Category: Statistics

Transl Behav Med. 2025 Jan 16;15(1):ibaf026. doi: 10.1093/tbm/ibaf026.

ABSTRACT

Physical activity and nutrition programs improve children’s health. However, cost and competition for resources between programs are common implementation challenges. Currently, no guidance exists for practitioners about how to spend money within various programs. This study examines spending patterns of schools that concurrently delivered multiple programs to help provide spending guidance. Middle schools (n = 8; 75% rural) that participated in the Healthy School Recognized Campus (HSRC) initiative were provided $3500. To achieve HSRC recognition, schools complete a school-wide walking program, a physical activity or nutrition program for students, and a physical activity or nutrition program for adults (teachers and parents). We tracked purchases, grouped receipts by categories and program, and analyzed spending using descriptive statistics. On average, schools spent $3383.26 ± $159.27. For both adult and teacher incentives, over half of the schools spent $0. Program equipment ($1145.14 ± $1139.10; e.g. cooking equipment and hydroponics kit) was the largest category of spending, followed by student incentives ($945.04 ± $946.62). Schools purchased 5031 items (628.88 ± 926.50 items/school) categorized as small student incentives (e.g. water bottles and gift cards), averaging $1.04 each, and 12 items (1.5 ± 2.78 items/school) on large student incentives (e.g. bike) averaging $124.72 each. On average schools completed 2.88 ± 0.83 (range 2-4) youth programs and 1.50 ± 0.93 (range 0-2) adult programs, which cost around $300-$1500 and $0-$700 per program, respectively. Schools spent almost all the money allocated for HSRC and made strategic spending decisions to maximize student engagement, specifically prioritizing student programs over adult ones. This information about how schools spend their money offers insights for decision-making in future programs.

PMID:40512531 | DOI:10.1093/tbm/ibaf026

JAMA Health Forum. 2025 Jun 7;6(6):e251288. doi: 10.1001/jamahealthforum.2025.1288.

ABSTRACT

IMPORTANCE: Children experiencing parental opioid use disorder are a growing population at heightened risk of physical and mental health issues over the life course. Yet these children are less likely to receive comprehensive, ongoing health care and their parents are more likely to report barriers to access health care for their children. School-based health services have potential to overcome some of these health care access barriers, including parental burden, transportation, time, costs, and health care discontinuity. In 2014, Medicaid revoked its longstanding free care rule, expanding the scope of school-based health services eligible for Medicaid reimbursement. Subsequently, some states began to expand their school Medicaid programs to benefit from the new federal rule.

OBJECTIVE: To estimate the early effects of state school Medicaid expansions on the receipt of Medicaid-funded school-based health services among children who have experienced parental opioid use disorder.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study using nationwide Medicaid claims data included Medicaid-enrolled children aged 5 to 18 years who experienced parental opioid use disorder at any point before age 19 years. A difference-in-differences design that exploits the staggered implementation of school Medicaid expansions between 2014 and 2019 was used. Data were analyzed between January 2023 and January 2025.

EXPOSURES: Children living in states implementing (treatment group) and not implementing (comparison group) school Medicaid expansions, before and after state-specific expansion dates.

MAIN OUTCOMES AND MEASURES: Binary measures indicating receipt of school-based health services, primary care, prevention, rehabilitative, dental, and mental health services, emergency department visits, and inpatient hospital stays.

RESULTS: The sample comprised 6 628 404 person-years from 1 700 304 children. The mean (SD) age was 10.5 (3.9) years and 3 371 918 (51%) were male. School Medicaid expansions increased the receipt of Medicaid-funded school-based health services by 8.9 percentage points (pp; P = .01). Growth was primarily driven by school claims for nursing services (difference, 7.4 pp; P = .02) and for Early and Periodic Screening, Diagnostic and Treatment services (difference, 8.6 pp; P = .04). Reductions in emergency department visits among children aged 5 to 11 years were also documented (difference, -1.8 pp; P = .02).

CONCLUSIONS AND RELEVANCE: This cohort study found that, given the complex health and health care needs of children growing up amid the opioid crisis, integrating health care into schools may offer a promising policy solution.

PMID:40512511 | DOI:10.1001/jamahealthforum.2025.1288

JAMA Health Forum. 2025 Jun 7;6(6):e251369. doi: 10.1001/jamahealthforum.2025.1369.

ABSTRACT

IMPORTANCE: In the context of the US opioid crisis, factors associated with the prevalence of opioid use disorder (OUD) must be identified to aid prevention and treatment. State medical cannabis laws (MCL) and recreational cannabis laws (RCL) are potential factors associated with OUD prevalence.

OBJECTIVE: To examine changes in OUD prevalence associated with MCL and RCL enactment among veterans treated at the Veterans Health Administration (VHA) and whether associations differed by age or chronic pain.

DESIGN, SETTING, AND PARTICIPANTS: Using VHA electronic health records from January 2005 to December 2022, adjusted yearly prevalences of OUD were calculated, controlling for sociodemographic characteristics, receipt of prescription opioids, other substance use disorders, and time-varying state covariates. Staggered-adoption difference-in-difference analyses were used for estimates and 95% CIs for the relationship between MCL and RCL enactment and OUD prevalence. The study included VHA patients aged 18 to 75 years. The data were analyzed in December 2023.

MAIN OUTCOME AND MEASURES: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) OUD diagnoses.

RESULTS: From 2005 to 2022, most patients were male (86.7.%-95.0%) and non-Hispanic White (70.3%-78.7%); the yearly mean age was 61.9 to 63.6 years (approximately 3.2 to 4.5 million patients per year). During the study period, OUD decreased from 1.12% to 1.06% in states without cannabis laws, increased from 1.13% to 1.19% in states that enacted MCL, and remained stable in states that also enacted RCL. OUD prevalence increased significantly by 0.06% (95% CI, 0.05%-0.06%) following MCL enactment and 0.07% (95% CI, 0.06%-0.08%) after RCL enactment. In patients aged 35 to 64 years and 65 to 75 years, MCL and RCL enactment was associated with increased OUD, with the greatest increase after RCL enactment among older adults (0.12%; 95% CI, 0.11%-0.13%). Patients with chronic pain had even larger increases in OUD following MCL (0.08%; 95% CI, 0.07%-0.09%) and RCL enactment (0.13%; 95% CI, 0.12%-0.15%). Consistent with overall findings, the largest increases in OUD occurred among patients with chronic pain aged 35 to 64 years following the enactment of MCL and RCL (0.09%; 95% CI, 0.07%-0.11%) and adults aged 65 to 75 years following RCL enactment (0.23%; 95% CI, 0.21%-0.25%).

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that MCL and RCL enactment was associated with greater OUD prevalence in VHA patients over time, with the greatest increases among middle-aged and older patients and those with chronic pain. The findings did not support state cannabis legalization as a means of reducing the burden of OUD during the ongoing opioid epidemic.

PMID:40512510 | DOI:10.1001/jamahealthforum.2025.1369

JAMA Health Forum. 2025 Jun 7;6(6):e251376. doi: 10.1001/jamahealthforum.2025.1376.

ABSTRACT

IMPORTANCE: National continuous Medicaid eligibility under the Families First Coronavirus Response Act (FFCRA) may have differentially affected children’s health care depending on whether states had preexisting 12-month continuous Medicaid eligibility for children.

OBJECTIVE: To estimate the association of states newly implementing continuous Medicaid eligibility under the FFCRA with children’s health care access, health care use, and barriers to care.

DESIGN, SETTING, AND PARTICIPANTS: This survey study used a difference-in-differences research design comparing states before (2017-2019) and during (2020-2022) the FFCRA overall, by caregiver-reported race and ethnicity, and among publicly insured children. Analyses used data from the National Survey of Children’s Health (NSCH), an annual household survey on the health and well-being of children 0 to 17 years old in the US. Data were analyzed from September 2024 to March 2025.

EXPOSURES: Whether states had pre-FFCRA 12-month continuous Medicaid eligibility for children.

MAIN OUTCOMES AND MEASURES: Insurance coverage, gaps in coverage, unmet health care needs, any health care visits, preventive visits, emergency department visits, hospitalizations, any time spent weekly arranging children’s health care, and problems paying medical bills.

RESULTS: The sample included 215 884 children, with children in states with pre-FFCRA continuous eligibility being similar to children in states newly implementing continuous eligibility with respect to age (8.6 years old in both sets of states), gender (49.6% female compared to 48.5%), and nativity (66.7% third generation or longer with all parents born in the US vs 69.6%), with lower proportions who were non-Hispanic Black (11.9% compared to 13.8%) or non-Hispanic White (50.5% compared to 52.9%), and higher proportions who were Hispanic (25.5% compared to 23.9%). In adjusted difference-in-difference models, newly implementing continuous eligibility under the FFCRA was associated with a 0.7-percentage point (95% CI, -1.2 to -0.1 percentage point) reduction in children’s unmet health care needs. There was no evidence of additional FFCRA-associated changes in outcomes overall. In subgroup analyses, there were reductions in coverage gaps, unmet health care needs, and time spent arranging care among Hispanic children and publicly insured children.

CONCLUSIONS AND RELEVANCE: In this survey study, newly implementing continuous eligibility for children under the FFCRA was associated with reductions in unmet health care needs and no additional changes in health care outcomes overall, with additional benefits for Hispanic children and publicly insured children. This could reflect expected changes under mandatory, national 12-month continuous eligibility for children implemented in January 2024.

PMID:40512509 | DOI:10.1001/jamahealthforum.2025.1376

Chem Biodivers. 2025 Jun 13:e00956. doi: 10.1002/cbdv.202500956. Online ahead of print.

ABSTRACT

One previously undescribed rosane diterpenoid (1) and 13 known ones (2-14) were isolated from the whole plant of Jatropha curcas L. The relative configuration 1 was determined by NMR calculation combined with DP4+ probability analysis, and its absolute configuration (AC) was further determined by ECD calculation. The final structure was further confirmed by single crystal x-ray diffraction. The biological testing revealed that compounds 5 and 14 possessed inhibitory effects on NLRP3 inflammasome with IC₅₀ values of 8.1 ± 0.3 and 9.7 ± 0.4 µM. Further investigation exhibited that compound 5 has an obvious effect on inhibiting pyroptosis.

PMID:40512504 | DOI:10.1002/cbdv.202500956

Environ Health Perspect. 2025 Jun 13. doi: 10.1289/EHP16515. Online ahead of print.

ABSTRACT

BACKGROUND: Growing evidence links air pollution to cognitive dysfunction in older adults. The gut microbiome and circulating metabolites present an important yet unexplored pathway, given their crucial role in the gut-brain axis.

OBJECTIVES: We aimed to explore the potential roles of gut bacteria, fungi, microbial functional potentials, and circuiting metabolites in the association of residential PM_2.5 and O₃ exposures with cognitive dysfunction.

METHODS: We analyzed gut microbiome data from 1,027 older adults using metagenome and internal transcribed spacer sequencing to profile bacterial and fungal taxa, functional pathways, and enzyme abundances. Targeted metabolomics quantified 195 circulating metabolites, such as amino acids and organic acids. Annual average ambient PM_2.5 and O₃ exposures were estimated using satellite-based models. Cognitive outcomes, including mild cognitive impairment and cognitive decline, were assessed using the Mini-mental State Examination and Hasegawa dementia scale. Statistical analyses included Microbiome Multivariable Association with Linear Models (with a false discovery rate threshold of 0.25) for microbial associations and multivariate regression for metabolites and cognitive outcomes.

RESULTS: Higher PM_2.5 and O₃ exposures were associated with disturbances in microbial composition, altered taxonomic profiles (e.g., decreased abundances of Blautia obeum and Gordonibacter pamelaeae), and disrupted functional pathways, particularly those regulating 2-oxoglutarate. These findings were partially replicated in an independent population. Higher air pollution levels were associated with increased circulating levels of 2-oxoglutarate and L-glutamine (key metabolites in neurodegenerative progression), which were further linked to higher odds of concurrent mild cognitive impairment (OR: 1.39-1.56) and an increased 2-year risk of cognitive decline (OR: 1.26-1.37). These associations were partially mediated by air pollution-related changes in microbial anaerobic energy metabolism pathways, especially involving 2-oxoglutarate metabolism and the enzyme aspartate transaminase.

CONCLUSIONS: Our findings highlight the role of the gut microbiome and microbial metabolites in mediating the detrimental impact of air pollution on cognitive health in older adults, providing new insights into the underlying etiology for future hypothesis generation. https://doi.org/10.1289/EHP16515.

PMID:40512497 | DOI:10.1289/EHP16515

JAMA Netw Open. 2025 Jun 2;8(6):e2515526. doi: 10.1001/jamanetworkopen.2025.15526.

ABSTRACT

IMPORTANCE: The efficacy and safety of endovascular thrombectomy (EVT) plus best medical treatment (BMT) for vertebrobasilar artery occlusion beyond 24 hours remain uncertain.

OBJECTIVE: To evaluate outcomes associated with EVT in patients treated beyond 24 hours after last known well time due to vertebrobasilar artery occlusion.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, prospective cohort study enrolled patients between 2019 and 2024 from 11 comprehensive stroke centers across China. Eligible patients with vertebrobasilar artery occlusions treated beyond 24 hours after the estimated onset were included.

EXPOSURES: Patients were categorized into 2 groups: those who underwent EVT plus BMT and those who received BMT alone.

MAIN OUTCOMES AND MEASURES: The primary outcome was good functional status (modified Rankin Scale score, 0-3) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage within 24 hours and 90-day mortality.

RESULTS: Among 202 patients with vertebrobasilar occlusion (158 male [78.2%]; median [IQR] age, 64.0 [56.2-70.0] years), 101 patients received EVT plus BMT and 101 patients received only BMT. The median (IQR) posterior circulation Acute Stroke Prognosis Early Computed Tomography Score was 8 (8-9), and the median (IQR) of time of onset to admission was 48 (24-96) hours. In the primary analysis using propensity score matching, 71 patients with EVT plus BMT had a higher rate of a good functional outcome at 90 days compared with 71 patients receiving BMT alone (41 patients [57.7%] vs 32 patients [45.1%]; adjusted risk ratio [aRR], 1.35 [95% CI, 1.02-1.79]). EVT plus BMT compared with BMT alone showed lower mortality (9 patients [12.7%] vs 20 patients [28.2%]; aRR, 0.27 [95% CI, 0.08-0.81]); differences in rates of symptomatic intracranial hemorrhage were not statistically significant (4 patients [5.6%] vs 0 patients; P = .13). A similar advantage in functional outcome for EVT plus BMT (aRR, 1.33 [95% CI, 1.04-1.71]) was observed in the inverse probability of treatment weighting analysis.

CONCLUSIONS AND RELEVANCE: In this study, EVT plus BMT was associated with improved functional outcomes and survival rates at 90 days and a nonsignificant but numerically higher frequency of symptomatic intracranial hemorrhage than BMT alone in patients treated beyond 24 hours after last known well time. These findings suggest that randomized clinical trials comparing EVT with BMT in patients with acute vertebrobasilar artery occlusion are warranted.

PMID:40512496 | DOI:10.1001/jamanetworkopen.2025.15526

JAMA Netw Open. 2025 Jun 2;8(6):e2515534. doi: 10.1001/jamanetworkopen.2025.15534.

ABSTRACT

IMPORTANCE: With shifting epidemiology and changes in the vaccine funding landscape, resource use considerations for COVID-19 vaccination programs are increasingly important.

OBJECTIVE: To assess the cost effectiveness of COVID-19 vaccination programs, where eligibility is defined by combinations of age and chronic medical conditions, including a strategy similar to current Canadian recommendations.

DESIGN, SETTING, AND PARTICIPANTS: Static, individual-based, probabilistic cost-utility model economic evaluation parameterized with recent data describing COVID-19 epidemiology, vaccine characteristics, and costs. The analysis used a 15-month time horizon from July 2024 to September 2025 and a modeled cohort of 1 million people with characteristics based on the Canadian population, stratified by age group and presence or absence of at least 1 chronic medical condition.

EXPOSURE: Annual or biannual COVID-19 vaccination strategies offered to different age and medical risk groups, with annual vaccination occurring in October and November in the primary analysis.

MAIN OUTCOMES AND MEASURES: Medically attended SARS-CoV-2 infections treated in outpatient and inpatient settings, including post-COVID condition cases and deaths. Costs in 2023 Canadian dollars, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs), discounted at 1.5% for the health system and societal perspectives.

RESULTS: Among 1 million simulated individuals, annual vaccination for adults aged 65 years and older consistently emerged as a cost-effective intervention, with ICERs less than CAD $50 000 per QALY compared with no vaccination for a range of model assumptions. Adding a second dose for adults aged 65 years and older or expanding programs to include vaccination for younger age groups, including those at higher risk of COVID-19 due to chronic medical conditions, generally resulted in ICERs greater than $50 000 per QALY. Shifting timing of vaccination programs to better align with periods of high COVID-19 case occurrence resulted in biannual vaccination for those aged 65 years and older being cost effective.

CONCLUSIONS AND RELEVANCE: In this economic evaluation of COVID-19 vaccination strategies, programs were observed to be cost effective when focused on groups at higher risk of disease. Optimal timing of programs improved the cost effectiveness of vaccination strategies. As COVID-19 transitioned to an endemic disease with high levels of population immunity, many jurisdictions revisited COVID-19 vaccination recommendations; these results identified COVID-19 vaccination programs that may provide good value for money.

PMID:40512495 | DOI:10.1001/jamanetworkopen.2025.15534

JAMA Netw Open. 2025 Jun 2;8(6):e2515592. doi: 10.1001/jamanetworkopen.2025.15592.

ABSTRACT

IMPORTANCE: Chronic low back pain (LBP) is a prevalent and costly condition, and regular physical activity may reduce its risk. Walking is a common and accessible form of physical activity, but its association with the risk of chronic LBP is unclear.

OBJECTIVE: To examine whether accelerometer-derived daily walking volume and walking intensity are associated with the risk of chronic LBP.

DESIGN, SETTING, AND PARTICIPANTS: This prospective population-based cohort study used data from the Trøndelag Health (HUNT) Study in Norway, with a baseline in 2017 to 2019 and follow-up in 2021 to 2023. The study included individuals without chronic LBP at baseline and with at least 1 valid day of device-measured walking.

EXPOSURE: Daily walking volume (minutes per day) and walking intensity, expressed as metabolic equivalent of task (MET) per minute.

MAIN OUTCOMES AND MEASURES: The primary outcome was self-reported chronic LBP at follow-up, defined as pain lasting 3 months or longer in the past 12 months. Poisson regression was used to estimate adjusted risk ratios (RRs) with 95% CIs of chronic LBP according to daily walking volume and mean walking intensity.

RESULTS: A total of 11 194 participants aged 20 years or older (mean [SD] age, 55.3 [15.1] years; 6564 women [58.6%]) were included in the analysis. At follow-up (mean [SD] follow-up time, 4.2 [0.3] years), 1659 participants (14.8%) reported chronic LBP. Continuous measures of both walking volume and walking intensity were inversely associated with the risk of chronic LBP using restricted cubic splines models. Compared with participants walking less than 78 minutes per day, those walking 78 to 100 minutes per day had an RR for chronic LBP of 0.87 (95% CI, 0.77-0.98), those walking 101 to 124 minutes per day had an RR of 0.77 (95% CI, 0.68-0.87), and those walking 125 minutes or more per day had an RR of 0.76 (95% CI, 0.67-0.87). Compared with a mean walking intensity of less than 3.00 MET per minute, participants with walking intensity of 3.00 to 3.11 MET per minute had an RR for chronic LBP of 0.85 (95% CI, 0.75-0.96), those with walking intensity of 3.12 to 3.26 MET per minute had an RR of 0.82 (95% CI, 0.72-0.93), and those with walking intensity greater than or equal to 3.27 MET per minute had an RR of 0.82 (95% CI, 0.72-0.93). After mutual adjustment, the association remained largely similar for walking volume but was attenuated for walking intensity.

CONCLUSIONS AND RELEVANCE: In this cohort study, daily walking volume and walking intensity were inversely associated with the risk of chronic LBP. The findings suggest that walking volume may have a more pronounced benefit than walking intensity.

PMID:40512494 | DOI:10.1001/jamanetworkopen.2025.15592

JAMA Netw Open. 2025 Jun 2;8(6):e2515894. doi: 10.1001/jamanetworkopen.2025.15894.

ABSTRACT

IMPORTANCE: Many conditions, including neurodegenerative diseases and psychiatric disorders, can impair financial decision-making in older age. Although banking data offer rich insights, they have not yet been leveraged to understand how the loss of financial capacity is associated with financial behaviors.

OBJECTIVE: To describe the behavioral indicators of financial capacity loss and the association of financial capacity loss with financial vulnerability.

DESIGN, SETTING, AND PARTICIPANTS: In this case-control study, banking data recorded by a major UK bank between January 1, 2009, and April 21, 2023, were used to compare the financial outcomes of a group of 16 742 donors of power of attorney (PoA) registrations with a “loss of financial capacity” marker and a control group of 50 226 individuals with no reported financial capacity loss that matched the demographic and socioeconomic characteristics of the donor group 10 years prior to their PoA registration. Group differences in financial outcomes were examined in the 10-year period leading up to the PoA registration. Analysis took place between December 2023 and December 2024.

EXPOSURES: Bank registrations of PoAs recorded between 2019 and 2023 for which the attorney reported that the donor lost financial capacity.

MAIN OUTCOME MEASURES: A broad range of 344 financial measures capturing day-to-day transactional activity (eg, spending on travel and hobbies) and other financial behaviors (eg, online banking logins).

RESULTS: The group of donors of PoA registrations with a “loss of financial capacity” marker comprised 16 742 individuals (mean [SD] age, 72.8 [8.5] years; 10 285 women [61.4%]), and the control group comprised 50 226 individuals (mean [SD] age, 72.7 [8.2] years; 30 657 women [61.0%]). During the 5 years prior to PoA registration, compared with the control group, donors were increasingly less likely to spend on everyday activities (clothing [difference, -9.1 percentage points (pp); 95% CI, -10.0 to -8.3 pp], travel [eg, hotels; difference, -9.6 pp; 95% CI, -10.5 to -8.8 pp], hobbies [eg, gardening; difference, -7.9 pp; 95% CI, -8.8 to -7.1 pp]) and more likely to spend on items associated with increased time at home (eg, household gas and electricity bills [difference, 5.1 pp; 95% CI, 4.6-5.7 pp]). Signs of heightened financial vulnerability in the donor group compared with the control group included an increase in the frequencies of PIN (personal identification number) reset requests (difference, 0.002 [95% CI, 0.002-0.003]), fraud cases (eg, animal charity difference, 0.0003 [95% CI, 0.0002-0.0003]), and lost or stolen credit or debit cards reported (difference, 0.005 [95% CI, 0.004-0.006]) and increased spending on charity (difference, 1.1 pp [95% CI, 0.5-1.7 pp]). In addition, the donor group exhibited reduced attention to finances compared with the control group via decreased online banking activity (difference in number of monthly online banking logins, -1.0 [95% CI, -1.1 to -0.8]).

CONCLUSIONS AND RELEVANCE: This study highlighted the financial behaviors and vulnerabilities associated with declining financial capacity, such as a decrease in activity across multiple domains of daily life. These findings illustrate how banking data can reveal early behavioral signs and financial harms associated with financial capacity loss.

PMID:40512491 | DOI:10.1001/jamanetworkopen.2025.15894