National Dataset Research Articles

Age Suppresses the Association Between Traumatic Brain Injury Severity and Functional Outcomes: A Study Using the NIDILRR TBIMS Dataset.

Recovery from traumatic brain injury (TBI) is extremely difficult to predict, with TBI severity usually demonstrating weak predictive validity for functional or other outcomes. A possible explanation may lie in the statistical phenomenon called suppression, according to which a third variable masks the true association between predictor and outcome, making it appear weaker than it actually is. Age at injury is a strong candidate as a suppressor because of its well-established main and moderating effects on TBI outcomes. We tested age at injury as a possible suppressor in the predictive chain of effects between TBI severity and functional disability, up to 10years post-TBI. Follow-up interviews were conducted during telephone interviews. We used data from the 2020 NDILRR Model Systems National Dataset for 4 successive follow-up interviews: year 1 (n =10,734), year 2 (n =9174), year 5 (n =6,201), and year 10 (n =3027). Successive cross-sectional multiple regression analyses. Injury severity was operationalized using a categorical variable representing duration of posttrauma amnesia. The Glasgow Outcomes Scale-Extended (GOS-E) operationally defined functioning. Sociodemographic characteristics having significant bivariate correlations with GOS-E were included. Entry of age at injury into the regression models significantly increases the association between TBI severity and functioning up to 10years post-TBI. Age at injury is a suppressor variable, masking the true effect of injury severity on functional outcomes. Identifying the mediators of this suppression effect is an important direction for TBI rehabilitation research.

The development and internal validation of a multivariable model predicting 6-month mortality for people with opioid use disorder presenting to community drug services in England: a protocol

BackgroundPeople with opioid use disorder have substantially higher standardised mortality rates compared to the general population; however, lack of clear individual prognostic information presents challenges to prioritise or target interventions within drug treatment services. Previous prognostic models have been developed to estimate the risk of developing opioid use disorder and opioid-related overdose in people routinely prescribed opioids but, to our knowledge, none have been developed to estimate mortality risk in people accessing drug services with opioid use disorder. Initial presentation to drug services is a pragmatic time to evaluate mortality risk given the contemporaneous routine collection of prognostic indicators and as a decision point for appropriate service prioritisation and targeted intervention delivery. This study aims to develop and internally validate a model to estimate 6-month mortality risk for people with opioid use disorder from prognostic indicators recorded at initial assessment in drug services in England.MethodsAn English national dataset containing records from individuals presenting to drug services between 1 April 2013 and 1 April 2023 (n > 800,000) (the National Drug Treatment Monitoring System (NDTMS)) linked to their lifetime hospitalisation and death records (Hospital Episode Statistics-Office of National Statistics (HES-ONS)). Twelve candidate prognostic indicator variables were identified based on literature review of demographic and clinical features associated with increased mortality for people in treatment for opioid use disorder. Variables will be extracted at initial presentation to drug services with mortality measured at 6 months. Two multivariable Cox regression models will be developed one for 6-month all-cause mortality and one for 6-month drug-related mortality using backward elimination with a fractional polynomial approach for continuous variables. Internal validation will be undertaken using bootstrapping methods. Discrimination of both models will be reported using Harrel’s c and d-statistics. Calibration curves and slopes will be presented comparing expected and observed event rates.DiscussionThe models developed and internally validated in this study aim to improve clinical assessment of mortality risk for people with opioid use disorder presenting to drug services in England. External validation in different populations will be required to develop the model into a tool to assist future clinical decision-making.

Contraception Usage and Workforce Trends Through 2022

This cross-sectional study uses a national data set of medical prescription claims to examine contraception service and workforce changes from January 2019 through December 2022 in the US.

Can proactive support prevent unscheduled care? A controlled observational retrospective cohort study in cancer patients in Scotland

IntroductionPreventative spend is a global health and social care strategy. Improving Cancer Journeys (ICJ) is a proactive, holistic, multidisciplinary project consistent with this agenda, currently being rolled out across Scotland and parts of UK. ICJ helps people with cancer access whatever support they need to mitigate their most pressing concerns. This study hypothesised that ICJ service users should subsequently use less unscheduled care than matched cohorts not using ICJ.MethodsRetrospective observational cohort study using linked national datasets. N = 1,214 ICJ users in Glasgow were matched for age, sex, deprivation, cancer type, stage, and diagnosis year to two control groups: 1. Cancer patients from Glasgow before ICJ (pre-2014), 2. Cancer patients from rest of Scotland during study period (2014–2018). Cancer registrations were linked for 12-month baseline and study periods to: NHS24 calls, A&E admissions, inpatient hospital admissions, unscheduled care, number & cost of psychotropic prescriptions. Per-person mean service uses were compared between groups.ResultsThere was a significant increase in NHS24 calls in the ICJ group (0.36 per person vs. -0.03 or 0.35), more and longer A&E attendances in ICJ (0.37 per person vs. 0.19 or 0.26; 2.19 h per person vs. 0.81–0.92 h), more and longer hospital admissions in ICJ (4.25 vs. 2.59 or 2.53; 12.05 days vs. 8.37 or 8.64), more care pathways involving more steps in ICJ (0.77 spells vs. 0.39 or 0.57; 1.88 steps vs. 1.56 or 1.21), more psychotropic drug prescriptions and higher costs in ICJ (1.88 prescription vs. 1.56 or 1.21; £9.51 vs. £9.57 or £6.95) in comparison to both control groups.DiscussionICJ users sourced significantly more unscheduled care than matched cohorts. These findings were consistent with much of the comparable literature examining the impact of non-health interventions on subsequent health spend. They also add to the growing evidence showing that ICJ reached its intended target, those with the greatest need. Together these findings raise the possibility that those choosing to use ICJ may also be self-identifying as a cohort of people more likely to use unscheduled care in future. This needs to be tested prospectively, because this understanding would be very helpful for health and social care planners in all countries where proactive holistic services exist.

An economic evaluation of antipsychotic medications given to persons with dementia

ABSTRACT Persons with dementia are often prescribed with antipsychotic medications, AP, even when they do not have the symptoms for which these medications were designed to treat. It is well documented that the consequence of this prescribing has many adverse effects, especially related to mortality. What is unknown is whether there are any compensating benefits of the AP in terms of dealing with the agitation associated with dementia that may increase the quality of life of those with dementia. This article carries out a comprehensive evaluation of the AP in terms of both mortality and the quality of life using a large national data set. We find that there are no benefits and only costs from taking the AP. We identify some of the possible pathways by which these adverse effects occur. Our conclusion therefore is that there is no justification for the persistent prescription of the AP for persons with dementia.

Conspiracy Beliefs and Consumption: The Role of Scientific Literacy

Abstract Conspiracy theories pose risks to consumers, businesses, and society. The present research investigates the role of scientific literacy in a variety of conspiracy beliefs with implications for consumer well-being and sustainability (e.g., regarding coronavirus disease 2019 [COVID-19], genetically modified organisms, and climate change). In contrast to the mixed effects of education in prior work, we find that scientific literacy undermines conspiracy beliefs and, in turn, conspiracy-related behaviors. This finding is explained by people’s ability to use two dimensions of scientific literacy—scientific knowledge and reasoning—to accurately assess conspiracy evidence. For robustness, we assess scientific literacy through both measurement and manipulation (i.e., interventions), identify two moderators (evidence strength and narration) that attenuate the effect, and further validate our theorizing using national and international datasets (regarding COVID-19 vaccination and Google search, respectively). We discuss the implications of our findings for consumers, companies, nonprofit organizations, and governments.

Comparison of Depression and Anxiety in Neuromyelitis Optica Spectrum Disease and Multiple Sclerosis Patients: Analysis of Two National Datasets (P11-14.002)

Comparison of Depression and Anxiety in Neuromyelitis Optica Spectrum Disease and Multiple Sclerosis Patients: Analysis of Two National Datasets (P11-14.002)

Frequency of Neuromyelitis Optica Spectrum Disorder Correlated Symptoms: A Pre- and Post-diagnosis Comparison from a National Dataset (P10-14.011)

Frequency of Neuromyelitis Optica Spectrum Disorder Correlated Symptoms: A Pre- and Post-diagnosis Comparison from a National Dataset (P10-14.011)

Depression and Anxiety in Neuromyelitis Optica Spectrum Disease (NMOSD): Analysis of a National Dataset (P10-14.007)

Depression and Anxiety in Neuromyelitis Optica Spectrum Disease (NMOSD): Analysis of a National Dataset (P10-14.007)

Enabling Spatial Data Interoperability through the Use of a Semantic Meta-Model—The Peatland Example from the JRC SEPLA Project

Numerous geographic data on peatland exist but definitions vary, and the correspondent classes are often neither harmonized nor interoperable. This hinders the efforts to employ the available national datasets on peatlands and wetlands for policy monitoring and reporting. The existing meta-languages, such as ISO-Land Cover Meta Language (LCML) and EAGLE, offer the possibility to “deconstruct” the relevant nomenclatures in an object-oriented manner, allowing the comparability and interoperable use of related information. The complex nature of peatlands calls for a dedicated and structured vocabulary of keywords and terms, comprising the biotic substrate and the soil. In the SEPLA project, a semantic meta-model has been developed, combining the hierarchical ontology of the LCML with the matrix structure of the EAGLE model. The necessary elements were provided to describe peatland bio-physical characteristics, while representing the definitions in a concise and user-friendly manner (semantic passports). The proposed semantic meta-model is innovative as it enables the documentation of the spatial distribution of peatland characteristics, considering also their temporal dimension, their intrinsic relation with land use, and the soil. It has been successfully implemented for the translation of the national peatland nomenclature into common land categories relevant for reporting under LULUCF regulation, as part of the EU Climate Law.

Outcomes After Community Discharge From Skilled Nursing Facilities: The Role of Medicaid Home and Community-Based Services.

This study investigated the association between Medicaid Home and Community-Based Services (HCBS) generosity and post-discharge outcomes among dual-eligible beneficiaries discharged from skilled nursing facilities (SNFs). We linked multiple national datasets for duals discharged from SNFs between 2010 and 2013. Accounting for SNF fixed effects, we estimated the effect of HCBS generosity, measured by its breadth and intensity, on the likelihood of remaining in the community, risks of death, nursing home (NH) admission, and hospitalizations within 30 and 180days after SNF discharge. We found that higher HCBS generosity was associated with an increased likelihood of remaining in the community. HCBS breadth and intensity were both significantly associated with reduced risks of NH admission, while higher HCBS intensity was related to a reduced risk of acute hospitalizations within 30days after discharge. Our findings suggest that more generous HCBS programs may facilitate smoother transitions and sustainable community living following SNF discharge.

Investigating the Connection between Chronic Periodontitis and Parkinson's Disease: Findings from a Korean National Cohort Study.

Recent research suggests a potential relevance between chronic periodontitis (CP) and Parkinson's disease (PD), raising concerns about comorbid PD among elderly CP patients. However, the epidemiologic basis for this association remains unclear. Employing a nested case-control design, this study explored the association between CP and subsequent PD occurrences in Korean adults, leveraging a validated national population-based dataset covering the period from 2002 to 2019. It included 8794 PD patients and 35,176 matched control individuals, established through propensity score matching for age, sex, residential area, and income. Baseline characteristics were compared using standardized differences, and logistic regression was employed to assess the impact of CP histories on PD likelihood while controlling for covariates. We performed a thorough examination of CP events within both 1-year and 2-year intervals preceding the index date, incorporating subgroup analyses. Our analysis revealed no statistically significant association between CP history and PD development overall. However, subgroup analysis revealed a slightly increased likelihood of PD development among CP individuals with a high disease burden (Charlson Comorbidity Index score ≥ 2). In conclusion, although our study did not find a significant overall association between CP history and PD development, the elevated likelihood of PD in subgroups with high disease burden may suggest that comorbidities influence PD probability among certain CP patients. Considering comorbid conditions in PD screening for some individuals with CP may be also important.

Factors Associated with Caregiver Decision Not to Transport Pediatric Patients Assessed by Emergency Medical Services

Objectives: Almost one third of pediatric 9-1-1 calls result in non-transport by Emergency Medical Services (EMS). It is unknown to what extent these decisions are driven by caregivers’ decisions to decline transport versus EMS advice that transport is unnecessary. Further, it is unknown whether demographic, encounter, or agency factors are associated with caregivers declining transport.
 Methods: We conducted a retrospective cross-sectional study with data from the national 2019 ESO Data Collaborative (a convenience sample with data from > 2,000 EMS agencies). We included 9-1-1 responses for children <18 years. The primary outcome was caregiver decision not to transport patient (per EMS documentation) compared to EMS-initiated non-transport. Descriptive data for patient dispositions were generated. Bivariable and multivariable logistic regression identified factors associated with caregiver decision not to transport.
 Results: Of 313,903 pediatric 9-1-1 activations, 37.2% resulted in non-transport, with 80.0% of pediatric non-transports attributable to a caregiver decision. The patient and encounter characteristics for children not transported by EMS were similar, regardless of whether the caregiver or EMS clinician made the decision not to transport. There was wide inter-agency variation in both the rate of non-transport (median 0.37, interquartile range (IQR 0.25 – 0.48)) and the proportion of these encounters attributable to a caregiver decision (median 0.82, IQR 0.68-0.94).
 Conclusions: In this large national dataset, pediatric non-transport by EMS was common, and in most cases non-transport was documented to result from a caregiver decision. Both the rates of non-transport and proportion of caregiver decision varied significantly between EMS agencies. Further research is needed to understand pediatric patient outcomes after non-transport and to identify the reasons for practice variability between EMS agencies. Developing standardized, evidence-based non-transport protocols for children may help reduce this potentially unwarranted clinical variation.

Increased risk of cardiovascular and renal disease, and diabetes for all women diagnosed with gestational diabetes mellitus in New Zealand-A national retrospective cohort study.

Gestational diabetes mellitus increases the risk of developing type 2 diabetes. The aim of this study is to compare cardiometabolic and renal outcomes for all women in New Zealand with gestational diabetes (2001-2010) with women without diabetes, 10-20 years following delivery. A retrospective cohort study, utilizing a national dataset providing information for all women who gave birth between 1 January 2001 and 31 December 2010 (n = 604 398). Adolescent girls <15 years, women ≥50 years and women with prepregnancy diabetes were excluded. In total 11 459 women were diagnosed with gestational diabetes and 11 447 were matched (for age and year of delivery) with 57 235 unexposed (control) women. A national hospital dataset was used to compare primary outcomes until 31 May 2021. After controlling for ethnicity, women with gestational diabetes were significantly more likely than control women to develop diabetes-adjusted hazard ratio (HR) 20.06 and 95% confidence interval (CI) 18.46-21.79; a first cardiovascular event 2.19 (1.86-2.58); renal disease 6.34 (5.35-7.51) and all-cause mortality 1.55 (1.31-1.83), all p values <.0001. The HR and 95% CI remained similar after controlling for significant covariates: diabetes 18.89 (17.36-20.56), cardiovascular events 1.79 (1.52-2.12), renal disease 5.42 (4.55-6.45), and all-cause mortality 1.44 (1.21-1.70). When time-dependent diabetes was added to the model, significance remained for cardiovascular events 1.33 (1.10-1.61), p = .003 and renal disease 2.33 (1.88-2.88), p < .0001 but not all-cause mortality. Women diagnosed with gestational diabetes have an increased risk of adverse cardiometabolic and renal outcomes. Findings highlight the importance of follow-up screening for diabetes, cardiovascular risk factors, and renal disease.

Performance status at the time of lung retransplant predicts long-term function.

Lung retransplantation is offered to select patients with chronic allograft dysfunction. Given the increased risk of morbidity and mortality conferred by retransplantation, post-transplant function should be considered in the decision of who and when to list. The aim of this study is to identify predictors of post-operative disability in patients undergoing lung retransplantation. Data were collected from the UNOS national dataset and included all patients who underwent lung retransplant from May 2005-March 2023. Pre- and post-operative function was reported by the Karnofsky Performance Status (KPS) and patients were stratified based on their needs. Cumulative link mixed effects models identified associations between pre-transplant variables and post-transplant function. A total of 1275 lung retransplant patients were included. After adjusting for between-group differences, pre-operative functional status was predictive of post-transplant function; patients requiring Total Assistance ( n=740) were 74% more likely than No/Some Assistance patients (n=535) to require more assistance in follow-up (OR 1.74, 95% CI 1.13-2.68, p=.012). Estimated one year survival of Total Assistance patients is lower than No/Some Assistance Recipients (72%vs. 82%, CI 69%-75%; 79%-86%) but similar to overall re-transplant survival (76%, CI 74%-79%). Both survival and regain of function in patients requiring Total Assistance prior to retransplant may be higher than previously reported. Pre-operative functional status is predictive of post-operative function and should weigh in the selection, timing and post-operative care of patients considered for lung retransplantation.

An improved habitat suitability index for the great crested newt Triturus cristatus

An improved habitat suitability index for the great crested newt Triturus cristatus

The 30,000 Foot View: Using Big Data to Address Complex Clinical Questions in the Most Vulnerable Older Adults

Older people of color, those who are socially isolated, veterans, and incarcerated older adults experience disparities in mental healthcare and high levels of psychiatric and physical comorbidity, including increased risk of suicide. The identification of risk factors and understanding the culture and context that impact risk are major public health challenges. Effective approaches to address these challenges are likely to involve using national databases and applying advanced methodologies to address complex clinical questions in older adults. By leveraging extensive epidemiological datasets, we can effectively pinpoint risk factors and consequences associated with mental health disorders in later stages of life. Moreover, these datasets allow us to disaggregate heterogeneous groups which are often treated as homogeneous (e.g. people of color, veterans, etc.). This disaggregation may reveal significant within group differences and provide important contextual information regarding these groups which can be used to deliver precision mental healthcare in an efficient manner and reduce the burden of mental illness in late life. In this session, we will explore innovative methodologies of utilizing national datasets to discern the cultural and contextual elements that impact the mental health and well-being of four high-risk, older adult populations. Emphasis will be placed on identifying patterns in mental healthcare disparities and comprehending how factors such as race, ethnicity, sex, gender, and incarceration contribute to feelings of loneliness, suicide rates, and dementia. Furthermore, we will also discuss the potential application of this data in developing precise risk assessment tools and targeted prevention and treatment strategies. interventions for late-life mental health issues.

Disparities in Study Inclusion and Breast Cancer Screening Rates Among Transgender People: A Systematic Review

BackgroundBreast cancer screening trends of transgender and gender diverse (TGD) people remain largely unknown. This is concerning, as data are necessary to inform recommendations made by clinicians to their patients and by national guidelines to clinicians. The aim of this review is to explore the state of existing research literature and provide a summary report of current breast cancer screening rates in TGD adults. MethodsAll articles were identified using Medical Subject Headings terms. Inclusion criteria were all the following: (1) documents inclusion of at least one participant who identifies as a TGD person; (2) at least one TGD participant with top surgery or currently receiving estrogen-based gender-affirming hormone therapy; (3) results that report rates of breast cancer screening or mammogram referral. ResultsTwelve articles met inclusion criteria, six cross-sectional studies and six retrospective chart reviews. Three studies conducted secondary analysis of the Behavioral Risk Factor Surveillance System national dataset, and nine articles recruited their own sample with number of TGD participants ranging from 30 to 1,822 and number of cisgender women ranging from 242 to 18,275. Three studies found lower rates of screening in transfeminine persons receiving gender-affirming care compared with cisgender women; two studies found lower rates among TGD people compared with cisgender women; and three studies found no differences between the breast cancer screening rates of TGD and cisgender participants. ConclusionLimited studies recruit and report trends in breast cancer screening of TGD people. Those that do include TGD participants have mixed results, but overall TGD people had lower rates of breast cancer screening. More research is needed regarding breast cancer screening of TGD people to inform the development of protocols that ensure equitable access to preventative care.

Novice Teachers and Student Attendance in Early Elementary School

Student absenteeism in the earliest years of elementary school has been linked to a range of negative outcomes. Though the literature has examined numerous factors that are associated with children missing school, the role of teachers—especially at the early elementary level—has not been well understood. Given that students spend the majority of their time in elementary school with one teacher in a single classroom, a large component of early elementary school is underexplored, and our understanding of absenteeism remains incomplete. In this vein, we looked into whether having novice versus more experienced teachers was linked to the frequency of student absenteeism in the earliest years of school. Using a national dataset including repeated observations of students in grades K-2, we found that novice teachers have students with fewer absences and a lower probability of being chronically absent. There were no differences in the outcomes of novice teachers as a function of child nor classroom characteristics. Implications for policy and practice are discussed.

Who has access to cycling infrastructure in Canada? A social equity analysis

Canadian cities have made significant investments in cycling infrastructure to support uptake in active transportation. Who has spatial access to supportive infrastructure is an important equity question: lack of access to safe infrastructure for cycling may limit who has an option to use a bicycle to meet their transportation needs (to access employment, educational, social, or other essential services) as well as who may achieve the physical and mental health benefits possible through physical activity. Our aim is to measure spatial access to cycling infrastructure in Canadian cities, and to provide a broad, national understanding of inequitable access to cycling infrastructure for equity-deserving populations (children, seniors, recent immigrants, visible minorities, and people with low incomes). Accordingly, we used a national dataset of cycling infrastructure (Can-BICS), which summarizes the quantity of cycling infrastructure for all dissemination areas in Canada, and 2016 Census data to estimate associations between area-level sociodemographic characteristics and access to cycling infrastructure. In unadjusted associations, equity-deserving groups (i.e., recent immigrants and people with low incomes) had better access to cycling infrastructure. Pearson coefficients highlighted variations in the equity of cycling infrastructure across cities. Overall, access was more equitable across equity-deserving groups in large cities, compared to mid-sized and small cities. After adjusting for covariates related to urban form and mode share, access to cycling infrastructure was higher in areas with more seniors, more recent immigrants, more visible minorities, and more people with low incomes, but lower in areas with more children. More importantly, there are still a substantial number of people from equity-deserving groups living in areas with very low levels of cycling infrastructure. For example, ∼ 1.5 million children under the age of 14 (31% of children), 1.5 million older adults (31%), 1.4 million visible minorities, and 0.5 million people with low income (20%) live in dissemination areas with the lowest level of cycling infrastructure. These results highlight the need to understand which populations stand to gain by cycling infrastructure investments and which populations are being left behind. This methodology represents a useful tool for information transport policy initiatives to advance bicycle equity at a national scale.