Category: Statistics

N Z Med J. 2025 Sep 19;138(1622):32-55. doi: 10.26635/6965.6952.

ABSTRACT

BACKGROUND: Copying results to a patient’s primary care provider confers a medico-legal responsibility to take action, which can complicate transfer of care. This practice contributes to administrative burden and creates uncertainty around the continuity of patient care. We aimed to survey primary care, with a focus on general practitioners (GPs), regarding their medico-legal awareness, preferences regarding receiving copied results, views on when transfer of care should happen, work-life balance, career pathway and the administrative burden (non-patient-facing clinical time) within their total clinical work hours.

METHODS: This was an anonymous, cross-sectional survey for clinically active primary care clinicians (GPs, urgent care physicians, nurse practitioners [NPs]) in the Northern region of Aotearoa New Zealand. The survey link was open from August to October 2023 and distributed via email, promoted during webinars and shared on social media.

RESULTS: A total of 470 eligible responses were collected: 428 GPs, 15 urgent care physicians, 18 NPs and 9 doctors that identify as “other primary care”. Across the professions, 34% were unaware of the medico-legal responsibilities of being copied into results they did not initiate. With the exception of NPs, most primary care clinicians prefer to not be copied to radiology, histology, microbiology, haematology and biochemistry results they did not order. Four out of five participants agreed that any results copied to primary care should involve prior discussion and acceptance by a relevant clinician. Although GPs and NPs reported poorer work-life balance, lower job satisfaction and higher rates of burnout compared with the other primary care professions, all professions have seen reductions in their patient-facing hours in the past 5 years, with increased administrative burden identified as a major contributing factor. Indeed, 47.7% of the GPs surveyed stated their intent to leave primary care within the next 5 years. The median proportion of non-patient-facing clinical hours as part of total clinical hours was 31% for GPs, 17% for urgent care physicians, and 31% for both NPs and other primary care professionals. Among GPs, a higher proportion of non-patient-facing clinical work was associated with older age, female gender, other non-European ethnicity, holding vocational registration in general practice, more years of general practice experience, having a personal list of enrolled patients and working in a non-Very Low Cost Access practice. However, medico-legal awareness of copied results was not associated with an increased proportion of non-patient-facing clinical work.

CONCLUSION: A gap in medico-legal knowledge related to test result responsibility exists within the primary care workforce. While this deficit was not linked to increased time spent on non-patient-facing clinical work, the majority of clinicians expressed a preference to not be routinely copied into test results unless a closed loop communication process with the ordering clinician is established. Improving the viability of primary care as a profession and patient care productivity will require coordinated efforts between primary care providers and Health New Zealand – Te Whatu Ora to reform current practices and uphold the principles of “Transfer of Care and Test Results Responsibility”.

PMID:40966698 | DOI:10.26635/6965.6952

JMIR Res Protoc. 2025 Sep 18;14:e67571. doi: 10.2196/67571.

ABSTRACT

BACKGROUND: The intertwining nature of gender-based violence (GBV) and violence perpetrated against women and girls (VAWG), as well as sexual and reproductive health rights (SRHR), underlines the urgent need for the health sector to enhance the coordination of services to improve health outcomes. Importantly, GBV and VAWG are intricately linked to a spectrum of SRHR challenges, ranging from unintended pregnancies to severe maternal, gynecological, and mental health outcomes. Cumulative GBV had a more significant effect on abortion risk than associated variables. Recognizing the interplay between GBV, VAWG, and SRHR highlights the necessity for a comprehensive health sector response. A systematic review of the health sector response to GBV, VAWG, and SRHR will be conducted to understand the extent and array of health facility-based coordinated responses to GBV, VAWG, and SRHR; lessons learned; and successes and challenges in the Commonwealth and selected African countries.

OBJECTIVE: We aim to understand the context of GBV, VAWG, and SRHR by conducting a comprehensive review of health sector responses in different national, cultural, and socioeconomic contexts, and we aim to share best practices, experiences, and lessons learned.

METHODS: A mixed methods systematic review will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. The population, intervention, comparison, and outcome framework will be applied to screen and select relevant sources guided by the inclusion and exclusion criteria. The review will include relevant research papers published in the last 15 years and conducted in the 24 Commonwealth and 7 selected African countries. Electronic databases to be searched will include PubMed, Google Scholar, Science Direct, EBSCOhost, Web of Science, Embase, PsycINFO, Cochrane, CINAHL, Index Medicus for the Eastern Mediterranean Region, and POPline.

RESULTS: Ethics approval will be waived as the study will use data in the public domain. The project has been commissioned by the Commonwealth Secretariat (2022-2025). The database search, data screening, and data extraction process for the review will be completed by September 2025. A manuscript will be submitted to a peer-reviewed international journal by November 2025. The initial online database searches, citations of eligible studies, and Microsoft Copilot identified 38,200 studies focusing on GBV, VAWG, and SRHR interventions. To date, 60 studies have been found eligible for inclusion in the review. The majority of these studies were conducted in eastern Africa (n=34), South Africa (n=14), and Asia (n=13). Evidence generated from this review will be made available through journal publications, seminars and workshops with key stakeholders, ministries of health, and local and international conferences.

CONCLUSIONS: The study will generate evidence to inform recommendations on addressing and mitigating the effects of GBV and VAWG on SRHR outcomes and coordinated services in the health sectors of Commonwealth and selected African countries.

TRIAL REGISTRATION: PROSPERO CRD42024520594; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024520594.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/67571.

PMID:40966689 | DOI:10.2196/67571

JMIR Res Protoc. 2025 Sep 18;14:e66326. doi: 10.2196/66326.

ABSTRACT

BACKGROUND: Black Americans are disproportionately impacted by HIV. This disparity is more profound in the Southern United States, with the highest rates being among young, Black, sexual minority men, who are also less likely to receive state-of-the-art interventions such as pre-exposure prophylaxis (PrEP). Individual-level interventions to increase PrEP uptake do not often capitalize on the opportunity to leverage the significant effects of this group’s social networks, including Black women, on attitudes, beliefs, and behaviors around HIV prevention.

OBJECTIVE: To increase PrEP use, an intervention, PrEP US NoW, was designed to engage young, Black, sexual minority men’s social networks in discussions with supportive Black female facilitators and ultimately enhance their social capital.

METHODS: First, qualitative information on core health-promoting elements of social capital bonds was captured among young, Black, sexual minority men and Black women in extant social support networks. This information was then applied to adapt an existing, evidence-based mobile health app to create the PrEP US NoW pilot through an unblinded randomized controlled trial. Six social network groups (5 young, Black, sexual minority men + 1 Black woman) will participate in the intervention arm. These will be recruited through a network-based approach and will undergo tailored training (mobile-based and face-to-face) for app usage. At baseline, men will undergo HIV testing and both men and women will complete a sociodemographic survey. The groups in the intervention arm will engage in four 60-minute discussions led by Black women through the modified mobile health app. After the intervention, young, Black, sexual minority men will complete surveys electronically at 1 and 3 months (accompanied by HIV testing) on additional factors such as experiences of discrimination and PrEP stigma. The Black women will complete an electronic survey at 1 month, measuring feasibility and acceptability, and will participate in web-based qualitative interviews at 3 months to gain more knowledge on the PrEP US NoW facilitation process. Participants in the control arm will not engage in Black women-facilitated group discussions and will use a control version of the app. The baseline and follow-up surveys and HIV testing will be documented similarly to the intervention arm.

RESULTS: Phase 1 (development) of PrEP US NoW research activities lasted from November 2019 to June 2024. Data collection for the phase 2 randomized controlled trial began in August 2024 and is expected to be completed in December 2025. The findings will capture the intervention’s feasibility and acceptability and changes in PrEP uptake among young, Black, sexual minority men.

CONCLUSIONS: The development and pilot implementation trial of the PrEP US NoW intervention is thought to leverage essential social capital among young, Black, sexual minority men, which may promote engagement in PrEP care, thus decreasing the overall number of HIV diagnoses.

TRIAL REGISTRATION: ClinicalTrials.gov NCT07024745; https://clinicaltrials.gov/study/NCT07024745.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/66326.

PMID:40966683 | DOI:10.2196/66326

JMIR Aging. 2025 Sep 18;8:e67312. doi: 10.2196/67312.

ABSTRACT

BACKGROUND: Self-management is critical for older adults with type 2 diabetes mellitus (T2DM); however, its practice remains suboptimal. Social media has become an accessible and effective stimulus source for the public, which has the potential to promote health behaviors, but its effect on the self-management of older adults with T2DM remains unknown.

OBJECTIVE: We aimed to investigate the relationship between social media exposure, specifically time exposure and content exposure, and the self-management of older adults with T2DM.

METHODS: In this cross-sectional study, we enrolled 257 older adults with T2DM who used short-form video apps from community health care centers. We assessed subjective and objective time and content exposure. We transformed text-based content exposure into diabetes-related content exposure encompassing irrelevant, harmful, hypobeneficial, and hyperbeneficial categories using Q-methodology. Self-management was assessed through a validated questionnaire. We used restricted cubic splines and linear regression models to model the relationships between time exposure and content exposure and self-management, respectively.

RESULTS: Of 257 older adults with T2DM, the median age was 69 (IQR 65-72) years, 53.3% (n=137) were women, the mean sum score of self-management was 35.7 (SD 10.4), the median subjective time exposure was 120 (IQR 60-120) minutes, and 61.1% (n=157) of them were exposed to hyperbeneficial content. There was an approximate L-shaped dextrorotatory relationship between time exposure and self-management, with a decline in self-management when time exposure surpassed 139.8 minutes daily. Exposure to hyperbeneficial content was positively associated with the overall self-management (B=3.46, 95% CI 0.71-6.21). For participants exposed for more than 139.8 minutes daily, this positive association remained robust (B=7.27, 95% CI 1.54-13.00). In subdimensional analyses, hyperbeneficial content exposure was positively associated with general diet (B=1.51, 95% CI 0.54-2.49) and blood glucose testing (B=1.31, 95% CI 0.25-2.38).

CONCLUSIONS: Social media exposure presented a double-edged sword for self-management of older adults with T2DM. Self-management declined when the daily time spent on social media exceeded 139.8 minutes. However, exposure to hyperbeneficial content was associated with better self-management of individuals, regardless of excessive time spent on social media. Future longitudinal and experimental studies that validate the multifaceted association between social media exposure and health behaviors are needed. If confirmed, these findings would support the implementation of media prescription programs by health care providers in communities.

PMID:40966679 | DOI:10.2196/67312

JMIR Cancer. 2025 Sep 18;11:e68037. doi: 10.2196/68037.

ABSTRACT

BACKGROUND: Thyroid cancer is one of the most commonly diagnosed malignancies in South Korea, with incidence rates among the highest globally. Young women, in particular, represent a high-risk group, likely due to a combination of biological, occupational, and environmental factors. However, the specific risk factors contributing to thyroid cancer development in this population remain poorly understood.

OBJECTIVE: This study aims to identify the risk factors associated with thyroid cancer among young female nurses using longitudinal survival analysis.

METHODS: This longitudinal study used data from the Korea Nurses’ Health Study (KNHS), a prospective national cohort of female nurses. Data from the first, fifth, seventh, and ninth surveys were used to construct a person-period data set. Female nurses aged in their 20s at baseline were included. Time-varying explanatory variables included age, marital status, BMI, smoking, alcohol consumption, perceived stress, sleep problems, nursing position, night shift work, working unit, and duration of radiation exposure. The dependent variable was self-reported physician-diagnosed thyroid cancer. Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to examine the association between risk factors and thyroid cancer occurrence.

RESULTS: A total of 22,759 person-period cases were analyzed, and 105 thyroid cancer events were identified. Kaplan-Meier analysis showed significant associations between thyroid cancer occurrence and age (χ²₁=51.6, P<.001), marital status (χ²₁=25.1, P<.001), sleep problems (χ²₁=20.3, P<.001), night shift work (χ²₁=20.1, P<.001), working unit (χ²₁=13.0, P<.001), and duration of radiation exposure (χ²₁=91.0, P<.001). In the Cox regression model, nurses aged in their 20s had a significantly higher risk of thyroid cancer than those aged in their 30s (hazard ratio [HR] 4.602, 95% CI 1.893-11.188). Those who worked night shifts were also at an increased risk (HR 1.923, 95% CI 1.127-3.280). Compared with no exposure, radiation exposure showed a dose-response relationship: <1 year: HR 3.449, 95% CI 1.474-8.074; ≥1 year: HR 4.178, 95% CI 2.702-6.461.

CONCLUSIONS: Younger age, night shift work, and duration of radiation exposure were significantly associated with an increased risk of thyroid cancer in young female nurses. These findings highlight the importance of early screening and occupational risk management, including regular radiation monitoring and support for circadian health, in health care settings.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.4178/epih.e2024048.

PMID:40966677 | DOI:10.2196/68037

Oral Dis. 2025 Sep 18. doi: 10.1111/odi.70098. Online ahead of print.

ABSTRACT

INTRODUCTION: The internet is a widely used source of health information for patients with head and neck cancer. However, the quality and readability of online content remain inconsistent. This study evaluated the usefulness of web-based resources by assessing their quality and readability.

METHODS: Searches were conducted using Google, Bing, and Yahoo! with nine common anatomical terms related to head and neck cancer. The first 50 results from each search engine were screened, and eligible websites were evaluated for quality using the DISCERN instrument by three independent reviewers. Readability was assessed using the Flesch-Kincaid Reading Grade Level (FKRGL) and the Flesch Reading Ease Score (FRES). Descriptive and inferential statistics were applied.

RESULTS: A total of 285 websites met the inclusion criteria. Of these, 46% were rated as poor quality (DISCERN score = 1). The median FKRGL was 8.6, and the median FRES was 55.7, both indicating reading levels above recommended thresholds for patient education materials.

CONCLUSIONS: Online information for patients with head and neck squamous cell carcinoma is often of low quality and too complex for the average reader. Improved, accessible, and reliable web-based resources are needed to support patient understanding and informed healthcare decisions.

PMID:40966670 | DOI:10.1111/odi.70098

J Med Internet Res. 2025 Sep 18;27:e69426. doi: 10.2196/69426.

ABSTRACT

BACKGROUND: App interventions show promise as effective interventions for trauma-related distress, but evaluations of their cost-effectiveness are scarce.

OBJECTIVE: This study aimed to assess the cost-effectiveness of an app-based intervention for self-management of posttraumatic stress compared to no guided self-management.

METHODS: An economic evaluation from a Swedish public health care perspective was conducted alongside a randomized controlled trial in which participants (N=179) were randomly assigned to either immediate exposure (intervention group; n=89, 49.7%) or delayed exposure at 3 months (waitlist group; n=90, 50.3%). The number of quality-adjusted life years (QALYs) gained or lost, increases or decreases in the use of different types of health care, and the monetary costs (in SEK; 2023 price level) saved or incurred with the intervention versus the comparator at 9 months after exposure were estimated based on functional disability and health care consumption reported by participants via a web-based written questionnaire at baseline and at 3, 6, and 9 months of follow-up. Estimation was done via linear regression with clustering at the participant level. The probability of the intervention being cost-effective was calculated over a range of cost-effectiveness thresholds up to SEK 1 million per QALY (US $94,225 per QALY; 2023 average exchange rate, US $1=SEK 10.61), and value of information analysis was used to interpret statistical uncertainty in the cost-effectiveness results.

RESULTS: There was no statistically significant difference between the intervention and comparator at 9 months after exposure when QALYs and all categories of health care consumption were analyzed jointly (P=.46). When analyzed separately, there was a significant increase in the number of consultations made in private mental health care (P=.03). The intervention was associated with 0.0065 (95% CI -0.0219 to 0.0349) QALYs gained per user and an increment in costs of SEK -46,359 (95% CI -111,696 to 18,977; US $-4368, 95% CI -10,525 to 1788) per user compared to no guided self-management. Cost savings were due to fewer consultations and care days per user in public health care (-5.50, 95% CI -14.83 to 3.83). The intervention had a 62% probability of both gaining QALYs and saving costs, and the probability that it would be cost-effective remained constant at 92% over our threshold range. The total expected value of perfect information was SEK 5.4 million (US $510,480) and was largely attributable to statistical uncertainty in incremental costs.

CONCLUSIONS: The use of a mobile app for self-management of posttraumatic stress was found to be cost-effective in a Swedish setting. A value-of-information analysis suggests that current research is sufficient to support the use of the app in Swedish practice from a cost-effectiveness perspective. However, to support its adoption in other settings or the potential of app-based interventions in general, stronger cost-effectiveness evidence is required.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04094922; https://clinicaltrials.gov/ct2/show/NCT04094922.

PMID:40966669 | DOI:10.2196/69426

Brief Bioinform. 2025 Sep 6;26(5):bbaf460. doi: 10.1093/bib/bbaf460.

ABSTRACT

Lipid-mediated effects play a crucial role in elucidating the pathological mechanisms linking the ε4 allele of the apolipoprotein E gene (APOE ε4) to Alzheimer’s disease (AD). However, traditional mediation analysis methods often suffer from insufficient statistical power in studies involving minority populations due to limited sample sizes. This study innovatively develops a high-dimensional mediation analysis model (TransHDM) based on a transfer learning framework. By leveraging information from source data with large-scale samples, it significantly enhances the ability to identify potential mediators in small sample target data. The method first constructs a high-dimensional regression model using aggregated data from the source data and target data, then applies transfer regularization to adjust for heterogeneity between the source and target domains, correcting for estimation bias in high-dimensional Lasso. Ultimately, it achieves parameter transfer across domains, addressing statistical bias and inferential uncertainty caused by small sample sizes. Simulation results demonstrate that, compared to traditional methods, this approach significantly improves the power in identifying true mediator variables while effectively controlling the family-wise error rate in multiple testing. When applied to the Alzheimer’s Disease Neuroimaging Initiative cohort, TransHDM transferred large-scale data from white and other ethnic groups, identifying additional lipid metabolic pathways mediating the influence of the APOE ε4 allele on AD pathological progression in African American populations compared to pre-transfer analysis. These pathways include glycerophospholipid metabolism, glycerolipid metabolism, sphingolipid metabolism, and ether lipid metabolism (false discovery rate < 0.05). The TransHDM framework not only provides a powerful methodological tool for small sample population research but also offers valuable insights for future research in exploring disease mechanisms and developing biomarkers for disease prediction.

PMID:40966649 | DOI:10.1093/bib/bbaf460

Am J Manag Care. 2025 Sep;31(9):457-461. doi: 10.37765/ajmc.2025.89786.

ABSTRACT

OBJECTIVE: To evaluate the relationship between the frequency of routine primary care visits and total health care expenditures among commercially insured adults.

STUDY DESIGN: Retrospective cross-sectional statistical analysis of a nationally representative data set of health care utilization and expenditures over a 2-year period.

METHODS: We used multivariate regression analysis to evaluate the association between the annualized number of visits with a primary care physician for routine care and total health care expenditures for commercially insured adults younger than 65 years, adjusting for underlying clinical complexity measured through risk scoring. Data were drawn from information collected by the Agency for Healthcare Research and Quality between 2021 and 2022.

RESULTS: For a sample cohort of 3879 participants, more frequent primary care visits were associated with incremental reductions in expenditures only for participants with high underlying clinical complexity. A relative risk level of approximately 2 times the average commercially insured adult was identified as an inflection point, above which cost reductions vs counterfactual prediction were observed, up to a limited number of visits.

CONCLUSIONS: Our results show a relationship between primary care visit frequency and health care expenditures with similar directionality and risk dependency as has been observed in other studies for Medicare-insured adults. This finding suggests that certain commercial populations may benefit from risk-stratified, high-touch primary care models like those being employed for some Medicare populations. The health care cost reduction benefits of these models appear premised more on clinical need than coverage type. Demonstrating this relationship is useful for health care providers, insurers, and policy makers who are developing advanced primary care models.

PMID:40966635 | DOI:10.37765/ajmc.2025.89786

Europace. 2025 Sep 1;27(9):euaf156. doi: 10.1093/europace/euaf156.

ABSTRACT

AIMS: Catheter ablation is the standard treatment for symptomatic atrial fibrillation (AF) and can be performed under general anaesthesia (GA) or varying levels of sedation to optimize patient comfort and lesion formation. However, the effect of different anaesthesia strategies on AF recurrence rates remains uncertain.

METHODS AND RESULTS: We systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for randomized controlled trials (RCTs) and observational studies comparing outcomes of catheter ablation under GA vs. sedation (including deep, moderate, and conscious sedation). We pooled risk ratios (RR) with 95% confidence intervals (CI) with a random effects model. R version 4.4.1 was used for statistical analyses. Our systematic review and meta-analysis included 6 RCTs and 17 observational studies, corresponding to 12 302 patients assigned to either sedation (n = 8952) or GA (n = 3350). There was no difference in recurrence of atrial tachyarrhythmias (ATAs) between groups (RR 1.15; 95% CI 0.97-1.36; P = 0.10; 95% prediction interval 0.66-2.01). There was no significant subgroup interaction in the recurrence of AF according to sedation type (conscious vs. mild vs. moderate sedation vs. deep sedation) (P = 0.20) or AF type (persistent AF vs. non-persistent) (P = 0.20).

CONCLUSION: In patients undergoing catheter ablation for AF, there was no significant difference in recurrence of ATA between GA and sedation.

PMID:40966626 | DOI:10.1093/europace/euaf156