Tag: statistics

JAMA Netw Open. 2025 Apr 1;8(4):e253698. doi: 10.1001/jamanetworkopen.2025.3698.

ABSTRACT

IMPORTANCE: There is limited evidence on the comparative effectiveness of different exercise modalities, such as yoga and strengthening exercises, for managing knee osteoarthritis (OA).

OBJECTIVE: To compare the effectiveness of yoga vs strengthening exercise for reducing knee pain over 12 weeks in patients with knee OA.

DESIGN, SETTING, AND PARTICIPANTS: This single-center, assessor-blinded (for nonpatient-reported outcomes), parallel-arm, active-controlled, superiority randomized clinical trial included adults aged 40 years or older with knee OA and knee pain levels of 40 or higher on a 100-mm visual analog scale (VAS) in Southern Tasmania, Australia. Participants were recruited from April 2021 to June 2022, and follow-up was completed in December 2022. Data were analyzed from May 2023 to July 2024.

INTERVENTIONS: Participants were randomized 1:1 to the yoga and strengthening exercise groups. Both groups attended 2 supervised and 1 home-based session per week for 12 weeks followed by 3 unsupervised home-based sessions per week for weeks 13 to 24.

MAIN OUTCOMES AND MEASURES: The primary outcome was the between-group difference in VAS score over 12 weeks assessed using a range of 0 (no pain) to 100 (worst possible pain) with a prespecified noninferiority margin of 10 mm. Secondary outcomes included knee pain over 24 weeks; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain, function, and stiffness; patient global assessment; Osteoarthritis Research Society International-Outcome Measures in Rheumatology Clinical Trials response; physical performance measures; leg muscle strength; health-related quality of life assessed via the Assessment of Quality of Life-8 Dimensions (AQol-8D) utility score; depression assessed with the Patient Health Questionnaire-9; and neuropathic pain assessment over 12 and 24 weeks. Analyses were based on the intention-to-treat principle.

RESULTS: In total, 117 participants were randomized to the yoga (n = 58) or strengthening exercise (n = 59) program. Baseline characteristics of the participants were similar, with a mean (SD) age of 62.5 (8.3) years, and 85 participants (72.6%) were female. The mean (SD) baseline VAS knee pain score of 53.8 (16.0) indicated moderate knee pain. Over 12 weeks, the between-group mean difference in VAS knee pain change was -1.1 mm (95% CI, -7.8 to 5.7 mm), which was not statistically significant but remained within the prespecified noninferiority margin. Of 27 secondary outcomes assessed over 12 and 24 weeks, 7 were statistically significant in favor of yoga. The yoga group showed modestly greater improvements than the strengthening exercise group (between-group differences) over 24 weeks for WOMAC pain (-44.5 mm [95% CI, -70.7 to -18.3 mm]), WOMAC function (-139 mm [95% CI, -228.3 to -49.7 mm]), WOMAC stiffness (-17.6 mm [95% CI, -30.9 to -4.3 mm]), patient global assessment (-7.6 mm [95% CI, -15.1 to -0.2 mm]), and 40-m fast-paced walk test (1.8 [95% CI, 0.4-3.2]). In addition, the yoga group had a modestly greater improvement than the strengthening exercise for depression at 12 weeks (between-group difference in PHQ-9 score, -1.1 [95% CI, -1.9 to -0.2]) and quality of life at 24 weeks (between-group difference in AQoL-8D score, 0.04 [95% CI, 0.0 to 0.07]). Adverse events were similar in both groups and mild.

CONCLUSION AND RELEVANCE: In this randomized clinical trial, yoga did not significantly reduce knee pain compared with strengthening exercises. However, yoga was found to be noninferior to strengthening exercises, suggesting that integrating yoga as an alternative or complementary exercise option in clinical practice may help in managing knee OA.

TRIAL REGISTRATION: ANZCTR.org Identifier: ACTRN12621000066886.

PMID:40198073 | DOI:10.1001/jamanetworkopen.2025.3698

JAMA Netw Open. 2025 Apr 1;8(4):e254026. doi: 10.1001/jamanetworkopen.2025.4026.

ABSTRACT

IMPORTANCE: Identifying whether people of minoritized religious identities are less likely to benefit from psychological therapy is key to tackling inequalities in mental health treatment.

OBJECTIVE: To assess inequalities in the effectiveness of routinely delivered psychological therapy across religious groups and by the intersections with ethnicity.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study including all patients who completed a course of treatment at 5 London-based National Health Service Talking Therapies for anxiety and depression (NHS TTad) services between 2011 and 2020. Individuals reported their religion using routine patient records collected by the services. Data were analyzed from September 2023 to October 2024.

EXPOSURES: Self-identified religion was categorized into (1) no religion, (2) Christian, (3) Muslim, and (4) other (which was further categorized into Buddhist, Hindu, Jewish, Sikh, and any other in a sensitivity analysis). Ethnicity was conceptualized as a potential confounder and separately as an effect modifier. Self-reported ethnicity was categorized based on UK Census codes into Asian, Black, mixed race, White, and other ethnic groups.

MAIN OUTCOMES AND MEASURES: Psychological treatment outcomes used to assess NHS TTad services nationally, including reliable recovery, recovery, and reliable deterioration. Dropout from treatment was also examined. These outcomes were defined based on pre-post treatment changes in depression and anxiety symptom measures according to national guidelines.

RESULTS: A total of 70 098 patients with data on self-reported religion were included in the study (mean [SD] age at referral, 39.2 [14.1] years; 47 797 [68.2%] female). After adjusting for sociodemographic, treatment-related, and clinical characteristics, the odds of reliable recovery were higher in patients who did not have any religious belief (odds ratio [OR], 1.34; 95% CI, 1.26-1.42) or self-reported Christian (OR, 1.39; 95% CI, 1.31-1.48) and other religion (OR, 1.25; 95% CI, 1.17-1.34) compared with Muslim patients. While treatment outcomes improved each year in all groups, Muslim patients remained least likely to improve and more likely to deteriorate. There were interactions between religion and ethnicity; in particular, Muslim patients of White or other ethnic backgrounds had worse outcomes than Muslim patients of Asian, Black, or mixed race ethnic backgrounds and compared with non-Muslim patients of those ethnicities.

CONCLUSIONS AND RELEVANCE: In England, patients who identified as Muslim, and particularly those of White or other ethnicities, had poorer outcomes from psychological therapies for depression and anxiety disorders than patients who reported no religion or any other religion. This may be partly due to unmeasured characteristics that warrant further investigation (eg, nationality and asylum-seeking or refugee status). Best practice guidelines on working with people of minoritized ethnicities may inform some of the changes needed to reduce inequalities, but must address religious identity separate from ethnicity, as well as their intersections.

PMID:40198069 | DOI:10.1001/jamanetworkopen.2025.4026

JAMA Netw Open. 2025 Apr 1;8(4):e254074. doi: 10.1001/jamanetworkopen.2025.4074.

ABSTRACT

IMPORTANCE: Posthospital inpatient rehabilitation is essential for many patients with traumatic injuries. However, rehabilitation centers lack transparency and oversight in their admission practices and may be influenced by health care practitioner (HCP) use of stigmatizing language in patient medical records, leading to inequities in access to care.

OBJECTIVES: To examine differences in admission to inpatient rehabilitation centers for patients hospitalized for violent penetrating (VP) injuries compared with motor vehicle crash (MVC) injuries.

DESIGN, SETTING, AND PARTICIPANTS: This mixed-methods retrospective qualitative study used data obtained from hospital records from 2015 to 2021. Data analysis occurred between July and December 2023. The study was performed at Boston Medical Center, an urban level I trauma center. The cohort included all patients hospitalized for VP or MVC injuries who were discharged to an inpatient rehabilitation center between 2015 and 2021.

EXPOSURES: Injury type, categorized as VP or MVC.

MAIN OUTCOMES AND MEASURES: The primary quantitative outcome was a denial for admission to an inpatient rehabilitation center. Qualitative content analysis identified similarities and differences across injury types in the manifestations of predetermined stigmatizing language categories in patients’ medical records.

RESULTS: Of 323 patients discharged to an inpatient rehabilitation center (median [IQR] age, 38 [25-59] years; 208 men [64.4%]; 29 Hispanic patients [9.0%], 118 non-Hispanic Black patients [36.5%], and 152 non-Hispanic White patients [47.1%]), 107 patients (33.1%) experienced at least 1 denial by a center before being placed (32 of 55 patients with VP injuries [58.2%] vs 75 of 268 patients with MVC injuries [28.0%]). Compared with patients with MVC injuries, patients with VP injuries had greater than 3 times the odds of experiencing a denial (odds ratio, 3.51; 95% CI, 1.93-6.48; P < .001). Medical records of patients with VP injuries had increased use of stigmatizing language that indicated culturally based or injury-related stereotyping, skepticism toward patient-reported symptoms, and heightened HCP-power dynamics contributing to unilateral decision-making.

CONCLUSIONS AND RELEVANCE: In this mixed-methods qualitative study of hospital patients discharged to rehabilitation centers, significant disparities in denials for admission were observed among survivors of violence, who were disproportionally Black or Hispanic. Stigmatizing language found in medical records suggested that bias within the referral process may have contributed to these disparities. These findings underscore the need for reformed clinical documentation practices and enhanced oversight of rehabilitation referral processes to promote equitable access to care.

PMID:40198068 | DOI:10.1001/jamanetworkopen.2025.4074

JAMA Netw Open. 2025 Apr 1;8(4):e254111. doi: 10.1001/jamanetworkopen.2025.4111.

ABSTRACT

IMPORTANCE: Extreme weather events disproportionately affect vulnerable populations, particularly nursing home residents. In February 2021, Winter Storm Uri caused unprecedented power outages and water shortages across Texas. However, its impact on nursing home residents remains poorly understood.

OBJECTIVE: To assess the association of power outages and water shortages during Winter Storm Uri with mortality and health care utilization among long-stay nursing home residents in Texas.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of long-stay nursing home residents before and after Winter Storm Uri (February 14 to February 17, 2021) in Texas. Data analysis was conducted from March 2024 to January 2025.

EXPOSURE: Residing in a nursing home that experienced a power outage or water shortage during Winter Storm Uri.

MAIN OUTCOMES AND MEASURES: The outcome measures were weekly rates of mortality, clinician visits to nursing homes, emergency department (ED) visits, and hospitalizations among long-stay nursing home residents. Medicare claims were used to determine weekly mortality, clinician visits, ED visits, and hospitalizations 6 weeks before and 6 weeks after the storm. Differences-in-differences (DiD) analysis using 2-level logistic regression models estimated changes in outcomes associated with nursing home power or water loss.

RESULTS: Of 1174 nursing homes, 231 (19.7%) reported power or water outages. The sample included 45 439 long-stay residents, with 8521 in facilities with outages (mean [SD] age, 80.07 [12.21] years; 5664 female [66.47%]) and 36 918 in facilities without outages (mean [SD] age, 80.42 [11.92] years; 12 705 female [65.59%]). DiD analysis found that residents of nursing homes with outages had a 0.13% (95% CI, 0.03% to 0.23%) higher mortality rate in the 3 to 5 weeks after the storm than those without outages. There were no significant differences in clinician visits (DiD, -0.31%; 95% CI, -1.08% to 0.47%), ED visits (DiD, 0.11%; 95% CI, -0.12% to 0.34%), or hospitalizations (DiD, 0.07%; 95% CI, -0.10% to 0.23%).

CONCLUSIONS AND RELEVANCE: In this cohort study of nursing home residents in Texas, power and water outages during Winter Storm Uri were associated with increased mortality but not ED visits or hospitalizations, highlighting the vulnerability of nursing home residents during extreme weather events.

PMID:40198067 | DOI:10.1001/jamanetworkopen.2025.4111

J Sci Food Agric. 2025 Apr 8. doi: 10.1002/jsfa.14277. Online ahead of print.

ABSTRACT

BACKGROUND: Lily bulbs are used as food and herbal medicine in the Chinese market. These are often sulfur-fumigated during postharvest processing for bleaching and preservation. This study aimed to compare the volatile compounds in non-fumigation and sulfur-fumigation lily bulbs by headspace solid-phase microextraction (HS-SPME) coupled with gas chromatography-mass spectrometry (GC-MS) detection and multivariate statistical analysis.

RESULTS: The results showed that sulfur fumigation led to the chemical transformation of certain original components and significantly changed the chemical characteristics of lily bulbs. A total of 56 volatile compounds were identified in the 12 samples, including one non-fumigated and 11 sulfur-fumigated lily bulbs. Based on multivariate statistical analysis, 13 most characteristic chemical markers were selected to distinguish non-fumigated and sulfur-fumigated lily bulbs. Moreover, the transformation mechanism of the four sulfur compounds and several chemical markers was inferred, which showed that an addition reaction and rearrangement reaction most occurred in the process of sulfur fumigation.

CONCLUSION: This newly proposed approach can be applied to ensure consistent quality associated with sulfur fumigation for lily bulbs and other food products. © 2025 Society of Chemical Industry.

PMID:40196924 | DOI:10.1002/jsfa.14277

J Cachexia Sarcopenia Muscle. 2025 Apr;16(2):e13793. doi: 10.1002/jcsm.13793.

ABSTRACT

BACKGROUND: Multiple myeloma (MM) is the second most common haematological malignancy. The predominantly older patients often suffer from comorbidities that impair their quality of life (QoL). Physical activity (PA) can be beneficial for cancer patients, but less evidence exists in MM. This randomized controlled trial (RCT) compared an exercise group with World Health Organization (WHO)-compliant PA (150 min aerobic exercise and 2 resistance training-sessions/week) vs. activity as usual (control group).

METHODS: Thirty-four newly diagnosed consecutive MM patients were randomized 1:1 to exercise vs. control groups. Guided training (2×/week) was performed for 3 months during bortezomib-cyclophosphamide-dexamethasone (VCd) induction. PA was monitored using smartwatches and diaries. Demographics, osteolytic lesions, infections, fatigue, depression, and biomarkers (albumin, creatine kinase, C-reactive protein, high-density lipoprotein, low-density lipoprotein and pro-brain natriuretic peptide) were compared in exercise vs. control cohorts. VCd-tolerance, response, ‘timed-up-and-go-test’ (TUGT), Revised Myeloma Comorbidity Index (R-MCI), QoL (SF-12 questionnaire), event-free survival and trainer assignment during the training period were assessed (13 tests at baseline, during VCd and end of treatment [EOT]).

RESULTS: The exercise group was more than twice as active as the control group, with an average aerobic activity of 162 versus 68 min/week, respectively. Trainer-guided muscle-strengthening exercises were performed 2×/week in the exercise group, in line with WHO recommendations. These data were monitored via smartwatches and training diaries. PA proved to be safe: No exercise-related SAEs or accidents occurred. The study adherence was 94% (32/34). In the exercise versus control group, AEs to VCd induction (6% vs. 25%), therapy intolerance (6% vs. 25%) and hospitalization (31% vs. 50%, respectively) occurred less frequently. VCd-dose adjustments in the exercise vs. control group were significantly less needed (6.3% vs. 37.5%, respectively). At EOT, patients in the exercise group showed less fatigue (6% vs. 75%), less depression (6% vs. 44%), better TUGT (6 vs. 11 s, respectively), improved R-MCI and QoL compared to the control group. Grip strength (right hand: 73-82 lb; left hand: 68-72 lb) significantly improved from baseline to EOT in the exercise group. Biomarkers did not significantly differ in both groups, but response to VCd-induction and event-free survival were improved in the exercise group, however, without reaching statistical significance.

CONCLUSIONS: PA in MM patients during induction is feasible and can improve fatigue, depression, TUGT, grip strength, comorbidities and QoL. More sport intervention offers are warranted to advance exercising in MM.

TRIAL REGISTRATION: drks.de: DRKS00022250.

PMID:40196920 | DOI:10.1002/jcsm.13793

Influenza Other Respir Viruses. 2025 Apr;19(4):e70098. doi: 10.1111/irv.70098.

ABSTRACT

BACKGROUND: The patterns of circulation and burden of influenza and respiratory syncytial virus (RSV) in Singapore are affected by the COVID-19 pandemic containment measures. These patterns in relation to SARS-CoV-2 in a post-pandemic era are unclear.

METHODS: Using data from 2015 to 2023, we estimated excess influenza-, RSV- and SARS-CoV-2-associated hospitalisation in Singapore, adjusted for rhinovirus/enterovirus activity in generalised additive models. The data include pneumonia and influenza (P&I) hospitalisation from a national inpatient database and a community-wide acute respiratory infection (ARI) sentinel surveillance programme, stratified by age groups.

RESULTS: Across all age groups, the proportion of hospitalisation associated with influenza, SARS-CoV-2 and RSV was 13.2% (95% CI 5.0%-21.6%), 19.3% (95% CI 13.8%-25.0%) and 4.0% (95% CI 0.9%-12.1%) in 2023, respectively. From 2019 to 2023, all-age influenza-associated hospitalisation declined from 264.4 per 100,000 person-years (95% CI 214.2-313.2) to 203.7 per 100,000 person-years (95% CI 76.8-333.6). In contrast, all-age RSV-associated hospitalisation after the pandemic was 62.2 per 100,000 person-years (95% CI 13.8-186.9), similar to pre-pandemic observations. Peak seasonal influenza occurred 3-8 weeks later as compared with the time of pre-pandemic peak influenza activity.

CONCLUSION: The overall burden of influenza has declined after the COVID-19 pandemic and its burden is comparable with SARS-CoV-2. Furthermore, shifts in the timing of peak influenza activity suggest a potential need to review the timing of vaccine recommendations in Singapore.

PMID:40196916 | DOI:10.1111/irv.70098

Pflege. 2025 Apr 8. doi: 10.1024/1012-5302/a001039. Online ahead of print.

ABSTRACT

Background: Incontinence-associated dermatitis (IAD) is a sequela of fecal and/or urinary incontinence with an estimated prevalence rate of 6% to 27%. To assess the severity of IAD the Ghent Global IAD Categorization Tool (GLOBIAD) was developed. A German translation of GLOBIAD (GLOBIAD-D) is available, but psychometric testing is pending. Aim: The aim of the study was to assess the interrater reliability, practicability and clinical relevance of the GLOBIAD-D. Methods: A multicenter study with cross-sectional design was conducted in four health and social care facilities in Germany and Austria including patients/residents with IAD. The overall percentage of observation agreement (POA) and interrater reliability was assessed using data from 23 observations of an IAD. Practicability and clinical relevance were assessed using a self-administered questionnaire. Data analysis was performed using descriptive statistics, Cohen’s kappa(κ), and Cramers V. Results: A high percentage of observational agreement (n = 22; POA = 68.20%) and moderate interrater reliability (n = 22; κ = 0.55; 95% CI [0.28; 0.82]) were obtained with GLOBIAD-D. Practicability and clinical relevance of GLOBIAD-D were rated as good and it was described as a simple, understandable, user-friendly, and time efficient tool. Potential for improvement was seen in image quality as well as description of category 2A. Conclusions: GLOBIAD-D shows a high overall POA and was proved to be practical and clinically relevant. Further studies are needed to make recommendations.

PMID:40196905 | DOI:10.1024/1012-5302/a001039

Eur Heart J. 2025 Apr 8:ehae812. doi: 10.1093/eurheartj/ehae812. Online ahead of print.

NO ABSTRACT

PMID:40196897 | DOI:10.1093/eurheartj/ehae812

Eur J Prev Cardiol. 2025 Apr 8:zwaf203. doi: 10.1093/eurjpc/zwaf203. Online ahead of print.

ABSTRACT

AIMS: Elevated remnant cholesterol is a causal factor for atherosclerotic cardiovascular disease (ASCVD); however, whether aggressive lowering will reduce ASCVD is unclear. In women and men, we tested the hypothesis that aggressive lowering of remnant cholesterol has the potential for substantial ASCVD reduction. This was tested using modelling of cohort data.

METHODS: From the Copenhagen General Population Study, 56 422 women and 43 952 men without a history of ASCVD were recruited from 2003 through 2015. They were subsequently followed in national Danish health registries until December 2021 for incident ASCVD.

RESULTS: During a median follow-up of 12 years, 4 946 women and 6 043 men developed ASCVD. In women at very-high cardiovascular risk, 2 mmol/L (77 mg/dL) lower levels of remnant cholesterol from 3 mmol/L (116 mg/dL) likely reduces absolute 10-year risk of ASCVD by 17% and 13% in statin users and non-users; corresponding values in men were 20% and 15%, respectively. Corresponding values by 1 mmol/L (39 mg/dL) lower remnant cholesterol were 10% and 7% in women and 11% and 9% in men, respectively. Similar values are also provided for lower starting remnant cholesterol levels, different lowering of remnant cholesterol, and for lower baseline cardiovascular risk.

CONCLUSIONS: In women and men, aggressive lowering of remnant cholesterol has the potential for substantial ASCVD reduction. Estimated absolute risk reduction was larger in statin users versus non-users and in men versus women, likely because statin users versus non-user and men versus women are at higher baseline absolute risk.

PMID:40196895 | DOI:10.1093/eurjpc/zwaf203