scholarly journals Latent class analysis of 216 patients with adult-onset Still’s disease

2022 ◽  
Vol 24 (1) ◽  
Author(s):  
Takahiro Sugiyama ◽  
Shunsuke Furuta ◽  
Masaki Hiraguri ◽  
Kei Ikeda ◽  
Yosuke Inaba ◽  
...  

Abstract Background Adult-onset Still’s disease (AOSD) is a rare systemic autoinflammatory disease which encompasses patients with heterogenous presentation and a wide range of clinical courses. In this study, we aimed to identify potential subgroups of AOSD and reveal risk factors for relapse. Methods We included a total of 216 AOSD patients who received treatment in nine hospitals between 2000 and 2019. All patients fulfilled the Yamaguchi classification criteria. We retrospectively collected information about baseline characteristics, laboratory tests, treatment, relapse, and death. We performed latent class analysis and time-to-event analysis for relapse using the Cox proportional hazard model. Results The median age at disease onset was 51.6 years. The median follow-up period was 36.8 months. At disease onset, 22.3% of the patients had macrophage activation syndrome. The median white blood cell count was 12,600/μL, and the median serum ferritin level was 7230 ng/mL. Systemic corticosteroids were administered in all but three patients (98.6%) and the median initial dosage of prednisolone was 40mg/day. Ninety-six patients (44.4%) were treated with concomitant immunosuppressants, and 22 (10.2%) were treated with biologics. Latent class analysis revealed that AOSD patients were divided into two subgroups: the typical group (Class 1: 71.8%) and the elderly-onset group (Class 2: 28.2%). During the follow-up period, 13 of 216 patients (6.0%) died (12 infections and one senility), and 76 of 216 patients (35.1%) experienced relapses. Overall and relapse-free survival rates at 5 years were 94.9% and 57.3%, respectively, and those rates were not significantly different between Class 1 and 2 (p=0.30 and p=0.19). Time-to-event analysis suggested higher neutrophil count, lower hemoglobin, and age ≥65 years at disease onset as risk factors for death and age ≥65 years at disease onset as a risk factor for relapse. Conclusions AOSD patients were divided into two subgroups: the typical group and the elderly-onset group. Although the survival of patients with AOSD was generally good, the patients often experienced relapses. Age ≥65 years at disease onset was the risk factor for relapse.

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e4592 ◽  
Author(s):  
Zhongheng Zhang

Acute respiratory distress syndrome (ARDS) is a highly heterogeneous syndrome that can exhibit significant differences in the underlying causes, leading to different responses to treatment. It is required to identify subtypes of ARDS to guideline clinical treatment and trial design. The study aimed to identify subtypes of ARDS using latent class analysis (LCA). The study was a secondary analysis of the EDEN study, which was a randomized, controlled, multicenter trial conducted from January 2, 2008 to April 12, 2011. The primary study endpoint was death through 90-day follow up. LCA was performed incorporating variables on day 0 before randomization. The number of classes was chosen by a bootstrapped likelihood ratio test, Bayesian information criterion and the number of patients in each class. A total of 943 patients were enrolled in the study, including 219 (23.2%) non-survivors and 724 (76.8%) survivors. The LCA identified three classes of ARDS. Class 1 (hemodynamically unstable type) had significantly higher mortality rate (p = 0.003) than class 2 (intermediate type) and 3 (stable type) through 90 days follow up. There was significant interaction between cumulative fluid balance and the class (p = 0.02). While more fluid balance was beneficial for class 1, it was harmful for class 2 and 3. In conclusion, the study identified three classes of ARDS, which showed different clinical presentations, responses to fluid therapy and prognosis. The classification system used simple clinical variables and could help to design ARDS trials in the future.


2021 ◽  
pp. 009385482199841
Author(s):  
Melinda Reinhardt ◽  
Zsolt Horváth ◽  
Boglárka Drubina ◽  
Gyöngyi Kökönyei ◽  
Kenneth G. Rice

Significantly higher rates of nonsuicidal self-injury (NSSI) have been discovered among justice-involved juveniles. Our study aimed to discriminate homogeneous subgroups of justice-involved youth with different self-harm behavior characteristics based on latent class analysis. A total of 244 adolescents (92.6% boys; Mage = 16.99, SD = 1.28) in Hungarian juvenile detention centers completed measures of NSSI and dissociation. High-NSSI (Class 1; 9%), moderate-NSSI (Class 2; 42.6%), and low-NSSI (Class 3; 48.4%) profiles were detected relating to different forms of NSSI. Multiple comparisons showed that girls were members of Class 1 and 2 at higher rates and these subgroups showed significantly higher dissociation proportions than Class 3. Our findings pointed out diversity in self-harm profiles with different characteristics in terms of methods and severity of self-harm, experienced emotions, and other emotion regulation tendencies among justice-involved adolescents. These results suggest sophisticated treatment approaches to match variations in severity and presentation.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 59-59
Author(s):  
Eric Jutkowitz ◽  
Lauren Mitchell ◽  
Joseph Gaugler

Abstract People living with Alzheimer’s disease and related dementias (ADRD) receive most of their care from family/friends, but little is known about the organization of this care. We used data from the Health and Retirement Study and latent class analysis to determine variation in the hours of care received by community-dwelling people with ADRD from disease onset up to 6-years post onset. At incidence (n=1,158), the latent class analysis identified two groups of caregiving patterns. In the first group, 10% (n=109) of people with ADRD received 481 hours (SD=177) of care. Most care was provided by a spouse (411 hours) with less from children (28 hours), other family/friends (17 hours), and paid individuals (25 hours). In the second latent class, the remaining 90% (n=1,049) of people with ADRD received 114 hours (SD=202) of care which was distributed between spouses (12 hours), children (51 hours), other relatives/friends (22 hours), and paid individuals (29 hours). By 6-years post incidence, 7% (n=76) of the original ADRD cohort remained in the community, and we identified two latent classes independent of those identified at incidence. Almost 15% (n=11) of people with ADRD received a majority of care from a spouse (376 hours) with care supplemented by children (10 hours) and paid individuals (54 hours). The remaining 85% (n=65) of people with ADRD received 294 (SD=314) hours of care from spouses (13 hours), children (104 hours), other family/friends (83 hours), and paid individuals (67 hours). Policies/interventions supporting caregivers must account for the heterogeneity in the organization caregivers.


Viruses ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1118
Author(s):  
Ralf Wagner ◽  
David Peterhoff ◽  
Stephanie Beileke ◽  
Felix Günther ◽  
Melanie Berr ◽  
...  

SARS-CoV-2 infection fatality ratios (IFR) remain controversially discussed with implications for political measures. The German county of Tirschenreuth suffered a severe SARS-CoV-2 outbreak in spring 2020, with particularly high case fatality ratio (CFR). To estimate seroprevalence, underreported infections, and IFR for the Tirschenreuth population aged ≥14 years in June/July 2020, we conducted a population-based study including home visits for the elderly, and analyzed 4203 participants for SARS-CoV-2 antibodies via three antibody tests. Latent class analysis yielded 8.6% standardized county-wide seroprevalence, a factor of underreported infections of 5.0, and 2.5% overall IFR. Seroprevalence was two-fold higher among medical workers and one third among current smokers with similar proportions of registered infections. While seroprevalence did not show an age-trend, the factor of underreported infections was 12.2 in the young versus 1.7 for ≥85-year-old. Age-specific IFRs were <0.5% below 60 years of age, 1.0% for age 60–69, and 13.2% for age 70+. Senior care homes accounted for 45% of COVID-19-related deaths, reflected by an IFR of 7.5% among individuals aged 70+ and an overall IFR of 1.4% when excluding senior care home residents from our computation. Our data underscore senior care home infections as key determinant of IFR additionally to age, insufficient targeted testing in the young, and the need for further investigations on behavioral or molecular causes of the fewer infections among current smokers.


2011 ◽  
Vol 23 (10) ◽  
pp. 1659-1670 ◽  
Author(s):  
Antonio Ciampi ◽  
Alina Dyachenko ◽  
Martin Cole ◽  
Jane McCusker

ABSTRACTBackground: The study of mental disorders in the elderly presents substantial challenges due to population heterogeneity, coexistence of different mental disorders, and diagnostic uncertainty. While reliable tools have been developed to collect relevant data, new approaches to study design and analysis are needed. We focus on a new analytic approach.Methods: Our framework is based on latent class analysis and hidden Markov chains. From repeated measurements of a multivariate disease index, we extract the notion of underlying state of a patient at a time point. The course of the disorder is then a sequence of transitions among states. States and transitions are not observable; however, the probability of being in a state at a time point, and the transition probabilities from one state to another over time can be estimated.Results: Data from 444 patients with and without diagnosis of delirium and dementia were available from a previous study. The Delirium Index was measured at diagnosis, and at 2 and 6 months from diagnosis. Four latent classes were identified: fairly healthy, moderately ill, clearly sick, and very sick. Dementia and delirium could not be separated on the basis of these data alone. Indeed, as the probability of delirium increased, so did the probability of decline of mental functions. Eight most probable courses were identified, including good and poor stable courses, and courses exhibiting various patterns of improvement.Conclusion: Latent class analysis and hidden Markov chains offer a promising tool for studying mental disorders in the elderly. Its use may show its full potential as new data become available.


Author(s):  
Peiyi Lu ◽  
Dexia Kong ◽  
Mack Shelley ◽  
Joan K. Davitt

Guided by an intersectionality framework, this study examined intersectional discrimination attributions and their associations with health outcomes. Older respondents (aged ≥50) from the Health and Retirement Study in 2014-2015 were included ( N = 6286). Their reasons for discrimination (age, gender, sexual orientation, race, national origin, religion, financial status, weight, physical appearance, disability, and others) were examined. Latent class analysis examined the subgroup profiles. Six classes were identified: class 1 (54.52% of the sample) had no/minimal discrimination; Class 2 (21.89%) experienced primarily ageism; class 3 (8.81%) reported discrimination based on age/gender/national origin/race; class 4 (7.99%) attributed discrimination to financial/other reasons; class 5 (5.87%) experienced discrimination based on age/weight/physical appearance/disability; and class 6 (0.92%) perceived high discrimination. Intersectional discrimination was associated with poorer self-rated health and higher depressive symptoms compared to the no/minimal discrimination group. Multiple marginalized identities co-occur and contribute to discrimination. An intersectional approach is recommended to understand discrimination in later life.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Jinju Lee ◽  
Yunsoo Lee ◽  
Soo Jung Kim ◽  
Ji Hoon Song

PurposeThe purpose of this study is to identify latent classes of work values that influence the career choices of Korean workers through a person-centred approach. Because work values may be diverse in individuals, investigating the various combinations of those values will help understand individual's decisions to take, maintain and leave a job.Design/methodology/approachThe authors used a total of 15,103 datasets collected at the national level in South Korea. Data were analyzed by using latent class analysis (LCA); a three-step approach was employed to address classification.FindingsAs the results of this study, Class 3, “seeking balanced work values rather than income,” presented the highest level of job satisfaction, whereas Class 1, “seeking job security and income,” exhibited the lowest.Originality/valueEmploying an assessment tool to identify the distinct combinations of work values that individuals possess and then providing them with appropriate training and development programs and customized Human Resource (HR) policies aligned with the classes will be essential tasks for HRD (Human Resource Development)/HRM (Human Resource Management) practitioners.


2012 ◽  
Vol 73 (5) ◽  
pp. 362-368 ◽  
Author(s):  
M.H.C.T. van Beek ◽  
M. Mingels ◽  
R.C. Oude Voshaar ◽  
A.J.L.M. van Balkom ◽  
M. Lappenschaar ◽  
...  

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