Tag: statistics

Eur J Obstet Gynecol Reprod Biol. 2026 Jan 14;318:114967. doi: 10.1016/j.ejogrb.2026.114967. Online ahead of print.

ABSTRACT

BACKGROUND: Long-acting reversible contraceptives (LARCs), including subdermal contraceptive implants (SCIs), are widely used and highly effective. General practitioners (GPs) provide most implant services, but little is known about their confidence, awareness of updated guidelines, and approaches to complications in the Irish setting.

AIM: To assess GPs’ experience, confidence, awareness of guidelines, and management of complications related to SCIs.

METHODS: We conducted a prospective quantitative survey of 100 randomly selected GPs in Ireland. A validated 12-item questionnaire was distributed via Qualtrics, with 74 complete responses analysed in SPSS v29.0. Frequency data and chi-square tests with Cramer’s V were used to assess associations between experience, confidence, and guideline awareness.

RESULTS: A total of n = 74 full responses were collected. Results showed that while a majority (94.6 %) have inserted subdermal contraceptive implants, confidence levels varied, with 37.3 % feeling confident in insertion and removal procedures. Notably, 39.2 % were unaware of updated guidelines from January 2020. Statistical analyses revealed significant associations between general practitioners’ reported experience in subdermal contraceptive implant procedures and confidence in these skills (p < 0.001), as well as awareness of guidelines (p = 0.011). General practitioners with greater experience tended to refer complicated cases to specialist services, contrasting with less experienced peers managing cases independently.

CONCLUSION: This study underscores the need for enhanced General Practitioners’ training on subdermal contraceptive implant procedures and guideline updates to optimise service delivery. Given the increasing popularity of subdermal contraceptive implants, addressing these gaps is crucial for ensuring safe and effective contraceptive care in primary care settings.

PMID:41554227 | DOI:10.1016/j.ejogrb.2026.114967

Public Health. 2026 Jan 18;252:106146. doi: 10.1016/j.puhe.2026.106146. Online ahead of print.

ABSTRACT

OBJECTIVES: To protect workers and individuals from second-hand smoke exposure, Japan’s national indoor smoking ban was enforced on April 1, 2020. However, certain exemptions were made for eating and drinking establishments. Local ordinances restricted these exemptions to increase their effectiveness. We aimed to evaluate the 2-year impact of the national ban and local ordinances on indoor smoking policies in eating and drinking establishments over a 2-year period.

STUDY DESIGN: Panel data analysis.

METHODS: From a commercial database of eating and drinking establishments, we used area-level summary data of 320,693 establishments for August 2016 and individual establishment data extracted biannually between January 2020 and December 2022 (n = 329,322 to 403,133). We calculated the category-specific and weighted proportions of smoke-free establishments. We analysed the short-term and trend changes using an interrupted time-series analysis.

RESULTS: The proportion of smoke-free establishments increased after the national ban (+5.7 % points). Local ordinances restricting the exemption for the establishments with non-family employees enhanced the impact of the national ban (+7.8 % points). In December 2022, the proportions of smoke-free establishments were 68.3 % in restaurants, 70.2 % in cafés, 32.8 % in izakaya, and 25.0 % in bars.

CONCLUSIONS: The indoor smoking ban has promoted indoor smoke-free policies in eating and drinking establishments in Japan. However, many establishments, nearly two-thirds of izakaya and bars, remain smoking-allowed, probably owing to exemptions and non-compliance. To effectively reduce second-hand smoke exposure in eating and drinking establishments, it is necessary to minimise exemptions by revising laws or enforcing additional ordinances and promoting compliance with these legislations.

PMID:41554192 | DOI:10.1016/j.puhe.2026.106146

Conscious Cogn. 2026 Jan 18;139:103979. doi: 10.1016/j.concog.2025.103979. Online ahead of print.

ABSTRACT

This study presents the first comprehensive psychometric comparison of Greyson’s (1983) 16-item Near-Death Experience Scale (NDE Scale) and Martial et al.’s (2020) 20-item Near-Death Experience Content Scale (NDE-C) using Rasch modeling and differential item functioning (or response bias) analyses. A total of 705 self-identified “near-death experiencers” (64% women) completed both measures, which were randomly intermingled and rated for experiential relevance. Results confirmed that the two scales measure the same underlying construct of NDE phenomenology, as evidenced by a near-perfect disattenuated Pearson correlation (r = 0.98, p < 0.001). However, Rasch analysis revealed limitations in the category structures of both scales-particularly the NDE-C-and identified psychometric and conceptual weaknesses in its five novel items. Critically, the core Rasch item hierarchy derived from the original NDE Scale was replicated both in this sample and a previously simulated dataset based on the NDE-C’s development research, confirming its long-term structural stability. Based on the present evidence and the principle of parsimony, we recommend the original NDE Scale supported by Rasch scoring and a validated cut-off of 7 (out of 32), as it is conceptually coherent and psychometrically robust, while maintaining historical comparison with previous research. These findings reinforce the value of Rasch modeling for cumulative theory-building and underscore the Rasch NDE hierarchy’s foundational role in operationalizing legitimate near-death experiences.

PMID:41554189 | DOI:10.1016/j.concog.2025.103979

West J Emerg Med. 2025 Dec 19;27(1):25-32. doi: 10.5811/westjem.47392.

ABSTRACT

INTRODUCTION: Free Open Access Medical Education (FOAMed) has emerged as a prominent component of online medical communication, with X (formerly Twitter) serving as an active hub for professional exchange among clinicians. Despite its reach and influence, few longitudinal studies have examined how FOAMed content and engagement patterns evolve over time. In this study we aimed to analyze thematic shifts and user interaction trends in #FOAMed tweets over a five-year period.

METHODS: We conducted a retrospective bibliometric and natural language processing (NLP) study of 6,000 high-engagement, English-language tweets tagged with #FOAMed, posted between January 1, 2020-December 31, 2024. Each month, the 100 tweets were selected from Twitter’s “Top” tab and manually curated. We used latent Dirichlet allocation (LDA) to identify thematic clusters. Hashtag usage and engagement metrics were assessed using descriptive statistics and linear regression.

RESULTS: We identified 10 distinct topics were identified through LDA modeling: point-of-care ultrasound (POCUS) education; neuro-radiology, cardiology-electrocardiogram (ECG); nephrology; and intensive care unit; ultrasound; prehospital/policy; webinars and learning; resuscitation scenarios; pediatric imaging; medical student education; and critical care and publications. Topic prevalence shifted over time: Early tweets focused on COVID-19 and critical care, while later years showed increasing attention to prehospital care, diagnostics, and POCUS. Mean tweet engagement peaked in 2023 (236.9 ± 914.6). Notably, hashtags such as #POCUS and #MedEd showed substantial increases in both usage and engagement, with #MedEd reaching a peak mean engagement of 287.7. In contrast, COVID-19 declined steadily, both in frequency (from 126 tweets in 2020 to just six in 2023) and in engagement (mean: 67.1 → 18.5). Spearman correlation analysis revealed that hashtag count had a weak but statistically significant correlation with engagement (ρ = 0.047, P < .001), suggesting that content quality, rather than volume, was the primary driver of visibility.

CONCLUSION: FOAMed discourse on Twitter/X remains dynamic, responsive to clinical priorities and shaped by peer interaction. Natural language processing and topic modeling are valuable tools to uncover longitudinal trends in digital medical education, reinforcing Twitter/X’s role in informal, real-time learning communities.

PMID:41554176 | DOI:10.5811/westjem.47392

West J Emerg Med. 2025 Dec 23;27(1):67-77. doi: 10.5811/westjem.48357.

ABSTRACT

INTRODUCTION: Prior research demonstrates that emergency department (ED) patients with suicidal ideation (SI), substance use (SUD), and/or intimate partner violence (IPV) have disproportionate adverse outcomes for both women and infants. The 2013 Hague Protocol suggested that children with caregivers with the above characteristics are also more likely to suffer from child maltreatment. Of all pregnancies in this group, as many as 90% are unintended. We hypothesized that women with SI/SUD/IPV have gaps in care access, high levels of unscheduled care use, and reduced ED contraceptive inquiry, which if addressed could potentially improve outcomes.

METHODS: We conducted a chart review of 62,284 ED visits from 2018-2021 from a suburban four-hospital system in the Southern United States. We compared women of reproductive age (15-44) with SI/SUD/IPV (4,776) against controls (57,508). The exposures were defined as women with SI, SUD, and/or IPV. We analyzed results using the chi-square test (χ²) with Bonferroni adjustment to test for independence and logistic regression.

RESULTS: Women suffering from SI/SUD/IPV who present to the ED have contraceptive status less frequently documented compared to controls without these factors (39.5 vs 51.7%, RR 0.77, CI, 0.74-0.79, P < .001). They also have reduced access to care, with higher rates of uninsurance (32.7 vs 26.1%, P < .001), more care in the acute care environment, longer ED length of stay (LOS) (mean was 10.38 vs 3.87 hours, P < .001), higher hospitalization rates (61.0 vs 8.7%, P < .001), and higher 30-day ED revisits (11.8 vs 8.8%, P < .001), even after adjusting for the Social Vulnerability Index, acuity, age, and obesity (adjusted odds ratio 1.52 95% CI 1.36-1.70 P < .001).

CONCLUSION: Despite significant morbidity coupled with reduced access to ambulatory care and disproportionately increased ED use, little ED contraceptive documentation exists. This practice contributes to inequity, given the increased number of unintended pregnancies and greater need of contraceptives in women with suicidal ideation/substance use disorder/intimate partner violence.

PMID:41554174 | DOI:10.5811/westjem.48357

West J Emerg Med. 2026 Jan 9;27(1):159-162. doi: 10.5811/westjem.47187.

ABSTRACT

INTRODUCTION: Viewing a solar eclipse without proper eye protection can lead to ocular injuries such as solar retinopathy or photokeratitis. The April 8, 2024, solar eclipse in the southern and eastern United States presented a rare opportunity to assess the public health impact of such events on eye-related emergency department (ED) visits.

METHODS: We identified a total of 1,774 ED visits for eye injuries across both periods. There were 853 visits before the eclipse and 921 visits after, showing no statistically significant difference (X² = 1.432, P > .05) between the two time periods.

RESULTS: We identified a total of 1,774 ED visits for eye injuries across both periods. There were 853 visits before the eclipse and 921 visits after. The chi-square statistic (X² = 1.432, degree of freedom = 1, P > .05) indicated no statistically significant difference in the incidence of eye injuries between the two time periods.

CONCLUSION: Despite concerns regarding eclipse-related eye injuries, we found no statistically significant increase in ED visits for ocular pain or photokeratitis following the April 8, 2024, solar eclipse. These results suggest that public education campaigns promoting safe eclipse viewing may have been effective. Ongoing efforts are warranted to continue promoting ocular safety during future eclipses.

PMID:41554171 | DOI:10.5811/westjem.47187

West J Emerg Med. 2025 Dec 24;27(1):214-218. doi: 10.5811/westjem.47475.

ABSTRACT

INTRODUCTION: Maricopa County, Arizona, experienced its largest West Nile virus outbreak in 2021, with 1,487 cases and 101 deaths, in the midst of the COVID-19 pandemic. We sought to describe initial presentations of emergency department (ED) patients ultimately diagnosed with West Nile virus and determine how often patients presented to the ED before their diagnosis. To assist with disease recognition during future outbreaks, we examined in detail cases where emergency physicians initially did not suspect West Nile virus.

METHODS: We reviewed records from May-December 2021 for patients with a positive West Nile virus result and at least one ED visit within 15 days. Data included age, sex, race, Emergency Severity Index (ESI) score, number of ED visits, chief complaint, vital signs, blood or cerebrospinal fluid (CSF) testing, diagnosis, and disposition. We excluded cases with only immoglobulin G-positive results or outpatient tests, leaving 147 cases.

RESULTS: Among 147 ED West Nile virus cases, the median patient age was 67 years, with patients being predominantly male (66.7%) and White (97.3%). The most common presenting chief complaints included fever (23.8%), headache (17.7%), and generalized weakness (11.6%). Emergency physicians initiated testing for the virus in 63 cases (42.9%). Patients dispositioned (n = 84, either discharged or admitted) from the ED without initiation of testing tended to be older (median 73 vs 62 years, P < .001), with higher triage respiratory rate (mean 19.4 vs 18.3 breaths per minute, P = .05) and lower triage oxygen saturation (median 96% vs 97%; P =.02). Emergency physicians predominantly performed CSF testing (n = 42 patients) over serum testing (n = 21 patients). Patients tested via CSF had lower ESI scores than those tested via serum (ESI score of 1-2 45.3% vs 14.3%, P = .03).

CONCLUSION: Emergency physicians did not initiate testing in 57.1% of initial ED encounters of patients ultimately found to have West Nile virus. During West Nile virus outbreaks, emergency physicians should stay vigilant for less acute presentations, such as generalized weakness in elderly patients, along with typical presentations including fever and headache, to avoid delayed diagnosis.

PMID:41554170 | DOI:10.5811/westjem.47475

West J Emerg Med. 2025 Dec 19;27(1):177-183. doi: 10.5811/westjem.47216.

ABSTRACT

INTRODUCTION: Mass shooting incidents (MSI) are single events injuring four or more victims, and they occur in the United States on average every 12.5 days. Studies have examined the psychological impact of MSIs on witnesses and surviving victims. However, the mental health of healthcare workers involved in the care of MSI victims requires further examination. We explored the association between work-related stress and symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) in healthcare workers involved in the 2017 Las Vegas mass shooting.

METHODS: Surveys were distributed to 170 healthcare workers involved in the care of victims of the largest MSI in US history, the 2017 Las Vegas Route 91 Harvest Festival (58 people killed, 413 wounded bv gunshot or shrapnel). Fifty healthcare workers (29.4% response rate; 68% female), 29-71 years of age, responded to demographic questions followed by the Beck Anxiety Inventory, Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire-9 (PHQ-9), PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5^th Ed, and the Health & Safety Executive Management Standards Indicator Tool, between October 15, 2022-March 15, 2023.

RESULTS: Results showed that work-related stress was significantly associated with symptoms of depression (BDI-II: P < .001, 22.9% variance; PHQ-9: P < .05, 20.5% variance) and PTSD (P < .001, 26.8% variance). No significant differences in symptom severity (work-related stress, anxiety, depression, and PTSD) were found between participants involved in critical care and non-critical care (P > .05). In addition, healthcare workers reported higher symptoms of depression (5.18 vs 2.91, P < .001), and lower symptoms of anxiety (8.84 vs 22.35, P < .05) than normative data of the general population.

CONCLUSION: Healthcare workers reporting a higher risk of work-related stress were more likely to report more symptoms of depression and PTSD. Healthcare workers involved in critical and non-critical care reported similar symptoms of anxiety, depression, PTSD, and work-related stress. Moreover, healthcare workers involved in the care of the Las Vegas mass shooting victims were more likely to report more symptoms of depression and fewer symptoms of anxiety than samples of the general population. Given the novelty of this study, the unpredictability of MSIs, and the current limitations, we offer recommendations for future studies.

PMID:41554169 | DOI:10.5811/westjem.47216

West J Emerg Med. 2025 Dec 31;27(1):219-224. doi: 10.5811/westjem.47491.

ABSTRACT

INTRODUCTION: First-generation antihistamines are frequently used in the emergency department (ED) but are discouraged in older adults due to increased adverse drug effects. Whether concerns about adverse drug effects apply to the ED is uncertain, as ED-specific data are limited, and risks with single-dose administration may differ from risks with chronic use. In this study we assessed frequency of use, adverse drug effects, and indications of first-generation antihistamines administered to older adults during ED visits.

METHODS: This retrospective cohort study identified adults ≥ 65 years of age who received first-generation antihistamines from January 1-December 31, 2022 in the ED at a single, urban, academic medical center. Abstractors blinded to study hypotheses identified indications for use and adverse effects through chart review. Indications other than severe allergic reactions and continuation of home use were classified as potentially inappropriate. We evaluated sex, age ≥ 85, history of cognitive impairment, drug received, and number of doses for association with adverse drug effects by regression analysis.

RESULTS: First-generation antihistamines were administered in 261 encounters (3% of geriatric ED encounters). Median patient age was 71 (range 65-107, interquartile range [IQR] 67-77) and 60.5% were female. Adverse drug effects occurred in 15% of encounters, with delirium (n = 20, 7.7%) and urinary retention (n = 11, 4.2%) being the most common. On multivariate analysis, patient age ≥ 85, history of cognitive impairment, and receipt of multiple doses were associated with elevated risk of adverse drug effects, with risk ratios of 5.5 (95% CI, 2.7-11.4), 3.1 (95% CI, 1.8-5.4), and 1.9 (95% CI, 1.1-3.6), respectively. Indications were classified as potentially inappropriate in 92% of encounters. Diphenhydramine was most used in patients with headache (n = 53, 30.1% of doses) and history of iodinated contrast media reaction (n = 46, 26.1% of doses), while hydroxyzine was most used for anxiety (n = 51, 60% of doses). The kappa value between abstractors was 0.84, indicating excellent agreement.

CONCLUSION: Emergency department use of first-generation antihistamines in older adults, especially those ≥ 85 years of age and with prior cognitive impairment, was associated with infrequent but clinically significant harm. Most use was potentially inappropriate. Prophylactic use of diphenhydramine for patients with a prior reaction to iodinated contrast media emerged as a common indication.

PMID:41554167 | DOI:10.5811/westjem.47491

West J Emerg Med. 2026 Jan 9;27(1):225-232. doi: 10.5811/westjem.43498.

ABSTRACT

INTRODUCTION: California has one of the highest rates of homelessness in the United States. Unhoused individuals often have complex medical and behavioral health disorders, frequently complicated by substance use disorders. They have a significant risk of sustaining traumatic injuries. This report compares unhoused and domiciled patients treated at our Northern California trauma center.

METHODS: In this retrospective analysis of trauma patients we used data extracted from our institution’s Trauma Quality Improvement Program Trauma Registry for January 1, 2019-April 22, 2022 and compared characteristics of unhoused and domiciled individuals. All unhoused patients in the registry were included in the analysis, as well as an equal number of domiciled patients who were randomly selected during the same time frame. We described and compared demographic and clinical characteristics.

RESULTS: Of 8,529 patients in the registry, 181 (2.1%) were unhoused, and we selected 181 domiciled patients to compare. Unhoused patients were more likely male (83% vs. 61%, P < .001) and younger (48.8 ± 12.3 vs. 55. 8 ± 23.7 years, P <.001). Both cohorts had similar Injury Severity Scores. However, unhoused patients had a higher rate of hospital admissions (76.8% vs. 61.9%, P <.001) and longer hospital stays than domiciled patients (4.0 [IQR 2.0-9.0] days vs. 3.0 [IQR 1.0-6.0] days, respectively; P = .02). A higher proportion of unhoused patients received alcohol-(85.6% vs. 74.6%, P = .01) and drug screening (56.4% vs. 30.4%, P < .001) than domiciled patients. Of those screened for urine drugs, unhoused patients had a higher positive rate (76.5% vs. 50.9%, P < .001). Unhoused patients were more frequently injured by assault (30.4% vs. 8.8%, P < .001) or pedestrian strike (21.5% vs. 3.3%, P < .001), whereas more domiciled patients were injured in falls (46.4% vs. 21.5%, P < .001) and motor vehicle accidents (29.8% vs. 8.3%, P < .001). Falls were most common in the oldest quartile for both groups. In both cohorts, a “sharp object” was the most common mechanism of assault injury (40.0% vs. 37.5%, respectively). Assault by firearm occurred in 14.5% of unhoused and 18.8% of domiciled patients. Overall mortality was 2.2%, with no significant difference between groups (1.7 vs. 2.8%, P = .70).

CONCLUSION: Unhoused patients were predominantly younger males with a higher incidence of substance use disorder and greater likelihood of injuries from assault and pedestrian strikes. Falls and assault with a sharp object were common in both cohorts. Unhoused patients were admitted more often and stayed longer in the hospital. Understanding the complexities of these patients can guide local and regional prevention and treatment measures.

PMID:41554166 | DOI:10.5811/westjem.43498