Category: Statistics

Skeletal Radiol. 2025 Apr 23. doi: 10.1007/s00256-025-04916-3. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim was to study the association between specific radiographic findings and patient reported shoulder pain and disability in patients suspected of subacromial impingement syndrome (SIS).

MATERIALS AND METHODS: This cross-sectional study used baseline data from a prospective study. Study population included patients age 18 to 63 years, referred to orthopaedic clinic on suspicion of SIS. Radiographic findings before first visit to a department of orthopaedic surgery comprised subacromial calcifications, acromial morphological characteristics (i.e. acromial type and spur), acromioclavicular osteoarthritis, signs of previous glenohumeral dislocation (Bankart/Hill-Sachs lesions), and architectural measures (i.e. acromial tilt, acromion index, and lateral acromial angle). Shoulder pain and disability were evaluated using the Oxford Shoulder Score (OSS) from patient’s response to a questionnaire at first visit to the public department of orthopaedic surgery or before surgery for SIS. A low OSS was defined as having a score < 25. Associations between the radiographic findings and low OSS were analysed using logistic regression.

RESULTS: The population comprised 825 patients. Median time between radiographic examination and completion of the questionnaire was 9 days (SD = 27.1). In adjusted analysis, we found a statistically significant association for lateral spur especially birdbeak type (OR = 2.24 (95% CI 1.36-3.71)), Bankart/Hill-Sachs lesion (OR = 2.49 (95% CI 1.38-4.48)), and acromial tilt > 35° (OR = 0.62 (95% CI 0.41-0.94)). Female sex (OR = 2.25 (95% CI 1.59-3.18)) was also associated with low OSS.

CONCLUSION: In terms of associations with patient-reported shoulder pain and disability, lateral spurs, with emphasis on birdbeak type, Bankart/Hill-Sachs lesions, and acromial tilt > 35°, seemed clinically important.

PMID:40268775 | DOI:10.1007/s00256-025-04916-3

Neuroimage Clin. 2025 Apr 12;46:103782. doi: 10.1016/j.nicl.2025.103782. Online ahead of print.

ABSTRACT

Between 22 and 45 % of children born preterm experience difficulties with expressive and receptive language when they reach school age. Little is currently known about the neural mechanisms behind their linguistic performance. This study investigates the brain areas and white matter connections that form the structural language network in extremely preterm-born children who have reached school age. Structural brain connectivity was quantified using diffusion-weighted imaging (DWI) and tractography in n = 58 (62 % female) extremely preterm-born children aged 8-12 years. Language outcomes were assessed using the CELF-4-NL Recalling Sentences subtest. Language scores were below average in n = 13 (22 %) children. Language outcomes related significantly to a subnetwork of 16 brain regions (p = 0.012). The network comprised brain regions from the left hemisphere including the pars orbitalis, middle and superior frontal gyrus, frontal pole, pre- and postcentral gyrus, superior temporal gyrus, insula, caudate nucleus, thalamus, and putamen. In the right hemisphere, the anterior cingulate was part of the network. These findings suggest that extremely preterm children rely mostly on their left hemisphere during language processing, which is similar to typically developing children. However, they seem to use compensatory neural pathways that include brain areas right next to the areas typically involved in language processing. These areas include the pars orbitalis (adjacent to Broca’s area) and the putamen and caudate nucleus (adjacent to the limbic system). It is important to note that language difficulties were not necessarily related to brain injury around birth.

PMID:40267537 | DOI:10.1016/j.nicl.2025.103782

Shock. 2025 Apr 4. doi: 10.1097/SHK.0000000000002599. Online ahead of print.

ABSTRACT

OBJECTIVE: Sepsis represents a leading cause of global mortality, defined by a dysregulated inflammatory response. This study aims to investigate the potential causal associations between circulating inflammatory proteins and sepsis risk using a two-sample Mendelian randomization (MR) approach.

METHODS: Publicly available summary statistics from genome-wide association studies (GWAS) were used in this study. Genetic instruments for circulating inflammatory protein were derived from a GWAS meta-analysis of 11 cohorts encompassing 14,824 European participants. The relationship between genetically predicted protein levels and sepsis-related outcomes was evaluated using aggregated data from the UK Biobank-a multicenter prospective cohort study comprising over 500,000 European participants. Analyses were stratified by age, 28-day mortality, and ICU admission. Multiple MR methods, including inverse-variance weighted (IVW), MR-Egger, and weighted median, were applied to ensure the robustness of our findings.

RESULTS: The MR analysis identified significant causal associations between inflammatory proteins and sepsis outcomes. Genetically predicted elevated levels of β-NGF and a reduced risk of sepsis (odds ratio [OR] 0.77, 95% confidence interval [CI] = 0.60-0.99, P = 0.039). Among sepsis patients aged below 75 years, the risk was reduced by 30% (OR 0.70, 95% CI = 0.52-0.93, P = 0.013). Genetically predicted increases in TRAIL (OR 1.11, 95% CI = 1.02-1.20, P = 0.020) and VEGF-A (OR 1.18, 95%CI = 1.02-1.37, P = 0.031) were positively associated with sepsis incidence, while genetically predicted levels of CST5 (OR 0.81, 95%CI = 0.69-0.94, P = 0.006) and MCP-1 (OR 0.64, 95%CI = 0.45-0.92, P = 0.015) were inversely associated with sepsis-induced mortality.

CONCLUSION: This study provides evidence from a Mendelian randomization framework supporting the causal role for specific circulating inflammatory proteins (e.g., β-NGF, VEGF-A, and TRAIL) in influencing sepsis risk and mortality. These findings underscore the potential for therapeutic interventions targeting these proteins to mitigate sepsis risk and improve patient outcomes, along with further investigation into the underlying mechanisms and clinical implications.

PMID:40267509 | DOI:10.1097/SHK.0000000000002599

JMIR Aging. 2025 Apr 23;8:e65183. doi: 10.2196/65183.

ABSTRACT

BACKGROUND: Disturbed sleep patterns are common among older adults and may contribute to cognitive and physical declines. However, evidence for the relationship between sleep duration and cognitive frailty, a concept combining physical frailty and cognitive impairment in older adults, is lacking.

OBJECTIVE: This study aimed to examine the associations of sleep duration and its changes with cognitive frailty.

METHODS: We analyzed data from the 2008-2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Cognitive frailty was rendered based on the modified Fried frailty phenotype and Mini-Mental State Examination. Sleep duration was categorized as short (<6 h), moderate (6-9 h), and long (>9 h). We examined the association of sleep duration with cognitive frailty status at baseline using logistic regressions and with the future incidence of cognitive frailty using Cox proportional hazards models. Restricted cubic splines were used to explore potential nonlinear associations.

RESULTS: Among 11,303 participants, 1298 (11.5%) had cognitive frailty at baseline. Compared to participants who had moderate sleep duration, the odds of having cognitive frailty were higher in those with long sleep duration (odds ratio 1.71, 95% CI 1.48-1.97; P<.001). A J-shaped association between sleep duration and cognitive frailty was also observed (P<.001). Additionally, during a mean follow-up of 6.7 (SD 2.6) years among 5201 participants who were not cognitively frail at baseline, 521 (10%) participants developed cognitive frailty. A higher risk of cognitive frailty was observed in participants with long sleep duration (hazard ratio 1.32, 95% CI 1.07-1.62; P=.008).

CONCLUSIONS: Long sleep duration was associated with cognitive frailly in older Chinese adults. These findings provide insights into the relationship between sleep duration and cognitive frailty, with potential implications for public health policies and clinical practice.

PMID:40267503 | DOI:10.2196/65183

Fam Med. 2025 Apr 9. doi: 10.22454/FamMed.2025.256581. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: The choice of specialty by medical students is pivotal for their careers and the health care system. The shortage of trained medical providers makes this choice particularly salient in Africa. Understanding the motivations and preferences of African medical students can inform interventions to improve the distribution and retention of doctors across specialties and regions. This study aims to explore the factors influencing specialty selection among medical students across Africa using a cross-sectional, mixed-methods approach.

METHODS: A survey conducted from June to October 2023 included 1,044 students from 152 medical schools. Descriptive statistics summarized sample characteristics, and linear regression models identified predictors of primary care selection. Thematic analysis was performed on qualitative data.

RESULTS: Students interested in primary care were, on average, older and reported higher anxiety levels compared to their counterparts. Key factors influencing specialty choice across all students included personal interest, scope of practice, and intellectual stimulation, with prestige being least important for those choosing primary care. Additionally, the importance of mentorship was lower among primary care aspirants. Country-specific analysis revealed that students from Benin, Botswana, Ivory Coast, Senegal, and Sierra Leone were more likely to choose primary care.

CONCLUSIONS: This study provides an overview of the motivations behind specialty choice among African medical students, highlighting the need for tailored interventions to address regional health care needs. Understanding these preferences can help in designing strategies to enhance the distribution and retention of medical professionals in various specialties, ultimately improving health care outcomes.

PMID:40267491 | DOI:10.22454/FamMed.2025.256581

Fam Med. 2025 Apr 4. doi: 10.22454/FamMed.2025.344685. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: The University of California, Los Angeles (UCLA) International Medical Graduate (IMG) program addresses the need for more bilingual and bicultural Latino family physicians in California where Latinos are the largest racial/ethnic minority group and a large percentage of the population speaks Spanish. The objective of this descriptive study was to assess family medicine residency match, board certification, and initial practice location outcomes of the program graduates.

METHODS: We conducted a cross-sectional study of program graduates (N=204) from 2007 to 2024. Data were abstracted from program administrative files and the California Medical Board. Primary outcomes were match rate into California family medicine residency programs, completion of a residency, board certification, and initial training practice location. We computed descriptive statistics for participant characteristics and outcomes.

RESULTS: A total of 177/204 (87%) participants completed the UCLA IMG program and entered the match. The country with the most graduates was Mexico followed by Cuba. All graduates, 177/177 (100.0%), that applied and entered the National Resident Matching Program matched in a family medicine residency program. A total of 172 (97%) matched in California programs and 5 (2.8%) matched out of state. Family medicine board certification was verified for 152/159 (95.6%) of those eligible. Few completed a fellowship.

CONCLUSIONS: The UCLA IMG program was effective at preparing program graduates that were fluent in Spanish and bicultural to match in a California family medicine residency program and subsequently practice family medicine in underserved areas. Future studies will examine long-term practice outcomes, predictors of success, and participant perspectives on the program.

PMID:40267486 | DOI:10.22454/FamMed.2025.344685

Obstet Gynecol. 2023 Dec 1;142(6):1477-1485. doi: 10.1097/AOG.0000000000005421. Epub 2023 Oct 26.

ABSTRACT

OBJECTIVE: To compare contraceptive provision to women with and without intellectual and developmental disabilities enrolled in North Carolina Medicaid.

METHODS: Our retrospective cohort study used 2019 North Carolina Medicaid claims to identify women aged 15-44 years with and without intellectual and developmental disabilities at risk for pregnancy who were continuously enrolled during 2019 or had Family Planning Medicaid with at least one claim. We calculated the proportion in each cohort who received 1) most or moderately effective contraception, 2) long-acting reversible contraception, 3) short-acting contraception, and 4) individual methods. We classified contraceptive receipt by procedure type and disaggregated across sociodemographic characteristics. Adjusting for age, race, ethnicity, and urban or rural setting, we constructed logistic regression models to estimate most or moderately effective contraceptive provision odds by intellectual and developmental disability status and by level or type of intellectual and developmental disability. We performed subanalyses to estimate co-occurrence of provision and menstrual disorders.

RESULTS: Among 9,508 women with intellectual and developmental disabilities and 299,978 without, a significantly smaller proportion with intellectual and developmental disabilities received most or moderately effective contraception (30.1% vs 36.3%, P <.001). With the exception of injectable contraception, this trend was consistent across all measures and remained statistically significant after controlling for race, ethnicity, age, and urban or rural status (adjusted odds ratio 0.75, 95% CI 0.72-0.79; P <.001). Among those who received most or moderately effective contraception, a significantly greater proportion of women with intellectual and developmental disabilities had co-occurring menstrual disorders (31.3% vs 24.3%, P <.001).

CONCLUSION: These findings suggest disparities in contraceptive provision and potential differences in clinical indication by intellectual and developmental disability status. Future studies should investigate reasons for and barriers to contraceptive use among women with intellectual and developmental disabilities.

PMID:40267481 | DOI:10.1097/AOG.0000000000005421

JMIR Med Inform. 2025 Apr 23;13:e57530. doi: 10.2196/57530.

ABSTRACT

BACKGROUND: Consuming high amounts of foods or beverages with high levels of saturated fats, salt, or sugar (HFSS) can be harmful for health. Many snacks fall into this category (HFSS snacks). However, the palatability of these snacks means that people can sometimes struggle to reduce their intake. Machine learning algorithms could help in predicting the likely occurrence of HFSS snacking so that just-in-time adaptive interventions can be deployed. However, HFSS snacking data have certain characteristics, such as sparseness and incompleteness, which make snacking prediction a challenge for machine learning approaches. Previous attempts have employed several potential predictor variables and have achieved considerable success. Nevertheless, collecting information from several dimensions requires several potentially burdensome user questionnaires, and thus, this approach may be less acceptable for the general public.

OBJECTIVE: Our aim was to consider the capacity of standard (unmodified in any way; to tailor to the specific learning problem) machine learning algorithms to predict HFSS snacking based on the following minimal data that can be collected in a mostly automated way: day of the week, time of the day (divided into time bins), and location (divided into work, home, and other).

METHODS: A total of 111 participants in the United Kingdom were asked to record HFSS snacking occurrences and the location category over a period of 28 days, and this was considered the UK dataset. Data collection was facilitated by a purpose-specific app (Snack Tracker). Additionally, a similar dataset from the Netherlands was used (Dutch dataset). Both datasets were analyzed using machine learning methods, including random forest regressor, Extreme Gradient Boosting regressor, feed forward neural network, and long short-term memory. We additionally employed 2 baseline statistical models for prediction. In all cases, the prediction problem was the time to the next HFSS snack from the current one, and the evaluation metric was the mean absolute error.

RESULTS: The ability of machine learning methods to predict the time of the next HFSS snack was assessed. The quality of the prediction depended on the dataset, temporal resolution, and machine learning algorithm employed. In some cases, predictions were accurate to as low as 17 minutes on average. In general, machine learning methods outperformed the baseline models, but no machine learning method was clearly better than the others. Feed forward neural network showed a very marginal advantage.

CONCLUSIONS: The prediction of HFSS snacking using sparse data is possible with reasonable accuracy. Our findings offer a foundation for further exploring how machine learning methods can be used in health psychology and provide directions for further research.

PMID:40267467 | DOI:10.2196/57530

JMIR Mhealth Uhealth. 2025 Apr 23;13:e56318. doi: 10.2196/56318.

ABSTRACT

BACKGROUND: Chronic obstructive pulmonary disease (COPD) negatively impacts clinical health outcomes, resulting in frequent exacerbations, increased hospitalizations, reduced physical activity, deteriorated quality of life, and diminished self-efficacy. Previous studies demonstrated that a self-management program tailored for adults with COPD improves self-management decisions, resulting in a positive effect on clinical health outcomes. Limitations of these studies include issues regarding heterogeneity among interventions used, patient population characteristics, outcome measures, and longitudinal studies. Limited studies focused on the use of a comprehensive self-management program using a smartphone app for adults with COPD over 12 months.

OBJECTIVE: This study aimed to explore the effectiveness of a smartphone app self-management program and monthly phone calls compared with standard respiratory outpatient care on clinical health outcomes in adults with COPD.

METHODS: This was a 3-arm parallel pilot randomized controlled trial (RCT) that included 92 participants. Participants were randomized into intervention arm 1, which included a self-management smartphone app and monthly phone calls (n=31); intervention arm 2, which included a self-management smartphone app (n=31); and arm 3, which was standard respiratory outpatient care (n=30). All arms received standard respiratory outpatient care. The primary outcome was a binary indicator equal to 1 if participants reported attendance to a general practitioner (GP) and or a hospital setting as a result of an exacerbation and 0 otherwise. This indicator was recorded at 6 months and 12 months from the baseline. Secondary outcomes included engagement, breathlessness, physical activity, health-related quality of life, and self-efficacy.

RESULTS: There was a statistically significant difference (P=.03), indicating fewer exacerbations in the intervention arm 2 compared with the control arm at 6 months in the hospital setting. The intervention arms had a statistically significant difference indicating a lower risk of developing an exacerbation at 6 months in both the GP (P=.01) and hospital setting (P=.006) compared to the control arm. Furthermore, intervention arm 1 demonstrated a statistically significant difference in exercise capacity at 6 and 12 months (P=.02 and P=.03). The intervention arm 2 illustrated a statistically significant difference in step count (P=.009) compared to the control arm. The majority of participants (60%, 33/55) used the app over the 12-month period.

CONCLUSIONS: This study demonstrated that a smartphone app self-management program had a positive effect on clinical health outcomes for participants with COPD in comparison to standard respiratory outpatient care. This study illustrated benefits such as reduced exacerbations resulting in fewer hospitalizations, improved exercise capacity, and physical activity among the intervention arms. This was a single-center study, which was limited in power to demonstrate significant effects on all measured outcomes but paves the way for a larger, fully powered multicenter trial exploring the effect of a smartphone app self-management program on clinical health outcomes in adults with COPD.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05061810; https://clinicaltrials.gov/study/NCT05061810.

PMID:40267465 | DOI:10.2196/56318

JMIR Med Educ. 2025 Apr 23;11:e45912. doi: 10.2196/45912.

ABSTRACT

BACKGROUND: Nursing students’ motivation in clinical learning is very important not only for their academic and professional achievement but also for making timely, informed, and appropriate decisions in providing quality and cost-effective care to people. However, the increased number of students and the scarcity of medical supplies, equipment, and patients, just to mention a few, have posed a challenge to educators in identifying and navigating the best approaches to motivate nursing students to learn during their clinical placements.

OBJECTIVE: This study primarily used descriptive and analytical methods to examine undergraduate nursing students’ desire for clinical learning both before and after participating in the program.

METHODS: An uncontrolled longitudinal quasi-experimental study in a quantitative research approach was conducted from February to March 2021 among 589 undergraduate nursing students in Tanzania. Following a baseline evaluation, nursing students were enrolled in an interactive web-based clinical practice monitoring system by their program, institution, names, registration numbers, and emails via unique codes created by the lead investigator and trainers. The system recorded and generated feedback on attendance, clinical placement unit, selected or performed clinical nursing procedures, and in-between and end-of-shift feedback. The linear regression was used to assess the effect of the intervention (interactive web-based clinical practice monitoring system) controlled for other correlated factors on motivation in clinical learning (outcome) among nursing students. Nursing students’ sociodemographic characteristics and levels of motivation in clinical learning were analyzed descriptively while a 2-tailed paired sample t test established a comparative mean difference in motivation in clinical learning between the pretest and the posttest. The association between variables was determined using regression analysis set at a 95% CI and 5% statistical significance.

RESULTS: The mean age of study participants (N=589) was 23 (SD 2.69) years of which 383 (65.0%) were male. The estimated effect (β) of a 3-week intervention to improve nursing students’ motivation in clinical learning was 3.041 (P=.03, 95% CI 1.022-7.732) when controlled for other co-related factors. The mean score for motivation in clinical learning increased significantly from the baseline (mean 9.31, SD 2.315) to the postintervention (mean 20.87, SD 5.504), and this improvement presented a large effect size of 2.743 (P<.001, 95% CI 1.011-4.107).

CONCLUSIONS: Findings suggest that an interactive web-based clinical practice monitoring system is viable and has the potential to improve undergraduate nursing students’ motivation for clinical learning. One alternative clinical pedagogy that educators in nursing education can use to facilitate clinical learning activities and develop motivated undergraduate nursing students is the integration of such technology throughout nursing curricula.

PMID:40267464 | DOI:10.2196/45912