Category: Statistics

JAMA Netw Open. 2026 Mar 2;9(3):e261585. doi: 10.1001/jamanetworkopen.2026.1585.

ABSTRACT

IMPORTANCE: Colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of cancer-associated deaths in the US. Hispanic and non-Hispanic Black patients experience higher colorectal cancer mortality rates compared with non-Hispanic White patients. More data are needed to understand the role of cancer biology in colorectal cancer survival disparities among racial and ethnic minority groups.

OBJECTIVE: To evaluate racial and ethnic differences in KRAS variant frequency and the association of presence of a KRAS variant with colorectal cancer-specific survival.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study used data from the Surveillance, Epidemiology, and End Results Program and included patients diagnosed with colorectal cancer from 2010 through 2015, with follow-up through December 31, 2018. Data were analyzed between December 2023 and August 2024.

EXPOSURE: Racial and ethnic differences in KRAS variant frequency.

MAIN OUTCOMES AND MEASURES: Outcomes of interest were cumulative incidence of colorectal cancer-specific death, assessed using cumulative incidence functions, and subdistribution hazard ratio (sHR) for colorectal cancer-specific death, assessed using Fine-Gray regression models.

RESULTS: A total of 21 354 patients (mean [SD] age at diagnosis, 62.54 [13.78] years; 9653 females [45.2%]; median [IQR] follow-up, 2.67 [1.25-4.17] years) were included in the analysis, including 1680 Asian or Pacific Islander patients (7.8%), 2459 Hispanic patients (11.5%), 2761 non-Hispanic Black patients (12.9%), and 14 454 non-Hispanic White patients (67.7%). Hispanic patients and non-Hispanic Black patients had higher KRAS variant frequencies than non-Hispanic Asian or Pacific Islander patients and non-Hispanic White patients (44.2% and 48.3% vs 37.5% and 39.3%, respectively). Among patients with KRAS wild-type tumors, the unadjusted cumulative incidence of colorectal cancer-specific death was highest for Hispanic patients (59.5%; 95% CI, 55.4%-63.3%; P < .001); among patients with KRAS variant tumors, colorectal cancer-specific death was highest for non-Hispanic Black patients (67.3%; 95% CI, 63.3%-70.9%; P < .001). Among patients with KRAS wild-type tumors, Hispanic patients showed a significantly increased risk of colorectal cancer-specific death (sHR, 1.11; 95% CI, 1.01-1.22; P = .03). Among patients with KRAS variant tumors, non-Hispanic Black patients had a significantly increased risk of colorectal cancer-specific death (sHR, 1.18; 95% CI, 1.07-1.29; P < .001).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of patients with colorectal cancer, Hispanic patients and non-Hispanic Black patients had higher KRAS variant prevalence than non-Hispanic White patients. Among patients with a KRAS variant, non-Hispanic Black patients had worse cause-specific survival than non-Hispanic White patients. Among patients with wild-type KRAS, Hispanic patients had worse survival compared with non-Hispanic White patients. These findings highlight the need for further research on racial and ethnic differences in KRAS-related outcomes.

PMID:41817523 | DOI:10.1001/jamanetworkopen.2026.1585

JAMA Otolaryngol Head Neck Surg. 2026 Mar 12. doi: 10.1001/jamaoto.2026.0044. Online ahead of print.

ABSTRACT

IMPORTANCE: Otitis media with effusion (OME) is a common condition in children that can lead to hearing loss and developmental delays. Although tympanostomy tube (TT) placement is the standard treatment for persistent OME, recurrence after tube extrusion and the need for reoperation remain significant concerns.

OBJECTIVE: To evaluate the clinical effectiveness of autoinflation in reducing OME recurrence and reoperation rates after TT extrusion in pediatric patients.

DESIGN, SETTING, AND PARTICIPANTS: This prospective randomized clinical trial, conducted from September 2019 to August 2022 at a tertiary hospital, enrolled children with chronic OME who underwent TT placement with 2 years of follow-up after TT extrusion. The statistical analysis took place between March 2024 and February 2025.

INTERVENTIONS: After TT extrusion, patients were randomized to receive autoinflation with the autoinflation device for 5 weeks or to undergo observation alone.

MAIN OUTCOMES AND MEASURES: The main outcomes were OME recurrence and reoperation rates using otoscopic and tympanometric evaluations.

RESULTS: Sixty-six children enrolled in the study; 54 were included in the final analysis (26 in the autoinflation group and 28 in the observation group). Among 54 children (mean [SD] age, 55.5 [18.5] months; 30 [55.6%] male), the recurrence rate was 5 of 26 patients (19.2%) in the autoinflation group and much higher at 10 of 28 patients (35.7%) in the observation group (difference, 16.5 percentage points [pp]; 95% CI, -7.4 pp to 37.8 pp), while the reoperation rate was much lower in the autoinflation group at 2 of 26 patients (7.7%) compared to the observation group at 8 of 28 patients (28.6%; difference, 20.9 pp; 95% CI,-0.29 pp to 40.2 pp). In the autoinflation group, tympanometry showed minimal change from the first follow-up after TT extrusion to after 5 weeks of autoinflation therapy (type A tympanogram: 19 of 26 patients [73.1%] to 20 of 26 patients [76.9%]; type C tympanogram: 7 of 26 patients [26.9%] to 6 of 26 patients [23.1%]). In contrast, the observation group exhibited a decline in type A tympanograms (21 of 28 patients [75.0%] to 16 of 28 patients [57.1%]) and an increase in type C tympanograms (7 of 28 patients [25.0%] to 12 of 28 patients [42.9%]).

CONCLUSION AND RELEVANCE: In this randomized clinical trial, autoinflation after TT extrusion was safe, feasible, and associated with a reduced need for repeat surgical intervention. The observed difference in recurrence was compatible with a clinically meaningful reduction. These findings support the use of autoinflation as a noninvasive rehabilitative strategy to enhance eustachian tube function and maintain middle ear ventilation following TT extrusion.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT07122999.

PMID:41817520 | DOI:10.1001/jamaoto.2026.0044

Value Health Reg Issues. 2026 Mar 12:101602. doi: 10.1016/j.vhri.2026.101602. Online ahead of print.

ABSTRACT

OBJECTIVES: Malaysia bears a considerable burden of cardiovascular diseases, reporting one of the highest prevalence rates in Southeast Asia. This underscores the need for equitable access to and efficient use of statins, the primary agents in cardiovascular disease prevention in Malaysia’s 2-tiered health system. This study compared trends in the utilization, expenditures, and cost per defined daily dose (DDD) of statins in Malaysia’s public and private healthcare sectors from 2004 to 2022.

METHODS: National aggregate data on simvastatin, atorvastatin, and rosuvastatin were extracted from the Malaysian Statistics on Medicines. Expenditures were adjusted for inflation. Cost per DDD was calculated by dividing inflation-adjusted expenditure by total DDDs consumed. Joinpoint regression was used to describe temporal changes in utilization and expenditure trends.

RESULTS: Statin utilization increased in both sectors over the study period, with substantially stronger growth in the public sector. Atorvastatin had the highest growth rate in the public sector with an average annual percent change of 25.27%, whereas rosuvastatin increased most rapidly in the private sector (average annual percent change 13.09%). There were substantial differences in the cost per DDD for the statins between the 2 sectors over the study period. The public sector demonstrated improved cost efficiency over time, whereas the private sector exhibited persistently high expenditures, especially for rosuvastatin.

CONCLUSIONS: There were distinct differences in statin utilization and cost burden between the public and private sectors. Targeted measures to promote generic uptake and address pricing disparities are essential to ensure equitable access to statins across Malaysia’s 2-tiered healthcare system.

PMID:41817501 | DOI:10.1016/j.vhri.2026.101602

J Nutr Educ Behav. 2026 Mar 12:S1499-4046(26)00031-X. doi: 10.1016/j.jneb.2026.01.016. Online ahead of print.

ABSTRACT

OBJECTIVE: An evaluation of a team-based pilot program with food vouchers.

DESIGN: Single-arm prepost mixed-method study.

SETTING: Two safety-net primary care clinics in San Francisco.

PARTICIPANTS: Black/African American and/or Hispanic/Latinx patients with uncontrolled diabetes (hemoglobin A1c >8%).

INTERVENTION(S): Six-month program including pharmacist and nutritionist visits, transportation assistance, and smoking cessation resources, plus $160 per month of grocery and produce vouchers.

MAIN OUTCOME MEASURE(S): Glycemic control and blood pressure. Secondary outcomes included qualitative insights into program benefits.

ANALYSIS: Descriptive statistics were used for patient characteristics, voucher use, and program satisfaction. Clinical outcomes used McNemar’s tests for paired categorical variables and paired t tests for continuous variables. Interviews were transcribed and analyzed with deductive coding.

RESULTS: A total of 45 participants redeemed 68.7% of vouchers. Uncontrolled hypertension (≥ 140/90 mmHg) decreased significantly from 45.9% to 21.6% (P = 0.007, n = 41). There was no statistically significant change in mean hemoglobin A1c from baseline to program end (10.1% vs 9.7%; P = 0.17). Mean low-density and body mass index were not significantly different. Major themes from interviews include changes in health behaviors, improved relationships with food, and strengthened engagement with team-based care.

CONCLUSIONS AND IMPLICATIONS: Combining vouchers and team-based care may be an avenue to improve care for patients with diabetes. Further investigation of this program model through a larger and rigorously designed study is needed for conclusive findings on this approach.

PMID:41817481 | DOI:10.1016/j.jneb.2026.01.016

J Nutr Educ Behav. 2026 Mar 11:S1499-4046(26)00005-9. doi: 10.1016/j.jneb.2026.01.006. Online ahead of print.

ABSTRACT

OBJECTIVE: Preschool Education in Applied Sciences (PEAS) intervention, a multicomponent intervention designed to improve teachers’ science teaching self-efficacy and enhance children’s fruit and vegetable consumption, science knowledge, and language development.

DESIGN: A 2-group (comparison/delayed intervention) quasi-experimental design was employed. Teachers completed baseline, formative, and postintervention surveys. Intervention teachers also completed a postintervention interview. Child outcomes were assessed at 3 timepoints (baseline, preintervention, and postintervention) using validated measures.

SETTING: Thirteen Head Start centers in central North Carolina.

PARTICIPANTS: Ninety-four teachers (n = 44 intervention; n = 50 comparison) and 330 English-speaking children aged 3-5 years (n = 140 intervention; n = 190 comparison), based on power analysis estimates.

INTERVENTION: Components included a 1-day Kick-Starter Workshop, 6 eLearning modules, PEAS teaching guide featuring 12 classroom activities, and center-based implementation supports including individualized coaching, peer learning communities, and farm to early care and education resources.

MAIN OUTCOME MEASURES: Teacher outcomes included self-reported teaching self-efficacy. Child outcomes include fruit and vegetable consumption (skin carotenoids via Veggie Meter®), height/weight, science knowledge, and academic vocabulary.

ANALYSIS: Quantitative data were analyzed using descriptive statistics, paired t tests, Wilcoxon signed-rank tests, and regression models. Qualitative data were analyzed phenomenologically.

PMID:41817479 | DOI:10.1016/j.jneb.2026.01.006

J Nutr Educ Behav. 2026 Mar 12:S1499-4046(26)00037-0. doi: 10.1016/j.jneb.2026.02.001. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess whether a nutrition and body image program improved healthy food consumption, physical activity, eating pathology, and psychosocial factors for women in recovery from substance use.

DESIGN: Secondary data, pretest-posttest.

SETTING: In-person intervention conducted in 6 substance use recovery centers.

PARTICIPANTS: Six hundred and seven adult women.

INTERVENTION: Ten-week, 90-minute weekly intervention led by trained instructors.

MAIN OUTCOME MEASURES: Self-report demographics, drug-use history, general nutrition and health behaviors, thin-ideal internalization, body dissatisfaction, eating pathology, binge eating, and intuitive eating. Researchers collected anthropometric/physiological measures.

ANALYSIS: Paired t tests using Cohen’s d tested the differences between pretest and posttest total scores on all outcome measures; univariate analysis of variance tests were used for pretest participant comparison.

RESULTS: Participants demonstrated statistically significant (P < 0.05) improvements in general nutrition, physical activity, thin-ideal internalization, body dissatisfaction, eating pathology, binge eating, and intuitive eating behaviors compared with pretest, with effect sizes ranging from small to large (d = 0.11-0.83). Participants also reported decreases in weight-related concerns.

CONCLUSIONS AND IMPLICATIONS: Healthy eating and physical activity significantly increased, whereas thin-ideal internalization, body dissatisfaction, and disordered eating symptoms significantly decreased. Results support this program to augment existing substance use treatment to address nutrition, physical activity, body image, eating pathology, and weight-related issues in women.

PMID:41817478 | DOI:10.1016/j.jneb.2026.02.001

J Hand Surg Am. 2026 Mar 12:S0363-5023(26)00137-1. doi: 10.1016/j.jhsa.2026.02.007. Online ahead of print.

ABSTRACT

In this Hand Surgery Landscape review, we aim to discuss the history and future of the peer-review process within hand and upper-extremity surgery. In addition, this review will serve as a practical “how to” guide for reviewers by providing strategies and insights aimed at improving the quality of manuscript reviews. Prereview considerations, such as content, statistical expertise, bias, and potential conflicts of interest, will be addressed. Topics relative to each manuscript section will be presented including common methodological errors.

PMID:41817471 | DOI:10.1016/j.jhsa.2026.02.007

Eye Contact Lens. 2026 Mar 11. doi: 10.1097/ICL.0000000000001263. Online ahead of print.

ABSTRACT

PURPOSE: Orthokeratology (OK) has been recognized as an effective intervention for slowing myopia progression. However, its effects on the accommodative response and its role in myopia control remain controversial. This systematic review and meta-analysis aimed to provide a comprehensive evaluation of the OK influence on accommodation.

METHODS: Cochrane, Embase, and PubMed were searched for studies published up to April, 2024. All eligible studies that compared OK with a neutral control and reported measurements related to accommodative response in myopic patients were included. The outcomes evaluated were accommodation lag (AL), positive relative accommodation, and accommodation amplitude (AA). The mean difference [MD] and 95% confidence interval were used for continuous outcomes. Heterogeneity was assessed using I2 statistics. The analysis was performed using R software version 4.4.1.

RESULTS: A total of 14 studies comprising 1,404 patients met the inclusion criteria. Single vision spectacles was the control group in 12 articles, soft single vision contact lenses in one, and no intervention in one. The OK group showed a significant reduction in AL compared with control groups at 3 months follow-up (MD: -0.38D; confidence interval [CI]: -0.54 to -0.22D; P<0.00001; I2=0%). At 12 months, OK significantly increased AA compared with controls (MD: 0.64D; CI: 0.25 to 1.03D; P=0.001; I2=69%), which was not observed at 3 months (MD: 0.26D; CI: -0.16 to 0.70D; P=0.21; I2=80%). Positive relative accommodation did not differ significantly at 3 months (MD: -0.53D; CI: -1.08 to 0.02D; P=0.06; I2=83%).

CONCLUSION: This meta-analysis demonstrates that OK significantly reduces AL and, in the long-term, increases AA compared with controls. These findings suggest that OK does improve the accommodation response, which may contribute to one of the mechanisms underlying its effectiveness in slowing myopia progression.

PMID:41817443 | DOI:10.1097/ICL.0000000000001263

Cancer Control. 2026 Jan-Dec;33:10732748261435696. doi: 10.1177/10732748261435696. Epub 2026 Mar 12.

ABSTRACT

IntroductionCancer clinical trials do not always represent the real-world cancer population, as older adults and marginalized racial groups are often underrepresented. This study assessed patterns of enrollment of underrepresented patients and how trial and site factors may influence enrollment.MethodsThis retrospective, pooled cross-sectional study used de-identified data from ECOG-ACRIN (EA)-sponsored breast cancer therapeutic clinical trials from 2002-2020. Patient- and trial-level data were extracted from EA trials and ClinicalTrials.gov. Site-level data were from de-identified Landscape Assessment surveys voluntarily completed by National Cancer Institute Community Oncology Research Program sites. Outcomes included the proportions of underrepresented patients enrolled on a trial. Fractional regression models evaluated associations between trial-level factors and enrollment proportions of underrepresented patients using adjusted means and 95% confidence intervals (CI). Weighted Kappa (Kw) statistics and corresponding 95% CI estimated the level of agreement between patient populations served by sites versus enrolled on a trial.ResultsOf 9,015 patients enrolled across 12 trials, 18% were aged ≥65 years old, 12% were Black, 15% were Medicare beneficiaries, and 15% were rural residents (unadjusted enrollment). Adjusted mean proportion enrollment of underrepresented patients was similar to unadjusted results. Over half of trials were randomized and 92% of studies had two or more drugs in the protocol, yet these did not appear to influence mean enrollment of underrepresented groups. Moderate levels of agreement were found between Black patients served versus enrolled (Kw 0.64; 95% CI 0.50-0.78), and low or no agreement for Medicare beneficiaries and patients aged ≥65 (Kw 0.18, 0.05-0.31; Kw 0.02, -0.06-0.11; respectively).ConclusionsEA-sponsored breast trials continue to enroll few individuals from underrepresented backgrounds. Trial design had a minimal impact on enrollment and patient populations sites served did not typically match the patients enrolled on trials. More research is needed to engage sites and test strategies for enrolling underrepresented patients.

PMID:41817416 | DOI:10.1177/10732748261435696

J Cell Biol. 2026 May 4;225(5):e202505190. doi: 10.1083/jcb.202505190. Epub 2026 Mar 12.

ABSTRACT

Tetraspanins are integral membrane proteins that play a crucial role in organizing and regulating cellular signaling by serving as scaffolds that compartmentalize receptors and other signaling molecules within membrane microdomains. Here, we report how the tetraspanin CD82 modulates the molecular organization and signaling of the EGF receptor (EGFR), a key molecule involved in cellular proliferation, differentiation, and survival. Combining multicolor super-resolution microscopy with advanced image reconstruction and analysis techniques, we demonstrate that CD82 selectively associates with EGFR, promotes receptor oligomerization, and acts as a regulator of ligand-independent receptor phosphorylation in a palmitoylation-dependent manner. Additionally, CD82 promotes a more compact molecular organization of EGFR, which correlates with altered endocytosis and downstream signaling outcomes. These findings underscore the importance of tetraspanins in the spatial and functional regulation of cell surface receptors, with implications for controlling aberrant signaling in disease and positions CD82 as a potential target for developing therapeutic strategies aimed at modulating EGFR signaling by influencing receptor organization.

PMID:41817402 | DOI:10.1083/jcb.202505190