Opportunity and accessibility: an environmental scan of publicly available data repositories to address disparities in healthcare decision-making.

BACKGROUND: Health disparities, starkly exposed and exacerbated by coronavirus disease 2019, pose a significant challenge to healthcare system access and health outcomes. Integrating health inequalities into health technology assessment calls for robust analytical methodologies utilizing disaggregated data to investigate and quantify the scope of these disparities. However, a comprehensive summary of population datasets that can be used for this purpose is lacking. The objective of this review was to identify publicly accessible health inequalities data repositories that are potential resources for healthcare decision-making and future health technology assessment submissions. METHODS: An environmental scan was conducted in June of 2023 of six international organizations (World Health Organization, Organisation for Economic Co-operation and Development, Eurostat, United Nations Inter-agency Group for Child Mortality Estimation, the United Nations Sustainable Development Goals, and World Bank) and 38 Organisation for Economic Co-operation and Development countries. The official websites of 42 jurisdictions, excluding non-English websites and those lacking English translations, were reviewed. Screening and data extraction were performed by two reviewers for each data repository, including health indicators, determinants of health, and health inequality metrics. The results were narratively synthesized. RESULTS: The search identified only a limited number of country-level health inequalities data repositories. The World Health Organization Health Inequality Data Repository emerged as the most comprehensive source of health inequality data. Some country-level data repositories, such as Canada's Health Inequality Data Tool and England's Health Inequality Dashboard, offered rich local insights into determinants of health and numerous health status indicators, including mortality. Data repositories predominantly focused on determinants of health such as age, sex, social deprivation, and geography. CONCLUSION: Interactive interfaces featuring data exploration and visualization options across diverse patient populations can serve as valuable tools to address health disparities. The data they provide may help inform complex analytical methodologies that integrate health inequality considerations into healthcare decision-making. This may include assessing the feasibility of transporting health inequality data across borders.

Helicobacter pylori infection treatment in the United States: clinical consequences and costs of eradication treatment failure.

INTRODUCTION: Helicobacter pylori (Hp) is causal in benign and malignant gastrointestinal diseases. Accordingly, current guidelines recommend Hp eradication in patients with active infection. Unfortunately, treatment failure is common, exposing patients to complications associated with persistent Hp infection and consequences of repeated treatment, including promotion of antibiotic resistance. In the United States (US), data regarding eradication rates with available therapies are limited. Moreover, the clinical and economic burden of eradication treatment failure have not been thoroughly described. AREAS COVERED: We aimed to characterize Hp eradication rates and the clinical consequences and associated costs of persistent Hp infection among US adults. We conducted focused literature reviews using initial searches in Embase, MEDLINE, and Cochrane Database of Systematic Reviews via Ovid followed by manual searches to identify relevant publications. EXPERT OPINION: Hp eradication rates were suboptimal, with most studies reporting rates ≤80% with clarithromycin-based triple therapy and bismuth quadruple therapy. There was direct evidence supporting numerous benefits of successful Hp eradication, including decreased risk of recurrent or complicated peptic disease and non-cardia gastric cancer. Cost benefits of eradication were related to mitigation of conditions associated with persistent Hp infection, (e.g. complicated peptic ulcer disease, and gastric cancer) which altogether exceed US$5.3 billion.

How well can we assess the validity of non-randomised studies of medications? A systematic review of assessment tools.

OBJECTIVE: To determine whether assessment tools for non-randomised studies (NRS) address critical elements that influence the validity of NRS findings for comparative safety and effectiveness of medications. DESIGN: Systematic review and Delphi survey. DATA SOURCES: We searched PubMed, Embase, Google, bibliographies of reviews and websites of influential organisations from inception to November 2019. In parallel, we conducted a Delphi survey among the International Society for Pharmacoepidemiology Comparative Effectiveness Research Special Interest Group to identify key methodological challenges for NRS of medications. We created a framework consisting of the reported methodological challenges to evaluate the selected NRS tools. STUDY SELECTION: Checklists or scales assessing NRS. DATA EXTRACTION: Two reviewers extracted general information and content data related to the prespecified framework. RESULTS: Of 44 tools reviewed, 48% (n=21) assess multiple NRS designs, while other tools specifically addressed case-control (n=12, 27%) or cohort studies (n=11, 25%) only. Response rate to the Delphi survey was 73% (35 out of 48 content experts), and a consensus was reached in only two rounds. Most tools evaluated methods for selecting study participants (n=43, 98%), although only one addressed selection bias due to depletion of susceptibles (2%). Many tools addressed the measurement of exposure and outcome (n=40, 91%), and measurement and control for confounders (n=40, 91%). Most tools have at least one item/question on design-specific sources of bias (n=40, 91%), but only a few investigate reverse causation (n=8, 18%), detection bias (n=4, 9%), time-related bias (n=3, 7%), lack of new-user design (n=2, 5%) or active comparator design (n=0). Few tools address the appropriateness of statistical analyses (n=15, 34%), methods for assessing internal (n=15, 34%) or external validity (n=11, 25%) and statistical uncertainty in the findings (n=21, 48%). None of the reviewed tools investigated all the methodological domains and subdomains. CONCLUSIONS: The acknowledgement of major design-specific sources of bias (eg, lack of new-user design, lack of active comparator design, time-related bias, depletion of susceptibles, reverse causation) and statistical assessment of internal and external validity is currently not sufficiently addressed in most of the existing tools. These critical elements should be integrated to systematically investigate the validity of NRS on comparative safety and effectiveness of medications. SYSTEMATIC REVIEW PROTOCOL AND REGISTRATION: https://osf.io/es65q.

Generalisation in language learning can withstand total sleep deprivation.

Research suggests that sleep plays a vital role in memory. We tested the impact of total sleep deprivation on adults' memory for a newly learned writing system and on their ability to generalise this knowledge to read untrained novel words. We trained participants to read fictitious words printed in a novel artificial orthography, while depriving them of sleep the night after learning (Experiment 1) or the night before learning (Experiment 2). Following two nights of recovery sleep, and again 10 days later, participants were tested on trained words and untrained words, and performance was compared to control groups who had not undergone sleep deprivation. Participants showed a high degree of accuracy in learning the trained words and in generalising their knowledge to untrained words. There was little evidence of impact of sleep deprivation on memory or generalisation. These data support emerging theories which suggest sleep-associated memory consolidation can be accelerated or entirely bypassed under certain conditions, and that such conditions also facilitate generalisation.

The role of complementary learning systems in learning and consolidation in a quasi-regular domain.

We examine the role of off-line memory consolidation processes in the learning and retention of a new quasi-regular linguistic system similar to the English past tense. Quasi-regular systems are characterized by a dominance of systematic, regular forms (e.g., walk-walked, jump-jumped) alongside a smaller number of high frequency irregulars (e.g., sit-sat, go-went), and are found across many cognitive domains, from spelling-sound mappings to inflectional morphology to semantic cognition. Participants were trained on the novel morphological system using an artificial language paradigm, and then tested after different delays. Based on a complementary systems account of memory, we predicted that irregular forms would show stronger off-line changes due to consolidation processes. Across two experiments, participants were tested either immediately after learning, 12 h later with or without sleep, or 24 h later. Testing involved generalization of the morphological patterns to previously unseen words (both experiments) as well as recall of the trained words (Experiment 2). In generalization, participants showed 'default' regularization across a range of novel forms, as well as irregularization for previously unseen items that were similar to unique high-frequency irregular trained forms. Both patterns of performance remained stable across the delays. Generalizations involving competing tendencies to regularize and irregularize were balanced between the two immediately after learning. Crucially, at both 12-h delays the tendency to irregularize in these cases was strengthened, with further strengthening after 24 h. Consolidated knowledge of both regular and irregular trained items contributed significantly to generalization performance, with evidence of strengthening of irregular forms and weakening of regular forms. We interpret these findings in the context of a complementary systems model, and discuss how maintenance, strengthening, and forgetting of the new memories across sleep and wake can play a role in acquiring quasi-regular systems.