Tag: statistics

J Clin Psychopharmacol. 2025 Jun 6. doi: 10.1097/JCP.0000000000002027. Online ahead of print.

ABSTRACT

PURPOSE/BACKGROUND: Intramuscular (IM) lorazepam is administered to acutely agitated patients. During a lorazepam shortage, midazolam was selected as the IM benzodiazepine of choice at this study location. This study aims to explore the efficacy and safety of IM haloperidol, diphenhydramine, and midazolam in treating acutely agitated patients.

METHODS/PROCEDURES: A single center, retrospective chart review was conducted in adult patients who received IM diphenhydramine and haloperidol in combination with either midazolam (midazolam+) or lorazepam (lorazepam+) in a psychiatric emergency department (ED) during 2 identified lorazepam shortage periods. Multivariate ordinary least squares and logistic regression analyses were used to evaluate post-IM patients’ conditions in behavioral activity rating scale (BARS) scores and the safety and tolerability of IM administrations.

FINDINGS/RESULTS: A total of 174 patients met inclusion criteria, with 87 patients in the midazolam+ group (treatment) and 87 patients in the lorazepam+ group (control). Lorazepam+ was associated with a 9.4% greater decrease in BARS score than midazolam+ (P<0.01). Midazolam+ administrations achieved a goal BARS score of 4 more frequently than lorazepam+ (P<0.05). 18.4% more patients received a BARS score of 2, oversedation with lorazepam+ (P<0.05). Lorazepam+ patients took nearly 3 hours (176 min) longer than midazolam+ to return to “normal” baseline behavior (P<0.001). No statistically significant differences were detected in the incidence of hypotensive episodes or oxygen desaturation between groups.

IMPLICATIONS/CONCLUSIONS: This is the first study to examine coadministration of intramuscular midazolam with haloperidol and diphenhydramine. Midazolam+ was effective at managing agitation and may be an alternative to lorazepam+.

PMID:40493972 | DOI:10.1097/JCP.0000000000002027

NCHS Data Brief. 2024 Dec;(517):1. doi: 10.15620/cdc/168516.

ABSTRACT

INTRODUCTION: Influenza, also known as flu, is a viral respiratory infection. In the 2022-2023 flu season, an estimated 31 million people developed influenza, 360,000 were hospitalized with influenza, and 21,000 died from influenza. To prevent more serious illness, early identification and treatment of influenza is important. This report uses data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to study trends in the use of influenza testing at hospital emergency department (ED)visits from 2013 through 2022.

METHODS: Data in this report are from NHAMCS, a nationally representative annual survey of nonfederal general and short-stay hospitals. Results are presented from 2013 to 2022. Estimates and their corresponding variances were calculated using SAS-callable SUDAAN software. Differences between percentages were evaluated using two-sided significance t tests at the 0.05 level. Linear regression was used to test the significance of slope.

KEY FINDINGS: ED visits by children ages 0-5 years had the highest percentage of influenza tests ordered or provided in 2013 and 2022. Percentages of ED visits with an influenza test ordered or provided increased between 2013 and 2022 for all age groups. Fever and cough were the most frequent first-listed reasons for ED visits at which an influenza test was ordered or provided in both 2013 and 2022. Percentages of ED visits with an influenza test ordered or provided increased within each region of the United States (Northeast, Midwest, South, and West) between 2013 and 2022.

PMID:40493962 | DOI:10.15620/cdc/168516

NCHS Data Brief. 2025 Apr;(212):1.

ABSTRACT

BACKGROUND: Synthetic data has been gaining popularity in many fields as an approach to retain data utility (the validity of inference using synthetic data) and protect confidentiality. However, creating synthetic data for complex surveys remains a challenge.

METHODS: This research compared three approaches to incorporate survey design information (stratification, clustering, and sampling weights) during the synthetic data-generating process using the Research and Development Survey (RANDS), a series of primarily web surveys conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention. Both parametric (logistic and linear regression models) and nonparametric (classification and regression trees [CART]) methods were used to create synthetic data. Data utility and disclosure risk were evaluated via confidence interval overlap, propensity score measurement, and average matching probability for re-identification.

RESULTS: Using the original survey design information as predictors during the synthesis process improved data utility for the parametric method. However, the nonparametric method yielded results with better data utility but slightly higher disclosure risk.

PMID:40493961

Natl Vital Stat Rep. 2025 May 20;(5):1. doi: 10.15620/cdc/174590.

ABSTRACT

BACKGROUND AND OBJECTIVES: Beginning with the 2023 data year, the National Center for Health Statistics (NCHS) will use a different, expanded measure of perinatal mortality for standard publications. This measure, Definition III, includes fetal deaths at 20 weeks of gestation or more and infant deaths younger than 7 days. Definition III replaces Definition I (fetal deaths at 28 weeks of gestation or more and infant deaths younger than 7 days), which has been used in NCHS reports since the 1980s. This change is being made due to the implementation of national reporting of all fetal deaths at 20 weeks of gestation or more as of 2014, allowing for the use of Definition III, which more fully represents the perinatal events most likely to be affected by similar factors. This report describes the reason for this change and compares trends in perinatal mortality rates based on Definition I and Definition III from 2014 to 2022 and differences in the two measures by maternal race and Hispanic origin, age, and state of residence for 2022.

METHODS: Data for perinatal mortality are derived from NCHS’s National Vital Statistics System’s fetal death, birth, and period linked birth/infant death files. Perinatal mortality rates for Definition III are compared with those for Definition I.

RESULTS: In 2022, Definition III comprised 91.4% of perinatal deaths (fetal deaths at 20 weeks of gestation or more and infant deaths younger than 28 days) compared with 60.7% of perinatal deaths captured by Definition I. The perinatal mortality rate for Definition III was about 50% higher than that for Definition I (8.27 and 5.51, respectively, in 2022). Trends in perinatal mortality were similar for both measures during 2014-2022; rates were stable from 2014 through 2016 and then declined from 2016 through 2022. For 2022, patterns by maternal race and Hispanic origin and age were also similar, but more variation in patterns was observed by state.

PMID:40493960 | DOI:10.15620/cdc/174590

Plast Reconstr Surg. 2025 Jun 10. doi: 10.1097/PRS.0000000000012244. Online ahead of print.

ABSTRACT

BACKGROUND: To investigate key factors related to the velopharyngeal insufficiency (VPI) by evaluating velopharyngeal morphology, soft palate mobility and surgical recovery in cleft palate patients with different types of velopharyngeal function.

METHODS: CT data was used to compare morphology in 49 postoperative velopharyngeal competence (VPC), 39 VPI, and 49 non-cleft individuals. Ultrasound assessed surgical recovery in 87 VPC, 77 VPI, and 75 non-cleft individuals. Soft palate mobility was evaluated in 20 VPC and 17 VPI patients through cephalometric X-rays.

RESULTS: In terms of velopharyngeal morphology, both VPC and VPI groups exhibited shorter velar and hard palate ratios, longer pharyngeal ratio, and lower VP ratio compared to the non-cleft group (p < 0.05), but there were no significant differences between VPC and VPI (p > 0.05). Both groups exhibited significantly lower echo intensity (EI), higher intensity dispersion index (IDI) and lower logarithm unit color velocity (LUCV) values compared to the non-cleft group (p < 0.05). However, the differences in EI, IDI and LUCV between the VPC and VPI groups were not statistically significant (p > 0.05). In contrast, VPC group showed significantly better soft palate mobility compared to VPI, with greater elevation angle (p = 0.042) and higher closure rate (p = 0.001) during speech.

CONCLUSION: The VPC group showed significantly improved soft palate mobility compared to the VPI group; however it was interesting to note the lack of significant differences in velopharyngeal morphology and surgical recovery in postoperative cleft palate patients with VPC and VPI.

PMID:40493959 | DOI:10.1097/PRS.0000000000012244

Curr Med Res Opin. 2025 Jun 10:1-18. doi: 10.1080/03007995.2025.2517697. Online ahead of print.

ABSTRACT

OBJECTIVE: Type 2 diabetes (T2D) is a chronic metabolic disorder requiring insulin therapy as β-cell function declines. Despite insulin’s proven efficacy, adherence remains a significant challenge. This study aims to identify factors influencing insulin adherence among patients with T2D to inform targeted clinical interventions.

METHODS: A cross-sectional study was conducted at a tertiary diabetes clinic, recruiting adult patients with T2D on insulin therapy for at least six months. A structured, validated questionnaire was administered in person to collect demographic, clinical, and treatment-related data, along with patient beliefs about insulin. Insulin adherence was defined as taking ≥80% of prescribed doses over the past month. Statistical analysis included univariate and multivariate logistic regression to identify independent predictors of adherence.

RESULTS: Among 111 patients, 49 (44.1%) were adherent, while 62 (55.9%) were non-adherent. Adherence was associated with male gender, higher education levels, smoking abstinence, and adherence to recommended diet and exercise regimens. Non-adherent patients had a higher prevalence of family history of diabetes, more diabetic complications, increased comorbidities, and more frequent hospitalizations. Self-injection of insulin and regular self-monitoring of blood glucose were linked to better adherence, whereas fear of injections and the use of herbal medicine were associated with lower adherence. Negative beliefs about insulin were not significantly different between groups.

CONCLUSION: Insulin adherence in T2D is influenced by lifestyle, clinical, and practical treatment factors rather than negative beliefs alone. Addressing practical barriers, such as fear of injection and alternative treatment use, through patient education and supportive interventions may improve adherence rates.

PMID:40493381 | DOI:10.1080/03007995.2025.2517697

JAMA Netw Open. 2025 Jun 2;8(6):e2513520. doi: 10.1001/jamanetworkopen.2025.13520.

ABSTRACT

IMPORTANCE: Commercial sexual exploitation (CSE) of young people (aged 6-26 years) poses a considerable public health and social challenge. Understanding how social network exposure to CSE influences CSE risk may inform targeted prevention strategies for at-risk youths.

OBJECTIVE: To examine the association between social network exposure to CSE and personal risk of experiencing CSE among youths, with a focus on how exposure interacts with childhood adversities.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data collected between January 1, 2015, and December 31, 2022, from a CSE program at a children’s advocacy center in the northeastern US. Eligibility criteria included referral for suspected or confirmed CSE risk. Social relationships with offenders, peers, and others sharing residential placements were examined as potential sources of exposure. The final analyses were completed on March 20, 2025.

EXPOSURE: Social network exposure to CSE among youths.

MAIN OUTCOMES AND MEASURES: Experiencing CSE was the main outcome. Logistic regression was used to assess associations between youth network exposure to CSE and the risk of experiencing CSE, and social network analyses were conducted to identify patterns in the connections between youths with and without CSE experiences.

RESULTS: A total of 997 youth were included in the study (mean [SD] age, 14.7 [2.1] years; 903 female [90.6%]). Youths exposed to CSE through their social networks were significantly more likely to experience CSE (adjusted odds ratio, 2.92; 95% CI, 1.91-4.47). A significant interaction between social exposure and childhood adversities revealed that social network exposure was associated with higher CSE risk among youth with fewer adversities (adjusted odds ratio, 1.45; 95% CI, 1.22-1.74). Network analyses revealed that youth experiencing CSE were more likely to be connected to one another (β [SE], 0.32 [0.14]), highlighting the clustering of CSE within social networks.

CONCLUSIONS AND RELEVANCE: These findings suggest that prevention strategies should aim to reduce unmitigated exposure to individuals experiencing CSE and focus on fostering supportive and healthy relationships. This study underscores the potential for social network modeling to identify at-risk youth and inform prevention efforts.

PMID:40493369 | DOI:10.1001/jamanetworkopen.2025.13520

JAMA Netw Open. 2025 Jun 2;8(6):e2514443. doi: 10.1001/jamanetworkopen.2025.14443.

ABSTRACT

IMPORTANCE: Firearm access increases fatal and nonfatal firearm injury risk among teens. Identifying parental firearm storage behaviors associated with teen access may inform efforts to prevent teen firearm injuries.

OBJECTIVE: To examine the associations between parent-reported household firearm storage behaviors and teen perceived access to firearms.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used national survey data of US firearm-owning parents and their teens (aged 14 to 18 years) surveyed between June and July 2020, with a response rate of 31% for parents and 21% for teens. Analyses were conducted January to May 2024.

EXPOSURES: The number of firearms stored in the household as (1) unlocked, (2) loaded, (3) unlocked and loaded, and (4) unlocked or loaded.

MAIN OUTCOMES AND MEASURES: Teen perceived firearm access, overall and stratified by teen gender, parental education, and urbanicity. Survey-weighted logistic regression analyses assessed the associations between the number of firearms parents reported storing in each unsecured state (unlocked and loaded, unlocked, loaded, and unlocked or loaded) and teen perceived firearm access, overall and stratified by teen gender, parental education, and urbanicity (metropolitan vs nonmetropolitan). The areas under the receiver operating characteristic curves (AUROC) were used to identify the firearm storage behaviors with the best ability to estimate teen perceived firearm access.

RESULTS: Analyses included 487 parent-teen dyad respondents. The mean (SE) ages of parents and teens were 46.6 (0.80) and 16.0 (0.12) years, respectively. Most parent respondents were male (58.1%; 95% CI, 50.3%-65.8%) and White (73.5%; 95% CI, 66.1%-80.9%), and most teen respondents were female (55.7%; 95% CI, 47.8%-63.6%) and White (69.5%; 95% CI, 61.8%-77.2%). All 4 unsecured firearm storage behaviors were associated with greater teen perceived firearm access (odds ratio [OR], 1.27-1.44; 95% CI, 0.99-2.10), but associations disappeared after restricting to those who stored at least 1 firearm unsecured (OR, 0.99-1.18; 95% CI, 0.67-1.89). The number of firearms stored unlocked performed the best in estimating teen perceived access to firearms in US households (AUROC, 65.7; 95% CI, 61.4-70.1), regardless of teen gender, parental education, and urbanicity. However, sensitivity of this measure was universally low (range, 42%-64%). Additionally, 36.3% (95% CI, 23.6%-49.0%) of teens reported access to a firearm in households where all firearms were stored locked and unloaded.

CONCLUSIONS AND RELEVANCE: This study found that parent-reported firearm storage may be a poor estimator of teen perceived firearm access, regardless of teen gender, parental education, and urbanicity. Strictly focusing safety efforts on locked and unloaded firearm storage may not fully negate teen’s perceptions that they can access and load household firearms. Storing additional firearms securely may not prevent teen access if at least 1 household firearm remains unlocked.

PMID:40493368 | DOI:10.1001/jamanetworkopen.2025.14443

JAMA Netw Open. 2025 Jun 2;8(6):e2514508. doi: 10.1001/jamanetworkopen.2025.14508.

ABSTRACT

IMPORTANCE: Current guidelines recommend oseltamivir treatment for all patients hospitalized with influenza, but this guidance is based on suboptimal evidence.

OBJECTIVE: To evaluate outcomes associated with oseltamivir treatment when compared with supportive care for severe seasonal influenza requiring hospitalization.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study using target trial emulation included adult patients admitted to hospital with influenza from 30 hospitals in Ontario, Canada, from January 2015 to June 2023. Data were analyzed from November 2024 to March 2025.

EXPOSURE: Oseltamivir treatment on hospital day 0 or 1 vs supportive care without oseltamivir.

MAIN OUTCOME AND MEASURES: The primary outcome was in-hospital mortality. Secondary outcomes included time to being discharged alive and readmission within 30 days. Overlap weighting of propensity scores was used to balance covariates, and a competing risk model was used to compare time to being discharged alive.

RESULTS: Of 11 073 patients (mean [SD] age, 72.6 [16.8] years; 5793 female [52.3%]), there were 7632 patients (68.9%) and 3441 patients (31.1%) in the oseltamivir and supportive care groups, respectively. In hospital, 268 patients (3.5%) and 168 patients (4.9%) in the oseltamivir and supportive care groups died, respectively, with an adjusted risk difference of -1.8% (95% CI, -2.8% to -0.9%; P < .001). The oseltamivir treatment group was more likely to be discharged alive (adjusted subdistribution hazard ratio, 1.20; 95% CI, 1.15 to 1.25; P < .001). After discharge, 645 patients (8.5%) and 336 patients (9.8%) were readmitted in the oseltamivir and supportive care groups, respectively, with an adjusted risk difference of -1.5% (95% CI, -2.8% to -0.2%; P = .02).

CONCLUSIONS AND RELEVANCE: In this cohort study of patients hospitalized with influenza, oseltamivir treatment was associated with a lower in-hospital mortality risk, earlier discharge, and lower readmission rate, supporting evidence for the current guideline recommendation of oseltamivir treatment for severe influenza. Clinical trials are needed to definitively answer this question.

PMID:40493366 | DOI:10.1001/jamanetworkopen.2025.14508

JAMA Netw Open. 2025 Jun 2;8(6):e2514519. doi: 10.1001/jamanetworkopen.2025.14519.

ABSTRACT

IMPORTANCE: Targeted therapies and immunotherapies prolong survival but are associated with high costs for patients with advanced non-small cell lung cancer (aNSCLC). To date, little is known about survival and medication cost by biomarker status in the US.

OBJECTIVE: To estimate survival and medication cost by aNSCLC biomarker status.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study using Flatiron Health data identified patients diagnosed with aNSCLC from January 1, 2016, through December 31, 2022. Each patient had received at least 1 biomarker test and 1 documented line of therapy; follow-up was through September 31, 2023. Patients were categorized based on the presence of driver alterations, including ALK rearrangement, BRAF variation, or EGFR variation. Patients without driver alterations were divided into 3 groups based on their programmed cell death 1 ligand 1 (PD-L1) expression (<1%, 1%-49%, or ≥50%).

MAIN OUTCOMES AND MEASURES: The primary outcome was medication costs, which were a function of survival probability and monthly medication costs. The secondary outcome was medication costs per survivor, defined as the mean aggregate medication costs within each patient cohort for each 1- or 2-year survivor.

RESULTS: The study cohort consisted of 26 635 patients with aNSCLC (mean [SD] age at diagnosis, 68.9 [10.0] years; 13 750 [52%] male; 2610 [10%] African American, 687 [3%] Asian, 18 352 [69%] White, and 4986 [19%] other race, including any race other than African American, Asian, or White). The median overall survival was 39.9 (95% CI, 33.9-48.5) months for patients with ALK rearrangement, 27.0 (95% CI, 24.8-28.8) months for EGFR variation, 18.7 (95% CI, 16.0-20.6) months for BRAF variation, 12.3 (95% CI, 12.0-12.7) months for PD-L1 less than 1%, 13.7 (95% CI, 13.1-14.3) months for PD-L1 of 1% to 49%, and 16.2 (95% CI, 15.3-17.0) months for PD-L1 of 50% or greater. The 1- and 2-year medication costs per patient for the overall cohort were $120 420 (95% CI, $115 540-$126 470) and $182 560 (95% CI, $172 900-$196 040), respectively. Patients with EGFR variation or PD-L1 of 50% or greater incurred relatively higher 1-year medication cost ($131 700 [95% CI, $125 340-$138 280] and $123 590 [95% CI, $115 970-$130 840], respectively) compared with patients with PD-L1 less than 1% ($110 350 [95% CI, $101 680-$120 040]). Patients with ALK rearrangement or EGFR variation incurred the highest 2-year medication cost ($242 130 [95% CI, $206 220-$267 330] and $241 940 [95% CI, $230 840-$254 730], respectively), whereas patients with PD-L1 less than 1% and PD-L1 of 1% to 49% had the lowest 2-year medication cost ($156 340 [95% CI, $142 450-$172 800] and $163 410 [95% CI, $152 410-$174 180], respectively). The medication costs per 1-year survivor were $152 370 (95% CI, $133 550-$178 080) for patients with ALK rearrangement, $175 720 (95% CI, $167 330-$185 390) for EGFR variation, $211 100 (95% CI, $195 030-$229 400) for PD-L1 less than 1%, $210 260 (95% CI, $193 190-$226 580) for PD-L1 of 1% to 49%, and $211 630 (95% CI, $198 670-$224 210) for PD-L1 of 50% or greater, whereas the costs per 2-year survivor were $363 480 (95% CI, $314 710-$401 320) for patients with ALK rearrangement, $468 400 (95% CI, $441 340-$497 860) for patients with PD-L1 of 50% or greater, $460 790 (95% CI, $427 340-$494 080) for patients with PD-L1 of 1% to 49%, and $500 220 (95% CI, $456 900-$556 730) for patients with PD-L1 less than 1%.

CONCLUSIONS AND RELEVANCE: In this cohort study, patients with aNSCLC with driver alterations experienced better survival and incurred lower medication costs per survivor than those without driver variation, indicating the need to develop more affordable and effective medications for patients without driver alterations.

PMID:40493365 | DOI:10.1001/jamanetworkopen.2025.14519