Category: Statistics

Med Care. 2025 Jun;63(6):436-442. doi: 10.1097/MLR.0000000000002143.

ABSTRACT

BACKGROUND: The impact of the COVID-19 pandemic on Veteran enrollment and health care utilization within the United States Veterans Health Administration (VHA) remains uncertain.

OBJECTIVE: To evaluate drivers of enrollment and utilization of health care services at VHA with an emphasis on differences before and during the COVID-19 pandemic.

METHODS: We included 14,107,785 Veterans from the US Veterans Eligibility Trends and Statistics (USVETS) FY2017-2021 annual datasets in a repeat cross-sectional design. We assessed the adjusted incidence of VHA enrollment, and the probability of utilizing VHA health care by fiscal year among social determinants of health, including number of children, attained education, income, marital status, household size, and rurality of residence.

RESULTS: Contrary to prepandemic years, Veterans with adverse or negative social determinants of health that can lead to poor health (eg, lower income and lower attained education) were less likely than other groups to enroll in FY2021. However, among those enrolled, the probability of using VHA health care service increased by (1%-2%) in FY2021 across all social determinants of health. The largest increases in the probability of VHA health care use were among Veterans with higher income, higher education, and those living in urban areas.

CONCLUSIONS: Veterans with adverse social determinants of health, that could lead to poor health, showed decreased VHA enrollment during FY2021. During the same time period, the largest utilization increases occurred among Veterans facing fewer adverse social determinants of health, highlighting nuanced socioeconomic dynamics and need for dedicated programs to ensure equitable care and access during significant societal disruptions.

PMID:40956598 | DOI:10.1097/MLR.0000000000002143

Epilepsia Open. 2025 Sep 16. doi: 10.1002/epi4.70148. Online ahead of print.

ABSTRACT

OBJECTIVE: This study explored the most prevalent misconceptions about epilepsy among Sudanese individuals, focusing on knowledge, attitude, and practices in Sudan.

METHODS: A community-based, cross-sectional study was conducted in the safe areas in Sudan due to the war from October 15 to November 30, 2024. A validated questionnaire, adapted from a previous study with cultural modifications, was administered both through face-to-face interviews and online platforms. Data were analyzed using R software, employing descriptive statistics and chi-square tests.

RESULTS: Out of 3525 participants, 98.8% reported having heard of epilepsy. Nonetheless, 56.7% believed it could be caused by genetic factors, 14.1% viewed it as a contagious disease, 37.8% attributed it to witchcraft, and 17.7% considered it a punishment from God. In terms of attitudes, 54.7% believed epilepsy prevents individuals from living a happy life, 17.2% saw it as an obstacle to marriage, 56.9% thought it negatively impacts education, 26.1% viewed it as a barrier to employment, and 74% felt that society discriminates against those with epilepsy. As for practices, 47.6% regarded spiritual healing (ruqya) as effective, while 72.3% recommended consulting a doctor during seizures. Additionally, 49.7% expressed skepticism about the effectiveness of traditional medical treatment for epilepsy.

SIGNIFICANCE: This study highlights considerable gaps in knowledge, attitudes, and practices related to epilepsy in Sudan. While many participants acknowledged genetic causes and endorsed the social inclusion of people with epilepsy (PWE), misconceptions-such as beliefs in contagion and supernatural causes-persist. Moreover, stigma and discrimination continue to pose significant challenges. Focused educational campaigns and public health interventions are essential to correct misconceptions, reduce stigma, and promote accurate, evidence-based awareness of epilepsy across Sudanese communities.

PLAIN LANGUAGE SUMMARY: This study among 3525 Sudanese adults assessed the most prevalent misconceptions about epilepsy by measuring their knowledge, attitudes, and practices related to the condition. Slightly more than half believed it could be inherited, about a third linked it to witchcraft, and some saw it as a punishment from God. Many participants also thought epilepsy prevents people from living happily, while others viewed it as an obstacle to marriage, education, and employment, with most recognizing discrimination in society. In terms of practice, almost half trusted spiritual healing, but most advised consulting a doctor, showing the need for education to reduce stigma and improve awareness.

PMID:40956593 | DOI:10.1002/epi4.70148

JAMA Netw Open. 2025 Sep 2;8(9):e2532020. doi: 10.1001/jamanetworkopen.2025.32020.

ABSTRACT

IMPORTANCE: Studies evaluating integrated pediatric behavioral health care using electronic medical record data are limited.

OBJECTIVE: To evaluate the association of receipt of integrated behavioral health services with changes in psychosocial symptoms among children receiving care at federally qualified health centers with behavioral health integration.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used electronic medical record data (June 2020 to April 2023) from children aged 4 to 18 years with an identified behavioral health concern at 4 Massachusetts federally qualified health centers with integrated behavioral health care. Data were analyzed in October 2024.

EXPOSURES: Receipt of integrated behavioral health services, categorized into 3 treatment groups: (1) receipt of behavioral health clinician (BHC) encounters, (2) community health worker encounters, and (3) psychotropic prescriptions. The control group included similar children who did not receive any of these treatments.

MAIN OUTCOMES AND MEASURES: The primary outcome was psychosocial symptom score based on the 17-item Pediatric Symptom Checklist (PSC-17). After applying propensity scores to match children receiving treatment and control groups on their baseline characteristics, associations of receiving a treatment with psychosocial symptoms were estimated by comparing scores before vs after treatment using linear regression models.

RESULTS: Of 942 unique children, 542 (57.5%) received any type of treatment and 400 (42.5%) were in the control group. Children with a BHC encounter and children without any treatment had similar baseline characteristics (female sex: 206 children [58.7%] vs 204 children [56.7%]; mean [SD] age, 11.8 [3.5] vs 11.7 [3.4] years). After having at least 1 encounter with a BHC, PSC-17 scores among children in the treatment group were 1.51 (95% CI, -2.65 to -0.37) points lower compared with the control group. After receiving a psychotropic prescription, PSC-17 scores among children in the treatment group were 2.21 (95% CI, -3.89 to -0.54) points lower compared with the control group. No statistically significant changes were observed among children with at least 1 community health worker encounter (-0.53 points; 95% CI, -1.86 to 0.80 points).

CONCLUSIONS AND RELEVANCE: In this cohort study of children at federally qualified health centers implementing behavioral health integration, receipt of encounters with BHCs and psychotropic prescriptions were associated with improved psychosocial symptoms, suggesting that expanding integrated pediatric behavioral health care might enhance behavioral health outcomes among marginalized pediatric populations.

PMID:40956583 | DOI:10.1001/jamanetworkopen.2025.32020

JAMA Netw Open. 2025 Sep 2;8(9):e2532100. doi: 10.1001/jamanetworkopen.2025.32100.

ABSTRACT

IMPORTANCE: Uterine fibroid embolization (UFE) is a minimally invasive alternative to surgery. Understanding utilization patterns and disparities in access is important to ensure that patients can explore all treatment options.

OBJECTIVE: To examine trends in the use of UFE vs hysterectomy and myomectomy for uterine fibroid management, with an emphasis on sociodemographic and institutional disparities.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used data from the 2016 to 2022 National Inpatient Sample obtained from the Healthcare Cost and Utilization Project, a population-based, multicenter inpatient dataset representing hospitals across the US. Adult patients with a diagnosis of uterine fibroids who underwent hysterectomy, myomectomy, or UFE were identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. Analysis was conducted in April 2025.

EXPOSURE: Patient age, race, ethnicity, insurance, income quartile, rurality, year of procedure, and hospital characteristics.

MAIN OUTCOMES AND MEASURES: The primary outcome was undergoing UFE, modeled using multivariable logistic regression, with hysterectomy, myomectomy, or surgery overall as reference groups. The covariate reference categories were age younger than 30 years, White race, private insurance, 76th to 100th income percentile, central metropolitan residence, the year 2016, small hospitals, rural hospitals, and hospitals in the Pacific division. Results were reported as adjusted odds ratios (aORs) with 95% CIs.

RESULTS: The sample encompassed 271 885 encounters, including 199 625 hysterectomies (73.4%), 62 675 myomectomies (23.1%), and 9585 UFEs (3.5%). The median (IQR) patient age was 47 (43-52) years for those undergoing hysterectomy, 45 (40-49) years for those undergoing UFE, and 37 (33-41) years for those undergoing myomectomy. With regard to race and ethnicity, 105 780 patients (38.9%) were African American, 16 175 (5.9%) were Asian or Pacific Islander, 48 810 (18.0%) were Hispanic, 1050 (0.4%) were Native American, 86 425 were White (31.8%), and 13 645 (5.0%) were other races. Increasing age was associated with lower odds of undergoing UFE vs hysterectomy, and higher odds of undergoing UFE vs myomectomy. African American patients were more likely to undergo UFE than hysterectomy (aOR, 1.64; 95% CI, 1.44-1.87), but less likely to undergo UFE than myomectomy (aOR, 0.84; 95% CI, 0.73-0.97). Hispanic patients were less likely to undergo UFE than both surgical procedures (aOR, 0.83; 95% CI, 0.71-0.97). Patients with Medicaid (aOR, 1.58; 95% CI, 1.41-1.77), self-pay (aOR, 1.97; 95% CI, 1.60-2.42), and no-charge (aOR, 1.97; 95% CI, 1.24-3.12) coverage had higher odds of undergoing UFE vs both surgical procedures. Among Medicare patients, UFE was more likely than myomectomy among those aged 30 to 49 years, but less likely among those aged 50 years and older. Those in the lowest income quartile (0-25th percentile) had greater odds of undergoing UFE vs myomectomy (aOR, 1.22; 95% CI, 1.04-1.43). Rural patients were less likely to undergo UFE than hysterectomy (aOR, 0.53; 95% CI, 0.34-0.83), whereas urban hospitals were more likely to perform UFE than both surgical procedures (aOR, 7.13; 95% CI, 3.43-14.80).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, UFE was underutilized with significant disparities across socioeconomic factors. Further efforts are needed to equitably expand access to UFE across the country.

PMID:40956582 | DOI:10.1001/jamanetworkopen.2025.32100

JAMA Netw Open. 2025 Sep 2;8(9):e2532164. doi: 10.1001/jamanetworkopen.2025.32164.

ABSTRACT

IMPORTANCE: The Predicting Risk of Cardiovascular Disease Events (PREVENT) equations are an updated model developed to improve on the Pooled Cohort Equation (PCE) for estimating 10-year atherosclerotic cardiovascular disease (ASCVD) risk. These equations facilitate patient-clinician discussions on initiating statin therapy and are used to estimate risk without treatment. However, statin exposure during follow-up was not fully accounted for in the development of these equations.

OBJECTIVE: To assess the performance of the PCE and PREVENT equations in estimating ASCVD, accounting for statin exposure during follow-up.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included adults from an integrated health care system with 10-year follow-up data. Adults without diabetes or ASCVD were identified in 2013 and followed-up through December 31, 2023, with analyses performed in January 2025.

MAIN OUTCOMES AND MEASURES: The primary outcome was incident ASCVD. Estimated risks from PCE and PREVENT equations were compared with observed risks, with discrimination assessed via C statistics. The performance of these equations was evaluated in patient populations stratified by statin exposure during follow-up.

RESULTS: Among 193 885 adults (median [IQR] age, 55 [48-63] years; 113 400 [58.5%] women), 6528 experienced an ASCVD event. The C statistic was 0.725 (95% CI, 0.719-0.731) for PCE and 0.723 (95% CI, 0.716-0.729) for PREVENT. In the overall population, regardless of statin exposure, the observed 10-year ASCVD risk was lower than estimated by PCE: 3.6% for individuals with estimated risk of 5% to less than 7.5%, 4.5% for those with estimated risk of 7.5% to less than 10%, and 8.0% for those with estimated risk of 10% or greater. The observed risk more closely aligned with the estimated risk from PREVENT: 5.2% for individuals with estimated risk of 5% to 7.5%, 8.1% for those with estimated risk 7.5% to less than 10%, and 11.6% for those with estimated risk of 10% or greater. In contrast, among patients not exposed to statin therapy during follow-up, PREVENT underestimated risk: observed risk was 8.2% for individuals with estimated risk of 5% to less than 7.5%, and 13.5% for those with estimated risk of 7.5% to less than 10%, while PCE-estimated risk more closely approximated the observed risk.

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study, the PREVENT model underestimated risk in patients not treated with statins, whereas the PCE estimates more closely reflected what a patient’s risk would be without statin therapy.

PMID:40956580 | DOI:10.1001/jamanetworkopen.2025.32164

Int Urol Nephrol. 2025 Sep 16. doi: 10.1007/s11255-025-04782-x. Online ahead of print.

ABSTRACT

PURPOSE: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is a cornerstone treatment for resectable peritoneal carcinomatosis. Urologic reconstructive surgery is required in 7-20% of cytoreductive surgeries due to urinary tract involvement or injury, yet current literature on outcomes remains limited. This study presents one of the largest single-institution cohorts examining outcomes of urologic reconstruction in CRS/HIPEC cases, and is the first to investigate the impact of preoperative planning and intraoperative timing of urologic reconstruction on postoperative outcomes.

METHODS: A retrospective analysis of 314 cases was performed from June 2010 to August 2023. Data from cases involving urologic reconstruction were analyzed, including demographics, surgical details, and outcomes. Statistical analyses evaluated associations between surgical variables and short and long-term urologic complications.

RESULTS: Urologic reconstruction was performed in 35 cases (11.1%), with the majority occurring after HIPEC administration. Postoperative urologic complications occurred in 57% of cases. 40% of the urologic reconstruction cases resulted in low-grade, short-term urologic complications (AKI, UTI) while 20% were deemed high-grade (sepsis, urine leak). 29% developed long-term sequelae such as ureteral stricture or urinary retention. Longer operative times were significantly associated with long-term complications. No significant differences were found in long-term complication rates based on the timing of urologic repair (pre-HIPEC or post-HIPEC) or whether urologic intervention was planned prior to surgery. Interestingly, there was a significant association between fewer prior abdominal surgeries and higher complication rates.

CONCLUSIONS: Surgical complexity and prior surgical history are key determinants of postoperative outcomes following urologic reconstruction at the time of cytoreductive surgery. Timing of urologic intervention and specific preoperative variables, such as age and peritoneal cancer index score, did not significantly impact long-term outcomes. Higher complication rates were also seen among patients with fewer prior abdominal surgeries, which may in part be due to selection bias or other unaccounted variables present in the patients with fewer abdominal surgeries. These findings highlight the importance of individualized surgical planning and inform preoperative discussions about the risks and benefits of CRS with HIPEC.

PMID:40956567 | DOI:10.1007/s11255-025-04782-x

J Endocrinol Invest. 2025 Sep 16. doi: 10.1007/s40618-025-02702-5. Online ahead of print.

ABSTRACT

OBJECTIVE: Cushing Disease (CD) presents with typical clinical findings, even though, there is a wide spectrum of manifestations. Over the years, the sings and symptoms of Cushing’s syndrome (CS) have become more subtle and atypical forms of CS have emerged. In this study, we aimed to investigate the changes in the clinical presentation of CD in recent years.

MATERIALS AND METHODS: In this study, CD patients followed by our center were examined. A total of 258 patients with CD were included in the study. The clinical findings at the time of presentation, laboratory and imaging findings, treatment modalities and remission status in the first year after treatment were evaluated.

RESULTS: The mean age of the patients included in the study was 41.3 ±13.28 years. CD patients diagnosed between 2013 and 2023 were older than those diagnosed between 1990 and 2012 (p < 0.001). There was no difference between the groups in terms of gender. Moon face, purple striae, hirsutism, and menstrual irregularities were statistically significantly less frequent in the last 10 years than in previous years (p < 0.001; p = 0.004; p < 0.001; p < 0.001, respectively). In addition, patients who applied after 2013 had lower baseline cortisol and adrenocorticotropic hormone (ACTH) levels, and a smaller median size of the pituitary adenoma. Limitations of the study include its retrospective design and the subjectivity of clinical data.

CONCLUSION: As the clinical presentation of Cushing’s disease changes over time, waiting for the typical Cushing’s clinic can delay diagnosis. It is important that clinicians take this into account when they suspect CD.

PMID:40956565 | DOI:10.1007/s40618-025-02702-5

Community Ment Health J. 2025 Sep 16. doi: 10.1007/s10597-025-01515-3. Online ahead of print.

ABSTRACT

Peer Recovery Support Specialists (PRSS) play a crucial role in the behavioral health (BH) workforce, assisting individuals in their recovery from substance use and mental health challenges. Despite their essential contributions to the BH field, research on resilience among peers remains limited. To address the literature gap, this study examined how PRSS’ personal resilience and workplace satisfaction with supervisor and organizational support mediate the relationship between burnout and job satisfaction. Secondary analysis was conducted using cross-sectional survey data of U.S.-based PRSS (N = 454). Validated measures of burnout, personal resilience, job satisfaction, and workplace support were utilized. Path analysis was used to test the hypothesized mediating roles of personal resilience and satisfaction with supervisor and organizational support. The hypothesized model accounted for 42% of the variance in job satisfaction and yielded excellent model fit: χ² (14) = 14.52, p = .41, RMSEA = 0.01 (90% CI = 0.00-0.05), CFI = 1.00, and TLI = 1.00. All three variables were statistically significant mediators. Burnout was directly and negatively associated with job satisfaction. Personal resilience and satisfaction with supervisor and organizational support were positively associated with job satisfaction and negatively with burnout. This study identified key mediating pathways through which burnout impacts job satisfaction among PRSS, underscoring the dual importance of personal resilience and workplace supports and demonstrating the multilevel conditions that can shape PRSS’ professional well-being. Results highlighted the need for organizations, policymakers, and researchers to collaboratively develop and assess PRSS-centric interventions that foster supportive and well-resourced work environments.

PMID:40956564 | DOI:10.1007/s10597-025-01515-3

Braz J Microbiol. 2025 Sep 16. doi: 10.1007/s42770-025-01774-y. Online ahead of print.

ABSTRACT

Epstein-Barr virus (EBV) infection has been suggested as a potential cofactor for the development and progression of cervical cancer, collaborating with high-risk Human Papillomavirus (HR-HPV). In situ hybridization (ISH) has been considered the gold standard in the investigation of EBV in neoplasms. This study aimed to detect EBV in cervical carcinoma samples using ISH targeting EBERs (EBER-ISH) and the BamHI-W region of the viral genome (BamHI-W-ISH), and compare the results of both targets. Of the 88 cases collected, 9 were EBER-ISH positive (10.2%), while 33 (37.5%) cases were positive for EBV by BamHI-W-ISH, all showing staining in the nuclei of the malignant cells. No statistically significant results were found between the presence of EBV and carcinoma type, differentiation grade or tumor staging. The kappa agreement index between the two targets was 0.092. Only 4 cases were EBER-ISH(+) and BamHI-W-ISH(-). On the other hand, 28 cases were BamHI-W-ISH(+) and EBER-ISH(-). Altogether, 37/88 (42%) cases were EBV-positive by one or both targets. Infected lymphocytes were verified in 9 (10.2%) and 34 (38.6%) cases, by EBER-ISH and BamHI-W-ISH, respectively. The slight agreement demonstrated between the targets may be due to the lack of expression of EBERs, suggesting that EBV may present a distinct latency pattern in the cervical mucosa, or that it has entered the replicative cycle in some of these tumors, in both cases, explaining the low positivity rate verified through EBER-ISH, while calling into question the latter’s gold standard status in the detection of EBV in malignancies. Our findings also indicate that the chosen viral genomic target may represent a suitable candidate for EBV detection by ISH.

PMID:40956558 | DOI:10.1007/s42770-025-01774-y

Diabetes Ther. 2025 Sep 16. doi: 10.1007/s13300-025-01788-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Early onset type 2 diabetes (T2D), diagnosed before age 40 years, is potentially more aggressive than later-onset disease and is increasing in prevalence globally. We examined the prevalence of early onset T2D in the USA and characterised this population.

METHODS: Data from the longitudinal series of NHANES cross-sectional surveys conducted between 1999 and 2020 were analysed retrospectively. The prevalence of diagnosed and undiagnosed early onset T2D was estimated across this period and the demographics, clinical characteristics and frequency of comorbidities in this population were described. Findings were compared with the US later-onset T2D population during the same period.

RESULTS: The prevalence of diagnosed and undiagnosed early onset T2D increased from 1.42% (standard error 0.19) and 0.18% (0.09), respectively, during the 1999-2000 survey cycle to 1.72% (0.24) and 0.35% (0.06), respectively, during the 2017-2020 cycle. Compared with those with later-onset disease, participants with early onset T2D had a lower mean poverty-income ratio, were more likely to be Hispanic or have no health insurance and less likely to be non-Hispanic white or have private or Medicare insurance (all p < 0.05). Individuals with early onset T2D generally had a worse cardiometabolic profile, with higher mean glycated haemoglobin, Homeostatic Model Assessment for Insulin Resistance score, fasting insulin and glucose, body mass index and waist circumference but were less likely to have congestive heart failure, coronary heart disease, stroke, chronic kidney disease or cancer (all p < 0.05). All comparisons remained statistically significant after adjustment for T2D duration among participants with diagnosed T2D.

CONCLUSIONS: These findings suggest that early onset T2D may disproportionately affect underserved populations with a higher likelihood of having cardiometabolic risk factors, suggesting a more aggressive disease that warrants the need for better diagnoses and treatment. Further research is needed to explore the potential link between cardiometabolic profile, risk of complications and longer-term cardiovascular outcomes in people with early onset T2D.

PMID:40956554 | DOI:10.1007/s13300-025-01788-7