Category: Statistics

J Med Internet Res. 2025 Nov 18;27:e80497. doi: 10.2196/80497.

ABSTRACT

BACKGROUND: Health disparities are closely associated with socioeconomic inequalities. Although this relationship is well recognized in the context of traditional health care access, its influence on online health-seeking behaviors such as posting questions on patient forums and seeking peer responses remains poorly understood, particularly in the context of resource-limited regions. Furthermore, it is unclear what types of questions are most frequently asked online and to what extent these questions receive helpful responses.

OBJECTIVE: This study aims to examine how socioeconomic status influences online health-seeking behavior by analyzing regional disparities in forum participation and their correlation with economic development. In addition, it aims to identify unmet informational needs among patients with lymphoma through large language model (LLM)-based forum thread classification and expert evaluation of forum responses by using data from the largest online blood cancer forum in China.

METHODS: We analyzed over 110,000 patient-initiated forum threads posted between 2012 and 2023, covering all the provinces of mainland China. Regional trends in forum participation rates were examined and correlated with economic development, as measured by gross regional product per capita. Second, an LLM was used to classify the threads into 6 predefined topics based on their semantic content, thereby providing an overview of the topics that users cared about. Additionally, an expert manual review was conducted based on relevance, accuracy, and comprehensiveness to assess whether users’ questions were adequately addressed within the forum discussions.

RESULTS: Regional forum participation rates were significantly associated with levels of regional economic development (Wilcoxon rank-sum test; P<.001), with the highest participation rates in the East Coast regions. Participation rates in less-developed regions steadily increased, reflecting the growing public demand for accessible health information. LLM-based analysis revealed that most discussions centered on medical concerns such as interpreting reports and selecting treatment plans across all regions. However, only 37% (117/316) of the user questions received useful responses, underscoring persistent gaps in access to reliable information.

CONCLUSIONS: To our knowledge, this study represents the most comprehensive real-world investigation to date of spontaneous online forum participation and information needs among patients with cancer. Our findings highlight the necessity for government and health care providers to implement initiatives such as artificial intelligence-driven information platforms and region-specific health education campaigns to bridge information gaps, reduce regional disparities, and improve patient outcomes across China.

PMID:41252192 | DOI:10.2196/80497

Mil Med. 2025 Nov 18:usaf571. doi: 10.1093/milmed/usaf571. Online ahead of print.

ABSTRACT

INTRODUCTION: Military medical students train in austere, high-stress environments that simulate prolonged casualty care and the cognitive and emotional demands of combat medicine. These scenarios can heighten stress and cognitive load, yet few curricula explicitly equip learners with structured strategies for psychological self-regulation. Mindfulness training has shown promise in clinical and operational contexts, but its educational role in military medical training is underexplored.

MATERIALS AND METHODS: We developed the Mental Strength and Resilience Training (MSRT), a brief, theory-informed mindfulness curriculum incorporating three 1-hour sessions and asynchronous video materials. Mental Strength and Resilience Training emphasized 5 mindfulness strategies-breathing, mantra, movement, stretching, and body scan-framed for transfer to prehospital operational environments. Ninety-seven third- and fourth-year medical students at the Uniformed Services University participated across 2 high-fidelity military medical field exercises: Operation Gunpowder (36 hours) and Operation Bushmaster (5 days). Outcomes were assessed with the Mindful Attention Awareness Scale (MAAS), Brief Resilience Scale (BRS), and Perceived Stress Scale (PSS) at 4 time points. These 4 time point measures were then analyzed using a repeated measures Analysis of Variance (ANOVA) model, and the relationships between each scale score were analyzed using correlations. Faculty observers also evaluated clinical performance at Operations Gunpowder and Bushmaster for all students. Performance comparisons between students involved in the study and students not involved were compared via independent samples t-testing. The relationships between study participants’ performance and their mindfulness, resilience, and stress were analyzed via correlations, with any significant correlations being entered into a regression model for further examination. This study was approved and deemed exempt by the Uniformed Services University Institutional Review Board (IRB) committee.

RESULTS: Learners demonstrated significant increases in mindfulness (η2p = 0.32, P < .001) and resilience (η2p = 0.06, P = .002), alongside reductions in perceived stress (η2p = 0.28, P < .001). Correlation analyses showed stress was consistently negatively associated with mindfulness and resilience. Faculty-rated performance scores did not differ significantly between the students involved in the study and non-participating students regularly enrolled at Operations Gunpowder and Bushmaster. However, pre-Bushmaster resilience predicted performance outcomes (P = .02) in the participating student sample.

CONCLUSIONS: Brief, theory-informed mindfulness training enhanced learners’ self-regulation and reduced stress during high-fidelity military medical exercises. Although performance gains were not statistically significant, the findings suggest mindfulness is a feasible and scalable approach to strengthen psychological readiness in military medical education, with potential applications across military and civilian health professions training.

PMID:41252179 | DOI:10.1093/milmed/usaf571

Environ Entomol. 2025 Nov 18:nvaf114. doi: 10.1093/ee/nvaf114. Online ahead of print.

ABSTRACT

One of the main challenges in improving agricultural productivity is the prevalence of pests and diseases, which are highly sensitive to extreme weather conditions. The interaction between weather patterns and pest infestations significantly affects crop yield. Traditional statistical methods often struggle to capture the complex temporal and geographical dynamics of these interactions. However, employing multivariate cointegration has proven valuable for estimating such interactions and quantifying the extent to which various environmental conditions influence pest populations. The study further investigated impulse response functions, which revealed substantial impacts of temperature and relative humidity on pest populations through unit standard deviation shocks to endogenous variables. Specifically, this research examined the dynamic causal relationships between major pest occurrences and environmental variables in 3 groundnut-growing states of India-Andhra Pradesh, Gujarat, and Tamil Nadu, using cointegration and Vector Error Correction Model techniques. The analysis incorporated key environmental variables, including temperature, relative humidity, and rainfall. Results from the Johansen test indicated a strong long-term equilibrium relationship between pest populations and climatic conditions, confirming the presence of at least one cointegrating vector at the 5% significance level. Granger causality tests further revealed that temperature and relative humidity had a unidirectional causal influence on the pest occurrence. Additionally, impulse response analysis further revealed that shocks to temperature and relative humidity produced significant and persistent effects on pest incidence over time.

PMID:41252177 | DOI:10.1093/ee/nvaf114

Proc Natl Acad Sci U S A. 2025 Nov 25;122(47):e2504913122. doi: 10.1073/pnas.2504913122. Epub 2025 Nov 18.

ABSTRACT

The architectures of biological neural networks result from developmental processes shaped by genetically encoded rules, biophysical constraints, stochasticity, and learning. Understanding these processes is crucial for comprehending neural circuits’ structure and function. The ability to reconstruct neural circuits, and even entire nervous systems, at the neuron and synapse level, facilitates the study of the design principles of neural systems and their developmental plan. Here, we investigate the developing connectome of Caenorhabditis elegans using statistical generative models based on simple biological features: neuronal cell type, neuron birth time, cell body distance, reciprocity, and synaptic pruning. Our models accurately predict synapse existence, degree profiles of individual neurons, and statistics of small network motifs. Importantly, these models require a surprisingly small number of neuronal cell types, which we infer and characterize. We further show that to replicate the experimentally observed developmental path, multiple developmental epochs are necessary. Our model’s predictions of the synaptic connections and their strength, using multiple reconstructions of adult worms, reflect that it identified much of the shared part of the connectivity graph. Thus, the accuracy of the generative statistical models we use here offers a general framework for studying how connectomes develop and the underlying principles of their design.

PMID:41252150 | DOI:10.1073/pnas.2504913122

Cancer J. 2025 Nov-Dec 01;31(6):e0797. doi: 10.1097/PPO.0000000000000797. Epub 2025 Nov 18.

ABSTRACT

Generative artificial intelligence (Gen-AI) powered technologies are increasingly integrated across virtually all fields, including oncology, poised to fundamentally transform human-machine interaction (HMI). In biomedicine and oncology, Gen-AI tools are forming the foundation for intuitive patient-facing and clinician-facing interfaces that increase accessibility and efficiency of health care applications, enhance patient experience, and improve clinical workflows, ultimately optimizing patient outcomes. Despite Gen-AI’s great potential in health care, limitations related to data quality and learning algorithms can create persistent challenges to patient safety, warranting a thorough HMI evaluation by end-users and experts that goes beyond traditional statistical validation. In parallel, a legal framework for assigning liability among developers, deployers, maintainers, and end-users is essential to ensure fairness and promote safe and beneficial application of clinical AI.

PMID:41252128 | DOI:10.1097/PPO.0000000000000797

Anat Sci Int. 2025 Nov 18. doi: 10.1007/s12565-025-00909-3. Online ahead of print.

ABSTRACT

This study aims to elucidate the morphometric and morphological details of teeth in the Syrian hamster (Mesocricetus auratus, Waterhouse, 1839) and guinea pig (Cavia porcellus, Linnaeus, 1758) using µ-CT and stereology (n = 5). Notably, the hamsters exhibited distinctive roots in their cheek teeth, in contrast to the guinea pigs, where the tooth body extended as a dental root into the alveolar socket, making anatomical diagnosis challenging. The first and second cheek teeth of the hamster had four roots, but the last one had three roots. The hamster incisor teeth had a more voluminous pulp cavity compared to those of guinea pigs. While the ratio differences of arch parameters and enamel thickness were not statistically significant (P ≥ 0.05). The enamel layer in guinea pig incisor teeth were significantly thicker than that in the hamster teeth (P ≤ 0.05). Regarding the dentine-tooth width, the difference between the upper incisor teeth of the hamster and guinea pig was significant (P ≤ 0.05). The ratio of pulp-tooth volume in all incisor teeth of the hamster was significantly higher than that in the guinea pig’s teeth (P ≤ 0.05) indicating hamsters might have better regenerative dental health despite dietary variances. These insights contribute to deeper understanding of the evolutionary adaptations in rodent dentition and suggest improved information and methodologies for translational dental studies and selecting more appropriate animal models in dental research.

PMID:41252122 | DOI:10.1007/s12565-025-00909-3

J Racial Ethn Health Disparities. 2025 Nov 18. doi: 10.1007/s40615-025-02734-w. Online ahead of print.

ABSTRACT

INTRODUCTION: COVID-19 disproportionately affected Black Americans, and social determinants of health (SDOH) likely contributed to this disparity, yet their impact remains unclear. This study investigated the association between race and COVID-19-related hospitalization, assessing the added explanatory value of SDOH and clinical factors.

METHODS: In this observational study, we invited 22,895 adult (≥ 18 years) Kaiser Permanente Georgia (KPGA) members with a COVID-19 diagnosis between Jan. 2020 and Jun. 2021 to take a survey of which 482 participated (response rate = 2.1%). We included non-Hispanic Black or non-Hispanic White KPGA members with complete data (n = 306). Surveys were linked to KPGA’s electronic medical records. Multivariable logistic regression assessed the relationship between race (non-Hispanic Black compared with White) and likelihood of 30-day hospitalization post-COVID-19 diagnosis adjusting for clinical factors (demographics, comorbidities) and SDOH (neighborhood SDOH, pre-COVID-19 health behaviors, and COVID-19 social impacts). Max-scaled R-squares and likelihood ratio tests assessed model variation and covariate significance.

RESULTS: Our study population was 39.2% Black, 32.4% male, and mean age was 52.3 ± 13.3 years. Overall, 20.0% of Black and 12.4% of White members were hospitalized within 30 days of COVID-19 diagnosis. While not statistically significant, Black (compared with White) members were 72% (aOR: 1.72 [95% CI: 0.75 3.91]) more likely to be hospitalized. Race, clinical factors, and SDOH explained 1.8%, 18.6%, and 14.4% of the variation in hospitalization risk, respectively, and cumulatively explained 34.8%.

CONCLUSION: No significant racial differences in 30-day hospitalization were observed; however, we found that clinical factors and SDOH explained similar variation in hospitalization risk.

PMID:41252118 | DOI:10.1007/s40615-025-02734-w

Eur J Health Econ. 2025 Nov 18. doi: 10.1007/s10198-025-01847-7. Online ahead of print.

ABSTRACT

BACKGROUND: Transthyretin amyloid cardiomyopathy (ATTR-CA) is a progressive, fatal disease that often presents as heart failure with preserved ejection fraction (HFpEF). To date, scarce evidence about the economic burden of ATTR-CA has been published. This study compared the economic impact of HFpEF in patients with and without ATTR-CA in Spain.

METHODS: The PRACTICA study was a cross-sectional, multicenter, nationwide study in twenty sites in Spain. A total of 387 consecutive ambulatory or hospitalized patients aged ≥ 50 years with HFpEF and LVH ≥ 12 mm were included and screened for ATTR-CA. Healthcare resource utilization (HRU), except specific pharmacologic treatments, non-HRU and its associated average cost per-patient per-year were assessed in year 2021 for ATTR-CA and non-ATTR-CA patients.

RESULTS: Patients were classified as: ATTR-CA (n = 65), non-ATTR-CA (n = 306) and inconclusive (n = 16). Mean total cost per-patient per-year was higher in ATTR-CA patients: €3,407 (Min-Max: €1,067-€6,473) in ATTR-CA, €3,203 (€1,168-€5,646) in non-ATTR-CA and €2,920 (€1,165-€5,080) in inconclusive patients (p < 0.001, Kruskal-Wallis). Determinants of differential cost favoring ATTR-CA were hospitalizations, genetic testing, implantable cardiac defibrillator, and scintigraphy. No statistical differences were observed between patients with and without ATTR-CA in non-healthcare resources paid by patients themselves, although inconclusive patients showed significantly higher home adaptation (shower, bed rail) and crutch utilization (p = 0.031, Kruskal-Wallis).

CONCLUSIONS: This is the first multicenter nationwide study assessing the economic impact on Spanish society of ATTR-CA patients with HFpEF and LVH ≥ 12 mm. The cost was substantial, with negative implications particularly for the Spanish National Health System.

PMID:41252105 | DOI:10.1007/s10198-025-01847-7

Eur J Health Econ. 2025 Nov 18. doi: 10.1007/s10198-025-01872-6. Online ahead of print.

ABSTRACT

BACKGROUND: Despite its increasing prevalence, the economic impact of eosinophilic esophagitis (EoE) in Europe is understudied and direct economic costs remain unknown.

OBJECTIVE: To assess contemporaneous direct medical costs during the first year after EoE diagnosis in Spain to identify key cost determinants and assess variables that could affect these costs.

METHODS: Observational study of Spanish participants in the EUREOS EoE CONNECT registry with incident EoE in 2017-2018. We assessed average costs/year in Euros for endoscopic procedures, out-patient visits, medication, emergency room visits and hospitalizations, 2018 being our base year. Official regional tariffs were used to estimate direct costs from a healthcare provider perspective; official price lists were used for drug therapies. Cost differences and determinants were assessed with multivariate models.

RESULTS: The mean annual direct cost of EoE per person among 302 patients (76.5% male, 77.5% adults) was €1,842.07 (SD €795.69). Endoscopic procedures accounted for 68% of this, followed by outpatient visits (15.9%) and drug prescriptions (10.8%). Cost was higher for pediatric compared to adult patients (€2,101.51 vs. €1,784.29, p < 0.01), for those with higher EREFS score (€1,979.36 vs. €1,794.49; p < 0.01), and in high-volume hospitals (€1,941.48 vs. €1,723.92; p = 0.02). Early response to first-line treatment reduced annual costs by -€368.95 (p < 0.01), by avoiding further medical procedures.

CONCLUSION: First year after EoE diagnosis produces significant direct costs in Spain, mainly due to endoscopic procedures, which are reduced in early responders to first-line therapy. Research for non-invasive methods for EoE assessment and identifying predictors of response are, therefore, key.

PMID:41252104 | DOI:10.1007/s10198-025-01872-6

J Ophthalmic Inflamm Infect. 2025 Nov 18;15(1):86. doi: 10.1186/s12348-025-00541-2.

ABSTRACT

BACKGROUND: Multidrug-resistant (MDR) bacteria are an escalating global public health concern and represent a cross-cutting issue affecting multiple sectors. In ophthalmic care, broad-spectrum antimicrobial agents are frequently prescribed empirically by healthcare professionals, often without culture-based evidence. This practice contributes to the development of drug-resistant pathogens. Therefore, routine surveillance of bacterial profiles and multidrug resistance in external ocular infections is crucial for effective treatment, prevention, and control efforts. The primary objective of this study was to determine the prevalence of multidrug resistance among bacterial isolates from external ocular infections and to identify associated risk factors.

METHOD: A cross-sectional study was conducted among 360 external ocular infection suspected patients between May 1 and July 30, 2023, at the University of Gondar Comprehensive Specialized Hospital’s Tertiary Eye Care and Training Center. Systematic random sampling was employed to recruit participants. Sociodemographic and clinical data were collected using structured questionnaires. Ocular specimens were collected aseptically and processed using standard microbiological techniques according to CLSI. Data were entered into EpiData version 25 and analyzed using SPSS version 25. Bivariate and multivariate logistic regression analyses were performed to assess the risk factors, with a 95% confidence interval. A p-value of less than 0.05 was considered statistically significant. A total of 360 patients participated in the study.

RESULTS: Bacterial pathogens were isolated in 59.7% (215/360) of the external ocular infection samples. Gram-positive bacteria were the most frequently identified, comprising 46.7% (168/222) of isolates. Staphylococcus aureus was the most common isolate (43.7%, 97/222), followed by coagulase-negative Staphylococcus species (29.7%, 66/222), Pseudomonas aeruginosa (10.8%, 24/222), and Escherichia coli (5.4%, 12/222). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 21.6%. Overall, multidrug resistance was observed in 62.2% (138/222) of the isolates. Notably, dental infections were significantly associated with the presence of bacterial external ocular infections.

CONCLUSIONS: This study highlights a high prevalence of bacterial and multidrug-resistant organisms in external ocular infections. Gentamicin and ciprofloxacin are effective antimicrobial agents against the isolated pathogens. These findings underscore the need for continuous monitoring of bacterial profiles and antimicrobial susceptibility patterns to support evidence-based antibiotic use and mitigate the rise of antimicrobial resistance in ocular infections.

PMID:41252093 | DOI:10.1186/s12348-025-00541-2