Examining the National Representativeness of the Axon Registry: A Neurology-Specific Patient Registry.

BACKGROUND AND OBJECTIVES: The objective of this study was to determine the external validity of the Axon Registry by comparing the 2019 calendar year data with 2 nationally representative, publicly available data sources, specifically the National Ambulatory Medical Care Survey (NAMCS) and the Medical Expenditure Panel Survey (MEPS). The Axon Registry is the American Academy of Neurology's neurology-focused qualified clinical data registry that reports and analyzes electronic health record data from participating US neurology providers. Its key function is to support quality improvement within ambulatory neurology practices while also promoting high-quality evidence-based care in clinical neurology. We compared demographics of patients who had an outpatient or office visit with a neurologist along with prevalence of selected neurologic conditions and neurologic procedures across the 3 data sets. METHODS: We performed a cross-sectional, retrospective comparison of 3 data sets: NAMCS (2012-2016), MEPS (2013-2017, 2019), and Axon Registry (2019). We obtained patient demographics (age, birth sex, race, ethnicity), patient neurologic conditions (headache, epilepsy, cerebrovascular disease, multiple sclerosis, parkinsonism, dementia, spinal pain, and polyneuropathy), provider location, and neurologic procedures (neurology visits, MR/CT neuroimaging studies and EEG/EMG neurophysiologic studies). Parameter estimates from the pooled 5-year samples of the 2 public data sets, calculated at the visit level, were compared descriptively with those of the Axon Registry. We calculated Cohen h and performed Wald tests (α = 0.05) to conduct person-level statistical comparisons between MEPS 2019 and Axon Registry 2019 data. RESULTS: The Axon Registry recorded 1.3 M annual neurology visits (NAMCS, 11 M; MEPS, 22 M) and 645 K people with neurologic conditions (MEPS, 10 M). Compared with the pooled national surveys, the Axon Registry has similar patient demographics, neurologic condition prevalence, neuroimaging and neurophysiologic utilization, and provider location. In direct comparison with MEPS 2019, the Axon Registry 2019 had fewer children (2% vs 7%), more elderly persons (21% vs 16%), fewer non-Black and non-White race persons (5% vs 8%), less number of patients with epilepsy (10% vs 13%), more patients with dementia (8% vs 6%), more patients with cerebrovascular disease (11% vs 8%), and a greater predominance of neurology providers in the Midwest (25% vs 20%). The only difference with a non-negligible effect size was the proportion of people younger than 15 years (Cohen h = 0.25). DISCUSSION: The Axon Registry demonstrates high concordance with 2 nationally representative surveys. Recruiting more and diverse neurology providers will further improve the volume, representativeness, and value of the Axon Registry.

Measuring Ambulatory Racial and Ethnic Neurologic Disparities With the Axon Registry.

Background and Objectives: The primary objective is to examine potential racial and ethnic (R/E) disparities in ambulatory neurology quality measures within the American Academy of Neurology Axon Registry. R/E disparities in neurologic US morbidity and mortality have been clearly documented. Despite these findings, there have been no nationwide examinations of how ambulatory neurologic care affects these negative health outcomes. Methods: This was a retrospective nonrandomized cohort study of patients in the AAN Axon Registry. The Axon Registry is a neurology-specific outpatient quality registry that collects, reports, and analyzes real-world deidentified electronic health record (EHR) data. Patients were included in the study if they contributed toward one of the selected quality measures for multiple sclerosis, epilepsy, Parkinson disease, or headache during the study period of January 1, 2019-December 31, 2019. Descriptive analyses of patient demographics were performed and then stratified by race and ethnicity. Results: There were a total of 633,672 patients included in these analyses. Separate analyses were performed for race (64% White, 8% Black, 1% Asian, and 27% unknown) and ethnicity (52% not Hispanic, 5% Hispanic, and 43% unknown). The mean age ranged from 18 to 55 years, with 61% female and 39% male. Quality measures were chosen based on completeness of R/E data and were either process or outcomes focused. Statistically significant differences were noted after controlling for multiple comparisons. Discussion: The large proportion of missing or unknown R/E data and low overall rate of performance on these quality measures made the relevance of small differences difficult to determine. This analysis demonstrates the feasibility of using the Axon Registry to assess neurologic disparities in outpatient care. More education and training are required on the accurate capture of R/E data in the EHR.

Canadian 24-h Movement Guidelines, Life Stress, and Self-Esteem Among Adolescents.

Background: Adolescence is often considered a period of heightened stress, and healthy active living behaviors may help those experiencing it to better cope with life stressors and increase their self-esteem. The 24-h movement guidelines for children and adolescents recommend ≥60 min per day of moderate-to-vigorous physical activity, ≤ 2-h per day of recreational screen time, and 9-11-h of sleep per night for school-aged children or 8-10-h per night for adolescents. The objective of this study was to examine the association of meeting the 24-h movement guidelines with life stress and self-esteem among students in Ontario, Canada. Methods: Self-reported data on movement behaviors, life stress and self-esteem were derived from the 2019 cycle of the Ontario Student Drug Use and Health Survey, a cross-sectional and province-wide survey of students in grades 7-12 aged 11 to 20 years (N = 6,932). Multivariable ordered logistic regression analyses were adjusted for the complex sample design of the survey and for important covariates. Results: Overall, meeting all combinations of movement behavior recommendations were associated with lower life stress and better self-esteem compared with meeting none of the recommendations, except meeting the physical activity only or screen time only recommendations that were not associated with lower life stress. Meeting all 3 recommendations was associated with lower life stress (OR: 0.40; 95 CI: 0.30-0.53) and better self-esteem (OR: 0.29; 95% CI: 0.21-0.40). There was a dose-response gradient between the number of recommendations met (3 > 2 > 1) and lower life stress (p < 0.001) and higher self-esteem (p < 0.001), with meeting all 3 recommendations being the best combination. Conclusions: These findings suggest that meeting the recommendations of the 24-h movement guidelines is associated with lower life stress and better self-esteem among adolescents.

Cyberbullying involvement and short sleep duration among adolescents.

BACKGROUND: Research has shown that cyberbullying victimization is associated with short sleep duration among adolescents; however, the association between cyberbullying perpetration and sleep duration is unclear. Furthermore, little is known about the factors that could moderate these associations. Thus, the objectives of this study were to investigate the associations of cyberbullying victimization, perpetration, or both with short sleep duration among adolescents, and to test whether age, sex, and adherence to the screen time recommendations (≤2 hours/day) moderate these associations. METHODS: Data on 6834 adolescents aged 11-20 years were derived from a representative cross-sectional study of middle and high school students across Ontario, Canada. Short sleep duration was self-reported and defined as sleeping less than the age-appropriate sleep duration recommendations. Multivariable logistic regression models were adjusted for important covariates. Adjusted odds ratios (AOR) and their 95% confidence intervals (CI) are reported. RESULTS: Cyberbullying victimization (AOR = 1.60, 95% CI = 1.37-1.86), perpetration (AOR = 1.44, 95% CI = 1.16-1.79), or both perpetration and victimization (AOR = 1.71, 95% CI = 1.27-2.30) was associated with greater odds of short sleep duration. Results further indicated that younger students who were not cyberbullied had a lower probability of short sleep duration, but there was no difference in the probability of short sleep duration between being cyberbullied or not among older adolescents. Sex and screen time did not moderate any of the associations between cyberbullying involvement and short sleep duration. CONCLUSION: Involvement in cyberbullying as either a victim, a perpetrator, or both is associated with short sleep duration among adolescents. Strategies that can help to eliminate cyberbullying are needed in public health.

Sociodemographic and mental health characteristics associated with changes in movement behaviours due to the COVID-19 pandemic in adolescents.

Objectives: Control measures enacted to control the spread of COVID-19 appear to have impacted adolescent movement behaviours. It remains unclear how these changes relate to sociodemographic characteristics and indicators of mental health. Understanding these relationships can contribute to informing health promotion efforts. The purpose of this study is to examine sociodemographic and mental health characteristics associated with changes in movement behaviours (physical activity, screen time, sleep duration) due to the COVID-19 pandemic among adolescents. Methods: This cross-sectional study used May-June 2020 survey data and included 7349 students from Quebec, Ontario, and British Columbia (Canada). ANOVA, χ2 tests, and estimation of effect sizes using Cohen's d and h tests were performed between self-reported perceived changes (increase; decrease; no change) to physical activity, TV watching, social media use, and sleep duration as a result of the COVID-19 pandemic and gender, age, race/ethnicity, income, depression and anxiety symptoms, flourishing-languishing, and self-rated mental health. Results: Over half of students reported increases in TV viewing and social media use and approximately 40% reported decrease in physical activity and increase in sleep duration due to the COVID-19 pandemic. More females (68.9%) than males (54.3%) reported increase in social media use (Cohen's h ≥ 0.2-0.5). No change from pre-COVID-19 social media use and sleep duration were associated with fewer depression and anxiety symptoms and better self-rated mental health compared to reports of an increase or decrease. These effect sizes ranged from small-to-moderate to moderate-to-large (Cohen's d/h ≥ 0.2-0.8). Decreased physical activity and sleep duration were associated with better psychological functioning with effects sizes of small-to-moderate. Compared to an increase or no change, decreased sleep had the largest effect size of less frequent depression symptoms (Cohen's d ≥ 0.5-0.8). Conclusion: Maintaining pre-COVID-19 screen time and sleep duration during early stages of the COVID-19 lockdown was generally beneficial to mental health, with sleep being particularly important in regards to symptoms of depression. Psychological functioning was more related to physical activity and sleep than screen time during the pandemic.

The Canadian 24-hour movement guidelines and self-rated physical and mental health among adolescents.

OBJECTIVE: The Canadian 24-hour movement guidelines for children and youth recommend a minimum of 60 min/day of moderate-to-vigorous physical activity, no more than 2 h/day of recreational screen time, and 8-11 h/night of sleep depending on age. The objective of this study was to examine the associations of meeting combinations of these recommendations with self-rated physical and mental health. METHODS: This study used data from the 2017 (n = 5739) and 2019 (n = 6960) cycles of the Ontario Student Drug Use and Health Survey (OSDUHS), a biennially repeated cross-sectional study of Ontario students in grades 7 through 12. Multivariable ordered logistic regression models were adjusted for age, gender, ethnoracial background, subjective socio-economic status, and body mass index z-scores. RESULTS: Similar patterns were seen in the 2017 and 2019 samples. Compared with meeting none of the recommendations, meeting different combinations of recommendations in the 2019 sample was associated with positive self-rated physical and mental health. A dose-response gradient between the number of recommendations met and self-rated physical (p < 0.001) and mental (p < 0.001) health was observed, with meeting one (AOR: 1.82; 95% CI: 1.58-2.09), two (AOR: 3.54; 95% CI: 2.98-4.22), or three recommendations (AOR: 6.34; 95% CI: 4.46-9.02) being increasingly associated with positive self-rated physical health compared with meeting none; and meeting one (AOR: 1.51; 95% CI: 1.33-1.71), two (AOR: 2.70; 95% CI: 2.31-3.17), or three recommendations (AOR: 3.58; 95% CI: 2.57-4.98) being increasingly associated with positive self-rated mental health compared with meeting none. CONCLUSION: Meeting the 24-hour movement guidelines is associated with better self-rated physical and mental health among adolescents.

RéSUMé: OBJECTIF: Les Directives canadiennes en matière de mouvement sur 24 heures pour les enfants et les jeunes recommandent un minimum de 60 min par jour d'activité physique d'intensité moyenne à élevée, un maximum de 2 heures par jour de temps de loisir devant un écran et de 8 à 11 heures de sommeil selon l'âge. L'objectif de cette étude était d'examiner les associations entre l'adoption d'une combinaison de ces recommandations et l'autoévaluation de la santé physique et mentale. MéTHODE: Cette étude s'est appuyée sur les données tirées des cycles de 2017 (n = 5 739) et de 2019 (n = 6 960) du Sondage sur la consommation de drogues et la santé des élèves de l'Ontario (SCDSEO), un sondage transversal réalisé tous les deux ans auprès d'élèves de la 7e à la 12e année en Ontario. Les modèles de régression logistique multivariés ont été ajustés en ce qui a trait à l'âge, au genre, aux antécédents ethnoraciaux, au statut socioéconomique subjectif et aux scores-z de l'indice de masse corporelle. RéSULTATS: Des tendances similaires ont été observées dans les échantillons de 2017 et de 2019. L'adoption d'une combinaison des recommandations parmi l'échantillon de 2019, comparativement au fait de ne se conformer à aucune d'elles, était associée à une autoévaluation positive de la santé physique et mentale. Un gradient dose-réponse entre le nombre de recommandations adoptées et l'autoévaluation de la santé physique (p < 0,001) et mentale (p < 0,001) a été observé. L'adoption d'une (RCa : 1,82; IC de 95% : 1,58 à 2,09), de deux (RCa : 3,54; IC de 95% : 2,98 à 4,22) ou de trois recommandations (RCa : 6,34; IC de 95% : 4,46 à 9,02) était étroitement associée à une autoévaluation positive de la santé physique, comparativement au fait de ne se conformer à aucune d'elles; et l'adoption d'une (RCa : 1,51; IC de 95% : 1,33 à 1,71), de deux (RCa : 2,70; IC de 95% : 2,31 à 3,17) ou de trois recommandations (RCa : 3,58; IC de 95% : 2,57 à 4,98) était étroitement associée à une autoévaluation positive de la santé mentale, comparativement au fait de ne se conformer à aucune d'elles. CONCLUSION: La conformité aux directives en matière de mouvement sur 24 heures est associée à une meilleure autoévaluation de la santé physique et mentale chez les adolescents.

Serum antibody response in COVID-19-recovered patients who retested positive.

BACKGROUND: Research studies comparing antibody response from coronavirus disease 2019 (COVID-19) cases that retested positive (RP) using reverse transcription polymerase chain reaction (RT-PCR) and those who did not retest positive (NRP) were used to investigate a possible relationship between antibody response and retesting status. METHODS: Seven data bases were searched. Research criteria included cohort and case-control studies, carried out worldwide and published before September 9, 2020, that compared the serum antibody levels of hospitalized COVID-19 cases that RP after discharge to those that did NRP. RESULTS: There is some evidence that immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody levels in RP cases were lower compared with NRP cases. The hypothesis of incomplete clearance aligns with these findings. The possibility of false negative reverse transcription polymerase chain reaction (RT-PCR test results during viral clearance is also plausible, as concentration of the viral ribonucleic acid (RNA) in nasopharyngeal and fecal swabs fluctuate below the limits of RT-PCR detection during virus clearance. The probability of reinfection was less likely to be the cause of retesting positive because of the low risk of exposure where cases observed a 14 day-quarantine after discharge. CONCLUSION: More studies are needed to better explain the immune response of recovered COVID-19 cases retesting positive after discharge.

Assessing the progression of the COVID-19 pandemic in Canada using testing data and time-dependent reproduction numbers.

OBJECTIVES: To compare a mathematical tool and time-dependent reproduction number (Rt) estimates to assess the COVID-19 pandemic progression in a Canadian context. METHODS: Total number of reported cases were plotted against total number of tests for COVID-19 performed over time, with and without smoothing, for Canada and some Canadian provinces individually. Changes in curvature profile were identified as either convex or concave as indicators of pandemic acceleration or deceleration, respectively. Rt estimates were calculated on an exponential growth rate. RESULTS: For Canada as a whole, the testing graphs had a slightly concave profile and a coincident decrease in Rt estimates. Saskatchewan more recently had a convex profile with a gradual shift to a concave profile and also demonstrated a gradual decline in Rt estimates. Curves and Rt estimates for Alberta, British Columbia, Manitoba, Nova Scotia, Ontario and Quebec displayed a gradual shift towards concavity over time and an overall decrease in Rt estimates, which is suggestive of a positive impact of public health interventions implemented federally and provincially. CONCLUSION: The present analyses compared a mathematical tool to Rt estimates to ascertain the status of the pandemic in Canada. Caution should be taken when interpreting results due to factors such as varying testing protocols, available testing data unique to each province and limitations inherent to each method, which may generate different results using the two approaches. Analysis of testing data may complement metrics obtained from surveillance data to allow for a weight-of-evidence approach to assess the status of the COVID-19 pandemic.

RéSUMé: OBJECTIFS: Comparer un outil mathématique aux estimations du taux de reproduction en fonction du temps (Rt) pour évaluer la progression de la pandémie de la COVID-19 dans le contexte canadien. MéTHODES: Le nombre total de cas signalés a été comparé au nombre total de tests à la COVID-19 effectués au fil du temps, avec et sans lissage, pour le Canada et certaines provinces canadiennes individuellement. Les modifications du profil de courbure identifiées comme étant convexes ou concaves seraient des indicateurs respectivement d'une accélération ou d'une décélération de la pandémie. Le calcul des estimations du Rt a été réalisé en fonction du taux de croissance exponentiel. RéSULTATS: Pour l'ensemble du Canada, la légère concavité des graphiques relatifs aux tests coïncidait avec la diminution des estimations du Rt. Plus récemment, la Saskatchewan avait un profil convexe avec un passage progressif à un profil concave et a également démontré une baisse progressive des estimations du Rt. Les courbes et les estimations du Rt pour l'Alberta, la Colombie-Britannique, le Manitoba, la Nouvelle-Écosse, l'Ontario et le Québec ont montré un glissement progressif vers la concavité au fil du temps et une diminution globale des estimations du Rt, ce qui suggère un impact positif des interventions de santé publique mises en œuvre au niveau fédéral et provincial. CONCLUSION: Les présentes analyses ont comparé un outil mathématique aux estimations de Rt pour déterminer l'état de la pandémie au Canada. Les résultats doivent être interprétés avec prudence en raison de certains facteurs tels que les différences entre provinces en ce qui concerne les protocoles de réalisation des tests et la disponibilité des données relatives aux tests. De plus, une limite inhérente à la méthodologie de cette étude est la possibilité d'obtenir des résultats différents en fonction de l'approche utilisée. L'analyse des données des tests pourrait être complémentaire à celle des données de surveillance pour permettre une approche fondée sur le poids de la preuve dans le cadre de l'évaluation de l'état de la pandémie de la COVID-19.