Tag: statistics

Elife. 2026 Apr 9;14:RP108023. doi: 10.7554/eLife.108023.

ABSTRACT

Using temporally delayed linear modeling (TDLM) and magnetoencephalography (MEG), we investigated whether items associated with an underlying graph structure are replayed during a post-learning resting state. In these same data, we previously provided evidence for replay during online (non-rest) memory retrieval. Despite successful decoding of brain activity during a localizer task, and contrary to predictions, we found no evidence for replay during a post-learning resting state. To better understand this, we performed a hybrid simulation analysis in which we inserted synthetic replay events into a control resting state recorded prior to the actual experiment. This simulation revealed that replay detection using our current pipeline requires an extremely high replay density to reach significance (>1 replay sequence per second, with ‘replay’ defined as a sequence of reactivations within a certain time lag). Furthermore, when scaling the number of replay events with a behavioral measure, we were unable to induce a strong correlation between sequenceness and this measure. We infer that even if replay was present at plausible rates in our resting state dataset, we would lack statistical power to detect it with TDLM. Finally, contrasting our novel hybrid simulation to existing purely synthetic simulations indicated that the latter approaches overestimate the sensitivity of TDLM. We discuss approaches that might optimize the analytic methodology, including identifying boundary conditions under which TDLM can be expected to detect replay. We conclude that solving these methodological constraints will be crucial for optimizing the non-invasive measurement of human replay using MEG.

PMID:41954994 | DOI:10.7554/eLife.108023

JAMA Netw Open. 2026 Apr 1;9(4):e265996. doi: 10.1001/jamanetworkopen.2026.5996.

ABSTRACT

IMPORTANCE: Pediatric dental-related emergency department visits have drastically increased in recent years. School-based caries prevention programs (SCPPs) aim to address unmet dental needs, yet it is unclear whether they effectively reach high-risk populations.

OBJECTIVE: To determine whether children with prior dental care utilization are more likely than children without prior utilization to participate in SCPPs.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study, conducted between June 2023 and October 2025, linked 2019 SCPP clinical trial data and 2016 to 2019 Medicaid claims data to examine disparities in sociodemographic characteristics and dental and dental-related medical care utilization prior to SCPP implementation between participants and nonparticipants. SCPPs were implemented in 47 primary schools in New York, New York, primarily in the Bronx, which was deemed to have the highest risk of tooth decay in the city. Participants included children aged 5 to 13 years in 2019 residing in the Bronx and continuously enrolled in Medicaid between 2018 and 2019.

EXPOSURES: Dental and dental-related medical care utilization in 2018, the year prior to SCPP implementation, demographic factors, individual-level clinical dental needs, and health system factors.

MAIN OUTCOMES AND MEASURES: The primary outcome was SCPP participation in 2019. Adjusted logistic regression was used to assess whether prior dental care use was independently associated with participation.

RESULTS: The study included 63 217 children in total (62 187 nonparticipants and 1030 participants), with a mean age of 7.7 years (95% CI, 7.6-7.7 years). There were 30 590 female children (48.4%), 1852 Asian children (2.9%), 13 926 Black children (22.0%), 31 620 Hispanic children (50.0%), and 1988 White children (3.2%). In multivariable analysis, compared with any dental visits, having no dental visits prior to SCPP implementation was associated with 17% lower odds of participating (adjusted odds ratio, 0.83; 95% CI, 0.71-0.96). Compared with having any dental emergencies, having no dental emergencies was associated with 32% increased odds of participating (adjusted odds ratio, 1.32; 95% CI, 1.08-1.62). Mitigating selection from a statewide SCPP rollout was estimated to save up to $2.4 million in nontraumatic dental-related emergency department visits.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of NY Medicaid claims data linked to SCPP participation data, there was evidence that children at high risk of tooth decay who are most in need of dental preventive services have a lower likelihood of participating in school-based prevention programs. More evidence is needed to identify successful strategies for recruitment of high-need children.

PMID:41954936 | DOI:10.1001/jamanetworkopen.2026.5996

JAMA Netw Open. 2026 Apr 1;9(4):e266000. doi: 10.1001/jamanetworkopen.2026.6000.

ABSTRACT

IMPORTANCE: Health-related social needs (HRSNs) may impede colorectal cancer (CRC) screening among US adults, yet population-based evidence on these associations remains limited.

OBJECTIVE: To examine associations between HRSNs and CRC screening uptake overall and by age group among US adults.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the 2023 National Health Interview Survey. Participants were US civilian, noninstitutionalized adults aged 45 to 75 years eligible for CRC screening. Age-stratified analyses were conducted for adults aged 45 to 49 years, 50 to 64 years, and 65 to 75 years. Data analysis was performed from April 2025 to February 2026.

EXPOSURES: Self-reported HRSNs, including housing instability, food insecurity, transportation barriers, and number of unmet needs.

MAIN OUTCOMES AND MEASURES: The primary outcome was being up to date with CRC screening according to US Preventive Services Task Force recommendations. Survey-weighted logistic regression models estimated adjusted odds ratios (aORs) and 95% CIs overall and by age group.

RESULTS: The analytic sample included 14 528 adults aged 45 to 75 years, and most participants were aged 50 to 64 years (6940 individuals [52.42%]), female (7788 individuals [51.36%]), insured (13 750 participants [94.07%]), and reported no unmet HRSNs (12 370 participants [85.40%]). Overall, 2158 adults (14.60%) reported at least 1 unmet HRSN. The proportion up to date with CRC screening was 63.91% (9758 adults) overall and increased with age, from 31.01% (586 adults) among adults aged 45 to 49 years to 64.24% (4539 adults) among those aged 50 to 64 years, and 80.85% (4633 adults) among those aged 65 to 75 years. In adjusted models, housing instability (aOR, 0.82; 95% CI, 0.67-0.99) and transportation barriers (aOR, 0.78; 95% CI, 0.64-0.95) were associated with lower odds of being up to date with CRC screening. Screening odds declined with increasing number of unmet HRSNs, including among adults reporting 1 unmet need (aOR, 0.84; 95% CI, 0.72-0.98). Associations were most pronounced among adults aged 50 to 64 years, among whom housing instability (aOR, 0.77; 95% CI, 0.61-0.97), transportation barriers (aOR, 0.71; 95% CI, 0.56-0.91), and reporting 1 HRSN (aOR, 0.80; 95% CI, 0.66-0.97) were associated with lower odds of being up to date with screening.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, unmet HRSNs were associated with lower CRC screening uptake, particularly among adults aged 50 to 64 years. Addressing HRSNs may support age-specific strategies to improve CRC screening.

PMID:41954935 | DOI:10.1001/jamanetworkopen.2026.6000

JAMA Netw Open. 2026 Apr 1;9(4):e266005. doi: 10.1001/jamanetworkopen.2026.6005.

ABSTRACT

IMPORTANCE: Invasive pneumococcal disease (IPD) remains a significant burden despite implementation of pneumococcal conjugate vaccines (PCVs) in childhood immunization programs.

OBJECTIVE: To analyze IPD epidemiology in Canada following 7-valent pneumococcal conjugate vaccine (PCV7) and 13-valent PCV (PCV13) introductions and evaluate the potential outcomes associated with newer vaccines, such as PCV15, PCV20, and PCV21.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included IPD isolates from children and adults with IPD across Canada from January 1, 2000, to December 31, 2019. Cases were identified through bacterial isolates sent to national reference laboratories. Data were analyzed from January 2022 to January 2026.

EXPOSURES: Introduction of PCV7 and PCV13.

MAIN OUTCOMES AND MEASURES: IPD incidence rates and proportion analyses were calculated for serotypes belonging to PCV7, PCV13, PCV15, PCV20, and PCV21 using Statistics Canada population estimates. PCV7 and PCV13 impact was assessed using generalized linear piecewise quasi-Poisson regression models.

RESULTS: A total of 37 921 IPD isolates were analyzed. Age data were available for 37 591 isolates (17.9% children aged <18 years; 82.1% adults aged ≥18 years), and sex data for 35 303 isolates (51.5% male; 41.6% female). Following PCV7 introduction, PCV7-specific serotype IPD rates decreased by 98.5%, from an incidence rate (IR) of 20.1 (95% CI, 17.8-22.6) in year 0 to 0.31 (95% CI, 1.0-0.5) in year 7 (P < .001), in children younger than 5 years (direct cohort) and 76.3%, from an IR of 2.2 (95% CI, 1.6-3.0) in year 0 to (0.5; 95% CI, 0.3-0.9) in year 7, in individuals aged 10 years or older (indirect cohort), although the difference was not statistically significant (P = .74). After PCV13 introduction, PCV13-only serotype IPD rates decreased by 90.6% in the direct cohort, from an IR of 10.3 (95% CI, 8.812.1) in year 0 to 1.0 (95% CI, 0.65-1.44) in year 9 (P = .03), and 57.1% in the indirect cohort, from an IR of 3.8 (95% CI, 3.1 to 4.6) in year 0 to 1.6 (95% CI, 1.2 to 2.1) in year 9 (P = .001). Vaccine serotypes 3, 4, and 19F persisted, with increases observed in adults aged 18 to 49 years and 50 to 64 years for serotypes 3 and 4, and in adults aged 65 years and older for serotype 19F. Serotype 19A cases declined after introduction of PCV13, with the highest incidence in adults aged 65 years and older. From 2015 to 2019, the potential serotype coverages by PCV15, PCV20, and PCV21 were estimated at 23% to 29%, 32% to 39%, and 36% to 49%, respectively, while nonvaccine types accounted for 45% to 52%.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of IPD isolates in Canada found that despite initial IPD reductions following PCVs, IPD in Canada increased, driven by emerging nonvaccine types and persistence of some vaccine serotypes. Indirect protection was limited, particularly among older adults, highlighting the need for direct adult vaccination strategies. These findings suggest that while PCV15, PCV20, and PCV21 may improve serotype coverage, continued development of broader-spectrum vaccines is essential to further reduce IPD burden.

PMID:41954934 | DOI:10.1001/jamanetworkopen.2026.6005

JAMA Netw Open. 2026 Apr 1;9(4):e266019. doi: 10.1001/jamanetworkopen.2026.6019.

ABSTRACT

IMPORTANCE: Several integrative indices at the neighborhood level have been developed in the US, but direct comparisons across these indices for the prevalence of cardiovascular-kidney-metabolic (CKM) conditions are limited. Moreover, it is not known whether certain indices better capture place-based variability in CKM conditions or provide additional information when compared with a single measure of income.

OBJECTIVE: To determine how much variability is explained by neighborhood indices in the prevalence of CKM conditions at the census tract level and the incremental value of each index when added to median household income.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of US national surveillance data (Behavioral Risk Factor Surveillance System and American Community Survey) included all census tracts with complete data for exposures, covariates, and outcomes from 2010 to 2022. Analyses were completed between October 2024 and July 2025.

EXPOSURES: Seven neighborhood indices available at the census tract level (Area Deprivation Index, Child Opportunity Index, Environmental Justice Index, Neighborhood Deprivation Index, Social Deprivation Index, Social Vulnerability Index, Structural Racism Effect Index) and median household income at the census tract level from the American Community Survey.

MAIN OUTCOMES AND MEASURES: The primary outcome was prevalence of CKM conditions (coronary heart disease [CHD], stroke, and chronic kidney disease [CKD]) at the census tract level. Differences in the exposures and outcomes were visualized by mapping index scores, median household income, and prevalences of CKM conditions for all census tracts. To assess index agreement, pairwise correlations were computed with Spearman rank correlation coefficients, and to assess the incremental variability explained by each index when added to median household income, change in r2 was calculated.

RESULTS: Of the 65 476 US census tracts included, median (IQR) prevalence was 5.9% (4.7%-7.4%) for CHD, 3.3% (2.6%-4.1%) for stroke, and 2.9% (2.5%-3.4%) for CKD. The indices and income were modestly to highly correlated (range, 0.46-0.94), with some discordance in how each measure classified census tracts by quartiles of index scores. All indices and income were significantly associated with CKM condition prevalence at the census tract level in multivariable linear regression models, adjusted for median population size and age. The r2 values of the indices with CHD, stroke, and CKD ranged from 0.379 (SE = 0.033) for the correlation between the Environmental Justice Index and stroke to 0.688 (SE = 0.002) for the correlation between the Structural Racism Effect Index and stroke. Additionally, the improvement in variability for CHD, stroke, and CKD (change in r2) explained by the addition of each index to income ranged from 0.014 (SE = 0.001) for the correlation between the Environmental Justice Index and CHD to 0.195 (SE = 0.002) for the correlation between Structural Racism Effect Index and stroke.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, there were similar associations across neighborhood indices and income with the prevalence of CKM conditions. These findings inform how different place-based measures can be applied in public health research and policy.

PMID:41954933 | DOI:10.1001/jamanetworkopen.2026.6019

Eur J Public Health. 2026 Mar 14;36(2):ckag050. doi: 10.1093/eurpub/ckag050.

ABSTRACT

Socioeconomic disadvantage is associated with severe maternal morbidity (SMM), across high-income countries. However, neighbourhood-level measures of disadvantage, often used in population-based studies, may underestimate the effect of individual socioeconomic disadvantage. This study aimed to compare the strength of the associations between individual- and neighbourhood-level measures of socioeconomic disadvantage and SMM risk in a high-income country. We conducted a nationwide, population-based cohort study using the Dutch Data InfrAstructure for ParEnts and childRen (DIAPER). The cohort consisted of 832 866 women who gave birth in the Netherlands between 1 January 2012, and 31 December 2021. Multilevel multivariable Poisson regression was used to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for individual and neighbourhood-level measures of socioeconomic disadvantage. The role of pre-existing physical and mental health conditions in this association was examined using causal mediation analysis. Individual-level measures of socioeconomic disadvantage showed the strongest association with SMM, with the largest risk ratio of SMM between women with individual low educational attainment compared to those with high educational attainment (aRR 1.41, 95% CI 1.33-1.50), whereas the aRR for low compared to high neighbourhood education was 1.21 (95% CI 1.14-1.28). Physical health conditions mediated between 11% and 29% of the association with SMM across the different measures of disadvantage. Individual measures of socioeconomic position are more strongly associated with SMM than neighbourhood-level measures and pre-existing physical health conditions are important factors in this association. Future research should recognize the potential underestimation of risk when using neighbourhood-level disadvantage as a proxy for individual disadvantage.

PMID:41954921 | DOI:10.1093/eurpub/ckag050

Eur J Public Health. 2026 Mar 14;36(2):ckag057. doi: 10.1093/eurpub/ckag057.

ABSTRACT

The spouses of women with gestational diabetes mellitus (GDM) seem to be at risk of developing type 2 diabetes and cardiovascular diseases (CVDs). We comparatively analysed the risk factors, lifestyle, socioeconomic factors, and health of the spouses of women with (cases, n = 599) and without (controls, n = 586) GDM. This cross-sectional study utilized data from the Finnish Gestational Diabetes study. Data of the spouses were collected using a structured questionnaire: socioeconomic factors, smoking, alcohol consumption, health, own perinatal health, and family history of diabetes and CVDs. Age-adjusted odds ratios (aORs) were analysed using multivariate logistic regression. The mean ages of the cases and the controls were 33.5 years and 31.2 years, respectively [mean difference: 2.4 years, 95% confidence interval (CI): 1.68-3.02]. The mean body mass index of the cases (26.9 kg/m2) was 0.78 kg/m2 (95% CI: 0.34-1.21) higher than that of the controls. Fewer cases attained the highest educational level (13.5% vs. 16.9%, aOR 0.64, 95% CI: 0.46-0.90). The cases reported more often alcohol consumption (85.4% vs. 78.7%, aOR 1.59, 95% CI: 1.16-2.17); chronic disease, impairment, or disability (17.4% vs. 12.6%, aOR 1.43, 95% CI: 1.03-2.00); or mental disorder (8.0% vs. 5.1%, aOR 1.63, 95% CI: 1.01-2.64). The cases reported more risk factors for adverse health outcomes, more chronic diseases and mental disorders than the controls. Therefore, lifestyle counselling should also be provided to the spouses of women with GDM.

PMID:41954919 | DOI:10.1093/eurpub/ckag057

JAMA Otolaryngol Head Neck Surg. 2026 Apr 9. doi: 10.1001/jamaoto.2026.0284. Online ahead of print.

ABSTRACT

IMPORTANCE: Morbidity after traditional extracapsular tonsillectomy (ECTE) is high in adolescents and adults. Alternatively, intracapsular tonsillectomy (ICTE) may have a similar efficacy and reduce postoperative morbidity.

OBJECTIVE: To investigate the recovery time and morbidity after ICTE compared to ECTE in 16- to 65-year-olds with recurrent or chronic tonsillitis.

DESIGN, SETTING, AND PARTICIPANTS: The FINITE randomized, patient-blinded, 3-arm clinical trial compared ECTE, intracapsular coblation tonsillectomy (ICTEc), and intracapsular microdebrider tonsillectomy (ICTEm) in the treatment of patients aged 16 to 65 years with recurrent and chronic tonsillitis. The trial was conducted from September 2019 to January 2023 with a 1-month follow-up. The study was conducted at 1 secondary and 1 tertiary hospital in Finland. The data were analyzed between January 2023 and January 2025.

INTERVENTIONS: The ECTE vs ICTEc vs ICTEm ratio was 1:1:1.

MAIN OUTCOMES AND MEASURES: The main outcome was postoperative recovery time. The clinically significant difference between groups in recovery time was predefined to be 3 days favoring the ICTE groups.

RESULTS: A total of 366 patients, aged 16 to 65 years who were diagnosed with recurrent or chronic tonsillitis and scheduled for tonsillectomy, were eligible for inclusion in the FINITE study. After exclusions, 179 patients were randomized (mean [SD] age, 26.7 [8.8] years; 39 [22%] male and 138 [78%] female), and 161 patients (94%) completed the 1-month follow-up. The mean (SD) postoperative recovery time was similar in the 3 groups: 12.1 (4.7) days in the ECTE group, 11.1 (4.6) days in the ICTEc group, and 10.3 (4.6) days in the ICTEm group. In the secondary outcome analysis, swallowing pain intensity was lower in the ICTEc and ICTEm group compared to the ECTE group during postoperative days 1 to 10 and 12, and days 2 to 12, respectively. Daily activity impairment due to pain interference resolved faster in the ICTE groups.

CONCLUSIONS AND RELEVANCE: In patients aged 16 to 65 years with recurrent or chronic tonsillitis who participated in this randomized clinical trial, recovery times of ICTE and ECTE did not differ to statistical significance. ICTE resulted in a lower pain intensity and faster resolution of pain interference compared to ECTE.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03654742.

PMID:41954901 | DOI:10.1001/jamaoto.2026.0284

Spine (Phila Pa 1976). 2026 Apr 9. doi: 10.1097/BRS.0000000000005688. Online ahead of print.

ABSTRACT

STUDY DESIGN: Prospective observational multicenter cohort study.

OBJECTIVE: To evaluate and compare functional outcomes, as measured by AO Spine Patient Reported Outcome Spine Trauma (PROST), in neurologically intact patients with thoracolumbar (TL) burst fractures treated operatively or nonoperatively.

SUMMARY OF BACKGROUND DATA: The optimal management of these patients remains debated.

METHODS: This investigation was part of a prospective observational international multicenter cohort study. Neurologically intact adults (18-65 y) with acute (≤10 d) TL burst fractures were included from various sites across the world. Provided treatment was determined by the local standard of care. PROST was administered at multiple prospective timepoints from baseline up to 2-years post-injury. Descriptive statistics were used to analyze patient and clinical characteristics. Multivariable mixed models for repeated measures were used to assess differences in treatment groups and between the fracture types.

RESULTS: A total of 93 patients were included (mean age 41 y, 57% male). Most sustained high-energy trauma (73.1%) and had type A3 fractures (63.4%), with 61.3% treated nonoperatively. Both nonsurgical (34.2 to 86.0) and surgical (39.9 to 85.6), as well as fracture types (A4: 38.4 to 85.6; A3: 36.4 to 87.3) demonstrated significant improvements in PROST scores over time (P<0.001). No statistically significant differences in PROST scores were found between treatment groups or fracture types. Although, surgically treated patients showed higher PROST scores within the first 3 months, and nonsurgical patients had marginally higher scores hereafter, these differences were not statistically significant and converged by 2 years.

CONCLUSION: Both surgical and nonsurgical treatment of neurologically intact TL burst fracture patients resulted in comparable long-term functional outcomes as measured by AO Spine PROST. A descriptive trend was observed with surgically treated patients showing higher mean PROST scores up to 3 months post-treatment, however, between-group differences were not statistically significant and equalized by two years.

PMID:41954890 | DOI:10.1097/BRS.0000000000005688

Genes Genomics. 2026 Apr 9. doi: 10.1007/s13258-026-01749-9. Online ahead of print.

NO ABSTRACT

PMID:41954879 | DOI:10.1007/s13258-026-01749-9