| 1. |
- Sysoev, Oleg, 1981-, et al.
(författare)
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PSICA : Decision trees for probabilistic subgroup identification with categorical treatments
- 2019
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Ingår i: Statistics in Medicine. - : Wiley. - 0277-6715 .- 1097-0258. ; 38:22, s. 4436-4452
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Tidskriftsartikel (refereegranskat)abstract
- Personalized medicine aims at identifying best treatments for a patient with given characteristics. It has been shown in the literature that these methods can lead to great improvements in medicine compared to traditional methods prescribing the same treatment to all patients. Subgroup identification is a branch of personalized medicine, which aims at finding subgroups of the patients with similar characteristics for which some of the investigated treatments have a better effect than the other treatments. A number of approaches based on decision trees have been proposed to identify such subgroups, but most of them focus on two-arm trials (control/treatment) while a few methods consider quantitative treatments (defined by the dose). However, no subgroup identification method exists that can predict the best treatments in a scenario with a categorical set of treatments. We propose a novel method for subgroup identification in categorical treatment scenarios. This method outputs a decision tree showing the probabilities of a given treatment being the best for a given group of patients as well as labels showing the possible best treatments. The method is implemented in an R package psica available on CRAN. In addition to a simulation study, we present an analysis of a community-based nutrition intervention trial that justifies the validity of our method.
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| 2. |
- Johansson, Emily White, 1976-, et al.
(författare)
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Diagnostic Testing of Pediatric Fevers: Meta-Analysis of 13 National Surveys Assessing Influences of Malaria Endemicity and Source of Care on Test Uptake for Febrile Children under Five Years
- 2014
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 9:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: In 2010, the World Health Organization revised guidelines to recommend diagnosis of all suspected malaria cases prior to treatment. There has been no systematic assessment of malaria test uptake for pediatric fevers at the population level as countries start implementing guidelines. We examined test use for pediatric fevers in relation to malaria endemicity and treatment-seeking behavior in multiple sub-Saharan African countries in initial years of implementation. Methods and Findings: We compiled data from national population-based surveys reporting fever prevalence, care-seeking and diagnostic use for children under five years in 13 sub-Saharan African countries in 2009-2011/12 (n = 105,791). Mixed-effects logistic regression models quantified the influence of source of care and malaria endemicity on test use after adjusting for socioeconomic covariates. Results were stratified by malaria endemicity categories: low (PfPR(2-10)<5%), moderate (PfPR(2-10) 5-40%), high (PfPR(2-10)>40%). Among febrile under-fives surveyed, 16.9% (95% CI: 11.8%-21.9%) were tested. Compared to hospitals, febrile children attending non-hospital sources (OR: 0.62, 95% CI: 0.56-0.69) and community health workers (OR: 0.31, 95% CI: 0.23-0.43) were less often tested. Febrile children in high-risk areas had reduced odds of testing compared to low-risk settings (OR: 0.51, 95% CI: 0.42-0.62). Febrile children in least poor households were more often tested than in poorest (OR: 1.63, 95% CI: 1.39-1.91), as were children with better-educated mothers compared to least educated (OR: 1.33, 95% CI: 1.16-1.54). Conclusions: Diagnostic testing of pediatric fevers was low and inequitable at the outset of new guidelines. Greater testing is needed at lower or less formal sources where pediatric fevers are commonly managed, particularly to reach the poorest. Lower test uptake in high-risk settings merits further investigation given potential implications for diagnostic scale-up in these areas. Findings could inform continued implementation of new guidelines to improve access to and equity in point-of-care diagnostics use for pediatric fevers.
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| 3. |
- Johansson, Emily White, 1976-, et al.
(författare)
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Effect of diagnostic testing on medicines used by febrile children less than five years in 12 malaria-endemic African countries: a mixed-methods study.
- 2015
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Ingår i: Malaria journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- In 2010, WHO revised guidelines to recommend testing all suspected malaria cases prior to treatment. Yet, evidence to assess programmes is largely derived from limited facility settings in a limited number of countries. National surveys from 12 sub-Saharan African countries were used to examine the effect of diagnostic testing on medicines used by febrile children under five years at the population level, including stratification by malaria risk, transmission season, source of care, symptoms, and age.
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| 4. |
- White Johansson, Emily, 1976-, et al.
(författare)
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Accessibility of basic paediatric emergency care in Malawi : analysis of a national facility census
- 2020
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundEmergency care is among the weakest parts of health systems in low-income countries with both quality and accessibility constraints. Previous studies estimated accessibility to surgical or emergency care based on population travel times to nearest hospital with no assessment of hospital readiness to provide such care. We analysed a Malawi national facility census with comprehensive inventory audits and geocoded facility locations to identify hospitals equipped to provide basic paediatric emergency care with estimated travel times to these hospitals from non-equipped facilities and in relation to Malawi's population distribution.MethodsWe analysed a Malawi national facility census in 2013-2014 to identify hospitals equipped to manage critically ill children according to an extended version of WHO Emergency Triage, Assessment and Treatment (ETAT) guidelines. These guidelines include 25 components including staff, transport, equipment, diagnostics, medications, fluids, feeds and consumables that defined an emergency-equipped hospital in our study. We estimated travel times to emergency-equipped hospitals from non-equipped facilities and relative to population distributions using geocoded facility locations and an established accessibility mapping approach using global road network datasets from OpenStreetMap and Google.ResultsFour (3.5, 95% CI: 1.3-8.9) of 116 Malawi hospitals were emergency-equipped. Least available items were nasogastric tubes in 34.5% of hospitals (95% CI: 26.4-43.6), blood typing services (40.4, 95% CI: 31.9-49.6), micro nebulizers (50.9, 95% CI: 41.9-60.0), and radiology (54.2, 95% CI: 45.1-63.0). Nationally, the median travel time from non-equipped facilities to the nearest emergency-equipped hospital was 73 min (95% CI: 67-77) ranging 1-507 min. Approximately one-quarter (27%) of Malawians lived over 120 min from an emergency-equipped hospital with significantly better accessibility in Central than North and South regions (16% vs. 38 and 35%,p < 0.001).ConclusionsThere are unacceptable deficiencies in accessibility of basic paediatric emergency care in Malawi. Reliable supply chains for essential drugs and commodities are needed, particularly nasogastric tubes, asthma drugs and blood, along with improved capacity for time-sensitive referral. Further child mortality reductions will require substantial investments to expand basic paediatric emergency care into all Malawi hospitals for better managing critically ill children at highest mortality risk.
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| 6. |
- Abdelmenan, Semira, et al.
(författare)
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Perception of affordable diet is associated with pre-school children's diet diversity in Addis Ababa, Ethiopia : the EAT Addis survey
- 2024
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Ingår i: BMC Nutrition. - : BioMed Central (BMC). - 2055-0928. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite improvements in food access and nutrition security over the last few decades, malnutrition remains a major public health problem. One of the significant contributors to these problems is affordability of nutritious food. This study aimed to examine the association between perceived food affordability and pre-school children's diet diversity in Addis Ababa, Ethiopia.Methods: Cross-sectional data from 2017 to 18 were used for the analysis. A 24-hour dietary recall assessment was done to assess children's dietary diversity (DD). We used a modified operational definition of affordability indicator called perceived affordability of dietary diversity (afford-DD) to evaluate the impact of the food environment in terms of affordability at the household level. A sample (n 4,898) of children aged 6-59 months representative of households in Addis Ababa was randomly selected using a multistage sampling procedure including all districts in the city. Mixed-effects linear regression models were used to assess the association between children's DD and afford-DD.Results: The survey revealed that the mean (standard deviation [SD]) of children's DD was 3.9 [±1.4] while the mean [SD] of afford-DD was 4.6 [±2.1]. Overall, 59.8% of children met the minimum dietary diversity (≥ 4 food groups). White roots and tubers were the most commonly consumed food groups regardless of their affordability. Considerable variations were observed between households that reported the food item affordable and not affordable in consumption of Vitamin A rich vegetables and fruits, meat and fish, egg, and dairy. The children's DD was positively associated with afford-DD after adjusting for maternal education, household wealth status and other relevant confounding. Higher maternal education modified the association between affordability and children's diet diversity.Conclusions: This study suggests higher perceived food affordability was associated with better diet diversity in children. A higher level of maternal education had the potential to mitigate affordability challenges in meeting the children's dietary diversity needs. Our study emphasizes the need for inclusive food programs and nutrition interventions addressing social differences, intensifying efforts to make nutrient-rich diets affordable for the less privileged, and highlights the potential benefits of targeting maternal education in addressing child dietary diversity.
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| 7. |
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| 8. |
- Duc, Duong M., 1984-, et al.
(författare)
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Measuring local healthcare context for knowledge translation in primary and secondary levels of care in northern Vietnam: A cross-sectional study
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundThe influence of context in shaping the effectiveness of knowledge translation (KT) is widely recognized. The Context Assessment for Community Health (COACH) tool aims to assess contextual aspects that are of importance for KT in healthcare in low- and middle-income settings. This study used the COACH tool to describe healthcare context as perceived by health workers in primary and secondary levels of care in a northern province in Vietnam and to further evaluate the internal structure of the COACH tool.MethodsThis cross-sectional study administered the COACH tool to 677 eligible health workers in primary and secondary levels of care. The relationships between individual background variables and COACH dimensions were analysed using binary logistic regression. Further, internal construct validity was calculated by a first-order independent cluster model confirmatory factor analysis (CFA).ResultsOverall, the healthcare context was perceived as supportive for KT. Gender, age, and geographic location showed significant relationships to one of the COACH dimensions. Male health workers rated their Commitment to work as lower than female health workers (OR=0.39, 95% CI: 0.20–0.78). There were, however, only minor differences in scores for the dimensions of context, at each health facility as well as between health facilities. The CFA asserted an acceptable internal structure of the COACH tool.ConclusionsThe survey enhanced the understanding of how aspects of the healthcare context for KT are perceived by health workers at primary and secondary levels of care in a province in Vietnam. There was an overall positive perception of the work context with only minor variability, reflecting a ‘receptive to change’ context for KT. This should, however, be interpreted with caution due to the risk of social desirability response bias. The findings on the acceptable internal structure of the COACH tool supports its further use as a valid instrument.
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| 9. |
- Ekholm Selling, Katarina, 1976-
(författare)
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Birth-characteristics, hospitalisations, and childbearing : Epidemiological studies based on Swedish register data
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the past decades there has been an improvement in the medical treatment of children born preterm or with reduced foetal growth. This has resulted in a much higher survival rate of these children, but also in a higher number of surviving children with chronic conditions. These changes have, in turn, increased interest in investigating the connection between birth-characteristics and outcomes in later life. The overall aim of the present thesis was to study the relations between birth-characteristics, subsequent hospitalisations, and childbearing by means of data available in Swedish population-based registries.The study population in this thesis consisted of women (and men in Paper III) born in 1973-75 according to the Medical Birth Register and the Total Population Register. Information available in other registries, such as the Hospital Discharge Register, was obtained by individual record linkage.In Paper I, 148,281 women, alive and living in Sweden at 13 years of age, were included. Of the women, 4.1% were born preterm and 5.4% were born small for gestational age, and approximately 30% of all women had given birth between 13 and 27 years of age. We found that reduced foetal growth and possibly preterm birth were related to the likelihood of giving birth during the study period. The intergenerational effects of preterm birth and reduced foetal growth were investigated in Paper II and the study population consisted of 38,720 mother-offspring pairs. An intergenerational effect of reduced foetal growth was found, and reduced foetal growth in the mother also increased the risk for preterm birth in the child.Paper III was concerned with 304,275 men and women living in Sweden at 13 years of age. Of these men and women, 30% were hospitalised during adolescence and early adulthood (i.e. between 12 and 23 years of age). We found that men and women born small for gestational age or preterm were more likely to be hospitalised, and that those born small for gestational age seemed to be more at risk compared to those born preterm. Finally, in Paper IV, the relation between hospitalisations during adolescence and the likelihood of giving birth was studied in 142,998 women living in Sweden at 20 years of age. We found that a majority of the causes of hospitalisation during adolescence were positively connected to the likelihood of giving birth between 20 and 27 years of age. The relations presented in Papers I-IV were evident although socio-economic characteristics were adjusted for.
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| 10. |
- Eriksson, Leif, 1971-, et al.
(författare)
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Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to impove neonatal survival in Quang Ninh province, Vietnam
- 2016
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAnnually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health – Knowledge Into Practice trial evaluated facilitation of community groups (2008–2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30–0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention.MethodsProcess data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models.ResultsTo ensure eight active facilitators over 3 years, 11 Women’s Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19–0.73) than control communes (n = 46).ConclusionsThis evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups’ work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.
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