Machine‐learning algorithms for predicting hospital re‐admissions in sickle cell disease

Reducing preventable hospital re‐admissions in Sickle Cell Disease (SCD) could potentially improve outcomes and decrease healthcare costs. In a retrospective study of electronic health records, we hypothesized Machine‐Learning (ML) algorithms may outperform standard re‐admission scoring systems (LACE and HOSPITAL indices). Participants (n = 446) included patients with SCD with at least one unplanned inpatient encounter between January 1, 2013, and November 1, 2018. Patients were randomly partitioned into training and testing groups. Unplanned hospital admissions (n = 3299) were stratified to training and testing samples. Potential predictors (n = 486), measured from the last unplanned inpatient discharge to the current unplanned inpatient visit, were obtained via both data‐driven methods and clinical knowledge. Three standard ML algorithms, Logistic Regression (LR), Support‐Vector Machine (SVM), and Random Forest (RF) were applied. Prediction performance was assessed using the C‐statistic, sensitivity, and specificity. In addition, we reported the most important predictors in our best models. In this dataset, ML algorithms outperformed LACE [C‐statistic 0·6, 95% Confidence Interval (CI) 0·57–0·64] and HOSPITAL (C‐statistic 0·69, 95% CI 0·66–0·72), with the RF (C‐statistic 0·77, 95% CI 0·73–0·79) and LR (C‐statistic 0·77, 95% CI 0·73–0·8) performing the best. ML algorithms can be powerful tools in predicting re‐admission in high‐risk patient groups.     

The association between problematic alcohol use,risk perceptions,and e-cigarette use

ABSTRACT

Background: Use of e-cigarettes among college students has escalated, in part due to the perception that they are less harmful than traditional cigarettes and have other benefits such as circumventing smoking bans. College students also drink more heavily than other age groups, and e-cigarettes are associated with alcohol, especially among students who engage in problematic drinking.

Objective: The present study sought to determine if an interaction between problematic alcohol use and increased perceptions of benefits and decreased perceptions of risks of e-cigarettes would predict whether participants had ever used an e-cigarette.

Method: The present study included 1,133 undergraduate college students surveyed between November 2014 – November 2016. Participants were primarily Caucasian (82.3%) and female (78.1%). Participants completed questionnaires regarding demographics, smoking status/history, and expectancies.

Results: Higher levels of problematic drinking and higher perceived benefits of e-cigarette use were both associated with having tried e-cigarettes. This relationship was significant even when controlling for several covariates such as cigarettes smoking status. However, there was not a significant interaction between problematic alcohol use and perceived benefits or risks of e-cigarettes. There was also no relationship between risk perceptions of e-cigarettes and e-cigarettes use.

Conclusions: Both problematic alcohol use and perception of benefits of e-cigarettes were associated with having tried an e-cigarette. This finding is problematic as the use of e-cigarettes may influence further engagement in risky behaviors including problematic drinking or transitioning to regular cigarette use. Thus, it is important to develop interventions to help college students develop more accurate risk perceptions about e-cigarettes.     

Neural correlates of verbal learning in adolescent alcohol and marijuana users

Aims Alcohol and marijuana are the most widely used intoxicants among adolescents, yet their potential unique and interactive influences on the developing brain are not well established. Brain regions subserving learning and memory undergo continued maturation during adolescence, and may be particularly susceptible to substance‐related neurotoxic damage. In this study, we characterize brain response during verbal learning among adolescent users of alcohol and marijuana. Design Participants performed a verbal paired associates encoding task during functional magnetic resonance imaging (fMRI) scanning. Setting Adolescent subjects were recruited from local public schools and imaged at a university‐based fMRI center. Participants Participants were 74 16–18‐year‐olds, divided into four groups: (i) 22 controls with limited alcohol and marijuana experience, (ii) 16 binge drinkers, (iii) eight marijuana users and (iv) 28 binge drinking marijuana users. Measurements Diagnostic interview ensured that all teens were free from neurological or psychiatric disorders; urine toxicology and breathalyzer verified abstinence for 22–28 days before scanning; a verbal paired associates task was administered during fMRI. Findings Groups demonstrated no differences in performance on the verbal encoding task, yet exhibited different brain response patterns. A main effect of drinking pointed to decreased inferior frontal but increased dorsal frontal and parietal fMRI response among binge drinkers (corrected P < 0.05). There was no main effect of marijuana use. Binge drinking × marijuana interactions were found in bilateral frontal regions (corrected P < 0.05), where users of either alcohol or marijuana showed greater response than non‐users, but users of both substances resembled non‐users. Conclusions Adolescent substance users demonstrated altered fMRI response relative to non‐using controls, yet binge drinking appeared to be associated with more differences in activation than marijuana use. Alcohol and marijuana may have interactive effects that alter these differences, particularly in prefrontal brain regions.     

The dimensionality of alcohol use disorders and alcohol consumption in a cross‐national perspective

Aims To replicate the finding that there is a single dimension trait in alcohol use disorders and to test whether the usual 5+ drinks for men and 4+ drinks for women and other measures of alcohol consumption help to improve alcohol use disorder criteria in a series of diverse patients from emergency departments (EDs) in four countries. Design Cross‐sectional surveys of patients aged 18 years and older that reflected consecutive arrival at the ED. The Composite International Diagnostic Interview Core was used to obtain a diagnosis of DSM‐IV alcohol dependence and alcohol abuse; quantity and frequency of drinking and drunkenness as well as usual number of drinks consumed during the last year. Setting Participants were 5195 injured and non‐injured patients attending seven EDs in four countries: Argentina, Mexico, Poland and the United States (between 1995–2001). Findings Using exploratory factor analyses alcohol use disorders can be described as a single, unidimensional continuum without any clear‐cut distinction between the criteria for dependence and abuse in all sites. Results from item response theory analyses showed that the current DSM‐IV criteria tap people in the middle–upper end of the alcohol use disorder continuum. Alcohol consumption (amount and frequency of use) can be used in all EDs with the current DSM‐IV diagnostic criteria to help tap the middle–lower part of this continuum. Even though some specific diagnostic criteria and some alcohol consumption variables showed differential item function across sites, test response curves were invariant for ED sites and their inclusion would not impact the final (total) performance of the diagnostic system. Conclusions DSM‐IV abuse and dependence form a unidimensional continuum in ED patients regardless of country of survey. Alcohol consumption variables, if added, would help to tap patients with more moderate severity. The DSM diagnostic system for alcohol use disorders showed invariance and performed extremely well in these samples.     

The added risk of opioid problem use among treatment‐seeking youth with marijuana and/or alcohol problem use

Objectives To determine the added risk of opioid problem use (OPU) in youth with marijuana/alcohol problem use (MAPU). Methods A total of 475 youth (ages 14–21 years) with OPU + MAPU were compared to a weighted sample of 475 youth with MAPU only (i.e. no OPU) before and after propensity score matching on gender, age, race, level of care and weekly use of marijuana/alcohol. Youth were recruited from 88 drug treatment sites participating in eight Center for Substance Abuse Treatment‐funded grants. At treatment intake, participants were administered the Global Appraisal of Individual Need to elicit information on demographic, social, substance, mental health, human immunodeficiency virus (HIV), physical and legal characteristics. Odds ratios with confidence intervals were calculated. Results The added risk of OPU among MAPU youth was associated with greater comorbidity; higher rates of psychiatric symptoms and trauma/victimization; greater needle use and sex‐related HIV risk behaviours; and greater physical distress. The OPU + MAPU group was less likely to be African American or other race and more likely to be aged 15–17 years, Caucasian; report weekly drug use at home and among peers; engage in illegal behaviors and be confined longer; have greater substance abuse severity and polydrug use; and use mental health and substance abuse treatment services. Conclusions These findings expand upon the existing literature and highlight the substantial incremental risk of OPU on multiple comorbid areas among treatment‐seeking youth. Further evaluation is needed to assess their outcomes following standard drug treatment and to evaluate specialized interventions for this subgroup of severely impaired youth.     

The influence of cultural orientation,alcohol expectancies and self‐efficacy on adolescent drinking behavior in Beijing

Objective We hypothesized that the drinking behavior of adolescents in China is influenced by expectancies and self‐efficacy and that adolescents' cultural orientation towards western versus traditional Chinese values influences expectancies, self‐efficacy and drinking behavior, with western values leading to more dysfunctional patterns of beliefs and drinking, and that these beliefs are influenced by students' gender and school environment. Methods A total of 1020 high school students from Beijing completed the Chinese Adolescent Alcohol Expectancy, the Chinese Cultural Orientation and the Chinese Self‐regulation Self‐efficacy questionnaires. Results Results generally confirmed our hypotheses. Higher negative expectancies and higher self‐efficacy reduced the likelihood of drinking significantly. Higher positive expectancies increased the likelihood of regular drinking but not occasional drinking. Having western cultural orientation increased the likelihood of drinking. Higher levels of western cultural orientation also increased positive expectancies, lowered negative expectancies and lowered self‐efficacy. Having more western (less traditional) views towards traditional Chinese values decreased positive and negative expectancies. Gender influenced beliefs, with males having higher positive and lower negative expectancies, lower self‐efficacy and more traditional cultural orientation. Students in key and general schools had less traditional cultural orientation and key school students had higher self‐efficacy. Conclusions Results indicate that cultural orientation influences adolescent drinking and this influence is mediated partially through cultural orientation influences on adolescent drinking expectancies and self‐efficacy. Having more western and less traditional Chinese cultural orientation leads to more drinking, lower self‐efficacy for regulating drinking and more risk‐promoting alcohol expectancies.