Category: Statistics

N Z Med J. 2025 Jun 27;138(1617):76-84. doi: 10.26635/6965.6788.

ABSTRACT

BACKGROUND: Metabolic bariatric surgery (MBS) is an effective treatment for obesity and its related comorbidities.1 Publicly funded MBS in New Zealand is regionally limited with variable case volumes, potentially limiting surgical training.2 This retrospective study aims to evaluate if MBS safety and effectiveness are impacted by teaching within a low-volume unit.

METHODS: A retrospective outcomes analysis was carried out for all MBS cases of a single surgeon (public and private). Cases were compared based on primary operator status: consultant (COP) and trainee/fellow (TOF). Primary outcomes included multiple safety and effectiveness parameters including leaks, haemorrhage, 30-day morbidity and total weight loss (TWL).

RESULTS: Two-hundred and fifty patients satisfied inclusion criteria. Results are reported as COP and TOF. Primary operator: 87 (34.8%) and 163 (65.2%). There were no leaks, strictures or 30-day mortalities. Perioperative haemorrhage: 1 and 4. Thirty-day morbidity: 1 and 5. One-year TWL: 36.0% and 35.0%. Sleeve stenosis: 0 and 1. Thirty-day readmissions: 1 and 4. One-year readmissions: 4 and 9. Length of stay: 3 and 4 (p=<0.001).

CONCLUSION: MBS safety and effectiveness outcomes in low-volume practice performed by TOF were no different to COP within our study setting.

PMID:40570336 | DOI:10.26635/6965.6788

N Z Med J. 2025 Jun 27;138(1617):50-61. doi: 10.26635/6965.6807.

ABSTRACT

AIM: We examined equity in the provision of cochlear implant services for New Zealand Māori compared with other New Zealanders.

METHODS: The client databases of both Aotearoa New Zealand cochlear implant programmes were searched and an anonymised dataset was provided to the audit team. Ethics committee approval was not required. Ethnicity was categorised as Māori or non-Māori.

RESULTS: There is no significant difference between Māori and non-Māori with respect to acceptance for surgery rates and time from acceptance to surgery. Māori children and adults have a higher rate of proceeding to surgery than non-Māori ethnic groups. Average days to surgery for adult clients reduced over the period studied. Time to surgery was low for both child ethnic groups. When a measure of prioritisation (clinical priority access criteria [CPAC]) was incorporated into the evaluation, we found that Māori clients waited slightly, but not significantly less time per unit of CPAC scored.

CONCLUSION: We were able to demonstrate that once Māori clients accessed the cochlear implant programmes, they were implanted at a similar rate as non-Māori, and adult clients experienced equivalent waiting times even when adjusted for CPAC score. These favourable results suggest that our internal systems and pathways are promoting equity.

PMID:40570334 | DOI:10.26635/6965.6807

N Z Med J. 2025 Jun 27;138(1617):12-49. doi: 10.26635/6965.6926.

ABSTRACT

AIM: A rib fracture guideline was implemented at Whangārei Hospital with the aim of improving the care of patients and mitigating the risk of preventable additional morbidity. The aim of this study was to assess the impact of this guideline on the management and outcomes of patients.

METHODS: A single centre retrospective audit was performed comparing patients with rib fractures pre and post the implementation of the RIB-IMPROVE guideline. The primary outcome of interest was pneumonia. Patients with an abbreviated injury score (AIS) head or abdomen >2 were excluded. Binomial logistic regression was conducted for the primary outcome with adjustments for clinically plausible variables.

RESULTS: There were 418 patients identified, 241 in the pre-guideline and 177 in the post-guideline group. There was no difference in age, sex, ethnicity, number of rib fractures, injury severity score (ISS) or local anaesthetic block placement. The pneumonia rate was 13% vs 7% comparing the pre- and post-guideline groups, respectively. After adjustment for age, sex and ISS, the relative risk of developing pneumonia was 0.52 comparing the post- with the pre-guideline group (p=0.04). No statistical difference in secondary outcomes was seen, including the length of stay, 30-day readmission rate or 30-day mortality rate.

CONCLUSION: This study found that the risk of pneumonia was decreased by almost half after implementation of the RIB-IMPROVE guideline at Whangārei Hospital. This study highlights the effectiveness of a multidisciplinary guideline in the management of patients with rib fractures.

PMID:40570333 | DOI:10.26635/6965.6926

JMIR Infodemiology. 2025 Jun 26;5:e58302. doi: 10.2196/58302.

ABSTRACT

BACKGROUND: The outbreak of SARS-CoV-2 in 2019 was accompanied by a rise in the popularity of conspiracy theories. These theories often undermined vaccination efforts. There is evidence that the spread of misinformation about COVID-19 is associated with online social media use. Online social media enables network effects that influence the dissemination of information. It is important to distinguish between the effects of using social media and the network effects that occur within the platform.

OBJECTIVE: This study aims to investigate the association between the modularity of online social networks and the spread of, as well as attitudes toward, information and misinformation about COVID-19.

METHODS: This study used data from the social network structure of the online social media platform Vkontakte (VK) to construct an adjusted modularity index (fragmentation index) for 166 Russian towns. VK is a widely used Russian social media platform. The study combined town-level network indices with data from the poll “Research on COVID-19 in Russia’s Regions” (RoCIRR), which included responses from 23,000 individuals. The study measured respondents’ knowledge of both fake and true statements about COVID-19, as well as their attitudes toward these statements.

RESULTS: A positive association was observed between town-level fragmentation and individuals’ knowledge of fake statements, and a negative association with knowledge of true statements. There is a strong negative association between fragmentation and the average attitude toward true statements (P<.001), while the association with attitudes toward fake statements is positive but statistically insignificant (P=.55). Additionally, a strong association was found between network fragmentation and ideological differences in attitudes toward true versus fake statements.

CONCLUSIONS: While social media use plays an important role in the diffusion of health-related information, the structure of social networks can amplify these effects. Social network modularity plays a key role in the spread of information, with differing impacts on true and fake statements. These differences in information dissemination contribute to variations in attitudes toward true and fake statements about COVID-19. Ultimately, fragmentation was associated with individual-level polarization on medical topics. Future research should further explore the interaction between social media use and underlying network effects.

PMID:40570328 | DOI:10.2196/58302

JMIR Ment Health. 2025 Jun 26;12:e70577. doi: 10.2196/70577.

ABSTRACT

BACKGROUND: Anxiety and depression are serious mental health conditions affecting millions of people worldwide; however, they are often underdiagnosed due to limited health care resources. Mobile games, with their widespread popularity and availability, offer a unique opportunity to use user-game interaction data for mental health screening.

OBJECTIVE: This study aimed to explore whether swipe gesture interactions from mobile games can serve as indicators of anxiety and depression symptoms.

METHODS: A total of 82 participants played 3 casual mobile games (puzzle, infinite runner, and object slicing games) for 15 minutes each and completed validated measures of anxiety (Generalized Anxiety Disorder-7; GAD-7) and depression (Patient Health Questionnaire-8; PHQ-8). Data were logged for each swipe event, and metrics were computed using statistical measures, yielding roughly 150 metrics per game. Spearman rank correlations were calculated between each metric and GAD-7 and PHQ-8 scores.

RESULTS: Multiple swipe gesture metrics showed significant associations with both anxiety and depression scores. For the puzzle game, mean swipe speed correlated with PHQ-8 (ρ=-0.405; P<.001) and GAD-7 (ρ=-0.400; P<.001) scores. For the infinite runner game, mean variance in swipe end pressure showed moderate to strong negative correlation with PHQ-8 (ρ=-0.405; P<.001) and GAD-7 (ρ=-0.309; P=.007) scores. In the object slicing game, minimum swipe start position along the y-axis correlated positively with PHQ-8 (ρ=0.368; P<.001) and GAD-7 (ρ=0.370; P<.001) scores.

CONCLUSIONS: The findings from this exploratory study provide preliminary evidence supporting the feasibility of using swipe gesture interactions in mobile games as novel, engaging, and nonintrusive indicators of anxiety and depression.

PMID:40570324 | DOI:10.2196/70577

Otol Neurotol. 2025 Jun 18. doi: 10.1097/MAO.0000000000004526. Online ahead of print.

ABSTRACT

INTRODUCTION: Paragangliomas of the middle ear (glomus tympanicum, GT) are commonly encountered neoplasms of the temporal bone. GT is a benign tumor of vascular origin, arising from the neural crest cells and located on the promontory. The treatment of choice is surgical excision of the lesion.

OBJECTIVE: Our aim was to describe the surgical and hearing outcomes in a cohort of patients with middle ear paragangliomas following resection.

METHODS: We retrospectively reviewed the data of patients with GT who were treated with a CO2 laser from 2014 to 2021. Preoperative and postoperative audiometric outcomes, symptom evaluations, and otomicroscopic examinations were performed. The surgical approach was individualized for each patient based on tumor characteristics demonstrated on computed tomography. Three different approaches were used: (1) canal wall down, canal wall reconstruction, and mastoid obliteration (CWD, CWR, and MO) mastoidectomy; (2) canal wall up (CWU) mastoidectomy; and (3) endaural/transcanal.

RESULTS: Three males and 12 females aged between 33 and 76 years (mean, 56 yr) were included. Complete removal was accomplished in all cases using a CO2 laser with no recurrence or complications during the postoperative follow-up period.CWU mastoidectomy, CWD mastoidectomy with CWR/MO, and endaural/transcanal approaches were used in 5, 3, and 7 patients, respectively. A flexible 500-micron CO2 laser fiber was employed at 3-4 watts on the continuous mode setting.Three patients underwent concurrent ossicular chain reconstruction along with CWD/CWR mastoidectomy owing to preoperative conductive hearing loss with an air-bone gap (ABG) of wider than 30 dB, resulting in postoperative ABG closure. In relation to the remaining patients, no statistically significant postoperative worsening of audiometric outcomes in Word Recognition Score, pure tone average, and speech recognition threshold were observed. The mean follow-up period was 12 months.

CONCLUSIONS: We found that using a flexible CO2 laser fiber and CWD mastoidectomy with canal wall reconstruction and mastoid obliteration are beneficial for managing these tumors.CO2 lasers are safe and reliable for GT resection. The advantages of this modality include complete removal, low complication and recurrence rates, and minimum morbidity.

PMID:40570318 | DOI:10.1097/MAO.0000000000004526

Otol Neurotol. 2025 Jun 18. doi: 10.1097/MAO.0000000000004514. Online ahead of print.

ABSTRACT

INTRODUCTION: Idiopathic sudden sensorineural hearing loss (ISSNHL) exhibits a diverse range of clinical presentations and treatment responses. Currently, there are no established variables that clinicians can utilize for the purposes of patient counseling when treating ISSNHL.

MATERIALS AND METHODS: This prospective study involved 35 patients diagnosed with ISSNHL who were treated with oral and intratympanic steroid injections. We measured the peak and average slow phase velocity (SPV) (°/sec) of nystagmus after caloric stimulation during the first session of intratympanic steroid injection (ITI), and four variables were evaluated: age, time elapsed before treatment (ET), gain, and pure tone average (PTA) posttreatment. An association between these variables was determined using Spearman’s Rho statistical analysis, followed by regression modeling.

RESULTS: We found a strong significant correlation between SPV and gain and PTA posttreatment (Spearman Rho 0.000). A significant correlation between SPV and ET was also detected (Spearman Rho 0.05). The linear regression analysis indicated that for every 1° increase in SPV, there is an expected increase of 0.27 dB in gain and a decrease of 0.18 dB in PTA posttreatment. Furthermore, an SPV of 17.7 (°/sec) demonstrated a strong correlation with Siegel grade 1 posttreatment (p 0.000).

CONCLUSIONS: The SPV (°/sec) of nystagmus during the first ITI may serve as a valuable tool for patient counseling in the management of ISSNHL, thereby encouraging the continuation or consideration of alternative treatment options. Further studies are warranted to validate these findings.

PMID:40570313 | DOI:10.1097/MAO.0000000000004514

Am J Sports Med. 2025 Jun 26:3635465251346961. doi: 10.1177/03635465251346961. Online ahead of print.

ABSTRACT

BACKGROUND: Knee cartilage injuries can lead to significant functional limitations, pain, and diminished quality of life. Microfracture (MF) is the most common surgical procedure for smaller (<2 cm²) cartilage lesions of the knee. However, there is no established gold-standard surgical intervention.

PURPOSE: To compare functional and patient-reported outcomes after MF and arthroscopic debridement (AD) for symptomatic, isolated femoral cartilage injuries <2 cm² in patients aged 18 to 50 years.

STUDY DESIGN: Randomized controlled trial; Level of evidence, 1.

METHODS: A total of 65 patients were included, randomized to undergo either MF (n = 31) or AD (n = 34), and followed for 2 years. The primary outcome was the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life subscore. Secondary outcomes included scores for the other KOOS subscales, Tegner activity scale, Lysholm score, and visual analog scale for pain.

RESULTS: The mean age at the time of inclusion was 33.2 ± 9.7 years. There were 44 (68%) male patients. The mean size of the lesion was 1.2 ± 0.6 cm². There was no statistically significant difference between the groups in the change in the KOOS Quality of Life subscore from baseline to 2 years (3.5 [95% CI, -10.0 to 16.9]; P = .61). There were 10 complications in 5 patients in the MF group and 2 complications in 2 patients in the AD group. According to a linear mixed model, there were no statistically significant differences between the groups for any of the secondary outcomes at any time point during the 2-year follow-up period.

CONCLUSION: MF was not superior to AD when treating femoral cartilage lesions of the knee <2 cm².

PMID:40570306 | DOI:10.1177/03635465251346961

J Strength Cond Res. 2025 Jun 24. doi: 10.1519/JSC.0000000000005158. Online ahead of print.

ABSTRACT

Klemola, SE, Gorman, BT, Welch, N, and Kung, SM. Isokinetic knee extension and flexion strength in female athletes at 20 and 40 weeks after bone-patellar tendon-bone anterior cruciate ligament reconstruction. J Strength Cond Res XX(X): 000-000, 2025-Despite females’ higher anterior cruciate ligament (ACL) injury risk, research assessing the rehabilitation of knee extensor and flexor strength after an ACL reconstruction (ACLR) with a bone-patellar tendon-bone (BPTB) graft in female athletes is limited. The purpose of this study was to investigate the restoration of knee extension strength in female athletes after ACLR with a BPTB graft, along with knee flexion strength, limb symmetry index (LSI), and return to sport (RTS) status. Eighty-nine 16-30-year-old female athletes who underwent a BPTB ACLR were eligible for analysis. Participants completed isokinetic knee extension and flexion strength testing at 20 ± 5 (T1) and 40 ± 5 (T2) weeks post-ACLR using an isokinetic dynamometer. Changes in peak knee extension and flexion torques, and LSI values were assessed in the injured and noninjured limbs from T1 to T2. RTS status was recorded at T2. Two-way repeated measures ANOVA analyzed peak extension and flexion torques and paired t-tests analyzed LSI. Statistical significance was set at p ≤ 0.05. Compared with the injured limb, the noninjured limb demonstrated a higher peak extension torque at T1 (p < 0.0001) and T2 (p < 0.0001) and a higher peak knee flexion torque at T1 only (p = 0.004). Peak knee extension (p < 0.0001) and flexion (p = 0.03) torque LSI were significantly higher at T2 than at T1. Despite significant improvements in knee extension and flexion strength, a deficit in the injured limb’s knee extensor strength remained at 40 weeks postsurgery, which highlights the need for female athletes to prioritize strengthening the injured limb’s knee extensors during rehabilitation, especially before returning to training and/or competition.

PMID:40570302 | DOI:10.1519/JSC.0000000000005158

J Strength Cond Res. 2025 Jun 24. doi: 10.1519/JSC.0000000000005163. Online ahead of print.

ABSTRACT

Metoyer, CJ, Lever, JR, McGinty, M, Landow, L, Hunt, R, Hauenstein, JD, Huebner, A, Stone, MH, and Wagle, JP. The impact of localized muscle mass on sprint mechanics during the swing and stance phases of Division I collegiate American football players. J Strength Cond Res XX(X): 000-000, 2025-This study evaluates the impact of localized muscle volume on sprint mechanics among Division-I collegiate American football players across 3 position groups: Skills (Defensive Backs, Wide Receivers), Mids (Linebackers, Running Backs, Tight Ends), and Bigs (Offensive, Defensive Linemen). A total of 108 male athletes (age: 21.4 ± 1.9 years, BMI: 29.6 ± 4.3) were assessed. Lower extremity muscle volumes were measured using magnetic resonance imaging, and sprint kinematics were captured using an inertial motor unit system during maximal effort sprints. Stepwise multiple linear regressions were conducted to evaluate the relationship between muscle volumes, stance, and swing times for each position group. In the Skills group, increased volumes in the vastus intermedius (β = -0.15, p < 0.01) and sartorius (β = -0.17, p = 0.01) were associated with reduced swing time, while those in the vastus medialis (β = 0.18, p < 0.01) increased swing time. For stance time, the gluteus maximus (β = -0.02, p = 0.03) was associated with reduced stance time, and the tibialis posterior (β = 0.28, p < 0.01) increased it. In the Mids group, the biceps femoris long head (β = -0.15, p < 0.01) was associated with reduced stance time, while the vastus medialis (β = 0.09, p < 0.01) increased it. In the Bigs group, the rectus femoris and sartorius were associated with reduced stance time, while the tensor fasciae latae and tibialis anterior increased stance time. These findings highlight the role of localized muscle volume in influencing sprint mechanics and emphasize the potential need for position-specific physical development programs tailored to the biomechanical demands of running mechanics in American football players.

PMID:40570301 | DOI:10.1519/JSC.0000000000005163