Category: Statistics

Am J Surg. 2025 Jan 9;244:116192. doi: 10.1016/j.amjsurg.2025.116192. Online ahead of print.

ABSTRACT

Approximately 22 ​% of the United States population communicates in a non-English language, potentially impacting healthcare communication and outcomes. Few studies have examined the association between non-English primary language (NEPL) and surgical outcomes and none to our knowledge in patients undergoing arteriovenous fistula creation within a safety net system. In this study, we conducted a retrospective analysis on adults who underwent AVF creation for hemodialysis access between January 1, 2014, and December 31, 2019. We employed a bivariate logistic regression analysis to assess the relationship between primary language and 30-day ED visits and readmissions, both for all-cause after AVF surgery and those specifically related to arteriovenous fistula (AVF) complications and a multivariate logistic regression to adjust for any cofounders. Among the study population of 1502 patients, 70 ​% were NEPL and predominantly self-identified as Hispanic/Latino. Despite the older age and higher prevalence of diabetes among NEPL patients, there was no statistically significant association of NEPL with 30-day readmission or ED visits post-AVF creation. The availability of certified translators and diverse array of healthcare professionals may have contributed to these findings. Nonetheless, further investigation is warranted to elucidate the impact of language discordance on post-surgical outcomes.

PMID:39808860 | DOI:10.1016/j.amjsurg.2025.116192

J Pediatr Surg. 2025 Jan 6;60(3):162104. doi: 10.1016/j.jpedsurg.2024.162104. Online ahead of print.

ABSTRACT

BACKGROUND: Inequities exist in pediatric surgical outcomes. Differential outcomes have been identified across racial groups, geography, and socioeconomic standing. However, the association between preferred language, interpreter use, and surgical outcomes is not well-studied in pediatric surgical literature.

METHODS: We performed a retrospective cohort study of surgical patients ages 0-21 years at a quaternary pediatric hospital between 1/1/2016 – 12/31/2020. The 95 languages spoken by our cohort were grouped into English, Spanish, Asian languages, Other Indo-European languages, and Other languages. Study outcomes were 30-day post-operative mortality and serious adverse events (SAE). Logistic regression assessed the relationship between language, interpreter use, and post-operative outcomes. Deviation contrasts avoided centering non-Hispanic white English speakers. All-pairs comparisons (Turkey contrasts) determined differences between language groups.

RESULTS: Among 56,655 patients, 89 % had a documented language of English, 6.7 % Spanish, 1.4 % Other, 1.3 % an Asian language, and 1.3 % an Other Indo-European language. On multivariable regression, English speakers had 54 % decreased odds of mortality (OR 0.46, 95 % CI: 0.31, 0.69), while Other language speakers had 240 % increased odds of mortality (OR 2.4, 95 % CI: 1.31, 4.41). Pairwise comparisons showed that English language speakers had reduced odds of mortality versus Other language speakers (OR 0.18, 95 % CI: 0.07, 0.45). Interpreter use was associated with a significant reduction in the odds of SAE but did not reduce mortality risk.

DISCUSSION: Pediatric surgical patients with a linguistic minority preference experienced statistically significant increased odds of post-operative mortality. Additional inquiry to assess and address disparate pediatric surgical care outcomes associated with language is warranted.

LEVEL OF EVIDENCE: Level III.

PMID:39808857 | DOI:10.1016/j.jpedsurg.2024.162104

J Strength Cond Res. 2024 Dec 1;38(12):2164-2171. doi: 10.1519/JSC.0000000000004978.

ABSTRACT

Hammert, WB, Dankel, SJ, Kataoka, R, Yamada, Y, Kassiano, W, Song, JS, and Loenneke, JP. Methodological considerations when studying resistance-trained populations: Ideas for using control groups. J Strength Cond Res 38(12): 2164-2171, 2024-The applicability of training effects from experimental research depends on the ability to quantify the degree of measurement error accurately over time, which can be accounted for by including a time-matched nonexercise control group. Yet, control groups are rarely included in studies on resistance-trained individuals. Many authors instead report short-term relative or absolute measures of reliability for the interpretation of statistical tests and the size or meaning of effects observed and assume that good short-term reliability justifies the lack of a control group. In this article, we offer some potential alternatives for employing control groups in research studies on resistance-trained individuals. We wish to suggest researchers consider using a “time-matched training group” (i.e., resistance-trained individuals who keep an exercise log, continue their normal training, and perform the pre- and posttest measures spanning the same duration as that of the exercise group or groups) and/or a time-matched nonexercise control group (i.e., non-resistance-trained individuals who perform only the pre- and posttest measures spanning the same duration as that of the exercise training group or groups). If it is not feasible (e.g., researchers do not wish to randomly assign individuals to a time-matched training group or include a time-matched nonexercise control group) to employ such designs, or relevant, then an alternative approach might be to include a run-in (i.e., control) period that spans the same duration as the exercise training intervention. Our hope is that this article can help strengthen future research designs conducted on resistance-trained individuals.

PMID:39808811 | DOI:10.1519/JSC.0000000000004978

J Strength Cond Res. 2024 Dec 1;38(12):2065-2073. doi: 10.1519/JSC.0000000000004914. Epub 2024 Sep 17.

ABSTRACT

Kember, LS, Riehm, CD, Schille, A, Slaton, JA, Myer, GD, and Lloyd, RS. Residual biomechanical deficits identified with the tuck jump assessment in female athletes 9 months after ACLR surgery. J Strength Cond Res 38(12): 2065-2073, 2024-Addressing biomechanical deficits in female athletes after anterior cruciate ligament reconstruction (ACLR) is crucial for safe return-to-play. The tuck jump assessment (TJA) is used to identify risks associated with ACL injury, yet its fundamental analyses lack the ability to explore landing forces. Kinetic asymmetries during the TJA were assessed in athletes with ACLR (n = 38) and matched healthy controls (n = 21) using discrete time-point analysis and statistical parametric mapping (p < 0.05). The ACLR group performed fewer jumping cycles with distinct kinetic differences, including longer ground contact time (g = 1.45), larger peak center of mass displacement (g = 1.29), and lower peak vertical ground reaction force (VGRF) (g = -2.05) and relative leg stiffness (g = -1.51). Greater interlimb kinetic asymmetries were evident in the ACLR group for VGRF (g = 0.84), relative leg stiffness (g = 0.85), average loading rate (g = 0.84), peak braking force (g = 0.85), and time of braking (g = 0.80) and propulsive peaks (g = 1.04). Moderate differences in VGRF favored the uninvolved limb of the ACLR group for the majority (2-100%) of the stance phase of TJA (d = -0.52). Distinct jump-landing strategies between ACLR athletes and healthy controls were revealed during the TJA, which may indicate compromised stretch-shortening cycle function. Findings highlight the need for targeted rehabilitation to foster greater kinetic symmetry in jump-landing performance and underscore the importance of longitudinal and progressive monitoring for optimized return-to-play outcomes in athletes after ACLR.

PMID:39808808 | DOI:10.1519/JSC.0000000000004914

J Strength Cond Res. 2024 Dec 1;38(12):2055-2064. doi: 10.1519/JSC.0000000000004924. Epub 2024 Sep 17.

ABSTRACT

Grammenou, M, Kendall, KL, Wilson, CJ, Porter, T, Laws, SM, and Haff, GG. Effect of fitness level on time course of recovery after acute strength and high-intensity interval training. J Strength Cond Res 38(12): 2055-2064, 2024-The aim was to investigate time course of recovery after acute bouts of strength (STR) and high-intensity interval training (HIIT). A secondary goal was to assess the influence of total fitness score (TFS), composed of handgrip strength and maximum aerobic power on recovery. Twenty-eight resistance-trained individuals completed 8 testing sessions within a 14- to 17-day period. Subjects performed a testing battery comprising isometric midthigh pull (IMTP), countermovement jump (CMJ), and a modified Wingate test (WINmod) at baseline, immediately after exercise, as well as at 6 and 24 hours after the training sessions. A one-way ANOVA was performed to examine time changes after the training sessions. Subjects were then grouped based on their TFS in high, medium, and low groups. To examine the influence of TFS on time course of recovery, we performed a linear mixed-effects model. Statistical significance was set at p < 0.05. Both training sessions resulted in a significant reduction in peak force (PF) that persisted for up to 6 (p < 0.05) and 24 hours (p < 0.001). The STR session showed immediate and 24-hour postexercise declines in jump height and reactive strength index modified (RSImod) compared with baseline. The low TFS group exhibited a significant RSImod reduction immediately after HIIT (p < 0.001), compared with the medium TFS group (p = 0.0002). In the STR session, the high TFS group displayed an increased eccentric displacement during CMJ 24 hours after exercise compared with baseline (p = 0.033). Overall, subjects with high TFS may be able to recover CMJ performance at the same rate as other TFS groups, despite performing more work.

PMID:39808807 | DOI:10.1519/JSC.0000000000004924

J Strength Cond Res. 2024 Dec 1;38(12):2022-2028. doi: 10.1519/JSC.0000000000004927. Epub 2024 Sep 17.

ABSTRACT

Garner, C, Nachtegall, A, Roth, E, Sterenberg, A, Kim, D, Michael, T, and Lee, S. Effects of movement sonification auditory feedback on repetitions and brain activity during the bench press. J Strength Cond Res 38(12): 2022-2028, 2024-Auditory stimulation and feedback have been found to enhance aspects of motor performance such as motor learning, sense of agency, and movement execution. While music is the most common form of auditory stimulation during exercise, movement sonification (MoSo) may better facilitate motor performance through its use of music elements representing dynamic movements. Despite evidence of MoSo’s benefits to motor performance, little is known about MoSo’s influence on resistance exercise. The purpose of this research was to investigate the effects of MoSo auditory feedback on repetitions and brain activity during bench press. Twenty men performed bench press to failure in 3 sound conditions (no-sound, self-selected music, and MoSo). Repetition maximum (RM) was measured, and brain activity was analyzed using beta power spectral density (PSD) and frontal alpha asymmetry (FAA). A 1-way repeated measures analysis of variance (ANOVA) was conducted to compare data across sound conditions. To gain a deeper understanding of brain activity during bench press, a 2-way repeated measures ANOVA was performed to investigate changes in beta PSD and FAA over time using sound and timepoint as independent variables. A 1-way ANOVA showed that FAA in MoSo was significantly higher than in music and no-sound; however, no statistically significant differences were observed in RM and beta PSD between conditions. A 2-way ANOVA revealed that beta PSD and FAA increased significantly as bench press repetitions approached failure. Our study suggests that MoSo auditory feedback may not improve bench press repetitions, but it may increase brain activity during bench press better than listening to music.

PMID:39808805 | DOI:10.1519/JSC.0000000000004927

J Neurosci Nurs. 2025 Jan 13. doi: 10.1097/JNN.0000000000000814. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with brain tumors continue to exhibit a lower quality of life than the general population, even after an extended period after surgery. Therefore, this study aimed to assess the postoperative quality of life of patients with brain tumors in South Korea and explore its determinants. METHODS: This study used a descriptive correlational design and collected data using questionnaires and electronic medical records. The collected data included the participants’ characteristics, anxiety and depression levels, uncertainty, social support, and quality of life. Data analysis was performed using SPSS 29.0, with descriptive statistics, Pearson correlation analysis, and multiple regression analysis. RESULTS: Of the 117 subjects, 84 (71.8%) had benign tumors, and 33 (28.2%) had malignant tumors, with an average postoperative duration of 42.7 (51.0) months. Thirty-four participants (29%) reported experiencing depression, whereas the average uncertainty score was 91.8 (12.0) points. The average quality-of-life score was 67.52 (20.31) points, indicating a lower quality of life compared with the general population. Lower average monthly income (β = 0.174, P = .044), higher depression levels (β = -0.413, P < .001), and greater uncertainty (β = -0.230, P = .025) were associated with reduced quality of life. In terms of social support, family support was linked to quality of life but did not have a significant influence (P = .780), whereas healthcare provider support significantly affected quality of life (P = .015). CONCLUSION: This study highlights the persistent decline in the postoperative quality of life of patients with brain tumors due to depression and uncertainty, emphasizing the need for healthcare provider support. Clarifying these challenges, it may serve as a basis for developing nursing interventions to enhance survivors’ long-term quality of life.

PMID:39808787 | DOI:10.1097/JNN.0000000000000814

J Med Internet Res. 2025 Jan 14;27:e60413. doi: 10.2196/60413.

ABSTRACT

BACKGROUND: With increasing adoption of remote clinical trials in digital mental health, identifying cost-effective and time-efficient recruitment methodologies is crucial for the success of such trials. Evidence on whether web-based recruitment methods are more effective than traditional methods such as newspapers, media, or flyers is inconsistent. Here we present insights from our experience recruiting tertiary education students for a digital mental health artificial intelligence-driven adaptive trial-Vibe Up.

OBJECTIVE: We evaluated the effectiveness of recruitment via Facebook and Instagram compared to traditional methods for a treatment trial and compared different recruitment methods’ retention rates. With recruitment coinciding with COVID-19 lockdowns across Australia, we also compared the cost-effectiveness of social media recruitment during and after lockdowns.

METHODS: Recruitment was completed for 2 pilot trials and 6 minitrials from June 2021 to May 2022. To recruit participants, paid social media advertising on Facebook and Instagram was used, alongside mailing lists of university networks and student organizations or services, media releases, announcements during classes and events, study posters or flyers on university campuses, and health professional networks. Recruitment data, including engagement metrics collected by Meta (Facebook and Instagram), advertising costs, and Qualtrics data on recruitment methods and survey completion rates, were analyzed using RStudio with R (version 3.6.3; R Foundation for Statistical Computing).

RESULTS: In total, 1314 eligible participants (aged 22.79, SD 4.71 years; 1079, 82.1% female) were recruited to 2 pilot trials and 6 minitrials. The vast majority were recruited via Facebook and Instagram advertising (n=1203; 92%). Pairwise comparisons revealed that the lead institution’s website was more effective in recruiting eligible participants than Facebook (z=3.47; P=.003) and Instagram (z=4.23; P<.001). No differences were found between recruitment methods in retaining participants at baseline, at midpoint, and at study completion. Wilcoxon tests found significant differences between lockdown (pilot 1 and pilot 2) and postlockdown (minitrials 1-6) on costs incurred per link click (lockdown: median Aus $0.35 [US $0.22], IQR Aus $0.27-$0.47 [US $0.17-$0.29]; postlockdown: median Aus $1.00 [US $0.62], IQR Aus $0.70-$1.47 [US $0.44-$0.92]; W=9087; P<.001) and the amount spent per hour to reach the target sample size (lockdown: median Aus $4.75 [US $2.95], IQR Aus $1.94-6.34 [US $1.22-$3.97]; postlockdown: median Aus $13.29 [US $8.26], IQR Aus $4.70-25.31 [US $2.95-$15.87]; W=16044; P<.001).

CONCLUSIONS: Social media advertising via Facebook and Instagram was the most successful strategy for recruiting distressed tertiary students into this artificial intelligence-driven adaptive trial, providing evidence for the use of this recruitment method for this type of trial in digital mental health research. No recruitment method stood out in terms of participant retention. Perhaps a reflection of the added distress experienced by young people, social media recruitment during the COVID-19 lockdown period was more cost-effective.

TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12621001092886; https://tinyurl.com/39f2pdmd; Australian New Zealand Clinical Trials Registry ACTRN12621001223820; https://tinyurl.com/bdhkvucv.

PMID:39808785 | DOI:10.2196/60413

JMIR Form Res. 2025 Jan 14;9:e66181. doi: 10.2196/66181.

ABSTRACT

BACKGROUND: The potential of telehealth psychotherapy (ie, the online delivery of treatment via a video web-based platform) is gaining increased attention. However, there is skepticism about its acceptance, safety, and efficacy for patients with high emotional and behavioral dysregulation.

OBJECTIVE: This study aims to provide initial effect size estimates of symptom change from pre- to post treatment, and the acceptance and safety of telehealth dialectical behavior therapy (DBT) for individuals diagnosed with borderline personality disorder (BPD).

METHODS: A total of 39 individuals meeting the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria for BPD received 1 year of outpatient telehealth DBT at 3 sites in Germany and Canada. Effect size estimates were assessed using pre-post measures of BPD symptoms, dissociation, and quality of life. Safety was evaluated by analyzing suicide attempts and self-harm. Additionally, acceptance and feasibility, satisfaction with treatment, useability of the telehealth format, and the quality of the therapeutic alliance were assessed from both therapists’ and patients’ perspectives. All analyses were conducted on both the intention-to-treat (ITT) and according-to-protocol (ATP) samples.

RESULTS: Analyses showed significant and large pre-post effect sizes for BPD symptoms (d=1.13 in the ITT sample and d=1.44 in the ATP sample; P<.001) and for quality of life (d=0.65 in the ITT sample and d=1.24 in the ATP sample). Dissociative symptoms showed small to nonsignificant reductions. Self-harm behaviors decreased significantly from 80% to 28% of all patients showing at least 1 self-harm behavior in the last 10 weeks (risk ratio 0.35). A high dropout rate of 38% was observed. One low-lethality suicide attempt was reported. Acceptance, feasibility, and satisfaction measures were high, although therapists reported only moderate useability of the telehealth format.

CONCLUSIONS: Telehealth DBT for BPD showed large pre-post effect sizes for BPD symptoms and quality of life. While the telehealth format appeared feasible and well-accepted, the dropout rate was relatively high. Future research should compare the efficacy of telehealth DBT with in-person formats in randomized controlled trials. Overall, telehealth DBT might offer a potentially effective alternative treatment option, enhancing treatment accessibility. However, strategies for decreasing drop-out should be considered.

TRIAL REGISTRATION: German Clinical Trials Register DRKS00027824; https://drks.de/search/en/trial/DRKS00027824.

PMID:39808784 | DOI:10.2196/66181

J Vector Borne Dis. 2024 Oct 5. doi: 10.4103/JVBD.JVBD_56_24. Online ahead of print.

ABSTRACT

BACKGROUND OBJECTIVES: Scrub typhus is an acute febrile zoonotic disease caused by the obligate intracellular gram-negative bacteria Orientia tsutsugamushi. Growing data over the last few years on the Indian subcontinent suggest that it is one of the most widespread but under-reported diseases. The study aimed to document the clinical and paraclinical profile and evaluate complications of scrub typhus in severe and nonsevere pediatric age groups.

METHODS: A prospective observational study was conducted in pediatric patients. Frequency, mean, percentage and standard deviation were all included in the descriptive statistical analysis calculation. Multivariate analysis was conducted to predict the severity factor.

RESULTS: A total of 189 patients met the eligibility criteria and were included in the final analysis. The mean and standard deviation (mean ± SD) age of the cohort was 5.54 ± 3.9 years, with a male predominance of 68.2%. The mean ± SD duration of fever was 6.64 ± 1.43 days. Patients with severe scrub typhus experienced complications including hepatic involvement (42, 64.6%), respiratory distress (23, 46.1%), neurological involvement (14, 24.6%), acute kidney injury (10, 15.4%), myocarditis (9, 13.8%), and (16, 24.6%) have multi-organ dysfunction. patients with raised transaminases (> 180 IU/L) have a 3.7 to 4.1 times greater chance of developing severity. Thrombocytopenia is found to be another independent predictor of severe scrub typhus in our study.

INTERPRETATION CONCLUSION: Clinical signs of hepatomegaly, skin rash, and lymphadenopathy were significant predictors of severity. Delays in treatment are a key contributor to the severity of pediatric scrub typhus.

PMID:39808781 | DOI:10.4103/JVBD.JVBD_56_24