Category: Statistics

JAMA Psychiatry. 2025 Oct 1. doi: 10.1001/jamapsychiatry.2025.2689. Online ahead of print.

ABSTRACT

IMPORTANCE: Associations among general intelligence (IQ), educational attainment (EA), and alcohol use disorder (AUD) are not well understood.

OBJECTIVE: To examine the relationship between IQ, EA, and AUD risk.

DESIGN, SETTING, AND PARTICIPANTS: The association between IQ and AUD risk was examined in a Swedish national conscription cohort. Potential causality was explored using mendelian randomization (MR) analyses, and the association of polygenic scores (PGS) for cognitive performance with AUD diagnosis was assessed. Participant data were obtained from cross-linked Swedish national registers, genome-wide association study (GWAS) summary statistics, and the US Yale-Penn cohort.

EXPOSURES: IQ and genetic variants associated with cognitive performance.

MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs; time-to-event analyses) or odds ratios (ORs) for AUD.

RESULTS: Included in this study was a national cohort of 645 488 males, born between 1950 and 1962, from the Swedish Military Conscription Register, of whom 573 855 individuals were included in this analysis. All individuals were aged 18 years at IQ assessment with no substance use disorder diagnosis at conscription, and mean (SD) follow-up time (SD) was 60.5 (7.9) years. Summary statistics from GWAS of cognitive performance (n = 257 481) and AUD (total = 753 248; cases = 113 325) in individuals of European-like genetic ancestry (EUR), with FinnGen AUD GWAS as a replication sample (total = 500 348; cases = 20 597), were used for MR analyses. PGS analyses were conducted using the data of EUR individuals from the Yale-Penn cohort (n = 5424). IQ at age 18 years was inversely associated with AUD risk in Swedish males (adjusted HR, 1.43; 95% CI, 1.40-1.47; P < .001), adjusting for parental substance use disorder, probands’ psychiatric disorders, socioeconomic factors, and birth year strata. MR analyses suggested a causal relationship between lower cognitive performance and AUD risk (β [SE], 0.11 [0.02]; P = 2.6 × 10-12). The mediating role of EA differed between national contexts. Higher cognitive performance PGS were associated with reduced odds of AUD in Yale-Penn participants (OR, 0.83; 95% CI, 0.78-0.89).

CONCLUSIONS AND RELEVANCE: IQ and cognitive performance have a significant but context-dependent association with AUD risk, highlighting the need for a better understanding of the interplay among genetic factors, cognitive traits, and sociocultural influences on AUD susceptibility.

PMID:41032335 | DOI:10.1001/jamapsychiatry.2025.2689

JAMA Surg. 2025 Oct 1. doi: 10.1001/jamasurg.2025.3611. Online ahead of print.

ABSTRACT

IMPORTANCE: Bariatric surgery is widely recognized for its health benefits; however, its association with work productivity and employment participation, though frequently reported, has not been systematically synthesized. This evidence is crucial to inform the economic evaluation of bariatric surgery.

OBJECTIVE: To systematically analyze the evidence on occupational outcomes of bariatric surgery.

EVIDENCE REVIEW: A systematic literature search was conducted in 5 online databases to identify empirical studies on bariatric surgery-related employment and productivity outcomes published up to April 2024. Two coauthors independently screened the literature, and all coauthors contributed to data extraction and validation. Differences in occupational outcomes were compared before vs after surgery and between surgery vs nonsurgery groups. Comparisons were categorized into 3 groups: improvement, no difference, and worse. Where possible, summary values of occupational outcomes (eg, the average employment rate) were synthesized for each observational time point. Reported barriers and enablers to employment return or productivity were also identified.

FINDINGS: A total of 42 studies from 15 countries were included. Studies were published between 1977 and 2023, with most conducted in high-income countries. Roux-en-Y gastric bypass was the most frequently studied procedure. The most commonly evaluated metrics were employment and unemployment rates and absenteeism and sick leave. Bariatric surgery was associated with improvements in presenteeism and work hours and ability and short-term absenteeism and employment rates. However, the long-term employment rate followed a reversed U-shape trajectory, with employment rates initially increasing postsurgery but returning to baseline levels after about 5 years. Key barriers to improved occupational outcomes included insufficient weight loss, female sex, older age, preoperative comorbidities, lower quality of life, and a lack of prior work experience.

CONCLUSIONS AND RELEVANCE: Bariatric surgery demonstrates positive short-term impact on productivity and employment, but its long-term occupational benefits remain uncertain. Certain subgroups, such as females and older adults, may require tailored postsurgery support to sustain employment and productivity gains. These findings highlight the critical need for long-term strategies to sustain the occupational benefits postsurgery and to develop targeted interventions for at-risk populations.

PMID:41032316 | DOI:10.1001/jamasurg.2025.3611

JAMA Dermatol. 2025 Oct 1. doi: 10.1001/jamadermatol.2025.3512. Online ahead of print.

NO ABSTRACT

PMID:41032310 | DOI:10.1001/jamadermatol.2025.3512

J Natl Cancer Inst. 2025 Oct 1:djaf272. doi: 10.1093/jnci/djaf272. Online ahead of print.

ABSTRACT

BACKGROUND: Lung adenocarcinoma (LUAD) in never-smokers is a major public health burden, especially among East Asian women. Polygenic risk scores (PRSs) are promising for risk stratification but are primarily developed in European-ancestry populations. We aimed to develop and validate single- and multi-ancestry PRSs for East Asian never-smokers to improve LUAD risk prediction.

METHODS: PRSs were developed using genome-wide association study summary statistics from East Asian (8,002 cases; 20,782 controls) and European (2,058 cases; 5,575 controls) populations. Single-ancestry models included PRS-25, PRS-CT, and LDpred2; multi-ancestry models included LDpred2+PRS-EUR128, PRS-CSx, and CT-SLEB. Performance was evaluated in independent East Asian data from the Female Lung Cancer Consortium (FLCCA) and externally validated in the Nanjing Lung Cancer Cohort (NJLCC). We assessed predictive accuracy via AUC, with 10-year and (age 30-80) absolute risks estimates.

RESULTS: The best multi-ancestry PRS, using East Asian and European data via CT-SLEB (clumping and thresholding, super learning, empirical Bayes), outperformed the best East Asian-only PRS (LDpred2; AUC = 0.629, 95% CI:0.618,0.641), achieving an AUC of 0.640 (95% CI : 0.629,0.653) and odds ratio of 1.71 (95% CI : 1.61,1.82) per SD increase. NJLCC Validation confirmed robust performance (AUC =0.649, 95% CI: 0.623, 0.676). The top 20% PRS group had a 3.92-fold higher LUAD risk than the bottom 20%. Further, the top 5% PRS group reached a 6.69% lifetime absolute risk. Notably, this group reached the average population 10-year LUAD risk at age 50 (0.42%) by age 41, nine years earlier.

CONCLUSIONS: Multi-ancestry PRS approaches enhance LUAD risk stratification in East Asian never-smokers, with consistent external validation, suggesting future clinical utility.

PMID:41032288 | DOI:10.1093/jnci/djaf272

South Med J. 2025 Sep;118(9):634-638. doi: 10.14423/SMJ.0000000000001866.

ABSTRACT

OBJECTIVES: The purpose of this study was to evaluate the financial literacy of medical trainees and assess knowledge gaps in loan repayment, credit management, investment strategies, and financial planning.

METHODS: A cross-sectional survey study was conducted at a single institution between July 25, 2023 and January 10, 2024. A 52-question financial literacy survey was distributed to 97 residents and 101 first- and second-year medical students. The survey assessed knowledge across financial domains, including student loans, credit cards, mortgages, investing, and business ownership. Statistical analysis included independent samples t tests and analysis of variance to compare financial literacy scores across trainee levels.

RESULTS: Residents demonstrated significantly higher financial literacy scores than medical students (mean 18.80 vs 9.40 out of 35; P < 0.05). Despite this, substantial knowledge gaps persisted across multiple financial concepts. Of all respondents, 84.5% reported student loan debt exceeding $50,000, yet 64.6% were not enrolled in income-driven repayment plans, and 57.3% could not differentiate between Pay As You Earn and Revised Pay As You Earn. In addition, although 74.2% contributed to retirement accounts, 60.8% lacked knowledge about investment strategies. Despite limited financial literacy, 82.5% expressed interest in receiving structured financial education.

CONCLUSIONS: Medical trainees, including both medical students and residents, exhibit significant financial literacy deficits despite their progression through medical education. These findings underscore the need for structured financial education early in training to improve financial decision making, debt management, and long-term financial stability among future healthcare professionals.

PMID:41032276 | DOI:10.14423/SMJ.0000000000001866

South Med J. 2025 Sep;118(9):628-633. doi: 10.14423/SMJ.0000000000001877.

ABSTRACT

OBJECTIVES: The residency application process has become increasingly complex, with factors like holistic review, specialty signaling, and multiple application services posing new challenges for medical schools seeking to offer personalized support to students. In addition, fourth-year students often quickly dive into demanding externships, which make it challenging to access residency support services from their home institution and dedicate adequate time to the application process. To address these challenges, the Offices of Student Affairs and Medical Education at Florida International University Herbert Wertheim College of Medicine launched the mandatory Career Advising and Professional Development (CAPD) course, which aimed to standardize residency application support and reduce student stress while increasing preparedness.

METHODS: The 2-week CAPD course, piloted during the 2024-2025 academic year, occurred immediately after students’ dedicated Step 2 study period. Students with scheduling conflicts participated in a longitudinal, asynchronous version of the course with specified due dates for each assignment. Both course formats used a mixture of lectures, small-group activities, and written assignments to cover topics such as crafting a curriculum vitae, writing personal statements, completing residency applications, developing a match strategy, and preparing for interviews. To assess student satisfaction with the course, students were e-mailed three anonymous, optional surveys: one before the course, one just after it, and one after submitting their residency applications. Surveys consisted of a mixture of Likert-type and short-answer questions. Likert-type responses were analyzed using descriptive statistics; thematic review was employed for short-answer questions.

RESULTS: Of the 69 students who participated in the in-person course, 51 (74%) completed the precourse survey, and 48 (70%) completed the postcourse survey. Before the course, 27% of respondents felt confident about their application preparation; after the course, 92% felt confident. After the course, all students reported having completed drafts of key documents like the curriculum vitae, personal statement, and residency application. Free-text responses describing student emotions regarding the application process shifted from anxiety to excitement. In the longitudinal asynchronous version of the course, similar trends existed, but to a lesser extent when compared with the in-person course. In a subsequent survey sent after applications were submitted, 86 (61%) students from both course formats responded. Results showed that 95% felt the course, regardless of format, helped them prepare for the Match, and 90% considered it a valuable use of their time. In addition, 83% agreed that the course should be a curricular requirement.

CONCLUSIONS: The CAPD course successfully offered a framework for personalized support in the rapidly evolving residency application process. As a mandatory part of the curriculum, it allowed faculty to ensure that all students were engaged in the support services offered by our institution, which ultimately increased student confidence and decreased anxiety about the application process. Successful implementation requires significant logistical support (course coordinators, faculty, and career specialists) and the identification and participation of key stakeholders (academic advisors, department chairs, and content experts) to guide students through critical application components.

PMID:41032275 | DOI:10.14423/SMJ.0000000000001877

South Med J. 2025 Sep;118(9):614-617. doi: 10.14423/SMJ.0000000000001873.

ABSTRACT

OBJECTIVE: Extreme temperatures negatively impact pulmonary function. This study explored whether the variability in ambient temperatures across disparate geographic regions in the United States was associated with differences in hospital outcomes for patients admitted with chronic obstructive pulmonary disease (COPD).

METHODS: Using the 2016-2019 National Inpatient Sample database, we compared adults hospitalized with COPD in the US Northeast with those in the US South. We conducted multivariable regression analyses to study outcomes, including mortality, resource utilization, and posthospital discharge disposition.

RESULTS: From 2016 to 2019, 463,830 (30.1%) patients were admitted with COPD in the Northeast and 1,078,930 (69.9%) in the South. The lowest hospitalization rates for COPD were observed in both regions during the hottest months (July and August). Those in the Northeast had higher adjusted odds of in-hospital mortality (adjusted odds ratio: 1.1 [95% confidence interval {CI} 1.0-1.2]; P = 0.03) and a lower likelihood of being discharged to home after the hospitalizations (adjusted odds ratio: 0.63 [95% CI 0.61-0.65]; P < 0.01]) compared with patients hospitalized in the South. Patients in the Northeast had longer hospital stays (adjusted mean difference: +0.19 days; 95% CI 0.13-0.25; P < 0.01) and incurred greater hospital charges compared with patients in the South (adjusted mean difference: $3728; 95% CI 1840-5616; P < 0.01).

CONCLUSIONS: Patients hospitalized with COPD in the Northeast had worse clinical outcomes and greater resource utilization than in the South. These findings, coupled with the higher admission rates during colder months, raise questions about the influence of colder ambient temperatures on COPD exacerbations.

PMID:41032272 | DOI:10.14423/SMJ.0000000000001873

South Med J. 2025 Sep;118(9):602-605. doi: 10.14423/SMJ.0000000000001874.

ABSTRACT

OBJECTIVES: Concussions are one of the most frequent pediatric injuries, especially for high school athletes. Many of the psychological sequalae from concussions go unnoticed and undertreated particularly in the rural setting. There is limited research on optimizing recovery for these patients; however, newer studies are beginning to show the utilization of deep breathing exercises. In this study, we evaluated the effectiveness of self-administered relaxation techniques for postconcussive mood symptoms in an Appalachian population.

METHODS: Patients’ charts (N = 308) from a rural specialty concussion clinic between September 2020 and May 2023 underwent a review. Eligible patients included those who completed the Post-Concussion Symptom Scale (PCSS), Patient Health Questionnaire, and Generalized Anxiety Disorder scale (GAD-7) during their initial intake visit. Patients who suffered from at least mild to moderate depression and/or anxiety were educated on self-administered relaxation techniques, which consisted of 15 minutes of deep breathing exercises to be performed nightly. Their mood symptoms were reassessed, after monitoring patient compliance with breathing exercises, via a 4-point Likert scale at their follow-up appointment (average 13.5 days). The data were grouped based on the patient’s compliance (good vs limited) with their respective score improvement and analyzed via paired t tests. Good compliance consisted of performing the breathing exercises “most of the time” and the limited compliance group performed exercises “some of the time, seldom, or rarely/none.” The second part of the analysis investigated if there were any significant difference in improvements between the good and limited compliance groups using unpaired t test statistics.

RESULTS: The good compliance group experienced a significant improvement in Patient Health Questionnaire (7.11, P < 0.01), GAD (6.33, P < 0.01), and PCSS (24.33, P < 0.01) scores at follow-up. The limited compliance group only had a significant improvement in GAD (2.14, P = 0.025) and PCSS (29.77, P < 0.01). There was a significant difference in anxiety improvement between good and limited compliance groups by 4.19 points as assessed by the GAD scale (P < 0.01).

CONCLUSIONS: Self-administered deep breathing exercises are a cost-free, practical, and safe intervention that may benefit patients with persistent mood symptoms in the concussion rehabilitation process, particularly in resource scarce areas in Appalachia.

PMID:41032270 | DOI:10.14423/SMJ.0000000000001874

South Med J. 2025 Sep;118(9):596-601. doi: 10.14423/SMJ.0000000000001868.

ABSTRACT

OBJECTIVE: Incidental lesions identified clinically or on imaging are diagnostically challenging. The workup for these lesions is not well established. We investigated diagnostic modalities used at our institutions for undiagnosed lesions and the timeline from intake to biopsy and resultant diagnoses.

METHODS: We retrospectively analyzed data from all 3 Mayo Clinic sites (Arizona, Florida, and Minnesota) between November 1, 2018 and July 31, 2022. We evaluated the frequency of the biopsy technique used (if any) and how often the resultant diagnosis was malignant, benign, or inconclusive. The turnaround time from intake to biopsy and final diagnosis also was evaluated.

RESULTS: Of 93 patients with an undiagnosed lesion, 54 (58%) underwent biopsy; most patients underwent a single biopsy (n = 42, 77%), and 12 (23%) had two or more biopsies. Unbiopsied patients were diagnosed as having benign lesions according to imaging or had follow-up imaging. Of the 54 patients biopsied, 38 (70%) biopsies were obtained via fine-needle aspiration. Biopsy results were malignant for 34 patients (63%), benign for 14 (26%), and inconclusive for six (11%). Most patients were seen within 9 days of their initial contact (69/93, 74%), underwent biopsy within 20 days of seeing the physician (40/54, 74%), and had a final diagnosis within 30 days of the initial visit (72/93, 77%).

CONCLUSIONS: Our findings can help clinicians dispel the misconception that most undiagnosed lesions are malignant. Our findings also may help clinicians determine the appropriate workup for undiagnosed lesions. Further research is recommended to guide clinicians on the best sampling methodologies to obtain the highest yield of tissue for analysis. Dedicated patient workflows can help expedite diagnosis.

PMID:41032269 | DOI:10.14423/SMJ.0000000000001868

South Med J. 2025 Sep;118(9):589-595. doi: 10.14423/SMJ.0000000000001878.

ABSTRACT

OBJECTIVES: Despite the common performance of thoracentesis, predicting risk for adverse outcomes and abnormal postprocedural findings remains difficult. Although guidelines and experts have suggested that routine postprocedure imaging has low yield, compliance with these guidelines has not been well studied. In addition, previous studies have shown that pleural effusions are associated with high short-term mortality rates, longer hospitalizations, and higher readmission rates, increasing the importance of systematic study of procedural results. We aimed to determine the rate of imaging abnormalities, the utility of routine postprocedure imaging, and health outcomes for hospitalized patients requiring thoracentesis.

METHODS: An epidemiologic description including adult inpatients at one academic medical center who underwent thoracentesis outside of radiology-specialty procedural areas during a 2-year period. Charts were individually reviewed for data extraction.

RESULTS: In total, 425 thoracentesis procedures in 329 patients were included. A chest x-ray was obtained after 80.9% of procedures. Postprocedure imaging abnormalities included pneumothorax (8.0%), hemothorax (1.6%), reexpansion pulmonary edema (7.8%), and pneumothorax ex vacuo (4.7%). The average hospital length of stay was 13 days, and 15% required mechanical ventilation during their hospitalization. Fifty-five percent of participants were discharged home, 22.8% to a medical facility, 14.4% transitioned to hospice care, and 8.1% died during hospitalization.

CONCLUSIONS: Overall, approximately 20% of patients required clinical reassessment or intervention following thoracentesis. The findings confirm a high rate of secondary morbidity, in-hospital mortality, and long length of stay for hospitalized patients undergoing thoracentesis. The requirement for inpatient thoracentesis represents an opportunity to address end-of-life issues and to identify approaches to optimize resource utilization.

PMID:41032268 | DOI:10.14423/SMJ.0000000000001878