Category: Statistics

JAMA Netw Open. 2025 Apr 1;8(4):e256841. doi: 10.1001/jamanetworkopen.2025.6841.

ABSTRACT

IMPORTANCE: Reported cases of assisted dying have increased in countries with such legislation. In Belgium, where euthanasia was legalized in mid-2002, cases rose from 236 in 2003 to 3423 in 2023. Most previous studies have focused on occurrence rates.

OBJECTIVE: To examine the magnitude of the increase in euthanasia cases and its association with demographic changes observed during the study period.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed complete data from the Belgian Federal Commission for the Control and Evaluation of Euthanasia (FCCEE) from September 1, 2002, to December 31, 2023, and adjusted the model for demographic composition and change by gender, age group, and region using data from the Belgian Office for Statistics. All cases of euthanasia reported to the FCCEE during the selected period were included.

EXPOSURE: Euthanasia reported to the FCCEE.

MAIN OUTCOME AND MEASURES: Poisson regression with and without a demographic offset was used to provide the rate ratios (RRs) and the prevalence rates (PRs) for euthanasia. The RRs were calculated by age, gender, region, and euthanasia characteristics. Estimates used a model including demographic offsets to calculate PRs and explore interactions across subcategories.

RESULTS: During the selected period, 33 647 cases of euthanasia were reported (50.23% male; 84.74% 60 years or older); analyses focused on 33 580 valid cases. The yearly RR was 1.07 (95% CI, 1.07-1.07), while the yearly PR was 1.05 (95% CI, 1.05-1.06), indicating that demographic changes were associated with the observed increase. The PR for euthanasia among males relative to females was overall higher (PR, 1.36; 95% CI, 1.33-1.39) but has decreased slightly (PR, 0.99; 95% CI, 0.99-1.00). Cases citing multimorbidity increased relative to those citing tumors (PR, 1.03; 95% CI, 1.02-1.04), whereas cases related to psychiatric disorders and deaths in care homes did not show significant increases. Higher prevalence was observed in the Flemish region relative to Wallonia (PR, 1.51; 95% CI, 1.47-1.55), but the gap has narrowed over the years.

CONCLUSIONS AND RELEVANCE: This study found that a substantial part of the increase in euthanasia cases was attributable to demographic changes. Early increases were mainly due to the regulatory onset, while recent trends reflect a growing influence of demographic factors and regional adjustments. These findings suggest that considering demographic shifts is essential, and long-term trends should be monitored.

PMID:40266615 | DOI:10.1001/jamanetworkopen.2025.6841

JAMA Netw Open. 2025 Apr 1;8(4):e257951. doi: 10.1001/jamanetworkopen.2025.7951.

ABSTRACT

IMPORTANCE: Regulatory agencies have begun incentivizing screening for adverse social determinants of health (SDOH) and responses in inpatient settings, missing a crucial safety net: the emergency department (ED). Little is known about the prevalence of ED-based adverse SDOH screening and response practices nationally.

OBJECTIVE: To describe the prevalence of ED-based adverse SDOH screening and response policies and to identify associated hospital characteristics.

DESIGN, SETTING, AND PARTICIPANTS: This survey study utilized a 5% random sample from the National Emergency Department Inventory-USA, including EDs stratified by geography, urbanicity, and practice setting (academic vs community). Data regarding 2022 policies were collected in 2023.

EXPOSURES: Practice setting, urbanicity, visit volume, and availability of social work.

MAIN OUTCOMES AND MEASURES: The presence of written policies for any adverse SDOH (housing, food, transportation, and utility payment difficulties) screening and responses, as well as other requirement-driven screening for SDOH risk factors (intimate partner violence, substance use, and mental health conditions). Responses were categorized as consultations (eg, social work), standardized information sheets, individualized resource information, or other.

RESULTS: Of a total of 280 EDs, 232 responded (83% response rate). Among 232 EDs, 28.4% (survey-weighted proportion; 95% CI, 21.0%-37.2%) had screening policies for at least 1 adverse SDOH domain, and 93.1% (95% CI, 89.2%-95.7%) performed at least 1 other requirement-driven screening (eg, intimate partner violence). Of EDs performing any screening (adverse SDOH or other), 81.6% (95% CI, 73.4%-87.7%) had response policies, primarily involving consultations (78.2%; 95% CI, 67.2%-86.3%), standardized information sheets (43.0%; 95% CI, 32.5%-54.3%), and individualized resource information (12.9%; 95% CI, 7.2%-21.8%). Among all responding EDs, only 23.4% (95% CI, 17.1%-31.2%) had around-the-clock social work availability, and 20.5% (95% CI, 14.2%-28.6%) had an ED-based social worker. There was no association between practice setting, urbanicity, visit volume, or around-the-clock social work with adverse SDOH screening or response policies.

CONCLUSIONS AND RELEVANCE: Despite the high prevalence of adverse SDOH in ED populations, in this survey study of 232 EDs, less than one-third performed screening, and one-fifth did not have policies requiring a response to positive screens. Bridging this gap may require expanding adverse SDOH screening practices while also ensuring that EDs have the resources and infrastructure to respond appropriately to identified social needs. Future research might explore advanced technological solutions to enhance screening and responses in these resource-constrained settings.

PMID:40266614 | DOI:10.1001/jamanetworkopen.2025.7951

Mil Med. 2025 Apr 23:usaf133. doi: 10.1093/milmed/usaf133. Online ahead of print.

ABSTRACT

INTRODUCTION: Little is known about the potential impact of shared versus private bedroom barracks configurations on the quality of life, retention, and mental health of enlisted Soldiers in the U.S. Army. The objective of the present study was to use a sample of enlisted U.S. Army Soldiers from five different installations to assess the differences in behavioral and social health outcomes between respondents in shared versus private bedroom configurations.

MATERIALS AND METHODS: The unaccompanied housing survey was administered to unaccompanied housing (UH) barracks residents at 5 different U.S. Army installations from July to November 2022 (n = 8,703). The main risk factor of interest was bedroom sharing (shared versus private), and the main outcomes of interest were intentions to leave the military after the current enlistment period (intent to leave), quality of life, issues experienced with others while living in the barracks, insufficient sleep, and symptoms of depression, anxiety, and loneliness. Seven separate multivariable logistic regression models were used to evaluate the associations between bedroom sharing and the outcomes.

RESULTS: Sixty percent of UH respondents reported residing in a private bedroom and 40% reported sharing a bedroom. UH respondents who lived in shared bedrooms had higher adjusted odds of poorer quality of life (adjusted odds ratio [AOR]: 1.67; 95% confidence interval [CI]: 1.54-1.82) when compared to respondents in private bedrooms. Respondents who lived in shared bedrooms also had a higher adjusted odds of reporting issues with others while living in the barracks (AOR: 1.47; 95% CI: 1.33-1.63) compared to respondents in private bedrooms. The models analyzing the association between bedroom sharing and intentions to leave, sleep, anxiety, and loneliness were statistically significant, but the lower level of the CI demonstrated that the associations were not clinically meaningful. There was no statistically significant association between bedroom sharing and depression (AOR: 1.09; 95% CI: 0.98-1.22). There were no meaningful differences in the types of issues reported between those who lived in shared and private bedrooms.

CONCLUSIONS: Bedroom sharing was associated with greater adverse behavioral and social health outcomes when compared to private bedrooms for a large sample of UH residents in the U.S. Army. Findings indicated private bedrooms may be more beneficial for quality of life, readiness, and reenlistment rates among Army Soldiers residing in the barracks. These findings should be used in the development of future studies aimed at assessing Soldier quality of life, as well as to inform Army Senior Leaders and decision makers during development of prevention and risk mitigation strategies and policies on barracks configurations.

PMID:40266613 | DOI:10.1093/milmed/usaf133

Transl Vis Sci Technol. 2025 Apr 1;14(4):23. doi: 10.1167/tvst.14.4.23.

ABSTRACT

PURPOSE: Biomarkers from choroidal imaging can enhance clinical decision-making for chorioretinal disease; however, identification of biomarkers is labor-intensive and limited by human intuition. Here we apply radiomics feature extraction to choroid imaging from swept-source optical coherence tomography (SS-OCT) to automatically identify biomarkers that distinguish healthy, central serous chorioretinopathy (CSCR), and unaffected fellow eyes.

METHODS: Radiomics features were extracted from SS-OCT images from healthy (n = 30), CSCR (n = 39), and unaffected fellow eyes (n = 20), with a total of 44,500 single-cross sectional horizontal images and 8900 en face images. Logistic regression classification of eyes as healthy versus CSCR, healthy versus fellow, or CSCR versus fellow was performed using radiomics features. Statistical significance was determined using 95% bootstrap confidence intervals.

RESULTS: Significant differences between healthy and CSCR eyes were found for all radiomics feature groups. Classification of health versus CSCR achieved classification accuracy of 84.2% (77.2%-89.9%) in horizontal images and 85.3% (78.2%-90.7%) in en face images. For en face images, classification accuracy increased by 1.02% (0.50%-1.53%) for every 10% increase in choroid depth. Fellow eye classification using a classifier trained to distinguish healthy and CSCR eyes resulted in 90.4% (90.2%-90.6%) of horizontal images and 90.2% (89.8%-90.2%) of en face images being classified as CSCR.

CONCLUSIONS: These results demonstrate accurate classification of healthy and CSCR eyes using choroid OCT radiomics features. Furthermore, radiomics features revealed signatures of CSCR in unaffected fellow eyes.

TRANSLATIONAL RELEVANCE: These findings demonstrate the potential for radiomics features in clinical decision support for CSCR.

PMID:40266602 | DOI:10.1167/tvst.14.4.23

J Child Neurol. 2025 Apr 23:8830738251330110. doi: 10.1177/08830738251330110. Online ahead of print.

ABSTRACT

Evidence to guide the critical care management of children with ruptured brain arteriovenous malformations is lacking. We aimed to determine whether there are associations between physiologic parameters and outcome in children with ruptured brain arteriovenous malformations. We performed a single-center retrospective review of patients ≤18 years of age with a ruptured brain arteriovenous malformation from 2011 to 2023. Categorization of outcome was based on the Pediatric Stroke Outcome Measure. Descriptive statistics were used. Most patients with an arteriovenous malformation rupture had a poor outcome at discharge (31/49, 63%) and in follow-up at 3-12 months (21/37, 57%). Patients who were normothermic and normoglycemic for the first 7 days after arteriovenous malformation rupture were less likely to have a poor outcome at discharge than those who had a temperature ≥38 °C (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.04-0.52; P = .01) or a blood glucose ≥200 mg/dL (OR 0.11, 95% CI 0.01-0.92; P = .04). A lower minimum hemoglobin concentration (10.00 g/dL [standard deviation (SD) 1.67] vs 12.46 g/dL [SD 6.29], t(47) 2.07, P = .04) and a higher average partial pressure of carbon dioxide (Paco₂) (40.98 mm Hg [SD 4.30] vs 35.58 mm Hg [SD 7.72], t(47) -2.09, P = .046) were also associated with a poor discharge outcome. A higher average maximum temperature was associated with a poor outcome in follow-up (37.46° C [SD 0.49] vs 37.09 °C [SD 0.59], t(47) -2.09; P = .04). Temperature, blood glucose, hemoglobin concentration, and Paco₂ are potentially modifiable parameters that could be targeted by quality improvement interventions to improve outcomes in this population.

PMID:40266567 | DOI:10.1177/08830738251330110

Mol Neurobiol. 2025 Apr 23. doi: 10.1007/s12035-025-04967-6. Online ahead of print.

ABSTRACT

Due to progressive cognitive loss and subsequent incapability of daily life, the development of novel therapeutics is urgently needed for dementia patients. We performed a two-sample bi-directional Mendelian randomization (MR) analysis using summary-level statistics to identify causality between peripheral and cerebrospinal fluid (CSF) proteins and the risk of dementia. Genetic variants were subtracted from the Genome-Wide Association Studies (GWAS) results. Wald ratio (WR) and inverse-variance weighted (IVW) ratio were utilized to estimate the causal effects of plasma and CSF proteins on dementia. Reverse MR, Steiger filtering, Bayesian co-localization phenotype scanning, and external validation were integrated to strengthen the robustness of primary MR results. After sensitivity analysis, six circulating proteins were identified in three dementia classifications, whereas no causality was found in frontotemporal dementia (FTD). Elevated levels of circulating C1R protein increased the odds of developing Alzheimer’s disease (AD), while PILRA and CELA2A were estimated to protect against the pathogenesis of AD; genetically predicted increase of α-synuclein and APOE elevated the occurrence of Dementia of Lewy Bodies (DLB); elevated level of circulating CRP was assessed to increase the onset of vascular dementia (VD). Our MR analyses identified a genetically predicted association between circulating C1R, PILRA, and CELA2A and the risk of AD, causal estimates between α-syn, APOE protein, and the onset of DLB, and a robust correlation between CRP and the etiology of VD. This study might guide the discovery of disease etiology and build up a novel disease-modifying paradigm of dementia.

PMID:40266545 | DOI:10.1007/s12035-025-04967-6

Int J Clin Pharm. 2025 Apr 23. doi: 10.1007/s11096-025-01915-1. Online ahead of print.

ABSTRACT

BACKGROUND: Antiseizure medications, particularly gabapentinoids like pregabalin, are increasingly prescribed for pain management. Despite their growing use, evidence of their effectiveness for pain is mixed. This highlights the need for a clearer understanding of the prevalence and prescribing patterns of antiseizure medications in pain management.

AIM: To investigate the initiation of antiseizure medications in people with and without pain or epilepsy diagnoses and to explore the concurrent use of opioids.

METHOD: This cross-sectional study used deidentified primary care data from 542 general practices in Victoria, Australia. Descriptive statistics were used to analyze antiseizure medication prevalence, concurrent opioid use, and prescribing patterns by age and gender.

RESULTS: We identified 171,619 primary care patients who initiated an antiseizure medication between January 1, 2018, and May 31, 2023, among whom 80.1% had pain without epilepsy. Pregabalin was the most commonly prescribed medicine (58.2%), followed by sodium valproate (7.0%), gabapentin (6.9%), and clonazepam (6.7%). Among younger patients (14-49 years old) with an epilepsy diagnosis, women were twice as likely as men to initiate topiramate (6.5% vs 4.4%) and lamotrigine (21.8% vs 11.4%), while men were more commonly initiated with sodium valproate (38.7% vs 18.9%).

CONCLUSION: Given the widespread off-label use of gabapentinoids and the potential for serious harm, further research is warranted to better understand their clinical and safety outcomes.

PMID:40266531 | DOI:10.1007/s11096-025-01915-1

Brain Imaging Behav. 2025 Apr 23. doi: 10.1007/s11682-025-01006-9. Online ahead of print.

ABSTRACT

Cognitive dysmetria suggests a disorganization of cognitive processes, particularly in relation to the cerebellum’s role in coordinating thoughts and actions. This phenomenon has been extensively studied in various psychiatric disorders, including schizophrenia (SCHZ), bipolar disorder II (BIPOL), and attention-deficit/hyperactivity disorder (ADHD). Understanding the relationship between cognitive dysmetria and functional connectivity in these disorders would reveal significant insights into their neurobiological underpinnings. This study explores how distinct and similar functional network connectivity (FNC) patterns between brain regions are associated with clinical symptoms and trait assessments across SCHZ, BIPOL, and ADHD patients by examining both working memory and task-free conditions compared to healthy volunteers (HC). Leveraging an open-source fMRI dataset from the UCLA Consortium for Neuropsychiatric Phenomics, we analyzed FNC patterns across 115 default mode and salience network regions, including cortical, subcortical, and cerebellar regions of interest in 135 participants (39 HC, 27 SCHZ patients, 38 BIPOL patients, and 31 ADHD patients). Abnormal FNC patterns compared to HC were localized to the cerebellar, thalamic, striatal, hippocampal, medial prefrontal and anterior insular cortices. Post-hoc multiple comparison analysis showed abnormal network connectivity predominantly in SCHZ and ADHD patients during rest, while the task condition demonstrated differential effects across all three disorders. Statistical analysis using a factor-by-covariance approach (GLM MANCOVA) suggested that regional functional connectivity was associated with select symptoms and traits pointing to neural signatures underlying psychiatric conditions. Our study suggests that examining and harnessing dysfunctional relationships in subcortical and cerebellar regions could provide a new perspective on the neurobiological basis of psychoses and help improve available treatment strategies.

PMID:40266512 | DOI:10.1007/s11682-025-01006-9

J Thromb Thrombolysis. 2025 Apr 23. doi: 10.1007/s11239-025-03087-1. Online ahead of print.

ABSTRACT

Although prior research has investigated the link between fibrinogen and mortality risk, there is a notable lack of long-term cohort studies. This study seeks to examine the relationship between plasma fibrinogen levels and all-cause mortality. Fibrinogen levels were divided into low and high groups based on the median and further categorized into quartiles. Kaplan-Meier analysis was employed for survival analysis, and hazard ratios (HRs) were calculated using the Cox proportional hazards model. Our study included 5,690 participants, divided into a lower fibrinogen group (fibrinogen ≤ 370 mg/dL, N = 2,851) and a higher fibrinogen group (fibrinogen > 370 mg/dL, N = 2,839). The survival probability of the lower fibrinogen group was higher than that of the higher group (70.98% vs. 47.98%, P < 0.0001). All-cause mortality was higher in the higher fibrinogen group compared to the low fibrinogen group (HR 1.26, 95% CI 1.09-1.45, P = 0.002). Compared to Q1, mortality risk increased in Q2 (HR 1.26, 95% CI 1.00-1.59, P = 0.05), Q3 (HR 1.39, 95% CI 1.15-1.69, P < 0.001), and Q4 (HR 1.51, 95% CI 1.23-1.87, P < 0.001). Higher fibrinogen levels correlate with an elevated risk of all-cause mortality, suggesting fibrinogen is a potential biomarker for mortality risk.

PMID:40266502 | DOI:10.1007/s11239-025-03087-1

Intern Emerg Med. 2025 Apr 23. doi: 10.1007/s11739-025-03947-x. Online ahead of print.

ABSTRACT

This study aims to investigate the effects of virtual reality (VR) interventions on the state anxiety levels of residents working 24-h shifts in an emergency department. This study utilizes a single-center, simulation-based, quasi-experimental design. In the study’s first phase, participants’ anxiety levels were measured using the STAI-I scale during their shifts, between 7:00 PM and 10:00 PM (Pre-Rest) and after a 10-min rest, a second measurement was performed (Post-Rest). In the second phase, anxiety levels were measured during the same time interval in their next shift (pre-VR), followed by another evaluation after 10 min of using a VR headset (Post-VR). The effects of rest and VR use on state anxiety levels compared. A total of 26 emergency medicine residents participated in the study. The mean age of the participants was 29 ± 2.6 years, with an equal gender distribution. The median pre-rest anxiety score was 46 (28-68), while the post-rest median was 43 (22-62), with a statistically significant difference (p = 0.02). The median anxiety score before VR use was 47 (25-73), and after VR use, it decreased to 30 (20-73), which was significant (p = 0.001). When comparing the changes in anxiety levels after rest and VR use, the median Δanxiety rest was 4.5 (- 17-25), whereas the median Δanxiety VR was 11.5 (- 21-47) (p = 0.017). Based on our study’s results, a 10-min VR session during a 24-h shift reduces emergency physicians’ state anxiety levels and is more effective than a rest break.

PMID:40266498 | DOI:10.1007/s11739-025-03947-x