Tag: statistics

Subst Use Misuse. 2026 Feb 4:1-8. doi: 10.1080/10826084.2026.2621260. Online ahead of print.

ABSTRACT

BACKGROUND: This study examined illicit substance use among youth in Taiwanese temple parade troupes, a culturally distinct but high-risk population.

METHODS: In 2019, we surveyed 696 participants recruited on-site through convenience sampling across Taiwan using a structured questionnaire that assessed demographics, alcohol and tobacco use, substance-involved social ties, and acquisition settings. Three domains of substance-involved ties (family, peers, intimate partners; range 0-3) and three types of acquisition settings (private, social, public; range 0-3) were analyzed using descriptive statistics, one-way ANOVAs, and logistic regression models. The lifetime prevalence of illicit substance use was 9.8%. Because only three female participants reported illicit substance use, multivariable logistic regression analyses were restricted to male participants (n = 593) and adjusted for age and education.

RESULTS: Odds of illicit substance use increased with the accumulation of substance-involved social relationships, with adjusted odds ratios (aORs, 95% CI) of 2.96 (1.48-5.91) for one type and 11.32 (3.72-34.44) for two types, compared with none; estimates for three types could not be obtained due to complete separation. In contrast, awareness of any acquisition setting was associated with markedly higher odds of illicit substance use (aORs, 95% CI: 1 = 22.48, 5.25-96.34; 2 = 59, 3.78-81.79; 3 = 37.27, 4.75-292.23).

CONCLUSIONS: Findings highlight that accumulated substance-involved relationships and access through any acquisition setting are key structural conditions shaping substance use in this cultural context. While limited by its cross-sectional design and convenience sampling, the study provides novel evidence on culture-embedded risk structures and underscores the need for longitudinal and context-sensitive prevention strategies.

PMID:41637117 | DOI:10.1080/10826084.2026.2621260

JAMA Dermatol. 2026 Feb 4. doi: 10.1001/jamadermatol.2025.5723. Online ahead of print.

ABSTRACT

IMPORTANCE: Recessive dystrophic epidermolysis bullosa (RDEB) is a rare monogenic blistering disorder with wide clinical heterogeneity, ranging from localized skin fragility to life-limiting systemic complications. Understanding genotype-phenotype correlations in COL7A1, the causative gene, is critical for clinical prognostication, genetic counseling, and the rational design of emerging molecular therapies.

OBJECTIVE: To determine the frequency of genotypic and phenotypic subtypes, and to assess whether variant type or location can predict phenotypic severity and extracutaneous complications in patients with RDEB carrying homozygous variants.

EVIDENCE REVIEW: This was a systematic review of all RDEB genotypes and phenotypes reported to the International Dystrophic Epidermolysis Bullosa Patient Registry (DEB Registry) and eligible studies published in English from May 1993 to September 2025. PubMed, Cochrane Library, and Web of Science were searched and eligible studies were reviewed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020) guidelines. Included studies reported bi-allelic COL7A1 variants and clinical phenotypes. Data from the DEB Registry were cross-checked to supplement the published cases. Descriptive statistics were used for data analyses, and Fisher exact and χ2 methods were used to test additional genotype-phenotype correlations in patients with RDEB carrying homozygous variants.

FINDINGS: A total of 1802 patients with RDEB comprising 1002 pathogenic variants within COL7A1 were identified from 217 articles. Among the 706 patients with homozygous variants (mean [SD; range] age, 12.2 [13.0; 0-72] years), 533 (75.5%) had severe RDEB, most frequently associated with frameshift and nonsense variants (388 [72.8%] premature termination codons [PTCs]). In contrast, intermediate and milder subtypes were associated with missense or non-PTC variants. Variant location also influenced phenotype: homozygous variants affecting the noncollagenous 1 domain were associated with severe RDEB in 74 of 83 unique variants (89.2%). Extracutaneous involvement clustered in homozygous PTC carriers and was observed almost exclusively in severe RDEB, with occasional cases in the intermediate subtype and rare instances in the inversa, localized, and self-improving subtypes. Recurrent and population-specific variants suggested founder effects. Splice site and missense variants showed phenotypic variability, with augmented intelligence-based predictions correlating with severity.

CONCLUSIONS AND RELEVANCE: In this systematic review, the type and site of pathogenic variants in COL7A1 correlated with the severity of RDEB phenotype across different nationalities, races, and ethnicities. These findings may provide improved patient prognosis, genetic counseling, and personalized therapeutics.

PMID:41637086 | DOI:10.1001/jamadermatol.2025.5723

Acta Odontol Scand. 2026 Feb 4;85:61-66. doi: 10.2340/aos.v85.45419.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the awareness levels of actively practicing dentists in Türkiye regarding artificial intelligence (AI)-related ethical issues, data security, anonymization, and legal regulations.

MATERIALS AND METHODS: A cross-sectional online survey (Google Forms) used a 12-item questionnaire (4 demographics; 8 awareness domains) rated on a five-point Likert scale. Participants were recruited via snowball sampling. Descriptive statistics, independent-samples t-tests, and one-way analysis of variance with Tukey post hoc tests were applied (p < 0.05).

RESULTS: A total of 257 dentists participated. Mean domain scores ranged from 2.97 to 3.13; awareness of ethical issues was highest (3.13 ± 1.44) and perception of encryption lowest (2.97 ± 1.45). No significant gender differences were observed. University hospital dentists reported significantly higher awareness of ethical issues and a greater perceived need for anonymization than other institution types (p < 0.05). For awareness of Personal Data Protection Law (KVKK), scores were higher in university hospitals and private dental polyclinics than in private practices and public hospitals (p < 0.05). Professional experience was associated with differences in perception of encryption, awareness of personal data protection law, awareness of ethical issues, and perceived AI ethical risks (p < 0.05); perception of data security and awareness of big data security did not differ significantly (p > 0.05).

CONCLUSION: Dentists demonstrated varying levels of awareness across domains, with higher awareness reported in academic settings. Experience-related patterns differed by domain, indicating the need for focused educational strategies addressing legal and ethical aspects of AI-supported dental practice.

PMID:41637082 | DOI:10.2340/aos.v85.45419

JAMA Netw Open. 2026 Feb 2;9(2):e2555855. doi: 10.1001/jamanetworkopen.2025.55855.

ABSTRACT

IMPORTANCE: Failure to rescue (FTR), defined as postoperative mortality among patients with treatable complications, is a recognized patient safety concern. FTR reflects institutional capacity for timely management of deterioration and has been proposed as a quality indicator less dependent on baseline complication risk. Evidence on systematic hospital-level variation outside the US remains limited.

OBJECTIVE: To estimate national postoperative FTR rates, quantify between-hospital variation, and identify hospitals with better- or worse-than-expected performance using risk-standardized mortality ratios (RSMRs).

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study conducted in Switzerland applied the Agency for Healthcare Research and Quality (AHRQ) patient safety indicator 04 (PSI04) definition to administrative hospital data to all acute-care hospitals in Switzerland from January 2019 to December 2023. Participants included surgical inpatients with at least 1 PSI04-defined complication (ie, deep vein thrombosis and/or pulmonary embolism, pneumonia, sepsis, shock and/or cardiac arrest, and gastrointestinal hemorrhage and/or ulcer). Hospital-level variation was assessed using multilevel logistic regression with hospital random intercepts and summarized with RSMRs. Alternative models were estimated to explore the stability of results.

EXPOSURE: Acute care hospitalization.

MAIN OUTCOMES AND MEASURES: In-hospital mortality following eligible complications, expressed as crude FTR rates and RSMRs. The intraclass correlation coefficient quantified systematic performance variation.

RESULTS: Among 41 506 inpatients undergoing surgery with PSI04-defined complications (mean [SD] age, 67.6 [14.8] years; 24 692 [59.5%] men), 7310 in-hospital deaths occurred. The crude national FTR rate was 18.07 (95% CI, 17.66-18.50) of 100 admissions. In 61 hospitals with at least 100 cases, adjusted odds ratio for death varied between the lowest- and highest-performing hospitals from 0.56 (95% CI, 0.38-0.80) to 1.75 (95% CI, 1.59-1.92). Hospital-level variance was 0.114 (intraclass correlation coefficient, 0.034; 95% CI, 0.020-0.055). An estimated 1045 of 7114 observed FTR deaths (14.7%) within the hospital sample were attributable to below-average hospital performance. Five hospitals (8.2%) performed significantly better than expected, 42 (68.9%) as expected, and 14 (23.0%) substantially worse than expected based on RSMR 95% CIs. Poorer performance clustered in medium- and high-volume hospitals. Alternative regression models confirmed stability of results.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of FTR, nearly 1 in 5 patients undergoing surgery who experienced serious complications died, with substantial between-hospital variation. Multilevel modeling indicated that institutional performance accounted for 1045 potentially avoidable deaths. These findings support FTR as an international patient safety indicator and highlight the need to investigate organizational determinants of variation to inform system-level improvement strategies.

PMID:41637075 | DOI:10.1001/jamanetworkopen.2025.55855

JAMA Netw Open. 2026 Feb 2;9(2):e2555875. doi: 10.1001/jamanetworkopen.2025.55875.

ABSTRACT

IMPORTANCE: Before elective surgery, direct oral anticoagulants (DOACs) are discontinued following a standardized protocol. However, this could result in insufficient lowering of DOAC levels that could increase bleeding risk.

OBJECTIVE: To estimate the proportion of patients with elevated DOAC levels at the time of elective surgery, evaluate factors associated with DOAC levels, and examine associated blood loss.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study (DOAC Level Prior to Incision [DALI]) assessed adult patients prescribed a DOAC (apixaban, dabigatran, or rivaroxaban) for any indication and at any dose, undergoing an elective procedure requiring DOAC interruption between May 27, 2018, and February 25, 2024, at 2 Dutch hospitals.

EXPOSURE: Standardized interruption protocol (1 day before moderate- and 2 days before high bleeding-risk procedures) with interruption adjustments for the patient’s kidney function.

MAIN OUTCOMES AND MEASURES: Blood was drawn immediately before surgery to determine DOAC levels (by liquid chromatography-mass spectrometry). Proportions of preoperative DOAC levels of 30 ng/mL or higher and their 95% CIs were estimated, stratified by DOAC type and surgical bleeding risk. Factors associated with DOAC levels were identified through multivariable linear regression. Surgical blood loss and 30-day postoperative complications were described according to DOAC concentrations.

RESULTS: The study was terminated after including 257 patients (100 receiving apixaban, 100 receiving rivaroxaban, and 57 receiving dabigatran due to the slow inclusion rate of those receiving dabigatran; median [IQR] age, 72 [66-78] years; 173 male [67%]); 212 patients (82%) underwent a high bleeding-risk operation. Preprocedural DOAC levels were 30 ng/mL or higher in 7.6% (95% CI, 4.9%-11.6%) of patients. Dabigatran and rivaroxaban had similar proportions, whereas 13.1% (95% CI, 7.8%-21.2%) of patients treated with apixaban had levels of 30 ng/mL or higher. Treatment with apixaban, decreased kidney function, and a shorter interruption time were associated with higher levels. Surgical blood loss (median [range], 0 [0-4250] mL) was not associated with DOAC levels. Twelve patients (4.7%; 95% CI, 2.7%-8.0%), who all had DOAC levels less than 30 ng/mL, experienced major bleeding.

CONCLUSIONS AND RELEVANCE: In this cohort study, most patients following the current protocol had DOAC levels less than 30 ng/mL, although the proportion of patients with elevated levels was higher for apixaban. Preoperative DOAC levels were not associated with blood loss during surgery.

PMID:41637074 | DOI:10.1001/jamanetworkopen.2025.55875

JAMA Netw Open. 2026 Feb 2;9(2):e2555896. doi: 10.1001/jamanetworkopen.2025.55896.

ABSTRACT

IMPORTANCE: Equity, diversity, and inclusion (EDI) initiatives are politically polarizing and increasingly adopted in the health care setting. Their broader impact across different health care career types, career stages, and various levels of education remains largely unknown.

OBJECTIVE: To assess EDI programs and their associated outcomes within health care institutions.

DATA SOURCES: A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020-compliant systematic review searching PubMed, Scopus, Web of Science, CINAHL, and PsychINFO databases from January 2010 to December 2023.

STUDY SELECTION: Two independent reviewers screened studies that assessed EDI programs or policies in health care institutions.

DATA EXTRACTION AND SYNTHESIS: Programs were categorized based on reported outcomes, including participant satisfaction, increased awareness of EDI-related topics, increases in the proportion of underrepresented minority individuals within medical education or the health care workforce, and overall program impact. Odds ratios (ORs) were pooled using a random-effects model. Analyses followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Analysis was conducted June 2025.

MAIN OUTCOMES AND MEASURES: Outcome measures included the proportion of diversity among the workforce, employee and patient satisfaction, and the proportion of employees recruited and retained after program implementation.

RESULTS: In total, 43 studies incorporating more than 15 000 individuals involved in EDI programs were included. Interventions were multifaceted, including 14 career advancement and training programs, 16 diversity representation programs, 11 academia and research support initiatives, and the growth of 2 pipeline programs. Furthermore, interventions demonstrated consistent improvement in EDI initiatives, with perceived benefit in promoting underrepresented minority populations. Findings from the meta-analysis of 2 studies showed that minority representation in competitive medical residencies increased after implementation of 2 EDI interventions (OR, 1.73; 95% CI, 1.21-2.47). Among the 43 studies included in the Joanna Briggs Institute assessment of methodological quality, 7 (16.3%) were rated as high quality, 20 (46.5%) as moderate quality, and 16 (37.2%) as low quality.

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of EDI initiatives in health care institutions, programs were associated with an increased workforce diversity. These findings support the continued use of EDI initiatives to promote a more inclusive and equitable health care culture.

PMID:41637073 | DOI:10.1001/jamanetworkopen.2025.55896

JAMA Netw Open. 2026 Feb 2;9(2):e2556832. doi: 10.1001/jamanetworkopen.2025.56832.

ABSTRACT

IMPORTANCE: Survivors of infant heart surgery for congenital heart disease (CHD) have high risk for neurodevelopmental (ND) disorders; few multistate data report the percentage with ND diagnosis or utilization across health care settings.

OBJECTIVE: To characterize time to and cumulative prevalence of any ND diagnosis and associated health care utilization in the first 5 years after infant heart surgery for publicly insured children.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included children with CHD with a birth hospitalization and infant cardiac surgery between January 2016 and December 2020. Data were obtained from the Merative MarketScan Medicaid Claims Database of deidentified individual Medicaid enrollees across 12 states. Data were analyzed from December 13, 2022, to October 4, 2024.

EXPOSURES: CHD and infant heart surgery.

MAIN OUTCOMES AND MEASURES: Times from index surgery to first ND diagnosis and ND utilization and their cumulative prevalences by 5 years after index surgery.

RESULTS: Among 3147 patients (mean [SD] duration of enrollment, 30.5 [17.4] months), 1686 (53.6%) were male; 619 (19.7%) were Black, 228 (7.2%) were Hispanic, 1051 (33.4%) were White, 145 (4.5%) belonged to additional racial and ethnic groups, and 1108 (35.2%) had missing data on race and ethnicity. Surgery was neonatal (<30 days) in 1518 (48.2%); 709 (22.5%) had a genetic diagnosis; and highest Risk Adjustment for Congenital Heart Surgery (RACHS-2) category was 1 for 945 patients (30.0%), 2 for 915 (29.1%), 3 for 398 (12.9%), 4 for 577 (18.3%), and 5 for 312 (9.9%). The cumulative prevalences of 1 or more ND diagnoses and use of 1 or more forms of ND services were, respectively, 43.5% (95% CI, 42.2%-44.7%) and 80.0% (95% CI, 78.9%-80.9%) at 3 years and 51.7% (95% CI, 50.4%-52.9%) and 82.9% (95% CI, 81.9%-83.8%) at 5 years. Although 1752 (55.7%) had ND screening, fewer had psychological or neuropsychological (207 [6.6%]) or comprehensive developmental (268 [8.5%]) evaluation. Independent risk factors for time to first ND diagnosis were Black race (hazard ratio [HR], 1.14 [95% CI, 1.00-1.30]; P = .04) or Hispanic ethnicity (HR, 1.24 [95% CI, 1.02-1.50]; P = .03) compared with White race and RACHS-2 category 4 (HR, 1.28 [95% CI, 1.09-1.49]; P = .002) or 5 (HR, 1.32 [95% CI, 1.08-1.61]; P = .007) compared with category 1. Independent risk factors for time to first ND utilization included RACHS-2 categories 2 (HR, 1.30 [95% CI, 1.06-1.60]; P = .01), 4 (HR, 1.63 [95% CI, 1.26-2.11]; P < .001), and 5 (HR, 2.25 [95% CI, 1.64-3.10]; P < .001) compared with category 1.

CONCLUSIONS AND RELEVANCE: In this cohort study of publicly insured children who underwent infant heart surgery, the prevalence of ND disorders and utilization of ND services was high. Developmental screening percentages were comparable with those in general pediatric samples, but few children received society-recommended formal ND evaluations.

PMID:41637072 | DOI:10.1001/jamanetworkopen.2025.56832

Evolution. 2026 Feb 4:qpag020. doi: 10.1093/evolut/qpag020. Online ahead of print.

ABSTRACT

The inhibitory cascade model (ICM) of morphogenesis is an effort to link development to the production of variation, which can influence evolutionary trajectories. The ICM proposes that serially developing features, such as molar teeth, are governed by the relative magnitudes of one activating and one inhibiting developmental process. The statistical expectations of the ICM are typically expressed and analyzed on a first-element standardized scale and seem to be a good predictor of molar proportions. However, the ICM has been applied to traits that occur in series but do not develop in sequence and still recovers as good a fit as when applied to serially developing traits. Such an undiscriminating result raises questions about whether the fit of the ICM is an artifact of standardization. The mathematical rendition of the ICM does not correspond with the verbal descriptions of the developmental argument. Applying our novel re-articulation of the ICM to biological, non-biological, and simulated data, we demonstrate that the apparent goodness of fit of the ICM to many biological systems is an artifact of scaling correlated values with a common denominator. There is no evidence supporting the ICM at the developmental, variational, or evolutionary levels.

PMID:41637054 | DOI:10.1093/evolut/qpag020

Eur Arch Paediatr Dent. 2026 Feb 4. doi: 10.1007/s40368-026-01172-4. Online ahead of print.

ABSTRACT

PURPOSE: To assess the influence of deep diaphragmatic breathing exercises on dental anxiety during the dental visits in children aged 7-13 years.

METHODS: A total of 84 healthy participants of both genders were enrolled in this study. The participants were randomly allocated to the deep breathing (DB) group and the conventional treatment-as-usual (TU) control group. All participants underwent psychological evaluation of their behaviour using Frankl’s Rating Scale (FRS), and their anxiety level using the Facial Image Scale (FIS), in addition to a physiological assessment of blood pressure (mmHg) and heart rate (bpm) using a digital blood pressure monitor, and oxygen saturation level (SpO₂%) using a pulse oximeter. These assessments were conducted at the beginning of the dental visit (T0), 5 min after beginning the dental procedure (T1), and at the end of the dental procedure (T2). Collected data were statistically analysed using the Statistical Package for Social Sciences (SPSS) software version 26 to test the significance at p value ≤ 0.05.

RESULTS: The DB and TU groups showed no significant differences in baseline demographics or clinical characteristics (p > 0.05). The mean procedure time was shorter in the DB group than in the TU group (p < 0.05). During and after treatment, a higher proportion of participants in the DB group were rated as “very happy” on the FIS (p < 0.001) and “definitely positive” on the FRS (p < 0.05). Assessment of physiological parameters revealed that the lower systolic and diastolic blood pressure values during treatment were lower in the DB group (p < 0.001). Pulse rate was similarly lower in the DB group, whilst oxygen saturation remained stable across groups (p > 0.05).

CONCLUSION: Diaphragmatic breathing effectively reduced physiological and behavioural indicators of dental anxiety in children, resulting in enhanced cooperation and shortened treatment times. Thus, it may serve as a practical, non-pharmacological approach for enhancing children’s comfort and procedural efficiency during dental treatment.

PMID:41637045 | DOI:10.1007/s40368-026-01172-4

Matern Child Health J. 2026 Feb 4. doi: 10.1007/s10995-026-04234-7. Online ahead of print.

ABSTRACT

The study was conducted to determine the effect of a web-based support program based on the Health Promotion Model (HPM) on healthy lifestyle behaviors, self-efficacy, and prenatal distress in pregnant women with preeclampsia. The study was conducted with 82 pregnant women diagnosed with preeclampsia, 41 of whom were in the web-based support group and 41 in the control group. Participant introduction form, Healthy Lifestyle Behaviors Scale-II (HLBS-II), Self-Efficacy Scale (SES), Prenatal Distress Scale (PDS), pregnant women’s self-monitoring form, and postpartum assessment form were used for data collection. The increase in the total scores of the HLBS-II and the SES and the decrease in the total score of the PDS was found to be statistically significant in the pregnant women in the web support-based group after the web support. The HPM-based web-based support program improved healthy lifestyle behaviors and self-efficacy and reduced prenatal stress levels of pregnant women with preeclampsia but did not contribute to neonatal outcomes. SIGNIFICANCE: Pregnant women diagnosed with preeclampsia often face heightened physiological and psychological challenges. This study demonstrates that a web-based support program structured around the Health Promotion Model (HPM) significantly improves healthy lifestyle behaviors and self-efficacy while reducing prenatal distress in this high-risk population. These findings suggest that digital health interventions are effective, accessible tools for enhancing maternal well-being. By integrating such platforms into standard obstetric care, healthcare providers can offer continuous, evidence-based support that empowers patients to manage their condition more effectively outside of clinical settings.

PMID:41637027 | DOI:10.1007/s10995-026-04234-7