Category: Statistics

Am J Public Health. 2025 Sep;115(9):1508-1517. doi: 10.2105/AJPH.2025.308205.

ABSTRACT

Objectives. To determine the Connect intervention’s effectiveness in reducing substance use among rural and tribal adolescents in northeastern Oklahoma. Methods. We conducted a 2-arm cluster randomized trial from 2021 to 2024, with 10 high schools per condition. Results. At baseline, 919 students were enrolled (mean age = 15 years), and the majority were American Indian or White. Alcohol-use days during the past 30 days was reduced by 18% per survey wave in the intervention compared with the control condition (rate ratio [RR] = 0.82; 95% confidence interval [CI] = 0.72, 0.93; t = -3.02; P = .003), binge drinking was reduced by 26% (RR = 0.74; 95% CI = 0.64, 0.86; t = -3.90; P < .001), cannabis use was reduced by 11% (RR = 0.89; 95% CI = 0.80, 1.00; t = -2.03; P = .04), and prescription opioid misuse was reduced by 40% (RR = 0.60; 95% CI = 0.43, 0.85; t = -2.86; P = .004). Model-predicted means revealed the control condition followed the expected developmental trajectory of increased substance use and the intervention condition showed a flat or decreasing use pattern. Conclusions. The Connect intervention prevented the typical escalation of substance use during adolescence. Trial Registration. ClinicalTrials.gov NCT04839978. Registered on April 9, 2021. Version 10, April 30, 2025. (Am J Public Health. 2025;115(9):1508-1517. https://doi.org/10.2105/AJPH.2025.308205).

PMID:40768695 | DOI:10.2105/AJPH.2025.308205

JCO Glob Oncol. 2025 Aug;11:e2500062. doi: 10.1200/GO-25-00062. Epub 2025 Aug 6.

ABSTRACT

PURPOSE: To test the feasibility of a point-of-care (POC) real-time urine metabolomics test, evaluate its validity in diagnosing colorectal cancer (CRC) among at-risk patients, and assess the willingness of patients in Southwestern Nigeria to use and pay for the test.

METHODS: This was a pilot-controlled trial carried out among 72 patients (34 cases and 38 controls) in southwestern Nigeria. The cases were those with histopathological diagnosis of CRC while controls were at-risk adults. The POC biosensor used a disposable chip and can be connected to a smart device using Bluetooth, and reported if the patient’s urine contained metabolites consistent with CRC. We assessed validity of the test using sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV), and prespecified a specificity of 50% with a goal of ≥80% sensitivity to estimate the potential of the test to half the referrals to colonoscopy. Additionally, we assessed perception toward the test and willingness to uptake the urine test using structured questionnaires.

RESULTS: The overall sensitivity, specificity, PPV, and NPV for all respondents were 91.18%, 81.58%, 81.58%, and 91.18% respectively, with an area under the receiver operating characteristic curve of 0.86. With specificity fixed at 50%, the overall sensitivity for all respondents was 94.5%, and all stratifications had sensitivity >90%. Overall, 70 (98.6%) were satisfied with the urine-based CRC screening, and respondents were willing to pay a mean amount of 8,008.20 Naira (about $5.2 US dollars) for the test.

CONCLUSION: Our urine metabolite early diagnosis POC test met our predetermined criteria for success and had high acceptance rates among Nigerian patients, supporting a future multi-institutional implementation trial assessing our ability to scale up utilization.

PMID:40768684 | DOI:10.1200/GO-25-00062

JMIR Cardio. 2025 Aug 6;9:e66557. doi: 10.2196/66557.

ABSTRACT

BACKGROUND: Virtual reality (VR) has emerged as a promising, low-risk strategy to manage many forms of psychological stress and may be a modality to improve cardiovascular health. Recent scientific statements on the mind-heart-body connection call for better adherence to psychological screening and adoption of more holistic “behavioral cardiology” interventions that improve the overall health of patients with or at risk for cardiovascular disease (CVD).

OBJECTIVE: The aim of this study is to assess safety and preliminarily explore how a VR experience can aid in stress reduction among patients with or at risk for CVD.

METHODS: A convergent mixed methods approach was used for this single-arm prospective pilot study. In total, 20 patients were recruited from the University of California Los Angeles adult cardiology clinics and cardiac rehabilitation. Surveys and physiologic parameters were collected before, during, and after a 30-minute VR experience aimed at relaxation. The primary outcome was the State-Trait Anxiety Inventory-State (STAI-S) scale. They participated in a 90-minute visit, during which they completed surveys, including the STAI-S scale, before and after a 30-minute VR experience. Physiological parameters were also collected before, during, and after the experience. Visits concluded with semistructured interviews analyzed with inductive thematic analysis to add depth and nuance to our analysis.

RESULTS: STAI-S scale scores after the VR experience were significantly decreased from baseline (median 31, IQR 28-38 vs median 24, IQR-29.25; P<.001). Verbal feedback revealed that participants experienced a relaxing sense of “distance from stress” moderated by unexpected, intense audiovisual components. Heart rate significantly decreased (mean 73, SD 8 vs mean 67, SD 6 beats per minute; P<.001), while blood pressure (mean systolic 128, SD 14 vs mean systolic 129, SD 18 mm Hg; P=.75 and mean diastolic 79, SD 9 vs mean diastolic 80, SD 10 mm Hg; P=.60) and galvanic skin response (mean 0.74, SD 0.89 vs mean 0.70, SD 0.57 microsiemens; P=.45) remained the same. Changes in heart rate variability parameters were consistent with increased vagal tone over time but were only statistically significant at certain time points. Survey results and interviews generally indicated safety, tolerability, and openness to using VR again.

CONCLUSIONS: This sample of patients with CVD or risk of CVD had above-average stress, consistent with epidemiological data; the statistically and clinically significant decrease in subjective perception of stress partially converged with physiologic data. Overall, the VR intervention was a safe and feasible stress reduction method. Future research is needed to evaluate the effectiveness of this immersive therapy in reducing cardiovascular risk profiles.

PMID:40768664 | DOI:10.2196/66557

J Trauma Acute Care Surg. 2025 Aug 1;99(3S Suppl 1):S20-S26. doi: 10.1097/TA.0000000000004699. Epub 2025 Aug 6.

ABSTRACT

BACKGROUND: Hemorrhage resulting from trauma is a leading cause of potentially survivable death. Current monitoring devices that offer measures of traditional vital signs can delay patient management during the early compensatory phases of treatment, creating a capability gap for advanced decision support in the austere prehospital setting. In this investigation, we tested the hypothesis that arterial waveform feature analysis outperforms standard vital signs (SVSs) for early detection of progressive reductions in central blood volume and prediction of hemodynamic decompensation.

METHODS: Tolerance to progressive reductions in central blood volume was determined for 187 human subjects (aged 18 to 55 years) who underwent exposure to lower-body negative pressure as a model to simulate human hemorrhage. Tolerance was defined by the onset of clinical decompensated shock as defined by a systolic blood pressure of <80 mm Hg with concurrent expression of presyncopal symptoms (e.g., nausea, cold sweat, tunnel vision). Continuous noninvasive beat-to-beat measurements of systolic, diastolic, and mean arterial blood pressures; heart rate; shock index; blood oxygen saturation; and respiration rate were measured. Arterial waveforms were recorded for arterial waveform feature analysis using a machine learning algorithm called the compensatory reserve measurement. Receiver operating characteristic area under the curve was calculated for predicting the onset of hemodynamic decompensation, and statistical assessment was performed on measurements of sensitivity, specificity, and accuracy for detection of reduced central blood volume.

RESULTS: Compensatory reserve measurement receiver operating characteristic area under the curve (0.94) for predicting onset of decompensated shock was greater (p < 0.001) compared with eight SVSs (0.57 to 0.83). Sensitivity, specificity, and accuracy for detecting reduced central blood volume were significantly higher (0.88, 0.87, 0.85) compared with the respective SVSs (0.57 to 0.83).

CONCLUSION: Arterial waveform feature analysis provides a breakthrough monitoring capability with earlier detection of ongoing hemorrhage and superior discriminative ability to predict the onset of decompensated shock compared with standard vital signs.

LEVEL OF EVIDENCE: Diagnostic Test or Criteria; Level III.

PMID:40768656 | DOI:10.1097/TA.0000000000004699

Aging Dis. 2025 Aug 5. doi: 10.14336/AD.2025.0414. Online ahead of print.

ABSTRACT

There is evidence that hip fragility fractures (HFF) are at least two different types of disease: intra- and extracapsular fractures (ICF and ECF). However, they are still mainly considered as one entity. Differentiating them may provide clues to improve their prevention, treatments and prognosis, and to reduce clinical, organisational and economic impacts. This work addressed published evidence about differences between ICF and ECF in older people, comparing demographic, etiologic, and therapeutic aspects, producing a summary of the state of the art, and determining which variables are associated with significant differences. A systematic review based on PRISMA methodology was conducted, searching in Google Scholar, Springer and Scopus from 01.01.1980 to 01.03.2024. Publications with p-values obtained from quantitative tests (p &;lt 0.05 statistically significant) were included. For meta-analysis, Weighted Mean Method was used. 51 studies (19 countries, 5 continents, 129,075 subjects) were included. 78.4% of main objectives was searching for differences between both HFF. 60.8% provide evidence for demographic variables; 29.4% for diagnostic variables; 11,8% for therapeutic variables. ECF occurred at an older age (p &;lt 0.05) in 43 studies (84.3%). There were no differences in sex (96.1%). 14 routine orthogeriatric blood parameters were studied. Haemoglobin, vitamin-B12, albumin and parathormone presented differences in &;gt50% of the studies. Surgical management was significantly different in all studies. Significant demographic, diagnostic and therapeutic differences exist between ICF and ECF. There is a lack of studies combining variables, especially haematological exams.

PMID:40768635 | DOI:10.14336/AD.2025.0414

J Am Coll Health. 2025 Aug 6:1-11. doi: 10.1080/07448481.2025.2501015. Online ahead of print.

ABSTRACT

Objective: This systematic review synthesizes results of small-scale studies previously conducted at colleges from all five U.S. regions to explore associations between food insecurity, minority status, and academic outcomes on a larger scale. Methods: Narrative analysis of studies from 12 U.S. colleges examines the associations between race and food insecurity, and food insecurity and educational outcomes. Results: Studies consistently demonstrate a higher prevalence of food insecurity in minority students, specifically African American and Hispanic students. Several studies demonstrate a statistically significant correlation between food insecurity and diminished academic outcomes. Discussion: These studies display similar trends, indicating that minority groups are disproportionally affected by food insecurity and that food-insecure groups are more likely to experience worse academic outcomes. While no causal relationships can be drawn from this qualitative analysis, findings suggest that there is an interplay between the variables of food insecurity, race, and decreased academic achievements.

PMID:40768628 | DOI:10.1080/07448481.2025.2501015

J Spinal Cord Med. 2025 Sep;48(5):773-780. doi: 10.1080/10790268.2024.2319917. Epub 2024 Mar 11.

ABSTRACT

OBJECTIVE: Assess the occurrence of traumatic spinal cord injury (TSCI) in Puerto Rico, a geographically delimited territory.

DESIGN: Retrospective review of data from all encounters with ICD-10-CM codes S12-14, S22-24, S32-34, G82.2 and G82.5 for years 2019-2022.

SETTING: Puerto Rico Trauma Hospital.

OUTCOME MEASURES: Patient (sex, age) and injury characteristics (neurological level, mechanism of injury, severity score, length of stay, mortality, and disposition).

RESULTS: Annual incidence rates did not change over time with an increasing trend among older adults (P = 0.08). Median age was 44 yrs and 85% were men. The most frequent neurological level was thoracic (P = 0.03). Falls were the most common mechanism and was associated with age (P < 0.0001). In-hospital mortality was 24.8%, higher (P = 0.05) in 2020-2021. Median length of stay was 26 days, higher (P = 0.014) in 2020-2021. An increase (P < 0.001) over time in discharges to inpatient rehabilitation was observed. The SARS-CoV-2 lockdown resulted in fewer and older patients; more cervical injuries and falls; longer length of stay, and higher in-hospital mortality.

CONCLUSION: The risk of TSCI in Puerto Rico was 74% lower than in the United States. The incidence of TSCI in older adults in Puerto Rico appears to be on the rise due to falls. Preventive strategies should include fall prevention education and social interventions to decrease motor vehicle accidents and firearm violence. Disasters such as the COVID-19 pandemic, can change demographic trends in TSCI. Trauma centers should consider implementing a physiatry consult service to improve patient disposition.

PMID:40768615 | DOI:10.1080/10790268.2024.2319917

JMIR Res Protoc. 2025 Aug 6;14:e73773. doi: 10.2196/73773.

ABSTRACT

BACKGROUND: Digital interventions for mental health are pivotal for addressing barriers such as stigma, cost, and accessibility, particularly for underserved populations. While the effectiveness of digital interventions has been established, poor adherence and lack of engagement remain critical factors that undermine efficacy. Millions of individuals will never have access to a trained mental health care practitioner, underscoring the need for highly tailored and engaging self-guided resources. This study builds on a prior study that successfully leveraged behavioral economics (nudges and prompts) to enhance engagement. Expanding on that study, this research will focus on building a foundational dataset of behavioral phenotypes to support artificial intelligence (AI)-driven personalization in digital mental health.

OBJECTIVE: This 6-arm randomized controlled trial aims to analyze user engagement with randomized tips and to-do lists within a resiliency course tailored for Ukrainian refugees affected by the ongoing humanitarian crisis (Спільна Сила), using the EvolutionHealth.care (V-CC Systems Inc) platform. Insights will inform the development of an AI-based personalization system to optimize engagement and address behavioral health challenges. Secondary objectives include identifying demographic and behavioral predictors of engagement and creating a scalable, culturally sensitive intervention model.

METHODS: Participants will be recruited through digital outreach, enrolled anonymously, and randomized into 6 groups to compare combinations of tips, nudges, and to-do lists. Engagement metrics (eg, clicks, completion rates, and session duration) and demographic data (eg, age and gender) will be collected. Statistical analyses will include a comparison between arms and interaction testing to evaluate the effectiveness of each intervention component. Ethical safeguards include institutional review board approval, informed consent, and strict data privacy standards.

RESULTS: This protocol was designed in January 2025. α and β testing of the intervention are scheduled to begin in July 2025, with a soft launch anticipated in August 2025. The experiment will remain active until the sample size requirements are met. Live monitoring and periodic data quality checks will be conducted throughout the study duration.

CONCLUSIONS: This trial represents a novel approach to behavioral health research by leveraging randomized experimentation to develop AI-ready behavioral datasets. By targeting an underserved and culturally sensitive population, it contributes critical insights toward scalable, personalized digital mental health interventions. Findings may help inform future digital health efforts that aim to improve engagement, accessibility, and long-term adherence.

TRIAL REGISTRATION: Open Science Framework 34rmg; https://osf.io/34rmg.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/73773.

PMID:40768247 | DOI:10.2196/73773

J Pediatr Endocrinol Metab. 2025 Aug 7. doi: 10.1515/jpem-2025-0137. Online ahead of print.

ABSTRACT

OBJECTIVES: Congenital hypothyroidism (CH) requires early diagnosis to prevent irreversible neurodevelopmental impairments. This study aimed to determine cutoff values for initial capillary thyroid-stimulating hormone (TSH), first venous TSH, and levothyroxine (LT4) dose at 6 months to differentiate between transient and permanent CH.

METHODS: A retrospective analysis was conducted on 289 patients diagnosed with CH at the Pediatric Endocrinology Clinic of the University of Health Sciences, Umraniye Training and Research Hospital, from January 2014 to September 2021. Patients received treatment and were followed for at least 6 months after treatment discontinuation or remained under therapy. Patients were divided into two groups: permanent CH and transient CH. Initial capillary TSH, first venous TSH, and LT4 dose at 6 months were recorded, and cutoff values were determined using ROC analysis.

RESULTS: Of the 289 patients, 179 (62 %) had transient CH and 110 (38 %) had permanent CH. The permanent CH group had significantly higher levels of capillary TSH, first venous TSH, and LT4 dose at 6 months (p<0.001). The cutoff values for predicting transient CH were <23.1 mIU/L for capillary TSH, <64.5 mIU/L for first venous TSH, and <3.6 mcg/kg/day for LT4 dose at 6 months, all statistically significant.

CONCLUSIONS: Initial capillary TSH, first venous TSH, and LT4 dose at 6 months are reliable predictors for distinguishing between transient and permanent CH. These cutoff values provide clinical guidance, especially for early treatment discontinuation in patients with LT4 doses below 3.6 mcg/kg/day, indicating a higher likelihood of transient CH.

PMID:40768246 | DOI:10.1515/jpem-2025-0137

Elife. 2025 Aug 6;14:RP105111. doi: 10.7554/eLife.105111.

ABSTRACT

Biological membranes are complex and dynamic structures with different populations of lipids in their inner and outer leaflets. The Ca²⁺-activated TMEM16 family of membrane proteins plays an important role in collapsing this asymmetric lipid distribution by spontaneously and bidirectionally scrambling phospholipids between the two leaflets, which can initiate signaling and alter the physical properties of the membrane. While evidence shows that lipid scrambling can occur via an open hydrophilic pathway (groove) that spans the membrane, it remains unclear if all family members facilitate lipid movement in this manner. Here, we present a comprehensive computational study of lipid scrambling by all TMEM16 members with experimentally solved structures. We performed coarse-grained molecular dynamics (MD) simulations of 27 structures from five different family members solved under activating and non-activating conditions, and we captured over 700 scrambling events in aggregate. This enabled us to directly compare scrambling rates, mechanisms, and protein-lipid interactions for fungal and mammalian TMEM16s, in both open (Ca²⁺-bound) and closed (Ca²⁺-free) conformations with statistical rigor. We show that all TMEM16 structures thin the membrane and that the majority of scrambling (>90%) occurs at the groove only when TM4 and TM6 have sufficiently separated. Surprisingly, we also observed 60 scrambling events that occurred outside the canonical groove, over 90% of which took place at the dimer-dimer interface in mammalian TMEM16s. This new site suggests an alternative mechanism for lipid scrambling in the absence of an open groove.

PMID:40768244 | DOI:10.7554/eLife.105111