Category: Statistics

Syst Biol. 2025 Jun 26:syaf039. doi: 10.1093/sysbio/syaf039. Online ahead of print.

ABSTRACT

The recent rapid radiation of Tillandsia subgenus Tillandsia (Bromeliaceae) provides an attractive system to study the drivers and constraints of species diversification. This species-rich Neotropical monocot clade includes predominantly epiphytic species displaying vast phenotypic diversity. Recent in-depth phylogenomic work revealed that the subgenus originated within the last 7 MY, with one major expansion from South into Central America within the last 5 MY. However, disagreements between phylogenies and lack of resolution at shallow nodes suggest that hybridization may have occurred throughout the radiation, together with frequent incomplete lineage sorting and rapid gene family evolution. We used whole-genome resequencing data to explore the evolutionary history of representative ingroup species employing both tree-based and network approaches. Our results indicate that lineage co-occurrence does not predict relatedness and confirm significant deviations from a tree-like structure, coupled with pervasive gene tree discordance. Focusing on hybridization, ABBA-BABA and related statistics were used to infer the rates and relative timing of introgression, while topology weighting uncovered high heterogeneity of the phylogenetic signal along the genome. High rates of hybridization within and among subclades suggest that, contrary to previous hypotheses, the expansion of subgenus Tillandsia into Central America proceeded through several dispersal events, punctuated by episodes of diversification and gene flow. Network analysis revealed reticulation as a plausible propeller during radiation and establishment across different ecological niches. This work contributes a plant example of prevalent hybridization during rapid species diversification, supporting the hypothesis that interspecific gene flow facilitates explosive diversification.

PMID:40569662 | DOI:10.1093/sysbio/syaf039

Nutr Rev. 2025 Jun 26:nuaf074. doi: 10.1093/nutrit/nuaf074. Online ahead of print.

ABSTRACT

CONTEXT: Dietary habits may significantly influence human health, potentially more than specific foods or nutrients. These habits also play crucial roles in the treatment and prevention of breast cancer (BC). Although the association between low-fat diets (LFDs) and BC has been extensively investigated, the effects of LFDs on BC-related mortality and prognosis remain insufficiently elucidated.

OBJECTIVE: In this meta-analysis we sought to elucidate the relationship between LFDs and BC risk and prognosis.

DATA SOURCES: The search spanned PubMed, Cochrane Library, Web of Science, and Clinical Trials.gov from database inception up to September 13, 2024. Qualified randomized controlled trials were included.

DATA EXTRACTION: Thirteen studies met the inclusion criteria, encompassing 63,373 participants. These investigations focused on the relationship between LFDs and BC mortality and prognosis.

DATA ANALYSIS: A significant connection exists between LFDs and lower mortality rates following BC (hazard ratio [HR] = 0.84; 95% CI, 0.74-0.95) and deaths specifically attributed to BC (HR = 0.77; 95% CI, 0.64-0.93). Additionally, LFDs significantly enhanced overall survival (HR = 0.76; 95% CI, 0.64-0.89). However, the beneficial effect of LFDs on BC incidence (HR = 0.96; 95% CI, 0.87-1.06) and other BC-related outcomes (HR = 1.02; 95% CI, 0.83-1.26) did not reach statistical significance. Low-fat diets decreased energy intake compared to standard control diets (total weighted mean difference [WMD], -122.01 (kcal); 95% CI, -185.35 to -58.67). Similarly, analysis of fat intake indicated that LFDs reduced energy derived from fat relative to usual control diets (total WMD, -6.28 (%); 95% CI, -7.56 to -4.99). The consumption of saturated fat also revealed a statistically significant effect (total WMD, -2.25 (%); 95% CI, -3.09 to -1.40). Egger’s test (P = 0.346) suggested no significant publication bias in the findings. Sensitivity analysis affirmed the robustness of the results.

CONCLUSIONS: This meta-analysis demonstrates that LFDs are significantly associated with improved mortality rates and prognostic outcomes in BC patients. Larger prospective cohorts are needed to confirm these findings and explore causal mechanisms.

PMID:40569655 | DOI:10.1093/nutrit/nuaf074

Hosp Top. 2025 Jun 26:1-18. doi: 10.1080/00185868.2025.2524800. Online ahead of print.

ABSTRACT

Underserved communities often face significant reproductive health challenges, including limited access to contraceptive methods. In the Isare health district, rates of unwanted pregnancies and sexually transmitted diseases are high due to insufficient information and resources. To explore how nurses can play a crucial role in improving knowledge, awareness and accessibility of contraceptive methods within underserved communities. Explore specific strategies, interventions, and education programs that nurses can implement to empower community members to make informed decisions about contraception. Qualitative and quantitative methods were used and it was the qualitative data coding system that allowed us to obtain reliable results. Using Alain Bouchard’s sampling technique, 72 community members and other health actors involved in the provision of contraceptive services were selected. Quantitative data were analyzed using statistical software for the social sciences. The results of this article provided practical recommendations to enhance the effectiveness of nurses in promoting awareness and access to contraceptive methods. These recommendations include continuing education for nurses to strengthen their communication skills, developing culturally appropriate awareness campaigns, and strengthening collaboration with other health and community actors. We find that this article will direct the efforts of nurses, health professionals and decision makers in the Isare health district toward more effective strategies to promote awareness and access to contraceptive methods. By following our recommendations given in this article, it is possible to make a significant contribution to improving reproductive health and quality of life in underserved communities.

PMID:40569645 | DOI:10.1080/00185868.2025.2524800

Geobiology. 2025 Jul-Aug;23(4):e70025. doi: 10.1111/gbi.70025.

ABSTRACT

In Arctic polar deserts, rocks can be extensively colonized by phototrophic hypolithic communities that exploit periglacial sorting processes to grow beneath opaque rocks. These communities are distinguished by green bands that are distinctly and abruptly separated from the black-pigmented communities on the rock surface (epiliths). We used 16S and 18S rDNA culture-independent methods to address the hypothesis that the two communities are different. Although both communities were dominated by cyanobacterial species (Chroococcidiopsis and Nostoc spp.), we found that the hypolithic and epilithic habitats host distinct microbial communities. We found that eukaryotic hypolithic and epilithic communities were statistically similar but that the hypolithic habitats contained tardigrade DNA, showing that the more clement subsurface habitat supports animal life in contrast to the surface of the rocks. These results reveal the distinctive communities and sharp demarcations that can develop across small spatial scales in the Earth’s rocky extreme environments.

PMID:40569605 | DOI:10.1111/gbi.70025

JAMA Netw Open. 2025 Jun 2;8(6):e2517616. doi: 10.1001/jamanetworkopen.2025.17616.

ABSTRACT

IMPORTANCE: As the primary facilities authorized to dispense methadone, opioid treatment programs (OTPs) are a critical access point for medications for opioid use disorder (MOUD). However, research is limited on the extent to which OTPs offer a broad range of MOUD and on the characteristics of programs that provide more comprehensive medication offerings.

OBJECTIVE: To assess the percentage of US OTPs offering all 3 forms of MOUD (methadone, buprenorphine, and naltrexone) and compare organizational and county characteristics of OTPs with different MOUD service offerings.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cross-sectional study used data on a panel of OTPs listed in the annual National Directory of Drug and Alcohol Use Treatment Facilities from 2017 to 2023.

MAIN OUTCOMES AND MEASURES: Measures included the percentage of OTPs offering buprenorphine, extended-release naltrexone, or all 3 MOUD from 2017 to 2023 (assuming all OTPs offered methadone). Descriptive statistics on organizational and county characteristics of OTPs by MOUD offerings were collected. Three longitudinal logistic regression models were used to estimate the odds of different MOUD offerings within OTPs, adjusting for organizational and county-level characteristics.

RESULTS: This analysis included 10 298 facility-year observations, ranging from 1211 in 2017 to 1421 in 2023. From 2017 to 2023, the percentage of OTPs offering MOUD beyond methadone increased (buprenorphine: 811 [67.0%] in 2017 to 1209 [85.1%] in 2023; naltrexone: 463 [38.2%] in 2017 to 749 [52.7%] in 2023; all 3 MOUD: 402 [33.2%] in 2017 to 639 [45.0%] in 2023). OTPs offering all 3 MOUD (3985 [38.7%]) had significantly higher odds of accepting Medicare (adjusted odds ratio [AOR], 2.14; 95% CI, 1.67-2.74); offering peer services (AOR, 1.63; 95% CI, 1.25-2.12), mental health services (AOR, 2.07; 95% CI, 1.53-2.80), and telemedicine services (AOR, 1.53; 95% CI, 1.22-1.92); and being private nonprofit (AOR, 7.45; 95% CI, 4.67-11.87) or government operated (AOR, 41.83; 95% CI, 19.71-88.75) compared with private for profit.

CONCLUSIONS: In this cross-sectional study of OTPs, although the availability of MOUD beyond methadone increased over time, most OTPs still did not offer all 3 forms of MOUD as of 2023. Specific organizational characteristics, such as being government operated and accepting Medicare, were associated with more comprehensive MOUD offerings. Future research should evaluate why OTPs vary in their MOUD offerings.

PMID:40569596 | DOI:10.1001/jamanetworkopen.2025.17616

JAMA Netw Open. 2025 Jun 2;8(6):e2518493. doi: 10.1001/jamanetworkopen.2025.18493.

ABSTRACT

IMPORTANCE: Despite expanded efforts to improve treatment access, inequities exist in the receipt of medications for opioid use disorder by race and ethnicity and insurance type.

OBJECTIVE: To examine inequities in access to medications for opioid use disorder (MOUD)-specifically buprenorphine and naltrexone-by race and ethnicity and insurance type after opioid-related health care events.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the Institute for Health Equity Research Multi-Payor Claims Database, which includes more than 130 million individuals across commercial, Medicaid, and Medicare Advantage insurance plans. The cohort consisted of patients aged 18 years or older with an opioid use disorder (OUD)-related health care event (opioid-related overdose, infection, or treatment event) that occurred between January 1, 2017, and December 31, 2022. Statistical analysis was conducted from October 2023 to December 2024.

EXPOSURE: Race and ethnicity and insurance type, including commercial insurance, Medicaid, and Medicare Advantage, were the primary exposures.

MAIN OUTCOMES AND MEASURES: The primary outcome was receipt of MOUD (buprenorphine or naltrexone) within 180 days of an OUD-related health care event. Logistic regression models were used to assess the associations of MOUD receipt with race and ethnicity and with insurance type, adjusting for demographic, clinical, time, and geographical covariates.

RESULTS: Among 176 997 index events involving 164 728 patients between 2017 and 2022, the mean (SD) patient age was 40.0 (13.1) years; 104 005 (58.8%) involved men; 1083 events (0.6%) were among Asian patients, 23 424 (13.2%) were among Black patients, 10 302 (5.8%) were among Hispanic patients, 90 124 (50.9%) were among White patients, and 4697 (2.7%) were among patients of other race and ethnicity; and 147 257 (83.2%) were covered by Medicaid. Black (adjusted estimated probability, 17.1% [95% CI, 13.0%-21.1%]) and Hispanic (adjusted estimated probability, 16.2% [95% CI, 11.6%-20.8%]) patients were significantly less likely than White patients (adjusted estimated probability, 20.5% [95% CI, 16.4%-24.7%]) to receive buprenorphine (Black patients: adjusted odds ratio [AOR], 0.75 [95% CI, 0.63-0.90]; adjusted risk difference [ARD], -3.4 percentage points [pp] [95% CI, -6.5 to -0.4 pp]; Hispanic patients: AOR, 0.69 [95% CI, 0.51-0.92]; ARD, -4.4 pp [95% CI, -9.1 to 0.4 pp]) but received naltrexone at similar rates. Patients with Medicaid (AOR, 1.39 [95% CI, 1.14-1.69]; ARD, 3.5 pp [95% CI, 0.9-6.1 pp]) or Medicare Advantage (AOR, 1.40 [95% CI, 1.05-1.86]; ARD, 3.6 pp [95% CI, -0.6 to 7.7 pp]) were more likely to receive buprenorphine compared with those with commercial insurance. Buprenorphine access improved incrementally from 2017 to 2022, reflecting recent clinical and policy changes; however, disparities persisted.

CONCLUSIONS AND RELEVANCE: In this cohort study of more than 17 600 opioid-related index health care events, race and ethnicity-based and insurance-based disparities in access to MOUD persisted despite efforts to expand treatment availability. These findings underscore the need for targeted interventions, including culturally tailored care, expanded access points, and policy reforms to address structural barriers and reduce inequities contributing to the overdose crisis.

PMID:40569592 | DOI:10.1001/jamanetworkopen.2025.18493

Am J Physiol Gastrointest Liver Physiol. 2025 Jun 26. doi: 10.1152/ajpgi.00100.2025. Online ahead of print.

ABSTRACT

Introduction: Defecatory dysfunction (DD) is a common cause of chronic constipation resulting from functional abnormalities or structural pelvic pathologies. Accurate diagnosis requires combining anorectal manometry (ARM), balloon expulsion test (BET), and defecography. This study evaluates the diagnostic utility of these modalities and explores uncertainties in their performance and interpretation. Methods: This retrospective study included 325 adult patients assessed for DD between 2020 and 2023. All patients went through ARM, BET in the left lateral position, and defecography. Statistical associations between test outcomes were analyzed to assess diagnostic concordance and significance. Results: A strong correlation was observed between ARM and defecography, with 65% of patients with normal anal relaxation on ARM achieving normal rectal evacuation on defecography (p < 0.0001). Conversely, patients with paradoxical contraction during ARM demonstrated a higher likelihood of evacuation failure. BET demonstrated high specificity but limited sensitivity in association with relaxation on ARM and evacuation on defecography. BET failure did not demonstrate a significant association with the presence of pelvic floor pathologies. Conclusion: Combining ARM, BET, and defecography provides a comprehensive framework for diagnosing DD, addressing its functional and structural components. This integrated approach facilitates targeted interventions, ultimately improving clinical outcomes.

PMID:40569575 | DOI:10.1152/ajpgi.00100.2025

Epileptic Disord. 2025 Jun 26. doi: 10.1002/epd2.70057. Online ahead of print.

ABSTRACT

OBJECTIVE: Sudden unexpected death in epilepsy (SUDEP) is a major cause of epilepsy-related mortality, especially in patients with drug-resistant epilepsy. However, pediatric data remain limited, and specific risk assessment tools for children are lacking. This study evaluates the association between peri-ictal prone positioning, postictal generalized EEG suppression (PGES), and SUDEP-7 Inventory scores in pediatric patients with epilepsy.

METHODS: A retrospective review was conducted on 273 generalized convulsive seizures (GCS) from 117 pediatric patients who underwent video-EEG monitoring from 2002 to 2022. We assessed body position during seizures, PGES presence and duration, and SUDEP-7 Inventory scores. Statistical comparisons were made across PGES-positive and -negative, and prone vs. non-prone subgroups.

RESULTS: Prone positioning occurred in 5.86% of seizures, with 91.6% of prone-onset seizures remaining in the prone position throughout. PGES was present in 50.4% of patients (mean duration: 120.5 s). SUDEP-7 scores were significantly higher in PGES-positive patients (mean: 7.04) compared to PGES-negative (mean: 6.36; p = 0.031). Daytime GCS occurred significantly earlier after sleep onset than night time GCS (53.3 vs. 131.4 minutes; p = 0.001).

SIGNIFICANCE: PGES appears to be a reliable marker associated with higher SUDEP-7 scores and may indicate increased SUDEP risk in children. While SUDEP-7 has limitations in pediatric use, it remains the most accessible clinical tool. Integrating EEG and body position metrics could enhance individualized monitoring for pediatric patients at risk.

PMID:40569567 | DOI:10.1002/epd2.70057

J Behav Med. 2025 Jun 26. doi: 10.1007/s10865-025-00582-x. Online ahead of print.

ABSTRACT

OBJECTIVE: Most individuals who complete a behavioral weight loss intervention (BWLI) regain weight. The current study is a preliminary investigation into the efficacy of a telephone coaching intervention to aid recovery from weight regain during weight loss maintenance.

METHODS: Participants (n = 77) who had recently completed a BWLI and had lost ≥ 5% of their initial body weight were instructed to engage in daily weighing using a “smart” scale. Participants were randomized to receive four consecutive weeks of brief coaching phone calls or no intervention. Randomization was activated when individuals regained > 1.5% of their baseline weight. Assessments were completed at baseline and 12 months.

RESULTS: Sixty-six participants (M ± SD age = 54.2 ± 9.9 years, 68% female) regained > 1.5% and were included in analyses. Individuals who received coaching completed 3.9 ± 0.5 calls and showed statistically-significant improvements in weight compared to the control group in the short-term (i.e., from randomization activation to 40 days later; M±SE Coaching: -1.05%±0.30 vs. Control: 0.37%±0.31, p < 0.001). However, there were not significant differences in weight regain by group at the 12-month study end (Coaching: 5.18%±0.72 vs. Control: 5.71%±0.76, p = 0.62).

CONCLUSIONS: Brief telephone coaching is a promising intervention for reversing short-term weight regain. Future research should focus on improving the coaching intervention to promote long-term weight loss maintenance, including exploration into offering multiple rounds of coaching.

CLINICAL TRIAL REGISTRATION: NCT04293055.

PMID:40569564 | DOI:10.1007/s10865-025-00582-x

J Community Health. 2025 Jun 26. doi: 10.1007/s10900-025-01497-z. Online ahead of print.

ABSTRACT

Seasonal influenza represents a significant public health challenge, with high hospitalization and mortality rates among the most vulnerable populations. Despite healthcare recommendations and the availability of safe and effective vaccines, vaccination coverage remains below the targets set by the WHO. This study analyzes the role of socioeconomic factors, knowledge, and individual attitudes in adherence to influenza vaccination in the City of Syracuse, Italy. A cross-sectional study was conducted on 394 adults from the ASP of Siracusa, recruited through General Practitioners. A questionnaire collected sociodemographic data, vaccination information, and assessments of knowledge and attitudes. Statistical analysis was performed using logistic regressions to evaluate the factors associated with vaccination. Multivariate analysis highlighted a significant association between vaccination adherence and socioeconomic and demographic factors. Older age was associated with a higher likelihood of vaccination (OR = 1.04; p = 0.002), while being married or cohabiting was linked to a lower probability of getting vaccinated (OR = 0.33; p = 0.002). Moreover, residents of small towns had a significantly lower probability of vaccination compared to those living in urban areas (OR = 0.04; p < 0.001). Knowledge about the vaccine had a marginal impact on adherence, whereas a favorable attitude did not show a significant association. Adherence to influenza vaccination is influenced by sociodemographic factors, with lower coverage in small municipalities and younger age groups. The active involvement of General Practitioners and targeted strategies for communication and accessibility could improve vaccination coverage.

PMID:40569554 | DOI:10.1007/s10900-025-01497-z