Category: Statistics

JAMA Netw Open. 2025 Jul 1;8(7):e2517160. doi: 10.1001/jamanetworkopen.2025.17160.

ABSTRACT

IMPORTANCE: Allergic rhinitis (AR) affects 10% to 30% of the adult population globally. The current framework of pharmaceutical care for managing AR focuses on community pharmacies, with limited structured pharmaceutical care in public health care settings.

OBJECTIVE: To evaluate the effectiveness of a pharmacist-led education intervention (AR-PRISE) in a public health care institution compared with standard care for managing AR among adults.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial used a 2-arm, parallel-group, open-label design in the otorhinolaryngology clinic of a government-funded tertiary referral hospital in northern Malaysia. Enrollment occurred from June 1, 2023, to February 15, 2024, with follow-up completed August 6, 2024. The trial included Malaysian patients aged 18 to 80 years who had received a diagnosis of AR and were able to comprehend English or Malay. Of the 209 screened patients, 154 were recruited and randomly assigned into intervention and control groups, with 149 completing the study.

INTERVENTIONS: The AR-PRISE intervention involved an 8-minute educational video on AR and structured pharmacist counseling.

MAIN OUTCOMES AND MEASURES: The primary outcomes were between-group differences at day 180 in knowledge level, symptom control (Total Nasal Symptom Score [TNSS] for the past 12 hours and past 2 weeks), medication adherence (number of days of intranasal corticosteroid use), and quality of life (assessed by the European Quality of Life 5-Dimension 5-Level Instrument and European Quality of Life Visual Analog Scale). Assessments were conducted at baseline and days 60 (±7), 120 (±7), and 180 (±7). All analyses were performed on an intention-to-treat basis.

RESULTS: Among the 154 participants, the mean (SD) age was 46.5 (17.0) years, and 97 (63.0%) were women; 77 participants were randomized to each group. In the intention-to-treat analysis, the intervention group showed statistically significant improvement in TNSSs for the past 2 weeks compared with controls (estimate [SE], 0.14 [0.06]; 95% credible interval [CrI], 0.03-0.25). Significant reductions in the TNSS for the past 2 weeks were observed at all time points (day 60: estimate [SE], 0.18 [0.05]; 95% CrI, 0.08-0.28; day 120: estimate [SE], 0.21 [0.05]; 95% CrI, 0.11-0.31; and day 180: estimate [SE], 0.11 [0.05]; 95% CrI, 0.01-0.21). No significant differences were observed for knowledge level, TNSS for the past 12 hours, medication adherence, or quality of life.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, the AR-PRISE intervention significantly improved AR symptom control (TNSS for the past 2 weeks) compared with standard care over 180 days but did not show significant effects on other coprimary outcomes (AR knowledge, TNSS for the past 12 hours, medication adherence, or quality of life). These findings suggest that while pharmacist-led education can enhance symptom management, additional strategies may be needed to address broader aspects of AR care.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06027736.

PMID:40668584 | DOI:10.1001/jamanetworkopen.2025.17160

JAMA Netw Open. 2025 Jul 1;8(7):e2520360. doi: 10.1001/jamanetworkopen.2025.20360.

ABSTRACT

IMPORTANCE: Identifying factors associated with resilience during the COVID-19 pandemic can inform targeted interventions and resource allocation for groups disproportionately affected by systemic inequities.

OBJECTIVE: To examine factors associated with self-reported resilience during the COVID-19 pandemic in racially and ethnically diverse, community-dwelling US adults.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted as part of the Collaborative Cohort of Cohorts for COVID-19 Research (C4R) study, which assessed the associations of the pandemic with self-reported resilience of participants from 14 established US prospective cohorts since January 2021. This report includes participants who responded to the self-reported resilience question on C4R questionnaires. Data was initially analyzed from October 2023 to May 2024, with updated analyses performed from August 2024 to April 2025.

EXPOSURE: Race and ethnicity, behavior factors, health conditions, and social determinants of health measurements accessed before and during the COVID-19 pandemic through cohort visits and C4R questionnaires.

MAIN OUTCOMES AND MEASURES: Self-reported resilience was collected via 1 question (from the Brief Resilience Scale) in C4R questionnaires, “I tend to bounce back quickly after hard times.” Participants who answered agree or strongly agree were classified as resilient, and those who reported neutral, disagree, or strongly disagree were classified as not resilient. Modified Poisson regression was performed to estimate prevalence ratios (PRs) and access multivariable-adjusted associations with resilience.

RESULTS: Of 31 045 participants (18 672 [60%] women; 10 746 [34.6%] aged <65 years), 1185 (3.8%) identified as American Indian, 6728 (21.7%) as Black, 293 (0.9%) as East Asian, 6311 (20.3%) as Hispanic, 565 (1.8%) as South Asian, and 15 961 (51.3%) as White; a total of 23 103 participants (74.4%) self-identified as resilient. Compared with White participants, Black and Hispanic participants had higher prevalence of self-reported resilience (adjusted PR [aPR], 1.04; 95% CI, 1.02-1.06; aPR, 1.08; 95% CI, 1.06-1.11; respectively) and American Indian and East Asian participants had lower prevalence (aPR, 0.90; 95% CI, 0.86-0.94; aPR, 0.76; 95% CI, 0.68-0.84; respectively). Higher education, being married or living as married, higher income, and overweight were also associated with higher prevalence of resilience. Being female, having diabetes, and being unemployed were associated with lower prevalence of self-reported resilience. Compared with participants with public insurance only, participants with private insurance had higher prevalence of resilience (aPR, 1.07; 95% CI, 1.03-1.10). COVID-19 vaccination and infection statuses were not significantly associated with resilience. Modification analyses showed important racial and ethnic differences in how factors such as hypertension, marital status, and insurance status were associated with resilience.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of 31 045 adults, self-reported resilience varied by race, ethnicity, and sociodemographic factors. These findings highlight the complex interplay of individual and social factors in shaping the perception of resilience.

PMID:40668582 | DOI:10.1001/jamanetworkopen.2025.20360

JAMA Netw Open. 2025 Jul 1;8(7):e2521324. doi: 10.1001/jamanetworkopen.2025.21324.

ABSTRACT

IMPORTANCE: Vaccination is the safest and most effective way to prevent infectious diseases. It not only reduces disease in the vaccinated portion of a population but also potentially provides indirect benefit to the unvaccinated portion. Indirect benefits to the unvaccinated portion in a population are difficult to estimate since indirect benefits cannot be determined from the general population simply.

OBJECTIVE: To estimate the influenza case burden, both direct and indirect, averted by vaccination using an agent-based model, which models agents as individuals in the simulation population.

DESIGN, SETTING, AND PARTICIPANTS: In this decision analytical modeling study, simulations included varied levels of virus transmissibility, vaccine effectiveness, and vaccine uptake among the 2010 Allegheny County, Pennsylvania, census population. Simulations were run from August 15, 2022, to May 31, 2023. Individuals were vaccinated beginning in September of the simulation year.

EXPOSURE: Influenza infection.

MAIN OUTCOMES AND MEASURES: Differences between number of influenza cases in vaccinated and unvaccinated portions of the population.

RESULTS: The population used in this study consisted of 1 218 695 agents (median [IQR] age, 40.6 [3.6-77.6] years; 51% female) and was statistically similar in demographics to the 2010 Allegheny County census population. The mean (SD) burden of influenza averted by vaccination with a vaccine effectiveness of 40% ranged from 32.9% (0.9%) in the high transmission scenario to 41.5% (3.4%) in the low transmission scenario for seasonal influenza. In the model, indirect benefit to the unvaccinated portion of the population was found over a range of modeled transmissibility characteristics of seasonal influenza and varied levels of vaccine effectiveness and vaccination coverage; however, direct benefit to the vaccinated portion was greater in all scenarios. At the highest levels of transmissibility, such as might be found in pandemic influenza, indirect benefit decreased and eventually disappeared.

CONCLUSIONS AND RELEVANCE: In this analytical model study, influenza vaccination provided substantial benefit in reducing infections to both the vaccinated and unvaccinated portions of the population. Even when both vaccine effectiveness and vaccine uptake were low, vaccination showed marked reductions in disease burden for transmission levels characteristic of seasonal influenza. However, when the level of transmission was very high, even a highly effective vaccine did not protect unvaccinated individuals. These findings underscore the importance of vaccination in disease prevention and control and show that indirect benefits are limited in high transmission situations.

PMID:40668579 | DOI:10.1001/jamanetworkopen.2025.21324

JAMA Netw Open. 2025 Jul 1;8(7):e2521921. doi: 10.1001/jamanetworkopen.2025.21921.

ABSTRACT

IMPORTANCE: Voluntary and temporary firearm storage outside the home in times of heightened risk, including where unauthorized access may be possible, may reduce firearm deaths. Firearm retailers and law enforcement agencies may provide this storage, but little is known regarding variability among firearm owners and their households in their willingness to use these 2 storage resources, and whether lockers within retailers would increase willingness.

OBJECTIVE: To determine the willingness of firearm owners and their households to voluntarily and temporarily store firearms with retailers and law enforcement agencies.

DESIGN, SETTING, AND PARTICIPANTS: In this survey study, a nationally representative sample of US adults was surveyed online in May 2024 cross-sectionally.

EXPOSURE: Living in a home with a firearm.

MAIN OUTCOMES AND MEASURES: The willingness to use each storage resource was assessed by participants’ willingness to store in at least 1 of 7 given circumstances. Three multivariable logistic regression models adjusting for participant characteristics were used to examine which characteristics were associated with (1) willingness to store with firearm retailers for any reason, (2) willingness to store with law enforcement agencies for any reason, and (3) whether lockers would make participant more willing to store with retailers.

RESULTS: A sample of 3146 US adults who live in a home with a firearm was surveyed (51.26% male; 95% CI, 49.37%-53.14%). Of participants, 41.38% (95% CI, 39.52%-43.27%) reported willingness to store firearms with retailers and 34.09% (95% CI, 32.31%-35.92%) to store with law enforcement agencies in at least 1 circumstance. The most common circumstance for willingness for both storage entities was concern that someone else in the home would use the firearm to hurt others (firearm retailers, 23.98% [95% CI, 22.41%-25.64%]; law enforcement agencies, 20.05% [95% CI,18.58%-21.61%]). Participants who believed that household firearm access increases suicide risk had increased odds of willingness to store with retailers (adjusted odds ratio, 1.68; 95% CI, 1.41-2.01) and law enforcement agencies (adjusted odds ratio, 1.86; 95% CI 1.55-2.24). Locker installation within retailers increased willingness to store with retailers for 22.24% (95% CI, 20.68%-23.89%) of participants.

CONCLUSIONS AND RELEVANCE: In this survey study, a meaningful minority of those who live in a home with a firearm reported willingness to temporarily store firearms with retailers and law enforcement agencies in some circumstances. Locker installation within retailers and increased knowledge of the relationship between household firearm access and suicide may increase willingness. Findings provide policymakers with actionable strategies, such as supporting locker installation and reducing liabilities for firearm retailers.

PMID:40668578 | DOI:10.1001/jamanetworkopen.2025.21921

JAMA Dermatol. 2025 Jul 16. doi: 10.1001/jamadermatol.2025.2281. Online ahead of print.

ABSTRACT

IMPORTANCE: Psoriasis affects up to 3% of the population, with 30% of patients with psoriasis developing psoriatic arthritis (PsA), yet the transition between psoriasis and PsA has yet to be fully understood. Subclinical synovitis is a hallmark of PsA and is thought to precede psoriatic arthritis; its detection among patients with psoriasis without musculoskeletal (MSK) involvement through medical imaging modalities could offer valuable insights into the transition from psoriasis to PsA.

OBJECTIVE: To evaluate the prevalence of synovitis on ultrasonograms and magnetic resonance imaging (MRI) among patients with psoriasis without MSK involvement compared with healthy controls and patients with PsA.

DATA SOURCES: A comprehensive literature search was conducted in MEDLINE, Embase, Scopus, and Web of Science from inception to October 2024 using keywords related to psoriasis, synovitis, and medical imaging. A PROSPERO protocol was registered (CRD42024571308).

STUDY SELECTION: Studies were eligible if they included patients with psoriasis without MSK involvement and assessed synovitis using imaging. Two reviewers independently screened studies and extracted data. Discrepancies were resolved by consensus. Twelve of 5132 initially identified studies met inclusion criteria.

DATA EXTRACTION AND SYNTHESIS: Data were extracted per PRISMA guidelines. Risk of bias was assessed using the Newcastle-Ottawa Scale. A random-effects model was used to pool risk ratios (RRs) for synovitis prevalence across comparison groups. Heterogeneity was assessed using the I2 statistic.

MAIN OUTCOMES AND MEASURES: The primary outcome was the presence of imaging-detected synovitis among patients with psoriasis without MSK involvement compared with healthy controls and patients with PsA.

RESULTS: Twelve studies (N = 2606 patients) were included comprising 1593 patients with psoriasis (mean [SD] age, 46.4 [7.5] years; 982 men [61.6%]), 327 patients with PsA (mean [SD] age, 50.2 [7.1] years; 210 men [64.2%]), and 686 healthy controls (mean [SD] age, 45.7 [6.9] years; 281 of 576 men [48.8%]). Synovitis was 2.5 times more likely among patients with psoriasis than controls (RR, 2.55; 95% CI, 1.18-5.52). Detection rates were higher with MRI (RR, 6.40; 95% CI, 1.87-21.95) than ultrasonography (RR, 2.50; 95% CI, 1.10-5.67). Synovitis was more frequent among patients with PsA than those with psoriasis, but the difference was not statistically significant (RR, 0.50; 95% CI, 0.13-1.87).

CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis found that subclinical synovitis is significantly more prevalent among patients with psoriasis without MSK involvement compared with healthy controls. This finding suggests that imaging may aid in identifying individuals at risk for progression to psoriatic arthritis.

PMID:40668567 | DOI:10.1001/jamadermatol.2025.2281

Brief Bioinform. 2025 Jul 2;26(4):bbaf341. doi: 10.1093/bib/bbaf341.

ABSTRACT

The 3D organization of chromatin is essential for the functioning of cellular processes, including transcriptional regulation, genome integrity, chromatin accessibility, and higher order nuclear architecture. However, detecting anomalous chromatin interactions in spatiotemporal Hi-C data remains a significant challenge. We present HiC4D-SPOT, an unsupervised deep-learning framework that models chromatin dynamics using a ConvLSTM-based autoencoder to identify structural anomalies. Benchmarking results demonstrate high reconstruction fidelity, with Pearson Correlation Coefficient and Spearman Correlation Coefficient values of 0.9, while accurately detecting deviations linked to temporal inconsistencies, topologically associating domain (TAD) and loop perturbations, and significant chromatin remodeling events. HiC4D-SPOT successfully identifies swapped time points in a time-swap experiment, captures simulated TAD and loop disruptions with high confidence scores and statistical significance of 0.01, and detects HERV-H boundary weakening during cardiomyocyte differentiation, as well as cohesin-mediated loop loss and recovery-aligning with experimentally observed chromatin remodeling events. These findings establish HiC4D-SPOT as an efficient tool for analyzing 3D chromatin dynamics, enabling the detection of biologically significant structural anomalies in spatiotemporal Hi-C data.

PMID:40668555 | DOI:10.1093/bib/bbaf341

Appl Biochem Biotechnol. 2025 Jul 16. doi: 10.1007/s12010-025-05340-y. Online ahead of print.

ABSTRACT

Myocardial infarction (MI) is a concerning coronary heart disease with increasing rates of death and morbidity worldwide. One potential approach to prevent MI involves exploring invertebrate supplements within the nanoliposome formulation to improve targeted delivery, thereby mitigating MI-induced heart damage. Therefore, the study aimed to evaluate the cardioprotective efficacy of liposomal delivery of Allolobophora caliginosa coelomic fluid (ACCF-liposomes) on adrenaline-induced MI in rats. Thirty male albino rats were allocated into five groups: Control, Untreated MI, MI-treated ACCF, MI-treated free liposomes, and MI-treated ACCF-liposomes. The treatment regimen spanned 21 days. Electrocardiography (ECG), biochemical, oxidative stress, inflammatory mediators, electrolyte balance, histopathological and immunohistochemical analyses, and DNA fragmentation were evaluated. Liposomal delivery of ACCF has shown promise in regulating ECG criteria and reducing myocardial markers, particularly AST, LDH, MMP-2, creatine kinase, and troponin-I. It also improves lipid metabolism and inhibits myocardial oxidative stress. Additionally, ACCF and ACCF-liposomes treatment improves cardiomyocyte architecture and reduces DNA fragmentation in myocardial infarcted rats. Furthermore, encapsulating ACCF within liposomes statistically reduced the expression of iNOS and Beclin-1 in cardiac tissue. This suggests that liposomal delivery of ACCF enhances its effectiveness in treating myocardial infarction, potentially via its antioxidant, anti-inflammatory, and anti-apoptotic attributes.

PMID:40668529 | DOI:10.1007/s12010-025-05340-y

Environ Sci Pollut Res Int. 2025 Jul 16. doi: 10.1007/s11356-025-36733-5. Online ahead of print.

ABSTRACT

Global population growth, industrialization, urbanization, and climate change have been shown to be major drivers leading to degradation of water resources, especially those designed for human and animal consumption. In this context, Water Safety Plans (WSPs) have been introduced to identify and assess potential site-specific risks as well as to develop mitigation strategies aimed at preventing and minimizing impacts. One of the crucial steps in the application of the WSP approach is to assess the risk posed by potential sources of contamination and to identify which chemicals may be of concern for a specific drinking water supply area. Identifying substances that may represent a risk based on their chemical-physical-toxicological profile, but which have not yet been monitored, and which could reasonably be present in the territory due to specific, often not very evident, explicit, and difficult to trace industrial processes is a complex but fundamental exercise within the implementation of a WSP. This is particularly challenging since chemical compounds and ingredients are renewed very quickly according to production needs and technological improvements. In this work, we developed an approach to identify these substances by integrating information reported in the European CHemical Agency (ECHA) database with site-specific data on industrial activities. The proposed approach was implemented within the deeply industrialized area of the Veneto Region (Italy), specifically located at the foothills of the Alps where major aquifers are being used for water provision, historically affected by severe groundwater/surface water contamination. A list of 46 non-regulated chemicals of concern was obtained, and the substances were further prioritized based on chemical PMT characteristics, site-specific environmental occurrence, and the quantity of wastewater discharged by the industrial activities. The results were consistent with those reported in similar prioritization exercises implemented at the EU scale, although several peculiarities emerged due to specific local characteristics of the case study area. The identification of chemical substances and other parameters of concern (especially if not yet regulated) represents an essential and undelayable propaedeutic activity for the definition of a coherent and evidence-based monitoring plans.

PMID:40668517 | DOI:10.1007/s11356-025-36733-5

Arch Osteoporos. 2025 Jul 16;20(1):96. doi: 10.1007/s11657-025-01570-z.

ABSTRACT

Chronic kidney disease (CKD)-associated osteoporosis increases fracture risk, yet clinical guidance remains unclear. A survey of 89 Italian nephrologists revealed heterogeneous biomarker availability and varied treatment approaches. Denosumab was the preferred antiresorptive agent, while anabolic drugs were rarely used. Findings highlight progress in CKD-related bone health management despite existing uncertainties. CKD-associated osteoporosis comprises the skeletal effects of a complex mineral and bone disorder causing increased risks of fragility fractures (FF), cardiovascular events, and mortality. Existing clinical guidance about CKD-associated osteoporosis is vague, leading us to hypothesize that a treatment gap exists and that clinical practice is dependent on local availability of diagnostic tools.

PURPOSE AND METHODS: The aim of the current survey was to determine current attitudes and practices among Italian nephrologists regarding the evaluation and management of CKD-associated osteoporosis. An online survey was designed, consisting of 9 thematic groups with a set of 16 closed questions regarding the availability of biomarkers and BTMs at reference laboratories and their use for the diagnosis and treatment of CKD-associated osteoporosis in patients with different stages of CKD, including CKD stages G4-5 and dialysis patients. Results were compared to a previous survey on the use of BTMs from 2022.

RESULTS: Eighty-nine Italian nephrologists participated in the survey, reporting that parathyroid hormone (PTH), alkaline phosphatase, and 25-hydroxy-vitamin D measurements were available in 92-100% of their reference laboratories. Measurements for fibroblast growth factor-23, Klotho, Matrix Gla protein, procollagen type 1 N-terminal propeptide, and tartrate-resistant acid phosphatase 5b were available in 64-74% of cases. Regarding PTH cut-off values, 47.2% followed KDOQI and 43.8% followed KDIGO recommendations. Vitamin D was widely used across CKD stages (cholecalciferol 27-37.1%, calcifediol 9-12.4%, calcitriol 47.2-53.9%, and paricalcitol 21.3-30.3). Denosumab was the preferred antiresorptive agent in all CKD stages (22.5%-28.1%), while the use of bisphosphonates was uncommon in advanced CKD. Anabolic drugs were rarely prescribed.

CONCLUSIONS: The availability of bone biomarkers is heterogeneous, and an uncertainty still exists regarding the clinical use of biomarkers in CKD-associated osteoporosis. Nonetheless, our findings indicate that Italian nephrologists are increasingly taking proactive steps to prevent and treat bone fragility in CKD patients.

PMID:40668510 | DOI:10.1007/s11657-025-01570-z

Updates Surg. 2025 Jul 16. doi: 10.1007/s13304-025-02332-9. Online ahead of print.

ABSTRACT

The climate emergency requires effective measures to reduce the environmental impact of the healthcare system. Approximately 20% of medical waste originates from operating rooms. Proper waste segregation, along with adherence to a correct definition of biohazardous waste, are good practice procedures in the operating unit that ensure waste reduction. This study aims to assess the effectiveness of waste segregation in a multispecialty Surgical Unit. During a 3-week observational period, compared with a subsequent 3-week experimental period, counts of paper and plastic bags and the number and weight of biohazardous waste were recorded. The experimental period incorporated heightened waste sorting attention and introduced new criteria for surgical uniform disposal. While no significant differences in paper and plastic bag production were observed between the two periods, there was a non-statistically significant reduction in numbers and weight of biohazardous waste (p = 0.22; p = 0.16 respectively). Multiple regression analysis revealed a statistically significant 20 kg reduction in biohazardous waste over 3 weeks, with the same number of surgical procedures performed (p<0.05), resulting in 3.7 kg of biohazardous waste per surgical procedure. This reduction increased to 24 kg in the second period under the same number and type of interventions (p<0.05). Notably, General Surgery, Urology, Otolaryngology, and Orthopedics were identified as the surgical branches with the highest biohazardous waste production. In particular, orthopedic procedures generated 9.35 kg of hazardous medical waste per intervention, with statistical significance (p = 0.006). A careful separate collection of waste in the operating room, focusing on limiting biohazardous waste production, could be an important tool for reducing environmental impact and fostering economic savings. A good practice involves finding tailored solutions through teamwork as demonstrated by the present study.

PMID:40668508 | DOI:10.1007/s13304-025-02332-9