Effect modifiers for patient-reported outcomes in operatively and nonoperatively treated patients with adult symptomatic lumbar scoliosis: a combined analysis of randomized and observational cohorts

2020 ◽  
Vol 33 (1) ◽  
pp. 17-26
Author(s):  
Elizabeth L. Yanik ◽  
Michael P. Kelly ◽  
Jon D. Lurie ◽  
Christine R. Baldus ◽  
Christopher I. Shaffrey ◽  
...  
Keyword(s):  
Mental Health ◽  
Socioeconomic Status ◽  
Operative Treatment ◽  
Nonoperative Treatment ◽  
Lower Socioeconomic Status ◽  
Effect Modifier ◽  
Lumbar Scoliosis ◽  
Lower Socioeconomic ◽  
High Bmi

OBJECTIVEAdult symptomatic lumbar scoliosis (ASLS) is a common and disabling condition. The ASLS-1 was a multicenter, dual-arm study (with randomized and observational cohorts) examining operative and nonoperative care on health-related quality of life in ASLS. An aim of ASLS-1 was to determine patient and radiographic factors that modify the effect of operative treatment for ASLS.METHODSPatients 40–80 years old with ASLS were enrolled in randomized and observational cohorts at 9 North American centers. Primary outcomes were the differences in mean change from baseline to 2-year follow-up for the SRS-22 subscore (SRS-SS) and the Oswestry Disability Index (ODI). Analyses were performed using an as-treated approach with combined cohorts. Factors examined were prespecified or determined using regression tree analysis. For each potential effect modifier, subgroups were created using clinically relevant cutoffs or via regression trees. Estimates of within-group and between-group change were compared using generalized linear mixed models. An effect modifier was defined as a treatment effect difference greater than the minimal detectable measurement difference for both SRS-SS (0.4) and ODI (7).RESULTSTwo hundred eighty-six patients were enrolled and 256 (90%) completed 2-year follow-up; 171 received operative treatment and 115 received nonoperative treatment. Surgery was superior to nonoperative care for all effect subgroups considered, with the exception of those with nearly normal pelvic incidence−lumbar lordosis (PI–LL) match (≤ 11°). Male patients and patients with more (> 11°) PI–LL mismatch at baseline had greater operative treatment effects on both the SRS-SS and ODI compared to nonoperative treatment. No other radiographic subgroups were associated with treatment effects. High BMI, lower socioeconomic status, and poor mental health were not related to worse outcomes.CONCLUSIONSNumerous factors previously related to poor outcomes with surgery, such as low mental health, lower socioeconomic status, and high BMI, were not related to outcomes in ASLS in this exploratory analysis. Those patients with higher PI–LL mismatch did improve more with surgery than those with normal alignment. On average, none of the factors considered were associated with a worse outcome with operative treatment versus nonoperative treatment. These findings may guide future prospective analyses of factors related to outcomes in ASLS care.

Risk factors for incidence of trachomatous scarring in a cohort of women in low endemic district

2018 ◽  
Vol 102 (4) ◽  
pp. 419-423 ◽  
Author(s):  
Rabia Karani ◽  
Meraf Wolle ◽  
Harran Mkocha ◽  
Beatriz Muñoz ◽  
Sheila K West
Keyword(s):  
Socioeconomic Status ◽  
Logistic Regression ◽  
Demographic Factors ◽  
Bivariate Analysis ◽  
Fire Exposure ◽  
Lower Socioeconomic Status ◽  
Multivariable Logistic Regression Model ◽  
Lower Socioeconomic ◽  
Endemic District

Background/aimsTo determine the incidence of scarring in women in a trachoma low endemic district of rural Tanzania and to determine the effects of lifetime cooking fire exposure and markers of lower socioeconomic status on incidence of scarring in these women.MethodsA prospective cohort study was conducted over a 3.5-year period from 2013 to 2016 in 48 villages in Kongwa, Tanzania where trachoma at baseline was 5.2% in children. A random sample of 2966 women aged 15 and older who were at risk for incident scarring were eligible for follow-up. Data on demographic factors, cooking fire exposure and trachomatous scarring were gathered at baseline and follow-up. An index of lifetime exposure to cooking fire exposure was created and bivariate analysis, age-adjusted logistic regression and multivariable logistic models were used to look for associations of demographic factors and cooking fire exposure with incident trachomatous scarring.ResultsThe cumulative incidence of scarring was 7.1% or 2.0% per year. Incidence of scarring increased with age and exposure to markers of lower socioeconomic status. A multivariable logistic regression model adjusting for confounding factors did not find an association between lifetime cooking fire exposure and incidence of scarring (OR=0.92; 95% CI 0.68 to 1.24, P=0.58).ConclusionsThere was still incident scarring in women in Tanzania despite low rates of active trachoma. There was no association between exposure to cooking fires and incident scarring. More research is needed to understand the factors that contribute to new scarring in these women.

Abstract P170: Cardiovascular-related Pregnancy Complications: Associations With Health Behaviors And Mental Health During The Covid-19 Pandemic

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Jennifer E Phipps ◽  
Machelle D Wilson ◽  
Imo A Ebong ◽  
Herman L Hedriana ◽  
Leigh Ann Simmons
Keyword(s):  
Mental Health ◽  
Socioeconomic Status ◽  
African American ◽  
Health Behaviors ◽  
Lower Socioeconomic Status ◽  
Fetal Outcomes ◽  
White Race ◽  
Uncomplicated Pregnancy ◽  
Lower Socioeconomic ◽  
Race Ethnicity

Pregnancies with cardiovascular (CV) complications are more likely to involve additional complications, poorer short and long-term health, and worse fetal outcomes. Additionally, CV complications are associated with poorer mental health, lower socioeconomic status, and non-White race/ethnicity. The COVID-19 pandemic has had negative effects on mental well-being and disproportionately affects people of lower socioeconomic status and non-White race/ethnicity. Thus, we hypothesized that the pandemic would differentially affect pregnant people with and without CV complications. We performed a cross-sectional survey of 465 pregnant people in California from June 6 through July 29, 2020. Twenty-three participants reported CV complications (e.g., hypertensive disorders, gestational diabetes) and 29 participants reported non-CV complications. The CV group was 56.5% (13 of 23) Latinx and 43.5% (10 of 23) White versus the uncomplicated pregnancy group, which was 33.7% (137 of 407) Latinx and 66.3% (270 of 407) White (chi-square, p=0.03; 6 respondents did not answer). The CV complications group was 9.5% (2 of 21) African American and the uncomplicated pregnancy group was 4.9% (19 of 392) African American (Fisher’s Exact, p=0.053; 23 respondents did not answer). We assessed 64 health behaviors reported on a Likert scale with the Wilcoxon 2-Sample Test and found the CV group reported more health-promoting behaviors, including: less likely to eat sweets (p=0.004), more likely to sanitize frequently used areas in their homes and their groceries (p=0.049 and 0.069, respectively). However, they were also more likely to smoke cigarettes (p=0.02). While the two groups did not differ significantly on stress, depression, or anxiety, the CV group was more likely to worry that their babies may be hospitalized after birth (p=0.01) and their provider may be unavailable during delivery (p=0.047). Concerns for self and baby trended towards significance for the CV group, which reported being more likely to worry about getting sick (p=0.077) and their babies being born early (p=0.079) or getting sick (p=0.098). While preliminary, these data suggest that COVID-19 disproportionately affects pregnant people with prenatal CV complications. Given limited research on pregnancy during COVID-19 and the primary focus on biological outcomes, these findings indicate a clear need to address the pandemic’s influence on behavioral and emotional health during pregnancy - especially for those with CV complications who are at higher risk of poor maternal and fetal outcomes.

Analysis of the influence of parents' going out on the mental health of left-behind children in rural areas

2021 ◽  
pp. 141-148
Author(s):  
Tao Guoqing
Keyword(s):  
Mental Health ◽  
Socioeconomic Status ◽  
Survey Data ◽  
Rural Areas ◽  
Physical And Mental Health ◽  
Lower Socioeconomic Status ◽  
Left Behind ◽  
Migrant Laborers ◽  
Lower Socioeconomic ◽  
The Impact

With the continuous and deepening of urbanization in my country, more and more migrant laborers appear, accompanied by the emergence of left-behind children. As a representative of children with lower socioeconomic status, left-behind children in rural areas have different degrees of problems in physical and mental health and learning. This article uses China’s education tracking survey data to empirically analyze the impact of parents’going out on the mental health of left-behind children in rural areas. The study found that mothers play an indispensable role in the growth of children and have a significant impact on the development of children’s mental health. Therefore, in the policy of focusing on the protection of left-behind children, it is necessary to rationally allocate the arrangements for parents to take care of home and work outside to create a normal and suitable family atmosphere for the left-behind children.

Operative versus nonoperative treatment for adult symptomatic lumbar scoliosis at 5-year follow-up: durability of outcomes and impact of treatment-related serious adverse events

2021 ◽  
pp. 1-13
Author(s):  
Justin S. Smith ◽  
Michael P. Kelly ◽  
Elizabeth L. Yanik ◽  
Christine R. Baldus ◽  
Thomas J. Buell ◽  
...  
Keyword(s):  
Adverse Events ◽  
Operative Treatment ◽  
Nonoperative Treatment ◽  
Incidence Rates ◽  
Mean Difference ◽  
Patient Counseling ◽  
Serious Adverse Events ◽  
Lumbar Scoliosis ◽  
The Impact

OBJECTIVE Although short-term adult symptomatic lumbar scoliosis (ASLS) studies favor operative over nonoperative treatment, longer outcomes are critical for assessment of treatment durability, especially for operative treatment, because the majority of implant failures and nonunions present between 2 and 5 years after surgery. The objectives of this study were to assess the durability of treatment outcomes for operative versus nonoperative treatment of ASLS, to report the rates and types of associated serious adverse events (SAEs), and to determine the potential impact of treatment-related SAEs on outcomes. METHODS The ASLS-1 (Adult Symptomatic Lumbar Scoliosis–1) trial is an NIH-sponsored multicenter prospective study to assess operative versus nonoperative ASLS treatment. Patients were 40–80 years of age and had ASLS (Cobb angle ≥ 30° and Oswestry Disability Index [ODI] ≥ 20 or Scoliosis Research Society [SRS]–22 subscore ≤ 4.0 in the Pain, Function, and/or Self-Image domains). Patients receiving operative and nonoperative treatment were compared using as-treated analysis, and the impact of related SAEs was assessed. Primary outcome measures were ODI and SRS-22. RESULTS The 286 patients with ASLS (107 with nonoperative treatment, 179 with operative treatment) had 2-year and 5-year follow-up rates of 90% (n = 256) and 74% (n = 211), respectively. At 5 years, compared with patients treated nonoperatively, those who underwent surgery had greater improvement in ODI (mean difference −15.2 [95% CI −18.7 to −11.7]) and SRS-22 subscore (mean difference 0.63 [95% CI 0.48–0.78]) (p < 0.001), with treatment effects (TEs) exceeding the minimum detectable measurement difference (MDMD) for ODI (7) and SRS-22 subscore (0.4). TEs at 5 years remained as favorable as 2-year TEs (ODI −13.9, SRS-22 0.52). For patients in the operative group, the incidence rates of treatment-related SAEs during the first 2 years and 2–5 years after surgery were 22.38 and 8.17 per 100 person-years, respectively. At 5 years, patients in the operative group who had 1 treatment-related SAE still had significantly greater improvement, with TEs (ODI −12.2, SRS-22 0.53; p < 0.001) exceeding the MDMD. Twelve patients who received surgery and who had 2 or more treatment-related SAEs had greater improvement than nonsurgically treated patients based on ODI (TE −8.34, p = 0.017) and SRS-22 (TE 0.32, p = 0.029), but the SRS-22 TE did not exceed the MDMD. CONCLUSIONS The significantly greater improvement of operative versus nonoperative treatment for ASLS at 2 years was durably maintained at the 5-year follow-up. Patients in the operative cohort with a treatment-related SAE still had greater improvement than patients in the nonoperative cohort. These findings have important implications for patient counseling and future cost-effectiveness assessments.

scholarly journals The Mental Health and Grade Point Average among College Students from Lower Socioeconomic Status Based on Healthcare Data Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xue Dong ◽  
Kaige Yang ◽  
Ruxin Zhang ◽  
Yuecheng Lv
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Academic Achievement ◽  
Socioeconomic Status ◽  
Self Esteem ◽  
Lower Socioeconomic Status ◽  
Grade Point ◽  
Mediating Role ◽  
Lower Socioeconomic ◽  
Health And Academic Achievement

This study evaluated the mediating role of social support in the relationships between mental health and academic achievement and used a sample of 640 college students from lower socioeconomic status (LSES) compared to 501 from higher socioeconomic status (HSES) in China. Self-report measures of depression, anxiety, Internet addiction, self-esteem, perceived social support, and grade point average (GPA) were measured online. Group differences were examined with Chi-square analyses. Results. (1) There were significant differences in mental health, academic achievement, and social support between LSES and HSES. (2) Anxiety, depression, and Internet addiction were significantly negatively correlated with academic achievement; self-esteem and social support were significantly positively correlated with academic achievement. (3) Social support has a mediating role between mental health and academic achievement. These results proved that it is necessary to pay more attention to their mental health and develop social support to improve their academic achievement for LSES students. Previous studies have paid little attention to the LSES students, but these students are more prone to psychological problems. Therefore, this study focuses on the LSES students.

Long-term Cognitive Outcome of Children With Parenchymal Neurocysticercosis: A Prospective Observation Study

2018 ◽  
Vol 33 (7) ◽  
pp. 468-473 ◽  
Author(s):  
Pratibha Singhi ◽  
Prabhjot Malhi ◽  
Renu Suthar ◽  
Brijendra Deo ◽  
N. K. Khandelwal
Keyword(s):  
Socioeconomic Status ◽  
Cognitive Assessment ◽  
Cognitive Outcome ◽  
Lower Socioeconomic Status ◽  
Observation Study ◽  
Lower Socioeconomic ◽  
Scholastic Performance ◽  
Poor Memory

To study the cognitive profile and scholastic performance of children with parenchymal neurocysticercosis. A total of 500 children with a diagnosis of neurocysticercosis and epilepsy registered in our pediatric neurocysticercosis clinic between January 1996 and December 2002 were enrolled. Patients were evaluated for their scholastic performance using their school grades. Cognitive assessment was done using Parental interview and the “Draw-a-Man” test. Poor scholastic performance was seen in 22.2% (111) children. Draw-a-Man test was done in 148 children; 18.2% (27/148) had scores equivalent to IQ <70. Intermittent headache, behavior problems, and poor memory were reported in 40% (201) children. Multiple lesions, lower socioeconomic status, and calcified lesions on follow-up were associated with academic underachievement ( P < .05). About a fourth of children with neurocysticercosis had cognitive impairment during follow-up. This was mostly seen in children from lower socioeconomic status and in those with multiple-lesion neurocysticercosis.

Socioeconomic Status and the Rorschach

1994 ◽  
Vol 74 (1) ◽  
pp. 95-98 ◽  
Author(s):  
George Frank
Keyword(s):  
Mental Health ◽  
Academic Achievement ◽  
Socioeconomic Status ◽  
Middle Class ◽  
Abstract Thinking ◽  
Growing Up ◽  
Socioeconomic Group ◽  
Lower Socioeconomic Status ◽  
Lower Socioeconomic ◽  
Mental Health Facilities

People from lower socioeconomic status are making increasing use of mental health facilities. Surveys have indicated that the Rorschach is still one of the more frequently used instruments by psychologists in such facilities, but research has also shown that clinicians tend to misinterpret Rorschachs of people from the lower socioeconomic group as reflecting greater psychopathology than the same Rorschachs identified as being given by people from the middle class. Research has also shown that growing up in conditions of poverty significantly affects how people perform on tests of abstract thinking, tests of intelligence, and tests of academic achievement; the question was raised as to whether this extends to the Rorschach. The lack of sufficient research on the effect of socioeconomic status on responsiveness to the Rorschach precluded that question being answered. The kind of research still needed was discussed.

scholarly journals Socioeconomic Disparities in Surveillance and Follow-Up of Patients with Thoracic Aortic Aneurysm

2021 ◽  
Author(s):  
Michael Shang ◽  
Gabe Weininger ◽  
Makoto Mori ◽  
Arianna Kahler-Quesada ◽  
Ellelan Degife ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Aortic Aneurysm ◽  
Competing Risks ◽  
Thoracic Aortic Aneurysm ◽  
Surgical Intervention ◽  
Aortic Aneurysms ◽  
Lower Socioeconomic Status ◽  
Lower Socioeconomic ◽  
Surveillance Imaging

Background: Thoracic aortic aneurysm is a significant risk factor for aortic dissection and rupture. Guidelines recommend referral of patients to a cardiovascular specialist for periodic surveillance imaging with surgical intervention determined primarily by aneurysm size. We investigated the association between socioeconomic status and surveillance practices in patients with ascending aortic aneurysms. Methods: We retrospectively reviewed records of 465 consecutive patients diagnosed between 2013-2016 with ascending aortic aneurysm ≥4cm on computed tomography scans. Primary outcomes were clinical follow-up with a cardiovascular specialist and aortic surveillance imaging within 2 years following index scan. We stratified patients into quartiles using the area deprivation index (ADI), a validated percentile measure of 17 variables characterizing socioeconomic status at the census block group level. Competing risks analysis was used to determine interquartile differences in risk of death prior to follow up with a cardiovascular specialist. Results: Lower socioeconomic status was associated with significantly lower rates of surveillance imaging and referral to a cardiovascular specialist. On competing risks regression, the ADI quartile with lowest socioeconomic status had lower hazard of follow-up with a cardiologist or cardiac surgeon prior to death (HR 0.46 [0.34, 0.62], p<0.001). Though there were no differences in aneurysm size at time of surgical repair, patients in the lowest socioeconomic quartile were more frequently symptomatic at surgery than other quartiles (92% vs 23-38%, p<0.001). Conclusion: Patients with lower socioeconomic status receive less timely follow-up imaging and specialist referral for thoracic aortic aneurysms, resulting in surgical intervention only when alarming symptoms are already present.

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