Category: Statistics

Indian J Ophthalmol. 2025 Sep 1;73(9):1364-1370. doi: 10.4103/IJO.IJO_2271_24. Epub 2025 Aug 29.

ABSTRACT

PURPOSE: Access to eye surgical care in low- and middle-income countries (LMICs) remains limited due to geographical and financial barriers. This survey evaluated the travel and financial burden on patients and caregivers attending perioperative cataract care at an urban base hospital (UBH) versus community clinics (vision centers [VC]) at the Aravind Eye Care System in South India.

METHODS: This cross-sectional study surveyed 105 cataract surgery patients divided into three groups based on perioperative appointment location: UBH-only (appointments at UBH), VC-only (appointments at VCs), and UBH/VC (Day 1 postoperative appointment at VCs, others at UBH). Descriptive statistics and linear regression assessed associations between subgroups and travel and financial burden. The UBH/VC group reported their preferred location and the reasons.

RESULTS: Over the entire appointment period, transport time for VC-only (353 ± 118 min) was over 3 h lower than UBH-only (589 ± 418 min) and UBH/VC (568 ± 230 min; P < 0.001). Total appointment time was lowest for VC-only (562 ± 177; 1069 ± 439 in UBH-only; 1021 ± 383 min in UBH/VC; P < 0.001). Compared to UBH-only, the VC-only group had the lowest transport time (-236 min, 95% CI: -371 to -102, P = 0.001) and total appointment time (-507 min, 95% CI: -673 to -340, P < 0.001). Transport costs and missed wages were lower for VC-only participants for preoperative and postoperative Day 1 appointments (P < 0.001). Among UBH/VC, 63% (n = 22) preferred VC, while 37% (n = 13) preferred UBH.

CONCLUSIONS: Decentralized perioperative follow-up care is associated with reduced travel and financial burdens for cataract surgery patients in rural, low-resource settings. Further research is needed to evaluate the clinical effectiveness and operational feasibility of decentralized postoperative care in LMICs.

PMID:40880154 | DOI:10.4103/IJO.IJO_2271_24

Indian J Ophthalmol. 2025 Sep 1;73(9):1355-1363. doi: 10.4103/IJO.IJO_2323_24. Epub 2025 Aug 29.

ABSTRACT

PURPOSE: We aimed to estimate prevalence of vision impairment (VI) due to cataract and its associated factors and barriers for accessing cataract surgical services in India in persons aged ≥50 years.

METHODS: Analysis of data collected in National Blindness and Visual Impairment Survey, India (2015-2018), was performed (n = 85135). Prevalence of cataract-associated VI was defined as cataract in at least one eye, pinhole visual acuity (PinVA) worse than threshold (6/12, 3/60) in the cataract-affected eye, and not having a more avoidable cause of VI (presenting visual acuity PVA < 6/12 in better eye) in the person.

RESULTS: The prevalence of cataract-associated VI at PinVA < 6/12 was 12.9% (95% CI: 11.8, 14.0) and 3.0% (95% CI: 2.6, 3.5) at PinVA < 3/60. The highest prevalences at PinVA < 6/12 were noted in Janjgir-Champa (19.0%), Nalbari (17.9%), and Warangal (17.9%). Females had higher prevalence at PinVA < 6/12 (univariate odds ratio [OR] 1.2) and PinVA <3/60 (univariate OR 1.5). Statistically significant gender differences (females worse off) were noted in Sikar, Ambedkar Nagar, Guna, Banda, and Thrissur at PinVA < 6/12. Prevalence increased with increasing age and decreasing literacy and varied across administrative zones on multivariate analysis. Need not felt was the major reason for not availing cataract surgical services in persons with visual impairment at PinVA < 6/12 (48.1%) and PinVA < 3/60 (27.8%) thresholds.

CONCLUSIONS: The burden of cataract-associated VI at PinVA < 6/12 in India is significant. Interventions to overcome social determinants and enhance awareness about surgery are required.

PMID:40880153 | DOI:10.4103/IJO.IJO_2323_24

Indian J Ophthalmol. 2025 Sep 1;73(9):1344-1349. doi: 10.4103/IJO.IJO_450_25. Epub 2025 Aug 29.

ABSTRACT

PURPOSE: The aim of the study was to evaluate optical coherence tomography (OCT) and indocyanine green angiography (ICGA) biomarkers in patients with chronic central serous chorioretinopathy (cCSC) as potential indicators of response to treatment with subthreshold nanosecond laser (NSL).

METHODS: In this retrospective study, we examined 36 eyes of 32 cCSC patients after NSL. High response (HR) was defined as complete resolution of subretinal fluid (SRF) 3 months after first NSL treatment, full response (FR) as complete resolution of SRF, 3 months after the last NSL, with all NSL sessions occurring within 1 year from the first NSL. Biomarkers included central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and intervortex venous anastomosis (IVA).

RESULTS: Patients were 54 ± 12 years old on average; 86% were male. OCT at baseline showed a mean CMT of 364 ± 130 µm and SFCT of 292 ± 45 µm; 64% showed IVA in ICGA. HR was seen in 50% and FR in 78%. Higher IVA rates (83% vs. 44%, P = 0.03) predicted poor response after the first NSL. Patients with IVA presence at baseline showed a statistically significant higher likelihood of requiring more than one NSL session compared to those without IVA presence (57% vs. 15%, P = 0.02).

CONCLUSION: OCT and ICGA biomarkers may play a role as indicators of anatomical responses to NSL. Patients with IVA at baseline showed a poor first response and may need repetitive laser treatments.

PMID:40880151 | DOI:10.4103/IJO.IJO_450_25

Indian J Ophthalmol. 2025 Sep 1;73(9):1307-1313. doi: 10.4103/IJO.IJO_14_25. Epub 2025 Aug 29.

ABSTRACT

PURPOSE: This study aimed to assess BioRing’s (Biotech, India) clinical and topographic efficacy in treating moderate-to-advanced keratoconus and compare its visual, refractive, and keratometric results to Keraring (Mediphacos, Brazil) at different stages of the disease.

METHODS: This retrospective study evaluated the results of 74 eyes (58 patients) that received femtosecond laser-assisted intrastromal corneal ring segment implantation from March 2019 to March 2024. The Amsler-Krumeich classification classified the patients as having either moderate or advanced keratoconus. Group 1 comprised 39 eyes with BioRing implants, whereas group 2 consisted of 35 eyes with Keraring implants. We classified each group into moderate and advanced keratoconus categories. Preoperative and 6-month postoperative assessments encompassed uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refractive errors, and corneal tomography metrics.

RESULTS: Both BioRing and Keraring showed statistically significant increases in visual acuity, refractive errors, and topographic parameters between preoperative and postoperative examinations. However, when postoperative results were compared between groups, no significant difference in UCVA was found (P = 0.097). In contrast, the Keraring group had considerably superior BCVA than the BioRing group (P = 0.042). In terms of topographic metrics, Keraring considerably improved keratometric flattening, including Kmax (P = 0.040), K1 (P = 0.012), and K2 (P = 0.024). Subgroup analysis revealed comparable improvements in moderate keratoconus, while Keraring showed superior outcomes in advanced cases.

CONCLUSION: BioRing and Keraring effectively improved visual acuity, refractive errors, and topographic parameters in moderate-to-advanced keratoconus. Keraring showed superior outcomes, particularly in advanced keratoconus.

PMID:40880150 | DOI:10.4103/IJO.IJO_14_25

Indian J Ophthalmol. 2025 Sep 1;73(9):1302-1306. doi: 10.4103/IJO.IJO_2224_24. Epub 2025 Aug 29.

ABSTRACT

PURPOSE: To compare the effect of induced astigmatism and defocus on visual performance in patients with a dominant eye implanted with a dual-technology diffractive intraocular lens (IOL) or an enhanced monofocal IOL.

METHODS: This non-randomized cohort study included 35 patients in each group. Group 1 underwent phacoemulsification and received the Tecnis Synergy IOL in the dominant eye. Group 2 received the Tecnis Eyhance IOL. All surgeries were performed using a 2.2 mm clear corneal incision. Patients were evaluated 16 weeks postoperatively. Astigmatic tolerance was assessed by measuring monocular distance visual acuity (DVA) using negative cylindrical (CYL) lenses of varying powers and axes on a defocus curve.

RESULTS: There were no significant differences in overall induced astigmatism between groups. However, Group 1 showed significantly better DVA with against-the-rule (ATR) astigmatism (90°) than with-the-rule (WTR, 180°) using 1.50 D CYL (P < 0.05). Additionally, Group 1 outperformed Group 2 at 1.00 D and 1.50 D ATR under -1.00 D defocus (P < 0.05). These findings were both statistically and clinically relevant, indicating that residual ATR astigmatism may be better tolerated by patients with a dual-technology diffractive IOL, resulting in improved performance for near and intermediate tasks.

CONCLUSION: The Tecnis Synergy IOL demonstrated superior tolerance to ATR astigmatism compared to the Tecnis Eyhance IOL, especially at higher cylindrical powers under -1.00 D defocus. These results highlight the relevance of astigmatic tolerance in IOL selection for spectacle independence, particularly in patients with ATR astigmatism. Findings are specific to these IOLs and should not be generalized to other premium lenses.

PMID:40880149 | DOI:10.4103/IJO.IJO_2224_24

JAMA Health Forum. 2025 Aug 1;6(8):e252647. doi: 10.1001/jamahealthforum.2025.2647.

ABSTRACT

IMPORTANCE: Recent trends in drug-related overdoses among adolescents have highlighted the need for mental health and substance use disorder (SUD) treatment. However, the extent of these treatment gaps is understudied.

OBJECTIVE: To characterize the factors associated with the diagnosis of and treatment for mental health and SUD for adolescents.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used survey-weighted descriptive statistics and χ2 tests to estimate differences in characteristics and treatment receipt and included US adolescents and young adults aged 12 to 20 years who participated in the National Survey on Drug Use and Health in 2021 and 2022. Data were analyzed from February 2024 to February 2025.

MAIN OUTCOMES AND MEASURES: Primary outcomes included the prevalence of depression and suicidality-related mental health diagnoses, SUDs, and treatment rates for both conditions. Additional measures included treatment setting, socioeconomic and demographic characteristics, and health insurance-related factors.

RESULTS: From 2021 to 2022, 13% of participants had SUD and 24% had a mental health diagnosis during the previous year (mean [SD] age, 16.0 [2.5] years; 48.4% female individuals; 6.1% Asian, 13.9% Black, 25.7% Hispanic, and 49.9% White individuals). Only 10% of participants with SUD and 51% of adolescents with mental health diagnoses received treatment for their conditions, with higher rates of treatment among adolescents with comorbid SUD and mental health diagnoses. When comparing adolescents (aged 12-17 years) and young adults (aged 18-20 years) with SUD for treatment receipt, reductions were found in any mental health treatment (63% vs 51%; P = .03) and any SUD treatment (11% vs 8%; P = .01). Moreover, these lower rates were also found in more resource-intensive treatment settings, such as inpatient mental health care (14% vs 9%; P = .02) and specialty mental health facilities (47% vs 33%; P = .003). However, adolescents with opioid use disorder were less likely to receive medication treatment (11% vs 28%; P = .02). Treatment differences were associated with socioeconomic and insurance coverage factors. Compared with adolescents, young adults with SUD experienced increased poverty rates (20% vs 26%; P = .02), uninsurance rates (5% vs 10%; P = .05), and private insurance rates (49% vs 56%; P = .02) while receiving decreased Medicaid coverage (47% vs 33%; P < .001) and government assistance (34% vs 25%; P = .001).

CONCLUSIONS AND RELEVANCE: The results of this cross-sectional survey study suggest that adolescents and young adults with SUDs rarely received treatment. Adolescents are especially vulnerable to treatment gaps once reaching young adulthood, and medications for opioid use disorder are systematically underused, especially for adolescents.

PMID:40880104 | DOI:10.1001/jamahealthforum.2025.2647

JAMA Netw Open. 2025 Aug 1;8(8):e2526636. doi: 10.1001/jamanetworkopen.2025.26636.

ABSTRACT

IMPORTANCE: The illicit use of anabolic androgenic steroids (AAS) is common among recreational athletes, yet studies on adverse cardiovascular outcomes, especially in female AAS users, are sparse.

OBJECTIVE: To assess cardiovascular status in Danish male and female recreational athletes using AAS compared with not using AAS.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study in a single center in Denmark included recreational athletes aged 18 years or older who were active AAS users, previous users (defined as those who discontinued AAS use at least 3 months prior to the study), or nonusers, all recruited from fitness centers between March and December 2022.

EXPOSURE: Cumulative lifetime use of AAS.

MAIN OUTCOMES AND MEASURES: Presence of atherosclerosis (carotid, femoral, and coronary artery plaques) and cardiac function assessed by echocardiography. Linear regression was used to estimate regression coefficients for echocardiographic characteristics and logistic regression to estimate odds ratios (ORs) for carotid and femoral plaques, coronary artery calcium (CAC) scores, and coronary noncalcified plaques (NCPs).

RESULTS: Of 164 participants, 80 (48.8%) were active AAS users (median age, 35 [IQR, 30-43] years; 61 men [76.2%]), 26 (15.9%) were previous users (median age, 36 [IQR, 28-51] years; 18 men [69.2%]), and 58 (35.4%) were nonusers (median age, 40 [IQR, 31-46] years; 42 men [72.4%]). Median cumulative lifetime AAS use was 2.2 (IQR, 1.2-7.2) years for active and 2.2 (IQR, 1.0-5.5) years for previous users. No group differences were observed when comparing the number of participants with femoral (active users, 15 [19.7%]; previous users, 5 [19.2%]; nonusers, 11 [20.8%]; P = .89) or carotid (active users, 24 [31.2%]; previous users, 12 [46.2%]; nonusers, 13 [24.1%]; P = .47) artery plaques or CAC scores (median score was 0 across all groups with range of 0-228 for active users, 0-800 for previous users, and 0-163 for nonusers; P = .36), whereas a statistically significant difference in the prevalence of coronary NCPs was found between active users (19 [23.8%]) and nonusers (6 [10.3%]) (P = .03). However, in confounder-adjusted logistic regression, longer cumulative lifetime AAS use was associated with higher odds of a positive CAC score (OR, 1.23; 95% CI, 1.09-1.39; P = .001) and presence of coronary NCPs (OR, 1.17; 95% CI, 1.05-1.30; P = .004). AAS use exceeding 5 years was associated with greater severity of calcifications (n = 94; χ2 = 9.78; P = .04). Echocardiography showed that cumulative AAS use was associated with worse left ventricular (regression coefficient: 0.08; 95% CI, 0.03-0.12; P = .002) and right ventricular (0.08; 95% CI, 0.03-0.13; P = .001) global longitudinal strain. Nearly all athletes (35 of 36) with more than 5 years of cumulative AAS use had ventricular mass greater than and left ventricular ejection fraction below the median of the normal range.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, cumulative lifetime AAS exposure was associated with adverse cardiovascular findings and impaired ventricular function in both sexes, and athletes with AAS exposure exceeding 5 years showed more severe calcification. The findings support measures to prevent AAS use by both men and women in recreational sports.

PMID:40880090 | DOI:10.1001/jamanetworkopen.2025.26636

JAMA Netw Open. 2025 Aug 1;8(8):e2529127. doi: 10.1001/jamanetworkopen.2025.29127.

ABSTRACT

IMPORTANCE: Postpartum uterine contraction pain manifests as a severe, intermittent lower abdominal discomfort caused by uterine contraction during the early puerperium. Transcutaneous auricular vagus nerve stimulation (taVNS) has demonstrated promising effects in managing both acute and chronic pain conditions; however, there remains a paucity of studies regarding the use of taVNS for alleviating postpartum uterine contraction pain.

OBJECTIVE: To investigate the effect of taVNS in alleviating postpartum uterine contraction pain among women receiving combined spinal-epidural anesthesia for elective cesarean delivery.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted from April 6 to August 31, 2024, at the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China. Participants were aged 18 years or older and scheduled for elective cesarean delivery. Statistical analysis was performed in September 2024. All analyses were conducted according to the intention-to-treat principle.

INTERVENTIONS: Participants were randomly allocated 1:1 to either the active taVNS group or the sham taVNS group. Both groups received the stimulation for 30 minutes each time, once a day, on the day of surgery and postoperative days 1 and 2.

MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of moderate to severe postpartum uterine contraction pain on the third postoperative day, evaluated using a visual analogue scale (uterine contraction pain was classified as moderate to severe if the score was ≥4). Secondary outcomes included peak uterine contraction pain and incision pain, postpartum anxiety, postpartum depression, postpartum recovery quality, and sleep quality.

RESULTS: A total of 156 women were recruited and randomized to the active taVNS group (78 patients; mean [SD] age, 31.5 [4.3] years) or the sham taVNS group (78 patients; mean [SD] age, 31.3 [4.5] years). The incidence of moderate to severe uterine contraction pain in the active taVNS group was 5.1% (4 of 78) compared with 28.2% (22 of 78) in the sham taVNS group on the third postoperative day (relative risk, 0.18 [95% CI, 0.07-0.50]; P < .001) The active taVNS group had lower median scores on the third postoperative day for incisional pain (visual analogue score: 2.20 [IQR, 2.00-2.50] vs 3.00 [IQR, 2.60-3.33]), depression (EPDS: 3.00 [IQR, 2.00-4.00] vs 5.00 [IQR, 3.00-6.00]), and anxiety (PRAQ-R2: 13.50 [IQR, 12.00-15.00] vs 15.00 [IQR, 13.75-17.00]), as well as significantly higher scores for recovery quality on the third postoperative day (ObsQoR-11: 104 [IQR, 103-105] vs 99 [IQR, 96-101]) and sleep quality on the second postoperative day (LSEQ: 52.00 [IQR, 50.00-55.00] vs 47.50 [IQR, 43.00-52.00]) compared with the sham taVNS group.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, taVNS significantly reduced uterine contraction pain, incisional pain, depression, and anxiety, and improved recovery quality and sleep quality compared with sham taVNS. These findings suggest that taVNS represents a novel and safe strategy for alleviating postpartum uterine contraction pain among women undergoing cesarean delivery and for promoting postoperative recovery.

TRIAL REGISTRATION: Chinese Clinical Trial Register Identifier: ChiCTR2400082716.

PMID:40880089 | DOI:10.1001/jamanetworkopen.2025.29127

JAMA Netw Open. 2025 Aug 1;8(8):e2530530. doi: 10.1001/jamanetworkopen.2025.30530.

ABSTRACT

IMPORTANCE: Although research has documented links between climate factors and violence, evidence specific to domestic violence (DV) remains limited, particularly in climate-vulnerable urban areas.

OBJECTIVE: To analyze the association between extreme heat events and DV-related calls to law enforcement in New Orleans, Louisiana, between 2011 and 2021.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a spatially weighted time-stratified case-crossover design analyzing DV-related call data between January 1, 2011, and December 31, 2021, from the New Orleans Police Department. Statistical analysis was conducted from March to May 2024.

EXPOSURES: Daily mean Universal Thermal Climate Index (UTCI) data were used to define 6 extreme heat definitions based on thresholds (30 °C and 90th percentile) and durations (1, 3, or 5 consecutive days). Additional thresholds were considered in sensitivity analyses.

MAIN OUTCOMES AND MEASURES: The primary outcome was DV-related calls made. Calls were aggregated to zip code days, and conditional logistic regression weighted by cases per zip code day was used to evaluate the association between extreme heat and DV calls. Attributable fractions and attributable numbers of DV calls due to extreme heat exposure were calculated.

RESULTS: Of the 150 523 DV-related calls during the study period, 69.6% were classified as domestic disturbances, and 22.4% were classified as simple battery. Consistent positive associations were found between extreme heat and DV-related calls; for example, the likelihood of a DV-related call increased by 4% (odds ratio, 1.04; 95% CI, 1.02-1.07) when the mean UTCI was above 30 °C. Stronger associations were seen during prolonged exposure to extreme heat; when the mean UTCI exceeded the 90th percentile for 5 consecutive days, the likelihood of a DV-related call increased by 7% (odds ratio, 1.07; 95% CI, 1.03-1.12). Eliminating such heat wave events would most likely prevent approximately 245.0 DV-related calls (95% CI, 105.1-370.9) during the study period.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of the association between extreme heat and DV-related calls in New Orleans, DV-related calls were associated with extreme heat events, with the strongest associations observed during prolonged heat waves. These findings highlight the need to integrate climate adaptation with violence prevention strategies during such extreme heat events.

PMID:40880082 | DOI:10.1001/jamanetworkopen.2025.30530

Clin Pharmacokinet. 2025 Aug 29. doi: 10.1007/s40262-025-01560-x. Online ahead of print.

ABSTRACT

BACKGROUND: Suboptimal peak inspiratory flow rates (PIFR) are common in patients with chronic obstructive pulmonary disease (COPD), hindering effective medication dispersion and aerosol delivery. This study aimed to assess whether administering a preliminary bronchodilator dose via a pressurized metered-dose inhaler (pMDI) improves aerosol drug delivery via dry powder inhaler (DPI) in patients with COPD with suboptimal PIFR (< 60 L/min), compared with those with optimal PIFR (≥ 60 L/min).

METHODS: Overall, 24 patients with COPD were evaluated. PIFR was measured using the In-Check Dial^© G16, dividing patients into optimal and suboptimal groups. All patients received a 200 µg dose of salbutamol via Diskus^® DPI. Patients with COPD with suboptimal PIFR received two puffs (100 µg each) preceded by a preliminary salbutamol dose administered via pMDI^®. Urine salbutamol levels (USAL30) and salbutamol that was eluted from filters (SALF) were measured after 30 min to assess lung deposition through high-performance liquid chromatography (HPLC).

RESULTS: Patients with COPD with suboptimal PIFR without a preliminary dose had significantly lower USAL30 than the optimal group (4.99% versus 6.18%, p = 0.013). A preliminary dose improved USAL30 in the suboptimal group but did not reach statistical significance (5.45% versus 4.99%, p = 0.071).

CONCLUSIONS: A significant difference in aerosol drug delivery was observed between optimal and suboptimal groups without a preliminary dose, suggesting that inhaler selection in patients with COPD may need to be individualized on the basis of inspiratory flow capability. Administering a preliminary dose of pMDI^® before using a DPI minimally affects the suboptimal inhalation through DPI.

PMID:40880053 | DOI:10.1007/s40262-025-01560-x