Category: Statistics

Cancer. 2025 Aug 1;131(15):e70007. doi: 10.1002/cncr.70007.

ABSTRACT

BACKGROUND: Agent Orange exposure (AOE) is considered a presumptive cause of prostate cancer (PCa) in the Veterans Affairs (VA) population; however, cohort studies reported inconsistent associations of AOE and PCa incidence and outcomes. In this nationwide cohort study, Vietnam veterans who received VA care were evaluated for associations of AOE and PCa incidence and adverse outcomes.

METHODS: Vietnam veterans 17-25 years old during military service (1962-1971) who received VA health care between 2005 and 2020 were stratified by presumptive AOE assigned by the VA and followed until death from any cause or censoring on September 31, 2023. Multivariable Cox models permitted estimation of adjusted hazard ratios (aHRs) of AOE with PCa incidence, de novo metastasis (DNM), any metastasis, metastatic castration-resistant PCa (mCRPC), all-cause mortality (ACM), or PCa-specific mortality (PCSM).

RESULTS: Among 2.6 million Vietnam veterans at risk for PCa, 779,472 (30%) had AOE. Compared to unexposed veterans, AOE veterans had higher PCa risk (aHR, 1.15; 95% confidence interval [CI], 1.15-1.16), higher DNM (aHR, 1.17; 95% CI, 1.16-1.17), any metastasis (aHR, 1.17; 95% CI, 1.16-1.17), mCRPC (aHR, 1.17; 95% CI, 1.16-1.17), ACM (aHR, 1.41; 95% CI, 1.41-1.42), and PCSM (aHR, 1.17; 95% CI, 1.16-1.17) in adjusted models. Sensitivity analyses suggested robustness of association between AOE and all-cause mortality, but selection bias could explain associations with PCa outcomes.

CONCLUSIONS: Presumptive AOE was associated with higher PCa incidence, mortality, and adverse outcomes. Although associations may not be causal, AOE may predict worse PCa outcomes in the Veterans Affairs.

PMID:40682278 | DOI:10.1002/cncr.70007

Psychophysiology. 2025 Jul;62(7):e70056. doi: 10.1111/psyp.70056.

ABSTRACT

During menopause, the majority of women experience hot flashes (HF) that have a significant negative impact on sleep and quality of life. Current HF therapies are either ineffective or associated with unacceptable side effects. Digital health technologies offer a novel opportunity to fill this treatment gap with just-in-time thermal interventions through wearable devices. Thermal interventions have shown promise in reducing the negative impact of HFs. We hypothesized that HF event onsets can be accurately and reliably predicted from physiological signals prior to a person’s perception of the events. This study investigated the feasibility of using skin conductance (SC) to predict the onset of HF events before they are subjectively perceived. 62 women who were experiencing HFs and self-reported being in peri- or postmenopause were recruited. Data collection consisted of three remotely conducted 48-h sessions. During each session, SC from the lateral torso was measured continuously and participants logged the precise timing of each perceived HF event onset. We developed new features to identify characteristics of SC signals before HFs were perceived. The best performing model trained with these features identified 82% of HF events on average 17 s before the onset with less than 2% false-positive rate. Among the identified events, the model predicted 69% of HF events before onset. This study demonstrates the feasibility of predicting HF event onsets before subjective perception. Future studies should investigate both multimodal prediction as well as user acceptance and effectiveness of just-in-time thermal interventions.

PMID:40682261 | DOI:10.1111/psyp.70056

Allergol Immunopathol (Madr). 2025 Jul 8;53(4):169-177. doi: 10.15586/aei.v53i4.1364. eCollection 2025.

ABSTRACT

BACKGROUND: The increasing prevalence of asthma necessitates consideration of modifiable asthma risk factors, such as sedentary lifestyle, overweight/obesity, and environmental tobacco smoke (ETS) exposure. The aim of this study was to analyze the relationship between asthma symptoms and the risk factors in young adolescents.

METHODS: This cross-sectional study, as part of the Global Asthma Network (GAN) Phase I project, used standardized questionnaires based on ISAAC (International Study of Asthma and Allergies in Childhood) Phase I and Phase III questionnaires. In Gjilan, Kosovo, self-reported data from 1200 school children aged 13-14 years were collected.

RESULTS: Overweight (BMI [body mass index] > 25 kg/m²) had a statistically significant association with asthma symptoms (p < 0.05), particularly with disturbed sleep due to wheezing (OR [odds ratio] = 3.93 [95% CI [confidence interval]: 1.27-12.12]) and the reported wheezing by females during or after exercise. Sedentary lifestyle (≥ 3 hours/day on a computer/television) was found to be associated with wheezing (OR = 1.89 [95% CI: 1.34-2.66]) and the diagnosis of asthma. ETS exposure was significantly associated with wheezing during or after exercise (OR = 1.67 [95% CI: 1.15-2.42]) and coughing at night (OR = 1.67 [95% CI: 1.19-2.33]).

CONCLUSION: The findings support the importance of sedentary lifestyle, obesity, and ETS exposure as asthma risk factors in young adolescents experiencing asthma symptoms. Future public health interventions should take these modifiable risk factors into account, especially in urban locations, in order to alleviate asthma morbidity.

PMID:40682245 | DOI:10.15586/aei.v53i4.1364

Allergol Immunopathol (Madr). 2025 Jul 1;53(4):68-77. doi: 10.15586/aei.v53i4.1323. eCollection 2025.

ABSTRACT

OBJECTIVE: To evaluate physicians’ management of non-immunoglobulin E-mediated gastrointestinal cow’s milk protein allergy (non-IgE-GI-CMPA) in Brazilian infants.

METHODS: A total of 447 physicians from all the regions of Brazil answered an online questionnaire concerning their management of formula-fed infants with mild-to-moderate (Case 1) or severe (Case 2) clinical manifestations of non-IgE-GI-CMPA.

RESULTS: In total, 95.3% and 86.0% of the interviewed physicians in cases 1 and 2 prescribed a cow’s milk elimination diet (p < 0.001). In the initial management, the prescription rates of formulas based on extensively hydrolyzed protein and amino acid were 81.7% and 14.6% for Case 1 and 32.7% and 65.4% for Case 2 (p < 0.001); the percentages of answers for prescriptions of drugs or probiotics were 8.3% and 12.1% in cases 1 and 2 (p < 0.001); and requests for laboratory tests were 12.3% and 37.7 % (p = 0.016). The oral food challenge (OFC) test for the diagnosis of non-IgE-GI-CMPA was indicated by 55.1% and 42.7% of the physicians in cases 1 and 2 (p < 0.001). The OFC test was chosen to assess tolerance development by 92% of the interviewees. Performing the diagnostic OFC (D-OFC) test was positively associated with having board certification in pediatric gastroenterology and < 20 years of professional experience and negatively associated with using baked foods as a protein source in the oral tolerance OFC test.

CONCLUSIONS: Most interviewees followed the guidelines regarding prescribing an elimination diet; however, many should include the OFC test in diagnosing infants with non-IgE-GI-CMPA. Not performing the D-OFC may have negative consequences on patients and on the public healthcare system.

PMID:40682230 | DOI:10.15586/aei.v53i4.1323

J Neurosurg. 2025 Jul 18:1-13. doi: 10.3171/2025.3.JNS2583. Online ahead of print.

ABSTRACT

OBJECTIVE: Applications to neurosurgical residency programs have progressively increased, both in applicant numbers and programs applied to per applicant. The adoption of signaling, beginning with 8 signals in the 2022-2023 cycle and increasing to 25 in the 2023-2024 cycle, has the potential to improve the match process and reduce applicant costs. This study analyzed trends in the neurosurgery residency match from 2017 to 2024 to evaluate the impact of signaling.

METHODS: The Texas STAR (Seeking Transparency in Application to Residency) is a survey administered annually to US applicants following the match. Data included neurosurgery applicants from 2017 to 2024 and were categorized into pre-COVID-19 (2017-2020), COVID-19 (2021-2022), and signaling (2023-2024) cohorts. Applicant-reported characteristics associated with matching were assessed. For the 2023 and 2024 cycles, signal yield (interviews at signaled programs divided by total signals), signal-to-interview ratio (percentage of interviews at signaled programs), and nonsignal yield (interviews at nonsignaled programs divided by nonsignaled applications) were calculated. Comparative statistics and regression models were applied.

RESULTS: Among 418 applicants (127 from 2023-2024 with signaling data), those in recent cycles submitted fewer applications (73.9 pre-COVID-19 vs 74.7 COVID-19 vs 64.3 signaling, p = 0.01) and received fewer interview offers (24.7 vs 23.0 vs 18.9, p < 0.001). In the 2023-2024 cycles, matched applicants had more abstracts, posters, presentations (8.65 vs 9.58 vs 10.47, p < 0.001) and publications (5.78 vs 7.71 vs 7.91, p < 0.001), with fewer total applications (72.62 vs 75.03 vs 62.26, p < 0.001) and interviews offered (25.85 vs 23.40 vs 21.02, p = 0.004), compared with matched applicants from previous cycles. A multivariable model showed that fewer applications was associated with greater match likelihood for 2023-2024 applicants (OR 0.87, 95% CI 0.77-0.99). Signal yield (54.0% vs 19.1%, p < 0.001), signal-to-interview ratio (71.5% vs 38.0%, p < 0.001), and nonsignal yield (22.4% vs 8.6%, p = 0.02) were higher among matched applicants versus unmatched applicants in 2024. The signal-to-interview ratio increased for matched applicants from 2023 to 2024 (18.2% vs 71.5%, p < 0.001), while the nonsignal yield decreased (33.7% vs 22.4%, p = 0.005), in line with increases in number of signals.

CONCLUSIONS: Signaling has changed the landscape of the neurosurgery residency match process, with fewer applications submitted and fewer interviews offered per applicant. Signals seemingly result in increased interview likelihood and may hone the selection process to more efficiently align applicant and program preferences.

PMID:40680308 | DOI:10.3171/2025.3.JNS2583

J Neurosurg Pediatr. 2025 Jul 18:1-17. doi: 10.3171/2025.3.PEDS24533. Online ahead of print.

ABSTRACT

OBJECTIVE: This scoping review aimed to assess themes and gaps in the existing scope of literature regarding psychological outcomes and quality of life in children with hydrocephalus.

METHODS: Using the search criteria “pediatric AND hydrocephalus AND (psychological OR behavioral OR emotional OR cognitive),” the authors imported articles from SCOPUS, PubMed, PsycINFO, PsycArticles, and independent citation searches into Covidence, and duplicates were removed (n = 372). After the abstract and full text were screened, the remaining articles (n = 44) underwent data extraction to identify key psychological outcomes and themes in the literature. Findings were quantified using descriptive statistics in SPSS software, and themes were analyzed to interpret knowledge trends and gaps in current studies.

RESULTS: These studies examined psychological outcomes in pediatric hydrocephalus, focusing on neuropsychological (56%), behavioral and emotional (32%), academic (13.6%), and developmental (11.4%) outcomes. Most studies were cross sectional (56.8%), with sample sizes ranging from 6 to 467 participants. Neuropsychological impairments, particularly in intelligence, memory, and attention, were prevalent, as were behavioral and emotional problems, especially internalizing behaviors. The literature supported diminished quality of life in pediatric hydrocephalus populations, and several medical factors such as severity of hydrocephalus and treatment type were found to influence psychological functioning and outcomes.

CONCLUSIONS: This scoping review highlights neuropsychological, behavioral, and emotional challenges in children with hydrocephalus, with deficits observed primarily in intelligence, memory, attention, and quality of life. Limitations in standardization of follow-up with patients made a systematic review difficult to conduct. Nonetheless, findings reveal the need for targeted interventions in these areas, as well as further research on the influence of medical factors, treatment type, and severity of hydrocephalus on long-term outcomes.

PMID:40680304 | DOI:10.3171/2025.3.PEDS24533

JMIR Public Health Surveill. 2025 Jul 18;11:e76195. doi: 10.2196/76195.

ABSTRACT

BACKGROUND: Unintentional injury is a leading cause of childhood morbidity and mortality worldwide. In China, real-world implementation of child injury prevention efforts remains inadequate due to constrained workforce capacity and a lack of operational frameworks.

OBJECTIVE: This study aims to assess the effectiveness of a mobile health (mHealth) intervention, the Intelligent Child Unintentional-Injury Reduction & Education (iCURE) project, embedded within China’s National Basic Public Health Service Program. The intervention relies on a WeChat (Tencent) service account for caregivers and a web-based platform for health care providers to deliver standardized unintentional injury prevention strategies for young children. Key features of the program include interactive questions and answers, injury risk assessment with instant feedback, a tailored injury prevention knowledge disseminator, and regular reminders to caregivers.

METHODS: A double-blind, 12-month follow-up, cluster randomized controlled trial will be implemented in Changsha, Hunan Province, China. Caregivers of children aged ≤5 years will be recruited. Randomization will be conducted at the street or town level. The control group will receive routine safety education, while the intervention group will receive both routine safety education and the iCURE mHealth intervention focused on unintentional injury prevention and delivered via WeChat. Data will be collected at baseline and every 3 months during the study period. The primary outcome is 12-month incidence of unintentional injuries among children, including minor injuries and as reported by caregivers. Secondary outcomes include children’s injury risk level and caregiver supervision behaviors assessed using a standard questionnaire. Data analysis will be conducted using generalized linear mixed models with a Poisson link function and generalized estimating equations to assess the effectiveness of the iCURE intervention, following intention-to-treat principles. Sensitivity analyses will be conducted with per-protocol principles and excluding participants with missing primary outcomes.

RESULTS: As of May 2025, a total of 6701 participants have been successfully enrolled and baseline data were collected for all participants. Of those enrolled, 87.2% (5842/6,701) completed the first follow-up assessment.

CONCLUSIONS: This trial will examine the effectiveness of an intelligent mHealth intervention for child unintentional injury prevention building on China’s National Basic Public Health Service Program. If successful, the iCURE intervention may provide a cost-effective strategy for child injury prevention in low- and middle-income countries.

PMID:40680288 | DOI:10.2196/76195

Nurs Res. 2025 Jul 14. doi: 10.1097/NNR.0000000000000852. Online ahead of print.

ABSTRACT

BACKGROUND: Nurses experience high rates of mental health stressors. Mental health support services can mitigate the burden of these stressors and mental health sequelae, but nurses may not access them due to stigma, unavailability, or concerns regarding professional standing.

OBJECTIVE: To examine the association between nurse characteristics and perceived need for and utilization of mental health services and identify barriers to nurses accessing mental health services.

METHODS: Cross-sectional survey data were analyzed from 367 nurses in one large urban health system. Descriptive statistics and multinomial logistic regression were used to examine demographic, workplace, and mental health characteristics that were independently associated with perceived need for and utilization of mental health services.

RESULTS: Nurses who reported experiences of verbal abuse, anxiety, or burnout and who were younger and partnered were more likely to have utilized mental health services and have perceived they would benefit from these services. The most prevalent barriers to care included not knowing how to find a provider, inconvenient hours, and embarrassment or concerns about judgment from others.

DISCUSSION: Several barriers prevent nurses who perceive a need for mental health services from accessing them. Interventions targeting these barriers may help mitigate the burden of mental health conditions in this population.

PMID:40680286 | DOI:10.1097/NNR.0000000000000852

Nurs Res. 2025 Jul 14. doi: 10.1097/NNR.0000000000000848. Online ahead of print.

ABSTRACT

BACKGROUND: Computable phenotyping is a data science method that systematically synthesizes clinical attributes, such as a disease, condition, or patient cohort, enabling a database to be queried for entries matching these characteristics. Developing computable phenotypes will enhance current clinical and research efforts and is foundational for effective nurse scholar participation in future data science endeavors, such as artificial intelligence (AI) and machine learning (ML) research.

OBJECTIVE: (a) Present a foundational, disease-agnostic framework for systematic computable phenotype construction; (b) demonstrate the framework used by exploring the following question: “Does early pubertal timing increase the risk of developing type II diabetes in males?”; and (c) outline the methodologic utility and limitations of computable phenotyping for nursing research.

METHODS: A proof-of-concept pilot project explored computable phenotype research utility by querying the TriNetX© de-identified health record database. Various computable phenotypes were constructed to retrieve complete case frequency counts of specific health records for children experiencing puberty. These retrieved records allowed for quantifying type 2 diabetes (T2D) risk by comparing children diagnosed with precocious puberty (medically diagnosed early puberty) to those without an abnormal puberty diagnosis. A translational science lens informed the extraction and synthesis of the underlying scientific and operational principles relevant to systematic computable phenotyping.

RESULTS: A six-step, disease-agnostic, computable phenotyping framework is synthesized for nurse researchers and clinicians to leverage “big data” applications in their work. The puberty case example-illustrating foundational use of the framework-suggests that males with precocious puberty may be six times more likely to develop T2D when 14-18 years old than those without diagnosed early puberty. The framework provides a foundation for sophisticated statistical analyses, such as leveraging computable phenotypes in multivariate modeling and machine learning algorithms.

DISCUSSION: The six-step, computable phenotype framework will introduce nurse scholars and clinicians to leverage data science principles in real-world interfaces. Applications using the framework can include generating and testing epidemiologic hypotheses, identifying participants for research with specific clinical attributes, deploying statistical models for health care monitoring and decision-making, and participating in future research on AI and ML algorithms. The puberty case example generates foundational evidence to justify future puberty research.

PMID:40680284 | DOI:10.1097/NNR.0000000000000848

JMIR Cancer. 2025 Jul 18;11:e72862. doi: 10.2196/72862.

ABSTRACT

BACKGROUND: Digital health portals are online platforms allowing individuals to access their personal information and communicate with health care providers. While digital health portals have been associated with improved health outcomes and more streamlined health care processes, their impact on individuals living with or beyond cancer remains underexplored.

OBJECTIVE: This scoping review aimed to (1) identify the portal functionalities reported in studies involving individuals living with or beyond cancer, as well as the outcomes assessed, and (2) explore the diversity of participant characteristics and potential factors associated with portal use.

METHODS: We conducted a scoping review in accordance with the JBI methodology (formerly the Joanna Briggs Institute) and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We included primary research studies published between 2014 and 2024 that involved participants living with or beyond cancer, had access to personal health information, and assessed at least one outcome related to health or the health care system. We searched the Embase, Web of Science, MEDLINE (Ovid), and CINAHL Plus with Full Text databases. Five reviewers independently screened all titles, abstracts, and full texts in duplicate using Covidence. We extracted data on study design, participant characteristics, portal functionalities, outcomes assessed, and PROGRESS-Plus (place of residence; race, ethnicity, culture, or language; occupation; gender or sex; religion; education; socioeconomic status; and social capital-Plus) equity factors.

RESULTS: We included 44 studies; most were conducted in the United States (n=30, 68%) and used quantitative (n=23, 52%), mixed methods (n=11, 25%), or qualitative (n=10, 23%) designs. The most common portal features were access to test results (28/44, 64%) and secure messaging (30/44, 68%). Frequently reported services included appointment-related functions (19/44, 43%), educational resources (13/44, 30%), and prescription management features (11/44, 25%). Behavioral and technology-related outcomes were the most frequently assessed (37/44, 84%), followed by system-level (19/44, 43%), psychosocial (16/44, 36%), and clinical outcomes (5/44, 11%). Overall, 43% (19/44) of the studies addressed PROGRESS-Plus factors. Age was the most frequently reported (13/19, 68%), followed by socioeconomic status (10/19, 53%), race or ethnicity (7/19, 37%), and gender or sex (7/19, 37%). Social capital (2/19, 11%), occupation (1/19, 5%), and disability (1/19, 5%) were rarely considered, and religion was not reported in any study.

CONCLUSIONS: While digital health portals enhance patient engagement, their clinical impact and equity implications remain insufficiently evaluated. We found disparities in functionalities, outcomes, and PROGRESS-Plus representation. To promote equitable benefits, future studies should adopt inclusive designs and evaluation strategies that address diverse outcomes and integrate social determinants of health.

PMID:40680274 | DOI:10.2196/72862