Category: Statistics

JAMA Netw Open. 2026 Jan 2;9(1):e2553530. doi: 10.1001/jamanetworkopen.2025.53530.

ABSTRACT

IMPORTANCE: Nutritional status is a key determinant of child health. While undernutrition and stunting persist among vulnerable populations, overweight and obesity have emerged as growing public health concerns. Quantifying these conditions across subpopulations is essential for guiding interventions.

OBJECTIVE: To describe and compare height-for-age and body mass index (BMI)-for-age adequacy, including the prevalence of overweight, obesity, and stunting, among low-income children in Brazil by region, age, sex, and ethnoracial group.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used administrative health records of 6 494 753 Brazilian children aged 0 to 10 years who were born between January 1, 2001, and December 31, 2015, and were enrolled in the public primary health care system. Data were obtained from 3 administrative databases-the Unified Registry, Live Birth Information System, and Food and Nutrition Surveillance System-and evaluated at 9 years of age until December 31, 2018. Descriptive statistics were used to summarize baseline characteristics, and prevalence estimates were presented with SEs. Data were analyzed from December 1, 2024, to June 31, 2025.

EXPOSURE: Demographic characteristics (age, sex, and ethnoracial group) and geographic region of residence.

MAIN OUTCOMES AND MEASURES: Anthropometric adequacy was assessed using height-for-age and BMI-for-age z scores, classified according to World Health Organization standards. Outcomes included the prevalence of stunting (height-for-age z scores less than -2), overweight (BMI-for-age z scores greater than 1), and obesity (BMI-for-age z scores greater than 2), reported overall and by subgroups.

RESULTS: Among the 6 494 753 million children, 51.48% were female, with a mean (SD) age of 3.6 (2.8) years. In terms of race and ethnicity, 0.26% were Asian; 3.84%, Black; 0.90%, Indigenous; 61.71%, Parda; and 28.72%, White; 4.57% had missing or inconsistent data. Overall, 433 754 children (6.68%) experienced stunting, 818 967 (12.61%) had overweight, and 489 541 (7.54%) had obesity. Estimated obesity prevalence (SE) at 5 years of age was 8.48% (0.02%), increasing to 10.09% (0.05%) at 9 years of age. Obesity was more frequent boys (14.12% [0.12%]) than girls (10.09% [0.05%]) at 9 years of age. Among girls, obesity prevalence (SE) was 11.8% (0.09%) among those who identified as White, 9.12% (0.06%) among those who identified as Parda, and 7.46% (0.48%) among those who identified as Indigenous.

CONCLUSIONS AND RELEVANCE: This large-scale cohort study highlights persistent regional and ethnoracial disparities in both growth faltering and excess weight gain. The coexistence of undernutrition and obesity in the same population underscores the urgency for targeted nutrition and health policies in early childhood.

PMID:41569564 | DOI:10.1001/jamanetworkopen.2025.53530

JAMA Netw Open. 2026 Jan 2;9(1):e2554972. doi: 10.1001/jamanetworkopen.2025.54972.

ABSTRACT

IMPORTANCE: Since 2012, the Hospital Readmissions Reduction Program (HRRP) has penalized hospitals for excess, risk-adjusted 30 day readmissions among traditional Medicare (TM) beneficiaries. While risk adjustment may address observable differences in patient severity, it cannot account for unobservable differences. Medicare Advantage (MA) enrollment has continued to increase, and MA beneficiaries have been found to be both observably and unobservably healthier than their TM counterparts. Because relatively lower-severity patients are increasingly likely to enroll in MA, hospitals with higher MA penetration may have unobservably higher-severity TM patients, resulting in higher-than-estimated readmission risk and excessive HRRP penalties.

OBJECTIVE: To determine whether unobserved selection, as proxied by MA penetration, could be associated with distorted HRRP penalties and how associations may be moderated by peer grouping, which was incorporated into HRRP’s 2019 revision to penalty calculations.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included hospitals serving Medicare beneficiaries from fiscal years 2019 to 2022 for 6 HRRP-targeted conditions, including acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, pneumonia, coronary artery bypass graft surgery, and elective primary total hip or knee arthroplasty. Data were analyzed from January 2024 to October 2025.

EXPOSURE: MA penetration at the hospital-year level.

MAIN OUTCOMES AND MEASURES: Excess readmission ratios (ERRs) and calculated HRRP penalties at the hospital-year level. To test whether HRRP penalties could have been distorted by unobserved selection, the association between the share of hospital admissions for MA patients (MA penetration) and excess readmission ratios (ERRs) for all patients was estimated, controlling for county-level variation and hospital-level covariates. The ERRs were rescaled by MA penetration to account for unobserved selection, and the rescaled ERRs were used to reestimate HRRP penalties under non-peer grouping and peer grouping paradigms.

RESULTS: This study included 3203 hospitals and 12 135 hospital-years. After adjusting for MA penetration, estimates indicated that hospitals in the first quintile of MA penetration would be penalized by a mean (SD) of $30 736 ($24 819.75) more, while hospitals in the fifth quintile would be penalized by a mean (SD) of approximately $26 915 ($42 017.23) less. Peer grouping does not mitigate these penalty distortions. Across hospitals, penalty redistributions would amount to $284 to $297 million annually.

CONCLUSIONS AND RELEVANCE: The findings of this study suggest that including MA penetration explicitly in risk adjustment or in peer group definitions may dampen distortions from unobservable patient severity in HRRP penalty calculations.

PMID:41569562 | DOI:10.1001/jamanetworkopen.2025.54972

Nutr Hosp. 2026 Jan 20. doi: 10.20960/nh.06129. Online ahead of print.

NO ABSTRACT

PMID:41569559 | DOI:10.20960/nh.06129

JAMA. 2026 Jan 22. doi: 10.1001/jama.2025.26179. Online ahead of print.

ABSTRACT

IMPORTANCE: For patients with idiopathic pulmonary fibrosis (IPF), cough impairs quality of life; effective treatments for IPF-associated cough are needed.

OBJECTIVE: To determine if nalbuphine extended release (ER), a κ opioid receptor agonist and μ-opioid receptor antagonist, decreases cough compared with placebo in patients with IPF-associated cough.

DESIGN, SETTING, AND PARTICIPANTS: In this randomized, double-blind, placebo-controlled phase 2b trial conducted at 52 sites in 10 countries, patients with IPF, chronic cough for at least 8 weeks, and a Cough Severity Numerical Rating Scale (0, no cough; 10, worst possible cough) score of 4 or higher were enrolled from February 2024 to February 2025, with last follow-up in April 2025. Statistical analyses were conducted from May to August 2025.

INTERVENTION: Patients were randomized 1:1:1:1 to receive nalbuphine ER at doses of 27 mg, 54 mg, or 108 mg or placebo twice daily for 6 weeks.

MAIN OUTCOMES AND MEASURES: The primary outcome was the relative change from baseline in 24-hour cough frequency (coughs/h), measured with a digital cough monitor, for nalbuphine ER compared with placebo at week 6. The key secondary outcome was the relative change from baseline in the patient-reported cough frequency (Evaluating Respiratory Symptoms in IPF cough subscale; scores range from 0-4, lower scores indicate lesser cough frequency) at week 6.

RESULTS: Of the 223 patients screened, 165 were randomized (42, 43, 40, and 40 to receive nalbuphine ER 27 mg, 54 mg, and 108 mg, and placebo, respectively) and 160 were included in the primary analysis (median age, 71 [range, 51-85] years; 28.5% female). The baseline mean (SD) cough count was 28.3 (27.4) coughs/h. In the nalbuphine ER 27 mg, 54 mg, and 108 mg twice-daily groups, the mean relative decrease in the cough count and the absolute decrease in coughs/h were 47.9% (from 24.6 to 11.9; P = .008), 53.4% (from 28.0 to 14.9; P < .001), and 60.2% (from 31.5 to 11.9; P < .001), respectively, compared with placebo (16.9%; from 29.4 to 28.1 coughs/h). For the key secondary outcome of patient-reported cough frequency at week 6, the relative and absolute changes were -31.4% (from 2.3 to 1.5; P = .14), -40.6% (from 2.6 to 1.4; P = .004), and -40.2% (from 2.4 to 1.4; P < .005) in the 27-mg, 54-mg, and 108-mg groups, respectively, compared with -21.9% (from 2.6 to 1.9) with placebo.

CONCLUSIONS AND RELEVANCE: For patients with IPF-associated chronic cough, all 3 doses of nalbuphine ER reduced objective cough frequency and the 2 higher doses improved patient-reported cough frequency at 6 weeks.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05964335.

PMID:41569557 | DOI:10.1001/jama.2025.26179

Psychol Trauma. 2026 Jan 22. doi: 10.1037/tra0002102. Online ahead of print.

ABSTRACT

OBJECTIVE: Research demonstrates that oppression can produce symptoms consistent with posttraumatic stress disorder (PTSD), but traditional trauma assessments do not account for the impacts of oppression. This study addressed this gap by establishing the dimensionality, measurement equivalence, reliability, and convergent validity of the Oppression-Based Traumatic Stress Inventory across two samples.

METHOD: The samples comprise PTSD treatment study clients (Sample 1; n = 129) and Hispanic-serving institution undergraduate students (Sample 2; n = 227) who completed a series of questionnaires, including the Oppression-Based Traumatic Stress Inventory.

RESULTS: Confirmatory item factor analyses for the 25 ordinal Oppression-Based Traumatic Stress Inventory items were conducted for each sample. Model fit was unsatisfactory for two initial four-factor solutions: one based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, PTSD symptom clusters and another based on exploratory factor analyses on a previous sample. Given the very high correlations among the factors, however, we refined the structure into three new factors (oppression-related distress and avoidance, fear and blame of others, and general depression and anxiety symptoms) that yielded acceptable fit after adding four error covariances. Measurement invariance testing revealed three of the 25 items had parameters that differed across samples. Excellent reliability was found for all three factors. A higher order factor appeared plausible but was largely noninvariant across samples. Finally, we provide evidence for convergent validity (with measures of standard PTSD, posttraumatic cognitions, depressive symptoms, psychosocial functioning, racial discrimination, gender discrimination, and, to some degree, material hardship).

CONCLUSIONS: Our findings strengthen the psychometric evidence supporting this novel measure of oppression-based traumatic stress, an important step in furthering intersectional research on this topic. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:41569537 | DOI:10.1037/tra0002102

J Am Heart Assoc. 2026 Jan 22:e042619. doi: 10.1161/JAHA.125.042619. Online ahead of print.

ABSTRACT

BACKGROUND: Black and female patients with atrial fibrillation have more strokes. Certain left atrial appendage (LAA) morphologies impose a higher stroke risk. Whether anatomic differences in LAA morphology are associated with race or sex remains unexplored.

METHODS: We identified consecutive patients with computed tomography for LAA morphology and categorized each patient by self-reported race (Black versus non-Black) and sex. Each LAA morphology was assigned a score based on published relative LAA thrombus risk (lowest to highest: “chicken wing,” “windsock” and “cactus,” “cauliflower”). Scores and prevalence were compared across races and sexes using a Wilcoxon rank-sum test and Fisher’s exact test, respectively. Logistic regression was performed to find the association of race (adjusting for sex) and sex with higher risk LAA morphologies.

RESULTS: Among 211 patients (27% Black, n=58; 47% female, n=100), there was no difference in the projected hypothetical stroke risk across race or sex (median for Black versus non-Black patients: 1 [interquartile range, 1-4] versus 1 [interquartile range, 1-1], P=0.11; median for women versus men: 1 [interquartile range, 1-4] versus 1 [interquartile range, 1-4], P=0.62). The highest risk LAA morphology, cauliflower, had greater odds of being present in Black versus non-Black patients (unadjusted odds ratio [OR], 6.0 [1.4-25.1], P=0.049; adjusted OR, 4.8 [1.1-20.9], P=0.035). Although cauliflower LAA morphology was more prevalent in women (n=7 [9%] versus n=2 [2%] in men; P=0.063), this difference nor odds of cauliflower LAA morphology being present in women were statistically significant.

CONCLUSIONS: The highest risk LAA morphology, cauliflower, demonstrated greater odds of being present in Black patients versus non-Black patients. The difference in women versus men did not reach statistical significance. Although the study was underpowered to make the findings declarative, these results are provocative regarding the differential stroke risk across races and sexes.

PMID:41568568 | DOI:10.1161/JAHA.125.042619

Eur J Psychotraumatol. 2026 Dec;17(1):2605803. doi: 10.1080/20008066.2025.2605803. Epub 2026 Jan 22.

ABSTRACT

Background: Physical activity is increasingly incorporated in trauma-focused treatments as an augmentation strategy to improve treatment outcome. In a novel VR exposure treatment known as 3MDR (Multi-modal Motion-assisted Memory Desensitization and Reconsolidation), patients engage in low-intensity physical activity by walking on a treadmill throughout the therapy session, approaching trauma-related pictures that progressively enlarge until fully displayed in a VR environment. Physical activity is considered a key augmentation strategy in this treatment, with the proposed mechanism that walking toward a trauma-related picture facilitates the reduction of trauma-related avoidance, thereby improving treatment outcome. However, neither the specific effect of walking during this treatment nor the proposed working mechanism have been scientifically examined yet.Objective: In this paper we describe the rationale and study design of a randomised controlled trial (RCT) to examine the specific effect of walking toward trauma-related stimuli during VR exposure on treatment outcome. In addition, we will test whether walking toward trauma-related pictures facilitates a greater reduction in trauma-related avoidance.Method: Patients with PTSD (N = 158) are randomised to two treatment conditions: walking (VR exposure while walking) or stationary (VR exposure without walking), while keeping all other treatment aspects constant. Participants in both conditions receive two preparatory treatment sessions, 6 or 12 VR exposure sessions, and one closure session. The primary outcome is clinician-rated PTSD symptom severity. Secondary outcomes are both clinician-rated- and self-reported trauma-related avoidance symptom severity, as well as self-reported PTSD symptom severity. Assessments take place pre- and after 6 and 12 VR exposure sessions (posttreatment), and at 3-, 6-, 12- and 18- months follow-up.Conclusion: This RCT aims to examine whether incorporating walking during trauma-focused treatment in a VR exposure environment augments the treatment of patients with PTSD.

PMID:41568558 | DOI:10.1080/20008066.2025.2605803

Int J Gynaecol Obstet. 2026 Jan 22. doi: 10.1002/ijgo.70831. Online ahead of print.

ABSTRACT

OBJECTIVE: Cervical cancer remains a major public health concern globally. It is the fourth leading cause of cancer deaths among women worldwide. In 2020, the global incidence of cervical cancer was estimated to be 604 000 with a standardized mortality rate of 341 000. In Tanzania, cervical cancer is the most common female cancer and a leading cause of cancer-related deaths. The majority of data demonstrating the survival rate of cervical cancer originates from high- and middle-income countries with contributions from low-income countries such as Tanzania being relatively scarce. Determining the factors associated with survival is critical in an attempt to inform strategies to improve outcome of women with cervical cancer. The aim of the present study was to determine the 3-year overall survival rate and associated factors among women with invasive cervical cancer attended at Ocean Road Cancer Institute (ORCI) from 2018 to 2020.

METHODS: A retrospective cohort study was conducted at ORCI by using their cancer registry database. The study included 256 women diagnosed with cervical cancer from 2018 to 2020. Survival analysis was estimated by using Kaplan-Meir analysis, Cox regression hazard proportion and log-rank test and a P value of less than 0.05 was considered statistically significant. Stata version 17 was used for analysis.

RESULTS: Among 256 women with cervical cancer, the survival rate across one-, two- and 3-years, respectively were 83.6%, 77.0%, and 72.7%. Survival rate was significantly associated with both FIGO stage during diagnosis and hemoglobin level. Those who received concurrent chemoradiotherapy had a higher survival rate compared to those who received radiotherapy or chemotherapy only, and it was statistically significant with P < 0.001.

CONCLUSION: The study found an overall survival rate of 72.7% over 3 years. Factors associated with survival rate were early FIGO stage at diagnosis, normal hemoglobin level at diagnosis, and the use of concurrent chemoradiotherapy. Proper staging, good patient preparation and good choice of treatment improves survival. With availability of advance treatment options in the country the survival rate of women is promising.

PMID:41568557 | DOI:10.1002/ijgo.70831

J Am Heart Assoc. 2026 Jan 22:e044241. doi: 10.1161/JAHA.125.044241. Online ahead of print.

ABSTRACT

BACKGROUND: The role of colchicine, an anti-inflammatory agent, in improving cardiovascular outcomes in patients with recent myocardial infarction remains unclear. We sought to evaluate the efficacy and safety of colchicine compared with placebo in patients with recent myocardial infarction (within 1 month of symptom onset) at a follow-up of at least 1 year.

METHODS: We systematically searched MEDLINE, Embase, and the Cochrane Library until January 2025 for randomized controlled trials comparing colchicine to placebo in recent myocardial infarction. The primary outcome was major adverse cardiovascular events (MACE; as defined by the included studies) at maximum follow-up. Secondary outcomes included individual MACE components and safety (serious adverse events [AEs], any AEs, and gastrointestinal AEs). Count data were pooled using random-effects models with inverse variance weighting to estimate risk ratios (RRs) and 95% CIs.

RESULTS: A total of 5 randomized controlled trials were included with 6620 patients randomized to colchicine and 6625 to placebo. Most participants (79%) were male, with mean ages ranging from 59 to 61 years. Follow-up durations ranged from 1 to 3 years. At maximum follow-up, there was no statistically significant difference in MACE between colchicine and placebo (8.2% versus 9.3%; RR, 0.83 [95% CI, 0.66-1.04]). Analyses of individual MACE components were also inconclusive. Randomization to colchicine did not increase the overall incidence of AEs or serious AEs compared with placebo.

CONCLUSIONS: In patients with recent myocardial infarction, the available evidence assessing the effect of colchicine, in addition to standard therapy, on MACE remains inconclusive over a median follow-up duration of 1 year.

PMID:41568554 | DOI:10.1161/JAHA.125.044241

J Am Geriatr Soc. 2026 Jan 22. doi: 10.1111/jgs.70301. Online ahead of print.

ABSTRACT

BACKGROUND: In 2015, the Netherlands implemented long-term care (LTC) reforms to promote aging-in-place, potentially impacting nursing home (NH) access for older individuals with dementia. This study examines how the reform affected NH admission rates and waiting list prevalence for this population.

METHODS: We performed interrupted time series analyses to evaluate trends in NH admissions (2011-2019, Statistics Netherlands) and waiting list prevalence (2013-2018, National Healthcare Institute) before and after the 2015 LTC reform. Incidence rate ratios (IRR) were calculated for monthly NH admission rates and waiting list prevalence.

RESULTS: Among 270,706 older people with dementia, the reform was negatively associated with NH admission rates (IRR 0.610 [0.547-0.681]), halting the pre-reform decline and stabilizing the post-reform trend (IRR 1.001 [0.999-1.002]). The reform was positively associated with NH waiting list prevalence (IRR 1.159 [1.048-1.282]).

CONCLUSION: Among older Dutch people with dementia, the 2015 Dutch LTC reform was associated with fewer NH admissions and longer waiting lists. While stabilization of the NH admissions may reflect prioritization of persons with dementia within stricter eligibility criteria, the concurrent rise in waiting list prevalence suggests that institutional capacity did not keep pace with persistent need. As a result, many older people with dementia remain longer in the community, raising concerns regarding their health and safety as well as the burden on their informal caregivers.

PMID:41568552 | DOI:10.1111/jgs.70301