generalized estimating equation
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2022 ◽  
Vol 12 (1) ◽  
pp. 102
Author(s):  
Ming-Hsiu Chiang ◽  
Yu-Yun Huang ◽  
Yi-Jie Kuo ◽  
Shu-Wei Huang ◽  
Yeu-Chai Jang ◽  
...  

Background. Hip fractures among older adults are a major public health concern worldwide. This study investigated the potential clinical factors that predict postoperative 1-year activities of daily living (ADL), quality of life (QoL), and mortality in Taiwanese older adults following hip fracture. Methods. This is a prospective cohort study enrolling older adults (≥60 years) who had undergone hip fracture surgery in a single medical center. The comprehensive clinical history of each patient was examined. QoL, ADL, and mortality events were recorded consecutively at 3, 6, and 12 months after operation. The multiple logistic regression model and the generalized estimating equation (GEE) were adopted to identify contributing factors for mortality and postoperative ADL and QoL prognosis, respectively. Results. Among 377 participants with hip fracture, 48 died within 1 year of the index operation. ADL and QoL considerably decreased at 3 months following hip surgery. Old age, high Charlson Comorbidity Index, and American Society of Anesthesiologists grading were crucial predictors for mortality at the 1-year follow-up. The generalized estimating equation analysis indicated that the length of postoperative follow-up time, serum albumin level, patient cognitive status, and handgrip strength were considerably associated with QoL and ADL recovery prognosis in the Taiwanese older adults following hip fracture. Conclusions. Hip fractures have long-lasting effects on the older adults. Our data imply several prognosis predicting parameters that may assist clinicians in accounting for an individual’s personalized risks in order to improve functional outcomes and reduce mortality.


2022 ◽  
pp. 1-9
Author(s):  
Els D. Bakker ◽  
Ingrid S. van Maurik ◽  
Arenda Mank ◽  
Marissa D. Zwan ◽  
Lisa Waterink ◽  
...  

Background: The COVID-19 pandemic poses enormous social challenges, especially during lockdown. People with cognitive decline and their caregivers are particularly at risk of lockdown consequences. Objective: To investigate psychosocial effects in (pre-)dementia patients and caregivers during second lockdown and compare effects between first and second lockdown. Methods: We included n = 511 (pre-)dementia patients and n = 826 caregivers from the Amsterdam Dementia Cohort and via Alzheimer Nederland. All respondents completed a self-designed survey on psychosocial effects of COVID-19. We examined relations between experienced support and psychosocial and behavioral symptoms using logistic regression. In a subset of patients and caregivers we compared responses between first and second lockdown using generalized estimating equation. Results: The majority of patients (≥58%) and caregivers (≥60%) reported that family and friends, hobbies, and music helped them cope. Support from family and friends was strongly related to less negative feelings in patients (loneliness: OR = 0.3[0.1–0.6]) and caregivers (loneliness: OR = 0.2[0.1–0.3]; depression: OR = 0.4[0.2–0.5]; anxiety: OR = 0.4[0.3–0.6]; uncertainty: OR = 0.3[0.2–0.5]; fatigue: OR = 0.3[0.2–0.4]; stress: OR = 0.3[0.2–0.5]). In second lockdown, less psychosocial and behavioral symptoms were reported compared to first lockdown (patients; e.g., anxiety: 22% versus 13%, p = 0.007; apathy: 27% versus 8%, p < 0.001, caregivers; e.g., anxiety: 23% versus 16%, p = 0.033; patient’s behavioral problems: 50% versus 35%, p < 0.001). Patients experienced more support (e.g., family and friends: 52% versus 93%, p < 0.001; neighbors: 28% versus 66%, p < 0.001). Conclusion: During second lockdown, patients and caregivers adapted to challenges posed by lockdown, as psychosocial and behavioral effects decreased, while patients experienced more social support compared to first lockdown. Support from family and friends is a major protective factor for negative outcomes in patients and caregivers.


2022 ◽  
Author(s):  
Joshua Kirabo Sempungu ◽  
Minjae Choi ◽  
Eun Hae Lee ◽  
Yo Han Lee

Abstract This study examines the relationship between changes in household size and depression through a temporal analysis using the Korean Welfare Panel Study. The number of household members at both t-1 and t year was measured and a generalized estimating equation was used. Households that increased in size after a year showed a lower prevalence of depression than the corresponding reference groups. On the contrary, when individuals from multi-person households inhabited single-person households after a year, their probability of experiencing depression increased by more than 70% in comparison to those who remained in single-person households throughout.


Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 53
Author(s):  
Do-Hoon Kim ◽  
Yura Lee ◽  
Ji Seon Oh ◽  
Dong-Woo Seo ◽  
Kye Hwa Lee ◽  
...  

Patient-generated health data (PGHD) can be managed easily by a mobile personal health record (mPHR) and can increase patient engagement. This study investigated the effect of PGHD functions on mPHR usage. We collected usage log data from an mPHR app, My Chart in My Hand (MCMH), for seven years. We analyzed the number of accesses and trends for each menu by age and sex according to the version-up. Generalized estimating equation (GEE) analysis was used to determine the likelihood of continuous app usage according to the menus and version-up. The total number of users of each version were 15,357 and 51,553, respectively. Adult females under 50 years were the most prevalent user group (30.0%). The “My Chart” menu was the most accessed menu, and the total access count increased by ~10 times after the version-up. The “Health Management” menu designed for PGHD showed the largest degree of increase in its likelihood of continuous usage after the version-up (1.245; p < 0.0001) across menus (range: 0.925–1.050). Notably, improvement of PGHD management in adult females over 50 years is needed.


Author(s):  
Ari Shechter ◽  
Codruta Chiuzan ◽  
Yimeng Shang ◽  
Gavin Ko ◽  
Franchesca Diaz ◽  
...  

Background: Prevalence, incidence, and factors associated with posttraumatic stress disorder (PTSD) symptoms at follow-up among healthcare workers after the first wave of the COVID-19 pandemic are unknown. Methods: A web survey invitation was sent to healthcare worker listservs at a NYC medical center (April, 2020). The Primary Care (PC)-PTSD questionnaire was used to screen for PTSD symptoms at baseline and then every 2 weeks for 10 weeks. Incidence and prevalence of PTSD symptoms were determined at each time point. Multivariable generalized estimating equation models were performed to investigate the factors associated with a positive PC-PTSD screen at follow-up. Results: Median age (interquartile range) of N = 230 participants was 36 (31–48) years; 79.6% were women; 82.6% worked in COVID-19-focused settings. The prevalence of PTSD symptoms decreased from 55.2% at baseline to 25.0% at 10 weeks (p < 0.001). Among participants who had a baseline negative screen for PTSD symptoms, the incidence of PTSD at 10 weeks was 12.2% (p-trend 0.034). In multivariable-adjusted analyses, being a nurse (odds ratio [OR]: 1.70, 95% confidence interval [CI]: 1.06–2.71), female (OR: 3.00, 95% CI: 1.59, 5.72), and working in a COVID-19-focused location (OR: 1.51, 95% CI: 1.02, 2.21) were associated with increased odds of PTSD symptoms at 10-weeks. Conclusions: PTSD symptoms improved over 3 months following the first wave of the COVID-19 pandemic. However, one out of four NYC healthcare workers still had an increased risk for PTSD at 10-weeks. Screening healthcare workers for PTSD symptoms should be considered during the COVID-19 pandemic.


2021 ◽  
Vol 12 ◽  
Author(s):  
Xueying Liu ◽  
Jingxiao Xu ◽  
Lixin Bi ◽  
Peihao Liu ◽  
Xue Jiao

BackgroundPoor ovarian response (POR) remains one of the most challenging conditions in assisted reproduction technology. Previous studies seemed to indicate that growth hormone (GH) was a potential solution for the dilemma of POR; however, the role GH played on the low-prognosis patients diagnosed and stratified by the POSEIDON criteria remains indistinct.MethodsThis retrospective study was performed among women with POR according to the POSEIDON criteria who failed a previous in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle, and the subsequent cycle was under GH cotreatment and conducted within 12 months. These participants were stratified into four groups according to the POSEIDON criteria. The comparison was implemented between the failed cycle and the cycle treated with GH. Generalized estimating equation (GEE) multivariate regression was applied for data analysis.ResultsA total of 428 low-prognosis women were included in this study. GH supplementation improved the live birth rates (47.66%, 28.33%, 45.45%, and 24.07%; in groups 1, 2, 3, and 4, respectively) and the clinical pregnancy rates (OR 19.16, 95% CI 7.87–46.63, p &lt; 0.001; OR 7.44, 95% CI 1.65–33.55, p = 0.009; OR 10.19, 95% CI 2.39–43.52, p = 0.002; OR 27.63, 95% CI 4.46–171.11, p &lt; 0.001; in groups 1, 2, 3, and 4, respectively) in all four POSEIDON groups. The number of oocytes retrieved was significantly elevated in the subgroups with normal ovarian reserve (IRR 1.47, 95% CI 1.36–1.59, p &lt; 0.001; IRR 1.31, 95% CI 1.15–1.49, p &lt; 0.001; in groups 1 and 2, respectively). The number of day-3 good-quality embryos was significantly elevated in the subgroups with either normal ovarian reserve or aged young (IRR 2.13, 95% CI 1.78–2.56, p &lt; 0.001; IRR 1.54, 95% CI 1.26–1.89, p &lt; 0.001; IRR 1.47, 95% CI 1.10–1.98, p = 0.010; in groups 1, 2, and 3, respectively).ConclusionGrowth hormone cotreatment could ameliorate the pregnancy outcome for women with POR under the POSEIDON criteria who failed a previous IVF/ICSI cycle. The application of growth hormone for low-prognosis women who experienced a failed cycle might be considered and further studied.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260809
Author(s):  
Beate Sander ◽  
Yaron Finkelstein ◽  
Hong Lu ◽  
Chenthila Nagamuthu ◽  
Erin Graves ◽  
...  

Objective To determine 1-year attributable healthcare costs of bronchiolitis. Methods Using a population-based matched cohort and incidence-based cost analysis approach, we identified infants <12 months old diagnosed in an emergency department (ED) or hospitalized with bronchiolitis between April 1, 2003 and March 31, 2014. We propensity-score matched infants with and without bronchiolitis on sex, age, income quintile, rurality, co-morbidities, gestational weeks, small-for-gestational-age status and pre-index healthcare cost deciles. We calculated mean attributable 1-year costs using a generalized estimating equation model and stratified costs by age, sex, income quintile, rurality, co-morbidities and prematurity. Results We identified 58,375 infants with bronchiolitis (mean age 154±95 days, 61.3% males, 4.2% with comorbidities). Total 1-year mean bronchiolitis-attributable costs were $4,313 per patient (95%CI: $4,148–4,477), with $2,847 (95%CI: $2,712–2,982) spent on hospitalizations, $610 (95%CI: $594–627) on physician services, $562 (95%CI: $556–567)] on ED visits, $259 (95%CI: $222–297) on other healthcare costs and $35 ($27–42) on drugs. Attributable bronchiolitis costs were $2,765 (95%CI: $2735–2,794) vs $111 (95%CI: $102–121) in the initial 10 days post index date, $4,695 (95%CI: $4,589–4,800) vs $910 (95%CI: $847–973) in the initial 180 days and $1,158 (95%CI: $1,104–1213) vs $639 (95%CI: $599–679) during days 181–360. Mean 1-year bronchiolitis costs were higher in infants <3 months old [$5,536 (95%CI: $5,216–5,856)], those with co-morbidities [$17,530 (95%CI: $14,683–20,377)] and with low birthweight [$5,509 (95%CI: $4,927–6,091)]. Conclusions Compared to no bronchiolitis, bronchiolitis incurs five-time and two-time higher healthcare costs within the initial and subsequent six-months, respectively. Most expenses occur in the initial 10 days and relate to hospitalization.


2021 ◽  
pp. 1-9
Author(s):  
Travis Hamilton ◽  
Mohamed Macki ◽  
Seok Yoon Oh ◽  
Michael Bazydlo ◽  
Lonni Schultz ◽  
...  

OBJECTIVE Socioeconomic factors have been shown to impact a host of healthcare-related outcomes. Level of education is a marker of socioeconomic status. This study aimed to investigate the relationship between patient education level and outcomes after elective lumbar surgery and to characterize any education-related disparities. METHODS The Michigan Spine Surgery Improvement Collaborative registry was queried for all lumbar spine operations. Primary outcomes included patient satisfaction determined by the North American Spine Society patient satisfaction index, and reaching the minimum clinically important difference of Patient-Reported Outcomes Measurement Information System Physical Function score and return to work up to 2 years after surgery. Multivariate Poisson generalized estimating equation models reported adjusted risk ratios. RESULTS A total of 26,229 lumbar spine patients had data available for inclusion in this study. On multivariate generalized estimating equation analysis all comparisons were done versus the high school (HS)/general equivalency development (GED)–level cohort. For North American Spine Society satisfaction scores after surgery the authors observed the following: at 90 days the likelihood of satisfaction significantly decreased by 11% (p < 0.001) among < HS, but increased by 1% (p = 0.52) among college-educated and 3% (p = 0.011) among postcollege-educated cohorts compared to the HS/GED cohort; at 1 year there was a decrease of 9% (p = 0.02) among < HS and increases of 3% (p = 0.02) among college-educated and 9% (p < 0.001) among postcollege-educated patients; and at 2 years, there was an increase of 5% (p = 0.001) among postcollege-educated patients compared to the < HS group. The likelihood of reaching a minimum clinically important difference of Patient-Reported Outcomes Measurement Information System Physical Function score at 90 days increased by 5% (p = 0.005) among college-educated and 9% (p < 0.001) among postcollege-educated cohorts; at 1 year, all comparison cohorts demonstrated significance, with a decrease of 12% (p = 0.007) among < HS, but an increase by 6% (p < 0.001) among college-educated patients and 14% (p < 0.001) among postcollege-educated compared to the HS/GED cohort; at 2 years, there was a significant decrease by 19% (p = 0.003) among the < HS cohort, an increase by 8% (p = 0.001) among the college-educated group, and an increase by 16% (p < 0.001) among the postcollege-educated group. For return to work, a significant increase was demonstrated at 90 days and 1 year when comparing the HS or less group with college or postcollege cohorts. CONCLUSIONS This study demonstrated negative associations on all primary outcomes with lower levels of education. This finding suggests a potential disparity linked to education in elective spine surgery.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1053-1053
Author(s):  
DaJung Chang

Abstract An older adult with negative self-perceptions of aging (SPA) can lead to lower self-rated health and a higher risk of mortality. To stay a positive SPA, keep a healthier status is very important. However, evidence also proved that health conditions, like a physical limitation, could predict the level of SPA. Older adults usually have a higher prevalence rate of chronic diseases than the younger population, which can adversely impact them. The purpose of this study is to determine the relationship between the severity of comorbidities and the change of SPA during a time. I examined data in 7,034 people from the 2012 wave Health and Retirement Study (HRS) and followed the respondents who have answer the SPA scale in the leave-behind questionnaire in 2016. The generalized estimating equation was used to analyze the relationship between the severity of comorbidities and SPA in different waves. To measure the severity of comorbidities, a reduced index of the comorbidities severity scale (CmSS) was created to collect the health condition from HRS. Results statistical model shows that an individual with more severity of comorbidities may have a more negative SPA. However, the relationship does not follow through with the times. These findings enhance the previous study that there are relationships between severity of comorbidities and SPA. The benefit of this study is to use a different measurement to identify the severity of comorbidities and extend to more in-depth research.


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