Category: Statistics

JAMA Netw Open. 2026 Apr 1;9(4):e264788. doi: 10.1001/jamanetworkopen.2026.4788.

ABSTRACT

IMPORTANCE: The Outcome and Assessment Information Set (OASIS) is essential for measuring home health quality and outcomes, and accurate linkage between OASIS, Medicare enrollment, and claims is crucial for monitoring utilization and informing payment policy. Preliminary documentation suggested a decrease in OASIS-beneficiary match rates beginning in 2019, but the extent and implications of this decrease have not been quantified.

OBJECTIVE: To quantify annual match rates between OASIS assessments and Medicare enrollment and fee-for-service (FFS) home health claims from 2017 through 2023.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used 100% OASIS assessments from 2017-2023 linked to the Master Beneficiary Summary File (MBSF) and FFS home health claims. OASIS assessments included patients receiving home health care in any payer category, while claims analyses were restricted to FFS beneficiaries. Data were analyzed from June 2025 to January 2026.

MAIN OUTCOMES AND MEASURES: The yearly number and proportion of OASIS assessments that can be matched to a person in the MBSF and the yearly number and proportion of FFS home health claims that can be matched to an OASIS assessment.

RESULTS: Across 2017-2023, approximately 18 million OASIS assessments and 6 million unique assessed beneficiaries were recorded annually. The proportion of assessments linked to a Medicare beneficiary decreased from 89.8% in 2017 to 76.4% in 2023. Among unmatched assessments, the share with Medicare as the recorded payer increased, while the share with Medicaid decreased. For FFS beneficiaries, the number of claims increased due to payment cycle changes, yet the number of unique FFS claimants decreased from 3 424 394 in 2017 to 2 636 931 in 2023. The match rate of FFS claims to an OASIS assessment decreased from 96.8% to 73.9%, with variation across states; by 2023, all state match rates were below 90%.

CONCLUSIONS AND RELEVANCE: The findings of this study suggest a reduced ability to accurately attribute OASIS assessments to individual Medicare beneficiaries or matching claims to corresponding OASIS assessments using Centers for Medicare & Medicaid Services (CMS) Research Identifiable Files. Until these issues are addressed by CMS, researchers should cautiously interpret findings utilizing individually linked Medicare claims and OASIS assessment data.

PMID:41926120 | DOI:10.1001/jamanetworkopen.2026.4788

JAMA Netw Open. 2026 Apr 1;9(4):e265039. doi: 10.1001/jamanetworkopen.2026.5039.

ABSTRACT

IMPORTANCE: Liver transplants are performed around the clock, often associated with substantial disutility for patients and clinicians. While short-duration dual hypothermic oxygenated machine perfusion (short-DHOPE) mitigates ischemia-reperfusion injury and related complications, prolonged DHOPE (DHOPE-PRO) may further extend preservation time and facilitate daytime liver transplant.

OBJECTIVE: To assess whether the use of DHOPE-PRO is associated with an increased proportion of daytime liver transplants without compromising graft or patient outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study conducted at a large academic liver transplant center in the Netherlands included adult and pediatric recipients of liver grafts received from donation after brain death (DBD), donation after circulatory death (DCD), or living donors. The study compared all liver transplants performed between January 1, 2023, and December 31, 2024, following routine DHOPE-PRO implementation, with a control cohort of all consecutive liver transplants performed between January 1, 2021, and December 31, 2022. Follow-up continued through December 31, 2025. Outcomes were stratified by graft type.

EXPOSURES: Grafts underwent DHOPE-PRO, with or without viability assessment depending on graft risk, or short-DHOPE (for DCD livers) or no perfusion (for DBD livers).

MAIN OUTCOMES AND MEASURES: The primary outcome was the difference in the percentage of daytime liver transplants, defined as surgery starting at or after 8 am and either (1) reperfusion occurring before 8 pm or (2) completion by midnight, between the 2021-2022 and 2023-2024 cohorts. Secondary outcomes included 1-year patient and graft survival, intraoperative parameters, and postoperative complications, stratified by graft type.

RESULTS: A total of 330 liver transplants (median [IQR] age, 45 [13-62] years; 186 [56.4%] male) were included in the analyses: 155 transplants in the 2021-2022 cohort and 175 transplants in the 2023-2024 cohort. Following DHOPE-PRO implementation, the percentage of daytime transplants increased from 48.4% (75 of 155) to 84.6% (148 of 175) for reperfusion (P < .001) and from 53.5% (83 of 155) to 89.1% (156 of 175) for completion (P < .001). Median (IQR) DHOPE duration increased from 2.1 (1.6-4.1) to 10.2 (5.1-13.1) hours (P < .001), with total preservation times up to 31.4 hours. Use of DHOPE-PRO showed no association with postoperative complications (eg, new-onset acute kidney injury; odds ratio, 0.64 [95% CI, 0.37-1.07]; P = .09]). One-year patient survival exceeded 90% in all subgroups. Use of DHOPE-PRO was not associated with either graft (hazard ratio, 1.28 [95% CI, 0.59-2.74]; P = .53) or patient (hazard ratio, 2.05 [95% CI, 0.75-5.59]; P = .16) survival.

CONCLUSIONS AND RELEVANCE: In this prospective cohort study, routine implementation of DHOPE-PRO was associated with increased proportions of daytime liver transplants and with improved surgical logistics. It was also associated with outcomes similar to those after short-duration DHOPE, supporting its broader application in clinical practice.

PMID:41926119 | DOI:10.1001/jamanetworkopen.2026.5039

JAMA Otolaryngol Head Neck Surg. 2026 Apr 2. doi: 10.1001/jamaoto.2026.0166. Online ahead of print.

ABSTRACT

IMPORTANCE: Malnutrition, common in patients with head and neck squamous cell carcinoma (HNSCC), may impair the effectiveness of immunotherapy. Understanding whether nutritional status affects outcomes can emphasize the importance of pretreatment nutritional optimization.

OBJECTIVE: To evaluate the associations of body mass index (BMI), pretreatment BMI change, and prognostic nutritional index (PNI) with progression-free survival (PFS) in patients with advanced HNSCC treated with immunotherapy.

DESIGN, SETTING, AND PARTICIPANTS: Cohort study using deidentified electronic health records from the Flatiron Health database between January 2014 to January 2024, with follow-up of 3000 days in multiple cancer institutions across the US. Patients were from community and academic practices in the US, diagnosed with all types of advanced head and neck cancer who received immunotherapy (nivolumab, pembrolizumab, cemiplimab, durvalumab, atezolizumab, avelumab, or ipilimumab) between January 2014 and January 2024. Exclusion criteria included age younger than 18 years, patients without a diagnosis of squamous cell carcinoma, missing stage information, missing treatment information (eg, a gap in documented care of ≥90 days or more), and incomplete data needed to calculate BMI or PNI prior to initiation of therapy.

EXPOSURES: Baseline BMI, pretreatment BMI change (≥2% decrease vs stable), and PNI (low <45 vs normal ≥45).

MAIN OUTCOMES AND MEASURES: PFS following treatment with immunotherapy.

RESULTS: Among 1108 patients (mean [SD] age, 66.2 [10.2] years; 236 [21.3%] female; 872 [78.7%] male), 214 (79%) experienced 2% or more pretreatment BMI loss. BMI loss was associated with worse PFS (hazard ratio, 1.17; 95% CI, 1.02-1.35); median PFS was 271 (IQR, 121-603) days with loss vs 415 days with stable BMI. In the 471 patients with laboratory data, 320 (67.9%) had a low PNI. Low PNI was associated with shorter PFS (adjusted hazard ratio, 1.58; 95% CI, 1.39-1.79); median PFS was 213 (IQR, 98-445) days for low vs 566 (IQR, 307-1094) days for patients with a normal PNI. Baseline BMI category was not independently associated with PFS.

CONCLUSIONS AND RELEVANCE: In this large, nationally representative cohort of patients with advanced head and neck squamous cell carcinoma treated with immunotherapy, pretreatment BMI loss and low PNI were independently associated with PFS, while baseline BMI was not. These findings suggest that dynamic measures of nutrition and immune status provide more meaningful prognostic information than static measures. Nutritional optimization may represent a modifiable factor to improve outcomes in patients receiving immunotherapy for advanced head and neck squamous cell carcinoma.

PMID:41926098 | DOI:10.1001/jamaoto.2026.0166

Child Dev. 2026 Apr 2:aacaf053. doi: 10.1093/chidev/aacaf053. Online ahead of print.

ABSTRACT

Methodological challenges diminish the number and reliability of longitudinal studies on executive functions (EFs) starting in infancy. To address this, the current study used latent profile analysis (LPA) to examine EF task performance across three age points: 8 months, 2.5 years, and 5 years. Participants were children (N = 830; 55.5% boys; > 95% White) from the FinnBrain Birth Cohort Study. Three profiles were identified: constant below average EF profile (14.2%), and two average EF profiles differentiated by Spin the Pots performance (working memory) at 5 years (above average 29.8%, below average 56%). Expected associations between the below average EF profile, male sex, and lower general cognitive performance were found, further supporting the validity of the profiles.

PMID:41926095 | DOI:10.1093/chidev/aacaf053

J Mol Endocrinol. 2026 Mar 25:JME-25-0171. doi: 10.1530/JME-25-0171. Online ahead of print.

ABSTRACT

Physiologic mechanisms underlying metabolic and renal diseases interact and are highly comorbid, yet their genetic associations and underlying mechanisms have not been systematically elucidated. Using Genome-Wide Association Study (GWAS) summary statistics from UK Biobank, FinnGen, and CKDGen, we integrated and analyzed gout, serum urate, chronic kidney disease, kidney stones, and metabolic syndrome. Using genomic structural equation modeling (GSEM), we created the first genetic linkage map for “Gout-Urate-Kidney-Metabolism” (GUKM) to explore shared genetic architecture. Post-GWAS analyses for GUKM-GSEM GWAS, including functional annotation, enrichment, fine-mapping, causal inference, and gsMap, identified key genetic loci, pathways, tissues/cell types, and potential drug targets. We identified 164 lead SNPs, including rs1260326 (chr2) and rs73607783 (chr8), with GSEA showing significant enrichment of GUKM-GSEM GWAS in cholesterol metabolism and lipid pathways (adjP < 0.05). Tissue and cell enrichment highlighted the liver, renal cortex, pancreas, proximal tubular epithelial cells, and hepatocytes (P < 0.05). Mendelian randomization indicated a potential causal role of GCKR (FDR < 0.05), which gsMap showed to be highly expressed in hepatocytes and liver tissue. The present study revealed the common genetic basis of metabolic and renal diseases and emphasized that lipid metabolism may be a key intermediary pathway connecting the “metabolic-renal axis.” The liver, renal cortex, and pancreas were the primary enriched tissues, and GCKR was identified as a core gene and potential drug target. Overall, this study provides an important reference for the genetic mechanisms, key mechanisms, and intervention targets of related diseases.

PMID:41926080 | DOI:10.1530/JME-25-0171

Spine Deform. 2026 Apr 2. doi: 10.1007/s43390-026-01354-6. Online ahead of print.

ABSTRACT

PURPOSE: Evaluate the utility of intraoperative traction (IOT) during posterior spinal fusion (PSF) in a matched cohort at a high-volume neuromuscular scoliosis (NMS) center.

METHODS: A nested case-control study was performed on a single-center retrospective database of NMS patients. Those diagnosed with cerebral palsy were pair-matched by age (± 1 year), preoperative curve magnitude (± 10°), preoperative traction curve magnitude (± 10°), and flexibility index (± 5%). Paired t tests or Wilcoxon signed-rank tests were used to analyze continuous variables between groups. Fisher’s Exact tests were used to compare categorical variables by group.

RESULTS: Thirty-one unique case-control matches were identified (n = 62). IOT and non-IOT groups were similar in terms of EBL 855 (IQR 500-1200) vs. 800 (IQR 650-1350) cc (p = 0.60), length of ICU stay 1.7 (IQR 1.0-2.7) vs. 2.3 (IQR 1.7-3.1) days (p = 0.14), BMI 18.0 (IQR 14-20) vs. 15.5 (IQR 14-18) (p = 0.10), sex distribution 54.8% vs. 51.6% (p > 0.99), and changes in neuromonitoring signals 4/31 (13%) vs. 3/31 (10%) (p > 0.99). Complication rate was 22.6% (7/31) for IOT and 25.8% (8/31) for non-IOT (p > 0.999). There were no statistical differences in surgical time 414 ± 131 vs. 397 ± 133 min (p = 0.64) or anesthesia time 551 ± 136 vs. 529 ± 135 min (p = 0.56). Both groups had similar postoperative curve magnitude IOT = 37° vs. non-IOT = 42° (p = 0.28) and percent curve correction IOT = 60% vs. non-IOT = 56% (p = 0.30). Percent correction of pelvic obliquity was also similar 78% (IQR 67-90) vs. 68% (IQR 60-91) (p = 0.18) between groups.

CONCLUSION: There was no difference in postoperative curve correction or pelvic obliquity between those treated with IOT versus those without during PSF.

LEVEL OF EVIDENCE: III.

PMID:41926074 | DOI:10.1007/s43390-026-01354-6

Can J Public Health. 2026 Apr 2. doi: 10.17269/s41997-026-01190-1. Online ahead of print.

ABSTRACT

BACKGROUND: While the literature indicates that corporal punishment, and specifically spanking, is associated with several poor outcomes, little is known about the prevalence of spanking and attitudinal beliefs about spanking in Canada. The overall aims of the study were to (1) compute the prevalence of self-reported spanking history and attitudinal spanking beliefs; (2) determine if a spanking history varies according to gender, sexual identity, or birth cohort; and (3) examine how spanking history, gender, sexual identity, and birth cohort are associated with (a) attitudinal spanking beliefs and (b) the practice of spanking one’s own child.

METHODS: Data were obtained from all Canadian provinces for the 2024 Childhood Adversity and Resilience-Youth and Early Adulthood Research Study (CARe-YEARS; n = 3767; ages 18 to 49 years). Data were analysed using descriptive statistics and logistic regression.

RESULTS: In the sample, 55.6% reported being spanked as a child with the lowest prevalence (48.9%) among the youngest birth cohort. Overall, 22.6% reported that the spanking left a mark or bruise, or caused lasting physical pain and 15.0% believed spanking is necessary to properly raise a child. Several gender, sexual identity, and birth cohort differences were noted.

CONCLUSIONS: Ongoing policies and prevention strategies are needed in Canada to further reduce both the attitudinal belief that spanking is necessary to properly raise a child and the use of spanking in a disciplinary context. An important step in advancing child protection in Canada is to repeal the law permitting spanking and to enhance prevention efforts with a focus on gender and sexual identity.

PMID:41926065 | DOI:10.17269/s41997-026-01190-1

Paediatr Drugs. 2026 Apr 2. doi: 10.1007/s40272-026-00747-4. Online ahead of print.

ABSTRACT

BACKGROUND: Infants and young children with severe atopic dermatitis (AD) have a high burden of disease with a strong impact on quality of life. Here we assess long-term efficacy and safety of dupilumab in pediatric patients aged 6 months to 5 years with severe AD.

METHODS: This is a subgroup analysis of patients aged 6 months to 5 years enrolled in the ongoing LIBERTY AD PED open-label extension (OLE) study of dupilumab who had previously participated in the parent study LIBERTY AD PRESCHOOL part B and had severe AD (Investigator’s Global Assessment [IGA] = 4) at parent study baseline. Patients received weight-tiered dupilumab every 4 weeks (200 mg for patients weighing 5 to < 15 kg; 300 mg for patients weighing 15 to < 30 kg). Key endpoints included the incidence and rate of treatment-emergent adverse events (TEAEs), the proportion of patients with a ≥ 75% improvement in Eczema Area and Severity Index (EASI-75) from parent study baseline, proportions of patients achieving IGA = 0/1 and IGA ≤ 2, and the proportion of patients with a ≥ 6-point improvement in Children’s Dermatology Life Quality Index (CDLQI) for patients aged ≥ 4 years or Infants’ Dermatitis Quality of Life (IDQoL) questionnaire for patients aged < 4 years.

RESULTS: This analysis included 121 patients, of whom 50 completed the week 104 visit. TEAEs were reported in 88% of patients; most TEAEs were mild or moderate and not related to treatment. Common TEAEs included upper respiratory tract infection, nasopharyngitis, and cough. Conjunctivitis events were reported in 19% of patients and were mild or moderate, with a median duration of 8 days. No conjunctivitis event led to treatment discontinuation, and most events resolved during the study. One drug-related event (severe urticaria) led to treatment discontinuation, but it was not serious and resolved over time. Serious TEAEs were reported in 17 patients (14%), including one drug-related pinworm event. No serious TEAE led to treatment discontinuation. By week 4 of the OLE study, patients who had received placebo in the parent study exhibited efficacy improvements comparable to patients who had received dupilumab. By week 104, 96% of patients achieved EASI-75 from parent study baseline, 27% of patients achieved an IGA score of 0/1 (clear/almost clear skin), 92% of patients achieved IGA ≤ 2 (clear skin to mild AD), and the least squares mean percent change in EASI from parent study baseline was – 89%. Additionally, 89% (23/26) of patients achieved a ≥ 6-point (clinically meaningful) improvement in CDLQI, and 100% (3/3) of patients achieved a ≥ 6-point improvement in IDQoL.

CONCLUSION: Long-term treatment with dupilumab for up to 2 years showed acceptable safety and sustained efficacy in signs, symptoms, and quality of life in patients aged 6 months to 5 years with severe AD, with a rapid improvement for patients who had received placebo in the parent study. Long-term safety in the OLE study was consistent with the short-term safety profile observed in the parent study, with no new safety signals detected. [Graphical abstract and plain language summary available] CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: NCT02612454 and NCT03346434 (part B).

PMID:41926052 | DOI:10.1007/s40272-026-00747-4

Prev Sci. 2026 Apr 2. doi: 10.1007/s11121-026-01897-0. Online ahead of print.

ABSTRACT

Developmental cascade models provide a valuable framework for understanding how risk and protective factors interact over time to shape health and behavioral outcomes. Traditional statistical methods, such as logistic regression and structural equation modeling, have been instrumental in uncovering developmental pathways within prevention science. However, these methods often impose constraints on model complexity and face limitations in capturing the non-linear and interdependent nature of developmental processes. Machine learning (ML) offers complementary advantages, such as the ability to incorporate high-dimensional data, detect complex interactions, and enhance predictive accuracy. These capabilities can improve identification of at-risk individuals, support the timing of interventions across developmental stages, and refine theory-driven models. By integrating ML with developmental cascade models, researchers can more effectively identify when and how which risk accumulates and protective factors exert influence, thereby improving the tailoring and efficiency of prevention strategies. This conceptual paper outlines how ML can extend traditional analytic approaches in developmental cascade research, discusses key practical considerations for researchers including data requirements, software selection, and model validation, and highlights its potential to advance prevention science across the life course.

PMID:41926047 | DOI:10.1007/s11121-026-01897-0

Neurol Ther. 2026 Apr 2. doi: 10.1007/s40120-026-00928-w. Online ahead of print.

ABSTRACT

INTRODUCTION: Fatigue is the most prevalent symptom in “long COVID”, affecting 6-7% of patients after COVID-19 infection. Its pathophysiology remains unclear, with viral persistence, immune dysregulation, and mitochondrial dysfunction among proposed mechanisms. Transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive neuromodulatory approach, has been suggested as a potential treatment.

METHODS: We conducted a randomized, sham-controlled, single-blinded pilot study to evaluate adherence and clinical effects of taVNS in long COVID-related fatigue. Forty-five patients were randomized 1:1:1 to sham stimulation, sub-threshold taVNS, or above-threshold taVNS for 4 weeks using the Conformité Européenne (CE)-certified tVNS-L device (25 Hz, 250 µs, 4 h/day). The primary co-endpoints were fatigue severity (MFI-20) and adherence, defined as mean daily stimulation duration. Secondary endpoints included depressive symptoms (BDI-II), health-related quality of life (SF-36), and post-COVID symptom burden (PCS).

RESULTS: Of 45 enrolled patients (mean age 42.4 years; 73% female), 4 (8.9%) dropped out early. Mean stimulation time was 236 min/day, fulfilling the adherence criterion in > 80% of participants. Adverse events were mild, including skin irritation (6.7%) and vertigo (6.7%). Across all groups, questionnaire scores improved over time; however, no statistically significant differences were observed between the sham and active stimulation groups. Baseline fatigue and quality-of-life scores were markedly impaired compared with normative data.

CONCLUSION: taVNS was safe, feasible, and associated with high adherence in long COVID-related fatigue, but showed no superiority over sham stimulation. Larger multicenter trials with more homogeneous populations and objective biomarkers are required to determine whether taVNS confers therapeutic benefit in this condition.

TRIAL REGISTRATION: The trial was approved by the ethics committee (23/7798) and registered at the German Clinical Trials Register, identifier DRKS00031974.

PMID:41926033 | DOI:10.1007/s40120-026-00928-w