Category: Statistics

JAMA Health Forum. 2025 Feb 7;6(2):e245436. doi: 10.1001/jamahealthforum.2024.5436.

ABSTRACT

IMPORTANCE: Considerable efforts have been dedicated to improving the quality of end-of-life care among patients with advanced cancer in the past decade. Whether the quality has shifted in response to these efforts remains unknown.

OBJECTIVE: To examine contemporary patterns of end-of-life care among patients with advanced cancer.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used a recent linkage of Surveillance, Epidemiology, and End Results and Medicare data to characterize patterns of end-of-life care. The cohort included fee-for-service Medicare decedents aged 66 years or older who were originally diagnosed with distant-stage breast, prostate, pancreatic, or lung cancers and died between 2014 and 2019. Analyses were conducted between June 1, 2023, and July 31, 2024.

MAIN OUTCOMES AND MEASURES: Outcomes included monthly use of acute care, systemic therapy, and supportive care (ie, palliative and hospice care and advanced care planning) in the last 6 months of life. Additionally, a claims-based indicator was evaluated of potentially aggressive care in the last 30 days of life, defined as experiencing more than 1 acute care visit, in-hospital mortality, late receipt of systemic therapy, or hospice entry.

RESULTS: The study included 33 744 Medicare decedents with advanced cancer (mean [SD] age, 75.7 [6.9] years; 52.1% male). From 6 months before death to month of death, there was an increase in the mean (SE) number of acute care visits (from 14.0 [0.5] to 46.2 [0.5] per 100 person-months), hospice use (from 6.6 [0.4] to 73.5 [0.5] per 100 person-months), palliative care (from 2.6 [0.2] to 26.1 [0.6] per 100 person-months), and advanced care planning (from 1.7 [0.6] to 12.8 [1.1] per 100 person-months). Overall, 45.0% of decedents experienced any indicator of potentially aggressive care.

CONCLUSIONS AND RELEVANCE: This study found persistent patterns of potentially aggressive care, but low uptake of supportive care, among Medicare decedents with advanced cancer. A multifaceted approach targeting patient-, physician-, and system-level factors associated with potentially aggressive care is imperative for improving quality of care at the end of life.

PMID:39982714 | DOI:10.1001/jamahealthforum.2024.5436

J Med Entomol. 2025 Feb 21:tjaf003. doi: 10.1093/jme/tjaf003. Online ahead of print.

ABSTRACT

Ticks and tick-borne disease (TBD) risks are increasing in Indiana and North America. The successful prevention, diagnosis, and treatment of TBDs requires healthcare professionals be well-informed and prepared. This study reports the findings of a 2020 online survey of 465 Indiana healthcare professionals, designed to assess their knowledge of ticks and TBDs and identify factors influencing total knowledge scores. The survey included 24 discrete/ordinal questions and one open-ended question. Statistical analyses, including ANOVA, t-tests, and the Boruta algorithm, were conducted in R. Indiana healthcare professionals scored 30.8% for tick- and 57.9% for disease-related questions. Professionals scored higher on most disease-related questions, including (i) the importance of prompt tick removal to reduce TBD transmission risk, (ii) that not all Lyme disease cases present with bull’s-eye rash, and (iii) the signs and symptoms of TBDs. They scored lower on tick-related questions, including (i) the tick species capable of transmitting diseases to humans, (ii) TBDs considered endemic, (iii) the distribution of Ixodes scapularis (deer tick), and (iv) regions considered higher risk for Lyme disease transmission in Indiana. Knowledge scores varied across demographic categories, with the use of online resources identified as the most important predictor of total knowledge scores. These findings highlight the importance of increasing awareness of existing resources, expanding online educational materials to cover TBDs beyond Lyme disease, and promoting self-guided learning. Achieving these goals will require collaboration among state and public health agencies, healthcare professionals, research institutions, and community outreach partners.

PMID:39982704 | DOI:10.1093/jme/tjaf003

J Med Entomol. 2025 Feb 21:tjaf017. doi: 10.1093/jme/tjaf017. Online ahead of print.

ABSTRACT

Deer keds (Lipoptena cervi), an introduced European species, are expanding their geographic range in North America. We document their first recorded presence in Québec, Canada, map their distribution, and highlight the detection of pathogens of potential public health relevance. In the Estrie region of southern Québec, 47 deer keds (L. cervi) were collected from 14 (5.5%) of 254 harvested white-tailed deer (Odocoileus virginianus). Borrelia spp. and Anaplasma phagocytophilum were detected in the body of 1/44 and 8/44 L. cervi specimens, respectively. A statistically significant spatial cluster of white-tailed deer infested by L. cervi was found in southern Estrie using the Bernoulli-based spatial scan statistic.

PMID:39982702 | DOI:10.1093/jme/tjaf017

Cancer Epidemiol Biomarkers Prev. 2025 Feb 21. doi: 10.1158/1055-9965.EPI-24-0970. Online ahead of print.

ABSTRACT

BACKGROUND: Tumor immunosurveillance theory supports that allergic conditions could decrease cancer risk. However, observational evidence yielded inconsistent results for the association between allergic diseases and colorectal cancer risk. We used Mendelian randomization (MR) to examine potential causal associations of allergies with risk of overall and early-onset colorectal cancer.

METHODS: Genome-wide association study summary statistic data were used to identify genetic variants associated with allergic diseases (Nvariants=65) and individual allergic conditions (asthma, hay fever/allergic rhinitis, eczema). Using two-sample MR, we examined these variants in relation to incident overall (Ncases=52,775 cases) and early-onset colorectal cancer (Ncases=6,176). The mediating role of white blood cells was examined using multivariable MR.

RESULTS: In inverse-variance weighted models, genetic liability to allergic diseases was inversely associated with overall (ORper log(odds)= 0.90 [95% CI= 0.85-0.96]; P< 0.01) and early-onset colorectal cancer (OR= 0.83 [95% CI= 0.73-0.95]; P= 0.01). Similar inverse associations were found for hay fever/allergic rhinitis or eczema, while no evidence of association was found between liability to asthma-related phenotypes and colorectal cancer risk. Multivariable MR adjustment for eosinophils weakened the inverse associations for liability to allergic diseases for overall (OR= 0.96 [95% CI= 0.89-1.03]; P= 0.26) and early-onset colorectal cancer (OR= 0.86 [95% CI= 0.73-1.01]; P= 0.06).

CONCLUSIONS: Our study supports a potential causal association between liability to allergic diseases, specifically hay fever/allergic rhinitis or eczema, and colorectal cancer, possibly at least in part mediated via eosinophil counts.

IMPACT: Our results provide evidence that allergic responses may also have a role in immunosurveillance against colorectal cancer.

PMID:39982694 | DOI:10.1158/1055-9965.EPI-24-0970

Interdiscip Sci. 2025 Feb 21. doi: 10.1007/s12539-025-00688-5. Online ahead of print.

ABSTRACT

Single-cell RNA sequencing (scRNA-seq) is a groundbreaking technology extensively utilized in biological research, facilitating the examination of gene expression at the individual cell level within a given tissue sample. While numerous tools have been developed for scRNA-seq data analysis, the challenge persists in capturing the distinct features of such data and replicating virtual datasets that share analogous statistical properties. Our study introduces a generative approach termed scRNA-seq Diffusion Transformer (scRDiT). This method generates virtual scRNA-seq data by leveraging a real dataset. The method is a neural network constructed based on Denoising Diffusion Probabilistic Models (DDPMs) and Diffusion Transformers (DiTs). This involves subjecting Gaussian noises to the real dataset through iterative noise-adding steps and ultimately restoring the noises to form scRNA-seq samples. This scheme allows us to learn data features from actual scRNA-seq samples during model training. Our experiments, conducted on two distinct scRNA-seq datasets, demonstrate superior performance. Additionally, the model sampling process is expedited by incorporating Denoising Diffusion Implicit Models (DDIMs). scRDiT presents a unified methodology empowering users to train neural network models with their unique scRNA-seq datasets, enabling the generation of numerous high-quality scRNA-seq samples.

PMID:39982678 | DOI:10.1007/s12539-025-00688-5

Eur J Health Econ. 2025 Feb 21. doi: 10.1007/s10198-024-01755-2. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: The aims of this study were to provide population norms for EQ-5D-5L in Hungary and investigate the differences in EQ-5D-5L normative data by survey mode, i.e. online surveys and computer assisted personal interviews (CAPI).

METHODS: A pooled database was built comprising six online (N = 7,034) and two CAPI (N = 3,020) population-based studies with the EQ-5D-5L. Descriptive statistics were performed. Multinominal logistic and linear regression analyses were applied to compare the online and CAPI samples. Traditional and machine learning regression tools were used to investigate the determinants of EQ-5D-5L index values.

RESULTS: ‘No problems’ in any of the five EQ-5D-5L domains were reported by 33.9% (online) and 58.9% (CAPI) of the participants. Most problems were reported on the pain/discomfort domain in both study types (51.9% and 33.6%, respectively). Men and more educated respondents had significantly higher average EQ-5D-5L index values. EQ-5D-5L index values and EQ VAS scores were significantly higher in the CAPI sample, except in age groups 65-74 (no difference) and 75+ (online scores were significantly higher). Only 7-10% of variance in the EQ-5D-5L index values was explained by the variables survey mode, education, sex and age, with age having the largest and sex the smallest effect.

CONCLUSIONS: EQ-5D-5L population norms derived from online and CAPI studies may differ significantly from each other. It is recommended to consider the survey mode, sampling and sociodemographic characteristics of the participants when choosing population norms as reference set. Further comparative studies investigating EQ-5D-5L population norms by different study designs and administration modes are encouraged.

PMID:39982665 | DOI:10.1007/s10198-024-01755-2

Hormones (Athens). 2025 Feb 21. doi: 10.1007/s42000-025-00636-4. Online ahead of print.

ABSTRACT

PURPOSE: Neoangiogenesis is necessary for adhesion and invasion of endometriotic lesions. We hypothesize that by blocking angiogenetic pathways we can suppress endometriosis. Oral contraceptive pills (OCs) are routinely used in endometriosis to suppress symptoms of the disease. In the current study, we attempt to evaluate the effects of OCs on various angiogenetic factors in women with endometriosis.

METHODS: Sixty women with endometriosis were randomly divided into two groups. Group A consisted of 30 women who received OCs in a cyclical manner for 3 months before surgery and group B of 30 women who did not. Biopsy specimens of ovarian endometrioma were collected. We used qRT-PCR to study the mRNA expression levels of VEGF, TF, PAR-2, SP1, and FGF1.

RESULTS: The levels of mRNA of all angiogenic factors were found to be elevated in women who received OCs compared with women who did not. This difference was statistically significant for VEGF, TF, FGF1, SP1 (p < 0.001), and PAR-2 (p = 0.046).

CONCLUSION: OC administration does not inhibit neoangiogenesis in endometriotic lesions; on the contrary, angiogenetic pathways might be upregulated.

PMID:39982662 | DOI:10.1007/s42000-025-00636-4

Anat Sci Educ. 2025 Feb 21. doi: 10.1002/ase.70003. Online ahead of print.

ABSTRACT

The aim of this study was to investigate the effects of narrative anatomy education and traditional anatomy education on academic achievement. The study included 64 students who were randomly divided into two groups. The two groups were (n = 32) control (Group 1) and (n = 32) experimental (Group 2). The pretest scores of the two groups were 36.40 ± 12.58 and 35.46 ± 9.18, respectively, and the difference between them was not significant. On this basis, the groups were randomly divided into experimental and control groups. The control group received traditional anatomy instruction, while the experimental group received narrative anatomy instruction in addition to traditional instruction. The posttest scores of the control group were 43.12 ± 10.37, while those of the experimental group were 57.03 ± 14.01, and there was a statistically significant difference (p < 0.001). It is predicted that providing narrative anatomy education in addition to traditional anatomy education will have a positive effect on academic success. The qualitative findings of the study revealed several key findings. Participants in the experimental group reported that narrative education facilitated a deeper understanding and retention of anatomical concepts. They highlighted the use of metaphors and storytelling as helpful in making complex material more relatable and memorable. In addition, students expressed that the narrative approach increased their engagement and motivation, contributing to a more enjoyable learning experience. These qualitative findings highlight the potential of narrative education to complement traditional teaching methods and provide a more holistic and interactive learning experience.

PMID:39981659 | DOI:10.1002/ase.70003

Cartilage. 2025 Feb 21:19476035251320747. doi: 10.1177/19476035251320747. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this research was to investigate the relationship between quantitative texture parameters and degenerative cartilage damage in knee osteoarthritis (KOA) by conducting a full-volume texture analysis of infrapatellar fat pad (IFP). In addition, this study also explored if the quantitative texture parameter models outperform semi-quantitative model in cartilage damage classification tasks.

MATERIALS AND METHODS: This retrospective study involved 202 patients who were diagnosed with KOA using imaging and clinical examinations. Texture parameters of the IFP were extracted from sagittal FSE PDWI fat-suppressed sequence images, and least absolute shrinkage and selection operator regression was used for feature selection. Spearman correlation analysis was conducted to assess the relationship between semi-quantitative parameter (Hoffa-synovitis score), quantitative parameters, and cartilage damage. Five multi-classification logistic regression models were developed to predict cartilage damage grade by using Hoffa-synovitis score, texture parameters, and clinical characteristics as independent variables. Subsequently, the performance of these models was compared.

RESULTS: Eight texture features were screened out in this study. Correlation analysis showed that Hoffa synovitis score, texture parameters, and cartilage damage grade were significantly correlated (all P < 0.05). The strongest correlation was found between Hoffa-synovitis score and cartilage damage, demonstrating a moderate positive relationship (r = 0.62). In terms of texture features, the Correlation parameter exhibited a moderate positive correlation with cartilage damage (r = 0.49), while other texture parameters had a slight positive correlation degree of positive or negative correlation. In the task of classifying cartilage damage, the model’s macro-average area under the curve (AUC) only using the Hoffa-synovitis score was 0.73 (95% confidence interval (CI): 0.64, 0.83), while the model using only selected texture parameters achieved a macro-average AUC of 0.84 (95% CI: 0.68, 0.94). Furthermore, the model that combined texture parameters and clinical features also achieved a macro-average AUC of 0.84 (95% CI: 0.72, 0.94). By integrating the Hoffa-synovitis score, texture parameters, and clinical features, the model’s macro-average AUC experienced a slight improvement to 0.85 (95% CI: 0.74, 0.93). Notably, the model combining only Hoffa-synovitis score and texture parameters had the best classification performance, with a macro-average AUC of 0.88 (95% CI: 77, 0.97). The performance of the 4 models incorporating texture parameters outperformed that of the Hoffa-synovitis score alone (all P < 0.05), however with no significant statistical difference observed among the 4 models (all P > 0.05).

CONCLUSIONS: There existed a correlation between the texture parameters of the infrapatellar fat IFP and cartilage damage in KOA. The models using texture parameters demonstrated better performance in classifying cartilage damage compared to the models using only semi-quantitative parameter. Thus, we can infer that texture parameters had the potential to be valuable imaging biomarkers for evaluating cartilage damage.

PMID:39981646 | DOI:10.1177/19476035251320747

J Glob Health. 2025 Feb 21;15:04010. doi: 10.7189/jogh.15.04010.

ABSTRACT

BACKGROUND: Sex and gender are important determinants of health. Gender-based health inequities in the paediatric population have been reported in various countries, but data remain limited. In Mozambique, research on this topic is very scarce. Here we aimed to explore whether boys and girls in Manhiça district, southern Mozambique, differ in access to and provision of healthcare.

METHODS: This retrospective analysis includes data on all paediatric (<15 years old) visits to six outpatient clinics and admissions to one hospital in Manhiça district from 2004 to 2020, collected through the morbidity surveillance system of the Manhiça Health and Demographic Surveillance System (HDSS). We compared characteristics and outcomes between boys and girls using descriptive statistics, standardised mean differences, and logistic regression. Post-discharge events were analysed using Cox proportional hazards regression and Fine-Gray competing risk regression. Minimum community-based incidence rates of outpatient clinic visits and hospitalisations were calculated using demographic surveillance data from the Manhiça HDSS and analysed with negative binomial regression.

RESULTS: Girls represented 49.2% (560 630 out of 1 139 962) of paediatric visits to outpatient clinics and 45.1% (18 625 out of 41 278) of hospitalisations. The girls-to-boys incidence rate ratio (IRR) for hospitalisations was 0.81 (95% confidence interval (CI) = 0.79-0.84). Both boys and girls experienced symptoms for a median duration of one day (interquartile range (IQR) = 1-2) before seeking care. Severe manifestations at presentation to an outpatient clinic or upon hospitalisation tended to be less frequent in girls (girls-to-boys odds ratios (ORs) = 0.71-1.11). Girls were less frequently referred or admitted to hospital after an outpatient clinic visit (OR = 0.82; 95% CI = 0.79-0.86 and OR = 0.85; 95% CI = 0.84-0.87, respectively). The hospital case fatality ratio was 4.1% in boys and 4.2% in girls. The median duration of hospitalisation was three days (IQR = 2-5) and did not differ between boys and girls. Revisits to outpatient clinics, hospital readmissions, and hospital post-discharge mortality were similar in both groups.

CONCLUSIONS: Girls had fewer referrals and admissions to hospital in Manhiça district, but they were also less likely to present with severe manifestations. Other studied indicators of healthcare access and provision were overall similar for boys and girls. Further research is needed to continue assessing potential gender biases and sex differences in paediatric healthcare in Mozambique.

PMID:39981643 | DOI:10.7189/jogh.15.04010