Secondary Analysis Of Longitudinal Data Research Articles

Disease Course of Clinically Isolated Optic Neuritis.

Optic neuritis is the most common optic neuropathy in young adults and a frequent manifestation of multiple sclerosis. Its clinical course is pertinent to the design of visual pathway neuroprotection trials. This is a secondary analysis of longitudinal data from the TONE trial, which included 103 patients from 12 German academic tertiary centers with acute unilateral optic neuritis as a clinically isolated syndrome and baseline high-contrast visual acuity <0.5 decimal. Patients were randomized to 1,000 mg methylprednisolone i.v./d plus either erythropoietin (33,000 IU/d) or placebo (saline solution) for 3 days. They were followed up at standardized intervals with a battery of tests including high-contrast visual acuity, low-contrast letter acuity, contrast sensitivity, visual fields, visual evoked potentials, and retinal optical coherence tomography. At 6 months, participants answered a standardized questionnaire on vision-related quality of life (NEI-VFQ 25). We describe the disease course with mixed-effects piecewise linear models and calculate structure-function correlations using Pearson r. Because erythropoietin had no effect on the visual system, we use pooled (treatment-agnostic) data. Patients experienced initial rapid and then decelerating improvements of visual function with thinning of inner and thickening of outer retinal layers. At 6 months, visual parameters were positively correlated with inner and negatively correlated with outer retinal thickness changes. Peripapillary retinal nerve fiber layer thinning predominantly occurred in sectors without previous swelling. At 6 months, macular ganglion cell and inner plexiform layer thinning was weakly correlated with the P100 peak time (r = -0.11) and moderately correlated with the amplitude of visual evoked potentials (r = 0.35). Only functional outcomes were at least moderately correlated with vision-related quality of life. The longitudinal data from this large study cohort may serve as a reference for the clinical course of acute optic neuritis. The pattern of correlation between visual evoked potentials and inner retinal thinning may argue that the latter is mostly due to ganglion cell loss, rather than dysfunction. Visual pathway neuroprotection trials with functional outcomes are needed to confirm that candidate drugs will benefit patients' vision-related quality of life. ClinicalTrials.gov, NCT01962571.

Multivariate mixed-effects ordinal logistic regression models with difference-in-differences estimator of the impact of WORTH Yetu on household hunger and socioeconomic status among OVC caregivers in Tanzania.

Although most of the livelihood programmes target women, those that involve women and men have been evaluated as though men and women were a single homogenous population, with a mere inclusion of gender as an explanatory variable. This study evaluated the impact of WORTH Yetu (an economic empowerment intervention to improve livelihood outcomes) on household hunger, and household socioeconomic status (SES) among caregivers (both women and men) of orphaned and vulnerable children (OVC) in Tanzania. The study hypothesized that women and men respond to livelihood interventions differently, hence a need for gender-disaggregated impact evaluation of such interventions. This is a secondary analysis of longitudinal data, involving caregivers' baseline (2016-2019) and follow-up (2019-2020) data from the USAID Kizazi Kipya project in 25 regions of Tanzania. Two dependent variables (ie, outcomes) were assessed; household hunger which was measured using the Household Hunger Scale (HHS), and Socioeconomic Status (SES) using the Principal Component Analysis (PCA). WORTH Yetu, a livelihood intervention implemented by the USAID Kizazi Kipya project was the main independent variable whose impact on the two outcomes was evaluated using multivariate analysis with a multilevel mixed-effects, ordinal logistic regression model with difference-in-differences (DiD) estimator for impact estimation. The analysis was based on 497,293 observations from 249,655 caregivers of OVC at baseline, and 247,638 of them at the follow-up survey. In both surveys, 70% were women and 30% were men. Their mean age was 49.3 (±14.5) years at baseline and 52.7 (±14.8) years at the follow-up survey. Caregivers' membership in WORTH Yetu was 10.1% at the follow-up. After adjusting for important confounders there was a significant decline in the severity of household hunger by 46.4% among WORTH Yetu members at the follow-up compared to the situation at the baseline (adjusted Odds Ratio (aOR) = 0.536, 95% Confidence Interval (CI) [0.521, 0.553]). The decline was 45.7% among women (aOR = 0.543 [0.524, 0.563]) and 47.5% among men (aOR = 0.525 [0.497, 0.556]). Regarding SES, WORTH Yetu members were 15.9% more likely to be in higher wealth quintiles at the follow-up compared to the situation at the baseline (aOR = 1.159 [1.128, 1.190]). This impact was 20.8% among women (aOR = 1.208 [1.170, 1.247]) and 4.6% among men (aOR = 1.046 [0.995, 1.101]). WORTH Yetu was associated with a significant reduction in household hunger, and a significant increase in household SES among OVC caregivers in Tanzania within an average follow-up period of 1.6 years. The estimated impacts differed significantly by gender, suggesting that women and men responded to the WORTH Yetu intervention differently. This implied that the design, delivery, and evaluation of such programmes should happen in a gender responsive manner, recognising that women and men are not the same with respect to the programmes.

Negative religious coping versus spiritual struggles: Moderator or main effect?

While previous research indicates that negative religious coping relates with distress, it is unclear if this represents generalized spiritual struggles or a specific vulnerability activated by negative events. Moreover, past research treats coping as a stable phenomenon, although it likely fluctuates. This research simultaneously tested both models longitudinally and examined the relationship between coping and distress. The current study is a secondary analysis of longitudinal data collected online over 3 years from 397 participants. Life events, negative religious coping, and depressive symptoms were assessed on six occasions, and linear mixed-effect models were used to analyze data. Negative religious coping was largely stable with increases at times of stress. Participants with higher mean negative coping reported more depressive symptoms regardless of life circumstances (i.e., main effect), likely reflecting generalized spiritual struggles. In addition, those with higher mean coping or with particularly high levels at a given time reported even higher levels of symptoms when they experienced more negative life events (i.e., moderation effect). Results suggest that previous research merges two distinct phenomena-spiritual struggles and negative coping. This has important theoretical and research implications and suggests that integrating spirituality and religion into treatment can be warranted.

Clinical Outreach Training and Supportive Supervision Quality-of-Care Analysis: Impact of Readiness Factors on Health Worker Competencies in Malaria Case Management in Cameroon, Mali, and Niger.

Improving the quality of malaria clinical case management in health facilities is key to improving health outcomes in patients. The U.S. President's Malaria Initiative Impact Malaria Project has supported implementation of the Outreach Training and Supportive Supervision (OTSS) approach in 11 African countries to improve the quality of malaria care in health facilities through the collection and analysis of observation-based data on health facility readiness and health provider competency in malaria case management. We conducted a secondary analysis of longitudinal data collected during routine supervision in Cameroon (April 2021-March 2022), Mali (October 2020-December 2021), and Niger (November 2020-September 2021) using digitized checklists to assess how service readiness affects health worker competencies in managing patients with fever correctly and providing those with confirmed uncomplicated malaria cases with appropriate treatment and referral. Linear or logistic regression analyses were conducted to assess the effect of facility readiness and its components on observed health worker competencies. All countries demonstrated significant associations between health facility readiness and malaria case management competencies. Data from three rounds of OTSS visits in Cameroon, Mali, and Niger showed a statistically significant positive association between greater facility readiness scores (including the availability of commodities, materials, and trained staff) and health worker competency in case management. These findings provide evidence that health worker performance is likely affected by the tools and training available to them. These results reinforce the need for necessary tools and properly trained staff if high-quality malaria case management services are to be delivered at health facilities.

Challenges in identification of HIV‐Associated Neurocognitive Disorders, a focus on low and middle income countries

AbstractBackgroundHIV‐associated neurocognitive disorders (HAND) are highly prevalent amongst people living with HIV (PLWH), especially in Sub‐Saharan Africa (SSA) where the majority of PLWH live. Current HAND identification measures lack accuracy in older PLWH on treatment, with substantial heterogeneity observed in SSA prevalence meta‐analyses There is a need to better understand the current cognitive phenotype of this newly emergent population, to develop appropriate screening tools. We report two linked studies.Study 1 compared diagnostic accuracy of the International HIV dementia scale (IHDS), and Identification and Interventions for Dementia in Elderly Africans (IDEA) screen, for identification of HAND in older PLWH in TanzaniaStudy 2 aimed to identify cognitive domains significantly associated with symptomatic HAND (s‐HAND) in older PLWH in Tanzania, with potential utility in future screening measures.MethodA systematic sample of 253 PLWH aged ≥ 50 attending a Government clinic underwent comprehensive HAND evaluation by consensus American Academy of Neurology (AAN) criteria including locally‐normed low‐literacy clinical neuropsychological assessment. A diagnostic accuracy study of the IHDS and IDEA screen versus AAN criteria was completed with strict blinding. Participants were offered identical annual reassessment at Y1 Y2 and Y3 and the relationship of cognitive domains with s‐HAND in a logistic mixed effects modelResultHAND was highly prevalent (47%) at baseline, increasing to 57.9% at year 3.At baseline, both IHDS and IDEA had limited diagnostic accuracy for HAND (AUROC 0.639–0.667 IHDS, 0.647–0.713 IDEA). On secondary analysis of longitudinal data, tests of verbal learning and memory, categorical verbal fluency, visual memory and visuoconstruction had AUROC &gt; 0.7 for s‐HAND (0.70 ‐ 0.72; p&lt;0.001 for all). Tests of visual memory, verbal learning and memory (delayed recall and recognition memory), psychomotor speed, language comprehension and categorical verbal fluency were independently associated with s‐HAND (p&lt;0.01 for all). Neuropsychological impairment pattern varied by education.ConclusionCurrent HAND screening tests no longer perform well in the new population of older PLWH in Africa. Tests most associated with s‐HAND include broad cortical and subcortical domains, some not included in existing HAND screening tests and vary by educational background. This should be considered in future HAND screening measure development.

A longitudinal study of care‐recipient relationship type on the quality of life in community‐dwelling older adults with dementia

AbstractBackgroundWith the prolongation of the human lifespan, dementia has become a significant public health issue. In 2050, the number of people living with dementia (PLWD) globally is projected to increase from 50 million in 2018 to 152 million ‐ a 204% increase1. Without a cure or effective treatment for these diseases, maintaining the quality of life (QoL) of PLWD has been identified as the primary goal of care services. In the current study, we used five rounds of National Health and Aging Trends Study (NHATS) data (Round 5 to Round 9) to evaluate how the care‐recipient relationship type influences changes in QoL of PLWD over time.MethodThis was a secondary analysis of longitudinal data. Older adults were categorized into different groups by the type of relationship: (1) spouse/partner; (2) adult child; (3) informal caregiver other than spouse/partner and adult child, such as child‐in‐law, sibling, friend, etc.; (4) If older adults indicated having multiple caregivers, they were assigned to the group of “multiple caregivers.” QoL was assessed in 4 domains: mental health (assessed by Patient Health Questionnaire for Depression and Anxiety, PHQ‐4), self‐reported physical health, pain (Yes/No) and functional limitations (i.e. number of ADLs assistance). Backward and forward stepwise regressions were used to determine the prediction of older adults’ socio‐demographics (age, sex, race, income, education, marital status, living arrangement) and dementia status (probable dementia, possible dementia, and no dementia) on their QoL over 4 years; the generalized estimating equation (GEE) approach was used to examine the prediction of relationship type on QoL across the 4 years.ResultOlder adults cared for by an adult‐child or multiple caregivers predicted increased risk for functional limitations after adjustment for their socio‐demographic and dementia status. The interaction between the type of relationship and education was significant, indicating that the effect of relationship types on functional limitations is not uniform across education levels.ConclusionThe relationship type between care recipients and caregivers is linked to QoL changes, particularly with functional limitations in PLWD. Socio‐demographics such as education attainment might shape the influence of care‐recipient relationship type on changes in functional limitations over time.

Fairness of Machine Learning Algorithms for Predicting Foregone Preventive Dental Care for Adults

Access to routine dental care prevents advanced dental disease and improves oral and overall health. Identifying individuals at risk of foregoing preventive dental care can direct prevention efforts toward high-risk populations. To predict foregone preventive dental care among adults overall and in sociodemographic subgroups and to assess the algorithmic fairness. This prognostic study was a secondary analyses of longitudinal data from the US Medical Expenditure Panel Survey (MEPS) from 2016 to 2019, each with 2 years of follow-up. Participants included adults aged 18 years and older. Data analysis was performed from December 2022 to June 2023. A total of 50 predictors, including demographic and socioeconomic characteristics, health conditions, behaviors, and health services use, were assessed. The outcome of interest was foregoing preventive dental care, defined as either cleaning, general examination, or an appointment with the dental hygienist, in the past year. Among 32 234 participants, the mean (SD) age was 48.5 (18.2) years and 17 386 participants (53.9%) were female; 1935 participants (6.0%) were Asian, 5138 participants (15.9%) were Black, 7681 participants (23.8%) were Hispanic, 16 503 participants (51.2%) were White, and 977 participants (3.0%) identified as other (eg, American Indian and Alaska Native) or multiple racial or ethnic groups. There were 21 083 (65.4%) individuals who missed preventive dental care in the past year. The algorithms demonstrated high performance, achieving an area under the receiver operating characteristic curve (AUC) of 0.84 (95% CI, 0.84-0.85) in the overall population. While the full sample model performed similarly when applied to White individuals and older adults (AUC, 0.88; 95% CI, 0.87-0.90), there was a loss of performance for other subgroups. Removing the subgroup-sensitive predictors (ie, race and ethnicity, age, and income) did not impact model performance. Models stratified by race and ethnicity performed similarly or worse than the full model for all groups, with the lowest performance for individuals who identified as other or multiple racial groups (AUC, 0.76; 95% CI, 0.70-0.81). Previous pattern of dental visits, health care utilization, dental benefits, and sociodemographic characteristics were the highest contributing predictors to the models' performance. Findings of this prognostic study using cohort data suggest that tree-based ensemble machine learning models could accurately predict adults at risk of foregoing preventive dental care and demonstrated bias against underrepresented sociodemographic groups. These results highlight the importance of evaluating model fairness during development and testing to avoid exacerbating existing biases.

"Doc, I Just Want My Life Back…": Total Knee Arthroplasty and Its Effects on Chronic Bodily Pain: Commentary on an article by Daniel L. Riddle, PhD, PT, FAPTA, and Levent Dumenci, PhD: "A Latent Change Score Approach to Understanding Chronic Bodily Pain Outcomes Following Knee Arthroplasty. A Secondary Analysis of Longitudinal Data".

"Doc, I Just Want My Life Back…": Total Knee Arthroplasty and Its Effects on Chronic Bodily Pain: Commentary on an article by Daniel L. Riddle, PhD, PT, FAPTA, and Levent Dumenci, PhD: "A Latent Change Score Approach to Understanding Chronic Bodily Pain Outcomes Following Knee Arthroplasty. A Secondary Analysis of Longitudinal Data".

Patient-physician agreement on function and pain is associated with long-term outcomes in sarcoma: findings from a longitudinal study.

We aimed to describe the level of agreement between patients and physicians on the ratings of daily functioning and pain in a cohort of sarcoma patients and assess how (dis)agreement and its change over time predicted patient-reported outcomes in survivorship. We performed secondary analysis of longitudinal data from a sarcoma-specialty clinic in Montreal, Canada. Demographics, clinical characteristics and patient-physician agreement were summarized descriptively. Linear mixed models were used to assess the effects of time, baseline agreement, change in agreement over time, interaction of time and change in agreement and 12-month daily functioning, quality of life, and fatigue. Data were available for 806 patients (57.7% male, x̄ = 53.3 years) who completed at least one questionnaire. Patient-physician disagreement was common on the level of function (43.4%) and pain (45.7%). Baseline physician-patient agreement was associated with better 12-month outcomes. Improvement in agreement on function over time was significantly associated with daily functioning (F(2, 212) = 3.18, p = 0.043) and quality of life (F(2, 212) = 3.17, p < 0.044). The pattern was similar though less pronounced for the agreement on pain. Our study offers novel insights into the importance of patient-physician agreement and communication's role in long-term patient-reported outcomes in sarcoma. The results emphasize the importance of mutual understanding of symptoms and patients' needs and suggest that further consultation in cases of discordance of ratings and opinions might be beneficial for optimal survivorship.

A Latent Change Score Approach to Understanding Chronic Bodily Pain Outcomes Following Knee Arthroplasty: A Secondary Analysis of Longitudinal Data.

The extent to which chronic bodily pain changes following total knee arthroplasty (TKA) is unknown. We determined the extent of chronic bodily pain changes at 1 year following TKA. Data from our randomized trial of pain coping skills, which revealed no effect of the studied interventions, were used. The presence and severity of chronic pain in 16 body regions, excluding the surgically treated knee, were determined prior to and 1 year following surgery. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale was used to quantify the extent of surgical knee pain. Latent change score (LCS) models were used to determine the extent to which true chronic bodily pain scores change after TKA. The mean age of the sample of 367 participants was 63.4 ± 8.0 years, and 247 (67%) were female. LCS analyses showed significant 20% to 54% reductions in pain in the surgically treated lower limb (not including the surgically treated knee), pain in the non-surgically treated lower limb, and whole body pain. In bivariate LCS analyses, greater improvement in the WOMAC pain score, indicating surgical benefit of TKA, led to greater improvement in all 4 bodily pain areas beyond the surgically treated knee, even after controlling for the latent change in pain catastrophizing. Clinically important chronic bodily pain reductions occurred following TKA and may be causally linked to the surgical procedure. Reduction in chronic bodily pain in sites other than the surgically treated knee is an additional benefit of TKA. Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.

Are trajectories of depressive symptoms during the first half of drug-sensitive pulmonary tuberculosis treatment associated with loss to follow-up? A secondary analysis of longitudinal data

ObjectiveThe objective of this study was to identify trajectories of depressive symptoms (DSs) during the first half of drug-sensitive pulmonary tuberculosis (PTB) treatment and examine their association with loss to...

Associations of Co-occurring Symptom Trajectories With Sex, Race, Ethnicity, and Health Care Utilization in Children

Co-occurring physical and psychological symptoms during childhood and early adolescence may increase risk of symptom persistence into adulthood. To describe co-occurring pain, psychological, and sleep disturbance symptom (pain-PSS) trajectories in a diverse cohort of children and the association of symptom trajectory with health care utilization. This cohort study was a secondary analysis of longitudinal data from the Adolescent Brain Cognitive Development (ABCD) Study, collected between 2016 and 2022 at 21 research sites across the US. Participants included children with 2 to 4 complete annual symptom assessments. Data were analyzed from November 2022 to March 2023. Four-year symptom trajectories were derived from multivariate latent growth curve analyses. Pain-PSS scores, including depression and anxiety, were measured using subscales from the Child Behavior Checklist and the Sleep Disturbance Scale of Childhood. Nonroutine medical care and mental health care utilization were measured using medical history and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) items. A total of 11 473 children (6018 [52.5%] male; mean [SD] age at baseline, 9.91 [0.63] years) were included in analyses. Four no pain-PSS and 5 pain-PSS trajectories were supported with good or excellent model fit (predicted probabilities, 0.87-0.96). Most children (9327 [81.3%]) had asymptomatic or low, intermittent, or single symptom trajectories. Approximately 1 in 5 children (2146 [18.7%]) had moderate to high co-occurring symptom trajectories that persisted or worsened. Compared with White children, there was a lower relative risk of having moderate to high co-occurring symptom trajectories among Black children (adjusted relative risk ratio [aRRR] range, 0.15-0.38), Hispanic children (aRRR range, 0.58-0.67), and children who identified as another race (including American Indian, Asian, Native Hawaiian, and other Pacific Islader; aRRR range, 0.43-0.59). Less than half of children with moderate to high co-occurring symptom trajectories used nonroutine health care, despite higher utilization compared with asymptomatic children (nonroutine medical care: adjusted odds ratio [aOR], 2.43 [95% CI, 1.97-2.99]; mental health services: aOR, 26.84 [95% CI, 17.89-40.29]). Black children were less likely to report nonroutine medical care (aOR, 0.61 [95% CI, 0.52-0.71]) or mental health care (aOR, 0.68 [95% CI, 0.54-0.87]) than White children, while Hispanic children were less likely to have used mental health care (aOR, 0.59 [95% CI, 0.47-0.73]) than non-Hispanic children. Lower household income was associated with lower odds of nonroutine medical care (aOR, 0.87 [95% CI, 0.77-0.99]) but not mental health care. These findings suggest there is a need for innovative and equitable intervention approaches to decrease the potential for symptom persistence during adolescence.

Racial disparities in opioid prescription and pain management among breast cancer survivors.

We examined whether there are racial disparities in pain management, opioid medicine prescriptions, symptom severity, and quality of life constructs in breast cancer survivors. We conducted a secondary analysis of longitudinal data from the Women's Hormonal Therapy Initiation and Persistence (WHIP) study (n=595), a longitudinal study of hormonal receptor-positive breast cancer survivors. Upon study enrollment, patients completed a survey assessing an array of psychological, behavioral, and treatment outcomes, including adjuvant endocrine therapy (AET)-induced symptoms, and provided a saliva biospecimen. Opioid prescription records were extracted from the health maintenance organizations (HMOs) pharmacy database. The final analytic sample included women with complete HMO pharmacy records for 1 year. There were 251 eligible patients, of which 169 (67.3%) were White. The average age was 61.09 years old (SD=11.07). One hundred seventy-two patients (68.5%) had received at least one opioid medication and 37.1% were prescribed opioids longer than 90 days (n=93). Sixty-four Black patients (78%) had a record of being prescribed with opioids compared to 64% of White patients (n=108, p=0.03). Black patients reported worse vasomotor, neuropsychological, and gastrointestinal symptoms, as well as lower quality of life and greater healthcare discrimination than White patients (p's < 0.05). Black patients were more likely to be prescribed opioids for 90 days or longer compared to White patients, when controlling for age, marital status, income, body mass index (BMI), cancer stage, and chemotherapy status (adjusted Odds Ratio = 2.72, p = 0.014). Findings indicate that there are racial differences in opioid prescriptions supplied for pain management and symptomatic outcomes. Future research is needed to understand the causes of disparities in cancer pain management and symptomatic outcomes.

Perceptions of prognosis and end-of-life care outcomes in patients with advanced lung and gastrointestinal cancer

Background: Many patients with advanced cancer have misperceptions of their prognosis, which may impact end-of-life decision-making. Data regarding associations between prognostic perceptions over time and end-of-life care outcomes are lacking. Aim: To describe patients’ perceptions of their prognosis with advanced cancer and examine associations between these perceptions and end-of-life care outcomes. Design: Secondary analysis of longitudinal data from a randomized controlled trial of a palliative care intervention for patients with newly diagnosed incurable cancer. Setting/Participants: Conducted at an outpatient cancer center in the northeastern United States and patients were within 8 weeks of a diagnosis with incurable lung or non-colorectal gastrointestinal cancer. Results: We enrolled 350 patients in the parent trial, of which 80.5% (281/350) died during the study period. Overall, 59.4% (164/276) of patients reported they were terminally ill, and 66.1% (154/233) reported that their cancer was likely curable at the assessment closest to death. Patient acknowledgment of terminal illness was only associated with lower risk of hospitalizations in the last 30 days of life (OR = 0.52, p = 0.025). Patients who reported their cancer as likely curable were less likely to utilize hospice (OR = 0.25, p = 0.002) or die at home (OR = 0.56, p = 0.043), and they were more likely to be hospitalized in the last 30 days of life (OR = 2.28, p = 0.011). Conclusions: Patients’ perceptions of their prognosis are associated with important end-of-life care outcomes. Interventions are needed to enhance patients’ perceptions of their prognosis and optimize their end-of-life care.

Uncertainty and change in American youth occupational expectations

ABSTRACT Grounded in Social Cognitive Career Theory (SCCT), this study contributes to empirical efforts to understand factors affecting the career-development process of American youth by focusing on change in occupational expectations between age 16 and 26. The study is based on the secondary analysis of longitudinal data from the Education Longitudinal Study of 2002. The main result is that occupational expectations decrease over time, and the change is strongly affected by student educational expectations and actual attainment by age 26. The study findings indicate that higher educational attainment leads to stability in occupational expectations and higher prestige scores of the intended occupations. Females are more likely than males to have higher occupational expectations. Academic self-efficacy and self-regulatory behaviours during secondary education lead to higher occupational expectations, as does an understanding of employment barriers. Non-college-bound youth and postsecondary non-completers experience a higher drop in occupational expectations over time which could reveal unrealistic career plans.

Forced vital capacity trajectories in patients with idiopathic pulmonary fibrosis: a secondary analysis of a multicentre, prospective, observational cohort

Idiopathic pulmonary fibrosis is a progressive fibrotic lung disease with a variable clinical trajectory. Decline in forced vital capacity (FVC) is the main indicator of progression; however, missingness prevents long-term analysis of patterns in lung function. We aimed to identify distinct clusters of lung function trajectory among patients with idiopathic pulmonary fibrosis using machine learning techniques. We did a secondary analysis of longitudinal data on FVC collected from a cohort of patients with idiopathic pulmonary fibrosis from the PROFILE study; a multicentre, prospective, observational cohort study. We evaluated the imputation performance of conventional and machine learning techniques to impute missing data and then analysed the fully imputed dataset by unsupervised clustering using self-organising maps. We compared anthropometric features, genomic associations, serum biomarkers, and clinical outcomes between clusters. We also performed a replication of the analysis on data from a cohort of patients with idiopathic pulmonary fibrosis from an independent dataset, obtained from the Chicago Consortium. 415 (71%) of 581 participants recruited into the PROFILE study were eligible for further analysis. An unsupervised machine learning algorithm had the lowest imputation error among tested methods, and self-organising maps identified four distinct clusters (1-4), which was confirmed by sensitivity analysis. Cluster 1 comprised 140 (34%) participants and was associated with a disease trajectory showing a linear decline in FVC over 3 years. Cluster 2 comprised 100 (24%) participants and was associated with a trajectory showing an initial improvement in FVC before subsequently decreasing. Cluster 3 comprised 113 (27%) participants and was associated with a trajectory showing an initial decline in FVC before subsequent stabilisation. Cluster 4 comprised 62 (15%) participants and was associated with a trajectory showing stable lung function. Median survival was shortest in cluster 1 (2·87 years [IQR 2·29-3·40]) and cluster 3 (2·23 years [1·75-3·84]), followed by cluster 2 (4·74 years [3·96-5·73]), and was longest in cluster 4 (5·56 years [5·18-6·62]). Baseline FEV1 to FVC ratio and concentrations of the biomarker SP-D were significantly higher in clusters 1 and 3. Similar lung function clusters with some shared anthropometric features were identified in the replication cohort. Using a data-driven unsupervised approach, we identified four clusters of lung function trajectory with distinct clinical and biochemical features. Enriching or stratifying longitudinal spirometric data into clusters might optimise evaluation of intervention efficacy during clinical trials and patient management. National Institute for Health and Care Research, Medical Research Council, and GlaxoSmithKline.

Mental Distress and Use of Stimulants: Analysis of a Longitudinal Cohort of Transgender Women.

Purpose: The purpose of our study was to examine the effects of mental distress (depression, anxiety, and post-traumatic stress disorder [PTSD]), incarceration, and hate crime on stimulant use (methamphetamine, crack, and cocaine) among transgender women. Methods: We conducted a secondary analysis of longitudinal data collected from 2016 to 2018 with 429 transgender women in the San Francisco Bay Area. Generalized estimating equation log-binomial regressions were used to calculate relative risks of stimulant use associated with mental distress, incarceration, and hate crime. Results: At baseline, transgender women experienced transphobic hate crime (46.4%), incarceration (53.0%), mental distress (69.2%), and stimulant use (28.4%). Transgender women who used stimulants reported lower education (45.1%, χ2 = 14.3, p = 0.001) and significantly more had been incarcerated (62.3%, χ2 = 5.9, p = 0.015), and reported diagnoses of depression (67.8%, χ2 = 6.1, p = 0.014), anxiety (62.8%, χ2 = 4.3, p = 0.039), and PTSD (43.8%, χ2 = 6.7, p = 0.010). Longitudinal multivariate analysis found that depression (adjusted relative risk [aRR] = 1.46, 95% confidence interval [CI] 1.09-1.95), anxiety (aRR = 1.42, 95% CI = 1.05-1.93), and PTSD (aRR = 1.38, 95% CI = 1.02-1.87) were associated with methamphetamine use but not with crack or cocaine use. Incarceration was associated with methamphetamine use and crack use, whereas experiencing hate crime was associated with crack use. Conclusions: Mental distress, incarceration, and hate crime were key exposures of stimulant use among transgender women. Intervention targets for reducing stimulant use should consider working upstream by addressing underlying stressors impacting mental health for transgender women, including laws to protect transgender women from hate crime and to reduce their disproportionate representation in the criminal justice system.

Relationship Between Longitudinal Coping Strategies and Outcomes in Patients With Acute Myeloid Leukemia.

Patients with acute myeloid leukemia (AML) face an abrupt life-threatening illness and experience immense physical and psychological symptoms. However, no data describe how patients with AML cope longitudinally with their illness or the relationship between longitudinal coping and outcomes. We conducted a secondary analysis of longitudinal data from 160 patients with high-risk AML enrolled in a supportive care intervention trial to describe coping strategies longitudinally across the illness course. We used the Brief COPE questionnaire, the Hospital Anxiety and Depression Scale, the Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian Version, and the Functional Assessment of Cancer Therapy-Leukemia to measure coping strategies, psychological distress, and quality of life (QoL) at baseline and at weeks 2, 4, 12, and 24 after diagnosis. Electronic health records were used to assess healthcare utilization and end-of-life (EoL) outcomes, and multivariate analyses were used to assess the relationship between coping and outcomes. Longitudinal utilization of approach-oriented coping strategies was significantly associated with less distress (anxiety: β, -0.18; P&lt;.001; depression symptoms: β, -0.42; P&lt;.001; PTSD symptoms: β, -0.60; P&lt;.001) and better QoL (β, 2.00; P&lt;.001). Longitudinal utilization of avoidant coping strategies was significantly associated with greater distress (anxiety: β, 0.64; depression symptoms: β, 0.54; PTSD symptoms: β, 2.13; P&lt;.001 for all) and worse QoL (β, -4.27; P&lt;.001). Although the use of approach-oriented and avoidant coping strategies was not significantly associated with hospitalization, chemotherapy administration, or hospice use in the last 30 days of life, approach-oriented coping was associated with lower odds of ICU admissions (odds ratio, 0.92; P=.049). Longitudinal use of approach-oriented coping strategies was associated with less psychological distress, better QoL, and a lower likelihood of ICU admission, suggesting a possible target for supportive oncology interventions. Coping strategies did not impact EoL outcomes, and further research is needed to elucidate which patient factors impact EoL decision-making.

Comparison of Simple-Summated Scoring and Toxicity Index Scoring of Symptom Bother in the NSABP B-30 Clinical Trial

BackgroundLevel of symptom burden for cancer patients can be summarized using simple-summated scoring of multiple patient-reported symptoms. The Toxicity Index (TI) is an alternative that has been used primarily to summarize clinician-reported toxicities.ObjectiveTo compare the TI with simple-summated scoring of 28 patient-reported symptoms.MethodsThis is a secondary analysis of longitudinal data from a clinical trial of women with stage 2 or 3 breast cancer: baseline (n = 2156) and 6 months later (n = 1764). Study participants completed the 28-item Breast Cancer Prevention Trial symptom checklist assessing level of symptom bother in the past 7 days and four criterion items assessing general health and overall quality of life.ResultsAssociations of simple-summated scoring of the 28 cancer-related symptoms with the general health and overall quality of life items tended to be larger than correlations of the TI summary scoring of the symptoms. For example, the Spearman correlation of change in quality of life was − 0.38 with change in the simple-summated score and − 0.23 with change in the TI.ConclusionThe findings suggest that simple-summated scoring and differential weighting of the level of symptom bother yield similar results.Implications for PracticeClinicians can use simple-summated scoring rather than more complicated scoring algorithms to obtain an indication of overall level of symptom burden among cancer patients.

Latent change modeling of Latino parent–child conflict and pathways to mental health

AbstractObjectiveThis secondary analysis of longitudinal data on Latino immigrant parents applied latent change modeling to investigate the association between within‐family change in parent–child conflict and within‐individual change in parent's psychological distress, and how within‐individual change in parenting stress mediates that association over time.BackgroundImmigrant parents face additional challenges when parenting their children. There is limited research regarding how parent–child conflict may influence parenting stress and parents' overall well‐being, in particular in Latino immigrant families.MethodSecondary analysis was conducted on data from a sample of 344 Latino immigrant parents who participated in a community‐based parenting skills invention. In the original intervention study, they were assigned randomly to intervention or waitlist control groups and assessed at three points: baseline, 4 months (post‐intervention), and a follow‐up 10 months after the baseline assessment.ResultsAcross 4 months, change in parent–child conflict was significantly associated with changes in parenting stress and psychological distress, whereas across 10 months, change in parent–child conflict was only associated with change in psychological distress. The indirect effects through parenting stress were non‐significant. However, participating in the intervention had a protective indirect effect by reducing parenting stress across 4 months and reducing psychological distress across 10 months via change in parent–child conflict.ConclusionChanges in parent–child relations were related to changes in parents' individual well‐being, with those associations varying across different time periods.