Category: Statistics

JAMA Netw Open. 2024 Aug 1;7(8):e2429682. doi: 10.1001/jamanetworkopen.2024.29682.

ABSTRACT

IMPORTANCE: Hemorrhagic fever with renal syndrome (HFRS), a neglected zoonotic disease, has received only short-term attention in postflood prevention and control initiatives, possibly because of a lack of evidence regarding the long-term association of flooding with HFRS.

OBJECTIVES: To quantify the association between severe floods and long-term incidence of HFRS in the Yangtze River basin and to examine the modifying role of geographical factors in this association.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study collected data on HFRS cases between July 1, 2013, and June 30, 2019, from 58 cities in 4 provinces (Anhui, Hubei, Hunan, and Jiangxi) in the Yangtze River basin of China, with a breakpoint of flooding in July 2016, generating monthly data. The 3 years after July 2016 were defined as the postflood period, while the 3 years before the breakpoint were defined as the control period. Statistical analysis was performed from October to December 2023.

EXPOSURES: City-level monthly flooding, elevation, ruggedness index, and closest distance from each city to the Yangtze River and its tributaries.

MAIN OUTCOMES AND MEASURES: The primary outcomes were the number of city-level monthly HFRS cases and the number of type 1 (spring or summer) and type 2 (autumn or winter) HFRS cases.

RESULTS: A total of 11 745 patients with HFRS were reported during the study period: 5216 patients (mean [SD] age, 47.1 [16.2] years; 3737 men [71.6%]) in the control period and 6529 patients (mean [SD] age, 49.8 [15.8] years; 4672 men [71.6%]) in the postflood period. The pooled effects of interrupted time series analysis indicated a long-term association between flooding and HFRS incidence (odds ratio, 1.38; 95% CI, 1.13-1.68), with type 1 cases being at highest risk (odds ratio, 1.71; 95% CI, 1.40-2.09). The metaregression results indicated that elevation and ruggedness index were negatively associated with the risk of HFRS, while the distance to rivers interacted with these associations.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of the long-term association between flooding and HFRS incidence, as well as the modification effects of geographical factors, suggests that severe floods were associated with an increased risk of HFRS within 3 years. This study provides evidence for the development of HFRS prevention and control strategies after floods.

PMID:39172449 | DOI:10.1001/jamanetworkopen.2024.29682

JAMA Netw Open. 2024 Aug 1;7(8):e2429760. doi: 10.1001/jamanetworkopen.2024.29760.

ABSTRACT

IMPORTANCE: Initial management of intermediate-risk prostate cancer is evolving, with no clear recommendation for treatment. Data on utilization of active surveillance for patients with newly diagnosed intermediate-risk prostate cancer may help clarify emerging trends.

OBJECTIVE: To further characterize US national trends of initial management of intermediate-risk prostate cancer.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included patients with intermediate-risk prostate cancer diagnosed from January 1, 2010, to December 31, 2020. Eligible patients were diagnosed in US hospitals included in the National Cancer Database; National Comprehensive Cancer Network risk stratification guidelines were used to characterize as favorable vs unfavorable intermediate risk. Analysis was performed in September 2023.

EXPOSURE: Active surveillance vs intervention with surgery and/or radiation or no treatment.

MAIN OUTCOMES AND MEASURES: Temporal trends in demographic, clinical, and socioeconomic factors among men with intermediate-risk prostate cancer and their association with the use of active surveillance; further subgroup analysis was conducted for those with favorable vs unfavorable intermediate risk classification.

RESULTS: In total, 289 584 men diagnosed with intermediate-risk prostate cancer were identified from 2010 to 2020 (46 147 Black [15.9%], 230 071 White [79.5%]). Among patients, 153 726 (53.1%) underwent prostatectomy, 107 152 (37.0%) underwent radiotherapy, and 15 847 (5.5%) underwent active surveillance as initial treatment strategy. Overall, active surveillance quadrupled from 418 of 21 457 patients (2.0%) in 2010 to 2428 of 28 192 patients (8.6%) in 2020 for the entire cohort (P < .001). Active surveillance increased from 317 of 12 858 patients (2.4%) in 2010 to 2020 of 12 902 patients (13.5%) in 2020 in men with favorable intermediate-risk prostate cancer (P < .001). In the unfavorable intermediate-risk cohort, active surveillance increased from 101 of 8181 patients (1.2%) in 2010 to 408 of 12 861 patients (3.1%) in 2020 (P < .001). On multivariable analysis, use of active surveillance was associated with increased age (age 70-80 years vs <50 years: odds ratio [OR], 3.09; 95% CI, 2.66-3.59), lower Gleason score (3 + 3 vs 3 + 4: OR, 3.45; 95% CI, 3.25-3.66), early T stage (T2c vs T1a through T2a: OR, 0.35; 95% CI, 0.32-0.38), treatment at an academic center (community vs academic center: OR, 0.72; 95% CI, 0.67-0.78), higher level of education (communities with 21% or higher population without high school vs less than 7%: OR, 0.73; 95% CI, 0.67-0.79), insurance type (Medicare or other governmental service vs private: OR, 1.11; 95% CI, 1.07-1.16), proximity to treatment facility (greater than 120 miles vs less than 60 miles: OR, 0.75; 95% CI, 0.68-0.84), facility location (South Atlantic vs New England: OR, 0.54; 95% CI, 0.46-0.53), and lower income (less than $38 000 vs $63 000 or greater: OR, 1.22; 95% CI, 1.14-1.31).

CONCLUSIONS AND RELEVANCE: These findings highlight increasing implementation of active surveillance in the initial management of intermediate risk prostate cancer. Prospective data with improved risk stratification incorporating genomics and digital pathology artificial intelligence as well as novel surveillance strategies may continue to better delineate optimal treatment recommendations in this patient population.

PMID:39172448 | DOI:10.1001/jamanetworkopen.2024.29760

JAMA Netw Open. 2024 Aug 1;7(8):e2431306. doi: 10.1001/jamanetworkopen.2024.31306.

ABSTRACT

IMPORTANCE: With the increasing legislation restricting health care access for transgender and nonbinary (trans) populations in recent years, there has been limited research on how awareness of and concerns about legislative restrictions and protections influence mental health outcomes.

OBJECTIVE: To examine whether awareness of and concerns about the current policy environment regarding trans individuals are associated with depression and anxiety symptoms among trans adults.

DESIGN, SETTING, AND PARTICIPANTS: This study uses cross-sectional data collected between March and April 2023 from the Washington Priority Assessment in Trans Health (PATH) Project, an online study designed by, with, and for trans communities. All participants were trans adults, aged 18 years or older, living in Washington state.

EXPOSURE: Awareness and concerns about the antitrans policy environment.

MAIN OUTCOMES AND MEASURES: The primary outcomes were depression and anxiety symptoms, assessed via the Patient Health Questionnaire-4. A series of multivariable regression models was used to assess the association between awareness and concerns about the antitrans policy environment and depression and anxiety symptoms. Models were adjusted for covariates, including demographics, social marginalization, and health care experiences.

RESULTS: A total of 797 participants (653 women [81.93%]; 455 aged 18-29 years [57.09%]) were included. The majority screened positive for current depression (689 individuals [86.45%]) and anxiety (686 individuals [86.07%]) symptoms. Trans individuals who were concerned or worried about their rights being taken away (vs not) had significantly higher odds of current depression symptoms (adjusted odds ratio [aOR], 1.66; 95% CI, 1.08-2.54), as well as current anxiety symptoms (aOR, 2.67; 95% CI, 1.63-4.36). Those who knew (vs did not know) about state-level protective legislation had significantly lower odds of current depression symptoms (aOR, 0.44; 95% CI, 0.28-0.67), as well as current anxiety symptoms (aOR, 0.11; 95% CI, 0.04-0.25). When examining interaction effect estimates, trans individuals who correctly knew about the protective policies and were not worried about having their rights taken away reported the lowest odds of depression and anxiety.

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study are consistent with research elucidating the negative mental health consequences of policies limiting health care access and provide insights into informing policies and interventions that target trans populations’ worsened mental health outcomes as a result of antitrans legislation.

PMID:39172447 | DOI:10.1001/jamanetworkopen.2024.31306

JAMA. 2024 Aug 22. doi: 10.1001/jama.2024.14618. Online ahead of print.

ABSTRACT

IMPORTANCE: Safe and effective nonhormonal treatments for menopausal vasomotor symptoms (VMS) are needed.

OBJECTIVE: To evaluate the efficacy and safety of elinzanetant, a selective neurokinin-1,3 receptor antagonist, for the treatment of moderate to severe menopausal vasomotor symptoms.

DESIGN, SETTING, AND PARTICIPANTS: Two randomized double-blind phase 3 trials (OASIS 1 and 2) included postmenopausal participants aged 40 to 65 years experiencing moderate to severe vasomotor symptoms (OASIS 1: 77 sites in the US, Europe, and Israel from August 27, 2021, to November 27, 2023, and OASIS 2: 77 sites in the US, Canada, and Europe from October 29, 2021, to October 10, 2023).

INTERVENTION: Once daily oral elinzanetant, 120 mg, for 26 weeks or matching placebo for 12 weeks followed by elinzanetant, 120 mg, for 14 weeks.

MAIN OUTCOMES AND MEASURES: Primary end points included mean change in frequency and severity of moderate to severe vasomotor symptoms from baseline to weeks 4 and 12, measured by the electronic hot flash daily diary. Secondary end points included Patient-Reported Outcomes Measurement Information System Sleep Disturbance Short Form 8b total T score and Menopause-Specific Quality of Life questionnaire total score from baseline to week 12.

RESULTS: Eligible participants (mean [SD] age, OASIS 1: 54.6 [4.9] years; OASIS 2: 54.6 [4.8] years) were randomized to elinzanetant (OASIS 1: n = 199; OASIS 2: n = 200) or placebo (OASIS 1: n = 197; OASIS 2: n = 200). A total of 309 (78.0%) and 324 (81.0%) completed OASIS 1 and 2, respectively. For the elinzanetant and placebo groups, the baseline mean (SD) VMS per 24 hours were 13.4 (6.6) vs 14.3 (13.9) (OASIS 1) and 14.7 (11.1) v 16.2 (11.2) (OASIS 2). Baseline VMS severity was 2.6 (0.2) vs 2.5 (0.2) (OASIS 1) and 2.5 (0.2) vs 2.5 (0.2) (OASIS 2). Elinzanetant significantly reduced VMS frequency at week 4 (OASIS 1: -3.3 [95% CI, -4.5 to -2.1], P < .001; OASIS 2: -3.0 [95% CI, -4.4 to -1.7], P < .001) and at week 12 (OASIS 1: -3.2 [95% CI, -4.8 to -1.6], P < .001; OASIS 2: -3.2 [95% CI, -4.6 to -1.9], P < .001). Elinzanetant also improved VMS severity at week 4 (OASIS 1: -0.3 [95% CI, -0.4 to -0.2], P < .001; OASIS 2: -0.2 [95 CI, -0.3 to -0.1], P < .001) and week 12 (OASIS 1: -0.4 [95% CI, -0.5 to -0.3], P < .001; OASIS 2: -0.3 [95% CI, -0.4 to -0.1], P < .001). Elinzanetant improved sleep disturbances and menopause-related quality of life at week 12, and the safety profile was favorable.

CONCLUSIONS AND RELEVANCE: Elinzanetant was well tolerated and efficacious for moderate to severe menopausal VMS.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: OASIS 1: NCT05042362, OASIS 2: NCT05099159.

PMID:39172446 | DOI:10.1001/jama.2024.14618

Int J Oral Maxillofac Implants. 2024 Aug 16:1-20. doi: 10.11607/jomi.11103. Online ahead of print.

ABSTRACT

Purpose: Immediate implant placement is a reliable solution to replace hopeless teeth, but this procedure may be associated to an increased risk of soft tissue complications in case of thin biotype. The use of tissue-level implants with a convergent transmucosal profile has been advocated to increase space for soft tissue, contributing to improve their stability and esthetics. The aim of this retrospective study was to evaluate the esthetic outcomes and the Patient-Reported Outcome Measures (PROMs) of immediately placed implants with a convergent transmucosal profile. Materials and methods: This single-cohort, monocentric, retrospective clinical study was conducted on patients treated with an immediately placed implant in the esthetic zone (from premolar to premolar). All the eligible patients were recalled for a clinical and radiographic follow-up visit. Results: This study included 20 patients (8 males, 12 females) with an average age of 55.5± 6.8 years, who received 20 implants, with a mean follow-up of 46.5± 15.3 months. At the time of follow-up, immediately placed implants showed a mean Marginal Bone Loss of 0.42± 0.49 mm, and a statistically significant improvement of the esthetic parameters from baseline to the last available follow-up; in particular, Pink and White esthetic scores (p=.001) and Papilla Index at mesial and distal sites (p<.001). All the patients reported a high satisfaction (VAS>9) both from esthetic and functional point of view. Conclusion: Immediately placed implants with convergent transmucosal profile in the esthetic zone showed good clinical and esthetic outcomes, with stable results over time.

PMID:39172437 | DOI:10.11607/jomi.11103

Dev Psychol. 2024 Aug 22. doi: 10.1037/dev0001824. Online ahead of print.

ABSTRACT

Economic disadvantage has often been associated with poorer performance on measures of early childhood development. However, the causal impacts of income on child development remain unclear. The present study uses data from the Baby’s First Years randomized control trial to identify the causal impact of unconditional cash transfers on maternal reports of early childhood development. One thousand racially and ethnically diverse mothers residing in poverty were recruited from four U.S. metropolitan areas shortly after giving birth. Mothers were randomized to receive either a $333/month or $20/month unconditional cash transfer for the first several years of their child’s life. Maternal reports of language and socioemotional development, concerns for developmental delay, and enrollment in early intervention services were collected annually at the time of the child’s first, second, and third birthdays. In this registered report, we document no statistically detectable impacts of the high-cash gift on maternal reports of child development. We discuss the significance and implications of these findings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:39172428 | DOI:10.1037/dev0001824

Dev Psychol. 2024 Aug 22. doi: 10.1037/dev0001796. Online ahead of print.

ABSTRACT

To be efficient, problem solvers need to be adaptive, tailoring their information search to the specific problem at hand. Across two studies, we investigated the emergence and early development of children’s ability to adapt their information search to a given goal (Studies 1 and 2) and to the statistical structure of the problem space (Study 2) to maximize effectiveness. In Study 1, 3-6-year-olds (n = 105) decided which of two cues to look up, the arms or the legs of two monsters, to predict the winner of a throwing or jumping challenge, knowing that monsters with long arms were good throwers and those with long legs were good jumpers. Children’s ability to adaptively select relevant information and tailor their search to the goal increased with age, surpassing chance level between the ages of 4 and 5. Study 2 (7-14-year-olds and adults, n = 175) demonstrated this competence in a more complex task, additionally investigating whether children tailor their search to the statistical structure, that is, the distribution of cue values, in their search environment (e.g., how common long legs are). The results suggest high reliability in ignoring irrelevant cues (confirming the results from Study 1) and developmental patterns in children’s preferential treatment of cues of differing statistical frequency. Together, these studies contribute to the literature on information search adaptiveness by tracing for the first time the emergence and developmental trajectory of children’s ability to tailor predecisional search to the changing goals and environmental resources of the problem at hand. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:39172427 | DOI:10.1037/dev0001796

Dev Psychol. 2024 Aug 22. doi: 10.1037/dev0001797. Online ahead of print.

ABSTRACT

Based on data for N = 2,756 children (1,410 girls; M_age = 8.10 years) from 16 data sets spanning five nations, this study investigated relations between national gender disparities and children’s beliefs about gender and academic subjects. One national-level gender disparity involved inequalities in socioeconomic standing favoring adult males over females (U.N. Human Development Index). The other involved national-level gaps in standardized math achievement, favoring boys over girls (Trends in International Mathematics and Science Study Grade 4). Three novel findings emerged. First, girls’ results from a Child Implicit Association Test showed that implicit associations linking boys with math and girls with reading were positively related to both national male advantages in socioeconomic standing and national boy advantages in Trends in International Mathematics and Science Study. Second, these relations were obtained for implicit but not explicit measures of children’s beliefs linking gender and academic subjects. Third, implicit associations linking gender to academic subjects increased significantly as a function of children’s age. We propose a psychological account of why national gender disparities are likely to influence children’s developing implicit associations about gender and academic subjects, especially for girls. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:39172414 | DOI:10.1037/dev0001797

Dev Psychol. 2024 Aug 22. doi: 10.1037/dev0001828. Online ahead of print.

ABSTRACT

Kagan theorized biologically based temperament types that are present in infancy, stable across development, and essential for understanding individual differences. Despite evidence, temperament research remains focused on a few prominent dimensions of temperament, without adequately addressing covariance among dimensions and temperament types. Using longitudinal twin data, we took a person-centered statistical approach to identify temperament types and examined continuity and change across five developmental periods (N_infancy = 602; N_toddlerhood = 522; N_{early childhood} = 390; N_{late childhood} = 718; Nearly adolescence = 700). We then examined the genetic and environmental etiology of temperament types. Twins were boys and girls (51-53% female), primarily Hispanic/Latinx (23-30%) and non-Hispanic/Latinx White (56-63%), and from socioeconomically diverse families (28-38% near-or-below the poverty line). Using latent profile analysis, we identified three temperament types at each age characterized by negative reactivity and dysregulation, positive reactivity and strong self-regulation, and moderate reactivity and regulation. Latent transition analyses revealed considerable continuity in membership type for “negative dysregulated” beginning in infancy, log odds = 1.58 (SE = .65) to 3.16 (SE = .77), p < .01, of remaining relative to transitioning to “typical expressive”, and “positive well-regulated” beginning in early childhood, log odds = 1.41 (SE = .56) to 2.25 (SE = .47), p < .05. Twin analyses revealed moderate heritability and a consistent role of the shared environment on positive well-regulated, with negative dysregulated and typical expressive also moderately heritable with the shared environment being important at some ages. Findings support the presence of theorized biologically based temperament types that develop rapidly in infancy and toddlerhood and provide a foundation for the study of individual differences and risk and resilience processes across the lifespan. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:39172413 | DOI:10.1037/dev0001828

Psychol Bull. 2024 Aug;150(8):1011-1019. doi: 10.1037/bul0000444.

ABSTRACT

Our meta-analysis on gender differences in sex drive found a stronger sex drive in men compared to women (Frankenbach et al., 2022). Conley and Yang (2024) criticized how we interpreted the findings and provided suggestions regarding the origins of these gender differences, an undertaking that we had refrained from doing in our original work. We concur with several important points made by Conley and Yang (2024): (a) women’s sexual experiences are generally more negative than men’s, which could partly explain why men report more sex drive; (b) lack of statistical moderation by some sociocultural variables does not imply that the sex drives of men and women are generally unaffected by the social environment; and (c) gender differences in sexuality are likely smaller than they are often portrayed in research, and that the practical impact of this difference is largely unknown. Still, we reject other assertions made by Conley and Yang (2024): (a) we did not frame our findings in support of the view that gender differences in sex drive are determined by biology, (b) we did not conflate response bias with sociocultural biases more broadly, and (c) we did not fail to incorporate and consider gendered cultural messages about sexuality in our methods and discussion. We make several suggestions about future research on these matters. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:39172391 | DOI:10.1037/bul0000444