Category: Statistics

JAMA Netw Open. 2025 Jan 2;8(1):e2454565. doi: 10.1001/jamanetworkopen.2024.54565.

ABSTRACT

IMPORTANCE: Improving access to high-quality maternity care and reducing maternal morbidity and mortality are major policy priorities in the US. Previous research has primarily focused on access to general obstetric care rather than access to high-risk pregnancy care provided by maternal-fetal medicine subspecialists (MFMs).

OBJECTIVE: To measure access to MFM services and determine patient factors associated with MFM service use, including MFM telemedicine.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study identified pregnancies in commercial health insurance claims from the Health Care Cost Institute from 2016 to 2021. More than 2.1 million pregnancies were included, where age at delivery was 18 years or greater and people were continuously enrolled for the duration of their pregnancy. The association of patient and pregnancy covariates with MFM involvement in care was analyzed using logistic regression; and rates of telemedicine for pregnancies in urban and rural areas were reported over time. Data were analyzed from June 2022 to March 2024.

MAIN OUTCOMES AND MEASURES: Primary study outcomes included whether a pregnancy ever had a service from an MFM, the type of MFM services provided, and whether MFM care occurred via telemedicine.

RESULTS: There were 2 169 026 pregnancies among 1 968 091 unique people (1 325 212 [61.2%] aged 25 to 34 years). Among 1 625 237 pregnancies at risk for conditions that might require MFM involvement, 838 493 (51.6%) had an MFM service. Rates of MFM involvement in care varied considerably by geography, with pregnancies in rural areas having lower use than urban areas. Use of telemedicine-enabled MFM care increased in 2020 and 2021 but remained low: in 2021, 2.7% of urban pregnancies (7535 of 276 599) and 1.7% of rural pregnancies (550 of 32 949) received telemedicine-enabled MFM care.

CONCLUSIONS AND RELEVANCE: In this cohort study, access to MFM services varied across geography, even among pregnancies at risk for conditions that might require MFM involvement. These results suggested a need to improve access to MFM care for at-risk pregnancies and to further explore expanded access via telemedicine.

PMID:39804642 | DOI:10.1001/jamanetworkopen.2024.54565

JAMA Netw Open. 2025 Jan 2;8(1):e2454694. doi: 10.1001/jamanetworkopen.2024.54694.

ABSTRACT

IMPORTANCE: Compared with cisgender (CG) individuals, transgender and gender-diverse (TGD) individuals experience substantial social and economic disparities that can result in adverse mental health consequences. It is critical to understand potential barriers to care and to address the causes of the disparities in the future.

OBJECTIVE: To characterize mental health care utilization among TGD veterans with depression.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used electronic health record data from the US Department of Veterans Affairs (VA) to create a 1:3 age group-matched and VA facility-matched nationwide cohort of TGD and CG veterans with documentation of depression during 2018 to 2020. Data analysis was performed from January to November 2023.

EXPOSURE: TGD identity was ascertained by diagnosis of a gender identity disorder.

MAIN OUTCOMES AND MEASURES: The primary outcome was mental health care utilization, including counts of outpatient (in specialty care and primary care settings), telehealth, emergency department, and inpatient visits in this cohort. Descriptive statistics were used to characterize counts of mental health utilization, and statistically significant differences between TGD and CG veterans were tested using χ2 and Fisher exact tests. Wilcoxon rank-sum tests were used to test for differences in utilization between the 2 groups. Adjusted logistic regression, controlling for age group, administrative sex, race, Charlson Comorbidity Index, and number of mental health medications (eg, antidepressant, antipsychotic, and anxiolytic medications), was also used to compare utilization between TGD and CG veterans.

RESULTS: Among 10 564 veterans with depression (mean [SD] age, 46.4 [15.2] years; 8050 male [76.2%]), 2643 TGD veterans were matched with 7921 CG veterans. TGD veterans had 6 more specialty mental health visits per year than CG veterans (mean [SD], 13.93 [20.08] vs 8.46 [14.96] visits a year; median [range], 7.14 [0.00-246.30] vs 3.76 [0.00-202.38] visits per year). In adjusted models, compared with CG veterans, TGD veterans were 2.6 times more likely to have an outpatient mental-health visit (odds ratio, 2.60; 95% CI, 2.16-3.15).

CONCLUSIONS AND RELEVANCE: In this cohort study of veterans with depression, TGD veterans had significantly higher utilization of mental health services compared with CG veterans, even after adjusting for several relevant health factors. Different health system resources may be required to meet the needs of this population. Further studies are needed to understand the determinants of these disparities and subsequently how to address them.

PMID:39804641 | DOI:10.1001/jamanetworkopen.2024.54694

JAMA Neurol. 2025 Jan 13. doi: 10.1001/jamaneurol.2024.4631. Online ahead of print.

ABSTRACT

IMPORTANCE: There is a lack of long-term efficacy and safety data on hereditary transthyretin amyloidosis with polyneuropathy (hATTR-PN) and on RNA interference (RNAi) therapeutics in general. This study presents the longest-term data to date on patisiran for hATTR-PN.

OBJECTIVE: To present the long-term efficacy and safety of patisiran in adults with hATTR-PN.

DESIGN, SETTING, AND PARTICIPANTS: This global open-label extension (OLE) of the APOLLO randomized clinical trial and phase 2 OLE study enrolled patients from 43 hospitals or clinical centers across 19 countries between July 2015 and August 2017, with follow-up until November 2022. Of 212 eligible patients with hATTR who completed the phase 3 APOLLO or phase 2 OLE parent studies, 211 enrolled in and 138 completed the global OLE.

INTERVENTION: Patisiran, 0.3 mg/kg, intravenously once every 3 weeks for up to 5 years.

MAIN OUTCOMES AND MEASURES: Outcomes evaluated at year 5 of the global OLE included disability (polyneuropathy disability [PND] score); polyneuropathy severity (Neuropathy Impairment Score [NIS]), nutritional status (modified body mass index [mBMI]), quality of life (Norfolk Quality of Life-Diabetic Neuropathy [Norfolk QOL-DN]), and Rasch-Built Overall Disability Scale (R-ODS), with no statistical hierarchy. Safety, survival probability, and mortality were also assessed.

RESULTS: At the global OLE baseline, the mean (SD) age was 61.3 (12.3) years, and 156 patients (73.9%) were male. In 138 patients completing the study, PND scores remained stable or improved in 89 patients (65.0%), NISs showed a mean (SD) change of 10.9 (14.7), and mean (SD) mBMI (calculated as weight in kilograms divided by height in meters squared times serum albumin in grams per liter) increased by 46.4 (120.7) over 5 years from baseline. Norfolk QOL-DN and R-ODS scores showed mean (SD) changes of 4.1 (16.7) and -3.7 (6.2), respectively. Adverse events (AEs) leading to study withdrawal occurred in 47 patients (22.3%). Infusion-related reactions were the most common treatment-related AE (n = 34 [16.1%]). Overall, 41 patients (19.4%) died during the study. Patisiran treatment in the parent study and low familial amyloid polyneuropathy score at parent study baseline were associated with significantly improved survival.

CONCLUSIONS AND RELEVANCE: In the longest study of an RNAi therapeutic for any disease, patisiran treatment resulted in modest changes for patients with hATTR-PN with an acceptable safety profile. These results highlight the importance of initiating early treatment for hATTR and the potential of RNAi therapeutics in medicine.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02510261.

PMID:39804640 | DOI:10.1001/jamaneurol.2024.4631

Invest Ophthalmol Vis Sci. 2025 Jan 2;66(1):31. doi: 10.1167/iovs.66.1.31.

ABSTRACT

PURPOSE: This study aimed to comprehensively assess visual performance in eyes with idiopathic epiretinal membrane (iERM). Additionally, it sought to explore the associations between optical coherence tomography (OCT) imaging biomarkers and visual performance in patients with iERM.

METHODS: In this prospective, non-interventional study, 57 participants with treatment-naïve iERM from the University of Turin, between September 2023 and March 2024 were enrolled. Visual performance was measured using distance best-corrected visual acuity (BCVA), near BCVA, and maximum reading speed (MaxRS). Structural retinal imaging biomarkers were obtained from OCT, focusing on retinal layer thicknesses and epiretinal membrane characteristics. Statistical analyses, including linear regression and multivariate analysis, were used to determine relationships between visual function and imaging metrics.

RESULTS: Monocular distance BCVA (0.37 ± 0.23 LogMAR), near BCVA (0.59 ± 0.18 LogMAR), and MaxRS (108.88 [68.38] words per minute [wpm]) in patients with iERM were significantly reduced compared with reference values. Both near BCVA and reading speed exhibited a greater percentage reduction than distance visual acuity. Patients with phakic showed worse visual acuity than patients with pseudophakia, although their reading performance was similar. Higher outer plexiform layers thickness and inner retinal thickness were associated with decreased distance and near visual acuity and reduced reading speed (beta, P value).

CONCLUSIONS: The iERM predominantly impacts near visual performance, with near visual acuity and reading speed being more affected than distance visual acuity. Structural OCT biomarkers, particularly retinal thickness in specific regions, correlate with worse functional impairments. This highlights the importance of near vision assessments and imaging biomarkers for a comprehensive evaluation of visual impairment in iERM.

PMID:39804627 | DOI:10.1167/iovs.66.1.31

Sleep Breath. 2025 Jan 13;29(1):73. doi: 10.1007/s11325-024-03231-w.

ABSTRACT

BACKGROUND: Fatigue, sleep disorders, and daytime sleepiness are interconnected, posing significant risks to occupational health and workplace safety. However, the literature on their relationships remains fragmented, with notable gaps, particularly concerning working populations. This descriptive cross-sectional study aimed to evaluate sleep quality (SQ), daily sleep time in hours (DST), daytime sleepiness, fatigue levels among employees in an automotive workplace, and their interrelationships.

METHODS: This study assessed fatigue, DST, SQ, and daytime sleepiness (DTS) among employees aged 21-51 years working under the same conditions. Data were collected using questionnaires and two validated scales: the Check Individual Strength Scale (CIS) for fatigue and the Epworth Sleepiness Scale (ESS) for excessive daytime sleepiness.

RESULTS: None of the Check Individual Strength Scale (CIS), or SQ points, mean values or DST hours values significantly differ due to any sociodemographic independent variables. Epworth Sleepiness Scale (ESS) points mean values differ significantly due to BMI values. However, statistically significant relationships were identified among CIS, ESS, SQ points, and DST hours. Additionally, a positive correlation was observed between ESS and CIS scores. These findings suggest reciprocal effects among fatigue, SQ, DST, and daytime sleepiness.

CONCLUSION: While sleep problems cause fatigue also chronic fatigue syndrome may be the reason of worse SQ. Further research is necessary to emphasize the importance of addressing the interplay between fatigue, excessive daytime sleepiness, SQ, and DST in hours to improve workplace safety and employee well-being.

PMID:39804542 | DOI:10.1007/s11325-024-03231-w

Dig Dis Sci. 2025 Jan 13. doi: 10.1007/s10620-024-08828-5. Online ahead of print.

ABSTRACT

BACKGROUND: Pouchitis is common among patients with ulcerative colitis (UC) who have had colectomy with ileal pouch-anal anastomosis. Antibiotics are first-line therapy for pouch inflammation, increasing the potential for gut colonization with multi-drug resistant organisms (MDRO). Fecal microbial transplant (FMT) is being studied in the treatment of pouchitis and in the eradication of MDRO. Prior work using aerobic antibiotic culture disks suggests that some patients with chronic pouchitis may regain fluoroquinolone sensitivity after FMT. However, gut MDRO include anaerobic, fastidious organisms that are difficult to culture using traditional methods.

AIM: We aimed to assess whether FMT reduced the abundance of antibiotic resistance genes (ARG) or affected resistome diversity, evenness, or richness in patients with chronic pouchitis.

METHODS: We collected clinical characteristics regarding infections and antibiotic exposures for 18 patients who had previously been enrolled in an observational study investigating FMT as a treatment for pouchitis. Twenty-six pre- and post-FMT stool samples were analyzed using FLASH (Finding Low Abundance Sequences by Hybridization), a CRISPR/Cas9-based shotgun metagenomic sequence enrichment technique that detects acquired and chromosomal bacterial ARGs. Wilcoxon rank sum tests were used to assess differences in clinical characteristics, ARG counts, resistome diversity and ARG richness, pre- and post-FMT.

RESULTS: All 13 of the patients with sufficient stool samples for analysis had recently received antibiotics for pouchitis prior to a single endoscopic FMT. Fecal microbiomes of all patients had evidence of multi-drug resistance genes and ESBL resistance genes at baseline; 62% encoded fluoroquinolone resistance genes. A numerical decrease in overall ARG counts was noted post-FMT, but no statistically significant differences were noted (P = 0.19). Richness and diversity were not significantly altered. Three patients developed infections during the 5-year follow-up period, none of which were associated with MDRO.

CONCLUSION: Antibiotic resistance genes are prevalent among antibiotic-exposed patients with chronic pouchitis. FMT led to a numerical decrease, but no statistically significant change in ARG, nor were there significant changes in the diversity, richness, or evenness of ARGs. Further investigations to improve FMT engraftment and to optimize FMT delivery in patients with inflammatory pouch disorders are warranted.

PMID:39804518 | DOI:10.1007/s10620-024-08828-5

Langenbecks Arch Surg. 2025 Jan 13;410(1):37. doi: 10.1007/s00423-025-03605-y.

ABSTRACT

PURPOSE: The impact of body-cavity depth on open (OLR) and laparoscopic liver resection (LLR) of segment 7 remains unclear. Therefore, we investigated the influence of body-cavity depth at the upper-right portion of the abdomen on LLR and OLR of segment 7.

METHODS: In total, 101 patients who underwent segment-7 liver resection over 2010-2023 were included. Body-cavity depth was measured from the abdominal-wall surface to the deepest site on the right side of the liver. Patients were categorized into shallow (< 18.4 cm) and deep (≥ 18.4 cm) populations based on median body-cavity depth. We compared surgical outcomes between OLR and LLR in shallow and deep populations after propensity-score adjustments.

RESULTS: In OLR and LLR groups, 27 and 22 patients in the shallow population, respectively, and 26 and 26 patients were included in the deep population, respectively, were included. The OLR group in the deep population had significantly greater blood loss than the corresponding LLR group (difference: 144 mL, 95% confidence interval (CI): [50, 238], P = 0.004). Other surgical outcomes, including operative time, were similar between groups. In the shallow population, the OLR group had significantly shorter operative time (difference: – 54 mL, 95% CI: [-101, – 6], P = 0.028) and similar blood loss than the LLR group.

CONCLUSIONS: For segment-7 liver resection, LLR is likely favorable for patients with a deep body cavity, with similar operative time and lower blood loss compared to OLR. Body-cavity depth could be a useful indicator for determining the suitable surgical approach for segment-7 liver resection.

PMID:39804508 | DOI:10.1007/s00423-025-03605-y

CNS Neurosci Ther. 2025 Jan;31(1):e70198. doi: 10.1111/cns.70198.

ABSTRACT

OBJECTIVES: Parkinson’s disease (PD) is characterized by olfactory dysfunction (OD) and cognitive deficits at its early stages, yet the link between OD and cognitive deficits is also not well-understood. This study aims to examine the changes in the olfactory network associated with OD and their relationship with cognitive function in de novo PD patients.

METHODS: A total of 116 drug-naïve PD patients and 51 healthy controls (HCs) were recruited for this study. Graph theoretical approaches were employed to reveal the abnormalities of topological characteristics in the olfactory network. Network-based statistics (NBS) analysis was employed to identify the abnormal subnetworks within the olfactory network. Moreover, partial correlation analysis and mediation analysis were performed to examine the relationship between the abnormal network metrics, olfactory function, and cognitive function.

RESULTS: Graph theoretical approaches revealed reduced betweenness centrality of the left insula in PD patients with OD. NBS analysis identified a disrupted subnetwork with decreased functional connectivity, primarily involving limbic regions. The average functional connectivity of this subnetwork partially mediated the relationship between olfactory and cognitive performance. Higher-granularity network analysis further highlighted the insula’s key role and revealed reduced efficiency of information integration within the olfactory network.

CONCLUSIONS: OD was associated with specific changes in the functional olfactory network, which, in turn, affects cognitive function. These findings underscore the importance of assessing and addressing OD. Understanding the neural correlates of OD could provide novel insights into the management and comprehension of cognitive impairment in PD.

PMID:39803685 | DOI:10.1111/cns.70198

J Eval Clin Pract. 2025 Feb;31(1):e14304. doi: 10.1111/jep.14304.

ABSTRACT

AIMS AND OBJECTIVES: In this study, it was aimed to determine nursing students’ attitudes towards clinical practice and their perceptions of occupational risk.

METHOD: The research is descriptive and cross-sectional. The population of this study consisted of second-, third- and fourth-year students studying in the Department of Nursing affiliated to the Faculty of Health Sciences of a university located in Turkey. The analysis was conducted using JASP 0.19.1.0 and SPSS 25 software. Mann-Whitney U and Kruskal-Wallis tests were applied. The Bonferroni test was performed to identify the group causing the difference.

RESULTS: A significant positive correlation was found between nursing students’ perception of occupational risk and nursing students’ attitude toward clinical practice (r = 0.434, p = 0.000). The mean score of the nursing students’ perception of occupational risk in nursing students was 68.74 ± 15.04. The mean score of attitude towards clinical practice in nursing students was 100.04 ± 24.83. A statistically significant difference was found between the presence of attitude towards clinical practice in nursing students and perception of occupational risk in nursing students in the gender variable (p < 0.05), whereas a statistically significant difference was found between adequate information about the nursing profession and attitude towards clinical practice in nursing students (p < 0.05).

CONCLUSION: In the findings of the study, nursing students’ perception of occupational risk and attitudes towards clinical practice were found at a high level. A statistically significant difference was found between the presence of perception of occupational risk in nursing students and attitude towards clinical practice in nursing students in the gender variable. In addition, a statistically significant difference was found between adequate knowledge and nursing profession about the nursing profession and attitude towards clinical practice in nursing students.

PMID:39803679 | DOI:10.1111/jep.14304

Br J Clin Psychol. 2025 Jan 13. doi: 10.1111/bjc.12525. Online ahead of print.

ABSTRACT

INTRODUCTION: Compared to their exclusively gay/lesbian or heterosexual identifying peers, young people identifying as bisexual+ (e.g. bisexual, pansexual, asexual, queer or questioning) are at elevated risk for suicidal ideation (SI) and attempts (SA). The present study aimed to establish whether the prevalence of, and psychosocial risk factors for, SI and SA vary as a function of sexual identity.

METHODS: Young adults (N = 274; 18-29 years old) were recruited via online crowdsourcing. They completed questionnaires assessing adverse childhood experiences (ACEs), emotion dysregulation, impulsivity, depression symptoms and lifetime history of SI and SA. Spearman correlations, Kruskal-Wallis H-tests and binomial logistic regression models were used.

RESULTS: No variable was associated with SI. Bisexual+ individuals reported greater SA than the heterosexual group, though statistically similar to the gay/lesbian group. A similar pattern emerged for ACEs. The bisexual+ group reported greater depression symptoms than the gay/lesbian group. Impulsivity and emotion dysregulation did not vary by sexual identity. Controlling for these psychosocial and sociodemographic variables did not alter results: bisexual+ individuals were almost three times more likely to report SA than heterosexual individuals, OR = 2.93 95% CI [1.16, 7.44]; gay/lesbian and heterosexual individuals had a statistically similar likelihood of reporting SA, OR = 1.09, 95% CI [0.27, 4.37].

CONCLUSION: This is the first study to establish that young adults identifying as bisexual+ are at greater risk for SA after controlling for well-established psychosocial correlates; this was not the case for SI. Further work is needed to establish the aetiology of this risk.

PMID:39803671 | DOI:10.1111/bjc.12525