Category: Statistics

Stat Methods Med Res. 2025 Jul 9:9622802251338409. doi: 10.1177/09622802251338409. Online ahead of print.

ABSTRACT

Many randomized trials have used overall survival as the primary endpoint for establishing non-inferiority of one treatment compared to another. However, if a treatment is non-inferior to another treatment in terms of overall survival, clinicians may be interested in further exploring which treatment results in better health utility scores for patients. Examining health utility in a secondary analysis is feasible, however, since health utility is not the primary endpoint, it is usually not considered in the sample size calculation, hence the power to detect a difference of health utility is not guaranteed. Furthermore, often the premise of non-inferiority trials is to test the assumption that an intervention provides superior quality of life or toxicity profile without compromising survival when compared to the existing standard. Based on this consideration, it may be beneficial to consider both survival and utility when designing a trial. There have been methods that can combine survival and quality of life into a single measure, but they either have strong restrictions or lack theoretical frameworks. In this manuscript, we propose a method called health utility adjusted survival, which can combine survival outcome and longitudinal utility measures for treatment comparison. We propose an innovative statistical framework as well as procedures to conduct power analysis and sample size calculation. By comprehensive simulation studies involving summary statistics from the PET-NECK trial, we demonstrate that our new approach can achieve superior power performance using relatively small sample sizes, and our composite endpoint can be considered as an alternative to overall survival in future clinical trial design and analysis where both survival and health utility are of interest.

PMID:40631392 | DOI:10.1177/09622802251338409

J Health Serv Res Policy. 2025 Jul 9:13558196251358761. doi: 10.1177/13558196251358761. Online ahead of print.

ABSTRACT

BackgroundThere is a growing debate on whether avoidable emergency department (ED) visits, those involving health issues that could have been managed in community settings, represent a significant workload for the department. Until recently an ED physician-validated measure of avoidable visits has not been available, hindering our understanding of these patients, services rendered in the ED and the nature of their conditions. We examined patient characteristics of ED visits retrospectively classified as avoidable and potentially avoidable at a Canadian academic hospital.MethodsWe conducted a retrospective cohort study using administrative ED data from an academic hospital in Hamilton, Canada from April 1, 2018 to August 31, 2023. We categorized all ED visits as avoidable, potentially avoidable, and not avoidable using the Emergency Department Avoidability Classification (EDAC). For each class, we analyzed patient characteristics and the top five physician interventions and diagnoses. We applied linear regression, locally weighted scatterplot smoothing (LOWESS) regression, and statistical process methods to examine monthly trends in avoidable and potentially avoidable visits. Additionally, we reported annual totals and length of stay for patients transported to the ED by paramedics.ResultsOverall, 58,528 (29.0%) of 201,741 ED visits were classified as either avoidable (11,302; 5.6%) or potentially avoidable (47,226; 23.4%). These patients were predominantly young-to-middle aged, with average visit durations of 3 hours 33 minutes (avoidable) and 4 hours 26 minutes (potentially avoidable). Their primary interventions were predominantly diagnostic imaging, skin repairs and mental health assessments. The proportion of ED visits in the study period that were avoidable increased from 2.1% to 7.7% and potentially avoidable from 18.2% to 21.2%. Approximately one-in-five paramedic transported patients were classified as having either an avoidable or potentially avoidable ED visit. Transported patients had an average length of stay of 4 hours 22 minutes for avoidable visits and 4 hours 35 minutes for potentially avoidable visits.ConclusionsA notable rise in the proportion of ED visits that could have been managed in non-ED settings was observed. Providing community clinicians with resources and capacity to manage and refer patients for diagnostic imaging, skin repairs and mental health assessments may reduce avoidable ED attendance. Further exploration of avoidable ED visits transported by paramedics could support refining ED diversion care models. Hospitals and health service policymakers could benefit from similar analyses using validated measures to identify care gaps that inform the development of new health services and models tailored to the specific needs of their communities.

PMID:40631383 | DOI:10.1177/13558196251358761

Violence Against Women. 2025 Jul 9:10778012251356959. doi: 10.1177/10778012251356959. Online ahead of print.

ABSTRACT

Despite the continuous efforts of different generations to eradicate violence against women, statistics reveal that the problem has not been solved. The aim was to identify convergences and divergences in the perceptions of young people and adults and highlight possible future solutions. This mixed study used questionnaires (N = 628) and involved focus groups with both youth and adults (N = 19). The study contributes to understanding the age-differentiated victimization of those who witness violent acts. Both groups agreed that the solution to violence is an individual responsibility with the victims even if it affects interpersonal relationships with the perpetrators.

PMID:40631379 | DOI:10.1177/10778012251356959

Eur J Psychotraumatol. 2025 Dec;16(1):2514327. doi: 10.1080/20008066.2025.2514327. Epub 2025 Jul 9.

ABSTRACT

Background: The global immigrant population is increasing annually, and Asian immigrants have a substantial representation within the immigrant population. Due to a myriad of challenges such as acculturation, discrimination, language, and financial issues, immigrants are at high risk of mental health conditions. However, a large-scale mapping of the existing literature regarding these issues has yet to be completed.Objective: This study aimed to investigate the mental health conditions, help-seeking behaviours, and factors affecting mental health service utilization among East Asian immigrants residing in Western countries.Method: This study adopted the scoping review methodology based on the Joanna Briggs Institute framework. A comprehensive database search was conducted in May 2024 in PubMed, CINAHL, Embase, Cochrane, and Google Scholar. Search terms were developed based on participants, concept, context framework. The participants were East Asian immigrants and their families, and the concept of interest was mental health help-seeking behaviours and mental health service utilization. Regarding the context, studies targeting East Asian immigrants in Western countries were included. Data were summarized narratively and presented in a tabular and word cloud format.Results: Out of 1990 studies, 31 studies were included. East Asian immigrants often face mental health conditions, including depression, anxiety, and suicidal behaviours. They predominantly sought help from informal sources such as family, friends, religion, and complementary or alternative medicine, rather than from formal sources such as mental health clinics or healthcare professionals. Facilitators of seeking help included recognizing the need for professional help, experiencing severe symptoms, higher levels of acculturation, longer length of stay in the host country. Barriers included stigma, cultural beliefs, and language barriers.Conclusions: The review emphasizes the need for culturally tailored interventions to improve mental health outcomes in this vulnerable population. These results can guide future research and policymaking to address mental health disparities in immigrant communities.

PMID:40631378 | DOI:10.1080/20008066.2025.2514327

Eur J Psychotraumatol. 2025 Dec;16(1):2515683. doi: 10.1080/20008066.2025.2515683. Epub 2025 Jul 9.

ABSTRACT

Background: Even though evidence-based treatments are generally effective in reducing post-traumatic stress disorder (PTSD) in youth, many still experience elevated symptoms after treatment. A better understanding of how PTSD develops throughout treatment can increase efficiency and reduce residual symptoms.Objective: This study investigated which PTSD symptom clusters and symptoms within these clusters changed the most and least through trauma-focused cognitive behavioural therapy (TF-CBT), and identified common residual symptoms after treatment.Method: Latent growth curve modelling was used to identify differences in intercepts and slopes of symptoms, and residual symptoms were identified with McNemar tests in a sample of 517 youth (aged 6-19 years, 75.6% girls) receiving TF-CBT.Results: We found small but statistically significant differences in slopes across clusters. Avoidance both reduced the most and demonstrated most residual symptoms. Also, within clusters, many of the symptoms that reduced the most, such as psychological cue reactivity, persistent negative emotional state, and difficulties sleeping and concentrating, had the highest symptom levels before treatment and the most residual symptoms after treatment.Conclusions: Overall, symptoms of PTSD were reduced throughout TF-CBT. Symptoms rated highest at treatment start decreased the most but also tended to persist as common residual symptoms. Symptoms such as psychological cue reactivity, persistent negative emotional state, and negative beliefs that were common residual symptoms and are known to be central in the development and maintenance of PTSD are of particular clinical relevance. Research based on frequent symptom measurements during treatment could capture subtler changes, increasing understanding of the mechanisms of effective trauma treatment.

PMID:40631373 | DOI:10.1080/20008066.2025.2515683

Am J Med Genet B Neuropsychiatr Genet. 2025 Jul 9:e33043. doi: 10.1002/ajmg.b.33043. Online ahead of print.

ABSTRACT

Polygenic risk scores (PRSs), which sum the effects of SNPs throughout the genome to measure risk afforded by common genetic variants, have improved our ability to estimate disorder risk for Attention-Deficit/Hyperactivity Disorder (ADHD) but the accuracy of risk prediction is rarely investigated. In a study of 10,887 participants across nine cohorts, we performed gene set analysis of GWAS data to select gene sets associated with ADHD within a training subset. For each gene set, we generated gene set polygenic risk scores (gsPRSs), which sum the effects of SNPs for each selected gene set. We created gsPRS for ADHD and for phenotypes that are genetically correlated with ADHD. These gsPRS were added to the standard PRS as input to machine learning models predicting ADHD. On the test subset, a random forest (RF) model using PRSs from ADHD and genetically correlated phenotypes and an optimized group of 20 gsPRS had an area under the receiving operating characteristic curve (AUC) of 0.72 (95% CI: 0.70-0.74). This AUC was a statistically significant improvement over logistic regression models and RF models using only PRS from ADHD and genetically correlated phenotypes. Summing risk at the gene set level and incorporating genetic risk from disorders with high genetic correlations with ADHD improved the accuracy of predicting ADHD. Learning curves suggest that additional improvements would be expected with larger study sizes. Our study suggests that better accounting of genetic risk and the genetic context of allelic differences results in more predictive models.

PMID:40631367 | DOI:10.1002/ajmg.b.33043

Physiol Rep. 2025 Jul;13(13):e70455. doi: 10.14814/phy2.70455.

ABSTRACT

The present study compared acute testosterone (T), cortisol (C), epinephrine (EPI), norepinephrine (NE), and 22 kDa growth hormone (GH-22 kDa) responses following low-load resistance exercise with blood flow restriction (LL-BFR) and traditional high-load resistance exercise (HL-RE). Twelve resistance-trained men performed bouts of LL-BFR (30%1RM) and HL-RE (70%1RM), each consisting of four sets of bilateral seated leg extensions taken to momentary task failure with 60 s rest periods. A randomized crossover design was used with time of day matched within-subjects. Upon arrival between 1200 and 1800, 24 h dietary recalls were performed with post-exercise blood samples obtained within 60 s (IP) and 5 min post-exercise (+5 min) via intravenous cannulation. Greater total repetitions (d = 2.37, p < 0.001) and less volume-load (d = 2.86, p < 0.001) were performed during LL-BFR. No Condition × Time interaction effects were found for any hormonal analyte measured (p > 0.05). Both LL-BFR and HL-RE elevate the potent β₂ adrenergic receptor (β₂AR) agonist EPI (IP: 1.29 ± 0.44 and 1.35 ± 0.60 nmol·L^-1, respectively), and the androgenic steroid T (+5 min: 27.4 ± 12.9 and 29.0 ± 14.3 nmol·L^-1, respectively). Thus, acute skeletal muscle β₂AR phosphorylation may be comparable between conditions. When lower resistance exercise intensities (e.g., 30% 1RM) are desired, athletes may perform LL-BFR in place of HL-RE and experience no statistical difference in acute endocrine responses.

PMID:40631360 | DOI:10.14814/phy2.70455

Health Sci Rep. 2025 Jul 8;8(7):e70995. doi: 10.1002/hsr2.70995. eCollection 2025 Jul.

ABSTRACT

BACKGROUND AND AIM: Foodborne diseases pose serious health challenges in developing countries like Somalia, contributing to high rates of illness and death due to inadequate food safety practices, poor sanitation conditions, ineffective regulatory systems, and a lack of educational resources for food handlers. This study determined food handling practices and their associated factors among food handlers in Mogadishu, Somalia.

METHODS: A cross-sectional study was conducted with 304 food handlers in Mogadishu, Somalia, and data were gathered through direct interviews. Analysis was performed using SPSS Version 26, including descriptive statistics and logistic regressions (binary and multivariate). Adjusted Odds Ratios (AOR) and a significance level of p < 0.05 were employed to assess significant variables related to food safety measures.

RESULTS: The results show that only 27.3% of food handlers practiced proper food handling procedures. This means that the majority of those observed exhibited poor food handling practices. Various factors significantly influenced these practices, including age (AOR = 0.1; 95% CI: 0.05-0.21), marital status (AOR = 0.1; 95% CI: 0.06-0.27), work experience (AOR = 0.2; 95% CI: 0.10-0.44), and monthly income (AOR = 3.1; 95% CI: 1.56-6.21).

CONCLUSION: The study revealed that over two-thirds of participants practiced poor food handling, posing public health risks. Key factors included age, marital status, work experience, and income. Authorities should improve health education, strengthen environmental health services, and train food handlers to enhance safety and health outcomes in Somalia.

PMID:40631346 | PMC:PMC12235575 | DOI:10.1002/hsr2.70995

bioRxiv [Preprint]. 2025 Jul 4:2025.06.30.662443. doi: 10.1101/2025.06.30.662443.

ABSTRACT

Mismatches between interacting mitochondrial and nuclear gene products in hybrids have been proposed to disproportionately contribute to the formation of early species boundaries. Under this model, genetic incompatibilities emerge when mitochondrial haplotypes are placed into a cellular context without their coevolved nuclear-encoded mitochondrial (n-mt) proteins. Although there is strong evidence that mitonuclear coevolution has contributed to reproductive isolation in some cases, it is less clear how far-reaching the effects of mitonuclear incompatibilities are in speciation. Does disrupting co-adapted mitonuclear genotypes have broad, genome-wide effects with numerous n-mt loci contributing to reproductive isolation? We leverage a system with several hybridizing species pairs ( Xiphophorus fishes) that have known mitonuclear incompatibilities of large effect to ask whether a general signal of incompatibility is present when considering all n-mt genes. After dividing nuclear-encoded proteins into three classes based on level of interaction with mitochondrial gene products, we found only inconsistent statistical evidence for a difference between these classes in the degree of conserved mitonuclear ancestry. Our results imply that genome-wide scans focused on enrichment of broad functional gene classes may sometimes be insufficient for detecting a history of mitonuclear coevolution, even when strong selection is acting on mitonuclear incompatibilities at multiple loci.

PMID:40631220 | PMC:PMC12236695 | DOI:10.1101/2025.06.30.662443

bioRxiv [Preprint]. 2025 Jul 4:2025.06.30.662450. doi: 10.1101/2025.06.30.662450.

ABSTRACT

India is the most populous country globally, yet genetic studies involving Indian individuals remain limited. The Indian population is composed of many founder groups and has a mixed genetic ancestry, including an ancestral component not observed anywhere outside of India. This presents a unique opportunity to uncover novel disease variants and develop more tailored medical interventions. To facilitate genetic research in India, a crucial first step is to create a foundational resource that serves as a benchmark for future population studies and methods development. To this end, we have constructed the largest and most nationally representative linkage disequilibrium and genotype imputation reference panels in India to date, using high-coverage whole-genome sequencing data of 2,680 Indian participants from the Longitudinal Aging Study in India-Harmonized Diagnostic Assessment of Dementia (LASI-DAD). As an LD reference panel, LASI-DAD includes 69.5 million variants, representing 170% and 213% increases relative to the 1000 Genomes Project (1000G) and TOP-LD panels, respectively. Besides serving as an LD lookup panel, LASI-DAD facilitates various statistical analyses that rely on precise LD estimates. In a polygenic risk score (PRS) analysis, LASI-DAD improved the predictive performance of PRS by 2.1% to 35.1% across traits and studies. As an imputation reference panel, LASI-DAD improved the imputation accuracy by 3% to 101% (mean = 38%) compared to the TOPMed panel (Version R3) and by 3% to 73% (mean = 27%) compared to the Genome Asia Pilot (GAsP) panel across different minor allele frequencies. The LASI-DAD reference panel is publicly available to benefit future studies.

PMID:40631173 | PMC:PMC12236690 | DOI:10.1101/2025.06.30.662450