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Cluver LD, Shenderovich Y, Seslija M, Zhou S, Toska E, Armstrong A, Gulaid LA, Ameyan W, Cassolato M, Kuo CC, Laurenzi C, Sherr L. Identifying Adolescents at Highest Risk of ART Non-adherence, Using the World Health Organization-Endorsed HEADSS and HEADSS+ Checklists. AIDS Behav 2024; 28:141-153. [PMID: 37589806 PMCID: PMC10803572 DOI: 10.1007/s10461-023-04137-6] [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] [Accepted: 07/11/2023] [Indexed: 08/18/2023]
Abstract
Brief tools are necessary to identify adolescents at greatest risk for ART non-adherence. From the WHO's HEADSS/HEADSS+ adolescent wellbeing checklists, we identify constructs strongly associated with non-adherence (validated with viral load). We conducted interviews and collected clinical records from a 3-year cohort of 1046 adolescents living with HIV from 52 South African government facilities. We used least absolute shrinkage and selection operator variable selection approach with a generalized linear mixed model. HEADSS constructs most predictive were: violence exposure (aOR 1.97, CI 1.61; 2.42, p < 0.001), depression (aOR 1.71, CI 1.42; 2.07, p < 0.001) and being sexually active (aOR 1.80, CI 1.41; 2.28, p < 0.001). Risk of non-adherence rose from 20.4% with none, to 55.6% with all three. HEADSS+ constructs were: medication side effects (aOR 2.27, CI 1.82; 2.81, p < 0.001), low social support (aOR 1.97, CI 1.60; 2.43, p < 0.001) and non-disclosure to parents (aOR 2.53, CI 1.91; 3.53, p < 0.001). Risk of non-adherence rose from 21.6% with none, to 71.8% with all three. Screening within established checklists can improve identification of adolescents needing increased support. Adolescent HIV services need to include side-effect management, violence prevention, mental health and sexual and reproductive health.
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Affiliation(s)
- Lucie D Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Yulia Shenderovich
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Marko Seslija
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Elona Toska
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Alice Armstrong
- UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | - Laurie A Gulaid
- UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | - Wole Ameyan
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | | | - Caroline C Kuo
- Department of Health Studies, American University, Washington, DC, USA
| | - Christina Laurenzi
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Lorraine Sherr
- Health Psychology Unit, Institute of Global Health, University College London, London, UK
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Xie K, Wang Z. A Predictive Model for the Risk of Recurrence of Cervical Spondylotic Radiculopathy After Surgery. Pain Ther 2023; 12:1385-1396. [PMID: 37695497 PMCID: PMC10616059 DOI: 10.1007/s40122-023-00548-4] [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: 06/19/2023] [Accepted: 07/24/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION This study aimed to analyze the risk factors affecting the recurrence of cervical spondylotic radiculopathy after surgery, construct a nomogram predictive model, and validate the model's predictive performance using a calibration plot. METHODS In this study, 304 cervical spondylotic radiculopathy patients who underwent computed tomography (CT)-guided radiofrequency ablation (RFA) of cervical intervertebral discs or low-temperature plasma RFA for cervical radiculopathy were enrolled at the Pain Department of Jiaxing College Affiliated Hospital from January 2019 to March 2022. The patients were randomly divided into training (n = 213) and testing (n = 91) groups in a 7:3 ratio. Lasso regression analysis was used to screen for independent predictors of recurrence 1 year after surgery. A nomogram predictive model was established based on the selected factors using multiple logistic regression analysis. RESULTS One year after surgery, 250 of the 304 cervical spondylotic radiculopathy patients did not have recurrences, while 54 had recurrences. Lasso regression combined with multiple logistic regression analysis revealed that duration, numbness, and the Numeric Rating Scale (NRS) were significant predictors of recurrence 1 year after surgery (P < 0.05). A nomogram predictive model was established using these variables. The area under the curve (AUC) of the nomogram predictive model for predicting recurrence in the training group was 0.918 [95% confidence interval (CI) 0.866-0.970], and the AUC in the testing group was 0.892 (95% CI 0.806-0.978). The Hosmer-Lemeshow goodness-of-fit test exhibited a good model fit (P > 0.05). Decision curve analysis (DCA) indicated that the nomogram predictive model had a higher net benefit for predicting the risk of postoperative recurrence in cervical radiculopathy patients when the threshold probability was between 0 and 0.603. CONCLUSION This study successfully developed and validated a high-precision nomogram prediction model (predictive variables include duration, numbness, and NRS) for predicting the risk of postoperative recurrence in cervical radiculopathy patients. The model can help improve the early identification of high-risk patients and screening for postoperative recurrence.
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Affiliation(s)
- Keyue Xie
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
- The Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, 1882 Zhong-Huan-South Road, Jiaxing, 314000, China
| | - Zi Wang
- The Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, 1882 Zhong-Huan-South Road, Jiaxing, 314000, China.
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WAMULIMA TITUS, MASABA JOHNPETERMASETTE, MUSOKE DAVID, MUKUNYA DAVID, MATOVU JOSEPHKB. Missed opportunity for tuberculosis screening among patients presenting at two health facilities in Manafwa district, Uganda. J Public Health Afr 2023; 14:2682. [PMID: 38500696 PMCID: PMC10946296 DOI: 10.4081/jphia.2023.2682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
Missed opportunities for Tuberculosis (TB) screening are key drivers of continued tuberculosis transmission. To determine the proportion of and factors associated with missing TB screening amongst patients who attended Bubulo and Butiru health facilities in the Manafwa district to inform future TB prevention and control efforts in Uganda. This was a facility-based, cross-sectional study with quantitative methods of data collection. 125 patients (≥18 years) with at least one symptom suggestive of TB were systematically selected and interviewed at the exit. Data analysis was done by Stata version 15, using a cluster-based logistic regression model. Of the 125 patients enrolled at both sites, 39% (n=49) were aged between 30 and 49 years; 75.2% (n=94) were females; 44% (n=55) were married while 66.4% (n=83) had a primary level of education. Of the patients enrolled in the study, 68% (n=85) had a missed opportunity for TB screening. Having a; post-primary education level (Adjusted Odds Ratio [AOR]=5.9; 95% Confidence Interval [95% CI]=1.3, 27.1) and attending Bubulo HCIV (AOR=0.01; 95% CI: 0.01, 0.2) were significantly associated with having a missed opportunity for TB screening. Our findings show that slightly more than two-thirds of the patients who presented to the study health facilities with symptoms suggestive of TB missed the opportunity to be screened for TB. Study findings suggest a need for interventions to increase TB screening, particularly among better-educated TB patients.
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Affiliation(s)
- TITUS WAMULIMA
- Faculty of Health Sciences, Busitema University, P.O. Box 1460, Mbale, Uganda
| | | | - DAVID MUSOKE
- Makerere University School of Public Health, Kampala, Uganda
| | - DAVID MUKUNYA
- Busitema University Faculty of Health Sciences, Mbale
| | - JOSEPH KB MATOVU
- Busitema University Faculty of Health Sciences, Mbale
- Makerere University School of Public Health, Kampala, Uganda
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Lau MSY, Becker A, Madden W, Waller LA, Metcalf CJE, Grenfell BT. Comparing and linking machine learning and semi-mechanistic models for the predictability of endemic measles dynamics. PLoS Comput Biol 2022; 18:e1010251. [PMID: 36074763 PMCID: PMC9455846 DOI: 10.1371/journal.pcbi.1010251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022] Open
Abstract
Measles is one the best-documented and most-mechanistically-studied non-linear infectious disease dynamical systems. However, systematic investigation into the comparative performance of traditional mechanistic models and machine learning approaches in forecasting the transmission dynamics of this pathogen are still rare. Here, we compare one of the most widely used semi-mechanistic models for measles (TSIR) with a commonly used machine learning approach (LASSO), comparing performance and limits in predicting short to long term outbreak trajectories and seasonality for both regular and less regular measles outbreaks in England and Wales (E&W) and the United States. First, our results indicate that the proposed LASSO model can efficiently use data from multiple major cities and achieve similar short-to-medium term forecasting performance to semi-mechanistic models for E&W epidemics. Second, interestingly, the LASSO model also captures annual to biennial bifurcation of measles epidemics in E&W caused by susceptible response to the late 1940s baby boom. LASSO may also outperform TSIR for predicting less-regular dynamics such as those observed in major cities in US between 1932-45. Although both approaches capture short-term forecasts, accuracy suffers for both methods as we attempt longer-term predictions in highly irregular, post-vaccination outbreaks in E&W. Finally, we illustrate that the LASSO model can both qualitatively and quantitatively reconstruct mechanistic assumptions, notably susceptible dynamics, in the TSIR model. Our results characterize the limits of predictability of infectious disease dynamics for strongly immunizing pathogens with both mechanistic and machine learning models, and identify connections between these two approaches.
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Affiliation(s)
- Max S. Y. Lau
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, United States of America
| | - Alex Becker
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, United States of America
| | - Wyatt Madden
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, United States of America
| | - Lance A. Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, United States of America
| | - C. Jessica E. Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, United States of America
| | - Bryan T. Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, United States of America
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Ji W, Xue M, Zhang Y, Yao H, Wang Y. A Machine Learning Based Framework to Identify and Classify Non-alcoholic Fatty Liver Disease in a Large-Scale Population. Front Public Health 2022; 10:846118. [PMID: 35444985 PMCID: PMC9013842 DOI: 10.3389/fpubh.2022.846118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/23/2022] [Indexed: 12/12/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a common serious health problem worldwide, which lacks efficient medical treatment. We aimed to develop and validate the machine learning (ML) models which could be used to the accurate screening of large number of people. This paper included 304,145 adults who have joined in the national physical examination and used their questionnaire and physical measurement parameters as model's candidate covariates. Absolute shrinkage and selection operator (LASSO) was used to feature selection from candidate covariates, then four ML algorithms were used to build the screening model for NAFLD, used a classifier with the best performance to output the importance score of the covariate in NAFLD. Among the four ML algorithms, XGBoost owned the best performance (accuracy = 0.880, precision = 0.801, recall = 0.894, F-1 = 0.882, and AUC = 0.951), and the importance ranking of covariates is accordingly BMI, age, waist circumference, gender, type 2 diabetes, gallbladder disease, smoking, hypertension, dietary status, physical activity, oil-loving and salt-loving. ML classifiers could help medical agencies achieve the early identification and classification of NAFLD, which is particularly useful for areas with poor economy, and the covariates' importance degree will be helpful to the prevention and treatment of NAFLD.
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Affiliation(s)
- Weidong Ji
- Department of Medical Information, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Mingyue Xue
- Hospital of Traditional Chinese Medicine Affiliated to the Fourth Clinical Medical College of Xinjiang Medical University, Urumqi, China
| | - Yushan Zhang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hua Yao
- Center of Health Management, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yushan Wang
- Center of Health Management, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- *Correspondence: Yushan Wang
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Li Y, Li C, Zhao S, Yin Y, Zhang X, Wang K. Nomogram for Prediction of Diabetic Retinopathy Among Type 2 Diabetes Population in Xinjiang, China. Diabetes Metab Syndr Obes 2022; 15:1077-1089. [PMID: 35418766 PMCID: PMC8999722 DOI: 10.2147/dmso.s354611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/23/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To establish an accurate risk prediction model of diabetic retinopathy (DR) using cost effective and easily available patients' characteristics and clinical biomarkers. PATIENTS AND METHODS Totally 18,904 cases diagnosed type 2 diabetes mellitus (T2DM) were collected, among which 13,980 cases were selected after quality screening. The least absolute shrinkage and selection operator (LASSO) regression models were used for univariate analysis and factors selection, and the multi-factor logistic regression analysis was used to establish the prediction model. Discrimination, calibration, and clinical usefulness of the prediction model were assessed using AUC/ Harrell's C statistic, calibration plot, and decision curve analysis. Both the development group and validation group were assessed. RESULTS Candidate variables were selected by Lasso regression and multivariate logistic regression analysis. Finally, the candidate predictive variables were included diabetic peripheral neuropathy (DPN), age, neutrophilic granulocyte (NE), high-density lipoprotein (HDL), hemoglobin A1c (HbA1C), duration of T2DM, and glycosylated serum protein (GSP) were used to establish a nomogram model for predicting the risk of DR. In the development group, the area under the receiver operating characteristic curve (AUC) was 0.882 (95% CI, 0.875-0.888). In the validation group, the AUC was 0.870 (95% CI, 0.856-0.881). Meanwhile, the optimism-corrected Harrell's C statistic were 0.878 and 0.867 in the development group and the validation group, respectively. Decision curve analysis demonstrated that the nomogram was clinically useful. CONCLUSION We constructed and verified nomograms that could accurately predict the risk of DR in T2DM patients, which could be used to predict the personalized risk of DR patients in Xinjiang, China.
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Affiliation(s)
- Yongsheng Li
- College of Public Health, Xinjiang Medical University, Urumqi, 830011, People’s Republic of China
| | - Cheng Li
- Center for Data Statistics and Analysis, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People’s Republic of China
| | - Shi Zhao
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, 999077, People’s Republic of China
| | - Yi Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, 211166, People’s Republic of China
| | - Xueliang Zhang
- Department of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, 830011, People’s Republic of China
- Correspondence: Xueliang Zhang; Kai Wang, Department of Medical Engineering and Technology, Xinjiang Medical University, No. 567 Shangde North Road, Shuimogou District, Urumqi City, Xinjiang, 830011, People’s Republic of China, Tel +86 18999978069; +86 13999801720, Fax +8609912110396, Email ;
| | - Kai Wang
- Department of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, 830011, People’s Republic of China
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Chen L, Shen Y, Huang X, Li H, Li J, Wei R, Yang W. MRI-Based Radiomics for Differentiating Orbital Cavernous Hemangioma and Orbital Schwannoma. Front Med (Lausanne) 2021; 8:795038. [PMID: 34977096 PMCID: PMC8716692 DOI: 10.3389/fmed.2021.795038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/29/2021] [Indexed: 01/05/2023] Open
Abstract
Aim: The purpose of this work was to develop and evaluate magnetic resonance imaging (MRI)-based radiomics for differentiation of orbital cavernous hemangioma (OCH) and orbital schwannoma (OSC). Methods: Fifty-eight patients (40 OCH and 18 OSC, confirmed pathohistologically) screened out from 216 consecutive patients who presented between 2015 and 2020 were divided into a training group (28 OCH and 12 OSC) and a validation group (12 OCH and 6 OSC). Radiomics features were extracted from T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI). T-tests, the least absolute shrinkage and selection operator (LASSO), and principal components analysis (PCA) were used to select features for use in the classification models. A logistic regression (LR) model, support vector machine (SVM) model, decision tree (DT) model, and random forest (RF) model were constructed to differentiate OCH from OSC. The models were evaluated according to their accuracy and the area under the receiver operator characteristic (ROC) curve (AUC). Results: Six features from T1WI, five features from T2WI, and eight features from combined T1WI and T2WI were finally selected for building the classification models. The models using T2WI features showed superior performance on the validation data than those using T1WI features, especially the LR model and SVM model, which showed accuracy of 93% (85–100%) and 92%, respectively, The SVM model showed high accuracy of 93% (91–96%) on the combined feature group with an AUC of 98% (97–99%). The DT and RF models did not perform as well as the SVM model. Conclusion: Radiomics analysis using an SVM model achieved an accuracy of 93% for distinguishing OCH and OSC, which may be helpful for clinical diagnosis.
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Affiliation(s)
- Liang Chen
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
| | - Ya Shen
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
| | - Xiao Huang
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
| | - Hua Li
- Department of Imaging, Shanghai Changzheng Hospital, Shanghai, China
| | - Jian Li
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
| | - Ruili Wei
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
- *Correspondence: Ruili Wei
| | - Weihua Yang
- Affiliated Eye Hospital, Nanjing Medical University, Nanjing, China
- Weihua Yang
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Atuegwu NC, Litt MD, Krishnan-Sarin S, Laubenbacher RC, Perez MF, Mortensen EM. E-Cigarette Use in Young Adult Never Cigarette Smokers with Disabilities: Results from the Behavioral Risk Factor Surveillance System Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5476. [PMID: 34065407 PMCID: PMC8160823 DOI: 10.3390/ijerph18105476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 12/29/2022]
Abstract
Young adult never cigarette smokers with disabilities may be at particular risk for adopting e-cigarettes, but little attention has been paid to these people. This study examines the associations between different types of disability and e-cigarette use in this population. Young adult never-smokers from the 2016-2017 Behavioral Risk Factor Surveillance System (BRFSS) survey who were either never or current e-cigarette users (n = 79,177) were selected for the analysis. The Least Absolute Shrinkage and Selection Operator (LASSO) algorithm was used to select confounders for multivariable logistic regression models. Multivariable logistic regression models were used to determine the associations between current e-cigarette use and different types of disability after incorporating BRFSS survey design and adjusting for confounders. Young adult never-smokers who reported any disability had increased odds (OR 1.44, 95% CI 1.18-1.76) of e-cigarette use compared to those who reported no disability. Young adult never-smokers who reported self-care, cognitive, vision, and independent living disabilities had higher odds of e-cigarette use compared to those who reported no disability. There was no statistically significant difference in the odds of e-cigarette use for those reporting hearing and mobility disabilities compared to those who reported no disability. This study highlights the need for increased public education and cessation programs for this population.
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Affiliation(s)
- Nkiruka C. Atuegwu
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT 06030, USA; (M.F.P.); (E.M.M.)
| | - Mark D. Litt
- Division of Behavioral Sciences and Community Health, University of Connecticut School of Medicine, Farmington, CT 06030, USA;
| | | | - Reinhard C. Laubenbacher
- Laboratory for Systems Medicine, Department of Medicine, University of Florida, Gainesville, FL 32610, USA;
| | - Mario F. Perez
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT 06030, USA; (M.F.P.); (E.M.M.)
| | - Eric M. Mortensen
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT 06030, USA; (M.F.P.); (E.M.M.)
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Li Y, Fei T, Wang J, Nicholas S, Li J, Xu L, Huang Y, Li H. Influencing Indicators and Spatial Variation of Diabetes Mellitus Prevalence in Shandong, China: A Framework for Using Data-Driven and Spatial Methods. GEOHEALTH 2021; 5:e2020GH000320. [PMID: 33778309 PMCID: PMC7989969 DOI: 10.1029/2020gh000320] [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: 09/01/2020] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
To control and prevent the risk of diabetes, diabetes studies have identified the need to better understand and evaluate the associations between influencing indicators and the prevalence of diabetes. One constraint has been that influencing indicators have been selected mainly based on subjective judgment and tested using traditional statistical modeling methods. We proposed a framework new to diabetes studies using data-driven and spatial methods to identify the most significant influential determinants of diabetes automatically and estimated their relationships. We used data from diabetes mellitus patients' health insurance records in Shandong province, China, and collected influencing indicators of diabetes prevalence at the county level in the sociodemographic, economic, education, and geographical environment domains. We specified a framework to identify automatically the most influential determinants of diabetes, and then established the relationship between these selected influencing indicators and diabetes prevalence. Our autocorrelation results showed that the diabetes prevalence in 12 Shandong cities was significantly clustered (Moran's I = 0.328, p < 0.01). In total, 17 significant influencing indicators were selected by executing binary linear regressions and lasso regressions. The spatial error regressions in different subgroups were subject to different diabetes indicators. Some positive indicators existed significantly like per capita fruit production and other indicators correlated with diabetes prevalence negatively like the proportion of green space. Diabetes prevalence was mainly subjected to the joint effects of influencing indicators. This framework can help public health officials to inform the implementation of improved treatment and policies to attenuate diabetes diseases.
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Affiliation(s)
- Yizhuo Li
- School of Resource and Environmental SciencesWuhan UniversityWuhanChina
| | - Teng Fei
- School of Resource and Environmental SciencesWuhan UniversityWuhanChina
| | - Jian Wang
- Research Center of Health Economics and ManagementDong Fureng Institute of Economic and Social DevelopmentWuhan UniversityBeijingChina
| | - Stephen Nicholas
- Top Education InstituteSydneyNSWAustralia
- Newcastle Business SchoolUniversity of NewcastleNewcastleNSWAustralia
- School of Management and School of EconomicsTianjin Normal UniversityTianjinChina
| | - Jun Li
- School of Resource and Environmental SciencesWuhan UniversityWuhanChina
| | - Lizheng Xu
- School of Public HealthCenter for Health Economics Experiment and Public PolicyShandong UniversityKey Laboratory of Health Economics and Policy ResearchNHFPC (Shandong University)JinanChina
| | - Yanran Huang
- School of Public HealthCenter for Health Economics Experiment and Public PolicyShandong UniversityKey Laboratory of Health Economics and Policy ResearchNHFPC (Shandong University)JinanChina
| | - Hanqi Li
- School of Resource and Environmental SciencesWuhan UniversityWuhanChina
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Han Y, Yang Y, Shi ZS, Zhang AD, Yan LF, Hu YC, Feng LL, Ma J, Wang W, Cui GB. Distinguishing brain inflammation from grade II glioma in population without contrast enhancement: a radiomics analysis based on conventional MRI. Eur J Radiol 2020; 134:109467. [PMID: 33307462 DOI: 10.1016/j.ejrad.2020.109467] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE In populations without contrast enhancement, the imaging features of atypical brain parenchyma inflammations can mimic those of grade II gliomas. The aim of this study was to assess the value of the conventional MR-based radiomics signature in differentiating brain inflammation from grade II glioma. METHODS Fifty-seven patients (39 patients with grade II glioma and 18 patients with inflammation) were divided into primary (n = 44) and validation cohorts (n = 13). Radiomics features were extracted from T1-weighted images (T1WI) and T2-weighted images (T2WI). Two-sample t-test and least absolute shrinkage and selection operator (LASSO) regression were adopted to select features and build radiomics signature models for discriminating inflammation from glioma. The predictive performance of the models was evaluated via area under the receiver operating characteristic curve (AUC) and compared with the radiologists' assessments. RESULTS Based on the primary cohort, we developed T1WI, T2WI and combination (T1WI + T2WI) models for differentiating inflammation from glioma with 4, 8, and 5 radiomics features, respectively. Among these models, T2WI and combination models achieved better diagnostic efficacy, with AUC of 0.980, 0.988 in primary cohort and that of 0.950, 0.925 in validation cohort, respectively. The AUCs of radiologist 1's and 2's assessments were 0.661 and 0.722, respectively. CONCLUSION The signature based on radiomics features helps to differentiate inflammation from grade II glioma and improved performance compared with experienced radiologists, which could potentially be useful in clinical practice.
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Affiliation(s)
- Yu Han
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710038, PR China
| | - Yang Yang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710038, PR China
| | - Zhe-Sheng Shi
- College of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - An-Ding Zhang
- College of Basic Medicine, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Lin-Feng Yan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710038, PR China
| | - Yu-Chuan Hu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710038, PR China
| | - Lan-Lan Feng
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, PR China
| | - Jiao Ma
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, PR China
| | - Wen Wang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710038, PR China.
| | - Guang-Bin Cui
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710038, PR China.
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11
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A simple nomogram score for screening patients with type 2 diabetes to detect those with hypertension: A cross-sectional study based on a large community survey in China. PLoS One 2020; 15:e0236957. [PMID: 32764769 PMCID: PMC7413482 DOI: 10.1371/journal.pone.0236957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Compared with unaffected individuals, patients with type 2 diabetes (T2DM) have higher risk of hypertension, and diabetes combined with hypertension can lead to server cardiovascular disease. Therefore, the purpose of this study was to establish a simple nomogram model to identify the determinants of hypertension in patients with T2DM and to quickly calculate the probability of hypertension in individuals with T2DM. MATERIALS AND METHODS A total of 643,439 subjects participating in the national physical examination has been recruited in this cross-sectional study. After excluding unqualified subjects, 30,507 adults with T2DM were included in the final analysis. 21,355 and 9,152 subjects were randomly assigned to the model developing group and validation group, respectively, with a ratio of 7:3. The potential risk factors used in this study to assess hypertension in patients with T2DM included questionnaire investigation and physical measurement variables. We used the least absolute shrinkage and selection operator models to optimize feature selection, and the multivariable logistic regression analysis was for predicting model. Discrimination and calibration were assessed using the receiver operating curve (ROC) and calibration curve. RESULTS The results showed that the major determinants of hypertension in patients with T2DM were age, gender, drinking, exercise, smoking, obesity and atherosclerotic vascular disease. The area under ROC curve of developing group and validation group are both 0.814, indicating that the prediction model owns high disease recognition ability. The p values of the two calibration curves are 0.625 and 0.445, suggesting that the nomogram gives good calibration. CONCLUSION The individualized nomogram model can facilitate improved screening and early identification of patients with hypertension in T2DM. This procedure will be useful in developing regions with high epidemiological risk and poor socioeconomic status just like Urumqi, in Northern China.
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12
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Xue M, Su Y, Feng Z, Wang S, Zhang M, Wang K, Yao H. A nomogram model for screening the risk of diabetes in a large-scale Chinese population: an observational study from 345,718 participants. Sci Rep 2020; 10:11600. [PMID: 32665620 PMCID: PMC7360758 DOI: 10.1038/s41598-020-68383-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/23/2020] [Indexed: 12/31/2022] Open
Abstract
Our study is major to establish and validate a simple type||diabetes mellitus (T2DM) screening model for identifying high-risk individuals among Chinese adults. A total of 643,439 subjects who participated in the national health examination had been enrolled in this cross-sectional study. After excluding subjects with missing data or previous medical history, 345,718 adults was included in the final analysis. We used the least absolute shrinkage and selection operator models to optimize feature selection, and used multivariable logistic regression analysis to build a predicting model. The results showed that the major risk factors of T2DM were age, gender, no drinking or drinking/time > 25 g, no exercise, smoking, waist-to-height ratio, heart rate, systolic blood pressure, fatty liver and gallbladder disease. The area under ROC was 0.811 for development group and 0.814 for validation group, and the p values of the two calibration curves were 0.053 and 0.438, the improvement of net reclassification and integrated discrimination are significant in our model. Our results give a clue that the screening models we conducted may be useful for identifying Chinses adults at high risk for diabetes. Further studies are needed to evaluate the utility and feasibility of this model in various settings.
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Affiliation(s)
- Mingyue Xue
- College of Public Health, Xinjiang Medical University, Ürümqi, 830011, China
| | - Yinxia Su
- Center of Health Management, The First Affiliated Hospital, Xinjiang Medical University, Ürümqi, 830011, China
| | - Zhiwei Feng
- College of Basic Medicine, Xinjiang Medical University, Ürümqi, 830011, China
| | - Shuxia Wang
- Center of Health Management, The First Affiliated Hospital, Xinjiang Medical University, Ürümqi, 830011, China
| | - Mingchen Zhang
- The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830011, China
| | - Kai Wang
- College of Medical Engineering and Technology, Xinjiang Medical University, Ürümqi, 830011, China.
| | - Hua Yao
- Center of Health Management, The First Affiliated Hospital, Xinjiang Medical University, Ürümqi, 830011, China.
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13
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Lee Y, Raviglione MC, Flahault A. Use of Digital Technology to Enhance Tuberculosis Control: Scoping Review. J Med Internet Res 2020; 22:e15727. [PMID: 32053111 PMCID: PMC7055857 DOI: 10.2196/15727] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023] Open
Abstract
Background Tuberculosis (TB) is the leading cause of death from a single infectious agent, with around 1.5 million deaths reported in 2018, and is a major contributor to suffering worldwide, with an estimated 10 million new cases every year. In the context of the World Health Organization’s End TB strategy and the quest for digital innovations, there is a need to understand what is happening around the world regarding research into the use of digital technology for better TB care and control. Objective The purpose of this scoping review was to summarize the state of research on the use of digital technology to enhance TB care and control. This study provides an overview of publications covering this subject and answers 3 main questions: (1) to what extent has the issue been addressed in the scientific literature between January 2016 and March 2019, (2) which countries have been investing in research in this field, and (3) what digital technologies were used? Methods A Web-based search was conducted on PubMed and Web of Science. Studies that describe the use of digital technology with specific reference to keywords such as TB, digital health, eHealth, and mHealth were included. Data from selected studies were synthesized into 4 functions using narrative and graphical methods. Such digital health interventions were categorized based on 2 classifications, one by function and the other by targeted user. Results A total of 145 relevant studies were identified out of the 1005 published between January 2016 and March 2019. Overall, 72.4% (105/145) of the research focused on patient care and 20.7% (30/145) on surveillance and monitoring. Other programmatic functions 4.8% (7/145) and electronic learning 2.1% (3/145) were less frequently studied. Most digital health technologies used for patient care included primarily diagnostic 59.4% (63/106) and treatment adherence tools 40.6% (43/106). On the basis of the second type of classification, 107 studies targeted health care providers (107/145, 73.8%), 20 studies targeted clients (20/145, 13.8%), 17 dealt with data services (17/145, 11.7%), and 1 study was on the health system or resource management. The first authors’ affiliations were mainly from 3 countries: the United States (30/145 studies, 20.7%), China (20/145 studies, 13.8%), and India (17/145 studies, 11.7%). The researchers from the United States conducted their research both domestically and abroad, whereas researchers from China and India conducted all studies domestically. Conclusions The majority of research conducted between January 2016 and March 2019 on digital interventions for TB focused on diagnostic tools and treatment adherence technologies, such as video-observed therapy and SMS. Only a few studies addressed interventions for data services and health system or resource management.
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Affiliation(s)
- Yejin Lee
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Mario C Raviglione
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Global Studies Institute, University of Geneva, Geneva, Switzerland.,Centre for Multidisciplinary Research in Health Science (MACH), Università di Milano, Milan, Italy
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Global Studies Institute, University of Geneva, Geneva, Switzerland
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14
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Maokola W, Ngowi B, Lawson L, Mahande M, Todd J, Msuya SE. Performance of and Factors Associated With Tuberculosis Screening and Diagnosis Among People Living With HIV: Analysis of 2012-2016 Routine HIV Data in Tanzania. Front Public Health 2020; 7:404. [PMID: 32117844 PMCID: PMC7015871 DOI: 10.3389/fpubh.2019.00404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/18/2019] [Indexed: 12/15/2022] Open
Abstract
People Living with HIV (PLHIV) should be screened for tuberculosis (TB) at every visit to the HIV care and treatment clinic (CTC), and those with positive results on screening should undergo further diagnostic investigations. We evaluated the performance of the TB diagnosis cascade among PLHIV attending CTC between January 2012 and December 2016 in three regions of Tanzania: Dar es Salaam, Iringa, and Njombe. We used descriptive epidemiology to evaluate performance and logistic regression to determine odds ratios (OR) for factors associated with TB screening and further TB diagnosis after positive TB screening. We analyzed 169,741 PLHIV who made 2,638,876 visits to CTC between January 2012 and December 2016. We excluded 2,074 (0.80%) visits as these involved PLHIV enrolled in CTC with a prior TB disease diagnosis. Of the 2,636,802 visits, 2,524,494 (95.67%) had TB screening according to national guidelines, of which 88,028 (3.49%) had TB screening positive results. Of the 88,028 visits with a positive TB screening, 27,810 (31.59%) had no records for further TB diagnosis following positive TB screening. Of all visits with positive TB screening, 32,986 (37.50%) had a TB disease diagnosis. On multivariate logistic regression, those who visited with World Health Organization (WHO) clinical stage four (aOR = 3.61, 95% CI 3.48–3.75, P < 0.001), enrolled in health center (aOR = 1.26, 95% CI 1.24–1.29, P < 0.001), enrolled in Iringa region (aOR = 1.54, 95% CI 1.50–1.57, P < 0.001), and enrolled in 2015 (aOR = 1.20, 95% CI 1.18–1.24, P < 0.001) were more likely to have no TB screening. Visits involving those who were of the female sex (aOR = 1.14, 95% CI 1.11–1.18, P < 0.001), enrolled in Njombe region (aOR = 4.36, 95% CI 4.09–4.65, P < 0.001), and enrolled in 2016 (aOR = 2.62, 95% CI 2.49–2.77, P < 0.001) were more likely to have no further TB diagnosis after positive TB screening. The study documented high performance of TB screening for PLHIV in HIV CTCs but a low transition of presumptive TB case undergoing further investigations. Better systems are needed for ensuring presumptive TB cases are diagnosed including using more efficient diagnostic methods like Gene pert.
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Affiliation(s)
- Werner Maokola
- National AIDS Control Program/Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania.,Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi Urban, Tanzania
| | - Bernard Ngowi
- National Institute of Medical Research, Dar es Salaam, Tanzania
| | | | - Michael Mahande
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi Urban, Tanzania
| | - Jim Todd
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi Urban, Tanzania.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sia E Msuya
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi Urban, Tanzania
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15
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Factors contributing to the ceiling effect of the EQ-5D-5L: an analysis of patients with prostate cancer judged "no-problems". Qual Life Res 2019; 29:755-763. [PMID: 31583618 PMCID: PMC7028791 DOI: 10.1007/s11136-019-02316-4] [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] [Accepted: 09/23/2019] [Indexed: 11/22/2022]
Abstract
Purpose The goal of the present study was to determine factors related to a ceiling effect (CE) on the EQ-5D-5L among Japanese patients with prostate cancer (PC). Methods An existent cross-sectional observational study dataset was used. Patients were ≥ 20 years of age and diagnosed with PC. For CE determinants on the EQ-5D-5L, we excluded possible “full-health” patients flagged by the EQ-VAS (score = 100) and/or FACT-P (score = 156) instruments. We then divided them into binary variables: A CE group (EQ-5D-5L score = 1) and others (< 1). The associations between CE, sociodemographic and medical characteristics, and FACT-P subscale scores were examined using a multivariate LASSO selection followed by a binomial logistic regression analysis performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results A total of 362 patients were analyzed. The LASSO selection variables, including all obtained variables, were as follows: age, palliative treatment, FACT-P physical well-being, and PC subscale score. Statistically significant variables predicting CE were palliative treatment (OR 0.23; 95% CI 0.09–0.60), physical well-being (OR 1.54; 95% CI 1.34–1.76), and PC subscale (OR 1.08; 95% CI 1.03–1.14). Conclusions This study revealed that palliative treatment and two FACT-P physical well-being and PC subscale scores were positively related to CE on the EQ-5D-5L. To our knowledge, this is the first study to examine predictors of CE on the EQ-5D-5L. The present results may be helpful for facilitating the consideration of “bolt-on” studies from the standpoint of PC patients.
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16
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Mitiku AM, Asfaw GZ, Tsegay HT, Zewdie BY, Tesfay AM. Levels and predictors of TB-HIV Diagnostic service linkage and testing in government hospitals of Southern zone of Tigray, Northern Ethiopia. Afr Health Sci 2019; 19:2335-2346. [PMID: 32127802 PMCID: PMC7040298 DOI: 10.4314/ahs.v19i3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) are global public health problems. TB and HIV diagnostic services linkage is imperative for the fight against the two diseases. OBJECTIVE To assess the diagnostic service linkage and testing of TB-HIV diagnostic services and identify predictors in Public hospitals of Northern Ethiopia. METHODS A cross-sectional study was conducted in five hospitals of Northern Ethiopia. Study subjects' socio-demographic, household and clinical variables were assessed. Data was analyzed using SPSS. Logistic regressions were used to determine the predictors of uptake of TB and HIV testing among HIV and TB patients, respectively. RESULT The level of HIV testing among TB patients was 94.4% and of TB screening among HIV patients was 90.5%. Factors that independently predict HIV testing among TB patients were Residence AOR=0.187(95% CI 0.05-0.76), being 9 grade and above AOR=13.17 (95%CI 2.67-65.03) and drinking alcohol AOR=0.03(95% CI 0.002-0.475). Likewise, being grade 9 and above AOR=6.92 (95% CI 1.75-27.4) and having chronic cough AOR=0.23 (95% CI 0.06-0.92) were predictor variables for having TB screening among HIV patients. CONCLUSION The levels of TB-HIV linkages and testing are high. Moreover, educational status is a strong predictor of TB screening among HIV patients and HIV testing among TB cases. The regional health bureau has to continue supporting its TB and HIV case teams in every health facility.
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Affiliation(s)
| | - Gebrezgi Zinabu Asfaw
- Department of Public Health, College of Health Sciences, Adigrat University, Adigrat, Ethiopia.
| | - Haftu Tesfahun Tsegay
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
- Department of Public Health, College of Health Sciences, Adigrat University, Adigrat, Ethiopia.
- Department of Health Systesm, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
- Private wing service, Ayder Comprehensive Specialized Hospital, College of Health of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Berhe Yodit Zewdie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Atsibeha Mussie Tesfay
- Department of Health Systesm, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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17
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Rich KM, Huamaní JV, Kiani SN, Cabello R, Elish P, Arce JF, Pizzicato LN, Soria J, Wickersham JA, Sanchez J, Altice FL. Correlates of viral suppression among HIV-infected men who have sex with men and transgender women in Lima, Peru. AIDS Care 2018; 30:1341-1350. [PMID: 29843518 PMCID: PMC8236114 DOI: 10.1080/09540121.2018.1476657] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In Peru, HIV is concentrated among men who have sex with men (MSM) and transgender women (TGW). Between June 2015 and August 2016, 591 HIV-positive MSM and TGW were recruited at five clinical care sites in Lima, Peru. We found that 82.4% of the participants had achieved viral suppression (VS; VL < 200) and 73.6% had achieved maximal viral suppression (MVS; VL < 50). Multivariable modeling indicated that patients reporting transportation as a barrier to HIV care were less likely to achieve VS (aOR = 0.47; 95% CI = 0.30-0.75) and MVS (aOR = 0.56; 95% CI = 0.37-0.84). Alcohol use disorders were negatively associated with MVS (aOR = 0.62; 95% CI = 0.30-0.75) and age was positively associated with achieving MVS (aOR = 1.29; 95% CI = 1.04-1.59). These findings underscore the need for more accessible HIV care with integrated behavioral health services in Lima, Peru.
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Affiliation(s)
| | - Javier Valencia Huamaní
- Asociación Civil Impacta Salud y Educación, Av. Almte. Miguel Grau 1010, Distrito de Barranco 15063, Peru
| | - Sara N. Kiani
- Yale AIDS Program, 135 College Street, New Haven, CT
| | - Robinson Cabello
- Associación Vía Libre, Paraguay 478, Distrito de Lima LIMA 01, Peru
| | - Paul Elish
- Yale AIDS Program, 135 College Street, New Haven, CT
| | - Jorge Florez Arce
- Hospital Nacional Arzobispo Loayza, Av. Alfonso Ugarte 848, Distrito de Lima, 15082 Peru
| | | | - Jaime Soria
- Hospital Nacional Dos de Mayo, Av. Miguel Grau 13, Distrito de Lima, 15003, Lima
| | - Jeffrey A. Wickersham
- Yale AIDS Program, 135 College Street, New Haven, CT
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT
- University of Malaya, Centre of Excellence on Research in AIDS (CERIA), Kuala Lumpar, Malaysia
| | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Av. Almte. Miguel Grau 1010, Distrito de Barranco 15063, Peru
- Centro de Investigaciones Biomédicas, Tecnológicas y Medioambientales, Calle Jose Santos Chocano 199, Bellavista, Callao, Peru
| | - Frederick L. Altice
- Yale AIDS Program, 135 College Street, New Haven, CT
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT
- University of Malaya, Centre of Excellence on Research in AIDS (CERIA), Kuala Lumpar, Malaysia
- Yale School of Public Health, Division of Epidemiology, New Haven, CT
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18
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Deckert K, Walter J, Schwarzkopf L. Factors related to and economic implications of inhospital death in German lung cancer patients - results of a Nationwide health insurance claims data based study. BMC Health Serv Res 2018; 18:793. [PMID: 30340487 PMCID: PMC6194570 DOI: 10.1186/s12913-018-3599-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/02/2018] [Indexed: 12/04/2022] Open
Abstract
Background When patients die in a hospital their quality of life is lower than when they die at home or in a hospice. Despite efforts to improve palliative care supply structures, still about 60% of lung cancer patients die in a hospital. Studies have examined factors related to inhospital death in lung cancer patients, yet none used data of a representative German population, additionally including economic aspects. This study aimed to identify factors related to inhospital death in German lung cancer patients and analysed resulting costs. Methods We analysed a dataset of health insurance claims of 17,478 lung cancer patients (incident 2009) with 3 year individual follow-up. We grouped patients into inhospital death and death elsewhere. Studied factors were indicators of healthcare utilization, palliative care, comorbidities and disease spread. We used logistic regression models with LASSO selection method to identify relevant factors. We compared all-cause healthcare expenditures for the last 30 days of life between both groups using generalized linear models with gamma distribution. Results Twelve thousand four hundred fifty-seven patients died in the observation period, thereof 6965 (55.9%) in a hospital. The key factors for increased likelihood of inhospital death were receipt of inpatient palliative care (OR = 1.85), chemotherapeutic treatments in the last 30 days of life (OR = 1.61) and comorbid Congestive Heart Failure (OR = 1.21), and Renal Disease (OR = 1.19). In contrast, higher care level (OR = 0.16), nursing home residency (OR = 0.25) and receipt of outpatient palliative care (OR = 0.25) were associated with a reduced likelihood. All OR were significant (p-values< 0.05). Expenditures in the last 30 days of life were significantly higher for patients with inhospital death (€ 6852 vs. € 33,254, p-value< 0.0001). Conclusion Findings suggest that factors associated with inhospital death often relate to previous contact with hospitals like prior hospitalizations, and treatment of the tumour or comorbidities. Additionally, factors associated with dying elsewhere relate to access to care settings which are more focused on palliation than hospitals. From these results, we can derive that implementing tools like palliative care into tumour-directed therapy might help patients make self-determined decisions about their place of death. This can possibly be achieved at reduced economic burden for SHIs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3599-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karina Deckert
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany. .,Helmholtz Zentrum München GmbH, German Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of Comprehensive Pneumology Center Munich (CPC-M), Member of German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Julia Walter
- Helmholtz Zentrum München GmbH, German Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of Comprehensive Pneumology Center Munich (CPC-M), Member of German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
| | - Larissa Schwarzkopf
- Helmholtz Zentrum München GmbH, German Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of Comprehensive Pneumology Center Munich (CPC-M), Member of German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
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19
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Guo J, Liu Z, Shen C, Li Z, Yan F, Tian J, Xian J. MR-based radiomics signature in differentiating ocular adnexal lymphoma from idiopathic orbital inflammation. Eur Radiol 2018; 28:3872-3881. [PMID: 29632999 DOI: 10.1007/s00330-018-5381-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the value of the MR-based radiomics signature in differentiating ocular adnexal lymphoma (OAL) and idiopathic orbital inflammation (IOI). METHODS One hundred fifty-seven patients with pathology-proven OAL (84 patients) and IOI (73 patients) were divided into primary and validation cohorts. Eight hundred six radiomics features were extracted from morphological MR images. The least absolute shrinkage and selection operator (LASSO) procedure and linear combination were used to select features and build radiomics signature for discriminating OAL from IOI. Discriminating performance was assessed by the area under the receiver-operating characteristic curve (AUC). The predictive results were compared with the assessment of radiologists by chi-square test. RESULTS Five radiomics features were included in the radiomics signature, which differentiated OAL from IOI with an AUC of 0.74 and 0.73 in the primary and validation cohorts respectively. There was a significant difference between the classification results of the radiomics signature and those of a radiology resident (p < 0.05), although there was no significant difference between the results of the radiomics signature and those of a more experienced radiologist (p > 0.05). CONCLUSIONS Radiomics features have the potential to differentiate OAL from IOI. KEY POINTS • Clinical and imaging findings of OAL and IOI often overlap, which makes diagnosis difficult. • Radiomics features can potentially differentiate OAL from IOI non invasively. • The radiomics signature discriminates OAL from IOI at the same level as an experienced radiologist.
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Affiliation(s)
- Jian Guo
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 of Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Chen Shen
- School of Life Science and Technology, Xidian University, Xi'an, Shanxi, 710126, China
| | - Zheng Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 of Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - Fei Yan
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 of Dongjiaominxiang, Dongcheng District, Beijing, 100730, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China. .,University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1 of Dongjiaominxiang, Dongcheng District, Beijing, 100730, China.
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20
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Roerink ME, Knoop H, Bronkhorst EM, Mouthaan HA, Hawinkels LJAC, Joosten LAB, van der Meer JWM. Cytokine signatures in chronic fatigue syndrome patients: a Case Control Study and the effect of anakinra treatment. J Transl Med 2017; 15:267. [PMID: 29284500 PMCID: PMC5747240 DOI: 10.1186/s12967-017-1371-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cytokine disturbances have been suggested to be associated with the Chronic Fatigue Syndrome/Myalgic encephalomyelitis (CFS/ME) for decades. METHODS Fifty female CFS patients were included in a study on the effect of the interleukin-1-receptor antagonist anakinra or placebo during 4 weeks. EDTA plasma was collected from patients before and directly after treatment. At baseline, plasma samples were collected at the same time from 48 healthy, age-matched female neighborhood controls. A panel of 92 inflammatory markers was determined in parallel in 1 μL samples using a 'proximity extension assay' (PEA) based immunoassay. Since Transforming growth factor beta (TGF-β) and interleukin-1 receptor antagonist (IL-1Ra) were not included in this platform, these cytokines were measured with ELISA. RESULTS In CFS/ME patients, the 'normalized protein expression' value of IL-12p40 and CSF-1 was significantly higher (p value 0.0042 and 0.049, respectively). Furthermore, using LASSO regression, a combination of 47 markers yielded a prediction model with a corrected AUC of 0.73. After correction for multiple testing, anakinra had no effect on circulating cytokines. TGF-β did not differ between patients and controls. CONCLUSIONS In conclusion, this study demonstrated increased IL-12p40 and CSF-1 concentrations in CFS/ME patients in addition to a set of predictive biomarkers. There was no effect of anakinra on circulating cytokines other than IL-1Ra. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02108210 , Registered April 2014.
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Affiliation(s)
- Megan E Roerink
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Hans Knoop
- Department of Medical Psychology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Ewald M Bronkhorst
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Luuk J A C Hawinkels
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Leo A B Joosten
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos W M van der Meer
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Ma Z, Fang M, Huang Y, He L, Chen X, Liang C, Huang X, Cheng Z, Dong D, Liang C, Xie J, Tian J, Liu Z. CT-based radiomics signature for differentiating Borrmann type IV gastric cancer from primary gastric lymphoma. Eur J Radiol 2017. [PMID: 28629560 DOI: 10.1016/j.ejrad.2017.04.007] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the value of CT-based radiomics signature for differentiating Borrmann type IV gastric cancer (GC) from primary gastric lymphoma (PGL). MATERIALS AND METHODS 40 patients with Borrmann type IV GC and 30 patients with PGL were retrospectively recruited. 485 radiomics features were extracted and selected from the portal venous CT images to build a radiomics signature. Subjective CT findings, including gastric wall peristalsis, perigastric fat infiltration, lymphadenopathy below the renal hila and enhancement pattern, were assessed to construct a subjective findings model. The radiomics signature, subjective CT findings, age and gender were integrated into a combined model by multivariate analysis. The diagnostic performance of these three models was assessed with receiver operating characteristics curves (ROC) and were compared using DeLong test. RESULTS The subjective findings model, the radiomics signature and the combined model showed a diagnostic accuracy of 81.43% (AUC [area under the curve], 0.806; 95% CI [confidence interval]: 0.696-0.917; sensitivity, 63.33%; specificity, 95.00%), 84.29% (AUC, 0.886 [95% CI: 0.809-0.963]; sensitivity, 86.67%; specificity, 82.50%), 87.14% (AUC, 0.903 [95%CI: 0.831-0.975]; sensitivity, 70.00%; specificity, 100%), respectively. There were no significant differences in AUC among these three models (P=0.051-0.422). CONCLUSION Radiomics analysis has the potential to accurately differentiate Borrmann type IV GC from PGL.
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Affiliation(s)
- Zelan Ma
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Mengjie Fang
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China; University of Chinese Academy of Sciences, Beijing, 100190, China.
| | - Yanqi Huang
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Lan He
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510006, China.
| | - Xin Chen
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China.
| | - Cuishan Liang
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Xiaomei Huang
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Zixuan Cheng
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510006, China.
| | - Di Dong
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China; University of Chinese Academy of Sciences, Beijing, 100190, China.
| | - Changhong Liang
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Jiajun Xie
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, China.
| | - Jie Tian
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.
| | - Zaiyi Liu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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