Evaluation of Motor Complications in Parkinson’s Disease: Understanding the Perception Gap between Patients and Physicians

Background. Patients with Parkinson’s disease (PD) receiving levodopa treatment often report motor complications including wearing-off (WO), dyskinesia, and morning akinesia. As motor complications are associated with a decrease in patients’ quality of life (QoL), it is important to identify their occurrence and commence immediate management. This study investigated whether differences in the perception of motor complications exist between patients and their physicians in routine clinical practice. Methods. After an Internet-based screening survey, questionnaires were distributed to physicians and their patients in Japan. The 9-item Wearing-Off Questionnaire (WOQ-9) was used to objectively assess the presence of WO; patients with WOQ-9 scores ≥2 were considered to have WO. McNemar’s test was used to compare physician assessment versus WOQ-9 scores, patient self-awareness versus physician assessment, and patient self-awareness versus WOQ-9, separately. Morning akinesia and dyskinesia were assessed by both physician assessment and patient self-awareness with McNemar’s test. QoL was assessed using the 8-item Parkinson’s Disease Questionnaire (PDQ-8) with the Wilcoxon rank-sum test. Results. A total of 235 patients with PD and their 92 physicians participated in this survey. A significant discordance was observed between the WOQ-9 and physician assessment of WO (67.2% vs 46.0%; p < 0.0001 ). Furthermore, patient self-awareness of WO was 35.3% ( p = 0.0004 , vs physician). Morning akinesia (patient, 58.7%; physician, 48.9%; p = 0.0032 ), dyskinesia (patient, 34.0%; physician, 23.4%; p = 0.0006 ), and bodily discomfort (patient, 25.0; physician, 0.0; p = 0.0102 ) of QoL were underrecognized by physicians. Conclusions. This study investigated differences in the perception of WO between patients with PD and their physicians in routine clinical practice and highlighted that patients have a low awareness of the symptoms of WO compared with physician assessments and WOQ-9. Conversely, morning akinesia, dyskinesia, and bodily discomfort were underrecognized by physicians.

Detection of Neisseria meningitidis in saliva and oropharyngeal samples from college students

Carriage of Neisseria meningitidis is an accepted endpoint in monitoring meningococcal vaccines effects. We have assessed N. meningitidis and vaccine-type genogroup carriage prevalence in college students at the time of MenACWY vaccine introduction in the Netherlands, and evaluated the feasibility of saliva sampling for the surveillance of carriage. For this, paired saliva and oropharyngeal samples collected from 299 students were cultured for meningococcus. The DNA extracted from all bacterial growth was subjected to qPCRs quantifying meningococcal and genogroup-specific genes presence. Samples negative by culture yet positive for qPCR were cultured again for meningococcus. Altogether 74 (25%) of students were identified as meningococcal carrier by any method. Sixty-one students (20%) were identified as carriers with qPCR. The difference between number of qPCR-positive oropharyngeal (n = 59) and saliva (n = 52) samples was not significant (McNemar’s test, p = 0.07). Meningococci were cultured from 72 students (24%), with a significantly higher (p < 0.001) number of oropharyngeal (n = 70) compared with saliva (n = 54) samples. The prevalence of genogroups A, B, C, W, and Y was none, 9%, 1%, 1% and 6%, respectively, and 8% of students carried MenACWY vaccine-type genogroup meningococci. Saliva is easy to collect and when combined with qPCR detection can be considered for meningococcal carriage studies.

Artificial intelligence-based detection of epimacular membrane from color fundus photographs

Epiretinal membrane (ERM) is a common ophthalmological disorder of high prevalence. Its symptoms include metamorphopsia, blurred vision, and decreased visual acuity. Early diagnosis and timely treatment of ERM is crucial to preventing vision loss. Although optical coherence tomography (OCT) is regarded as a de facto standard for ERM diagnosis due to its intuitiveness and high sensitivity, ophthalmoscopic examination or fundus photographs still have the advantages of price and accessibility. Artificial intelligence (AI) has been widely applied in the health care industry for its robust and significant performance in detecting various diseases. In this study, we validated the use of a previously trained deep neural network based-AI model in ERM detection based on color fundus photographs. An independent test set of fundus photographs was labeled by a group of ophthalmologists according to their corresponding OCT images as the gold standard. Then the test set was interpreted by other ophthalmologists and AI model without knowing their OCT results. Compared with manual diagnosis based on fundus photographs alone, the AI model had comparable accuracy (AI model 77.08% vs. integrated manual diagnosis 75.69%, χ2 = 0.038, P = 0.845, McNemar’s test), higher sensitivity (75.90% vs. 63.86%, χ2 = 4.500, P = 0.034, McNemar’s test), under the cost of lower but reasonable specificity (78.69% vs. 91.80%, χ2 = 6.125, P = 0.013, McNemar’s test). Thus our AI model can serve as a possible alternative for manual diagnosis in ERM screening.

Five-year outcome of clinical recovery and subjective well-being in older Dutch patients with schizophrenia

ABSTRACT Outcome of schizophrenia in later life can be evaluated from different perspectives. The recovery concept has moved forward this evaluation, discerning clinical-based and patient-based definitions. Longitudinal data on measures of recovery in older individuals with schizophrenia are scant. This study evaluated the five-year outcome of clinical recovery and subjective well-being in a sample of 73 older Dutch schizophrenia patients (mean age 65.9 years; SD 5.4), employing a catchment-area based design that included both community living and institutionalized patients regardless of the age of onset of their disorder. At baseline (T1), 5.5% of participants qualified for clinical recovery, while at five-year follow-up (T2), this rate was 12.3% (p = 0.18; exact McNemar’s test). Subjective well-being was reported by 20.5% of participants at T1 and by 27.4% at T2 (p = 0.27; exact McNemar’s test). Concurrence of clinical recovery and subjective well-being was exceptional, being present in only one participant (1.4%) at T1 and in two participants (2.7%) at T2. Clinical recovery and subjective well-being were not correlated neither at T1 (p = 0.82; phi = 0.027) nor at T2 (p = 0.71; phi = −0.044). There was no significant correlation over time between clinical recovery at T1 and subjective well-being at T2 (p = 0.30; phi = 0.122) nor between subjective well-being at T1 and clinical recovery at T2 (p = 0.45; phi = −0.088). These results indicate that while reaching clinical recovery is relatively rare in older individuals with schizophrenia, it is not a prerequisite to experience subjective well-being.

Indications and Outcomes of Corneal Transplant Surgery in Ghana

Background: Corneal blindness contributes to 25% of all blindness. We review corneal transplant, a common surgical remedy, in Ghana to determine indications and visual outcomes in resource-poor environments. Methods: A retrospective cross-sectional study of keratoplasty evaluating indications, pre- and postoperative outcomes complications and their associations, between January 2014 and December 2018 at a teaching hospital in Ghana. Descriptive statistics and McNemar’s test were used for the analyses. Results: Seventy-five eyes were studied. The mean ± standard deviation (SD) age of patients was 45.08 ± 17.85 years, the majority being 20–39 years (58.7% were male). Pseudophakia bullous keratopathy (PBK) was the commonest indication for keratoplasty (26.7%) followed by keratoconus (21.3%). Preoperatively 96% of eyes were blind with vision <3/60 with 64% out of the total eyes with vision <1/60. Postoperatively, 60% of all grafts had uncorrected vision of 3/60 or better after the last follow-up. McNemar’s test revealed a statistically significant difference between postsurgical and pre-surgical visual acuity (VA) (p < 0. 001). The median follow-up period was 12 months. The commonest postsurgical complication was raised intraocular pressure (IOP) (22.7%) with a total of 14.7% of grafts failures. Conclusion: In this setting, PBK is the leading indication for corneal transplant. Visual outcomes for corneal transplant in this resource poor area are not worse than in other settings. We need to pay attention to corneal transplant services to cater for the expected increase in PBK from the increasing cataract surgical rate.

การศึกษาผลของกระบวนการเตรียมความพร้อมเพื่อรับการรักษาและการติดตามเพื่อให้กำลังใจในผู้ป่วยมะเร็งกลุ่มศีรษะและลำคอที่หน่วยตรวจทูเมอร์คลินิกที่มีแผนการรักษาหลัก โรงพยาบาลศิริราช

วัตถุประสงค์: เพื่อศึกษาประสิทธิผลของกระบวนการเตรียมความพร้อมเพื่อรับการรักษาและการติดตามเพื่อให้กำลังใจในผู้ป่วยมะเร็งกลุ่มศีรษะและลำคอที่หน่วยตรวจทูเมอร์คลินิกที่มีแผนการรักษาหลัก เพื่อหาสาเหตุที่ไม่ไปรับการรักษา และประเมินความเครียดของผู้ป่วยก่อนและหลังเข้ารับการตรวจ วิธีการศึกษา: ศึกษาผู้ป่วยมะเร็งกลุ่มศีรษะและลำคอ อายุ 18 - 75 ปี ที่หน่วยตรวจทูเมอร์คลินิกซึ่งมีแผนการรักษาหลัก จำนวน 120 ราย เทียบกับกลุ่มควบคุม คือ ข้อมูลผู้ป่วยมะเร็งกลุ่มดังกล่าวจากฐานข้อมูลสถิติทูเมอร์คลินิก ปี 2557 จำนวน 120 ราย เครื่องมือที่ใช้ในการวิจัย ได้แก่ กระบวนการเตรียมความพร้อมเพื่อรับการรักษาและการติดตามเพื่อให้กำลังใจ เครื่องมือที่ใช้ในการเก็บรวบรวมข้อมูล ได้แก่ แบบบันทึกข้อมูลและติดตามผู้ป่วย แบบประเมินความเครียด และแบบประเมินการเห็นคุณค่าในตนเองของโรเซ็นเบิร์ก (Rosenberg Self-Esteem Scale) สถิติที่ใช้ คือ t-test, Chi-square test และ McNemar’s test ผลการศึกษา: ผู้ป่วยกลุ่มศึกษาไปรับการรักษาตามแผนการรักษา 109 ราย คิดเป็นร้อยละ 90.8 และไม่ไปรับการรักษา 11 ราย คิดเป็นร้อยละ 9.2 ผู้ป่วยกลุ่มควบคุมไปรับการรักษาตามแผน 102 ราย คิดเป็นร้อยละ 85 และไม่ไปรับการรักษา 18 ราย คิดเป็นร้อยละ 15 เมื่อเปรียบเทียบกันพบว่า จำนวนผู้ป่วยไปรับการรักษาตามแผนแตกต่างกันอย่างไม่มีนัยสำคัญทางสถิติ สาเหตุที่ผู้ป่วยไม่ไปรับการรักษาส่วนใหญ่กลัวการรักษา ร้อยละ 46 รองลงมา ได้แก่ สภาพร่างกายไม่แข็งแรง ไปใช้บริการแพทย์ทางเลือก มีปัญหาเรื่องค่าใช้จ่าย และไม่มีผู้ดูแลระหว่างเข้ารับการรักษา ร้อยละ 20, 20, 7 และ 7 ตามลำดับ เมื่อเปรียบเทียบความเครียดก่อนและหลังเข้ารับการตรวจแตกต่างกันอย่างไม่มีนัยสำคัญทางสถิติ และการเห็นคุณค่าในตนเองก่อนและหลังเข้ารับการตรวจในผู้ป่วยกลุ่มศึกษาไม่แตกต่างกัน สรุป: กระบวนการเตรียมความพร้อมเพื่อรับการรักษาและการติดตามเพื่อให้กำลังใจ มีผลทำให้จำนวนผู้ป่วยไปเข้ารับการรักษาตามแผนแตกต่างกันอย่างไม่มีนัยสำคัญทางสถิติ อย่างไรก็ดีการจัดทำให้มีระบบการติดตามดูแลผู้ป่วยได้ครอบคลุม ส่งผลให้ผู้ป่วยได้รับการดูแลเพื่อคุณภาพชีวิตที่ดีขึ้น ดังนั้นจึงควรมีการติดตามเยี่ยมเป็นระยะเพื่อทราบและช่วยแก้ไขปัญหาให้ผู้ป่วย ซึ่งจะส่งผลให้ผู้ป่วยได้รับการรักษาตามแผนที่วางไว้

Household Food Insecurity and Dietary Diversity Among Kenyan Households During the COVID-19 Pandemic

Objectives This study compares 1) household food insecurity and 2) household dietary diversity before and during the COVID-19 pandemic, and 3) examines self-reported coping strategies among three communities around Lake Victoria, Kenya. Methods We conducted in-person home interviews with 90 randomly selected households in March 2020 prior to the first reported case of COVID-19 in Kenya and followed up with 88 of these same households by phone in June 2020 during COVID-19. We assessed household food insecurity status using the Household Food Insecurity Access Scale (HFIAS) and assessed dietary diversity using the Household Dietary Diversity Score. We compared differences in household food insecurity scores and prevalence across time using the paired T-test and McNemar's test, respectively. We compared household dietary diversity scores and the proportion of households consuming each food group across time using the Wilcoxon signed rank test and McNemar's test for paired samples, respectively. Results The prevalence of severe food insecurity increased from 82% before COVID-19 to 91% during COVID-19 (P = 0.03) and household dietary diversity scores fell from 9.5 ± 1.5 to 8.6 ± 1.5 (P &lt; 0.001). Households coped by reducing their food intake at mealtimes, borrowing money from family and friends, and purchasing food on credit. Conclusions These findings demonstrate a high and growing level of vulnerability faced by these communities. Strategies to address food insecurity and access to diverse foods during the COVID-19 pandemic are urgently needed. Funding Sources Cornell Atkinson Center for Sustainability

Clinical performance and acceptability of self-collected vaginal and urine samples compared with clinician-taken cervical samples for HPV testing among women referred for colposcopy. A cross-sectional study

ObjectivesTo increase effectiveness of the cervical cancer screening program, self-sampling can be an option. Both self-collected vaginal samples (SCV) and urine samples may be useful alternatives to clinician-taken cervical samples (CS).DesignCross-sectional study.SettingColposcopy clinic.ParticipantsWomen (n=305) referred to colposcopy after abnormal cervical screening result or conditions like postcoital bleeding.InterventionAll women self-collected a urine and a vaginal sample prior to colposcopy, where a CS and biopsies were taken. All samples were tested for high-risk human papillomavirus (HPV) using the Cobas HPV assay. The gold standard was histology diagnoses (CIN2+/CIN3+) from biopsies obtained at the same examination.Primary outcomeAbsolute and relative sensitivity and specificity of HPV testing on SCV and urine to detect CIN2+/CIN3+ compared with the CS.Secondary outcomeThe acceptability by women of self-sampling.ResultsBoth the vaginal and urine sample were comparable to the CS in identifying severe intraepithelial neoplasia (CIN2+/CIN3+). Absolute sensitivity ranged from 93% for urine samples to 96% for SCV for detecting CIN2+, which is comparable to the sensitivity of CS (overlapping 95% CI).The relative sensitivity for detecting CIN2+ was 1.00 (95% CI 0.96 to 1.04) for SCV and 0.96 (95% CI 0.91 to 1.03) for urine samples. At CIN3+, the relative sensitivity was 1.00 (95% CI 0.96 to 1.08) and 0.97 (95% CI 0.89 to 1.07) for SCV and urine samples, respectively. There were no statistical differences between the self-collected samples and the CS (McNemar’s test >0.05). The relative specificity was also similar (1.03 (95% CI 0.95 to 1.12) for SCV and 0.98 (95% CI 0.89 to 1.09) for urine samples) (McNemar’s test >0.05).The acceptability of self-sampling was evaluated by questionnaire. The women found the instructions on sample collection easy to understand and were positive about self-sampling with a preference for the urine sample.ConclusionSelf-sampling by SCV and urine is a clinically safe alternative to CS with a high degree of acceptability.

Medication Adherence Reminder System for Virtual Home Assistants: Mixed Methods Evaluative Study (Preprint)

BACKGROUND Medication non-adherence is a global public health challenge that results in sub-optimal health outcomes and increases healthcare costs. Forgetting to take medicines is one of the most common reasons for unintentional non-adherence. Research findings indicate that voice-activated virtual home assistants (VHAs), such as Amazon Echo and Google Home devices, may be useful in promoting medication adherence. OBJECTIVE Create a medication adherence app (skill) for Amazon Echo devices and measure the use, usability, and usefulness of that skill. METHODS A single-group mixed methods cohort feasibility study was conducted with females who took oral contraceptives (n=25). Participants were undergraduate students (mean age = 21.8, SD 6.2) at an urban university in the Southeast United States. Participants were given an Amazon Echo Dot with MedBuddy, a new medication reminder skill for Echo devices created by our team, attached to their study account, which they used for 60 days. Participants self-reported baseline and post-study medication adherence. MedBuddy use was objectively evaluated by tracking the participants’ interaction with MedBuddy through Amazon Alexa. The usability and usefulness of MedBuddy were evaluated through a post-study interview with participants responding to both quantitative and qualitative questions. RESULTS Participants’ interactions with MedBuddy, as tracked through Amazon Alexa, only occurred on half of the study days (mean of 50.97, SD 29.5). Compared to baseline, at study end participants reported missing their medication less in the past one and six months (χ 2 = .884 and .420 respectively, McNemar’s test p < .001 for both). However, there was no significant difference in participants’ reported adherence to consistently taking medication within the same two-hour time frame each day the past one or six months at the end of the study compared to baseline (χ 2 = 3.544 and 5.526 respectively, McNemar’s test p = .63 and p = .13 respectively). Overall feedback about usability was positive, and participants provided constructive feedback about features of the skill that could be improved. Participants’ evaluation of the usefulness of Medbuddy was overwhelmingly positive. Most participants (65.2%, n=15) said they would continue to use MedBuddy as a medication reminder in the future if provided the opportunity and the majority (91.3%, n=21) said they would recommend it to others. MedBuddy features that participants enjoyed were an external prompt separate from their phone, being able to hear the reminder prompt from a separate room, multiple reminders, and verbal responses as prompts. CONCLUSIONS The results of this feasibility study indicate the MedBuddy medication reminder skill may be useful in promoting medication adherence, but the skill could benefit from further usability enhancements.

A Multivariate Extension of McNemar’s Test Based on Permutations

The purpose of this publication is to propose a permutation test to detect the departure from symmetry in multidimensional contingency tables. The proposal is a multivariate extension of McNemar’s test. McNemar’s test could be applied to 2 × 2 contingency tables. The proposal may be also treated as a modification of Cochran’s Q test which is used for testing dependency for multivariate binary data. The form of the test statistics that allows us to detect the departure from counts symmetry in multidimensional contingency tables is presented in the article. The permutation method of observations was used to estimate the empirical distribution of the test statistics. The considerations were supplemented with examples of the use of a multivariate test for simulated and real data. The application of the proposed test allows us to detect the asymmetrical distribution of counts in multivariate contingency tables.