Tag: statistics

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

ABSTRACT

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

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

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

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

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

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

ABSTRACT

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

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

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

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

PMID:40680308 | DOI:10.3171/2025.3.JNS2583

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

ABSTRACT

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

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

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

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

PMID:40680304 | DOI:10.3171/2025.3.PEDS24533

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

ABSTRACT

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

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

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

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

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

PMID:40680288 | DOI:10.2196/76195

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

ABSTRACT

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

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

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

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

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

PMID:40680286 | DOI:10.1097/NNR.0000000000000852

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

ABSTRACT

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

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

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

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

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

PMID:40680284 | DOI:10.1097/NNR.0000000000000848

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

ABSTRACT

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

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

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

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

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

PMID:40680274 | DOI:10.2196/72862

J Am Acad Orthop Surg Glob Res Rev. 2025 Jul 17;9(7). doi: 10.5435/JAAOSGlobal-D-25-00195. eCollection 2025 Jul 1.

ABSTRACT

BACKGROUND: Climate change is a global health emergency, with substantial carbon emissions coming from health care. This study compares the carbon footprint of in-person versus virtual orthopaedic care at a large, urban, academic healthcare system.

METHODS: Data were abstracted from the billing and claims database for orthopaedic clinic visits from 2018 to 2023 at a large, urban, academic medical center and its suburban satellite clinics. Carbon footprint per in-person visit was determined by combining emissions from supplies, facility energy use, and patient travel. The reduction in emissions of virtual visits was calculated compared with if all visits occurred in person.

RESULTS: Overall, 508,394 orthopaedic clinic visits (94.3% in-person, 5.7% virtual) were recorded. The average in-person visit resulted in 7.12 vs. 0.026 kg CO2e for the average virtual visit. Actual carbon emissions were estimated to be 3,411,206 kg CO2e compared with 3,714,565 kg if all visits occurred in person (8.2% reduction). Most emissions (99.8%) were attributed to patient travel, with 0.2% coming from supplies and <0.1% from facility energy use. The peak of the COVID-19 pandemic in 2020 saw the greatest reduction in carbon emissions at 19.5%, with emissions increasing each year thereafter (8.3% reduction in 2023).

CONCLUSION: The carbon footprint of clinic-based orthopaedic care is large and can be reduced by transitioning from in person to virtual care. Although virtual orthopaedic care has limitations, the environmental benefits are clear. Further research into virtual outpatient orthopaedic care should consider environmental impacts in addition to safety, effectiveness, and patient satisfaction.

PMID:40680267 | DOI:10.5435/JAAOSGlobal-D-25-00195

J Am Acad Orthop Surg Glob Res Rev. 2025 Jul 2;9(7). doi: 10.5435/JAAOSGlobal-D-24-00263. eCollection 2025 Jul 1.

ABSTRACT

INTRODUCTION: To assess ballistic proximal femur fracture outcomes in comparison with proximal femur fractures sustained by blunt mechanisms. We hypothesized that ballistic proximal femur fractures would have higher rates of infection, nonunion, and compartment syndrome than nonballistic fractures.

METHODS: A retrospective cohort was collected from the electronic medical record of a single, Level I, trauma center over a 10-year period (2013 to 2022) using Current Procedural Terminology codes. All consecutive adult patients with ballistic proximal third femur fractures (femoral neck, intertrochanteric, subtrochanteric) managed with surgical fixation were identified. A comparison group of proximal femur fractures sustained by nonballistic mechanisms was collected from consecutive patients in a 3-year period (2020 to 2022), creating a 2:1 nonballistic-to-ballistic fracture ratio. Exclusion criteria consisted of younger than 18 years or older than 65 years, primary fixation of total/hemi hip arthroplasty, primary pathologic fractures, and fractures across existing prosthesis. The primary outcomes measured include concomitant genitourinary injury, computed tomographic angiography with abnormality, vascular injury requiring repair, soft-tissue reconstruction, thigh compartment syndrome, length of stay, fracture-related infection, revision surgery to promote bone healing, and implant failure.

RESULTS: A total of 411 patients were included with 137 (33%) sustaining ballistic proximal femur fractures. Most blunt fractures were closed (86.8%), whereas most ballistic fractures were Gustilo Anderson type 1 open fractures (81.7%). The individuals in the ballistic cohort were more likely to have vascular injury requiring surgical intervention (8.8% vs. 1.1%, P < 0.001), computed tomographic angiography with abnormality (10.9% vs. 1.1%, P < 0.001), compartment syndrome (7.3% vs. 0.7%, P < 0.001), concomitant GU injury (12.4% vs. 1.8%, P < 0.001), and deep vein thrombosis (5.1% vs. 1.5%, P = 0.048).

CONCLUSION: Ballistic proximal femur fractures are associated with a higher risk of developing complications associated with trauma to nearby vascular structures and concomitant genitourinary structures. The rates of infection, revision surgery to promote bone healing, and implant failure were similar between the ballistic and nonballistic proximal femur fractures.

PMID:40680257 | DOI:10.5435/JAAOSGlobal-D-24-00263

JMIR Form Res. 2025 Jul 18;9:e74411. doi: 10.2196/74411.

ABSTRACT

BACKGROUND: Digital interventions have been proposed as a solution to meet the growing demand for mental health support. Large language models (LLMs) have emerged as a promising technology for creating more personalized and adaptive mental health chatbots. While LLMs generate responses based on statistical patterns in training data rather than through conscious reasoning, they can be designed to support important psychological processes. Prospection-the ability to envision and plan for future outcomes-represents a transdiagnostic process altered across various mental health conditions that could be effectively targeted through such interventions. We designed “Future Me,” an LLM-powered chatbot designed to facilitate future-oriented thinking and promote goal pursuit using evidence-based interventions including visualization, implementation intentions, and values clarification.

OBJECTIVE: This study aims to understand how users engage with Future Me, evaluate its effectiveness in supporting future-oriented thinking, and assess its acceptability across different populations, with particular attention to postgraduate students’ stress management needs. We also seek to identify design improvements that could enhance the chatbot’s ability to support users’ mental well-being.

METHODS: In total, 2 complementary studies were conducted. Study 1 (n=20) examined how postgraduate students used Future Me during a single guided session, followed by semistructured interviews. Study 2 (n=14) investigated how postgraduate students interacted with Future Me over a 1-week period, with interviews before and after usage. Both studies analyzed conversation transcripts and interview data using thematic analysis to understand usage patterns, perceived benefits, and limitations.

RESULTS: Across both studies, participants primarily engaged with Future Me to discuss career or education goals, personal obstacles, and relationship concerns. Users valued Future Me’s ability to provide clarity around goal-setting (85% of participants), its nonjudgmental nature, and its 24/7 accessibility (58%). Future Me effectively facilitated self-reflection (80%) and offered new perspectives (70%), particularly for broader future-oriented concerns. However, both studies revealed limitations in the chatbot’s ability to provide personalized emotional support during high-stress situations, with participants noting that responses sometimes felt formulaic (50%) or lacked emotional depth. Postgraduate students specifically emphasized the need for greater context awareness during periods of academic stress (58%). Overall, 57% of requests occurred outside office hours, dropping from 40 on day 1 to 12 by day 7.

CONCLUSIONS: Future Me demonstrates promise as an accessible tool for promoting prospection skills and supporting mental well-being through future-oriented thinking. However, effectiveness appears context-dependent, with prospection techniques more suitable for broader life decisions than acute stress situations. Future development should focus on creating more adaptive systems that can adjust their approach based on the user’s emotional state and immediate needs. Rather than attempting to replicate human therapy entirely, chatbots like Future Me may be most effective when designed as complementary tools within broader support ecosystems, offering immediate guidance while facilitating connections to human support when needed.

PMID:40680255 | DOI:10.2196/74411