Category: Statistics

JAMA Netw Open. 2026 Apr 1;9(4):e267479. doi: 10.1001/jamanetworkopen.2026.7479.

ABSTRACT

IMPORTANCE: Collaborative statisticians and methodologists are essential members of multidisciplinary teams, yet little is known about how their diverse responsibilities, including technical analysis, project leadership, and domain-specific consultation across multiple concurrent projects, affect their work-life balance and professional well-being.

OBJECTIVE: To assess perceptions of work-life balance and identify individual, job-related, and organizational factors associated with work-life balance among collaborative statisticians and methodologists working in multidisciplinary settings.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey study collected data from November 2022 to May 2024, with analysis conducted in December 2024. Anonymous electronic surveys were distributed through international professional statistical societies, including organizations in North America, Europe, Africa, South America, and Asia. Participants were recruited via a convenience sample through society email listservs and newsletters. Eligible respondents were statisticians, data scientists, or methodologists working in multidisciplinary collaborative settings who had been continuously employed full-time during the previous year.

MAIN OUTCOMES AND MEASURES: Work-life balance was assessed using the 15-item Work-Life Balance Self-Assessment Scale, which consists of 3 subscales: Work Interference With Personal Life, Personal Life Interference With Work, and Work/Personal Life Enhancement. Regression analyses were used to identify the demographic, organizational, and discipline-specific factors associated with respondents’ perception of work-life balance.

RESULTS: Of 627 individuals who accessed the survey, 450 (71.8%) met eligibility criteria and completed the survey. Of the 450 respondents who completed the survey, the mean (SD) age was x (y) years, 240 (53.7%) were female, and 270 (60.0%) worked in academia; 143 (31.8%) reported dissatisfaction with their work-life balance, and an additional 47 (10.4%) reported neutral satisfaction. Factors associated with higher work interference scores included unmanageable workload (mean difference, 0.70; 95% CI, 0.48 to 0.92), work-related health issues (mean difference, 0.58; 95% CI, 0.33 to 0.83), inability to complete work during regular hours (mean difference, 0.56; 95% CI, 0.34 to 0.78), and lack of organizational support for work-life balance (mean difference, 0.48; 95% CI, 0.24 to 0.73). Organizational flexibility to attend to personal matters (mean difference, -0.33; 95% CI, -0.64 to -0.01) and adequate compensation (mean difference, -0.29; 95% CI, -0.49 to -0.09) were associated with lower interference scores.

CONCLUSIONS AND RELEVANCE: These findings suggest that targeted educational initiatives, effective mentorship, and wellness-focused organizational policies can foster sustainable work-life balance among statisticians and methodologists in multidisciplinary settings.

PMID:42043821 | DOI:10.1001/jamanetworkopen.2026.7479

JAMA Netw Open. 2026 Apr 1;9(4):e268823. doi: 10.1001/jamanetworkopen.2026.8823.

ABSTRACT

IMPORTANCE: Patient delays in recognizing and acting on acute coronary syndrome (ACS) symptoms worsen outcomes.

OBJECTIVE: To evaluate the effectiveness of a heart attack education intervention (Heart Matters) aiming to improve recognition and response to ACS symptoms in communities with elevated cardiovascular risk and low emergency medical service (EMS) use.

DESIGN, SETTING, AND PARTICIPANTS: This stepped-wedge cluster randomized clinical trial was conducted in 8 high-risk communities (local government areas; 4 metropolitan and 4 rural with a combined population of approximately 792 000 adult residents) in Victoria, Australia (December 2021 to March 2023 with follow-up to March 2024), with clusters crossing to the intervention every 4 months. Data were obtained from administrative datasets and registries (analysis complete June 2025).

INTERVENTION: A multicomponent community education program including 490 community sessions (approximately 10 088 residents), more than 174 110 households mailouts, more than 50 000 resource handouts, opportunistic media, and a geotargeted social-media campaign (reach of approximately 350 000 residents). The control period did not include any educational campaign.

MAIN OUTCOME AND MEASURES: The primary outcome was the proportion of patients with ACS transported to hospitals by EMS, as recorded in the Victorian Emergency Minimum Dataset. Outcomes were analyzed at the patient level using mixed-effects regression models, reporting risk differences (RDs) and odds ratios (ORs). A program evaluation was also conducted to assess implementation and inform potential replication and scale-up.

RESULTS: Among 1775 patients with ACS (865 intervention and 910 control; 924 [52.1%] aged ≥65 years; 1193 male [67.2%]), EMS use was unexpectedly high during the initial control period, coinciding with a COVID-19 wave. EMS transport occurred in 624 of 910 patients with ACS (68.6%) in the control period and 548 of 865 patients (63.4%) in the intervention period (adjusted RD, -8.98%; 95% CI, -17.50% to -0.46%; P = .04; adjusted OR, 0.67; 95% CI, 0.45 to 1.01; P = .05). Reductions were more pronounced in metropolitan areas (RD -10.73%; 95% CI -20.43% to -1.03%) and during a severe flooding event (RD -13.50%; 95% CI -26.52% to -0.47%). Early treatment-seeking was also lower, although estimates were imprecise. The program evaluation identified COVID-19 pandemic and seasonal impacts, as well as community concerns regarding EMS costs, demand, and wait times.

CONCLUSIONS AND RELEVANCE: In this community ACS education trial conducted in high-risk regions, the intervention did not improve EMS use or prehospital care-seeking. External contextual factors, including the COVID-19 pandemic and natural disasters, appeared to influence patient behavior and may have attenuated intervention effects, highlighting the complexity of achieving behavioral change through community education alone.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04995900.

PMID:42043820 | DOI:10.1001/jamanetworkopen.2026.8823

JAMA Netw Open. 2026 Apr 1;9(4):e269267. doi: 10.1001/jamanetworkopen.2026.9267.

ABSTRACT

IMPORTANCE: A thorough examination of the patient is a crucial component of providing high-quality care and is regarded as best practice in the assessment of female patients presenting with lower urinary tract symptoms (LUTS). Nevertheless, anecdotal reports suggest that pelvic examinations are infrequently performed in the outpatient setting, raising important questions regarding adherence to established standards of care.

OBJECTIVE: To explore the practices and attitudes of urologists toward pelvic examination for patients with LUTS.

DESIGN, SETTING, AND PARTICIPANTS: In this qualitative, mixed-methods study, a structured 9-question survey about digital rectal and pelvic examination practices was distributed between November 19, 2023, and May 19, 2024, to urologists and urology trainees via the Urological Society of Australia and New Zealand newsletter across Australia and New Zealand. The end of the survey invited clinicians to participate in a semistructured interview to further discuss their responses.

MAIN OUTCOMES AND MEASURES: The primary outcomes were urologist-reported responses to the survey assessing the numbers and percentages of male and female clinicians who routinely performed pelvic and digital rectal examinations for patients with LUTS at their initial appointment and qualitative semistructured interview responses to identify themes associated with clinician attitudes toward pelvic examinations.

RESULTS: Of 553 consultant urologists and 100 urology trainees sent the survey, 74 participants responded, a response rate of 11.8%. A total of 74 clinicians (46 [62.2%] male), comprising 63 urologists and 11 urology trainees, completed the survey. While 89.1% (95% CI, 80.1%-98.1%) of male clinicians and 92.9% (95% CI, 83.3%-100.0%) of female clinicians consistently performed digital rectal examinations for male patients presenting with LUTS, only 8.7% (95% CI, 5.5%-16.8%) of male clinicians routinely conducted pelvic examinations for female patients compared with 85.7% (95% CI, 72.8%-92.9%) of female clinicians (P < .001). In total, 10 semistructured interviews were conducted. Two major themes were identified: fear, including medicolegal reprimand, clinician and patient discomfort or reluctance, and failure to recognize pathology; and barriers to pelvic examinations, including perceived poor utility, limited access to chaperones, and concerns for patient discomfort.

CONCLUSIONS AND RELEVANCE: Findings of this study suggested that male clinicians were less likely than female clinicians to perform pelvic examination for female patients who presented with LUTS. Barriers to pelvic examination need to be addressed to enable female patients to receive optimal care. Focused training may help prevent unnecessary operative procedures and improve patient outcomes.

PMID:42043817 | DOI:10.1001/jamanetworkopen.2026.9267

JAMA Netw Open. 2026 Apr 1;9(4):e269274. doi: 10.1001/jamanetworkopen.2026.9274.

ABSTRACT

IMPORTANCE: Pediatric hemovigilance is a nascent field in transfusion medicine. The lack of standardized hemovigilance reporting in the US makes it difficult to determine age-specific transfusion reaction rates and risks.

OBJECTIVE: To evaluate the rates and epidemiology of transfusion reactions reported to transfusion services in neonatal and pediatric populations.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed transfusion reactions occurring in children younger than 18 years reported to 8 hospitals’ transfusion services during April 1, 2019, through December 31, 2023. Data were evaluated from March 2024 to June 2025 using standardized data collection forms and associated electronic health records.

EXPOSURE: Patients who received transfused blood products (red blood cells [RBCs], platelets, plasma, or cryoprecipitate) with at least 1 transfusion reaction reported to the transfusion service.

MAIN OUTCOMES AND MEASURES: Reaction rates per 100 000 products transfused were calculated. Pediatric transfusion reactions were characterized in detail, including reported severity and imputability; product type; patient age, sex, race, and ethnicity; and reported symptoms, premedication, and clinical management.

RESULTS: The sample included 228 886 products transfused to 22 628 patients (median [IQR] age, 4.2 [0.3-12.4] years; 127 903 males [55.9%]). The products were transfused to patients of Asian (18 649 [8.2%]), Black (37 673 [16.5%]), White (93 824 [41.0%]), multiracial (3680 [1.6%]), other (68 857 [30.1%]), or unknown race (6203 [2.7%]) and Hispanic or Latinx (52 398 [22.9%]), non-Hispanic and non-Latinx (144 017 [62.9%]), and unknown ethnicity (32 471 [14.2%]). A total of 1165 imputable transfusion reactions were reported, with an overall reaction rate of 0.52% (95% CI, 0.49%-0.55%). Patients aged 5 to 11 years had the highest reported transfusion reaction rate (891.11 [95% CI, 799.81-989.11] per 100 000 products transfused). Platelet transfusions had the highest transfusion reaction rates (821.75 [95% CI, 754.14-893.80] per 100 000 products transfused), with allergic reactions being most common (506.04 [95% CI 453.30, 563.24] per 100 000 products transfused), whereas RBC transfusions had more reported febrile nonhemolytic transfusion reactions (FNHTRs; 296.20 [267.06, 327.67] per 100 000 products transfused) than other types of reactions. The most common symptoms were urticaria (69.6% [368 of 529 patients]) in allergic reactions, fever (96.5% [559 of 579 patients]) in FNHTRs, and acute respiratory distress (87.5% [21 of 24 patients]) in transfusion-associated circulatory overload (TACO); the most common treatments were antihistamines (80.3% [425 of 529 patients]) for allergic reactions, antipyretics (67.9% [393 of 579 patients]) for FNHTRs, and diuretics (83.3% [20 of 24 patients]) for TACO. Many patients (35.8% [107 of 299]) did not receive premedication after the first reaction in subsequent transfusions, regardless of reaction type. When transfusion reactions recurred, they were often of the same type (77.9% of reactions [120 of 154] after allergic reactions were allergic; 72.1% of reactions [98 of 136] after FNHTRs were FNHTRs).

CONCLUSIONS AND RELEVANCE: In this cohort study of pediatric transfusion reactions, reactions appeared to be age dependent, and rates of allergic reactions and FNHTRs were higher than rates from previously published, possibly underreported, predominantly adult data. These findings underscore the importance of pediatric-specific hemovigilance to improve recognition, reporting, and safety monitoring of transfusion reactions.

PMID:42043816 | DOI:10.1001/jamanetworkopen.2026.9274

JAMA Netw Open. 2026 Apr 1;9(4):e269328. doi: 10.1001/jamanetworkopen.2026.9328.

ABSTRACT

IMPORTANCE: Enrollment in Medicaid expansion may improve financial outcomes for low-income adults, but this association has not been studied in the longer-term postenrollment period.

OBJECTIVE: To estimate the association of enrollment in Medicaid expansion with financial outcomes for enrollees as long as 7 years after enrollment.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study used an event study analysis to compare changes in credit outcomes after relative to before enrollment, controlling for changes in outcomes over time, differences between individuals who enroll at different times, and linear trends in outcomes prior to enrollment. Participants included first-time enrollees in the Healthy Michigan Plan (HMP), Michigan’s Medicaid expansion plan, between April 1, 2014, and December 31, 2017. Enrollees were linked with their credit reports from a large national credit agency at 6-month intervals from 2013 to 2021, with outcomes obtained on the final business day of January and July of each calendar year. Data were analyzed from January 4, 2023, to December 9, 2025.

EXPOSURE: Enrollment in HMP.

MAIN OUTCOMES AND MEASURES: The event study analysis compared changes in 4 credit outcomes: medical debt in collections, nonmedical debt in collections, a subprime credit score (<600), and bankruptcy in the prior 2 years.

RESULTS: The study cohort included 575 283 enrollees (308 814 male [53.7%]; mean [SE] age, 42.1 [10.6] years). HMP enrollment was associated with large reductions in medical debt in collections (from -$101.9 [95% CI, -$127.6 to -$76.3] in postenrollment quarter 8 to -$983.0 [95% CI, -$1090.8 to -$875.1] in postenrollment quarter 29) and rates of subprime credit scores (from -0.038 [95% CI, -0.041 to -0.035] in postenrollment quarter 8 to -0.234 [95% CI, -0.247 to -0.221] in postenrollment quarter 29), with the magnitude of association increasing over time. No associations were observed between HMP enrollment and nonmedical debt in collections or bankruptcy.

CONCLUSIONS AND RELEVANCE: In this cohort study of HMP enrollees, Medicaid expansion enrollment was associated with reductions in medical debt in collections and rates of subprime credit scores as long as 7 years after enrollment. These results suggest enrollment in Medicaid expansion was associated with excellent protection from out-of-pocket costs of medical care and overall improved financial stability, which in turn may be associated with improvements in enrollees’ health and well-being.

PMID:42043815 | DOI:10.1001/jamanetworkopen.2026.9328

JAMA Netw Open. 2026 Apr 1;9(4):e2610114. doi: 10.1001/jamanetworkopen.2026.10114.

ABSTRACT

IMPORTANCE: Missed pediatric preventive care visits can delay essential developmental screenings, immunizations, and management of chronic conditions, adversely impacting child health. Understanding the relationship between extreme temperatures and missed preventive care is essential for developing adaptive strategies to maintain care access amid increasing climate variability.

OBJECTIVE: To assess the association of extreme temperatures with rates of missed pediatric preventive care visits and evaluate differences by patient age, insurance, and neighborhood socioeconomic status (SES).

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional time-series study used electronic health record data of patients aged younger than 19 years with scheduled preventive care visits at 32 primary care practices in the Children’s Hospital of Philadelphia primary care network in Pennsylvania and New Jersey from January 1, 2009, to December 31, 2023. Statistical analyses were completed between March and October 2025.

EXPOSURE: Daily maximum temperature (°F), derived from the National Oceanic and Atmospheric Administration’s weather stations and averaged at the county level for each practice.

MAIN OUTCOME AND MEASURES: Daily rate of missed preventive care visits (the proportion of scheduled visits resulting in same-day cancellation or no-show). Generalized linear quasi-Poisson models estimated associations of daily maximum temperature (in °F) with daily rate of missed preventive care visits overall and stratified by age, insurance, and neighborhood SES. Associations were evaluated separately for warm (May-October) and cold (November-April) months. Heterogeneity across strata was evaluated using the Cochran Q test.

RESULTS: Among 504 428 patients, 51% were male, 36% had public insurance, and 27% were from very low SES neighborhoods. Mean (SD) patient age was 6.0 (5.7) years. Among 4 137 542 scheduled preventive care visits, 13% were missed. Each 1 °F decrease below a maximum daily temperature of 41.5 °F in cold months and 1 °F increase above 88.0 °F in warm months was associated with a higher rate of missed visits (rate ratios, 1.01 [95% CI, 1.01-1.01] and 1.01 [95% CI, 1.00-1.01], respectively). Significant heterogeneity in missed visits across age, payer, and neighborhood SES was observed in cold months, with higher rates of missed visits among patients with commercial vs public or other types of insurance (RR, 1.02; 95% CI, 1.02-1.02) as well as among younger patients and those from high SES neighborhoods.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, extreme outdoor temperatures were associated with increased rates of missed pediatric preventive care visits, with heterogeneity across age, payer, and neighborhood SES during cold months. The findings suggest proactive scheduling strategies and alternative care delivery models should be assessed to maintain access to essential pediatric preventive care services during temperature extremes.

PMID:42043814 | DOI:10.1001/jamanetworkopen.2026.10114

Curr Protoc. 2026 Apr;6(4):e70371. doi: 10.1002/cpz1.70371.

ABSTRACT

India accounts for one-third of the global incidence and mortality of oral cancer. The national oral cancer screening program uses Conventional Oral Examination by Primary Healthcare (PHC) workers. This subjective assessment leads to unnecessary referrals to higher centers for biopsy and false negatives due to inappropriate biopsy site selection. Angiogenesis is one of the steps in early carcinogenesis, as solid tumors, such as oral cancers, cannot grow beyond 2-3 mm in diameter without inducing their own blood supply. The increased vascular supply and metabolic rate in malignant cells lead to a rise in temperature, which can be detected by sensitive digital infrared (IR) cameras. An Artificial Intelligence-enabled automatic analysis of intraoral IR images of oral lesions can be used for screening, early detection of Stage I and II oral cancers, and biopsy site selection as an objective Point-of-Care (POC) adjunct. A standardized protocol for passive and active IR imaging of intraoral lesions (index test) with a smartphone-based IR camera will be prepared to train a Medical Scientist and Technician. IR images of already diagnosed normal, Inflammatory, potentially malignant disorders, and malignant oral lesions (N = 100 each) will be used in Phase I to train an AI model to classify images as malignant or non-malignant. A second set of IR images of these oral lesions will be used in Phase II (N = 100 each) for evaluating the performance of the AI model. The reference test for malignancy will be histopathology (Gold standard). The intra/inter observer reliability will be assessed using the kappa statistics A clinical trial and validation of the proof of concept are proposed for IR imaging of intraoral lesions as a noninvasive POC adjunct for early detection and screening of oral cancer by PHC workers, and for the selection of biopsy sites by surgeons. © 2026 Wiley Periodicals LLC.

PMID:42043801 | DOI:10.1002/cpz1.70371

Alzheimers Dement. 2026 Apr;22(4):e71372. doi: 10.1002/alz.71372.

ABSTRACT

INTRODUCTION: We investigated the association between retirement, age at retirement, and domain-specific cognitive decline.

METHODS: Three hundred twenty-one participants aged 65+ from the Study of Healthy Aging in African Americans completed verbal episodic memory (VEM) and executive function (EF) assessments across three waves (every 16 months). Linear mixed-effects models with random intercepts and slopes examined associations of retirement status (retired, not retired) and timing (retired before age 65, retired at 65+, and not retired) with cognitive decline adjusting for demographics and parental education.

RESULTS: Participants’ mean age was 74.6 ± 6.9, 65% were women, and 87% were retired (33% at age 65+). Retirement status and timing were not associated with baseline cognition. Over 2.11 ± 0.66 years, non-retirees had slower EF decline than retirees (b = 0.11 [0.03, 0.19]). Participants who retired at 65+ had slower VEM decline than those who retired before 65 (b = 0.11 [0.02, 0.21]).

DISCUSSION: Retirement and early retirement were associated with faster cognitive decline among Black/African American adults.

PMID:42043792 | DOI:10.1002/alz.71372

Nurs Educ Perspect. 2026 Apr 27. doi: 10.1097/01.NEP.0000000000001537. Online ahead of print.

ABSTRACT

In this pilot study, which utilized a pretest/posttest design, baccalaureate nursing students used artificial intelligence to generate a case scenario and nursing care plan and analyzed the content for accuracy, bias, and holistic nursing practices. The authors found that students had statistically significant improvements in their perceived ability to identify accurate nursing content, bias, and holistic nursing concepts. This article provides recommendations for nurse educators to improve students’ ability to analyze artificial intelligence-generated content.

PMID:42043776 | DOI:10.1097/01.NEP.0000000000001537

Indian Pediatr. 2026 Apr 27. doi: 10.1007/s13312-026-00340-5. Online ahead of print.

ABSTRACT

OBJECTIVE: This survey was conducted to explore the current status of empyema thoracis management practices of pediatricians in India, as a prelude to developing evidence-based guidelines for managing empyema.

METHODS: A questionnaire examining various aspects of empyema management (diagnosis, investigations, treatment, monitoring and follow-up) was prepared, refined, and pilot-tested. It was disseminated to pediatricians across the country, through a Google form link, using email and a social media platform. Responses were collated, analyzed, and presented with descriptive statistics.

RESULTS: Ninety-four complete responses were received, mostly from pediatricians in teaching/ tertiary-care hospitals. There were significant variations in all aspects of empyema management. There was overuse of computed tomography (CT) scan (27%) and pleural fluid Cartridge Based Nucleic Acid Amplification Test (CBNAAT) (61%) in children with pleural effusion. Whilst > 80% pediatricians used ceftriaxone empirically for pneumonia and empyema, co-amoxiclav (18%), vancomycin (56%), and teicoplanin or linezolid (16%) were also used for empyema. Less than three quarters of respondents used intercostal drainage appropriately. 25% pediatricians routinely used intrapleural fibrinolytic therapy (most often streptokinase); 37% did not use it at all. The common indications were septations/loculations on ultrasonography (57%), thick pus (38%), and persisting clinical features (33%). The duration of antibiotics ranged from < 4 weeks (18%), 4-6 weeks (59%), and > 6 weeks (15%). The indications for surgical referral also varied widely, as did monitoring during therapy, and post-treatment follow-up protocols.

CONCLUSION: There are significant variations in all facets of empyema management amongst pediatricians working in diverse Indian healthcare settings, underscoring the need for evidence-based guideline recommendations.

PMID:42043772 | DOI:10.1007/s13312-026-00340-5