Category: Statistics

J Med Internet Res. 2025 Sep 18;27:e69426. doi: 10.2196/69426.

ABSTRACT

BACKGROUND: App interventions show promise as effective interventions for trauma-related distress, but evaluations of their cost-effectiveness are scarce.

OBJECTIVE: This study aimed to assess the cost-effectiveness of an app-based intervention for self-management of posttraumatic stress compared to no guided self-management.

METHODS: An economic evaluation from a Swedish public health care perspective was conducted alongside a randomized controlled trial in which participants (N=179) were randomly assigned to either immediate exposure (intervention group; n=89, 49.7%) or delayed exposure at 3 months (waitlist group; n=90, 50.3%). The number of quality-adjusted life years (QALYs) gained or lost, increases or decreases in the use of different types of health care, and the monetary costs (in SEK; 2023 price level) saved or incurred with the intervention versus the comparator at 9 months after exposure were estimated based on functional disability and health care consumption reported by participants via a web-based written questionnaire at baseline and at 3, 6, and 9 months of follow-up. Estimation was done via linear regression with clustering at the participant level. The probability of the intervention being cost-effective was calculated over a range of cost-effectiveness thresholds up to SEK 1 million per QALY (US $94,225 per QALY; 2023 average exchange rate, US $1=SEK 10.61), and value of information analysis was used to interpret statistical uncertainty in the cost-effectiveness results.

RESULTS: There was no statistically significant difference between the intervention and comparator at 9 months after exposure when QALYs and all categories of health care consumption were analyzed jointly (P=.46). When analyzed separately, there was a significant increase in the number of consultations made in private mental health care (P=.03). The intervention was associated with 0.0065 (95% CI -0.0219 to 0.0349) QALYs gained per user and an increment in costs of SEK -46,359 (95% CI -111,696 to 18,977; US $-4368, 95% CI -10,525 to 1788) per user compared to no guided self-management. Cost savings were due to fewer consultations and care days per user in public health care (-5.50, 95% CI -14.83 to 3.83). The intervention had a 62% probability of both gaining QALYs and saving costs, and the probability that it would be cost-effective remained constant at 92% over our threshold range. The total expected value of perfect information was SEK 5.4 million (US $510,480) and was largely attributable to statistical uncertainty in incremental costs.

CONCLUSIONS: The use of a mobile app for self-management of posttraumatic stress was found to be cost-effective in a Swedish setting. A value-of-information analysis suggests that current research is sufficient to support the use of the app in Swedish practice from a cost-effectiveness perspective. However, to support its adoption in other settings or the potential of app-based interventions in general, stronger cost-effectiveness evidence is required.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04094922; https://clinicaltrials.gov/ct2/show/NCT04094922.

PMID:40966669 | DOI:10.2196/69426

Brief Bioinform. 2025 Sep 6;26(5):bbaf460. doi: 10.1093/bib/bbaf460.

ABSTRACT

Lipid-mediated effects play a crucial role in elucidating the pathological mechanisms linking the ε4 allele of the apolipoprotein E gene (APOE ε4) to Alzheimer’s disease (AD). However, traditional mediation analysis methods often suffer from insufficient statistical power in studies involving minority populations due to limited sample sizes. This study innovatively develops a high-dimensional mediation analysis model (TransHDM) based on a transfer learning framework. By leveraging information from source data with large-scale samples, it significantly enhances the ability to identify potential mediators in small sample target data. The method first constructs a high-dimensional regression model using aggregated data from the source data and target data, then applies transfer regularization to adjust for heterogeneity between the source and target domains, correcting for estimation bias in high-dimensional Lasso. Ultimately, it achieves parameter transfer across domains, addressing statistical bias and inferential uncertainty caused by small sample sizes. Simulation results demonstrate that, compared to traditional methods, this approach significantly improves the power in identifying true mediator variables while effectively controlling the family-wise error rate in multiple testing. When applied to the Alzheimer’s Disease Neuroimaging Initiative cohort, TransHDM transferred large-scale data from white and other ethnic groups, identifying additional lipid metabolic pathways mediating the influence of the APOE ε4 allele on AD pathological progression in African American populations compared to pre-transfer analysis. These pathways include glycerophospholipid metabolism, glycerolipid metabolism, sphingolipid metabolism, and ether lipid metabolism (false discovery rate < 0.05). The TransHDM framework not only provides a powerful methodological tool for small sample population research but also offers valuable insights for future research in exploring disease mechanisms and developing biomarkers for disease prediction.

PMID:40966649 | DOI:10.1093/bib/bbaf460

Am J Manag Care. 2025 Sep;31(9):457-461. doi: 10.37765/ajmc.2025.89786.

ABSTRACT

OBJECTIVE: To evaluate the relationship between the frequency of routine primary care visits and total health care expenditures among commercially insured adults.

STUDY DESIGN: Retrospective cross-sectional statistical analysis of a nationally representative data set of health care utilization and expenditures over a 2-year period.

METHODS: We used multivariate regression analysis to evaluate the association between the annualized number of visits with a primary care physician for routine care and total health care expenditures for commercially insured adults younger than 65 years, adjusting for underlying clinical complexity measured through risk scoring. Data were drawn from information collected by the Agency for Healthcare Research and Quality between 2021 and 2022.

RESULTS: For a sample cohort of 3879 participants, more frequent primary care visits were associated with incremental reductions in expenditures only for participants with high underlying clinical complexity. A relative risk level of approximately 2 times the average commercially insured adult was identified as an inflection point, above which cost reductions vs counterfactual prediction were observed, up to a limited number of visits.

CONCLUSIONS: Our results show a relationship between primary care visit frequency and health care expenditures with similar directionality and risk dependency as has been observed in other studies for Medicare-insured adults. This finding suggests that certain commercial populations may benefit from risk-stratified, high-touch primary care models like those being employed for some Medicare populations. The health care cost reduction benefits of these models appear premised more on clinical need than coverage type. Demonstrating this relationship is useful for health care providers, insurers, and policy makers who are developing advanced primary care models.

PMID:40966635 | DOI:10.37765/ajmc.2025.89786

Europace. 2025 Sep 1;27(9):euaf156. doi: 10.1093/europace/euaf156.

ABSTRACT

AIMS: Catheter ablation is the standard treatment for symptomatic atrial fibrillation (AF) and can be performed under general anaesthesia (GA) or varying levels of sedation to optimize patient comfort and lesion formation. However, the effect of different anaesthesia strategies on AF recurrence rates remains uncertain.

METHODS AND RESULTS: We systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for randomized controlled trials (RCTs) and observational studies comparing outcomes of catheter ablation under GA vs. sedation (including deep, moderate, and conscious sedation). We pooled risk ratios (RR) with 95% confidence intervals (CI) with a random effects model. R version 4.4.1 was used for statistical analyses. Our systematic review and meta-analysis included 6 RCTs and 17 observational studies, corresponding to 12 302 patients assigned to either sedation (n = 8952) or GA (n = 3350). There was no difference in recurrence of atrial tachyarrhythmias (ATAs) between groups (RR 1.15; 95% CI 0.97-1.36; P = 0.10; 95% prediction interval 0.66-2.01). There was no significant subgroup interaction in the recurrence of AF according to sedation type (conscious vs. mild vs. moderate sedation vs. deep sedation) (P = 0.20) or AF type (persistent AF vs. non-persistent) (P = 0.20).

CONCLUSION: In patients undergoing catheter ablation for AF, there was no significant difference in recurrence of ATA between GA and sedation.

PMID:40966626 | DOI:10.1093/europace/euaf156

Europace. 2025 Sep 1;27(9):euaf152. doi: 10.1093/europace/euaf152.

ABSTRACT

AIMS: Persistent atrial fibrillation (AF) patients undergoing a catheter ablation are at risk for adverse outcomes, due to comorbidities and a more advanced arrhythmia substrate. There may be barriers to catheter ablation in patients with persistent AF, compared to those with paroxysmal AF. We compared long-term outcomes after ablation in patients with paroxysmal and persistent AF.

METHODS AND RESULTS: Patients undergoing de novo AF catheter ablation from April 2012 to March 2022 in Ontario, Canada, were included. The primary outcome was a composite of all-cause mortality and all-cause hospitalization. Inverse probability of treatment weighting created balanced cohorts of paroxysmal and persistent AF patients. Cox proportional hazards models estimated the effect on persistent vs. paroxysmal AF. There were 10 788 patients who underwent an ablation. Persistent AF patients accounted for 25% of the population. In our weighted cohort, patients had similar age (standardized difference 0.027), female sex [standardized difference (SD) 0.018], and medical comorbidities (Charlson comorbidity score; 0.5% in both, SD 0.018). In the weighted cohort, the primary composite outcome occurred in 5.5% in paroxysmal AF and 6.3% in persistent AF at 30 days (HR 1.15, 95% CI 0.94-1.40, P = 0.168), 19.8% vs. 19.7% at 1 year (HR 1.00, 95% CI 0.90-1.11, P = 0.971), and 34.1% vs. 35.4% at 3 years (HR 1.05, 95% CI 0.97-1.13, P = 0.269). There was no increased risk of the individual components at 30 days, 1 year, or 3 years.

CONCLUSION: The risk of all-cause mortality and hospitalization outcomes in persistent and paroxysmal AF patients undergoing ablation was similar at 30 days, 1 year, and 3 years post-ablation. The impact of persistent AF on long-term outcomes (i.e. all-cause mortality) is primarily attributable to comorbid conditions.

PMID:40966624 | DOI:10.1093/europace/euaf152

JMIR Res Protoc. 2025 Sep 18;14:e73927. doi: 10.2196/73927.

ABSTRACT

BACKGROUND: Everyday life has changed since the COVID-19 pandemic. Existing health disparities among underserved communities have been exacerbated. Latino and Native Hawaiian and Pacific Islander (NHPI) populations disproportionately experience health disparities, even when compared to other minority populations. Both populations have heart disease, cancer, and diabetes as the leading causes of death, and both have high rates of obesity. As we recover from the pandemic, we must consider the intersection of continued health disparities, new social norms and attitudes, and new patterns of health behavior.

OBJECTIVE: The overarching goal of this project is to reduce health disparities among Latino and NHPI populations, considering new health behavior patterns, social norms, and increased technology use. The research project-specific aims are to (1) conduct key informant interviews and focus groups among Latino and NHPI populations; (2) develop and implement a community health and health behavior survey; and (3) co-design, develop, and test new technology that is meaningful and responsive to community needs and preferences.

METHODS: Using community-based participatory research (CBPR) and mixed methods approaches, the interdisciplinary research team will develop new technology based on community insights (key informant interviews, focus groups, and a community health survey). With our community liaisons, we will recruit adult (18+ years old) Latino and NHPI community members from the northern region in San Diego County (ie, Oceanside, San Marcos, and Escondido), largely from culturally related groups and organizations, such as dance schools (hālaus) and churches. Qualitative data will be analyzed using directed content analysis, and quantitative data will be analyzed using descriptive and multivariate statistics. The main outcomes include the identification of community health needs, culturally appropriate interventions, desired modality of intervention strategies, and acceptability of the technology. We expect the new technology to be focused on mobile health (mHealth) smartphone apps. Components will likely include strategies to improve obesity-related health behaviors and mental health.

RESULTS: This study received funding from the National Institute of General Medical Sciences in April 2022 as part of the Support for Research Excellence (SuRE) Program (R16). Key informant interviews and focus groups were completed in July 2023. Community health surveys were completed in August 2024. The development of the beta mHealth app began in September 2024 in partnership with California State University San Marcos (CSUSM) computer science students. Beta testing and evaluation will be completed by December 2025. The qualitative findings, identifying themes for a new mHealth app, were published in June 2025.

CONCLUSIONS: A major strength of this study is that it works with the communities of intended impact to directly inform new innovations to promote health behaviors. This study includes unique partnerships and an interdisciplinary team of researchers, students, community members, and consultants/collaborators to inform practices that can impact health disparities among Latino and NHPI populations with technology and strategies that are innovative and effective.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/73927.

PMID:40965967 | DOI:10.2196/73927

Sci Prog. 2025 Jul-Sep;108(3):368504251381584. doi: 10.1177/00368504251381584. Epub 2025 Sep 18.

ABSTRACT

ObjectiveSoft tissue sarcomas (STSs) are rare, heterogeneous tumors of mesenchymal origin that arise from muscle, fat, fibrous tissue, blood vessels, nerves, and connective tissue. They pose significant diagnostic and therapeutic challenges, and limited data exist on their epidemiology and outcomes in sub-Saharan Africa. This study assessed the clinicopathological characteristics and one-year survival of patients with STSs managed at a tertiary facility in Tanzania.MethodsA retrospective cohort review was conducted of medical records from January 2019 to April 2023. Data included patient demographics, tumor site, histological subtype, grade, stage at diagnosis, treatment modalities, and follow-up. Survival was estimated using Kaplan-Meier analysis, and Cox proportional hazards regression was applied to identify predictors of one-year survival.ResultsNinety-six cases were analyzed. Males constituted 54.2% of patients, and the majority (70.8%) were aged 15-64 years. Rhabdomyosarcoma was the most frequent histological type (34.4%), followed by sarcoma not otherwise specified (28.1%). Surgery was the predominant treatment modality. The overall one-year survival rate was 63.8% (95% CI: 48.0-71.7). Female sex (adjusted hazard ratio (HR): 3.36; 95% CI: 1.25-9.03; p = 0.016) and absence of surgery (adjusted HR: 5.57; 95% CI: 1.92-16.14; p = 0.002) were independent predictors of increased mortality. The advanced stage (Stage IV: HR = 9.37; unknown stage: HR 10.30) showed a trend toward poorer outcomes, although not statistically significant. Histological subtype was not clearly associated with mortality, though gastrointestinal stromal tumors (GISTs) trended toward improved survival (HR = 0.06; p = 0.057). Adjuvant chemotherapy was associated with increased mortality (HR = 4.39; p = 0.049), likely due to confounding by indication.ConclusionApproximately two-thirds of patients with STSs survive one year post-diagnosis. Prognosis is strongly influenced by sex, stage, and surgical management. These findings highlight the need for early diagnosis, appropriate surgery, and structured multidisciplinary care to improve survival outcomes in Tanzanian tertiary settings.

PMID:40965966 | DOI:10.1177/00368504251381584

Psychol Methods. 2025 Sep 18. doi: 10.1037/met0000770. Online ahead of print.

ABSTRACT

When processing and analyzing empirical data, researchers regularly face choices that may appear arbitrary (e.g., how to define and handle outliers). If one chooses to exclusively focus on a particular option and conduct a single analysis, its outcome might be of limited utility. That is, one remains agnostic regarding the generalizability of the results, because plausible alternative paths remain unexplored. A multiverse analysis offers a solution to this issue by exploring the various choices pertaining to data-processing and/or model building, and examining their impact on the conclusion of a study. However, even though multiverse analyses are arguably less susceptible to biases compared to the typical single-pathway approach, it is still possible to selectively add or omit pathways. To address this issue, we outline a novel, more principled approach to conducting multiverse analyses through crowdsourcing. The approach is detailed in a step-by-step tutorial to facilitate its implementation. We also provide a worked-out illustration featuring the Semantic Priming Across Many Languages project, thereby demonstrating its feasibility and its ability to increase objectivity and transparency. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40965962 | DOI:10.1037/met0000770

J Pediatr Endocrinol Metab. 2025 Sep 15. doi: 10.1515/jpem-2024-0626. Online ahead of print.

ABSTRACT

OBJECTIVES: There is little data on prevalence, incidence rate and clinical characteristics on diabetes amongst the pediatric and adolescent group in sub-Saharan Africa. Therefore, this study aimed to document annual case counts, describe clinical characteristics, and assess loss to follow-up among pediatric and adolescent patients with diabetes at Kenyatta National Hospital.

METHODS: This was a hospital-based retrospective, descriptive study carried out at Kenyatta National Hospital, Pediatric Endocrinology Unit, between January 2008 and December 2021 amongst diabetic patients aged 25 years and below. Data was analyzed using Statistical Package for Social Science (SPSS) version 23.0.

RESULTS: Type 1 diabetes was the leading form of diabetes at 99.3 % (n=288). Most, 56.3 %, of cases of type 1 diabetes got diagnosed within the ages of 6-18 years, majority being 6-11 years. Most patients, 90.2 % presented in diabetic ketoacidosis (DKA) at initial diagnosis. There was a sustained increasing trend in type 1 diabetes with a notable dip in hospital visitations during covid time, the year 2020. Patients with type 1 diabetes took an average of 2.5 months and a median interval of 18 days from symptom onset to diagnosis. A third of the cases of type 1 diabetes, 31.25 %, were lost to follow up.

CONCLUSIONS: The increasing cases of type 1 diabetes with delayed diagnosis require allocation of more resources and increased awareness creation. Measures need to be put in place to manage chronic conditions during pandemics. Hospital-based tracking system is required to prevent loss to follow up cases.

PMID:40965958 | DOI:10.1515/jpem-2024-0626

Psychol Trauma. 2025 Sep 18. doi: 10.1037/tra0002029. Online ahead of print.

ABSTRACT

OBJECTIVE: This study examined the effectiveness of trauma practice (TP), a multimodal, triphasic approach to trauma therapy, within a community-based setting, including phase-linked effects on therapeutic outcomes.

METHOD: The sample included 39 clients and 15 clinicians. Participants varied in terms of trauma exposure and comorbid mental health to increase generalizability of results and representation of various trauma presentations in research. Posttraumatic symptoms (Post-Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition) and trauma-related distress (Trauma Symptom Checklist [TSC-40]) were measured at baseline, after each phase, and at 6 months posttherapy.

RESULTS: Mixed effects models, nested by participants and clinician education level, showed significant decreases in posttraumatic symptoms and trauma symptom distress, reflecting a shift from clinical to nonclinical levels with robust effect sizes and reliable change indices. Phase-based analyses indicated symptom improvement during each treatment phase, with the greatest improvement observed in Phase I. Treatment gains were maintained at follow-up; however, sample sizes at follow-up were small.

CONCLUSIONS: This study’s implications suggest a strong foundation for TP’s effectiveness and clinical utility, encouraging further exploration into its phase-specific benefits and broader application in trauma therapy. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40965953 | DOI:10.1037/tra0002029