Category: Statistics

JMIR Form Res. 2026 Apr 14;10:e79427. doi: 10.2196/79427.

ABSTRACT

BACKGROUND: The use of online physician rating platforms has significantly increased and has been shown to influence physician selection. There are limited data on the use of these platforms for rating surgeons.

OBJECTIVE: In this study, we sought to assess the geographic distribution of and patterns in rating scores of surgeons in the United States. Additionally, we examined rating volumes across different surgical specialties and the association between peer-nominated and patient-initiated ratings on online rating platforms in the United States.

METHODS: We conducted a cross-sectional study by identifying 201,154 surgeons in the United States via the National Plan and Provider Enumeration System records and Doctors and Clinicians downloadable file. We assessed surgeon coverage on 3 online rating platforms and their geographic use patterns. We described the rating scores and volumes across different surgical specialties and assessed the relationship between rating platforms by comparing peer-nominated and patient-initiated online ratings.

RESULTS: A total of 78.86% (158,630/201,154) of the surgeons had ratings on at least 1 of the 3 patient-initiated websites across 11 specialties. Plastic surgeons, neurosurgeons, and orthopedic surgeons had the highest mean number of patient-initiated ratings. Surgeons with “Top Doctor” recognition from peers (23,171/201,154, 11.52%) were associated with an increased median patient-initiated rating (Healthgrades: 4.36, IQR 3.88-4.71 vs 4.20, IQR 3.64-4.64, P<.001, and r=0.09; Vitals: 4.30, IQR 4.00-4.60 vs 4.20, IQR 3.80-4.50, P<.001, and r=0.09; RateMDs: 4.20, IQR 3.80-4.50 vs 3.80, IQR 3.60-4.60, P<.001, and r=0.16). Geographic analysis indicated that 91.06% (295,816,471/324,870,510) of the US population lives in a county with a surgeon rated 10 times or more.

CONCLUSIONS: Both patient-initiated and peer-nominated rating platforms have a comprehensive coverage of surgeons in the United States, but this coverage differs significantly between surgical specialties. Further work should assess how publicly available online ratings drive surgeon selection and their association with patient experience and postoperative outcomes.

PMID:41980177 | DOI:10.2196/79427

Addiction. 2026 Apr 14. doi: 10.1111/add.70412. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Prescription opioid-related harm remains a significant public health concern. This study aimed to evaluate the efficacy of the Opioid Safety Toolkit, a co-designed, interactive online resource, in increasing naloxone uptake and healthcare provider discussions among adults prescribed opioids for pain.

DESIGN: Parallel-group, open-label, randomised controlled trial.

SETTING: Community-based, online recruitment across Australia.

PARTICIPANTS: Adults (n = 314) prescribed opioids for non-cancer pain.

INTERVENTIONS: Participants were randomised to receive either the Opioid Safety Toolkit (intervention, n = 152), which included interactive and tailored educational content on opioid safety, or an active control website presenting evidence-based opioid safety information (n = 162). Both groups were followed for four weeks.

MEASUREMENTS: The primary outcome was self-reported naloxone requests four weeks post-intervention. Other outcomes were intentions to access naloxone immediately post-intervention, and healthcare provider discussions about opioid safety at four weeks, opioid safety knowledge (immediately after the intervention and at four weeks), satisfaction with resources and naloxone possession at four weeks.

FINDINGS: Participants in the intervention group were more likely to have requested naloxone at four weeks compared with controls [21.7% vs 9.9%, odds ratio (OR) = 2.5, 95% confidence interval (CI) = 1.3, 4.8; P = 0.005], and more likely to report intentions to access naloxone immediately post-intervention compared with controls (41.4% vs 15.4%, OR = 3.9, 95% CI = 2.3, 6.6; P < 0.001). Participants in the intervention group were not more likely to have healthcare provider discussions at four weeks compared with controls (OR = 1.1, 95% CI = 0.7, 1.8; P = 0.620). Post-intervention opioid overdose knowledge was statistically significantly higher in the intervention group compared with control group (Mean score 16.6, 95% CI = 15.5, 17.7 vs control mean score 13.3, 95% CI = 12.3, 14.3). Satisfaction with the resource was higher in the intervention group compared with control group (Mean = 20.0, 95% CI = 18.7, 21.3 vs Mean = 18.0, 95% CI = 16.7, 19.3, P = 0.035).

CONCLUSIONS: We found good evidence that, compared with a gold-standard opioid information website, the Opioid Safety Toolkit increased naloxone requests among Australian adults prescribed opioids for non-cancer pain. We also observed consistent effects across secondary outcomes, with the Toolkit increasing intentions to access naloxone, enhancing opioid overdose knowledge and yielding higher satisfaction ratings, although it did not increase healthcare provider discussions at four weeks.

PMID:41980176 | DOI:10.1111/add.70412

J Air Waste Manag Assoc. 2026 Apr 14. doi: 10.1080/10962247.2026.2657443. Online ahead of print.

ABSTRACT

In recent decades, ethylene oxide (EtO) has been a widely used industrial sterilant and chemical intermediate that has faced increasing scrutiny related to its carcinogenic potential. This study evaluated residential and occupational exposure to EtO in a valley surrounding two point-source emissions in close proximity (~11 meters apart). Air samples were collected in residential and industrial areas. Eight locations, ranging from 100 to 1700 meters from the center of the point-sources in varying directions, had average concentrations between 0.290 and 3.212 µg/m³ (0.16 to 1.8 ppb) with peak levels reaching 26.4 µg/m³ (15 ppb). Exposure scenarios were developed based on daily activity patterns, long-term residency, and estimates derived from historical emissions data. Under the most conservative assumptions, including 40 years of occupational exposure during the periods of highest recorded emissions around the facility, the maximum estimated cumulative lifetime exposure was 591 ppm-days. When compared with epidemiology studies of EtO-exposed workers from similar facilities (studies used by the EPA and IARC in their cancer risk assessments), the highest cumulative exposures observed (13,500+ ppm-days) were at least 23-fold higher than our maximum estimated lifetime exposure value (591 ppm-days). Importantly, these high-exposure groups showed no statistically significant cancer incidence, particularly for breast and lymphohematopoietic cancers. When compared to regulatory values and health-based benchmarks adjusted to cumulative exposures, estimated exposures were substantially below levels associated with increased cancer incidence in epidemiological cohorts for the community surrounding the sterilization facility, even to the most susceptible populations.Implications: This study provides a data-driven, site-specific framework for evaluating long-term human health risks from ethylene oxide (EtO) emissions, using ambient air monitoring, historical emissions data, and conservative EPA-aligned exposure assumptions. Despite assessing one of the highest-emitting sterilization facilities in the U.S. estimated exposures remained well below levels linked to increased cancer risk in epidemiological studies. These findings challenge the assumption that facility proximity alone poses significant health risk and support the development of risk-based, proportionate air quality policies. The approach offers regulatory agencies a more transparent and scientifically grounded basis for EtO risk characterization under the Clean Air Act, TSCA, and state air toxics programs.

PMID:41980174 | DOI:10.1080/10962247.2026.2657443

WMJ. 2026;125(1):162-166.

ABSTRACT

BACKGROUND: The University of Wisconsin’s Rural and Urban Community Health Scholars (RUSCH) pathway program was developed to prepare undergraduate students interested in addressing health disparities in Wisconsin for successful medical school matriculation.

METHODS: Post-completion enrollment outcomes and demographics of participants who completed RUSCH from 2010 through 2024 were analyzed to assess medical school and health professions school matriculation, with associations evaluated using chi-square tests.

RESULTS: Seventy-four percent of participants enrolled in a health professions degree program, with 49% enrolling in medical school, most at institutions within Wisconsin. Men were more likely than women, and non-Hispanic participants were more likely than Hispanic participants, to enroll in medical school following RUSCH completion.

DISCUSSION: RUSCH participation was associated with success in pursuing a health profession degree; however, demographic differences in enrollment outcomes need to be addressed.

PMID:41980157

WMJ. 2026;125(1):158-161.

ABSTRACT

INTRODUCTION: The adoption of artificial intelligence (AI) in image generation raises concerns about potential bias, as these technologies may not accurately reflect the populations represented in the images they create. This study examined whether AI-generated images of medical students accurately represent the diversity of the current US medical student population.

METHODS: Using the DALL-E (Open AI) image-generation algorithm, we created 300 images with the text prompt “medical student.” Two researchers independently analyzed images for demographic indicators, including perceived sex, race/ethnicity, age group, setting, and attire. Descriptive statistics summarized the data, and subgroup analyses assessed differences in portrayals by sex and race/ethnicity. Demographic proportions in the virtual cohort were graphically compared with Association of American Medical Colleges enrollment data.

RESULTS: Of the 300 generated images, 227 (76%) were females and 223 (74%) were White, indicating overrepresentation compared with actual medical school demographics. Black and Latino/Hispanic students were more commonly depicted in scrubs compared to White students, who were often portrayed in white coats or collared shirts (P = .002). No images represented Native American/Alaskan Native or Native Hawaiian/Pacific Islander students.

CONCLUSIONS: AI-generated images of medical students demonstrated significant demographic disparities, indicating potential bias in these technologies. Such biased portrayals may perpetuate stereotypes and hinder diversity efforts. Future research should identify and address these biases to promote more equitable and inclusive applications of AI tools.

PMID:41980156

J Appl Physiol (1985). 2026 Apr 14. doi: 10.1152/japplphysiol.01212.2025. Online ahead of print.

ABSTRACT

Fractal dynamics characterize healthy human gait, with stride-interval fluctuations exhibiting long-range correlations generated by intrinsic locomotor control. These correlations diminish when gait is synchronized to an external metronome, often accompanied by curvature in detrended fluctuation analysis (DFA) scaling, but whether this reflects suppression of intrinsic structure or a scale-dependent reorganization of control remains unclear. Here, we identified a delayed-correction mechanism capable of reproducing the characteristic curvature of DFA scaling during metronome walking. We reanalyzed treadmill data from twelve healthy men (1.1 m/s, 20 min) under free walking (FW) and metronome walking (MW). Stride intervals were extracted from foot-switch measurements and evaluated using DFA. As expected, FW showed a near-linear DFA profile, whereas MW exhibited pronounced curvature, indicating reorganization of temporal structure across scales. To test the mechanism underlying this curvature, we constructed difference series from FW stride intervals and compared their DFA profiles with those of MW. Guided by simulation results predicting curvature emergence under delayed error correction, we systematically varied the differencing lag (j = 1-30). Both empirical and simulated analyses showed that MW-like curvature emerged when the current stride was corrected using information from approximately six earlier strides, with statistical analyses supporting an optimal range of 4-8 strides. These findings indicate that metronomic cueing does not simply eliminate fractal (long-range temporal) structure of gait but reorganizes gait dynamics through the superposition of two control processes: long-range fractal structure and a short-range, multi-stride delayed error correction loop.

PMID:41979889 | DOI:10.1152/japplphysiol.01212.2025

J Spinal Cord Med. 2026 Apr 14:1-10. doi: 10.1080/10790268.2026.2650949. Online ahead of print.

ABSTRACT

CONTEXT: Life satisfaction (LS) is associated with health and longevity but decreases after spinal cord injury (SCI). Yet, little is known about changes in LS over time, many years after SCI.

OBJECTIVES: To assess changes in LS over six years among older adults aging with long-term SCI, determine how changes in LS are associated with sex, age, injury characteristics, and with changes in secondary health conditions (SHCs), activity limitations, marital status and vocational situation.

DESIGN: Longitudinal cohort study from the Swedish Aging with Spinal Cord Injury Study (SASCIS).

SETTING: Community settings, Sweden.

PARTICIPANTS: Seventy-eight individuals (32% women), mean age 68 years, mean time since injury 31 years, injury levels C1-L3, AIS A-D.

OUTCOME MEASURES: The Life Satisfaction Questionnaire (LiSat-11), consisting of life as a whole and ten different life domains.

RESULTS: Over six years, there were no statistically significant changes in self-rated LS at the group level, but some variability at the individual level. To stop working was associated with increased LS, whereas none of the included variables were associated with decreased LS. A majority of the participants were dissatisfied with life as a whole and with five of the ten life domains, particularly with sexual life, somatic health, and self-care.

CONCLUSIONS: Our findings indicate stability in global and domain-specific LS over time in older adults aging with long-term SCI. Giving up work can be beneficial for LS in this population as they age. The low LS in several life domains calls for attention in the long-term follow-up after SCI.

PMID:41979885 | DOI:10.1080/10790268.2026.2650949

JAMA Netw Open. 2026 Apr 1;9(4):e264917. doi: 10.1001/jamanetworkopen.2026.4917.

ABSTRACT

IMPORTANCE: Medicaid beneficiaries-particularly those with mental health (MH) conditions, substance use disorder (SUD), and alcohol use disorder (AUD)-frequently use emergency departments (EDs). Timely primary care follow-up can reduce high 30-day ED revisit rates for these conditions; however, primary care follow-up after such ED visits remains understudied.

OBJECTIVE: To examine rates of 30-day condition-concordant primary care follow-up for MH, SUD, and AUD after ED visits related to these conditions and identify characteristics associated with condition-concordant primary care follow-up.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study retrospectively analyzed 2022 Medicaid claims data from beneficiaries residing in Washington State who had at least 1 ED visit during the study period. Data were analyzed between March and May 2025.

EXPOSURE: ED visits for MH conditions, SUDs, or AUD.

MAIN OUTCOMES AND MEASURES: The primary outcome was primary care follow-up for MH conditions or SUDs within 30 days following ED visits for those diagnoses (condition-concordant primary care follow-up), and the secondary outcome was condition-concordant primary care follow-up for AUD within the same time frame. Multivariable logistic regression with marginal effects was used to assess associations between beneficiary characteristics and probability of primary care follow-up.

RESULTS: This study included 859 043 Medicaid ED visit claims from 367 245 unique individuals in Washington (mean [SD] age, 41.7 [16.2] years); 496 775 claims (57.8%) were for women. Among the claims, 52 500 (6.1%) were for beneficiaries self-reporting as Alaska Native or American Indian, 48 103 (5.6%) as Asian or Pacific Islander, 89 548 (10.4%) as non-Hispanic Black, 476 968 (55.5%) as non-Hispanic White; and 173 996 (20.3%) as other race (17 928 [2.1%] did not provide or had missing information on race); 142 556 (16.6%) claims were for beneficiaries self-reporting as Hispanic and 678 961 (79.0%) as non-Hispanic (37 526 [4.4%] did not provide or had missing information on ethnicity). Condition-concordant primary care follow-up occurred after 18 722 of 131 704 MH condition- (14.2%), 11 353 of 101 684 SUD (11.2%)-, and 3675 of 33 196 AUD (11.1%)-related ED visits. All racial groups, and non-Hispanic White individuals in particular, had a higher probability of receiving condition-concordant primary care follow-up than non-Hispanic Black individuals (estimated marginal effects: MH, 4.47 [95% CI, 3.87-5.07] percentage points; SUD, 4.70 [95% CI, 4.12-5.27] percentage points; AUD, 4.00 [95% CI, 2.87-5.13] percentage points). Individuals experiencing homelessness had a significantly lower probability of receiving condition-concordant primary care follow-up (estimated marginal effects: MH, -2.74 [95% CI, -3.25 to -2.23] percentage points; SUD, -1.88 [95% CI, -2.33 to -1.44] percentage points; AUD, -1.86 [95% CI, 2.73 to -0.99] percentage points) compared with those not experiencing homelessness.

CONCLUSIONS AND RELEVANCE: In this cohort study of Medicaid beneficiaries in Washington, condition-concordant primary care follow-up after ED visits for MH conditions, SUDs, and AUD was infrequent. Observed racial and social differences suggest potential barriers to care access and coordination following ED visits. Tailored care coordination and outreach may be necessary to improve continuity of and access to primary care services among these populations.

PMID:41979881 | DOI:10.1001/jamanetworkopen.2026.4917

JAMA Netw Open. 2026 Apr 1;9(4):e264922. doi: 10.1001/jamanetworkopen.2026.4922.

ABSTRACT

IMPORTANCE: Extreme weather disasters leave behind long-lasting mental and physical health problems. Displacement related to climate change disproportionately impacts children, whose developmental stage leaves them particularly at risk to its devastating effects.

OBJECTIVE: To compare pediatric mental health needs and care for those in need between displaced households and other households.

DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional analysis with multivariable logistic regression models used data from the US Census Household Pulse Survey, a nationally representative dataset, from June 1, 2023, through September 31, 2024. The study included biweekly, individual-level data reported by individual adults for all members of their household.

EXPOSURE: Experience of displacement in the past year due to a natural disaster.

MAIN OUTCOMES AND MEASURES: Mental health needs were defined based on response to a question asking whether any children in the household needed mental health treatment, such as counseling or medication, in the past 4 weeks. Then the likelihood of receiving mental health treatment was examined for those who reported mental health needs.

RESULTS: Of the 324 466 households with children identified during the study period, 277 081 respondents (mean [SD) age, 42.7 [0.05) years; 162 288 [58.6%] female) were included in the analytic sample. This sample represents approximately 35 million US households with children. Among households with children, those that experienced displacement due to natural disaster had a significantly higher chance of reporting that the children needed mental health counseling or medication (odds ratio, 1.29; 95% CI, 1.12-1.48; P < .001). Among households with reported pediatric mental health needs, displaced households were more likely to report inadequate or no treatment, even after controlling for socioeconomic hardships (odds ratio, 0.55; 95% CI, 0.38-0.66; P < .001).

CONCLUSIONS AND RELEVANCE: The cross-sectional study found that displaced children experience more unmet mental health needs after natural disasters compared with nondisplaced children, which may negatively impact their long-term development. As climate change progresses, targeted research is urgently needed to understand how best to meet these needs.

PMID:41979880 | DOI:10.1001/jamanetworkopen.2026.4922

JAMA Netw Open. 2026 Apr 1;9(4):e266838. doi: 10.1001/jamanetworkopen.2026.6838.

ABSTRACT

IMPORTANCE: In 2023, the American Heart Association Cardiovascular-Kidney-Metabolic Scientific Advisory Group introduced the Predicting Risk of Cardiovascular Disease Events (PREVENT) equations, a race-free, sex-specific model for cardiovascular disease (CVD) risk prediction in adults aged 30 to 79 years. While initial validations showed strong performance, their reliability under missingness conditions remains unclear.

OBJECTIVE: To evaluate discrimination and calibration of the PREVENT equations in an electronic health record (EHR) cohort and assess robustness to missingness.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used Duke University Health System, a health network encompassing tertiary hospitals, regional hospitals, and primary care practices across North Carolina, EHR data from March 2014 to December 2024 with up to 8 years follow-up. Patients without baseline CVD with sufficient data to calculate PREVENT risk were included. Two cohorts were defined: a relaxed cohort, allowing for missing laboratory and vital sign data with race-sex median imputation, and a strict cohort, restricted to those with complete records. Data were analyzed from October 2024 to June 2025.

EXPOSURES: Published PREVENT equations alongside locally fitted Cox proportional hazards, discrete-time neural network, and recalibrated PREVENT models.

MAIN OUTCOMES AND MEASURES: The primary outcomes were estimated 5-year risk of incident CVD and assessed discrimination (C-index) and calibration (expected vs observed event rates) at 5 years by race, sex, and socioeconomic subgroups. The local adaptation via Duke retraining was compared with machine learning-based recalibration of PREVENT scores.

RESULTS: The study included 406 230 patients in the relaxed cohort (239 764 females with a mean [SD] age of 49 [20] years and 166 466 males with a mean [SD] age of 49 [20] years; 16 291 Asian [4.0%], 107 114 Black [26.4%], and 256 403 White [63.1%]) and 127 151 patients in the strict cohort (71 086 females with a mean [SD] age of 54 [13] years and 56 065 males with a mean [SD] age of 53 [12] years; 8210 Asian [6.5%], 29 033 Black [22.8%], and 83 515 White [65.7%]). PREVENT showed strong discrimination in both cohorts (C-index, 0.77 for both males and females in the strict cohort vs 0.75 for males and 0.77 for females in the relaxed cohort), indicating robustness to missing data. Calibration ratios were higher in the strict cohort, indicating more risk underestimation in the relaxed cohort. Local adaptations minimally affected discrimination and modestly improved calibration.

CONCLUSIONS AND RELEVANCE: In this cohort study, the PREVENT equations showed strong discrimination and generalizability, including with missing laboratory and vital sign data when imputation was applied, supporting reliable CVD risk identification and ranking in routine practice.

PMID:41979878 | DOI:10.1001/jamanetworkopen.2026.6838