Category: Statistics

Psychol Assess. 2025 Jun 2. doi: 10.1037/pas0001389. Online ahead of print.

ABSTRACT

The Inventory of Depression and Anxiety Symptoms-II (IDAS-II) addresses current clinical demands by providing individual scores for depressive, anxiety, and bipolar symptoms consistent with transdiagnostic approaches and the Hierarchical Taxonomy of Psychopathology. The general aim was to expand the clinical utility of the IDAS-II to assess changes in internalizing symptoms, quality of life (QoL), and disability. Participants included 1,072 community adults (50% women) and 289 patients (74% women) who completed the IDAS-II. Patients also completed the Short Form-36 Health Survey and World Health Organization Disability Assessment Schedule to evaluate QoL and disability, respectively. First, the sensitivity of the IDAS-II scores to treatment impact was assessed through statistical significance and reliable changes based on the internal consistency of the IDAS-II. Second, the relationship between changes in IDAS-II scores and changes in QoL and disability was analyzed using weighted Cohen’s κ and Spearman correlations. Third, an anchor-based longitudinal method determined the minimal clinically important difference in QoL and disability for the IDAS-II scales (i.e., the smallest difference in IDAS-II scores perceived as beneficial for QoL and disability). Reliable change index values and cutoff c were provided to identify reliable improvement, deterioration, no change, and clinically significant change for each symptom. Changes in general depression and dysphoria were most strongly associated with changes in QoL and disability. The minimal clinically important difference values for the IDAS-II provide insights into perceived QoL and disability improvement without requiring additional measures. Tracking symptom changes and their implications for QoL and disability is useful in guiding evidence-based decisions in clinical practice. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40455509 | DOI:10.1037/pas0001389

J Fam Psychol. 2025 Jun 2. doi: 10.1037/fam0001361. Online ahead of print.

ABSTRACT

It is well-established that parenting plays a crucial role in shaping the mental health of adolescents. This study aimed to investigate the longitudinal association between adolescents’ perceived parental warmth, COVID-19 peritraumatic distress, and emotional problems. Participants were recruited from schools in Zhuhai, Xinyang, and Ningxiang. A total of 579 adolescents (55.4% girls, M_age = 12.83; SD_age = 0.76) took part in this three-wave study conducted in January 2023 (Time 1), March 2023 (Time 2), and May 2023 (Time 3), with each wave being 2 months apart. The results from the cross-lagged panel model supported significant bidirectional relations between emotional problems and COVID-19 peritraumatic distress. In addition, the influence of maternal or paternal warmth on subsequent emotional problems was not statistically significant. The COVID-19 peritraumatic distress at Time 2 mediated the longitudinal effect of emotional problems at Time 1 on paternal warmth at Time 3. Nevertheless, COVID-19 peritraumatic distress did not significantly influence subsequent maternal warmth. These findings contribute to our understanding of the varying responses to adolescents’ stress across parental gender. Furthermore, they imply potential strategies to protect the healthy development of adolescents. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40455507 | DOI:10.1037/fam0001361

J Prosthodont. 2025 Jun 2. doi: 10.1111/jopr.14078. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate and compare the clinical outcomes of translucent monolithic zirconia (TMZ) and metal-ceramic (MC) posterior crowns fabricated with digital workflow over a 5-year observation period.

MATERIALS AND METHODS: Fifty-two patients, in need of a posterior crown, were included in the study and randomly divided into 2 groups to receive either TMZ or MC crowns (n = 30 each). The restorations were fabricated with a digital workflow and cemented with resin cement. The clinical outcomes and periodontal parameters were assessed at baseline and yearly for 5 years. Statistical analysis was performed using the Wilcoxon signed-rank test, Friedman test, and Mann-Whitney U test.

RESULTS: The survival rate at 5 years was 100% for both groups. Mechanical complications were detected in the MC group due to minor ceramic chipping. No biological complications were observed. All crowns were assessed as satisfactory in both groups. A significant variation in gingival index (GI) scores was observed in both groups throughout the observation period.

CONCLUSIONS: Translucent monolithic zirconia may be considered a reliable alternative to MC posterior crowns within the assessed follow-up period. The digital workflow provided satisfactory clinical performance.

PMID:40455497 | DOI:10.1111/jopr.14078

JAMA Intern Med. 2025 Jun 2. doi: 10.1001/jamainternmed.2025.1380. Online ahead of print.

ABSTRACT

IMPORTANCE: A single text-only e-cigarette warning about nicotine addiction is required by the US Food and Drug Administration in the US, yet little is known about whether health harms warnings are more effective than the required nicotine addiction warning.

OBJECTIVE: To assess the effectiveness of text-only e-cigarette warnings on message processing, risk belief, and behavioral intention outcomes, as well as the impact of health harm warnings and the required nicotine addiction warning or similar addiction warnings.

DATA SOURCES: A comprehensive search was conducted using PubMed, Embase, Scopus, PsycINFO, and Business Source Premier from inception through February 2024. Review articles were also examined for potential studies.

STUDY SELECTION: Experimental studies that randomized participants to view nicotine addiction or health harms e-cigarette warnings were included. Studies had to report 1 or more message processing, risk perception, or behavioral intention outcomes.

DATA EXTRACTION AND SYNTHESIS: Using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines, 2 independent coders (Y.J. and J.S.) screened and coded all studies. Effect sizes characterizing overall warning effects and health harm vs addiction warning effects were calculated using the standardized mean difference (d). Effect sizes were pooled using random-effects models and tested for heterogeneity using the Q statistic and I2. Effect sizes with their 95% CIs, as well as prediction intervals, are reported.

MAIN OUTCOMES AND MEASURES: The outcomes were attention, negative affect, and effects perceptions (message processing); addiction, risk, and relative risk beliefs (risk perceptions); and intentions to vape and intentions to quit vaping (behavioral intentions).

RESULTS: Across 24 studies with 22 549 participants (mean [SD] age, 27.91 [6.36] years; 53.9% female), e-cigarette text-only warnings were associated with improvement of most outcomes. Compared to control, e-cigarette warnings were associated with greater attention (d, 0.52; 95% CI, 0.33-0.70), negative affect (d, 0.65; 95% CI, 0.49-0.81), and effects perceptions (d, 0.95; 95% CI, 0.69-1.21), as well as increased addiction beliefs (d, 0.24; 95% CI, 0.05-0.42) and risk beliefs (d, 0.26; 95% CI, 0.16-0.36) but not relative risk beliefs (d, 0.00; 95% CI, -0.11 to 0.12). E-cigarette warnings also were associated with reduced intentions to vape (d, -0.14; 95% CI, -0.27 to -0.01) and increased intentions to quit vaping (d, 0.34; 95% CI, 0.09-0.58). Health harm warnings outperformed nicotine addiction warnings on many outcomes. Compared to addiction warnings, health harm warnings were associated with more negative affect (d, 0.44; 95% CI, 0.32-0.52), attention (d, 0.37; 95% CI, 0.26-0.49), and effects perceptions (d, 0.36; 95% CI, 0.23-0.49), as well as increased risk beliefs (d, 0.07; 95% CI, 0.00-0.13) and intentions to quit vaping (d, 0.17; 95% CI, 0.06-0.27). There were no differences in addiction beliefs, relative risk beliefs, or intentions to vape for health harms vs addiction warnings.

CONCLUSIONS AND RELEVANCE: In this meta-analysis of experimental studies, text-only e-cigarette warnings were associated with increased beliefs about the harm and addictiveness of e-cigarettes without creating the misperception that e-cigarettes are more harmful than cigarettes. Warnings were also associated with reduced intentions to vape and increased intentions to quit vaping. These findings support adding health harms to e-cigarette warnings and have important implications for warning policy.

PMID:40455487 | DOI:10.1001/jamainternmed.2025.1380

JAMA Netw Open. 2025 Jun 2;8(6):e2513177. doi: 10.1001/jamanetworkopen.2025.13177.

ABSTRACT

IMPORTANCE: Musculoskeletal injuries (MSKIs) are pervasive problems in novice training environments. Evaluation of modifiable and nonmodifiable risk factors of MSKI risk prior to entry into these environments is largely understudied.

OBJECTIVE: To provide military leaders, civilian and military clinicians, and physical training instructors with an MSKI risk model for identifying low-, moderate-, and high-risk profiles among individuals starting US Army Basic Combat Training (BCT) or a physical training program.

DESIGN, SETTING, AND PARTICIPANTS: In this prospective cohort study, data collection was conducted between August 5, 2017, and April 15, 2023, at 2 US Army BCT sites. The sample consisted of volunteer trainees between the ages of 17 and 41 years. They were followed up from the start of BCT. Data analyses were conducted from April to September 2024.

EXPOSURES: Data for the factors potentially associated with MSKI were collected during the first week of BCT and included blood draws, total body dual-energy x-ray absorptiometry, and muscle power test results; surveys of demographics, medical history, physical activity, psychological characteristics, and sleep patterns; and physical fitness results.

MAIN OUTCOMES AND MEASURES: MSKIs identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes. Logistic regression-based models estimating the risk of MSKI were generated using 5-fold internal cross-validation for the total cohort, males, and females. Traffic light model examples of low (green), moderate (amber), and high (red) MSKI risk tiers were produced.

RESULTS: In this cohort study of 2988 Army trainees (median [IQR] age, 19.0 [19.0-22.0] years; 1880 males [62.9%]), 729 females (49.0%) and 758 males (51.0%) had an ICD-10 code-identified MSKI, and 1067 (35.7%) had more than 1 ICD-10 code-identified MSKI. Factors associated with increased MSKI risk in the total cohort and female- and male-specific MSKI risk models (with areas under the receiver operator characteristic curve of 0.701, 0.678, and 0.661, respectively) encompassed 7 variable categories: demographics; anthropometrics and body composition; nutritional status; medical and health history; history of sports and past or current physical activity or fitness; psychological factors (ie, pain, grit, and hardiness); and sleep parameters.

CONCLUSIONS AND RELEVANCE: This cohort study presents a tiered approach to identifying persons at increased MSKI risk before the start of a physical training program. Applying a tiered quantification risk metric and incorporating multifactorial interventions from these findings may play a role in reduced MSKI risk.

PMID:40455447 | DOI:10.1001/jamanetworkopen.2025.13177

JAMA Netw Open. 2025 Jun 2;8(6):e2513274. doi: 10.1001/jamanetworkopen.2025.13274.

ABSTRACT

IMPORTANCE: As a result of consolidation in the health care delivery system, most very preterm infants in the US are born and receive care in multihospital health systems. The extent of variation in patient outcomes and length of stay for this vulnerable population across health systems and across hospitals within systems is not known.

OBJECTIVE: To evaluate the extent of variation in mortality and length of stay within and across health systems for infants born very preterm (gestational age 24-29 weeks).

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined data contributed by Vermont Oxford Network US member hospitals in 224 health systems that delivered care to very preterm infants born between January 1, 2021, and December 31, 2022.

EXPOSURE: Receipt of neonatal intensive care unit (NICU) care in a horizontally integrated multihospital health system.

MAIN OUTCOMES AND MEASURES: Mortality rates and length of stay among surviving infants were estimated using multilevel logistic and linear models.

RESULTS: The sample included 38 501 infants (median [IQR] gestational age, 27 [26-28] weeks; 52.8% boys). The median (IQR) number of infants receiving care at a hospital system during the 2-year period was 108 (59-198); 91.0% were born at the reporting hospital, and 95.4% were born in the reporting system. The mean adjusted mortality rate in the highest performing quartile of systems was 7.8% (95% credible interval [CrI], 7.3%-8.3%) compared with 9.8% (95% CrI, 9.1%-10.7%) for the lowest performing quartile. The mean adjusted length of stay for surviving infants ranged from 78 days (95% CrI, 77-79 days) to 90 days (95% CrI, 88-91 days) between the highest and lowest performing quartiles of systems, respectively.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of very preterm infants, there was a 2-percentage point difference in mortality between systems in the highest and lowest performing quartiles and a 12-day difference in mean length of stay among surviving infants, which are potentially clinically meaningful. Opportunities exist for health systems to improve quality at the health system level to decrease mortality among infants born very preterm and reduce resources used in patient care.

PMID:40455446 | DOI:10.1001/jamanetworkopen.2025.13274

JAMA Netw Open. 2025 Jun 2;8(6):e2513280. doi: 10.1001/jamanetworkopen.2025.13280.

ABSTRACT

IMPORTANCE: Understanding the primary social drivers of unsafe firearm storage practices is essential for preventing firearm-related injuries.

OBJECTIVE: To examine household firearm ownership and storage practices, assess their association with social drivers of health (SDOH), and identify factors associated with unsafe storage practices among adult residents.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used 2022 Behavioral Risk Factor Surveillance System data from adults in 5 US states. Data analysis occurred from April 1 to October 2, 2024.

EXPOSURES: Participation in the Behavioral Risk Factor Surveillance System. SDOH include food insecurity, housing insecurity, social isolation, job loss or employment insecurity, feeling stressed, transportation barriers, and financial hardship.

MAIN OUTCOMES AND MEASURES: Firearm ownership and storage were assessed using structured questions. Storage practices were categorized as safest (all firearms unloaded), intermediate risk (at least 1 loaded and locked), and unsafe (at least 1 loaded and unlocked). Multivariable weighted logistic regression models estimated adjusted odds ratios (aORs) for firearm ownership and storage practices, accounting for demographic, socioeconomic, behavioral and mental health characteristics, and state firearm policies.

RESULTS: The unweighted study included 44 736 adults. The weighted population was 52.5% (95% CI, 51.5%-53.5%) female; 1.6% (95% CI, 1.4%-1.9%) American Indian, Alaska Native, and Pacific Islander; 10.0% (95% CI, 9.2%-10.8%) Asian non-Hispanic; 7.7% (95% CI, 7.2%-8.3%) Black non-Hispanic; 25.1% (95% CI, 24.1%-26.1%) Hispanic; 52.5% (95% CI, 51.5%-53.5%) White non-Hispanic; and 3.1% (95% CI, 2.7%-3.6%) multiracial. Firearms were owned in 29.3% of households (17 146 respondents), with 67.9% (11 396 respondents) storing them unloaded, 15.9% (2391 respondents) storing them loaded and locked, and 16.4% (2816 respondents) storing them loaded and unlocked. Unsafe storage was most common among non-Hispanic Black firearm owners (aOR, 2.23; 95% CI, 1.39-3.57). Food insecurity (aOR, 3.09; 95% CI, 1.29-7.40), housing insecurity (aOR, 1.66; 95% CI, 1.01-2.79), transportation barriers (aOR, 2.16; 95% CI, 1.19-3.90), and financial hardship (aOR, 2.22; 95% CI, 1.16-4.28) were significantly associated with unsafe storage practices. Households with children had higher odds of firearm ownership (aOR, 1.22; 95% CI, 1.05-1.43), but lower odds of unsafe storage (aOR, 0.38; 95% CI, 0.26-0.55). Child access prevention laws were associated with lower odds of firearm ownership (aOR, 0.57; 95% CI, 0.51-0.63) and unsafe storage (aOR, 0.52; 95% CI, 0.40-0.68). Behavioral risks like binge alcohol use (aOR, 1.39; 95% CI, 1.01-1.93) and life dissatisfaction (aOR, 1.81; 95% CI, 1.05-3.11) were associated with increased firearm ownership and unsafe storage.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of US adults, firearm ownership was more prevalent among non-Hispanic White, higher-income, and highly educated households, but unsafe storage was more common among non-Hispanic Black and lower-income households. SDOH and high-risk behaviors, including alcohol misuse and life dissatisfaction, were linked to unsafe storage. Targeted public health initiatives are crucial for improving firearm safety.

PMID:40455445 | DOI:10.1001/jamanetworkopen.2025.13280

JAMA Netw Open. 2025 Jun 2;8(6):e2513293. doi: 10.1001/jamanetworkopen.2025.13293.

ABSTRACT

IMPORTANCE: Socioeconomic disparities are increasingly recognized as key factors in health outcomes among patients with type 2 diabetes. Understanding how income level and its changes are associated with severe hypoglycemia risk may inform targeted interventions and policy decisions.

OBJECTIVE: To evaluate the association between income level, including changes in income status, and the risk of severe hypoglycemia, and to assess whether this association varies across key subgroups in middle-aged adults.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included adults aged 40 to 70 years with type 2 diabetes from the Korean National Health Information Database (NHID) who underwent health examinations from 2015 to 2016. Participants aged 40 to 70 years with type 2 diabetes and valid income information were recruited between 2006 and 2010 from the UK Biobank (UKBB) and were included for sensitivity analysis. Data were analyzed from January 2023 to September 2024.

EXPOSURES: Participants were categorized into annual income quartiles (NHID) or self-reported income brackets (UKBB). In the NHID, medical aid beneficiaries (ie, those receiving government medical aid due to income below 40% of the median income and limited assets) were identified, and income changes over a 5-year period were assessed.

MAIN OUTCOMES AND MEASURES: Severe hypoglycemia requiring medical intervention.

RESULTS: Among 1 838 362 adults with type 2 diabetes from the NHID (mean [SD] age, 57.1 [8.1] years; 1 157 263 [63.0%] male) and 17 287 participants from the UKBB (mean [SD] age, 56.9 [6.8] years; 11 522 [66.7%] male), lower income was associated with a higher risk of severe hypoglycemia (NHID: hazard ratio [HR], 2.50; 95% CI, 2.33-2.57; UKBB: HR, 5.38; 95% CI, 1.72-16.85). In the NHID, individuals whose income increased from the lowest quartile or medical aid status to the fourth quartile over 5 years had a significantly lower risk (HR, 0.74; 95% CI, 0.67-0.81; P for trend <.001), whereas receiving medical aid for at least 1 year was associated with a significantly higher risk (HR, 1.71; 95% CI, 1.54-1.89). The association between income and severe hypoglycemia was consistently greater in men, individuals not using insulin, those without chronic kidney disease, and those with a shorter duration of diabetes.

CONCLUSIONS AND RELEVANCE: In this cohort study of adults with type 2 diabetes, low income was found to be a significant factor associated with risk for severe hypoglycemia. Addressing socioeconomic disparities and implementing targeted interventions may help reduce the incidence and severity of hypoglycemia.

PMID:40455444 | DOI:10.1001/jamanetworkopen.2025.13293

JAMA Netw Open. 2025 Jun 2;8(6):e2513361. doi: 10.1001/jamanetworkopen.2025.13361.

ABSTRACT

IMPORTANCE: Sickle cell disease (SCD) is a complex hemoglobinopathy. Vaso-occlusive episodes are the primary cause of emergency department (ED) utilization among individuals with SCD. Literature lacks a standardized definition for high ED utilization.

OBJECTIVE: To explore ED utilization, redefine high ED utilization, and describe factors associated with super-high ED utilization among individuals with SCD.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study analyzed the North Carolina Hospital Discharge Datasets (2013-2019). Participants were included if they had SCD, defined as at least 3 SCD visits (ED, inpatient, or outpatient surgery) in a rolling 5-year period. All age groups, sexes, and payers, regardless of state of residence, were included. Data were analyzed from July 2023 to August 2024.

EXPOSURES: Variables included sex, race, ethnicity, age, age at death, distance (in miles) to the closest SCD center, number of annual ED visits, and social vulnerability index (SVI).

MAIN OUTCOMES AND MEASURES: To determine ED utilization categories, first the distribution of people based on the number of annual ED visits was examined, then the categories across years were identified to determine the data-informed cutoff for each category. Univariate analysis determined differences between participants based on the ED utilization category using χ2 tests of independence or analysis of variance, as applicable. Descriptive statistics were conducted to describe characteristics of utilization in the sample and by ED utilization group. A parsimonious multinomial regression was conducted using significant factors from the univariate analysis.

RESULTS: The cohort included 9964 unique patients (5364 [53.83%] female; mean [SD] age, 24.49 [17.54] years), including 9355 Black patients (93.89%), with 100 188 total ED visits from 2013 to 2019. ED visits were categorized into 4 levels: low (0-1 visits per year), moderate (2-9 visits per year), high (10-32 visits per year), and super high (≥33 visits per year). A small subset (178 patients [1.79%]) exhibited super-high ED utilization, contributing disproportionately to the total number of ED visits. Older age, younger age for in-facility deaths, and higher SVI were significantly associated with higher ED utilization. Patients with high utilization were more likely to die, die younger (eg, median [IQR] age at death, 33.0 [30.0-44.0] years in the super-high utilization group vs 50 [38.0-61.0] years in the moderate utilization group), use multiple EDs (eg, 93.8% of participants in the super-high utilization group vs 40.08% of participants in the moderate utilization group), and reside in counties more disadvantaged on socioeconomic and transportation characteristics.

CONCLUSIONS AND RELEVANCE: This cohort study of 7 years of North Carolina Hospital Discharge Data described 4 new categories of ED utilization in SCD. These categories could be used to reframe how high ED use is determined.

PMID:40455443 | DOI:10.1001/jamanetworkopen.2025.13361

JAMA Netw Open. 2025 Jun 2;8(6):e2513384. doi: 10.1001/jamanetworkopen.2025.13384.

ABSTRACT

IMPORTANCE: Dementia is a significant public health challenge, with its prevalence expected to increase as life expectancy continues to extend globally.

OBJECTIVE: To estimate generational differences in age-specific dementia prevalence across the US, Europe, and England.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from 1994 to 2021 from the United States Health and Retirement Study (HRS), from 2004 to 2020 from the Survey of Health, Ageing and Retirement in Europe (SHARE), and from 2002 to 2019 from the English Longitudinal Study of Ageing (ELSA). Statistical analysis was performed from May 2023 to February 2025.

MAIN OUTCOMES AND MEASURES: First, 2 different methods-the validated algorithm and machine learning techniques as the robustness check-were used to identify respondents with probable dementia. Then the status of dementia was used to estimate the association of cohort with dementia status by age-period-cohort methodology.

RESULTS: Of the 99 420 individuals (mean [SD] age, 79.1 [6.2] years; 59.2% women) in the HRS dataset, 21 069 (21.2%) were included in this study; of the 83 580 individuals (mean [SD] age, 78.6 [5.9] years; 54.7% women) in the SHARE dataset, 32 490 (38.9%) were included in this study; and of the 31 384 individuals (mean [SD] age, 77.9 [5.6] years; 55.8% women) in the ELSA dataset, 8878 (28.3%) were included in this study. Focusing on people aged 71 years or older and controlling for age and period effects, birth cohorts born more recently were less likely to develop dementia in all 3 regions, albeit at different rates (point estimate for 1944-1948 vs 1919-1923 cohorts: US, -0.55 [95% CI, -0.77 to -0.34] vs -0.18 [95% CI, -0.25 to -0.10]; Europe, -1.49 [95% CI, -1.72 to -1.27] vs -0.24 [95% CI, -0.35 to -0.13]; and England, -0.48 [95% CI, -0.89 to -0.08] vs -0.23 [95% CI, -0.38 to -0.07]). This decreasing trend was more pronounced among women than men (point estimate in 1944-1948 for women vs men: US, -0.55 [95% CI, -0.86 to -0.30] vs -0.48 [95% CI, -0.84 to -0.13]; Europe, -1.50 [95% CI, -1.80 to -1.21] vs -1.34 [95% CI, -1.70 to -0.99]; and England, -0.76 [95% CI, -1.30 to -0.23] vs -0.07 [95% CI, -0.69 to 0.54]); the point estimates for men in England were not statistically significant.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study examining generational differences in age-specific dementia prevalence across the US, Europe, and England, we found that individuals from more recent birth cohorts had lower proportions of people with dementia. Work of this kind is relevant to plan for health and long-term care policy and workforce requirements across these regions now and into the future.

PMID:40455442 | DOI:10.1001/jamanetworkopen.2025.13384