Journal of epidemiology and population health最新文献

Background: In Illinois, the Opioid Alternative Pilot Program (OAPP) was launched to expand access to medical cannabis to use as a direct substitute for opioids. Although therapeutic benefits have been reported in reducing opioid use, there is an absence of literature that examines how medical cannabis use impacts an individual's quality of life (QoL). This study examines the association of medical cannabis use with QoL among the first enrollees in OAPP.

Methods: A survey was sent to enrollees between February and July 2019. Cannabis users (n=626) were compared to non-users (n=234) to determine whether there was an association between cannabis use within the past year and QoL. Ordered logistic regression and backwards stepwise regression modelling was used.

Results: Across the study sample of 860 participants, the average age was 47 years; 60 % of the cohort was male; 72 % were not of Hispanic, Latino, or Spanish origin; 67 % were married. Across the entire study sample, the average perceived QoL was 2.86 (between 'Good' and 'Fair'), with no statistically significant difference in QoL between the two groups (non-users: 2.85; cannabis users: 2.86; p=0.92). Logistic regression reported cannabis use within the past year did not have a statistically significant association with QoL (OR=1.33, 95% confidence interval, 0.85 to 2.08, p=0.21).

Discussion: Overall, there was no significant association between cannabis use within the past year and QoL. This may be attributed to pain being a qualifying condition to enter the program.

Background: Script Concordance Tests (SCTs) represent an innovative assessment method which have been introduced in the 2024 French National Ranking Examinations (EDN). These tests compare a student's clinical reasoning with that of a panel of experts under conditions of uncertainty. Typically, the question involves the impact of new information on an initially proposed hypothesis, with answers given on a Likert scale.

Main findings: This article aims to didactically illustrate how SCTs are consistent with probabilistic reasoning as modeled by Bayes' theorem. In addition, by comparing SCT writing guidelines with Bayesian reasoning concepts, several ambiguities were identified: (1) What stage of clinical reasoning do SCTs evaluate? (2) What are the appropriate labels for Likert scale responses? (3) Does the expert panel provide a relevant reference for SCTs?

Conclusions: Currently, many of these questions remain unanswered in the literature, with recent data suggesting that experienced physicians' responses to SCTs are often biased. Beyond their use as an assessment tool in the EDN, SCTs offer a valuable opportunity to develop and deepen the teaching of probabilistic reasoning in medical education and serve as a potential area of research to improve clinical practice.

Background: In France, the infant mortality rate had a long period of decline, but it stopped decreasing after 2010 and then rose. Neonatal mortality is a large part of infant mortality. The aim of this study was thus to describe its main changes, by cause of death and gestational age, and the main changes in socio-spatial distribution, from 2001 to 2017.

Methods: For this purpose, we investigated data on neonatal deaths reported in France from 2001 to 2017. Crude, cause-specific and gestational age-specific neonatal mortality rates were computed and an ecological analysis, according to several contextual factors at commune level, was performed using quasi-Poisson regressions.

Results: The average neonatal mortality rate was 2.42 per 1000 live births in France during the study period, showing an increase from 2011 onwards. This increase was mostly related to perinatal conditions and more births at very low gestational age. Gestational age-specific neonatal mortality rates did not increase during the period. The analysis of socio-spatial factors showed increased mortality rates in large cities, deprived areas and cities with higher percentages of migrants.

Conclusion: This study suggests that a shift in the distribution of gestational age at birth toward low gestational ages may have contributed to the rise in neonatal mortality in France. Furthermore, there is notable spatial heterogeneity in neonatal mortality. Nevertheless, this observation poorly explains the specificity of the high level and recent upsurge in infant mortality in France, in contrast to its European counterparts.

Introduction: In France, the average steady decline in tuberculosis (TB) incidence close to 5 % per year over the past half-century has been occasionally interrupted by disruptions related to external events. We describe the impact of the COVID-19 pandemic on TB incidence, severity and treatment outcome.

Methods: We analysed the number of TB cases and treatment outcomes reported through the mandatory notification system through 2018-2023. We compared cases reported, notification rates and percentage of cases completing treatment before and after the occurrence of the COVID-19 pandemic.

Results: The TB rate and the mean weekly number of cases decreased from 7.6/100,000 to 6.8/100,000 (-10 %) (p=0.96) between 2019 and 2020. This decreasing trend continued, albeit more moderately, in 2021 (-7 %) and 2022 (-2 %). The trend shifted upward in 2023 (7.1/100,000, +15 % compared to 2022). The mean weekly number of reported cases significantly decreased between 2018 (n=97), 2019 (n=97) and 2020 (n= 88) (p<0.01) and significantly increased between 2022 (n=77) and 2023 (n=91) (p<0.01). There was no increase in the number of severe cases, multidrugresistant (MDR) cases or deaths in the years following the pandemic. The proportion of persons that completed treatment was 83.3 % for cases notified in 2022, a significant increase compared to the 79.7 % estimated for 2019 cases (p<0.01). However, less than half of the reported cases had information on treatment outcome.

Conclusion: The important fall in TB incidence in France in 2020 is likely explained among other factors by the social and health measures that were implemented soon after the onset of the COVID-19 pandemic. In 2023, the situation had reversed although no impact on severe and MDR cases and deaths was observed.

Objective: This study aimed to investigate the critical factors for reimbursement decisions of innovative medicines in Scotland and to explore the feasibility of machine learning models for predicting decisions.

Method: All appraisals for innovative medicines issued by the Scottish Medicines Consortium (SMC) from 2016 to 2020 were screened to extract decision outcomes and 24 explanatory factors. SelectKBest with chi-square test was used for factor selection. The factors with P-value <0.05 were considered to have statistically significant associations with decision outcomes and were selected. Six machine learning models including decision tree, random forest, support-vector machine, Xgboost and K-nearest neighbours and logistic regression were used to build models with selected factors. Indicators comprising accuracy, precision, recall, F1-score were used to evaluate the performance of models.

Result: A total of 111 appraisals were identified, among which, 47 medicines were recommended, 48 recommended with restricted use and 16 not recommended. Seven were identified to be significant and selected for the prediction models. The factors of request for restriction on indication by manufacture, uncertainty of economic evidence, validation of primary outcomes and acceptance of comparator were identified as the most important predictors for SMC decisions. Four models had good prediction performance with both accuracy and F1-score over 0.9 in the internal validation, and random forest had the best prediction performance.

Conclusion: Low uncertainty of economic evidence, validated primary outcomes and accepted comparators were significantly associated with positive SMC decisions. Machine learning models may be feasible for predicting reimbursement decisions in the future.

Background: Social determinants of health (SDOH) have been shown to be important predictors of health outcomes. Here we developed methods to extract them from inpatient electronic medical record (EMR) data using techniques compatible with current EMR systems.

Methods: Four social determinants were targeted: patient language barriers, employment status, education, and whether the patient lives alone. Inpatients aged 18 and older with records in the Calgary-wide EMR system were studied. Algorithms were developed on the January 2019 hospital admissions (n=8,999) and validated on the January 2018 hospital admissions (n=8,839). SDOH documented as structured data were compared against those extracted from unstructured free-text notes.

Results: More than twice as many patients had a note documenting a language barrier in EMR data than in structured data; 12 % of patients indicated by EMR notes to be living alone had a partner noted in their structured marital status. The Positive Predictive Value (PPV) of the elements extracted from notes was high, at 99 % (95 % CI 94.0 %-100.0 %) for language barriers, 98 % (95 % CI 92.6 %-99.9 %) for living alone, 96 % (95 % CI 89.8 %-98.8 %) for unemployment, and 88 % (95 % CI 80.0 %-93.1 %) for retirement.

Conclusions: All SDOH elements were extracted with high PPV. SDOH documentation was largely missing in structured data and sometimes misleading.

Objectives: A "patient-researcher" training intervention was designed to improve participants' empowerment by building on their level of critical health literacy and to build a trustful partnership between participants and researchers, with the longer-term objective of co-constructing a community-based research project. The participants in the training intervention were recruited through the collaborative research platform "Seintinelles". This training intervention was aimed at patients or former patients suffering from cancer. The study's objective is to identify intervention's elements that appear to be relevant and those that should be improved for future implementation.

Methods: This study is descriptive research in the form of a case study. A questionnaire (post-intervention) and logbook were designed to analyze the implementation of patient-researcher training.

Results: Results suggest that the intervention should be flexible to adapt content to formal and informal exchanges. Participants were satisfied, although the intervention did not completely meet their expectations. Following the intervention, most participants felt able to participate in a research study.

Conclusion: At the end of this analysis, we can conclude that the 'patient-researcher' training intervention fulfilled its two objectives. First, it provided the knowledge and skills necessary for the implementation of a community-based research study and helped participants feel that they could take part in the different stages of such a study. Second, it initiated the construction of an alliance between 'lived experience' experts and scientific experts.

Context: Alcohol-related health problems represent a significant public health concern, and it is imperative for the healthcare team to accurately perceive and detect these issues to provide appropriate care. The objective of this survey was to evaluate the knowledge, practices, and educational background of healthcare professionals in the field of alcohol-related health concerns, aiming to identify their information requirements.

Methods: This study employs a cross-sectional descriptive survey methodology, in which data were gathered through a digital questionnaire designed for healthcare professionals (including those in medical, paramedical, and medico-social professions) working in addictology services as well as other relevant services across France and its overseas departments.

Results: A total of 611 questionnaires were deemed usable for analysis. A considerable percentage of participants reported their knowledge and skills to be insufficient or very insufficient, with rates of 33 % and 36 %, respectively. Moreover, a significant proportion of respondents (≈ 28 %) stated that they had received no education in addictology. Our results highlight differences in levels of knowledge and competence among the various healthcare settings, notably with lower reported levels of satisfaction in hospital settings (public and private), private practice, and in Harm Reduction Centers. Furthermore, certain professions reported unsatisfactory levels of skills and knowledge in alcohol-related issues, particularly support staff, pharmacists, expert patients, administrative staff, and social workers. These findings suggest the need to enhance knowledge and skills by tailoring interventions according to the specific healthcare settings and professions. Additionally, the priority themes and channels for disseminating information varied depending on age, region, and professional category.

Conclusion: This survey reveals a low level of knowledge, practice, and education in addictology, emphasizing the critical need for training. The importance of training extends not only to the priority topics addressed but also to the channels used for dissemination, all while customizing them to suit the age, professional category, structure, and region of healthcare professionals.

Background: Psychological and social support for adolescents living with HIV remains undocumented and unaddressed in Central Africa. This study aimed at assessing effectiveness of a peer-facilitated community-based support model in improving retention in care among adolescents living with HIV and attending care in Chantal Biya Foundation, Yaounde, Cameroon.

Materials and methods: We conducted an analysis of adolescents aged 10-19 years old, perinatally infected with HIV, on follow-up in the Day Care Unit of a reference hospital in Yaounde, Cameroon, and enrolled in the IAS-CIPHER-2021/1214-ATE-SMAVI, a individually randomized controlled trial. While the control arm only received routine care in the health facility, the intervention arm, in addition, was assigned to an HIV association for sustained support model, including support groups, leisure workshops and home visits. Structured questionnaires, including validated French versions of mental health scales, were quarterly administered to the study participants in both study arms by trained healthcare providers. The main outcome was maintaining retention in care beyond the first 15-month period of the study start. Kaplan-Meier and Cox regression models were fitted to assess association between intervention and outcome. Hazard Ratio (HR) across categories of exposure variables were compared using Wald's test. p-value <0.05 was considered significant.

Results: In total, 305 adolescents were recruited in the study at a median age of 15.2 years old, including 162 (53.1 %) females and 153 individuals in the intervention arm. Mental health troubles were prevalent: severe depression (26.9 %), high or very high anxiety (28.9 %), and low self-esteem (84.9 %). Noteworthy, all of the baseline characteristics were balanced irrelevant to the study arm. Probability of maintaining good retention in care beyond the first 15-month period of study start remained higher in the intervention arm (82.0 % [95 %CI: 73.7 %-88.4 %]) versus the control arm (71.0 % [95 %CI: 63.2 %-78.1 %]), [cHR (95 %CI): 2.0 (1.1-3.3), p=0.044].

Conclusions: Capacity should be built in terms of implementing community-based peer-facilitated support groups in local organizations providing care to adolescents living with HIV.