Category: Statistics

J Assoc Physicians India. 2025 May;73(5):e6-e10. doi: 10.59556/japi.73.0955.

ABSTRACT

BACKGROUND: With major attention paid to the most evidently manifested illness like a seizure, few of the silent and deep-boring illnesses like dental issues are often neglected. This study has aimed to analyze the dental illness in people living with epilepsy (PWE).

METHODS: This was a prospective, single-center, case-control study conducted among PWE and their family members from March to May 2022. A survey on demographic parameters, dental hygiene practices, and symptoms of dental illness was taken, followed by a detailed dental examination of the study participants. Independent t -test was used to compare dental illness among PWE and controls.

RESULTS: A total of 69 patients were included, with a mean age of 32.5 ± 2.4 years, and 45 (63%) patients were symptomatic with dental issues. Patients from higher socioeconomic status were found to have better dental hygiene practices but also had a higher prevalence of wasting disease of teeth. About 67 of 69 PWE and 19 of 33 controls were found to have dental illness. PWE had a higher degree of asymptomatic soft tissue abnormalities (24 vs 0%, p < 0.0001) and periodontal disease (13 vs 7.4%, p < 0.0001) as compared to controls. Symptomatic PWE, in comparison to controls, had statistically significant hard tissue abnormalities (66 vs 33%, p = 0.0001), periodontal disease (48 vs 0%, p < 0.0001), and poor dental hygiene status (83 vs 33%, p < 0.0001). Duration and type of epilepsy had no impact on being symptomatic or asymptomatic with dental issues.

CONCLUSION: The hidden yet significant burden of dental illness must be addressed in PWE to improve the quality of life.

PMID:40553526 | DOI:10.59556/japi.73.0955

J Assoc Physicians India. 2025 May;73(5):44-48. doi: 10.59556/japi.73.0969.

ABSTRACT

INTRODUCTION: To study outcomes of the triple-drug therapy in newly diagnosed type 2 diabetes mellitus (T2DM) [glycated hemoglobin (HbA1c) ≥9%] with respect to change in HbA1c, low-density lipoprotein (LDL) levels, weight, waist circumference, variation in drug dosages, hypoglycemic events, patient response of well-being, and corresponding result satisfaction.

MATERIALS AND METHODS: It was a prospective, observational study conducted from 1st June 2018 to 31st May 2019 at Indira Gandhi Medical College and Hospital, Shimla, a tertiary care hospital in Himachal Pradesh. During the initial 3 months, patients were treated with triple-drug [oral hypoglycemic agents (OHAs)] therapy and then switched over to dual or single therapy (OHAs) depending on the HbA1c levels and were followed up for 1 year.

OBSERVATIONS: A total of 137 participants completed the study period. At baseline, the mean values of fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), HbA1c, and LDL were 218.4 ± 36 mg/dL, 343.94 ± 60 mg/dL, 10.5 ± 1.42%, and 120.34 ± 30.99 mg/dL, respectively. At the end of 12 weeks, the mean values of FPG, PPPG, HbA1c, and LDL were reduced to 123 ± 16 mg/dL, 164 ± 30 mg/dL, 8.14 ± 0.97%, and 109.04 ± 28.28 mg/dL, respectively. The differences were highly significant statistically when compared with the baseline observations. At the end of the study (52 weeks), the mean values of FPG, PPPG, HbA1c, and LDL were 96 ± 10 mg/dL, 146 ± 16 mg/dL, 6.14 ± 0.43%, and 90.55 ± 28.14 mg/dL. Reductions in values were statistically significant when compared with both the baseline and 12-week values.

CONCLUSION: Early induction of combination therapy with glimepiride, metformin, and pioglitazone results in more desirable outcomes in terms of greater reduction in HbA1c level and lower incidence of hypoglycemia as compared to the conventional add-on therapy.

PMID:40553523 | DOI:10.59556/japi.73.0969

J Assoc Physicians India. 2025 May;73(5):37-42. doi: 10.59556/japi.73.0946.

ABSTRACT

INTRODUCTION: Human immunodeficiency virus (HIV)-associated neurocognitive deficits (HAND) distress a substantial proportion of people living with HIV (PLHIV). The present research intends to examine the neurocognitive functions in PLHIV, compared to healthy volunteers.

MATERIALS AND METHODS: About 48 HIV patients were recruited from one tertiary health care center, while 24 matched healthy volunteers were enrolled as controls from the community. Neurocognitive functions were assessed using the Hindi Mental Status Examination (HMSE), Addenbrooke’s Cognitive Examination (ACE)-III, and International HIV Dementia Scale (IHDS) questionnaires, along with the computer-based color-word Stroop cognitive task.

RESULTS: The total HMSE scores (p = 0.0047), IHDS scores (p = 0.0002), and ACE-III scores (p < 0.0001) were statistically lower in PLHIV, compared to controls. The specific domain scores of ACE-III in PLHIV were also statistically lower compared to the control group, with greater differences seen in memory (p < 0.0001) and language (p = 0.0012) domains. Similarly, higher reaction time was seen in PLHIV in comparison with the control group (p < 0.0001) during Stroop cognitive task performance, while a statistically significant difference in accuracy was not observed among groups. Further, among PLHIV, reaction time had a significant positive correlation with years since diagnosis of HIV infection (p = 0.006, r = 0.39, Spearman correlation).

CONCLUSION: Observations demonstrate neurocognitive deficits in PLHIV across multiple domains. Our study, therefore, offers insights into the neurocognitive manifestations of HIV infection, which could facilitate tailored preventive and therapeutic interventions by healthcare providers to enhance the overall quality of life for PLHIV.

PMID:40553522 | DOI:10.59556/japi.73.0946

J Assoc Physicians India. 2025 May;73(5):34-36. doi: 10.59556/japi.73.0937.

ABSTRACT

BACKGROUND: The Family Adoption Program (FAP) is an integral part of medical education aimed at fostering empathy and practical skills among medical students by exposing them to rural healthcare settings. This study assesses the perceptions and experiences of Bachelor of Medicine and Bachelor of Surgery (MBBS) students regarding the FAP, with a focus on their professional development and challenges encountered during the program.

METHODS: A cross-sectional study was conducted using a predesigned and pretested questionnaire. The questionnaire link was distributed via WhatsApp to MBBS students from the 2021, 2022, and 2023 batches. The data collected included students’ prior exposure to rural settings, perceived professional growth, and challenges faced during the program. Descriptive statistics were used to analyze the data.

RESULTS: The study found that 63.8% of students had prior exposure to rural settings before joining MBBS, reflecting a diverse participant background. A majority (81.4%) believed that the FAP enhanced their ability to become empathetic and confident physicians. However, 44.9% of students reported communication barriers, and 35.8% faced difficulties in gaining trust and cooperation from family members, highlighting key challenges in the program.

CONCLUSION: The FAP is valued for its role in developing empathy and confidence among medical students, though communication and trust-building remain significant challenges. Addressing these issues could further enhance the program’s effectiveness.

PMID:40553521 | DOI:10.59556/japi.73.0937

J Assoc Physicians India. 2025 May;73(5):25-28. doi: 10.59556/japi.73.0930.

ABSTRACT

OBJECTIVES: Cardiovascular diseases (CVDs) have become a major cause of mortality in India and abroad. Various risk scores have been formulated to estimate CVD risk. The preferred biomarker for the detection of myocardial cell necrosis is cardiac troponin. Highly sensitive troponin assays are now available. Computed tomography coronary angiogram (CT-CAG) is the standard noninvasive modality to identify as well as exclude coronary artery disease (CAD). Our study aims to correlate high-sensitivity troponin I (hs-cTnI) and the QRESEARCH cardiovascular (CV) risk algorithm (QRISK3) score against CT-CAG and determine whether, by using these data, we can detect or rule out CAD accurately by noninvasive means alone.

MATERIALS AND METHODS: We evaluated 100 subjects who presented with chest pain (primary prevention population) to the cardiology outpatient department. A detailed history was obtained, and blood investigations, including hs-cTnI, were conducted. The QRISK3 score was calculated, and CT-CAG was performed for all. Hs-cTnI >6 was considered significant. Those who had >50% diameter stenotic lesion(s) were deemed to have significant CAD.

RESULTS: In our study with 100 subjects, 80 had hs-cTnI <6, and 20 subjects had hs-cTnI >6. The QRISK3 score did not show any statistical correlation with hs-cTnI. The hs-cTnI levels were compared with CT-CAG results and found that 80% of subjects with elevated hs-cTnI had CAD.

CONCLUSION: A strong correlation between elevated hs-cTnI levels and CAD by CT-CAG was established by our study. The early detection of CAD will prompt early management and delay further progression of the disease.

PMID:40553519 | DOI:10.59556/japi.73.0930

J Med Internet Res. 2025 Jun 24;27:e69077. doi: 10.2196/69077.

ABSTRACT

BACKGROUND: The demand for wearable technologies has surged in recent years, demonstrating remarkable potential, especially in health promotion. However, there is currently a lack of clarity about the types and roles of wearable devices in health care of older adults.

OBJECTIVE: This review aims to provide a comprehensive overview and categorize the current research conducted with wearable devices for health promotion and disease prevention in older adults.

METHODS: We conducted a systematic literature review using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework and synthesized the results. A total of 6 databases were searched to identify wearable devices reported in studies from inception to July 28, 2024. Titles, abstracts, and full texts were independently screened by 2 reviewers. Any discrepancies were resolved by a third reviewer when necessary. The types of results from relevant studies were systematically mapped into predefined categories.

RESULTS: Based on the inclusion criteria, 109 studies were included. The most commonly reported health targets of wearable devices were mobility, mental health, fall-related, arrhythmia detection, activity recognition, disease diagnosis, and sleep monitoring. Most studies were application design and observational study, and in European countries and the United States, 51 studies of the participants were healthy. The most popular anatomical landmarks for wearable placement were the wrist, waist, and chest. Two evaluation approaches for wearable devices were used: performance metrics in controlled settings and real-world assessments with end users. The opportunities presented by wearable devices are countered by multiple challenges, including data availability and reliability, technical limitations, utility and user acceptance, cost, security and privacy, performance gaps, and challenges.

CONCLUSIONS: Wearable devices hold great promise for promoting health in older adults, but several hurdles remain for full adoption. A broader and more diverse group of older adults is needed to identify the most beneficial wearables and to optimize the technology. Further studies are required to statistically synthesize real-world performance and evaluation results. We hope that this review will serve as a valuable reference for the development of wearable devices in older adults.

PMID:40553512 | DOI:10.2196/69077

JAMA Netw Open. 2025 Jun 2;8(6):e2511804. doi: 10.1001/jamanetworkopen.2025.11804.

ABSTRACT

IMPORTANCE: High-need, high-cost (HNHC) patients account for 5% of the US population yet represent nearly half of health care spending.

OBJECTIVE: To evaluate whether national care coordination could reduce health care cost and utilization in a commercially insured HNHC population.

DESIGN, SETTING, AND PARTICIPANTS: This national, 2-arm randomized clinical trial with intention-to-treat and instrumental variable analyses included patients aged 18 years or older who were defined as HNHC according to a proprietary model (in the top 5% of spend within a rolling 12-month claims utilization window and projected to remain in the top 5% over the subsequent 12 months). Patients were randomized from January 2018 to October 2019. Data were analyzed from January 1 to December 31, 2024.

INTERVENTION: Participants were randomized monthly 60:40 to telephonic care coordination from a registered nurse, including medication review, a barriers-to-care survey, addressing urgent coordination needs (eg, patient unable to fill prescriptions), development of a case management plan addressing identified clinical risk factors, and establishing an outreach time frame, or to the control group with usual care. The nurse contacted patients over the 60 days after enrollment until all risk factors included in the management plan were addressed.

MAIN OUTCOMES AND MEASURES: The main outcomes were mean monthly emergency department visits, inpatient hospitalizations, and total plan cost (medical and pharmacy) over 12 months following the index date, defined as the enrollment date for intervention participants or the randomly generated synthetic enrollment date for nonparticipants. Outcomes were examined separately among patients with diabetes.

RESULTS: The analytic sample included 93 379 HNHC patients with a mean (SD) age of 46 (12) years (54% female). In intention-to-treat analyses, there were no differences between groups in mean (SE) monthly emergency department visits (0.033 [0.001] for control vs 0.033 [0.001] for treatment; mean difference [SE], 0 [0]; 95% CI, -0.001 to 0.002; P = .69), inpatient hospitalizations (0.009 [0] for control vs 0.010 [0] for treatment; mean difference [SE], 0.001 [0]; 95% CI, 0-0.002; P = .06), or cost (total: $2507 [$32] for control vs $2568 [$26] for treatment; mean difference [SE], $60 [$41]; 95% CI, -$20 to $140; P = .14). In the instrumental variable analyses and in the subsample with diabetes, no evidence of statistically significant reductions in these outcomes were found.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of a national care coordination intervention, neither health care cost nor acute care utilization was reduced in the intervention group compared with the control group. The results emphasize the challenges of improving efficiency of care in a complex HNHC population with escalating health care costs.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04415515.

PMID:40553475 | DOI:10.1001/jamanetworkopen.2025.11804

JAMA Netw Open. 2025 Jun 2;8(6):e2516947. doi: 10.1001/jamanetworkopen.2025.16947.

ABSTRACT

IMPORTANCE: Breast cancer (BC) incidence trends are known to vary by race, ethnicity, and geography among younger women. Less is known about trends among older women (aged ≥65 years), who are typically aggregated, despite different screening guidelines for those older than 74 years.

OBJECTIVE: To disaggregate US BC incidence trends among older women (ages 65-74, 75-84, and ≥85 years) according to stage at diagnosis, race and ethnicity, hormone receptor subtype, and geography.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study included women aged 65 years and older who were diagnosed with BC from January 2001 to December 2019. Data came from the US Cancer Statistics public use database, with information on women in all 50 US states. Data were analyzed from March to June 2024.

EXPOSURE: Age (65-74 years, 75-84 years, and ≥85 years).

MAIN OUTCOMES AND MEASURES: Age-adjusted BC incidence rates were obtained, and average annual percent changes (AAPCs) from 2001 to 2019 were estimated using joinpoint regression for each age group, stratified by stage at diagnosis, race and ethnicity, and geography.

RESULTS: From 2001 to 2019, 2 278 611 women (1 249 750 [54.9%] aged 65-74 years; 119 287 [5.2%] Hispanic [all races], 205 738 [9.0%] non-Hispanic Black, and 1 826 084 [80.1%] non-Hispanic White) were diagnosed with BC. Age-adjusted BC incidence rates were 530.4 (95% CI, 529.5 to 531.3) per 100 000 persons, 515.3 (95% CI, 514.2 to 516.5) per 100 000 persons, and 376.8 (95% CI, 375.3 to 378.2) per 100 000 persons for ages 65 to 74 years, 75 to 84 years, and 85 years and older, respectively. Annually, incidence rates increased in women aged 65 to 74 years (AAPC, 0.4%, 95% CI, 0.2% to 0.6%), remained stable in women aged 75 to 84 years, and decreased in women aged 85 years or older (AAPC, -1.1%, 95% CI, -1.4% to -0.8%). In women aged 65 to 74 years, the AAPC was 7 to 11 times higher in Hispanic, non-Hispanic American Indian or Alaska Native, non-Hispanic Asian or Pacific Islander, and non-Hispanic Black women compared with non-Hispanic White women. Across all age groups, regional stage diagnoses decreased (ages ≥65 years: AAPC, -0.8%, 95% CI, -1.1% to -0.5%), while distant stage diagnoses increased (ages ≥65 years: AAPC, 1.3%, 95% CI, 1.2% to 1.6%). Trends for in situ and localized diagnoses varied by age. Across all age groups, non-Hispanic Black women had the highest proportion of hormone receptor and ERBB2-negative cancers.

CONCLUSIONS AND RELEVANCE: In this population-based cross-sectional analysis of BC incidence trends among older US women, racial and ethnic as well as stage-specific patterns differed across age groups, highlighting the importance of disaggregating BC incidence rates into age groups better aligned with screening guidelines. Future research is needed to directly examine the contribution of screening patterns to these trends and their impact on BC mortality.

PMID:40553473 | DOI:10.1001/jamanetworkopen.2025.16947

JAMA Netw Open. 2025 Jun 2;8(6):e2517149. doi: 10.1001/jamanetworkopen.2025.17149.

ABSTRACT

IMPORTANCE: Many individuals with lung cancer are not eligible for lung cancer screening (LCS). Race-based and sex-based differences in smoking patterns reduce the effectiveness of LCS criteria.

OBJECTIVE: To assess the value of expanding LCS criteria beyond US Preventive Services Task Force (USPSTF) 2021 guidelines by relaxing cigarette smoking exposure criteria.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included individuals enrolled in an incidental pulmonary nodule (IPN) program with non-screening-detected, potentially malignant pulmonary nodules, or enrolled in a LCS program from 2015 to 2023. Participants were treated in a community-based health care system serving more than 125 counties in Mississippi, Tennessee, Arkansas, Kentucky, Missouri, and Alabama. Data were examined from October 1, 2024, to May 29, 2025.

EXPOSURES: LCS eligibility criteria included USPSTF 2021, Potter criteria (20-year smoking history), and American Cancer Society criteria ([ACS] 20 pack-years, no quit duration), and expansions to 10 years or 10 pack-years.

MAIN OUTCOMES AND MEASURES: The main outcomes were proportions of individuals eligible for LCS and diagnosis of lung cancer. Characteristics between groups were compared using the χ2 test for categorical variables and the Wilcoxon-Mann-Whitney test for continuous variables.

RESULTS: In this study, 43 521 individuals were evaluated, including 13 770 (32%) from LCS and 29 751 (68%) from IPN programs. Of the 29751 individuals in IPN programs, 3840 (13%) were eligible for LCS by USPSTF 2021 criteria, 4905 (16%) by IPN-Potter criteria, 5263 (18%) by IPN-ACS criteria, and 6307 (21%) by IPN-Potter-ACS criteria. There were 1103 additional individuals eligible by IPN-Potter criteria (606 female [55%] and 382 Black [35%]), 1423 by IPN-ACS criteria (628 female [44%]; 237 Black [17%]), and 2467 by IPN-Potter-ACS criteria (1200 female [49%]; 615 Black [25%]). There were significant differences in the number of additional eligible individuals who were female (55% vs 48%; P < .001) and Black (35% vs 22%; P < .001) between the IPN-Potter and USPSTF 2021 criteria. Lung cancer was diagnosed in 504 of 13 770 of LCS enrollees (4%) and 1714 of 29 751 of IPN enrollees (6%), including 872 of 4905 (18%) eligible by IPN-Potter criteria, 955 of 5263 (18%) by IPN-ACS criteria, and 1051 of 6307 (17%) by IPN-Potter-ACS criteria. The additional eligible individuals with lung cancer in IPN programs who were female included 70 of 128 (55%) by IPN-Potter criteria, 89 of 208 (43%) by IPN-ACS criteria, and 143 of 304 (47%) by IPN-Potter-ACS criteria, with statistically significant differences between the IPN-Potter criteria and USPSTF 2021 criteria (55% vs 48%; P < .001). The additional eligible individuals who were Black included 50 of 128 (39%) by IPN-Potter criteria, 32 of 208 (15%) by IPN-ACS criteria, and 73 of 304 (24%) by IPN-Potter-ACS criteria, with statistically significant differences between IPN-Potter criteria and IPN-USPSTF 2021 criteria (39% vs 22%; P < .001). When LCS criteria were expanded to individuals older than 50 years who had smoked for 10 years or 10 pack-years, 7993 of 29 751 individuals (27%) from IPN programs would have been eligible. Among these, 1251 of 7993 (16%) were diagnosed with lung cancer.

CONCLUSIONS AND RELEVANCE: In this cohort study, changing smoking criteria from 20 pack-years to a 20-year smoking history was associated with improved access to LCS while maintaining diagnostic efficiency. Expansion to individuals with a 10-year or 10 pack-years smoking history should be explored.

PMID:40553471 | DOI:10.1001/jamanetworkopen.2025.17149