnson & Johnson, Titusville, NJ, United States
| | - David Mellor
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Jun Chen
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yifeng Xu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Miller ME, Nicely S, Shefet D, Stage VC. Head Start Health and Nutrition Managers' Perceptions of the Process of Measuring BMI and Communicating Preschooler's Weight Status. HEALTH EDUCATION & BEHAVIOR 2023; 50:41-48. [PMID: 36314367 DOI: 10.1177/10901981221131264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Body mass index (BMI) screenings are conducted as part of Head Start's (HS) health and nutrition assessments. Weight status classifications, which rely on the accuracy of the BMI measurements, are communicated to caregivers to engage them in health behavior change. Limited qualitative research has been conducted on the procedures for BMI measurement and reporting in HS programs. Interviews (n=28) were conducted with HS health/nutrition managers in Ohio and North Carolina to understand the processes used to conduct BMI screenings and disseminate reports and identify related needs. Themes included Personnel, Equipment, and Training for BMI Measurements; Classifying and Communicating BMI and Referrals; Professional Development Opportunities; and Resource, Training/Policy Needs to Support BMI Practices. Programs need additional resources to implement BMI measurement training and improve data accuracy and entry. Clarification of the referral/follow-up process and training around communicating with caregivers is also needed to better support families in implementing behavior change.
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Affiliation(s)
| | | | - Dana Shefet
- East Carolina University, Greenville, NC, USA
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Vanoli J, Nava CR, Airoldi C, Ucciero A, Salvi V, Barone-Adesi F. Use of State Sequence Analysis in Pharmacoepidemiology: A Tutorial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413398. [PMID: 34949007 PMCID: PMC8705850 DOI: 10.3390/ijerph182413398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/22/2022]
Abstract
While state sequence analysis (SSA) has been long used in social sciences, its use in pharmacoepidemiology is still in its infancy. Indeed, this technique is relatively easy to use, and its intrinsic visual nature may help investigators to untangle the latent information within prescription data, facilitating the individuation of specific patterns and possible inappropriate use of medications. In this paper, we provide an educational primer of the most important learning concepts and methods of SSA, including measurement of dissimilarities between sequences, the application of clustering methods to identify sequence patterns, the use of complexity measures for sequence patterns, the graphical visualization of sequences, and the use of SSA in predictive models. As a worked example, we present an application of SSA to opioid prescription patterns in patients with non-cancer pain, using real-world data from Italy. We show how SSA allows the identification of patterns in prescriptions in these data that might not be evident using standard statistical approaches and how these patterns are associated with future discontinuation of opioid therapy.
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Affiliation(s)
- Jacopo Vanoli
- London School of Hygiene and Tropical Medicine (LSHTM), London WC1E 7HT, UK;
- School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki 852-8521, Japan
| | - Consuelo Rubina Nava
- Department of Economics and Statistics “Cognetti de Martiis”, University of Turin, 10124 Turin, Italy
- Correspondence:
| | - Chiara Airoldi
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (C.A.); (A.U.)
| | - Andrealuna Ucciero
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (C.A.); (A.U.)
| | - Virginio Salvi
- Department of Neuroscience, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (V.S.); (F.B.-A.)
| | - Francesco Barone-Adesi
- Department of Neuroscience, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (V.S.); (F.B.-A.)
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Le Meur N, Vigneau C, Lefort M, Lebbah S, Jais JP, Daugas E, Bayat S. Categorical state sequence analysis and regression tree to identify determinants of care trajectory in chronic disease: Example of end-stage renal disease. Stat Methods Med Res 2018; 28:1731-1740. [PMID: 29742976 DOI: 10.1177/0962280218774811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with chronic diseases, like patients with end-stage renal disease (ESRD), have long history of care driven by multiple determinants (medical, social, economic, etc.). Although in most epidemiological studies, analyses of health care determinants are computed on single health care events using classical multivariate statistical regression methods. Only few studies have integrated the concept of treatment trajectories as a whole and studied their determinants. METHODS All 18- to 80-year-old incident ESRD patients who started dialysis in Ile-de-France or Bretagne between 2006 and 2009 and could be followed for a period of 48 months after initiation of a renal replacement therapy were included (n = 5568). Their care trajectories were defined as categorical state sequences. Associations between patients' characteristics and care trajectories were assessed using a regression tree model together with a discrepancy analysis. RESULTS On average, each patient experienced 1.56 different renal replacement therapies (min = 1; max = 5) during the 48 months of follow-up. About 55% of patients never changed treatment and only 1% tried three or more renal replacement therapy modalities. Twelve homogeneous care trajectory groups were identified. Covariates explained 12% of the discrepancy between groups, particularly age, regions and initiation of hemodialysis with a catheter. CONCLUSIONS Regression tree analysis of categorical state sequence highlighted geographical disparities in the care trajectory of French patients with ESRD that cannot be observed when focusing on a single outcome, such as survival. This method is an original tool to visualize and characterize care trajectories, notably in the context of chronic condition like ESRD.
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Affiliation(s)
- Nolwenn Le Meur
- 1 Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449, Rennes, France
| | - Cécile Vigneau
- 2 CHU Pontchaillou, Service de Néphrologie, Rennes, France.,3 IRSET, INSERM UMR 1085, Rennes, France
| | - Mathilde Lefort
- 1 Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449, Rennes, France
| | - Saïd Lebbah
- 4 CHU Necker Enfants Malades, Biostatistics unit, INSERM UMR S 872, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean-Philippe Jais
- 4 CHU Necker Enfants Malades, Biostatistics unit, INSERM UMR S 872, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Eric Daugas
- 5 Hôpital Bichat, Service de Néphrologie, DHU FIRE, INSERM U1149, Université Paris Diderot, Paris, France
| | - Sahar Bayat
- 1 Univ Rennes, EHESP, REPERES (Recherche en Pharmaco-épidémiologie et Recours aux Soins) - EA 7449, Rennes, France
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Cerniglia L, Cimino S, Erriu M, Jezek S, Almenara CA, Tambelli R. Trajectories of aggressive and depressive symptoms in male and female overweight children: Do they share a common path or do they follow different routes? PLoS One 2018; 13:e0190731. [PMID: 29304081 PMCID: PMC5755891 DOI: 10.1371/journal.pone.0190731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/19/2017] [Indexed: 01/18/2023] Open
Abstract
The prevalence of childhood overweight is a major social and public health issue, and primary assessment should focus on early and middle childhood, because weight gain in these phases constitutes a strong predictor of subsequent negative outcomes. Studies on community samples have shown that growth curves may follow linear or non-linear trajectories from early to middle childhood, and can differ based on sex. Overweight children may exhibit a combination of physiological and psychosocial issues, and several studies have demonstrated an association between overweight and internalizing/externalizing behavior. Nevertheless, there is a dearth of longitudinal studies on depressive and aggressive symptoms in children with high BMI. This study adopted a growth curve modeling over three phases to: (1) describe BMI trajectories in two groups of children aged 2–8 (overweight and normal weight) from a community sample; (2) describe the developmental trajectories of children’s aggressive and depressive symptoms from 2 to 8 years of age. Results indicate higher BMI in 2-year-old girls, with males catching up with them by age 8. While overweight females’ BMIs were consistently high, males’ increased at 5 and 8 years. The mean scores for aggressive symptoms at T1 (2 years of age) were the same in all subjects, but a significant deviation occurred from T1 to T2 in both samples, in divergent directions. With regards to children’s depressive symptoms, the two groups had different starting points, with normal weight children scoring lower than overweight youths. Overweight females showed lower depressive scores than overweight males at T1, but they surpassed boys before T2, and showed more maladaptive symptoms at T3. This study solicits professionals working in pediatric settings to consider overweight children’s psychopathological risk, and to be aware that even when children’s BMI does not increase from 2 to 8 years, their psychopathological symptoms may grow in intensity.
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Affiliation(s)
- Luca Cerniglia
- International Telematic University Uninettuno, Psychology Faculty, Department of Psychology, Rome, Italy
- * E-mail:
| | - Silvia Cimino
- Sapienza, University of Rome, Psychology and Medicine Faculty, Department of Dynamic and Clinical Psychology, Rome, Italy
| | - Michela Erriu
- Sapienza, University of Rome, Psychology and Medicine Faculty, Department of Dynamic and Clinical Psychology, Rome, Italy
| | - Stanislav Jezek
- Institute for Research on Children, Youth and Family, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Carlos A. Almenara
- Institute for Research on Children, Youth and Family, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
- Universidad Peruana de Ciencias Aplicadas, Faculty of Psychology, Chorrillos, Lima, Perú
| | - Renata Tambelli
- Sapienza, University of Rome, Psychology and Medicine Faculty, Department of Dynamic and Clinical Psychology, Rome, Italy
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