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Changes in overactive bladder medication following bariatric surgery: segmented regression analysis

WORLD JOURNAL OF UROLOGY 2022年第7期40卷 1777-1783页

作者： Al-Bahou, Julie Bhagwandass, Hemita Valdes, Ivelisse L. Friedman, Jeffrey Vouri, Scott Martin Univ Florida Coll Pharm Dept Pharmaceut Outcomes & Policy POB 100496 Gainesville FL 32610 USA Univ Florida Coll Med Dept Surg Gainesville FL 32610 USA Univ Florida Ctr Drug Evaluat & Safety Gainesville FL 32610 USA

Purpose Bariatric surgery has shown reductions in overactive bladder (OAB) symptoms;however, the impacts on OAB treatment is unknown. The goal of our study is to evaluate the impact of bariatric surgery on OAB medication utilization. Methods We used IBM(R) MarketScan(R) commercial databases from 2005 to 2018. We included patients aged >= 18 years with 360 days of continuous enrollment before and after bariatric surgery (Roux-en-Y Gastric Bypass and Sleeve Gastrectomy) with at least one fill of an OAB medication in the 360 days prior to bariatric surgery. We evaluated all included patients and stratified by surgery type and patient sex. segmented regression analyses were used to assess the proportion of patients on OAB medications before and after bariatric surgery. We replicated our findings using hip or knee replacement surgery as a negative control. Results Among the included patients (n = 3069), 92.2% were females, 58.6% underwent Roux-en-Y Gastric Bypass. Immediately following bariatric surgery, the proportion of patients treated with an OAB medication reduced from 34.8 to 14.1% (p < 0.001) resulting in a 59.5% relative reduction. Patients who underwent Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy (63.8% vs. 55.1%) relative reduction (p = 0.009)) and females versus males [62.3% vs. 52.9% relative reduction (p < 0.001)] had a more pronounced reduction in OAB medication use. There was slight decrease in OAB medication use in the negative control analysis. Conclusions A reduction in OAB medication use following bariatric surgery may be associated with a reduction in OAB symptoms suggesting an additional benefit of bariatric surgery.

关键词： Bariatric surgery Overactive bladder Antimuscarinics Mirabegron segmented regression analysis

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segmented regression analysis of emergency departments patient visits from Septicemia in Taiwan

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HEALTH POLICY AND TECHNOLOGY 2018年第2期7卷 149-155页

作者： Tzeng, I-Shiang Chien, Kuo-Liong Tu, Yu-Kang Chen, Jau-Yuan Ng, Chau Yee Chien, Cheng-Yu Chen, Jih-Chang Chaou, Chung-Hsien Yiang, Giou-Teng Buddhist Tzu Chi Med Fdn Taipei Tzu Chi Hosp Dept Res 289 Jianguo Rd New Taipei Taiwan Natl Taipei Univ Dept Stat Taipei Taiwan Feng Chia Univ Taichung Dept Risk Management & Insurance Taichung Taiwan Natl Taiwan Univ Coll Publ Hlth Inst Epidemiol & Prevent Med Taipei Taiwan Natl Taiwan Univ Hosp Dept Med Res Taipei Taiwan Chang Gung Mem Hosp Dept Family Med Taoyuan Taiwan Chang Gung Mem Hosp Dept Dermatol Drug Hypersensit Clin & Res Ctr Taipei Taiwan Chang Gung Mem Hosp Dept Dermatol Drug Hypersensit Clin & Res Ctr Linkou Taiwan Chang Gung Mem Hosp Dept Dermatol Drug Hypersensit Clin & Res Ctr Keelung Taiwan Ton Yen Gen Hosp Dept Emergency Med Hsinchu Hsinchu County Taiwan Taoyuan Gen Hosp Minist Hlth & Welf Taoyuan Taiwan Chang Gung Mem Hosp Linkou Branch Dept Emergency Med Taoyuan Taiwan Buddhist Tzu Chi Med Fdn Dept Emergency Med Taipei Tzu Chi Hosp New Taipei Taiwan

Background: The protocol for early goal-directed therapy (EGDT) is effective for improving both the costs and outcomes of septicemia treatment, including a significant reduction in case fatality. However, this complicated protocol may have a downside. Furthermore, the Joint Taiwan Critical Care Medicine Committee has launched a nationwide educational program after the publication of the Surviving Sepsis Campaign (SSC) to improve the overall survival rate from septicemia in the emergency care system of Taiwan. Objectives: To assess the impact of the EGDT protocol and SSC education programs on island-wide septicemia-related emergency department (ED) visits. Methods: segmented regression techniques were utilized to assess the differences in annual rates and changes in septicemia-related ED visits between 1998 and 2012. We considered annual incidence of two medical comorbidities as potential confounders: metastatic malignant neoplasms and malignant neoplasms of the lymphatic and hematopoietic tissues. Results: The EGDT protocol was associated with decreased septicemia-related ED visits in 2002 (level change;p < 0.001), while the SSC education program led to a slight increase in septicemia-related ED visits in 2007 (slope change;p < 0.001). For the EGDT protocol, the number of patient visits decreased by 32.9% after the protocol was implemented in 2002 compared with the expected number without the intervention. For the SSC education program, the number of patient visits increased by 20.2% (compared with the predicted number) in 2007 after the education program was implemented. Conclusions: The EGDT protocol and SSC education program were associated with significant immediate changes and lagged intervention effects on island-wide septicemia-related ED visits. (C) 2018 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.

关键词： Septicemia segmented regression analysis Program evaluation Policy intervention Emergency care

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The impact of prescriptions audit and feedback for antibiotic use in rural clinics: interrupted time series with segmented regression analysis

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BMC HEALTH SERVICES RESEARCH 2018年第1期18卷 1-7页

作者： Zhen, Li Jin, Chenggang Xu, Hao-nan Xiamen Univ Sch Publ Affairs Room 308 Chengzhi Bldg422 Siming South Rd Xiamen 361005 Fujian Peoples R China Beijing Normal Univ Sch Social Dev & Publ Policy 2008 North Main Bldg19 Xinjiekouwai St Beijing 100875 Peoples R China

BackgroundProblems of irrational antibiotic use by prescribers are ongoing and have escalated following reductions in the cost of essential drugs policy. In an attempt to improve prescribing practices for village doctors and rational use of essential drugs, a program designed to audit and monitor drug use was established. However, the effects of the program to control antibiotic resistance and changing the village doctors' prescribing behaviors remain largely unknown. This study measured the effect of the program on levels of antibiotic *** was collected covering a 22-month period, before, during and after the program was implemented in rural clinics. segmented regression analysis with interrupted time series (ITS) data was used to examine whether there had been a significant interaction with the onset of the program in September 2011 and levels of antibiotic use from November 2010 to August 2012. Both serial and 12-month lag autocorrelations were controlled *** noticeable drop about 6.15% per month (95% CI: -13.36%;1.06%, P=0.089) for the antibiotic use in outpatients, which is lower of effect size assuming that the program has the immediate impact of the program were captured for the immediate effect of the program. Meanwhile, levels of antibiotic use would have continued to decrease by 1.12% per month (P=0.034) as they did in the absence of the *** central finding was that the prescription audit and feedback program was associated with significant decreases (P=0.034) in antibiotic use after its implementation.

关键词： segmented regression analysis Interrupted time series Antibiotic use Prescription audit and feedback

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segmented regression analysis of interrupted time series data to assess outcomes of a South American road traffic alcohol policy change

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PUBLIC HEALTH 2017年 150卷 51-59页

作者： Nistal-Nuno, Beatriz Stanford Univ Med Ctr Dept Emergency Med Palo Alto CA 94304 USA

Background: In Chile, a new law introduced in March 2012 decreased the legal blood alcohol concentration (BAC) limit for driving while impaired from 1 to 0.8 g/1 and the legal BAC limit for driving under the influence of alcohol from 0.5 to 0.3 g/l. The goal is to assess the impact of this new law on mortality and morbidity outcomes in Chile. Methods: A review of national databases in Chile was conducted from January 2003 to December 2014. segmented regression analysis of interrupted time series was used for analyzing the data. In a series of multivariable linear regression models, the change in intercept and slope in the monthly incidence rate of traffic deaths and injuries and association with alcohol per 100,000 inhabitants was estimated from pre-intervention to postintervention, while controlling for secular changes. In nested regression models, potential confounding seasonal effects were accounted for. All analyses were performed at a two-sided significance level of 0.05. Results: Immediate level drops in all the monthly rates were observed after the law from the end of the prelaw period in the majority of models and in all the de-seasonalized models, although statistical significance was reached only in the model for injures related to alcohol. After the law, the estimated monthly rate dropped abruptly by -0.869 for injuries related to alcohol and by -0.859 adjusting for seasonality (P < 0.001). Regarding the postlaw long-term trends, it was evidenced a steeper decreasing trend after the law in the models for deaths related to alcohol, although these differences were not statistically significant. Conclusions: A strong evidence of a reduction in traffic injuries related to alcohol was found following the law in Chile. Although insufficient evidence was found of a statistically significant effect for the beneficial effects seen on deaths and overall injuries, potential clinically important effects cannot be ruled out. (C) 2017 The Royal Society for Public Healt

关键词： Interrupted time series segmented regression analysis Public health Blood alcohol concentration Drunk driving

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Public reporting influences antibiotic and injection prescription in primary care: a segmented regression analysis

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JOURNAL OF EVALUATION IN CLINICAL PRACTICE 2015年第4期21卷 597-603页

作者： Liu, Chenxi Zhang, Xinping Wan, Jie Huazhong Univ Sci & Technol Sch Med & Hlth Management Tongji Med Coll Wuhan 430000 Hubei Province Peoples R China

Rationale, aims and objectivesInappropriate use and overuse of antibiotics and injections are serious threats to the global population, particularly in developing countries. In recent decades, public reporting of health care performance (PRHCP) has been an instrument to improve the quality of care. However, existing evidence shows a mixed effect of PRHCP. This study evaluated the effect of PRHCP on physicians' prescribing practices in a sample of primary care institutions in China. segmented regression analysis was used to produce convincing evidence for health policy and reform. MethodsThe PRHCP intervention was implemented in Qian City that started on 1 October 2013. Performance data on prescription statistics were disclosed to patients and health workers monthly in 10 primary care institutions. A total of 326655 valid outpatient prescriptions were collected. Monthly effective prescriptions were calculated as analytical units in the research (1st to 31st every month). This study involved multiple assessments of outcomes 13 months before and 11 months after PRHCP intervention (a total of 24 data points). Resultssegmented regression models showed downward trends from baseline on antibiotics (coefficient = -0.64, P = 0.004), combined use of antibiotics (coefficient=-0.41, P<0.001) and injections (coefficient=-0.5957, P=0.001) after PRHCP intervention. The average expenditure of patients slightly increased monthly before the intervention (coefficient=0.8643, P<0.001);PRHCP intervention also led to a temporary increase in average expenditure of patients (coefficient=2.20, P=0.307) but slowed down the ascending trend (coefficient=-0.45, P=0.033). The prescription rate of antibiotics and injections after intervention (about 50%) remained high. ConclusionsPRHCP showed positive effects on physicians' prescribing behaviour, considering the downward trends on the use of antibiotics and injections and average expenditure through the intervention. However, the effect was not i

关键词： antibiotics injections interrupted time series analysis public reporting rational use of medicine segmented regression analysis

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Refractive tolerance in the use of monofocal intraocular lenses enhanced with new aspheric design

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GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY 2025年 1-7页

作者： Toyama, Naoki Kuwabara, Naoto Ogata, Miyuki Mori, Yosai Minami, Keiichiro Miyata, Kazunori Miyata Eye Hosp 6-3 Kurahara Cho Miyakonojo 8850051 Japan

Purpose To evaluate the refractive tolerance in eyes with enhanced monocular intraocular lens (IOL) with a new aspheric design. Methods This study included two assessments. Clinical records of consecutive eyes with conventional monofocal IOL (SY60WF, Alcon) were retrospectively reviewed, and changes in uncorrected distance visual acuity (UDVA) with myopic and hyperopic refractive errors were evaluated using segmented regression analysis. Next, in 39 eyes of 39 cataract patients who received an enhanced monofocal IOL (NSP-3, Nidek), UDVA, refractive error, and photopic and mesopic contrast sensitivities were examined at one-three months postoperatively. Changes in the UDVA with refractive error were evaluated in the same manner. With resultant segmented regression lines, ranges of UDVA of 0.20 logMAR or better were obtained as refractive tolerances. Results The clinical records of 717 eyes of 551 patients with SY60WF were analyzed. segmented regression analysis revealed a breakpoint in emmetropia and UDVA degradation myopically and hyperopically. The refractive tolerance was 2.03 D, while it was 0.73 D on the myopic side. In the prospective study, there was a breakpoint at -1.088 D, where there was a relatively flat slope between the breakpoint and emmetropia, then UDVA steeply degraded. Refractive tolerance on the myopic side was 1.12 D. There was no significant degradation in the photopic/mesopic contrast sensitivity. Conclusion Enhanced monofocal IOLs provided wider myopic refractive tolerance, in which UDVA of 0.2 logMAR or better would be anticipated between emmetropia and myopic error of -1.12 D.

关键词： Enhanced monofocal intraocular lens Refractive tolerance segmented regression analysis Modulation transfer function (MFT): through focus

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Use of Interrupted Time Series analysis in Understanding the Course of the Congenital Syphilis Epidemic in Brazil

LANCET REGIONAL HEALTH-AMERICAS

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LANCET REGIONAL HEALTH-AMERICAS 2022年 7卷 100163-100163页

作者： Pinto, Rafael Valentim, Ricardo da Silva, Lyrene Fernandes de Souza, Gustavo Fontoura de Moura Santos Lima, Thaisa Gois Farias Pereira de Oliveira, Carlos Alberto dos Santos, Marquiony Marques Miranda, Angelica Espinosa Cunha-Oliveira, Aliete Kumar, Vivekanandan Atun, Rifat Univ Fed Rio Grande do Norte Natal RN Brazil Lab Technol Innovat Hlth LAIS Natal RN Brazil Fed Inst Rio Grande do Norte Natal RN Brazil Minist Hlth Brasilia DF Brazil Univ Estado Rio De Janeiro Rio De Janeiro RJ Brazil Univ Fed Espirito Santo Vitoria ES Brazil Hlth Sci Res Unit Nursing UICISA E Coimbra Portugal Nursing Sch Coimbra ESEnfC Coimbra Portugal Univ Coimbra Ctr Interdisciplinary Studies 20th Century CEIS20 Coimbra Portugal Athabasca Univ Athabasca AB Canada Harvard Univ Harvard Sch Publ Hlth Boston MA 02115 USA

Background To fight against the rising incidence of syphilis, the Brazilian Ministry of Health (MoH) launched the "Syphilis No!" Project (SNP), with specific resources funded by a parliamentary amendment. Then, in 2018, a national rapid response started to be implemented on the Brazilian Unified Health System (SUS, Sistema Unico de Saude) in two strategic lines (1) to reinforce SUS's universal actions and (2) to implement specific ones to 100 municipalities chosen by the MoH as priorities for syphilis congenital response. In 2015, such localities represented 6895% of congenital syphilis cases in Brazil. In this context, SNP has implemented actions to strengthen epidemiological surveillance of acquired syphilis and congenital syphilis by instituting an integrated and collaborative response through health services networks and reinforcing interstate relations. Methods A quasi-experimental study using time series analysis was conducted to assess immediate impacts and changes to the trend in national congenital syphilis before and after the project, from September 2016 to December 2019. Data were assessed considering rates of congenital syphilis per 1,000 live births in all priority municipalities (n=100) covered by the project and in non-priority municipalities (n=5,470) from all five macro-regions of Brazil. Findings Priority municipalities showed a greater reduction (change in trend) in comparison to non-priority. The linear regression model revealed trend changes after the intervention, with both groups of municipalities showing a drop in the average monthly number of cases per 1,000 live births, with a reduction of -0.21 (CI 95% -0.33 to -0.09;p=0.0011) in priority municipalities and of -0.10 (CI 95% -0.19 to -0.02;p=0.0216) in non-priority municipalities. Interpretation The study using ITS provides important evidence on the direction, timing, and magnitude of the effects of interventions introduced as part of the SNP on congenital syphilis in Brazil. Our results s

关键词： public health policy interrupted time series segmented regression analysis notifiable disease syphilis

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Reflection on modern methods: a common error in the segmented regression parameterization of interrupted time-series analyses

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INTERNATIONAL JOURNAL OF EPIDEMIOLOGY 2021年第3期50卷 1011-1015页

作者： Xiao, Hong Augusto, Orvalho Wagenaar, Bradley H. Univ Washington Dept Global Hlth 1959 NE Pacific St Seattle WA 98195 USA Zhejiang Univ Sch Publ Hlth Hangzhou Zhejiang Peoples R China Univ Eduardo Mondlane Maputo Mozambique Univ Washington Dept Epidemiol Seattle WA 98195 USA

Interrupted time-series (ITS) designs are a robust and increasingly popular non-randomized study design for strong causal inference in the evaluation of public health interventions. One of the most common techniques for model parameterization in the analysis of ITS designs is segmented regression, which uses a series of indicators and linear terms to represent the level and trend of the time-series before and after an intervention. In this article, we highlight an important error often presented in tutorials and published peer-reviewed papers using segmented regression parameterization for the analyses of ITS designs. We show that researchers cannot simply use the product between their calendar time variable and the indicator variable indicating pre- versus post-intervention time periods to represent the post-intervention linear segment. If researchers use this often-presented parameterization, they will get an erroneous result for the level change in their time-series. We show that researchers must take care to use the product between their intervention variable and the time elapsed since the start of the intervention, rather than the time since the beginning of their study. Thus, the second linear segment of the time-series indexing the post-intervention level and trend should be zero before intervention implementation and begin by counting from zero, rather than counting from the time elapsed since the beginning of the study. We hope that this article can clarify segmented regression parameterization for the analysis of ITS designs and help researchers avoid confusing and erroneous results in the level changes of their time-series.

关键词： Interrupted time-series analysis segmented regression analysis quasi-experimental design and analysis

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Headwind or tailwind? The evolution of bike-sharing and ride-hailing demand during the COVID-19 pandemic

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JOURNAL OF TRANSPORT GEOGRAPHY 2024年 118卷

作者： Chang, Annie Y. J. Wang, Xudong Sharafi, Mojdeh Miranda-Moreno, Luis Sun, Lijun McGill Univ Dept Civil Engn Montreal PQ H3A 0C3 Canada

The COVID-19 pandemic has significantly reshaped travel patterns globally, prompting shifts in mobility preferences and behaviors. After controling for temporal trends and weather, this paper investigates the impacts of the pandemic on station-based bike-sharing and ride-hailing services in New York City (NYC), spanning the periods before, during, and after the pandemic. Specifically, we examine how these transportation modes evolved across various land-use types and pandemic periods. To achieve this, we employ a spatial clustering method to group NYC traffic zones into distinct functional areas, i.e., Mixed Area, Commercial Area, Residential Area, and Educational Area, based on land use characteristics. Subsequently, we develop two time series models based on the seasonal autoregressive integrated moving average with exogenous variables (SARIMAX) model to analyze the impact of the pandemic on trip demand across different spatial areas and years. Our modeling analysis enables us to precisely quantify the average effects of pandemic phases on daily trip ridership, while also assessing shifts in daily trip demand trends across each COVID phase, accounting for variables such as land use and weather. Our findings uncover strikingly different recovery trajectories for bike-sharing and ride-hailing services. Bike-sharing rapidly rebounded, surpassing pre-pandemic trip levels by the end of the reopening phase. In contrast, ride-hailing has not yet fully recovered and continues to lag behind its pre-pandemic levels. Moreover, we observe disparities in cycling recovery across various land-use types, with Mixed and Residential Areas exhibiting faster recovery compared to Commercial and Educational zones. The varying recovery patterns can be attributed to evolving traveler sentiments and preferences, shifts in trip needs and purposes, and the implementation of local policies aimed at fostering sustainable transportation options.

关键词： COVID-19 Bike-sharing service Ride-hailing service segmented regression analysis SARIMAX

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Looking at the bigger picture: effect of performance-based contracting of district health services on equity of access to maternal health services in Zambia

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HEALTH POLICY AND PLANNING 2020年第1期35卷 36-46页

作者： Chansa, Collins Mukanu, Mulenga Mary Chama-Chiliba, Chitalu Miriam Kamanga, Mpuma Chikwenya, Nicholas Bellows, Ben Kuunibe, Naasegnibe Heidelberg Univ Heidelberg Inst Global Hlth Neuenheimer Feld 130-3 D-69120 Heidelberg Germany Amer Inst Res Dept Int Res & Dev 2nd FloorElunda 2Rhodes Pk Lusaka Zambia Univ Zambia Inst Econ & Social Res Plot 2631 ChudleighPOB 30900 Lusaka Zambia Minist Hlth Dept Policy & Planning Ndeke HouseHaile Selassie AvePOB 30205 Lusaka Zambia Minist Transport & Commun Dept Transport Fairley RdPOB 50065 Lusaka Zambia Populat Council 4301 Connecticut AveSuite 280 Washington DC 20008 USA Univ Dev Studies Dept Econ & Entrepreneurship Dev Wa Campus Wa Upper West Regi Ghana

Zambia has been using output-based approaches for over two decades to finance whole or part of the public health system. Between 1996 and 2006, performance-based contracting (PBC) was implemented countrywide with the Central Board of Health (CBoH) as the provider of health services. This study reviews the association between PBC and equity of access to maternal health services in Zambia between 1996 and 2006. A comprehensive document review was undertaken to evaluate the implementation process, followed by a trend analysis of health expenditure at district level, and a segmented regression analysis of data on antenatal care (ANC) and deliveries at health facilities that was obtained from five demographic and health survey datasets (1992, 1996, 2002, 2007 and 2014). The results show that PBC was anchored by high-level political support, an overarching policy and legal framework, and collective planning and implementation with all key stakeholders. Decentralization of health service provision was also an enabling factor. ANC coverage increased in both the lower and upper wealth quintiles during the PBC era, followed by a declining trend after the PBC era in both quintiles. Further, the percentage of women delivering at health facilities increased during the PBC era, particularly in rural areas and among the poor. The positive trend continued after the PBC era with similar patterns in both lower and upper wealth quintiles. Despite these gains, per capita health expenditure at district level declined during the PBC era, with the situation worsening after the PBC era. The study concludes that a nationwide PBC approach can contribute to improved equity of access to maternal health services and that PBC is a cost-efficient and sustainable policy reform. The study calls for policymakers to comprehensively evaluate the impact of health system reforms before terminating them.

关键词： Performance-based contracting contracting purchasing results-based financing maternal health segmented regression analysis Zambia

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