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] | {"Title": "Exploring Intersectionality of Race and Newcomer Status with Material and Social Deprivation in Ontario Census Data: A Comparative Analysis of the ON-MARG Deprivation Index and Machine-Learning Derived Demographic Clusters", "Authors": "Calderon Anyosa Renzo, Anderson Geoffrey", "Abstract": "Abstract Background The Ontario Marginalization Index (ON-MARG) is widely used to assess health inequalities in Ontario by measuring four dimensions of marginalization at the dissemination area (DA) level. However, averaging these dimensions into an overall deprivation score can obscure important information, in particular information on intersectionality of material and social deprivation and race and immigrant status. Objective To use machine learning algorithms to uncover relationships among the four ON-MARG dimensions across DAs as demographic clusters and to compare the use of these clusters to understand and map marginalization and to describe health inequities. Methods We applied K-means clustering to 2021 ON-MARG data on the four On-MARG dimensions \u2014 Households and Dwellings (HD), Material Resources (MR), Age and Labour Force (AL), and Racialized and Newcomer Populations (RN) across 20,123 DAs. We then compared these clusters to ON-MARG average index scores in terms of mapping marginalization in Toronto and examined how these clusters were associated with inequities in mental health service as compared specific dimensions of the ON-MARG index. Results We identified four clusters: (1) Advantaged White Canadians, (2) Disadvantaged White Canadians, (3) Advantaged Visible Minorities and Immigrants, and (4) Disadvantaged Visible Minorities and Immigrants. The clustering approach revealed nuanced patterns not captured by the ON-MARG summary scores alone. Disadvantaged White Canadians exhibited the highest outpatient mental health visit rates, particularly among females (250\u2013300 visits per 100,000). Disadvantaged Visible Minorities and Immigrants followed with elevated rates, while both advantaged clusters showed significantly lower utilization. The clusters provided better discrimination of health service disparities than ON-MARG quintiles alone, highlighting that disadvantaged groups, regardless of racial composition, had higher rates of mental health service use. Conclusions Combining ON-MARG with machine learning clustering offers a more comprehensive understanding of marginalization\u2019s intersectionality, revealing disparities in health service utilization not apparent from the index alone. This approach underscores the need for targeted, intersectional policies to address the specific needs of diverse populations, ultimately contributing to more equitable healthcare interventions in Ontario.", "URL": "https://doi.org/10.1101/2024.10.30.24316442"} |
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] | {"Title": "Spatial Patterns of COVID-19 Mortality: Examining Socioeconomic Determinants in U.S. Counties Using Cluster Analysis", "Authors": "Wardrup Robert Ross", "Abstract": "Abstract Aim This study aims to investigate the spatial patterns of COVID-19 mortality across U.S. counties and identify the socioeconomic determinants that influence these mortality trends, using spatial epidemiological methods. Subject and Methods We conducted a spatial analysis of COVID-19 mortality data from over 3,000 U.S. counties, applying cluster detection techniques, including SatScan, to identify areas with significant mortality trends. Spatial regression models, including spatial lag and spatial error models, were employed to examine the impact of socioeconomic variables, such as race, income inequality, and insurance rates, on COVID-19 mortality. The analysis controlled for multicollinearity and spatial autocorrelation in the data. Results Counties with higher proportions of Black populations and higher uninsured rates exhibited significantly lower COVID-19 trends over the study period. Spatial clustering revealed regions in the northwestern and eastern/northeastern United States with a mix of positive and negative mortality rate trends. The spatial lag model showed the strongest fit, confirming the importance of spatial dependency in explaining mortality patterns. Conclusion This study highlights the significant spatial disparities in COVID-19 mortality across U.S. counties. The findings emphasize the need for targeted public health interventions in vulnerable regions to address these disparities.", "URL": "https://doi.org/10.1101/2024.10.30.24316443"} |
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] | {"Title": "Clinical Characteristics Associated with Functional Seizures in Individuals with Psychosis", "Authors": "Lake Allison M., Reddy India A., Havranek Robert, Davis Lea K., Fox Jonah", "Abstract": "Abstract Background and Hypothesis Functional seizures (FS) are episodes characterized by seizure-like events that are not caused by hypersynchronous neuronal activity. Prior studies have suggested an increased prevalence of psychotic disorders among patients with FS, but results have been inconsistent. We hypothesize that FS are associated with psychosis and that among patients with psychosis, the presence of FS may influence patient clinical characteristics, mortality, and medical resource utilization. Study Design The association between FS and psychosis was assessed using electronic health records data from a total of 752,883 individuals receiving care at Vanderbilt University Medical Center between 1989 and 2023. Analyses of the association between FS and psychiatric outcomes, sexual trauma, healthcare utilization, and other clinical comorbidities were conducted in a subset of 5,239 patients with psychosis. Study Results Odds of FS were elevated among patients with psychosis compared to controls (OR=10.17, 95% CI=8.55-12.08, p<0.001). Among patients with psychosis, those with FS exhibited higher rates of suicidality (OR=1.98, 95% CI=1.40-2.8, p<0.001), catatonia (OR=1.95, 95% CI=1.23-3.09, p=0.03), sexual trauma history (OR=2.98, 95% CI=2.08-4.26, p<0.001) and had a greater numbers of antipsychotic trials (4.56 versus 3.37, beta=1.16, SE=0.16, p<0.001) than those without FS. Furthermore, patients with comorbid FS had a greater numbers of hospital presentations at one, three, five, and ten years after receiving a psychosis diagnosis (p<0.001). Conclusions FS are more common among patients with psychosis and are associated with increased healthcare utilization as well as an increased prevalence of suicidality, catatonia, and certain psychiatric and medical comorbidities.", "URL": "https://doi.org/10.1101/2024.10.30.24316444"} |
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] | {"Title": "Applications of Synthetic Data Integration for Deep Learning for Volumetric Analysis and Segmentation in Thoracic CT Imaging", "Authors": "Zeyrek Ali, Navarro Sergio M", "Abstract": "Abstract This study presents a framework for processing Digital Imaging and Communications in Medicine (DICOM) medical imaging data by integrating synthetic objects for volumetric analysis and simulation for applications in assessment of computed tomography (CT) imaging used in thoracic surgery. Functions are designed to generate synthetic objects including geometric shapes such as spheres, cubes, rectangular prisms, cylinders, and blobs with known volumes. Validation is performed through test functions to ensure accuracy and consistency. Additionally, the use of UNet models for segmenting various chest pathologies, such as hemothorax and pneumothorax, as well as organs, is demonstrated. The created framework is used to generate synthetic data to address the scarcity of publicly available hemothorax CT imaging data. Models achieved high performance, assessed by various metrics. The framework and models provide a robust tool for data augmentation and analysis in medical imaging, potentially enhancing clinical decision-making and supporting research in thoracic surgery and related fields.", "URL": "https://doi.org/10.1101/2024.10.30.24316446"} |
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] | {"Title": "The Impact of Clinical Audits on Improving the Effectiveness of Type 2 Diabetes Mellitus (T2DM) CARE in Primary Health Centers. A Comprehensive Pre-post analysis through Multi-layered Intervention: The ICAE-DM CARE study protocol", "Authors": "Pallath Majeed Ansif, Panakaje Niyaz, Thekke Veettil Shajitha, Harikumar Kiran, Al Mujalli Hanan, Ali Shah Abdul, Jassim AlKubaisi Noora, Sameer Alnuaimi Ahmed", "Abstract": "Abstract Background Conducting clinical reviews is integral to the continuous process of enhancing healthcare quality by identifying specific areas or aspects within medical services and clinical practices. These reviews involve measuring a clinical outcome or process against established evidence-based standards, aiming to spotlight discrepancies between current practice and these benchmarks to facilitate improvements in care quality. Notably, clinical reviews rely on the exceptional skill of the driving force, underscored by key elements: the clinical expertise of participants, result confidentiality, and an objective strongly linked to the professional \u2018quality\u2019. The worldwide prevalence of type 2 diabetes mellitus (T2DM) is on the rise, especially in economically developing nations. Current research conducted in Qatar indicates a significant prevalence of diabetes mellitus within the adult population, alongside a considerable proportion of pre-diabetes cases that are likely to elevate the incidence of diabetes mellitus in the coming years. This information underscores the critical need for effective diabetes management at the primary care level, particularly for individuals with pre-diabetes. A comprehensive systematic assessment and intervention are essential to enhance diabetes care. Methods The proposed research will adopt a quasi-experimental design, which includes a baseline cross-sectional situational analysis conducted across 31 Primary Health Care Centers (PHCCs) prior to the intervention. The study will focus on patients aged 18 and older who have been diagnosed with Type 2 Diabetes Mellitus (T2DM), encompassing both newly diagnosed individuals and those in follow-up care, while excluding pregnant patients. A random sampling method will be utilized to ensure a representative sample size of 450 patients from the last three months of diabetes consultations. Following the identification of gaps in the situational analysis, an intervention will be implemented, after which a post-intervention cross-sectional study will be carried out using the same sample as the baseline to evaluate changes in the measured parameters. Additionally, a cohort study will be performed through a telephonic survey of a random sample of 60 patients, both before and after the intervention, to assess changes from the patients\u2019 perspective. Discussion A comprehensive assessment and intervention are essential to evaluate the quality of diabetes care delivered at primary health centers. The ICAE-DM CARE study aims to provide an effective situational analysis, which will include the identification of gaps and the underlying causes of these gaps in the DM care using suitable quality improvement tools. The study will also showcase appropriate intervention strategies to improve practice. Furthermore, the implications of this process will be thoroughly examined. This study design will closely reflect a practical understanding of healthcare quality management in diabetes care, which can be applied in similar settings.", "URL": "https://doi.org/10.1101/2024.10.30.24316448"} |
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] | {"Title": "Disentangling effects of ethnicity, deprivation, and payment source on obstetric outcomes in American primigravidae: A structural equation model of observational data", "Authors": "Williams Jonathan", "Abstract": "Abstract Background Women from ethnic minorities have worse obstetric outcomes. Possible reasons for this are (1) social deprivation; (2) different standards of obstetric care; and (3) intrinsic ethnic differences. Here I aim to disentangle (1)-(3). Methods I constructed two path models of causal links between parental ethnicity and obstetric outcomes. The first, \u2018no-racism\u2019, model estimated independent causal effects of ethnicity, deprivation and payment source on pregnancy and birth outcomes. The second \u2018realistic\u2019 model additionally tested how far deprivation and payment source may mediate effects of ethnicity. Analyses of the models used Bayesian estimation. I analysed both the full sample of complete data and a random 1% sample. Findings Data were complete for 762786 births. The \u2018no-racism\u2019 model did not fit the data, but the \u2018realistic\u2019 model fitted adequately. It indicated that ethnicity, social deprivation, and private funding for care all adversely affected outcomes: (i) African American and Hispanic ethnicity caused deprivation; (ii) deprivation increased pregnancy hypertension, shortened gestation and reduced birthweight; (iii) private funding directly increased pregnancy hypertension and indirectly shortened gestation; (iv) participation in the Supplemental Nutrition Program for Women, Infants and Children (WIC) counteracted adverse effects of deprivation. (v) independently of (i)-(iv), ethnic-minority parents had shorter gestation and lighter babies. Interpretation Deprivation largely accounts for adverse obstetric outcomes in ethnic minorities. Private funding may also worsen pregnancy hypertension, but WIC improved outcomes. The uniformity of adverse birth outcomes for all ethnic minorities suggests that these result from a common factor, which may be systemic racism. Policies to reduce deprivation and increase government-funded care could importantly improve obstetric outcomes, irrespective of ethnicity. Funding none \u2013 I undertook the study at home. Research in Context Evidence before this study Many studies during the past century have shown that ethnic minorities have worse social deprivation and worse access to health services. Ethnicity, deprivation and care can all determine health outcomes, and ethnic-minority mothers have worse obstetric outcomes. However, the independent contributions of ethnicity, deprivation and care to these adverse outcomes are unknown. Added value of this study I present here causal model of routine observational data that differentiates direct and indirect effects of ethnicity, deprivation and payment source on obstetric outcomes. The model allows (a) deprivation to mediate effects of ethnicity and (b) payment source to mediate effects of both ethnicity and deprivation. Hence, this model can disentangle the \u201cintertwined\u201d effects of ethnicity, deprivation and payment source on obstetric outcomes. The model also examines effects of participation in the Supplemental Nutrition Program for Women, Infants and Children on outcomes. The model fitted a 1% sample of the data after Bayesian estimation \u2013 so it bears interpretation as a representation of the real-world causal structure of the data. In the model, minority ethnicity causes deprivation and medical insurance and all of these factors independently determine adverse obstetric outcomes. Notably, medical insurance and private payment may increase the risk of pregnancy hypertension and consequently shorten gestation. Participation in WIC was beneficial. Implications of all the available evidence Causal modelling of routine natality data may allow effective audit of health care in its social context. Understanding causes of poor outcomes can enable prediction of effects of policy change. The present results indicate that policies to ameliorate social deprivation and expand access to WIC and government-subsidised care should improve obstetric outcomes \u2013 with long-term benefits for both mothers and their babies. Extrapolating beyond obstetrics, the present results may help to illuminate mechanisms of the healthcare crisis in America.", "URL": "https://doi.org/10.1101/2024.10.30.24316452"} |
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] | {"Title": "Dietary Iron Intake and Mental and Behavioral Disorders Due to Use of Tobacco: A Cross-Sectional and Longitudinal Study Based on the UK Biobank", "Authors": "Qi Xueting, Zhang Ronghui, Zhu Hailong, Luo Jia, Zhang Qiuge, Wang Weijing, Wang Tong, Zhang Dongfeng", "Abstract": "ABSTRACT Introduction Over 1 billion smokers worldwide, one-third of whom have mental and behavioral disorders, exist. However, factors influencing mental and behavioral disorders due to use of tobacco remain unexplored. We aim to investigate the relationship between dietary iron intake and mental and behavioral disorders due to use of tobacco. Methods Using large population cohort data from the UK Biobank, we employed logistic and Cox regression to explore the cross-sectional and longitudinal associations between dietary iron intake and mental and behavioral disorders due to use of tobacco. Additionally, we assessed the nonlinear relationship between dietary iron intake and mental and behavioral disorders due to use of tobacco using restricted cubic spline plots. Results The cross-sectional analysis included 50,991 participants. The logistic regression results indicated that dietary iron intake was negatively associated with mental and behavioral disorders due to use of tobacco. A total of 50,921 participants were included in the cohort study. The Cox regression results supported the protective effect of increased dietary iron intake against mental and behavioral disorders due to use of tobacco. The stratified and sensitivity analysis results were consistent with the main results. The restricted cubic spline plots showed a nonlinear relationship between dietary iron intake and mental and behavioral disorders due to use of tobacco. The risk reduction rate initially accelerated and then slowed in the total sample, the two age, and the male groups. In contrast, it declined rapidly at first and then leveled off in the female group. Conclusion This study found that dietary iron intake has a protective effect against mental and behavioral disorders due to use of tobacco, revealing a nonlinear association between the two. These findings offer valuable insights for the prevention and treatment of mental and behavioral disorders due to use of tobacco in the future. What is already known on this topic Existing research primarily focuses on tobacco as a risk factor for physical diseases. In contrast, the factors influencing mental and behavioral disorders due to use of tobacco have not been adequately explored. Furthermore, findings regarding the relationship between dietary iron intake and mental health in the general population are inconsistent, highlighting the need for this study to clarify the potential association between dietary iron intake and mental and behavioral disorders due to use of tobacco among smokers. What this study adds In this combined cross-sectional and longitudinal study, we assessed the association between dietary iron intake and mental and behavioral disorders due to use of tobacco using data from UK Biobank. We found that high dietary iron intake was protective against mental and behavioral disorders due to use of tobacco. In the fully adjusted model, the OR (95% CI) and HR (95% CI) for the highest intake group compared to the lowest intake group were 0.41 (0.18 - 0.98) and 0.50 (0.43 - 0.58), respectively. In addition, we found a similar L-shaped nonlinear association between dietary iron intake and mental and behavioral disorders due to use of tobacco utilizing restricted cubic spline plots. How this study might affect research, practice or policy Our study provides evidence of a negative association between dietary iron intake and mental and behavioral disorders due to use of tobacco. For groups that find it difficult to quit smoking, increasing iron intake to an appropriate level may alleviate the discomfort associated with mental and behavioral disorders due to use of tobacco. National mental health is crucial for every country, and this becomes especially important in a modern context where mental stress is increasingly recognized.", "URL": "https://doi.org/10.1101/2024.10.30.24316458"} |
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] | {"Title": "Integrating post-validation surveillance of lymphatic filariasis with the WHO STEPwise approach to non-communicable disease risk factor surveillance in Niue, a study protocol", "Authors": "Craig Adam T, Lawford Harriet, Mokoia Grizelda, Ikimau Minerva, Fetaui Peter, Marqardt Tonia, Lau Colleen L", "Abstract": "Abstract Background Lymphatic filariasis (LF),a mosquito-borne parasitic disease caused by three species of filarial worms, was first detected in Niue, a small Pacific Island nation of approximately 1,600 people, in 1954. After extensive efforts involving multiple rounds of Mass Drug Administration, Niue was validated by the World Health Organization (WHO) as having eliminated LF as a public health problem in 2016. However, no surveillance has been conducted since validation to confirm infection rates have remained below WHO\u2019s elimination threshold. WHO has encouraged an integrated approach to disease surveillance; integrating LF post-validation surveillance (PVS) with existing surveys is an anticipated recommendation of the upcoming WHO LF-PVS guidelines. This paper describes a protocol for the implementation of an integrated approach to LF-PVS in Niue. We hypothesise that the approach describe here will offer a cost-efficient and operationally feasible means of monitoring the disease in the population. Methods The LF-PVS will be implemented as part of a planned national population-based WHO STEPwise approach to non-communicable disease (NCD) risk factor surveillance (STEPS) in Niue. Integration between the LF-PVS and STEPS will occur at multiple points, including during pre-survey community awareness raising and engagement, when obtaining informed consent, during the collection of demographics, risk factor, and location data, and when collecting finger-prick blood samples (for glucose as part of the STEPS survey and LF as part of the LF-PVS). The primary outcome measure for LF transmission will be antigen positivity. Microfilaria slides will be prepared for any antigen-positive cases. Dried blood spots will be prepared for all participants for Multiplex Bead Assays-based analysis to detect anti-filarial antibodies. We estimate a total sample size of 1,062 participants aged 15-69, representing approximately 66% of the population. Conclusions The results of this study will provide insight into the status of LF in Niue and evaluate the advantages, challenges, and opportunities offered by integrated approaches to disease surveillance.", "URL": "https://doi.org/10.1101/2024.10.30.24316465"} |
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] | {"Title": "Discriminative capacity of the 6-item Vision-related Quality of life and Limitations questionnaire (VQL-6)", "Authors": "Dol Vera Linde, Roelofs Antonius A. J., Fuermaier Anselm B. M., Vrijling Anne C. L., Heutink Joost, Jansonius Nomdo M.", "Abstract": "Abstract Purpose The 6-item Vision-related Quality of life and Limitations questionnaire (VQL-6) is a screening instrument that signals a need for additional low vision care in patients with chronic ophthalmic diseases. This study aims to (1) determine the optimal scoring method for the VQL-6 and (2) evaluate its discriminative capacity for clinical use. Methods Patients with glaucoma and retina\u2013 and cornea-related disorders completed the VQL-6 and participated in an interview designed to distinguish between patients with and without a need of additional care. For the two subscales (general health and quality of life, HQOL, and vision-related limitations, VL) we compared a scoring model with equal item weights to a cross-validated model using regression weights. The optimal scoring method and discriminative capacity of the subscales were determined using receiver operating characteristics (ROC) analysis, with the interview outcome as gold standard. Sensitivities were evaluated at specificities of 90 and 95%. Results In 297 interview assessments, 96 patients (32%) appeared to need additional care. Both scoring models demonstrated very similar area under the ROC curves (AUC). The selected equal weight model yielded an AUC of 0.91 (95% confidence interval 0.87-0.94) for VL and 0.71 (0.65-0.77) for HQOL. For VL, sensitivity was 72 and 64% at 90 and 95% specificity, respectively. Corresponding HQOL sensitivities were 34 and 17%. Conclusions The subscale VL shows excellent discriminative capacity and outperformed HQOL. Future studies should explore the feasibility of the VQL-6 in clinical practice.", "URL": "https://doi.org/10.1101/2024.10.31.24316475"} |