Category: Statistics

Rev Saude Publica. 2026 May 1;60(suppl 1):e4s. doi: 10.11606/s1518-8787.2026060006988. eCollection 2026.

ABSTRACT

OBJECTIVE: To explore factors associated with the use of chloroquine, hydroxychloroquine, and ivermectin for Covid-19 prevention in socioeconomically vulnerable populations in Brazil.

METHODS: A cross-sectional study was conducted using data from the project “Expansion of testing, quarantine, digital health, and telemonitoring strategies to tackle the Covid-19 pandemic in Brazil.” Participants were users of 19 primary healthcare units in Salvador (Bahia, BA) and Rio de Janeiro (Rio de Janeiro, RJ) from July 2022 to July 2023. Data were collected via a socioeconomic questionnaire and analyzed using logistic regression to assess factors associated with the use of chloroquine, hydroxychloroquine, or ivermectin for Covid-19 prevention. Multicollinearity was assessed using the generalized variance inflation factor (GVIF), with GVIF^(1/(2*df)) > 5 indicating potential collinearity. Sensitivity analyses were performed using the same backward selection procedure as the main model: excluding “sometimes” responses and stratifying analyses by city (Rio de Janeiro and Salvador).

RESULTS: Among 7,505 participants, 11.7% reported using chloroquine, hydroxychloroquine, or ivermectin for Covid-19 prevention. Use was more frequent among people who identified themselves as Brown (ORa = 1.38; 95%CI 1.10-1.75), aged 35-44 (ORa = 1.34; 95%CI 1.03-1.75) or 44-59 (ORa = 1.36; 95%CI 1.06-1.77), evangelical (ORa = 1.32; 95%CI 1.14-1.53), and with comorbidities (ORa = 1.25; 95%CI 1.07-1.47). Having up to two doses of Covid-19 vaccine (ORa = 1.30; 95%CI 1.06-1.59) and being unvaccinated while living with someone with comorbidities (ORa = 10.34; 95%CI 2.27-53.48) also increased the odds of use. GVIF values were low except for city (8.79), due to its interaction with income; the variable was retained for conceptual reasons. Sensitivity analyses yielded results consistent with the main model.

CONCLUSION: The use of ineffective medications for Covid-19 prevention was higher among specific demographic groups, reflecting inequalities in access to information and the influence of religious factors. Scientific communication and community engagement strategies remain essential to combat misinformation.

PMID:42090660 | DOI:10.11606/s1518-8787.2026060006988

Rev Saude Publica. 2026 May 1;60(suppl 1):e3s. doi: 10.11606/s1518-8787.2026060006406. eCollection 2026.

ABSTRACT

OBJECTIVE: To describe the prevalence of adoption of Covid-19 preventive behaviors and to evaluate associated factors among users of health units in Salvador and Rio de Janeiro.

METHODS: Cross-sectional study conducted between July 2022 and July 2023. Adoption of preventive behaviors was assessed based on eight behaviors, grouped into the following outcomes: social distancing; respiratory etiquette; mask use; hand hygiene; sociodemographic, housing, structural characteristics, and individual perceptions. All analyses were stratified by study site. Bivariate and multivariate analyses were performed using Poisson regression with robust variance.

RESULTS: A total of 5,476 participants from Salvador and 1,940 from Rio de Janeiro were evaluated. The most prevalent preventive behaviors were respiratory etiquette (82.7 and 84.3%) and hand hygiene (84.9 and 79.1%), respectively. In Salvador, age remained associated with all behaviors assessed. In Rio de Janeiro, adoption of preventive behaviors increased among those who received a Covid-19 vaccine booster. In both cities, individuals aged 40-59 years, ≥ 60 years, and those not employed showed higher adherence to social distancing. Respiratory etiquette was more prevalent among women, individuals with complete high school education, and those who received a Covid-19 booster. Mask use and hand hygiene were associated with female sex, older age, and vaccine booster in both locations. Mask use was also more frequent among those vaccinated against influenza, while hand hygiene was associated with higher education.

CONCLUSIONS: These findings reinforce the importance of public policies that promote maintenance of preventive behaviors and awareness of epidemic prevention, particularly among men, younger individuals, those with lower education, and those who do not receive recommended vaccines or booster doses.

PMID:42090659 | DOI:10.11606/s1518-8787.2026060006406

Rev Saude Publica. 2026 May 1;60(suppl 1):e10s. doi: 10.11606/s1518-8787.2026060006399. eCollection 2026.

ABSTRACT

OBJECTIVE: To identify factors associated with the acceptability of Covid-19 self-testing among socioeconomically vulnerable populations.

METHODS: Cross-sectional study using data from the “TQT Covid-19” project, which involved users from 19 primary health care (PHC) units located in socioeconomically vulnerable areas in Salvador (BA) and Rio de Janeiro (RJ), Brazil. Data were collected between July 2022 and July 2023. Descriptive analysis of Covid-19 self-test acceptability was performed, and logistic regression models were used to estimate factors associated with acceptability, with respective 95% confidence intervals (95%CI).

RESULTS: Among 7,939 study participants, 45.8% (95%CI 44.75-46.95) reported willingness to use a Covid-19 self-test. In the analysis of associated factors, regarding sociodemographic profile, non-Black individuals (ORa = 1.17; 95%CI 1.02-1.34), cisgender men (ORa = 1.23; 95%CI 1.12-1.37), and participants with higher educational levels (ORa = 1.60; 95%CI 1.43-1.79) were more likely to accept the self-test. Those with prior knowledge of the self-test (ORa = 2.33; 95%CI 2.11-2.58) and those previously diagnosed with Covid-19 (ORa = 1.17; 95%CI 1.05-1.28) also reported higher acceptance.

CONCLUSIONS: Provision of Covid-19 self-testing should be considered as a complement to testing within the public health system, especially due to its acceptance among vulnerable populations and the difficulties in accessing testing in many Brazilian regions. During periods of increased Covid-19 incidence, self-testing may serve as an important strategy for mass case detection, provided that access and knowledge are expanded so communities can play an active role in SARS-CoV-2 epidemiological surveillance.

PMID:42090656 | DOI:10.11606/s1518-8787.2026060006399

Cien Saude Colet. 2026 Mar;31(3):e13322024. doi: 10.1590/1413-81232026313.13322024.

ABSTRACT

More than one billion people are affected by a mental disorder according to the World Health Organization (WHO). In this context, information coverage of mental health is one of the great challenges for the media in a scenario marked by misinformation and digital noise. This work, from a transversal descriptive methodological approach, has analysed the news related to mental health in the main digital media of 20 Latin American countries. The study identifies that depression, anxiety, stress, suicide, substances and addictions, and neurocognitive disorders are the disorders with the greatest presence in news coverage. Furthermore, the work detects a moderate relationship between the variable’s ‘disorder’ and ‘relationship with violence’. On the other hand, only 25% of the information analysed raised recovery processes as a significant topic in the writing. The work also highlights that messages with interviews with experts or citations to medical studies contribute to more positive approaches in mental health coverage.

PMID:42090653 | DOI:10.1590/1413-81232026313.13322024

J Sex Res. 2026 May 6:1-11. doi: 10.1080/00224499.2026.2664807. Online ahead of print.

ABSTRACT

This study assessed the effects of condom types and brands on use in a free condom distribution intervention in hostales (love hotels). New policies are needed to overcome the low levels of contraceptive use in Perú. Hostales could serve as a distribution point in a condom availability program. The last-minute decision of condom use might be affected by the type and brand provided. Previous studies used self-reported measures of use; this methodology is unreliable. New methods are needed. A hostal was used for a field experiment. Its rooms were divided into seven treatments by combining different condom brands (Durex, Piel, Generic/State-provided) and types (Extra-thin, Extra-safe, Textured) and a Control group. Clients were randomly assigned to a room with one free condom or to the control group (no condom provided). Instead of relying on self-reports, I searched the recently vacated room for used condoms. 423 couples were studied. Using Barnard’s Exact Test, statistically significant differences in condom use were found between the control group (23%) and Piel Extra-thin (40%), Piel Extra-safe (41%), Durex Extra-safe (37%), and Durex Textured (34%). No effect from Generic/State-provided condoms (29%) or Durex Extra-thin (25%) was identified. Providing condoms from commercial, well-known brands significantly increased condom use; providing generic condoms did not. No effect from condom type was found; the lack of effect from Durex Extra-thin appears to stem from couples not perceiving the free condom. Additional research is needed.

PMID:42090194 | DOI:10.1080/00224499.2026.2664807

JAMA Surg. 2026 May 6. doi: 10.1001/jamasurg.2026.1259. Online ahead of print.

ABSTRACT

IMPORTANCE: Hospital accreditation programs aim to improve quality of care and patient outcomes but often require substantial institutional investment in staffing, infrastructure, and regulatory compliance. Despite these costs, the broader institutional impact of accreditation, particularly on patient volumes and care patterns, are poorly understood.

OBJECTIVE: To evaluate whether National Accreditation Program for Rectal Cancer (NAPRC) accreditation is associated with changes in rectal cancer patient volume, stage-specific procedural volumes, and care fragmentation.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a quasi-experimental difference-in-differences design. A total of 316 US Commission on Cancer-accredited (COC) hospitals, including 80 that received NAPRC-accreditation and 236 matched nonaccredited centers. Participants included adult patients diagnosed with primary rectal adenocarcinoma between 2010 and 2022 from the National Cancer Database. These data were analyzed from April 2025 to August 2025.

EXPOSURE: Hospital-level NAPRC accreditation, which requires adherence to multidisciplinary rectal cancer care standards, external audits, and specialized training.

MAIN OUTCOMES AND MEASURES: Annual hospital-level rectal cancer patient volume, stage-specific procedural volumes (stage I and stage II/III), and care fragmentation. Care fragmentation was defined as any case in which the diagnosis and first-course treatment (or decision not to treat) were not completed at the reporting COC-accredited facility. Outcomes were assessed using linear fixed-effects multivariable regression models.

RESULTS: Prior to matching, 1336 COC-accredited facilities were identified, including 80 that achieved NAPRC accreditation and 1256 that never attained accreditation. After propensity score matching, the final analytic sample included 316 hospitals: 80 NAPRC-accredited and 236 nonaccredited facilities. NAPRC accreditation was associated with a mean annual increase of 4.3 patients with rectal cancer per institution (β = 4.29; 95% CI, 0.55-8.03; P = .03). Sensitivity analyses demonstrated increases beginning in the first postaccreditation year, with larger point estimates in subsequent years, though later estimates were not statistically significant. Accreditation was associated with an increase in stage I procedural volume (β = 1.01; 95% CI, 0.016-1.99; P = .05), but not stage II/III surgical volume. No significant changes in care fragmentation were observed.

CONCLUSIONS AND RELEVANCE: In this study, NAPRC accreditation was associated with increased institutional rectal cancer patient volumes and higher procedural volume for early-stage disease without evidence of increased care fragmentation. These findings suggest that accreditation may promote institutional growth while preserving care continuity, offering a potential strategic incentive for hospitals to pursue NAPRC accreditation beyond quality improvement alone. Understanding these dynamics may inform hospital investment decisions, payer strategies, and policy efforts to support high-quality oncologic care delivery.

PMID:42090174 | DOI:10.1001/jamasurg.2026.1259

JAMA Netw Open. 2026 May 1;9(5):e2610798. doi: 10.1001/jamanetworkopen.2026.10798.

ABSTRACT

IMPORTANCE: Patients are often monitored closely during pregnancy, then face barriers to transitioning to primary care after delivery. These barriers may contribute to a reliance on acute care for primary care-treatable concerns.

OBJECTIVES: To evaluate the association of an intervention that increased postpartum primary care engagement over the first year after delivery with overall acute care (emergency department [ED] and urgent care center [UC]) use and acute care use for primary care-treatable concerns (ie, nonemergency conditions or conditions typically managed by a primary care practitioner [PCP]).

DESIGN, SETTING, AND PARTICIPANTS: This is a nonprespecified secondary analysis of a randomized clinical trial (RCT) conducted from November 3, 2022, to October 11, 2023, at 1 hospital-based clinic and 5 community-based obstetric clinics at a large academic medical center. The 353 participants included English- and Spanish-speaking pregnant or recently postpartum adults with 1 or more comorbidities and an assigned PCP.

EXPOSURE: This behavioral science-informed intervention included default scheduling of postpartum PCP appointments within 4 months post partum and tailored messages and reminders about the appointments and the importance of postpartum primary care.

MAIN OUTCOME AND MEASURES: Main outcomes included the use of any acute care and the number of acute care visits during the postpartum period, as well as the use of acute care and the number of visits specifically for primary care-treatable concerns (based on the reason for visit). Ordinary least-squares regression, adjusted for randomization strata and patient demographic and health characteristics, was used to assess the association of the intervention with the use of acute care. Outcomes were analyzed using an intent-to-treat approach.

RESULTS: A total of 353 patients (mean [SD] age, 34.1 [4.9] years) were enrolled in the RCT (control, 173 [49.0%]; intervention, 180 [51.0%]). The intervention had no statistically significant association with overall postpartum acute care use, but it was associated with decreased acute care use for primary care-treatable concerns (control, 70 of 173 [40.5%]; intervention, 53 of 180 [29.4%]); in the adjusted model, the intervention was associated with in a 10.2-percentage point reduction in these visits (95% CI, -20.4 to -0.04 percentage points). The intervention was also associated with a reduced number of visits for primary care-treatable concerns (control: mean [SD], 0.7 [1.1] visits; intervention: mean [SD], 0.4 [0.8] visits), corresponding to a reduction of 0.3 visits (95% CI, -0.5 to -0.1 visits) in the adjusted model.

CONCLUSIONS AND RELEVANCE: In this secondary analysis of an RCT, a behavioral science-informed intervention that increased postpartum primary care engagement was associated with decreased acute care use for primary care-treatable concerns. The results suggest that supporting postpartum transitions to primary care may reduce reliance on acute care, perhaps by facilitating greater care coordination and early detection and management of chronic conditions in the primary care setting.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05543265.

PMID:42090155 | DOI:10.1001/jamanetworkopen.2026.10798

JAMA Netw Open. 2026 May 1;9(5):e2610898. doi: 10.1001/jamanetworkopen.2026.10898.

ABSTRACT

IMPORTANCE: Children with acute gastroenteritis-associated vomiting discharged from emergency departments (EDs) have improved outcomes when provided with ondansetron for home use. However, only one-third of children who present with significant vomiting experience ongoing vomiting after discharge.

OBJECTIVE: To identify characteristics associated with 3 or more vomiting episodes among pediatric patients within 24 hours of ED discharge.

DESIGN, SETTING, AND PARTICIPANTS: This nonprespecified secondary analysis of a randomized clinical trial of children aged 6 months to less than 18 years presenting to EDs between September 14, 2019, and June 27, 2024, with acute gastroenteritis-associated vomiting and who were followed up for 7 days. A prognostic score was derived using generalized linear mixed models across 10 imputed datasets. Data analysis was performed between May 9, 2025, and February 13, 2026.

MAIN OUTCOMES AND MEASURES: The primary outcome was 3 or more episodes of vomiting within 24 hours of ED discharge. Secondary outcomes included unscheduled health care revisits, intravenous fluid administration, and hospitalization within 7 days after the ED visit.

RESULTS: Of 1030 children enrolled, 977 had follow-up data available and were included in this analysis (median age, 47.0 months [IQR, 22.1-80.1 months]; 493 [50.5%] girls; 925 [89.8%] with complete follow-up data). Eighty of 927 children (8.6%) had 3 or more episodes of vomiting in the 24 hours after ED discharge. In unadjusted analysis, only age 6 months to less than 2 years was associated with ongoing vomiting after discharge (odds ratio [OR], 2.17; 95% CI, 1.37-3.43). In multivariable regression analysis, variables associated with postdischarge vomiting included age 6 months to less than 2 years, symptom duration of 24 to 48 hours, or 10 or more vomiting episodes in the 24 hours preceding the ED visit. In a predictive model, a score of 4 points or more was associated with a 13.6% (95% CI, 9.9%-18.1%) probability of 3 or more vomiting episodes within 24 hours of ED discharge, with a sensitivity of 0.50 (95% CI, 0.39-0.61) and specificity of 0.70 (95% CI, 0.67-0.73). Children with 3 or more vomiting episodes within 24 hours of discharge, compared with those without, were more likely to have an unscheduled health care visit (33 of 80 [41.3%] vs 65 of 846 [7.7%]; difference, 33.6%; 95% CI, 22.6%-44.5%), receive intravenous fluids (9 of 80 [11.3%] vs 15 of 846 [1.8%]; difference, 9.5%; 95% CI, 2.5%-16.5%), and be hospitalized (5 of 80 [6.2%] vs 9 of 846 [1.1%]; difference, 5.2%; 95% CI, -0.2% to 10.5%) within 7 days of discharge.

CONCLUSIONS AND RELEVANCE: In this analysis of children presenting for ED care with vomiting, younger children and those unwell for 24 to 48 hours with 10 or more episodes of vomiting at presentation were more likely to have persistent vomiting after discharge. Based on these findings, these children are most likely to benefit from being provided ondansetron for home administration.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03851835.

PMID:42090154 | DOI:10.1001/jamanetworkopen.2026.10898

JAMA Netw Open. 2026 May 1;9(5):e2611045. doi: 10.1001/jamanetworkopen.2026.11045.

ABSTRACT

IMPORTANCE: The COVID-19 pandemic was associated with a substantial prevalence of physicians intending to reduce their clinical hours (ITR) or intending to leave their current organization (ITL). It is unclear how work intentions have changed since that time.

OBJECTIVE: To characterize how the prevalence of ITR and ITL changed among physicians since the COVID-19 pandemic, factors associated with ITR and ITL, and factors associated with physicians’ decision to remain at their current clinical workload or their current organization.

DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study was conducted from January 7, 2022, to November 3, 2024, among 160 organizations across the US with 100 or more physicians across specialties. Physicians responded to the American Medical Association’s Organizational Biopsy study in 2022, 2023, or 2024.

MAIN OUTCOMES AND MEASURES: Main outcomes were ITR within the next 12 months and ITL within the next 24 months.

RESULTS: The sample consisted of 37 112 physicians (7176 physicians in 2022, 12 248 in 2023, and 17 688 in 2024; median organizational response rate of 41.5% [IQR, 29%-60%]; 18 626 of 35 202 male physicians [52.9%]) from 160 organizations, including 81.4% physicians (25 381 of 31 182) who identified as practicing clinically full-time. The overall point prevalence of ITR decreased from 25.6% (1489 of 5815) in 2022 to 22.5% (3266 of 14 540) in 2024 (P = .002), while the prevalence of ITL decreased from 19.9% (1345 of 6760) in 2022 to 15.1% (2414 of 15 935) in 2024 (P = .002). Decreases in ITR and ITL were seen across multiple physician groups. In multivariable-adjusted models, female physicians had higher odds of ITR than male physicians (odds ratio [OR], 1.11; 95% CI, 1.04-1.20), but lower odds of ITL (OR, 0.93; 95% CI, 0.87-0.99). Part-time physicians had 1.18 (95% CI, 1.09-1.29) times the odds of ITR and 1.35 (95% CI, 1.25-1.45) times the odds of ITL compared with full-time physicians. The most prevalent factors that would make respondents reconsider ITR or ITL-including a desire for increased workflow efficiency, improved staffing, and enhanced compensation-were common across the 2 outcomes.

CONCLUSIONS AND RELEVANCE: This serial, cross-sectional, multisite study of US physicians suggests that while the prevalence of ITR and ITL have decreased since the COVID-19 pandemic, more than one-fifth of physicians continued to report ITR and nearly 1 in 6 reported ITL. In aggregate, compared with historical data, current rates represent mixed progress with favorable overall trends in ITL but unfavorable trends in ITR. Common factors, including greater workflow efficiency and consistent staffing, were reported as potentially mitigating both ITR and ITL. These findings can help leaders prioritize and target interventions to sustain the effort of the physician workforce.

PMID:42090152 | DOI:10.1001/jamanetworkopen.2026.11045

JAMA Netw Open. 2026 May 1;9(5):e2611402. doi: 10.1001/jamanetworkopen.2026.11402.

ABSTRACT

IMPORTANCE: Scalable interventions are urgently needed to mitigate the adverse effects of heat on pregnancy and newborn health.

OBJECTIVE: To evaluate whether low-dose aspirin modifies the association between heat exposure and preterm birth.

DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of the Global Network for Women’s and Children’s Health Research Aspirin Supplementation for Pregnancy Indicated Risk Reduction in Nulliparas (ASPIRIN) randomized, double-blinded, placebo-controlled clinical trial was conducted from March 2016 to June 2018. Statistical analyses were performed from June 2024 to June 2025. The study settings included the Democratic Republic of Congo, Zambia, Kenya, Guatemala, Pakistan, and Belagavi and Nagpur, India. Participants included nulliparous individuals between 6 and 13 weeks’ gestation recruited through local clinics and communities, with delivery at 20 or more weeks’ gestation.

EXPOSURES: Prenatal care site-specific daily maximum humid heat averaged across gestation and by gestational week, and randomization to aspirin or placebo.

MAIN OUTCOME AND MEASURE: The main outcome was preterm birth (delivery between 20 and <37 weeks’ gestation) with gestational age confirmed by enrollment ultrasonography.

RESULTS: Of 11 558 participants (mean [SD] age, 20.9 [3.3] years), 5787 were randomized to receive aspirin and 5771 to receive placebo. Preterm birth occurred among 754 placebo recipients (13.1%) and 668 aspirin recipients (11.6%). In mixed-effects pooled logistic regression, each 1 °C increase in mean daily maximum shaded wet-bulb globe temperature across gestation was associated with a 5% increased odds of preterm birth (adjusted odds ratio, 1.05; 95% CI, 1.01-1.10). In stratified analyses, this increased risk was observed only among placebo recipients (adjusted odds ratio [AOR], 1.07; 95% CI, 1.02-1.13), not among aspirin recipients (AOR, 1.03; 95% CI, 0.97-1.10). In pooled mixed-effects logistic distributed lag models, increased odds of preterm birth were observed 17 to 19 weeks before delivery among individuals whose daily maximum shaded wet-bulb globe temperature exceeded the site-specific 75th percentile compared with the lowest 3 quartiles. This vulnerability was not observed among aspirin recipients. In contrast, the association of heat with perinatal mortality was observed only among those receiving aspirin (AOR, 1.15; 95% CI, 1.05-1.26) and not among those receiving placebo (AOR, 1.03; 95% CI, 0.96-1.11).

CONCLUSIONS AND RELEVANCE: The findings of this secondary analysis of the Global Network ASPIRIN trial suggest that low-dose aspirin initiated early in pregnancy among nulliparous individuals may mitigate the effects of heat exposure on preterm birth. The increasing global prevalence of heat stress warrants testing its efficacy more broadly among pregnant people as well as its safety with respect to perinatal mortality.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02409680.

PMID:42090150 | DOI:10.1001/jamanetworkopen.2026.11402