Category: Statistics

Gait Posture. 2025 Jul 17;122:272-278. doi: 10.1016/j.gaitpost.2025.07.319. Online ahead of print.

ABSTRACT

BACKGROUND: Knee osteoarthritis (KOA) is a debilitating condition affecting knee function and mobility. Lateral wedge insoles (LWIs) are used to manage KOA, but their effects in different footwear types need further investigation. This study aimed to evaluate the effects of LWIs on lower-limb joint kinematics in KOA patients, comparing walking barefoot (Bare), conventional sandals with LWIs (SAN), and combo slipper socks with LWIs (SOC), a novel footwear design.

METHODS: 23 female patients with bilateral medial compartment KOA (K-L grades II-III), aged 45-65 years, walked in three conditions: Bare, SAN, and SOC. Assessments included comfort levels (Likert scale), pain severity (Visual Analog Scale), and lower-limb joint kinematics. Statistical analysis utilized paired t-tests with Statistical Parametric Mapping. Results are presented as means ± standard deviations, with comparisons between conditions done via mean differences (MD) and Cohen’s d (d).

RESULTS: Our analysis revealed SOC provides greatest comfort and lowest pain, followed by SAN, with Bare condition exhibited the lowest comfort and highest pain levels. Hip flexion angles during mid-swing were significantly greater in SOC (M=22.07 ± 12.29°) compared to Bare (M=19.80 ± 11.95°; p < 0.01; MD = 2.27°, d=-0.10). Knee flexion during terminal stance was significantly lower in SOC (24.38 ± 1.30°) than in Bare (27.65 ± 1.27°; p < 0.01, MD=-3.27°, d=2.54). Hip external rotation angles during pre-swing were significantly reduced in SAN (-15.36 ± 0.92°) and SOC (-14.82 ± 0.64°) relative to Bare (-17.85 ± 1.04°; p < 0.01, [Bare vs. SAN] MD=2.49, d=-2.54; [Bare vs. SOC] MD=3.09, d=-3.6). SAN also demonstrated significantly lower ankle plantarflexion angles during both stance (1.97 ± 3.71°) and swing (-19.45 ± 4.76°) compared to Bare stance (6.49 ± 3.42°, MD= -4.52°, d=1.27) and swing (-13.33 ± 4.83°;p < 0.001, MD=-6.12°, d=1.27).

CONCLUSION: A unique LWI-integrated design (SOC), improved comfort, reduced pain, and altered joint kinematics during walking in females with medial KOA. These findings demonstrate the potential of SOC for conservative KOA management. Further studies should explore SOC’s impact on joint loading and long-term clinical outcomes.

PMID:40768789 | DOI:10.1016/j.gaitpost.2025.07.319

JMIR Form Res. 2025 Aug 6;9:e70672. doi: 10.2196/70672.

ABSTRACT

BACKGROUND: Increasing reliance on digital health resources can create disparities among older patients. Understanding health-related, mobility, and socioeconomic factors associated with the use of eHealth technologies is important for addressing inequitable access to health care.

OBJECTIVE: We sought to assess digital health literacy among patients aged ≥65 years and identify factors associated with their ability to access, understand, and use digital health resources.

METHODS: We developed a survey instrument grounded in the Technology Acceptance Model and conducted a cross-sectional, mixed-mode survey of patients aged ≥65 years from an integrated, multispecialty medical center. Digital health literacy was measured using the eHeals health literacy scale, and responses were analyzed across self-rated health, self-reported mobility, and socioeconomic deprivation assessed with the Area Deprivation Index (ADI). Counts (n) and frequencies (%) are reported across response groups, and analyses for differences are performed using the χ2 test for independence or the Fisher exact test.

RESULTS: Analyses included 878 responses (response rate=878/2847; 30.8%). There was a significant difference in the distribution of race between responders and nonresponders (P<.001) but no significant differences were observed by age (P=.053) or gender (P=.73). Respondents with lower self-rated health had lower levels of digital health literacy; only 54.2% (n=13/25) participants with poor self-rated health were able to send a message to their doctor compared to 89.5% (n=68/77) of patients with excellent self-rated health. All comparisons across the digital health literacy domains revealed significant differences across self-rated health groups (P<.05). Respondents with mobility restrictions had lower levels of digital health literacy, including lower frequencies of reporting knowledge of what health resources are available on the internet (mobility restricted, n=92/182; 52.0% vs no mobility restriction, n=433/688; 64.7%), knowledge of how to find health resources on the internet (mobility restricted, n=120/182; 67.4% vs no mobility restriction, n=513/688; 76.8%), and ability to use a camera or video with a doctor easily (mobility restricted, n=58/182; 32.6% vs no mobility restriction, n=321/688; 48.0%). Older adults experiencing increased socioeconomic deprivation, as measured by the ADI, reported lower rates of digital health literacy across most categories, including knowledge of how to find health resources on the internet (high ADI, n=28/49; 59.6% vs low ADI, n=551/751; 75.5%) and the ability to send an electronic message to their doctor easily (high ADI, n=27/49; 57.4% vs low ADI, n=584/751; 80.2%).

CONCLUSIONS: Our findings highlight the need for targeted interventions to improve engagement with eHealth among patients aged ≥65 years, who are impacted by poor health, limited mobility, and socioeconomic deprivation. Enhancing digital health literacy can help bridge the gap in access to digital health resources and improve overall health outcomes for this population.

PMID:40768764 | DOI:10.2196/70672

J Med Internet Res. 2025 Aug 6;27:e72607. doi: 10.2196/72607.

ABSTRACT

BACKGROUND: Ovarian follicles and endometrial thickness are monitored repeatedly for assisted reproduction, burdening patients and clinics. Self-scans with a home ultrasound device can relieve this.

OBJECTIVE: We aimed to evaluate the reliability of self-scans using the smartphone-based Pulsenmore follicle count vaginal self-scan device (FC) versus in-clinic (IC) sonographies, in ovarian stimulation for in-vitro fertilization or fertility preservation.

METHODS: This study is a single-center, interventional, controlled, prospective study including 44 patients without pelvic pathologies undergoing stimulation for in-vitro fertilization (2022-2024). Following training, patients used a vaginal home ultrasound device to scan their uterus and ovaries with remote guidance by a sonographer in each cycle check-point. Clinical decisions were based on standard IC sonographies. FC and IC results were compared for image quality, endometrial thickness, and follicle count or size. Aspirated oocyte numbers were compared to the follicles recorded at the last visit by home and IC scans. Absolute differences in follicular count and endometrial thickness between IC and FC scans were compared using means, SDs, and 95% CIs. The Spearman correlation (r) analyzed the relations between IC and FC outcomes. All tests applied were 2-tailed, with a P value of ≤5% considered statistically significant. Patient and sonographer satisfaction were assessed via surveys.

RESULTS: Of 44 patients, 34 completed this study. The mean age was 34.7 (SD 4.0) years, and BMI was 25.8 (SD 5.0) kg/m². A total of 65% (22/34) pursued fertility preservation and 35% (12/34) aimed to conceive. The image quality scores of all home scans were at a minimum suitable level, with most of better quality. FC measurements closely matched IC findings for key clinical parameters: antral follicle count (mean FC 11.94, SD 6.62 vs mean IC 15.23, SD 10.2, ρ=0.86, P<.001); number of stimulated follicles ≥10 mm (FC 12.19, SD 6.27 vs IC 13.5, SD 8.87, ρ=0.84, P<.001); identification of the leading follicle >14 mm (achieved in 87% of FC scans); and follicular number or size pretriggering. The aspirated oocyte or last-visit stimulated follicles (>10 mm; FC 1.12, SD 0.6 vs IC 1.06, SD 0.56, ρ=0.82, P<.001), mature oocytes or follicles >13 mm ratios (FC 1.28, SD 1.11 vs IC 1.04, SD 0.77, ρ=0.88, P<.001), and endometrial thickness pretriggering (FC 9.87, SD 2.2 mm vs IC 9.63, SD 2.7 mm, ρ=0.54, P=.002) were well-correlated between the home and standard scans, with 87.1% concordance in identifying endometrial adequacy (≥7 mm). In the patient survey, 82% (28/34) expressed interest in future use of the FC device. In the sonographer survey, 91% (31/34) demonstrated patient improvement.

CONCLUSIONS: The home ultrasound device was feasible, comparable, and well-correlated with standard IC scans, laying the basis for remote home-based monitoring of follicular development during ovarian stimulation. We believe this also applies to monitoring milder stimulations and even natural cycles.

PMID:40768762 | DOI:10.2196/72607

JMIR Aging. 2025 Aug 6;8:e70040. doi: 10.2196/70040.

ABSTRACT

BACKGROUND: The demand for home medical care services has increased in aging societies. Therefore, allocating health care resources optimally to meet the needs of each community is essential. Geographical accessibility is an important factor affecting access to home medical care services; however, little research has been conducted on regional disparities in geographical accessibility.

OBJECTIVE: This study aims to analyze the regional disparities in geographical accessibility to home medical care services using the Kokuho database (KDB), a comprehensive medical claims database for a prefecture in Japan.

METHODS: This study included 39 municipalities in Nara Prefecture, Japan. Using a geographical information system, accessibility to home medical care services, that is, travel distance and time from hospitals and clinics to hypothetical patients, was analyzed in two scenarios: (1) an ideal scenario, where we assumed that all hospitals or clinics in Nara Prefecture provided those services and (2) an actual scenario, where hospitals or clinics in Nara Prefecture that actually provided home medical care services, identified from KDB data analysis, were used in the analysis. Hypothetical patients were randomly distributed on the geographical information system in accordance with the usage rates of home medical care services and with the distributions of the population aged ≥75 years. The usage rate by municipalities was aggregated from the analysis of KDB data of Nara Prefecture in FY2019.

RESULTS: The median travel distance was longer than 16 km, the reference limit value specified in the Japanese fee table, and the median travel time exceeded 30 min in certain rural municipalities in the southern part of Nara Prefecture, in the actual scenario, whereas the travel distance and time were improved in the ideal scenario. The differences in travel time between the ideal and actual scenarios were the largest in the depopulated municipalities in the southern part, such as Totsukawa (32.6 vs 5.8 min), Kawakami (30.1 vs 11.8 min), Kurotaki (21.3 vs 5.2 min), and Kamikitayama (20.7 vs 3.5 min). The usage rates were also lower in rural municipalities in the southern part.

CONCLUSIONS: The results revealed that geographical accessibility was lower in depopulated municipalities in the southern part, and the disparity could be partly solved in the ideal scenario, especially in that area, highlighting the necessity of increasing supply in the southern areas. KDB is a comprehensive database that includes medical claims information for home medical care patients and details of the provision of medical institutions, enabling geographical analysis that reflects actual health care usage.

PMID:40768758 | DOI:10.2196/70040

Medwave. 2025 Aug 6;25(7):e3088. doi: 10.5867/medwave.2025.07.3088.

ABSTRACT

INTRODUCTION: In Chile, the number of migrants affected by tuberculosis has experienced a significant increase from 7.1% in 2014 to 29.7% in 2023, ranking as the first group at risk. The objective was to estimate the time to diagnosis of tuberculosis from arrival in Chile in a series of migrants undergoing treatment between January 2021 and March 2022.

METHODS: We analyzed a cohort of migrants over 18 years of age with a diagnosis of tuberculosis treated in the communes of Recoleta and Independencia. Those who agreed to participate and signed the informed consent form were included. Cases with non-tuberculous mycobacteria and residents outside the Metropolitan Region were excluded. Sociodemographic, clinical, and arrival dates, as well as symptoms and diagnoses, were recorded. Proportional hazards models in STATA v.18 were used to analyze times according to independent variables. A p value < 0.05 was considered significant.

RESULTS: The median time to diagnosis was 93.5 months, varying by subgroup. The recent migration subgroup without Chilean documentation had a hazard ratio of 13.1, which indicates that, at any time after arrival, these individuals have a 13-fold increased risk of tuberculosis diagnosis compared to the reference subgroup (traditional migration with Chilean identity documents). This hazard ratio is reduced by 2.4 times when these types of migrants have documentation from Chile (95% confidence interval: 1.2 to 4.5).

CONCLUSIONS: There is a wide range of time from arrival in Chile to the diagnosis of tuberculosis. Factors such as the type of migration and the type of identity document have an impact on the development of this disease. It is necessary to expedite the legal administrative process for migrants and implement timely screening policies, along with follow-up and improved access to healthcare, to reduce exposure and risk of tuberculosis.

PMID:40768753 | DOI:10.5867/medwave.2025.07.3088

Chaos. 2025 Aug 1;35(8):083114. doi: 10.1063/5.0244302.

ABSTRACT

The Dansgaard-Oeschger events are sudden and irregular warmings of the North Atlantic region that occurred during the last glacial period. A key characteristic of these events is a rapid shift to warmer conditions (interstadial), followed by a slower cooling toward a colder climate (stadial), resulting in a saw-tooth pattern in regional proxy temperature records. These events occurred many times during the last 100 000 years and have been hypothesized to result from various mechanisms, including millennial variability of the ocean circulation and/or nonlinear interactions between ocean circulation and other processes. Our starting point is a non-autonomous, conceptual, but process-based, model of Boers et al. [Proc. Natl. Acad. Sci. 115, E11005-E11014 (2018)] that includes a slowly varying non-autonomous forcing represented by reconstructed global mean temperatures. This model can reproduce Dansgaard-Oeschger events in terms of shape, amplitude, and frequency to a reasonable degree. However, the model of Boers et al. has instantaneous switches between different sea-ice evolution mechanisms on crossing thresholds and, therefore, cannot show early warning signals of the onset or offset of these warming events. In this paper, we regularize this model by adding a fast dynamic variable so that the switching occurs smoothly and in finite time. This means the model has the potential to show early warning signals for sudden changes. However, the additional fast timescale means these early warning signals may have short time horizons. Nonetheless, we find some evidence of early warning for the transition between slow and rapid cooling for the model.

PMID:40768746 | DOI:10.1063/5.0244302

N Engl J Med. 2025 Aug 7;393(6):544-555. doi: 10.1056/NEJMoa2413772.

ABSTRACT

BACKGROUND: Plague is a high-consequence infectious disease with epidemic potential. Current treatment guidelines are based on weak evidence.

METHODS: We enrolled persons (excluding pregnant persons) in Madagascar who had clinically suspected bubonic plague during 2020-2024. Using an open-label noninferiority design, we compared two treatments included in the national plague guidelines: oral ciprofloxacin for 10 days (ciprofloxacin monotherapy) or injectable aminoglycoside for 3 days followed by oral ciprofloxacin for 7 days (aminoglycoside-ciprofloxacin). The primary end point was treatment failure on day 11, with treatment failure defined as death, fever, secondary pneumonic plague, or alternative or prolonged plague treatment. To show noninferiority of ciprofloxacin monotherapy among patients with laboratory-confirmed or probable infections, the upper boundary of the 95% confidence interval around the risk difference had to be less than 15 percentage points.

RESULTS: A total of 933 patients underwent screening; 450 patients with suspected bubonic plague were enrolled and underwent randomization. A total of 220 patients (110 per group) had confirmed infection, and 2 (1 per group) had probable infection. Of the patients who underwent randomization, 53.2% were male, and the median age was 14 years (range, 2 to 72). Ciprofloxacin monotherapy was noninferior to aminoglycoside-ciprofloxacin therapy: among the patients with confirmed or probable infection, treatment failure occurred in 9.0% (10 of 111 patients) in the ciprofloxacin monotherapy group and 8.1% (9 of 111 patients) in the aminoglycoside-ciprofloxacin group (difference, 0.9 percentage points; 95% confidence interval, -6.0 to 7.8). Noninferiority was consistent in other prespecified analysis populations. A total of 5 patients in the ciprofloxacin monotherapy group and 4 patients in the aminoglycoside-ciprofloxacin group died, and secondary pneumonic plague developed in 3 patients in each group. The incidence of adverse events among patients with confirmed or probable infections was similar in the two groups – 18.0% in the ciprofloxacin monotherapy group and 18.9% in the aminoglycoside-ciprofloxacin group had adverse events, and 7.2% and 5.4%, respectively, had serious adverse events.

CONCLUSIONS: Oral ciprofloxacin monotherapy for 10 days was noninferior to an aminoglycoside-ciprofloxacin sequential combination for the treatment of patients with bubonic plague. (Funded by the U.K. Foreign, Commonwealth, and Development Office and Wellcome; IMASOY ClinicalTrials.gov number, NCT04110340.).

PMID:40768716 | DOI:10.1056/NEJMoa2413772

Eur J Dent Educ. 2025 Aug 6. doi: 10.1111/eje.70030. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to evaluate access cavity preparation quality, procedure time, and working posture of general dentistry residents using different types of magnification (naked eye, traditional loupe and deflection loupe).

METHODS: This in vitro study used a randomised cross-over design. Thirty general dentistry residents performed access cavity preparations using naked eye, traditional loupe, and deflection loupe on plastic right maxillary first molars in manikins. The working posture was evaluated using the Posture Assessment Instrument (PAI). The access cavity preparation quality scores, procedure time, and PAI scores were compared between groups. Questionnaire results on residents’ perceptions were also analysed.

RESULTS: The access cavity preparation scores were higher for both loupe groups than the naked eye group. Procedure time was not different between groups. Both PAI_total and PAI_neck scores were statistically lower in the deflection loupe group and traditional loupe group than in the naked eye group. The deflection loupe group had lower PAI_neck scores than the traditional loupe group. Both traditional loupe and deflection loupe were rated positively in terms of precision, ergonomics, treatment quality, and adaptability. The deflection loupe was considered superior in ergonomics but less comfortable. Eye fatigue is a common problem for both types of loupes.

CONCLUSION: Both deflection loupe and traditional loupe can improve working posture and access cavity preparation quality. Deflection loupe had an ergonomic advantage over traditional loupe. The comfort of deflection loupe needed improvement because of its heavy weight. Another perceived problem of deflection loupe and traditional loupe was eye fatigue.

PMID:40768709 | DOI:10.1111/eje.70030

Am J Public Health. 2025 Sep;115(9):1518-1528. doi: 10.2105/AJPH.2025.308136.

ABSTRACT

Objectives. To expand COVID-19 containment indicators to evaluate the relationship between excess mortality and government response. Methods. We developed a longitudinal study analyzing excess mortality, COVID-19 containment, and structural conditions in 34 countries between 2020 and 2022. Results. The average excess mortality ratios of the 34 countries were 1.09, 1.14, and 1.11 in 2020, 2021, and 2022, respectively. Thirteen countries experienced continuous annual rises, while only 2 had consistent annual declines. Top-performing countries significantly reduced excess deaths by 5.7% (b = -0.06; 95% CI [confidence interval] = -0.10, -0.01; P = .02) in 2020 and 12.9% (b = -0.13; 95% CI = -0.17, -0.08; P < .001) in 2021, compared to bottom performers. Middle-performing countries saw reductions of 6.7% (b = -0.07; 95% CI = -0.11, -0.02; P = .01) and 10.6% (b = -0.11; 95% CI = -0.15, -0.06; P < .001). These findings suggest that better containment is associated with fewer excess deaths, even after accounting for preexisting structural differences. Conclusions. The COVID-19 containment indicators’ precision emphasizes the association between better containment and lower excess mortality during early and postvaccine development periods. Public Health Implications. Our findings urge governments to utilize new metrics that balance flexibility and strictness for pandemic strategies, informing future policy interventions. (Am J Public Health. 2025;115(9):1518-1528. https://doi.org/10.2105/AJPH.2025.308136).

PMID:40768708 | DOI:10.2105/AJPH.2025.308136

Am J Public Health. 2025 Sep;115(9):1417-1425. doi: 10.2105/AJPH.2025.308148.

ABSTRACT

Objectives. To examine how perceived authenticity may buffer the impact of racial discrimination on depressive symptoms and suicidal ideation among young Black/African American men. Methods. In 2024, we collected data online in the United States using Qualtrics. Participants were 350 Black men aged 18 to 24 years (mean = 21.49; SD = 1.96), most of whom identified as heterosexual or straight and had completed a high school diploma or general equivalency diploma. We measured suicidal ideation, depressive symptoms, racial discrimination, and perceived authenticity through self-report questionnaires. Results. Authenticity reduced suicidal ideation (b = -0.24; P < .001) and depressive symptoms (b = -0.22; P < .001). An interaction effect emerged for suicidal ideation (b = -0.09; P = .045) but not depressive symptoms (b = 0.02; P = .58). Conclusions. Perceived authenticity served as a protective factor for young Black men. Public Health Implications. Practitioners may consider incorporating strategies to enhance perceived authenticity as part of interventions aimed at improving men’s mental health. (Am J Public Health. 2025;115(9):1417-1425. https://doi.org/10.2105/AJPH.2025.308148).

PMID:40768697 | DOI:10.2105/AJPH.2025.308148