Category: Statistics

JAMA Netw Open. 2025 Dec 1;8(12):e2551677. doi: 10.1001/jamanetworkopen.2025.51677.

ABSTRACT

IMPORTANCE: Approximately 2000 children die each year of child abuse and/or neglect. Foster care is designed as a targeted intervention to reduce harm to children, but its association with child maltreatment mortality is not well understood.

OBJECTIVE: To examine whether foster care entry rates are negatively associated with rates of child mortality due to child abuse and/or neglect.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study assessed associations between child maltreatment mortality rates and foster care entry rates at the state level using administrative data from all US states from January 1, 2010, to December 31, 2023 (N = 700 state-years). Administrative records on all children in state-supervised foster care and all children whose death was attributed by child welfare agencies to child maltreatment were assessed.

EXPOSURES: Number of children entering foster care per 1000 child population.

MAIN OUTCOMES AND MEASURES: Number of child fatalities due to child abuse and/or neglect per 100 000 child population.

RESULTS: The study analyzed 3.4 million records of children in state-supervised foster care from 2010 to 2023 and 24 108 child fatalities that states attributed to child abuse and/or neglect. In 2023, states reported a mean (SD) of 2.62 (1.85) deaths per 100 000 child population and reported a mean (SD) of 3.21 (1.75) entries into foster care per 1000 child population. No evidence was found of a negative association between state-year level foster care entry rates and state-year-level child maltreatment mortality rates (β = 0.17; 95% CI, 0.01-0.34).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, child maltreatment mortality rates did not appear to decrease with higher foster care entry rates or increase with decreasing foster care entry rates. This evidence suggests that there is not a negative association between child maltreatment mortality rates and foster care entry rates.

PMID:41468015 | DOI:10.1001/jamanetworkopen.2025.51677

JAMA Netw Open. 2025 Dec 1;8(12):e2551683. doi: 10.1001/jamanetworkopen.2025.51683.

ABSTRACT

IMPORTANCE: Best-practice guidelines recommend oral medications for treating agitation in the emergency department (ED). However, there is limited study of their use in the ED, especially in the setting of drug and alcohol intoxication.

OBJECTIVE: To evaluate the implementation of oral medications to treat agitation in an ED in which intramuscular medications were standard and to increase the use of oral medications to treat agitation.

DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study analyzed 2 populations. First, all ED patients in an urban level 1 adult and pediatric trauma center from January 1, 2018, to May 31, 2024, were studied to compare the preintervention and postintervention periods. Second, during the 12-month implementation period from September 16, 2020, to August 31, 2021, patients were prospectively observed in an area of the ED dedicated to caring for patients with drug and alcohol intoxication.

EXPOSURE: Oral medications to treat agitation, including olanzapine and lorazepam, were encouraged via education and real-time feedback for ED staff.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of patients receiving their first sedating medication via the oral route. Secondary outcomes included data on time to adequate sedation and adverse drug events.

RESULTS: Of 460 600 ED encounters (median patient age, 38 years [IQR, 27-55 years]; 57.8% men; 184 050 [40.0%] before the intervention, 276 550 [60.0%] after), the proportion of patients receiving any sedating medication was similar between time periods (11.8% before intervention vs 11.5% after). The proportion of patients receiving their first sedating medication via the oral route increased after the intervention (7.2% vs 31.4%; difference, 24.2 percentage points [pp] [95% CI, 23.6-24.8 pp]). Among 1178 patients receiving sedating medications during implementation (860 [73.0%] with alcohol intoxication; median breath or blood concentration, 0.22% [IQR, 0.16%-0.28%]), 630 (53.5%) were offered oral medication, of whom 446 (70.8%) accepted it. Time to adequate sedation was 15 minutes (IQR, 7-33 minutes) for oral and 15 minutes (IQR, 9-26 minutes) for intramuscular medications (median difference, 1 minute [95% CI, -0.6 to 2.6 minutes]). There were no significant differences between routes in rates of additional rescue medications (oral, 31.8%; intramuscular, 28.4%; difference, 3.4 pp [95% CI, -2.0 to 8.8 pp]) or adverse drug reactions (oral, 2.7%; intramuscular, 1.1%; difference, 1.6 pp [95% CI, -0.1 to 3.3 pp]).

CONCLUSIONS AND RELEVANCE: In this quality improvement study, emergency physicians successfully adopted oral medications for treating agitation, primarily from intoxication. No difference was found in time to adequate sedation when oral or intramuscular medications were used as primary therapy. These data support best-practice guidelines that suggest oral medications should be first-line treatment for agitation in the ED.

PMID:41468014 | DOI:10.1001/jamanetworkopen.2025.51683

JAMA Netw Open. 2025 Dec 1;8(12):e2551690. doi: 10.1001/jamanetworkopen.2025.51690.

ABSTRACT

IMPORTANCE: As assisted reproductive technology (ART) becomes increasingly prevalent, concerns regarding the potential short-term and long-term health outcomes of children conceived through these methods have emerged.

OBJECTIVE: To investigate whether conception via ART is associated with a risk of atopic disease development in offspring.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, population-based cohort study was conducted using data obtained from Taiwan’s National Health Insurance Research Database, Assisted Reproduction Database, and Maternal and Child Health Database. Children conceived via ART and born between January 1, 2004, and December 31, 2014, were identified as the exposure group. A control group of children conceived naturally was selected using 1:4 matching based on maternal age, neonatal sex, and birth month. Data analysis was performed from December 1, 2023, to November 1, 2025.

EXPOSURE: Conception via ART or naturally.

MAIN OUTCOMES AND MEASURES: The primary outcome was development of atopic disease. Both groups were followed up until December 31, 2020. Cox proportional hazards regression models were used to adjust potential confounders.

RESULTS: A total of 69 785 children (13 957 in the ART group and 55 828 in the control group) were included in this study, with follow-up beginning at birth. The study population was 47.5% female and 52.5% male. For the ART and control groups, the mean (SD) follow-up duration was 7.99 (4.22) and 8.41 (4.18) years for asthma, 5.79 (4.12) and 6.34 (4.28) years for allergic rhinitis, and 7.34 (5.13) and 7.62 (5.14) years for atopic dermatitis, respectively. After adjusting for potential confounders, the ART group exhibited a higher likelihood of developing asthma (adjusted hazard ratio [AHR], 1.13 [95% CI, 1.09-1.18]), allergic rhinitis (AHR, 1.15 [95% CI, 1.12-1.18]), or atopic dermatitis (AHR, 1.08 [95% CI, 1.05-1.12]) (all P < .001) compared with the control group. Subgroup analysis revealed that children conceived with fresh embryos faced a greater risk of developing allergic rhinitis compared with those conceived with frozen embryos (AHR, 1.12 [95% CI, 1.06-1.19]; P < .001).

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that children conceived via ART had a higher risk of developing asthma, allergic rhinitis, or atopic dermatitis. These findings underscore the importance of long-term follow-up for offspring conceived via ART and further investigation into the underlying biological mechanisms by which ART may contribute to atopic disease development.

PMID:41468013 | DOI:10.1001/jamanetworkopen.2025.51690

JAMA Netw Open. 2025 Dec 1;8(12):e2551865. doi: 10.1001/jamanetworkopen.2025.51865.

ABSTRACT

IMPORTANCE: Long-term survivors of childhood cancer may be at elevated risk for accelerated brain aging.

OBJECTIVES: To determine the brain age gap estimation (BrainAGE), defined as the difference between estimated brain age and chronological age; the association between BrainAGE scores and poor neurocognitive outcomes; and the correlations of plasma biomarkers of oxidative stress, neuroinflammation, and cardiovascular health with older BrainAGE scores and previous exposure to central nervous system-directed therapy in adult survivors of childhood cancer.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed participants in the St. Jude Lifetime Cohort Study. Included participants were survivors of childhood cancer (brain tumor, acute lymphoblastic leukemia, and Hodgkin lymphoma) and community controls (no history of childhood cancer) aged 18 years or older with a whole brain scan following a neurocognitive assessment. BrainAGE was calculated from January 2016 to February 2021 and analyzed from February 2022 to March 2025. Treatment information, plasma biomarkers, and neurocognitive outcomes were collected.

MAIN OUTCOMES AND MEASURES: The primary outcome was estimated brain age (using previously trained machine learning pipelines) and associations of brain age with neurocognitive outcomes. Associations among BrainAGE scores, plasma biomarkers, and neurocognitive outcomes were examined using multivariable linear regression models and Spearman correlations.

RESULTS: A total of 253 survivors of childhood cancer (127 males [50.2%]; mean [SD] age, 31.7 [8.6] years; mean [SD] time since diagnosis, 21.2 [9.8] years) and 43 community controls (24 females [55.8%]; mean [SD] age at evaluation, 31.4 [9.6] years) were included in analyses. Survivors had significantly higher mean BrainAGE scores than controls (6.6 [95% CI, -12.5 to 41.1] years vs 0.7 [95% CI, -1.0 to 2.4] years older than chronological age; P < .001). A 10-year increase in BrainAGE score was associated with lower cognitive flexibility (β = -0.63; 95% CI, -0.82 to -0.45), processing speed (β = -0.49; 95% CI, -0.67 to -0.31), working memory (β = -0.28; 95% CI, -0.53 to -0.03) and visual memory (β = -0.40; 95% CI, -0.58 to -0.22), vocabulary (β = -0.33; 95% CI, -0.48 to -0.18), and reading (β = -0.31; 95% CI, -0.45 to -0.18) z scores after adjusting for age at diagnosis and sex. Neurofilament light was correlated with BrainAGE score in female survivors (Spearman ρ = 0.24 [P = .04]) and controls (Spearman ρ = -0.47 [P = .03]). Female survivors who were younger than 10 years at cancer diagnosis and treated with 40 Gy or higher cranial radiation had mean BrainAGE scores higher than 30 years (37.34 [95% CI, 17.4-41.0] years) older than chronological age (P = .004) and had lower sex hormone precursor correlated with higher BrainAGE score (Spearman ρ = -0.44 [P = .01]) and higher cranial radiation dose (Spearman ρ = -0.48 [P = .01]). Among male survivors, correlations of BrainAGE score and cranial radiation dose with malondialdehyde (Spearman ρ = -0.25 [P = .04] and -0.26 [P = .04]) and oxidized low-density lipoprotein (Spearman ρ = 0.24 [P = .049] and 0.40 [P = .001]) were identified.

CONCLUSION AND RELEVANCE: This cross-sectional study found that accelerated brain aging was associated with poorer neurocognitive outcomes and correlated with cranial radiation, biomarkers of atherogenesis, neuronal damage, and sex hormone precursors. These findings can guide future research efforts to reduce the risk of vascular disease in this at-risk population.

PMID:41468012 | DOI:10.1001/jamanetworkopen.2025.51865

Crit Rev Anal Chem. 2025 Dec 30:1-13. doi: 10.1080/10408347.2025.2606194. Online ahead of print.

ABSTRACT

Nearly 10 million deaths from cancer occurred in 2020, making it a major cause of death globally, according to the WHO and other important statistics. Given that lung cancer is one of the most prevalent types of cancer, it accounts for around 25% of all deaths from cancer-related causes. The two forms of lung cancer that are treated and characterized differently are small-cell and non-small-cell lung cancer. To identify malignant cells, several techniques have been used in recent decades, including MRI (magnetic resonance imaging), CT (computed tomography scans), and PET (positron emission tomography). The standard detection threshold of conventional assays is insufficient for early-stage detection. As a result, numerous detection techniques have been used to identify lung cancer early. The stages of lung cancer are indicated by the amounts of these biomarkers. As a result, lung cancer screening and clinical diagnosis can be accomplished by the identification of biomarkers. EGFR, CEA, CYFRA 21-1, ENO1, NSE, CA 19-9, CA 125, and VEGF are among the many biomarkers for lung cancer. To identify lung cancer disease biomarkers, an organized summary of several biosensing platforms is given in this article. In particular, it addresses the most recent advancements in optical and electrochemical biosensors, the analytical capabilities of various biosensors, the challenges, and potential directions for future study in regular clinical analysis. Therefore, this study reviews the latest developments and enhancements (2011-2025) in biosensors for the identification of biomarkers for lung cancer.

PMID:41467998 | DOI:10.1080/10408347.2025.2606194

J Laparoendosc Adv Surg Tech A. 2025 Dec 18. doi: 10.1177/10926429251408415. Online ahead of print.

ABSTRACT

Background: Robotic-assisted laparoscopic adrenalectomy (RALA) became a useful tool for the treatment of adrenal lesions. This study aims to identify areas where RALA may offer better outcomes than laparoscopic techniques. Methods: We conducted a retrospective study between August 2014 and November 2024. We involved 321 patients who underwent adrenalectomy during this time. Among these patients, 170 had laparoscopic adrenalectomy (LA), and 151 underwent RALA. We grouped these patients according to the surgical approach, collected, and analyzed preoperative data, and compared their perioperative and postoperative outcomes. Results: In this study, we compared two groups, showing the robotic approach was associated with a significantly shorter operative time compared with the laparoscopic group, 100.5 (±51.7) minutes versus 117.9 (±67.4) minutes, P = .02. There were no significant differences in estimated blood loss (P = .97) or conversion to open (P = .6) between the two groups. But robotic patients did exhibit a shorter duration of hospital stay, a median of 1 versus 2 days in the case of the laparoscopic approach, P value <0.01, and statistically lower 30-day complication rates in the robotic approach, 7.3% versus 14.7%, P = .035. Other short- and long-term complications were comparable between the two groups. Subanalysis of large tumor mass (>5 cm) showed comparable outcomes, with robotic cases showing statistically lower early complication rates (P = .05). Conclusion: The study shows that RALA offers some advantages compared to the traditional LA, particularly with shorter operative time, lesser hospital stay, and fewer early complications. More randomized trials will help to confirm the findings and reach a more definitive conclusion.

PMID:41467988 | DOI:10.1177/10926429251408415

Thyroid. 2025 Dec 18. doi: 10.1177/10507256251409074. Online ahead of print.

ABSTRACT

Background: Bile acid sequestrants have been reported to reduce serum thyroid hormone levels by binding T4 and T3 excreted into the intestinal lumen, preventing their reabsorption into the systemic circulation and interrupting the enterohepatic circulation of these hormones. This meta-analysis evaluates whether adjunctive bile acid sequestrants accelerate reductions in serum iodothyronine when added to standard hyperthyroidism therapy. Methods: A systematic review and meta-analysis were conducted and registered in PROSPERO (CRD42025643217). MEDLINE, Embase, Web of Science, and Cochrane databases were searched from March 1971 to September 2025 for randomized controlled trials (RCTs) assessing adult non-critically ill patients with hyperthyroidism treated with standard therapy (thionamides and beta-blocker) plus adjunctive bile acid sequestrants (cholestyramine or colestipol) versus standard therapy alone. Primary outcomes included a reduction in serum-free T4 and total T3. The secondary outcome was adverse effect frequency. Results: Initial search yielded 705 results. After removal of duplicates and title/abstract screening, 17 full-text articles were reviewed, and five RCTs met the inclusion criteria, totaling 173 adult patients: 93 (53.75%) received adjunctive therapy, and 80 (46.25%) were controls. Causes for thyrotoxicosis included Graves’ disease, toxic adenoma, and multinodular goiter. Doses ranged from cholestyramine 1 g twice a day to 4 g four times a day, and colestipol 20 g daily. At 2 weeks of treatment, bile acid sequestrants showed a non-significant reduction in serum total T3 (mean difference [MD] -0.44 nmol/L, 95% confidence interval [CI]: -1.2 to +0.32) and free T4 level (MD -0.55 ng/dL, CI: -1.15 to +0.04). At 4 weeks, there was a statistically significant reduction in total T3 (MD -1.59 nmol/L, CI: -2.90 to -0.27) and free T4 level (MD -1 ng/dL, CI: -1.74 to -0.25). Conclusions: Adjunctive bile acid sequestrants with standard hyperthyroidism therapy appear to enhance reductions in serum total T3 and free T4 at the mark of four weeks and were well tolerated. However, due to considerable heterogeneity and low quality of evidence, our results should be interpreted with caution. Larger, high-quality RCTs are needed to strengthen the evidence regarding the efficacy of adjunctive bile acid sequestrant therapy.

PMID:41467975 | DOI:10.1177/10507256251409074

J Back Musculoskelet Rehabil. 2025 Dec 30:10538127251407665. doi: 10.1177/10538127251407665. Online ahead of print.

ABSTRACT

BackgroundBooster sessions are suggested to maintain self-management behaviors and treatment effects in chronic low back pain (LBP) interventions, but the effects of boosters on outcomes and the best parameters for booster prescription are unclear.Objectives(1) Compare booster prescription for two LBP treatments in an RCT where prescription was based on self-management program independence, (2) Determine if participant-specific variables predict requiring additional boosters, (3) Explore effects of boosters on outcomes in those requiring additional boosters.MethodsSecondary analysis of an RCT where 154 participants with LBP were randomized to motor skill training (MST), MST + Boosters (MST + B), strength/flexibility exercise (SFE), or SFE + B. This analysis focuses only on the + Boosters groups (age: 40.1 ± 11.2 years, 49 female, LBP duration 9.8 ± 8.8 years). Participants received MST or SFE and six months later received up to 3 boosters. Self-management program independence was assessed at the first booster, and those who were not independent required additional (>1) boosters. Chi-square tests were used to analyze booster prescription. Logistic regression analyses were used to examine predictors of requiring additional boosters. Descriptive statistics were calculated for outcomes for participants who did and did not require additional boosters.ResultsMST + B and SFE + B did not significantly differ in returning for the first booster, χ²(1) = 1.76, p = 0.185. SFE + B were over 10 times more likely to require additional boosters than MST + B; OR = 10.9, 95% CI = [3.1, 38.1]. No participant-specific factors were statistically related to needing additional boosters. Attending additional boosters did not appear to change pain or function.ConclusionsIntervention type, not participant-specific factors, predicted the need for additional boosters. Attending additional boosters did not appear to change pain or function in the current sample.

PMID:41467961 | DOI:10.1177/10538127251407665

Epilepsia. 2025 Dec 30. doi: 10.1002/epi.70070. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the performance of single-item global ratings (SIGRs) and multi-item scales (MISs) in epilepsy research, and assess the influence of diverse constructs, study designs, and statistical methods.

METHODS: Systematic scoping review following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Joanna Briggs Institute guidelines. MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Register of Controlled Trials were searched from 1980 onward. English-language articles including ≥30 persons with epilepsy and using at least one SIGR and one MIS were analyzed. Citation screening at all levels was done independently by two reviewers; data extraction was standardized. We analyzed individual measurements of effect magnitude for SIGRs and MISs. For meta-analyses, correlation-related metrics were transformed to Pearson r and Fisher z transformed, and effect-size metrics were converted to Cohen’s d with Hedges g correction. Multilevel meta-analyses were used to account for data heterogeneity and clustering of effect sizes within studies, and to assess the influence of predefined moderators. Publication bias was assessed with standard methods.

RESULTS: A total of 18 267 citations were identified, and 58 studies were included. Effect magnitude was medium to large across measurements, and it was slightly larger for MISs than for SIGRs, both for correlations and effect sizes (difference = .04, p < .001). Overall, SIGRs and MISs were comparable, and statistically significant differences did not cross effect thresholds (from small to medium or medium to large). Correlations and effect sizes for SIGRs and MISs were lowest in studies involving children and when assessing change; and for SIGRs when Global Clinical Impression (GCI) formats were used.

SIGNIFICANCE: SIGRs are likely comparable to MISs across multiple study and statistical contexts. However, in certain clinical scenarios, MISs will outperform SIGRs and vice versa. Researchers should carefully consider whether SIGRs, MISs, or a combination is most appropriate to answer the research question.

PMID:41467957 | DOI:10.1002/epi.70070

J Interpers Violence. 2025 Dec 30:8862605251398461. doi: 10.1177/08862605251398461. Online ahead of print.

ABSTRACT

Coerced debt is an important but understudied form of intimate partner violence. It occurs when abusive partners use fraud, coercion, or manipulation to incur debt in their partners’ names. For the current study, we sampled 187 women who had recently divorced an abusive husband and their combined 2,833 credit accounts to answer the questions: (1) On what types of credit accounts and using what types of transactions (i.e., fraud, coercion, and manipulation) did ex-husbands create coerced debt in their partners’ names? (2) How much money was spent and what items were purchased? and (3) What reasons did ex-husbands give for pressuring participants to open accounts in their names that resulted in coerced debt? We collected data via an online survey and telephone interview. We analyzed quantitative data with descriptive statistics and responses to open-ended questions with inductive thematic analysis. The findings indicated that coerced debt is a common and expensive problem with a wide variety of presentations. The 116 participants with coerced debt had a mean of 4.4 and a maximum of 24 such debts and owed a combined total of over 12.5 million dollars. The most common types of accounts with coerced debt were credit cards, vehicle loans, mortgages, personal loans, and student loans. Coercive transactions were much more common than debt created by fraudulent transactions. Coerced debt was used for basic necessities, lifestyle purchases, transportation, the ex-husbands’ personal interests, financial needs and obligations, and other household members’ needs. The most common reason ex-husbands gave for putting accounts in their partners’ names was personal resource adequacy. This study indicates the need for future research on the effects of coerced debt and the effectiveness of interventions to address it; screening tools and practices for use in direct service settings; and laws that address debt created by coercive transactions.

PMID:41467937 | DOI:10.1177/08862605251398461