Category: Statistics

Turk Arch Pediatr. 2026 Mar 5;61(3):206-213. doi: 10.65717/TurkArchPediatr.2026.25004.

ABSTRACT

OBJECTIVE: To describe demographic, clinical, and laboratory characteristics of patients with juvenile localized scleroderma (JLS), determine the presence of extracutaneous involvement (ECI) and other comorbidities, and assess treatment response.

MATERIALS AND METHODS: Retrospective single-center cohort study of JLS patients followed between 2015 and 2025 who met Padua classification criteria and had ≥6 months of regular follow-up. Clinical, laboratory, and treatment data were systematically collected, and ECI was analyzed using comparative statistics.

RESULTS: Among 87 patients, 77% were female. Mean ages at symptom onset, diagnosis, and last visit were 7.1, 9.0, and 14.4 years, respectively, with a median diagnostic delay of 1.2 years. The most frequent subtype was linear scleroderma (36.7%), followed by circumscribed (31.0%), generalized (20.6%), mixed-type (6.8%), and pansclerotic morphea (4.6%). The lower extremities were the most commonly affected, accounting for 54 of 136 sites (39.7%). The ECI occurred in 47.1% of patients, mainly musculoskeletal, and was linked to generalized/pansclerotic subtypes, limb involvement, higher erythrocyte sedimentation rate, higher disease activity scores, and poorer response to conventional disease-modifying antirheumatic drugs (cDMARDs). Overall, 85 patients received at least 1 cDMARD, with 85.9% responding. Methotrexate regimens had high response rates; 14.1% were non-responsive to at least 2 cDMARDs, and 5.7% had active disease at last visit.

CONCLUSION: The JLS carries substantial cutaneous and extracutaneous morbidity, particularly in generalized and pansclerotic subtypes with limb involvement. These findings underscore the importance of early recognition, systematic assessment of ECI, and close longitudinal monitoring in specialized centers and support the need for prospective studies to refine risk stratification and optimize treatment strategies for refractory JLS.

PMID:42044443 | DOI:10.65717/TurkArchPediatr.2026.25004

Turk Arch Pediatr. 2025 Oct 3;61(2):170-172. doi: 10.5152/TurkArchPediatr.2025.25006.

NO ABSTRACT

PMID:42044435 | DOI:10.5152/TurkArchPediatr.2025.25006

Turk Arch Pediatr. 2025 Dec 29;61(2):152-161. doi: 10.5152/TurkArchPediatr.2025.25261.

ABSTRACT

OBJECTIVE: This study explores whether GSTM1, GSTT1, and TP53 rs1042522 polymorphisms, key regulators of detoxification and oxidative stress responses, influence obesity risk and related metabolic profiles in children.

MATERIALS AND METHODS: Blood samples from 60 obese children and 60 healthy controls were analyzed. GSTM1 and GSTT1 deletions were assessed via polymerase chain reaction melting curve analysis, and TP53 rs1042522 was genotyped by direct DNA sequencing. Deviations from Hardy-Weinberg expectations and genotype frequencies in controls were evaluated, and the association of genetic variants with obesity, clinical complications, and metabolic parameters was examined.

RESULTS: In obese children, GSTM1 and GSTT1 genotype frequencies deviated from Hardy-Weinberg expectations and differed from controls, whereas TP53 rs1042522 conformed to expected distributions yet was statistically underpowered. The GSTM1 null genotype increased obesity risk 3.28-fold (95% CI: 1.36-7.93, P < .05). The GSTT1 null genotype conferred a 4.76-fold higher risk (95% CI: 2.08-10.88, P < .001). TP53 rs1042522 showed no association (OR = 1.12, 95% CI: 0.44-2.87). The GSTM1 null carriers had elevated cholesterol, low-density lipoprotein (LDL), and gamma-glutamyl transferase, while TP53 Arg/Arg and Pro/Pro carriers exhibited higher LDL and alanine aminotransferase, respectively. No significant links were observed with insulin resistance or hepatic steatosis.

CONCLUSION: The GSTM1 and GSTT1 null genotypes are significant genetic risk factors for childhood obesity, likely through reduced detoxification capacity and subsequent oxidative stress-related metabolic disruption. These findings highlight the importance of considering detoxification pathways when assessing genetic predisposition to obesity in children.

PMID:42044432 | DOI:10.5152/TurkArchPediatr.2025.25261

Turk Arch Pediatr. 2025 Dec 22;61(2):139-146. doi: 10.5152/TurkArchPediatr.2025.25342.

ABSTRACT

OBJECTIVE: To describe oral health status and its relationship with glycemic control in children with type 1 diabetes mellitus (T1DM) using standardized indices.

MATERIALS AND METHODS: A comparative cross-sectional study was conducted with 30 children aged 6-14 years with T1DM and 30 healthy controls. Oral examinations recorded DMFS/dfs (Decayed, Missing, Filled Surfaces), PUFA/pufa (Pulpal involvement, Ulceration, Fistula, Abscess), Plaque Index (PI), Gingival Index (GI), and Simplified Oral Hygiene Index (OHI-S). Glycated hemoglobin (HbA1c) levels were categorized as ≤7% or >7%. Non-parametric tests, Spearman’s correlation analyses were performed. The level of statistical significance was set at P < .05.

RESULTS: The T1DM group had significantly lower DMFS/dfs and PUFA/pufa scores than controls (P < .001 and P = .004, respectively), and no significant differences were found in PI, GI, and OHI-S values. In the T1DM group, correlation analyses between HbA1c levels and oral health indices (DMFS/dfs, PUFA/pufa, PI, GI, and OHI-S) revealed no statistically significant associations (P > .05). No statistically significant correlations were found between HbA1c and any of the oral health indices (P > .05).

CONCLUSION: Children with T1DM showed lower caries experience, possibly due to regular medical follow-up, nutritional counseling, and improved oral hygiene. Routine oral health monitoring should be integrated into pediatric diabetes care.

PMID:42044430 | DOI:10.5152/TurkArchPediatr.2025.25342

Am J Manag Care. 2026 Apr;32(4):230-236. doi: 10.37765/ajmc.2026.89919.

ABSTRACT

OBJECTIVES: Significant variation in coding intensity exists across patients and institutions, with important implications for reimbursement and risk-adjusted quality metrics. The degree to which coding intensity for hospitalized patients may be a function of primary payer is not well understood. We sought to measure differences in coding intensity between commercially insured and Medicare, Medicaid and Medicare, and self-pay and Medicare inpatient encounters for the same cohort of patients.

STUDY DESIGN: Regression discontinuity, leveraging the fact that patients typically enroll in Medicare at age 65 years.

METHODS: A multivariable linear regression was estimated to evaluate the relationship between the outcomes of interest and primary payer, controlling for age, age by payer interaction term, and inpatient visit count. Our analysis included Florida inpatients with at least 1 commercially insured, Medicaid, or self-pay inpatient hospitalization before age 65 years and at least 1 inpatient Medicare hospitalization at 65 years and older, with patients serving as their own controls. The outcome of interest was the number of hospital discharge diagnoses. Outcomes were measured separately for each group (commercial insurance to Medicare, Medicaid to Medicare, and self-pay to Medicare).

RESULTS: Medicare inpatient encounters were associated with 0.8 (95% CI, 0.4-1.2), 1.0 (95% CI, 0.5-1.5), and 2.0 (95% CI, 1.2-2.8) more discharge diagnoses than commercially insured, Medicaid, and self-pay inpatient encounters, respectively.

CONCLUSIONS: Our findings suggest that Medicare inpatient encounters are associated with higher coding intensity than commercially insured, Medicaid, or self-pay inpatient encounters for those same individuals prior to age 65 years. This has important implications for the impact that insurance status may have on risk-adjusted quality measures.

PMID:42044421 | DOI:10.37765/ajmc.2026.89919

Am J Manag Care. 2026 Apr;32(4):212-217. doi: 10.37765/ajmc.2026.89917.

ABSTRACT

OBJECTIVES: This study aimed to quantify the economic impact of missed billing opportunities for tobacco cessation counseling at an academic medical center to identify what may be a systematic defect in the administration of tobacco cessation services and to highlight opportunities to improve patient outcomes and revenue. Patient surveys show that evidence-based tobacco cessation interventions are provided at low rates despite guidelines supporting the use of these services at every eligible encounter.

STUDY DESIGN: Retrospective cohort study.

METHODS: The study analyzed deidentified patient health data from electronic health records at an academic medical center, focusing on primary care encounters from January 1, 2020, to December 31, 2023, involving patients 18 years and older with a history of current tobacco use. Billing data for tobacco cessation counseling ( Current Procedural Terminology codes 99406 or 99407) were examined to estimate revenue loss from unbilled eligible encounters.

RESULTS: Of 1,068,875 primary care visits, 16.8% (179,304) involved tobacco users. However, only 1.0% of these encounters were billed for cessation services, representing an estimated potential revenue loss of $3.2 million over 4 years.

CONCLUSIONS: These findings identify a significant discrepancy between the billing of tobacco cessation services and the opportunities to do so. Better provision and billing of tobacco cessation counseling can improve patient health outcomes, advance value-based care goals, and enhance financial sustainability.

PMID:42044419 | DOI:10.37765/ajmc.2026.89917

Am J Manag Care. 2026 Apr 1;32(4):e133-e137. doi: 10.37765/ajmc.2026.89926.

ABSTRACT

OBJECTIVE: To examine trends in Dual-Eligible Special Needs Plan (D-SNP) offerings and enrollment before and after permanent authorization in 2018.

STUDY DESIGN: Retrospective descriptive analysis.

METHODS: We analyzed publicly available monthly SNP Comprehensive Reports, comparing preauthorization (2010-2018) and postauthorization (2019-2025) periods. We calculated annual totals of D-SNPs and enrollees along with mean annual growth rates for both periods.

RESULTS: The mean annual growth rate of unique D-SNP offerings increased from 10.0% preauthorization to 16.2% post authorization. Enrollment of dually eligible beneficiaries increased from a mean annual growth rate of 0.3% preauthorization to 12.8% post authorization. D-SNP enrollment has steadily increased, more than doubling over the past 5 years. By January 2025, there were 986 D-SNPs with 6,030,665 dual enrollees, representing approximately 44% of total dual enrollees.

CONCLUSIONS: The significant acceleration in both D-SNP offerings and enrollment reflects notable changes in the D-SNP market following permanent authorization. As states transitioned plans into D-SNPs through 2025, these specialized Medicare Advantage plans are positioned to play an increasingly vital role in addressing the complex needs of Medicare-Medicaid dual enrollees.

PMID:42044401 | DOI:10.37765/ajmc.2026.89926

J Phys Chem Lett. 2026 Apr 27. doi: 10.1021/acs.jpclett.6c00978. Online ahead of print.

ABSTRACT

Precise control of nucleation pathways under nonequilibrium optical trapping conditions remains a fundamental challenge. Here, we report an enantiomer-specific reversal in phase selection during the optical trapping-induced crystallization of binary systems containing acetaminophen and either l- or d-phenylalanine. Switching the handedness of circularly polarized light reverses the dominant product between a thermodynamically stable cocrystal and a metastable phenylalanine phase. In situ Raman spectroscopy reveals constant local stoichiometry during irradiation, indicating the absence of a macroscopic polarization-induced concentration gradient. Instead, the results are consistent with a proposed mechanism where phase selection is driven by a polarization-dependent kinetic bias under strongly nonequilibrium conditions. We propose that this bias originates from subtle differences in the residence dynamics of transient nanoscale clusters within the optical trapping field, which are statistically amplified over time. These findings highlight a sophisticated kinetic route for controlling crystallization beyond conventional thermodynamic strategies.

PMID:42043851 | DOI:10.1021/acs.jpclett.6c00978

JAMA Intern Med. 2026 Apr 27. doi: 10.1001/jamainternmed.2026.1085. Online ahead of print.

ABSTRACT

IMPORTANCE: The Centers for Medicare & Medicaid Services Oncology Care Model (OCM) was an episode payment model for patients with cancer; episodes were triggered by receipt of systemic cancer therapy. OCM provided monthly care management payments, and all practices were engaged in 1-sided risk in its early years. A concern about episode payment models triggered by use of a particular service is that they may prompt increases in episode volume.

OBJECTIVE: To assess if OCM is associated with an increase in the likelihood of initiating systemic therapy for cancer.

DESIGN, SETTING, AND PARTICIPANTS: This quasi-experimental study used matched difference-in-differences analysis of serial cross sections of Medicare beneficiaries with an index visit for cancer from January 2010 to December 2019 who were treated at OCM practices or matched practices not participating in the OCM and followed up for 1 year, comparing changes in outcomes before vs after OCM began in July 2016. Data were analyzed from October 2021 to November 2025.

MAIN OUTCOMES AND MEASURES: Systemic therapy initiation in the year after an index visit for newly diagnosed (incident) or poor-prognosis cancer; a secondary outcome examined total Medicare payments in the year after the index visit.

RESULTS: The study included 754 182 patient episodes (750 483 patients; mean [SD] age, 74.1 [9.0] years; 467 071 female [62.2%]) in the incident population and 517 858 patients (mean [SD] age, 72.4 [9.7] years; 270 416 female [52.2%]) in the poor prognosis cohort treated at 197 intervention and 197 comparison practices. There was no statistically significant differential change in the initiation of systemic therapy in the incident population (-0.9 percentage point difference; 95% CI, -2.2 to 0.3 percentage points; P = .14). Among patients with poor-prognosis cancers, there was a statistically significant differential decrease in the likelihood of systemic therapy initiation (1.5 percentage points, 95% CI, -2.8 to -0.2 percentage points; P = .03). Following OCM, there was a non-statistically significant relative decrease in spending (-$898.26; 95% CI, -$1890.31 to $93.80; P = .08) in the year after the index incident diagnosis and a statistically significant relative decrease (-$2192.15; 95% CI, -3559.66 to -833.63; P = .002) in the poor prognosis cohort.

CONCLUSIONS AND RELEVANCE: Despite concerns about greater use of systemic therapy for patients with cancer under 1-sided risk, this study found that the OCM was not associated with an increase in the likelihood of initiating systemic therapy episodes among patients with incident cancers but was associated with less chemotherapy initiation and lower spending among patients with poor-prognosis cancers. By not examining changes in chemotherapy initiation, the OCM evaluation may have underestimated savings related to the model.

PMID:42043828 | DOI:10.1001/jamainternmed.2026.1085