Tag: statistics

JAMA Health Forum. 2025 May 2;6(5):e251424. doi: 10.1001/jamahealthforum.2025.1424.

ABSTRACT

IMPORTANCE: Millions of lower-income Health Insurance Marketplace enrollees were defaulted from zero-premium to positive-premium health plans in 2022, 2023, and 2024. This turnover in zero-premium plans may cause coverage losses by creating administrative burdens that complicate enrollees’ ability to maintain coverage.

OBJECTIVE: To determine how turnover affected Marketplace reenrollment.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used log-linear fixed-effects models including counties in 29 states that used the HealthCare.gov platform from 2022 through 2024.

EXPOSURE: HealthCare.gov enrollees living in a county that experienced turnover that year.

MAIN OUTCOMES AND MEASURES: County-year-level counts of overall reenrollment, automatic and active enrollment, and active reenrollment split by whether enrollees stayed with or switched from their previous plan. We controlled for premium affordability, insurer competition, other county characteristics, and state-by-year policy changes.

RESULTS: The sample consisted of 2159 counties representing roughly 10 million HealthCare.gov enrollees annually in 29 states that used the HealthCare.gov platform from 2022 through 2024. The share of enrollees living in counties exposed to turnover increased from 10.3% to 93.9% from 2021 to 2022 as the American Rescue Plan Act subsidies were implemented. These increases have persisted into 2024. Turnover across insurers was associated with a 7.0% (95% CI, -12.7 to -1.3) decrease in automatic reenrollment. Any turnover was not associated with changes in active enrollment, though it was associated with a 13.4% decrease (95% CI, -17.7 to -9.1) in enrollees choosing to stay with their previous, default plan and a roughly equivalent 15.0% increase (95% CI, 11.5-18.5) in enrollees choosing to switch plans.

CONCLUSIONS: Turnover affects coverage losses by decreasing automatic, passive reenrollment among lower-income enrollees that may not realize they need to start paying premiums to retain coverage that previously did not have a premium. Turnover also nudges returning enrollees to select new plans rather than selecting their previous plans. This likely increases insurer price competition but also may create hassles for enrollees. These findings suggest that coverage losses from turnover in 2026 among lower-income Marketplace enrollees may be particularly large if enhanced subsidies from the Inflation Reduction Act expire.

PMID:40408089 | DOI:10.1001/jamahealthforum.2025.1424

J Physician Assist Educ. 2025 May 22. doi: 10.1097/JPA.0000000000000678. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to evaluate whether physician assistant/associate (PA) students’ sociodemographic factors were predictors of risk for mistreatment. A secondary analysis aimed to evaluate whether sociodemographic features were evenly distributed among respondents who answered mistreatment items.

METHODS: Data originated from the PA Education Association End of Program Surveys (2018, 2019, 2021, and 2022). Independent variables were gender, race, ethnicity, and sexual orientation. Using logistic regression, odds ratios were calculated for 2 separate dependent variables: whether respondents experienced mistreatment and whether respondents completed mistreatment items.

RESULTS: Surveys included 11,461 respondents, 3218 (28.1%) of whom experienced mistreatment; however, 3258 (28.4%) of respondents did not answer any mistreatment items. Analysis showed statistically significant sociodemographic factors for risk for mistreatment, but the model had poor fit (P-value = 0; receiver operating characteristic [ROC] 0.553), possibly related to partial nonresponse bias. Completing mistreatment items was statistically significantly more likely for respondents who indicated they were gay or lesbian (odds ratio [OR] 1.52) or bisexual (OR 1.82) and less likely for respondents who indicated they were male (OR 0.68), sexual orientation “I don’t know/prefer not to answer” (OR 0.65), Hispanic (OR 0.79), or not White (OR 0.49).

DISCUSSION: The sociodemographic factors evaluated were inadequate to predict mistreatment of PA students, but sociodemographic factors were associated with willingness to complete mistreatment questions. Qualitative research is needed to determine why respondents who are male, Hispanic, or not White are reluctant to complete mistreatment questions. Findings could inform survey improvements to more accurately measure health professions student mistreatment.

PMID:40408079 | DOI:10.1097/JPA.0000000000000678

Aesthet Surg J. 2025 May 23:sjaf057. doi: 10.1093/asj/sjaf057. Online ahead of print.

ABSTRACT

BACKGROUND: Very little is known of how urinary symptoms and low back pain related to rectus abdominis diastasis tend to change after reparative surgery.

OBJECTIVES: In this study we aimed to investigate these symptom changes in women who underwent abdominoplasty with diastasis correction, and also provide an overview on quality of life, psychosocial aspects, and patient satisfaction.

METHODS: A total of 78 patients underwent abdominoplasty with diastasis repair and were included in this prospective study. Urinary symptoms and low back pain were evaluated respectively by the International Consultation on Incontinence Questionnaire, Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) and the Roland-Morris questionnaire. The Derriford Appearance Scale (DAS-59) was administered for evaluation of the respondent’s discomfort, as was the BODY-Q for body image and quality of life. Furthermore, the assessment of satisfaction by 3 external surgeons was obtained. Statistical analysis was conducted with Prism 9.

RESULTS: Statistically significant differences between time T0 (preoperative) and T3 (3 months postoperatively) and between time T0 and T12 (12 months postoperatively) were found for the BODY-Q, ICIQ-FLUTS, and Roland-Morris scores. No correlation was found between diastasis width and the difference from T0 to T12 in any of the symptom questionnaires. A correlation between patient and surgeon satisfaction emerged. In just 9 cases the patient was dissatisfied when the expert observer was satisfied. The mean preoperative DAS-59 value of satisfied patients and satisfied surgeons was compared with that of dissatisfied patients and satisfied surgeons, and a statistically significant difference was noted.

CONCLUSIONS: Abdominoplasty with correction of rectus muscle diastasis may improve women’s quality of life. From the patient’s point of view, voiding and incontinence symptoms and back pain tended to improve after surgery regardless of the width of the diastasis.

PMID:40408076 | DOI:10.1093/asj/sjaf057

J Prim Care Community Health. 2025 Jan-Dec;16:21501319251344427. doi: 10.1177/21501319251344427. Epub 2025 May 23.

ABSTRACT

BACKGROUND: The association between social risk and biomarkers of inflammation remains underexplored in low-resource communities, where social risk and levels of inflammation differ from those in industrialized urban centers. This study aims to assess the association between levels of social risk and biomarkers of inflammation in adults residing in remote rural settings.

METHODS: This population-based, cross-sectional study involved 1392 community-dwellers aged ≥40 years. Social risk was assessed using the social determinants of health (SDH) included in Gijon’s Social Familial Evaluation Scale (SFES). Biomarkers of inflammation were measured through the Systemic Immune-Inflammation Index (SII) and the C-Reactive Protein (CRP)/albumin ratio. Both unadjusted and multivariate models were fitted to determine the independent association between SDH and biomarkers of inflammation, treated as dependent variables.

RESULTS: The mean (±SD) age of 1392 study participants was 53.8 ± 11.5 years (59% women). The mean Gijon’s SFES score was 10.1 ± 2.6 points, the mean SII was 451.6 ± 240.5 × 10⁹ L, and the mean CRP/albumin ratio was 0.13 ± 0.29. Unadjusted generalized linear regression models demonstrated direct significant associations between SDH scores and both dependent variables, including SII (β: 6.12; 95% CI: 1.35-10.89) and the CRP/albumin ratio (β: 0.03; 95% CI: 0.01-0.05). These associations remained significant after adjusting for demographics, level of education, and cardiovascular risk factors for both, the SII (β: 7.24; 95% CI: 2.08-12.41) and the CRP/albumin ratio (β: 0.03; 95% CI: 0.01-0.05).

CONCLUSIONS: Social risk is directly associated with biomarkers of inflammation in the study population, suggesting that inflammation may be associated with adverse health outcomes in individuals with high social risk. Study results demonstrate that this association is not only evident in high-income regions but in underserved rural communities as well.

PMID:40408075 | DOI:10.1177/21501319251344427

J Cancer Educ. 2025 May 23. doi: 10.1007/s13187-025-02650-x. Online ahead of print.

ABSTRACT

The rising cancer incidence has increased demand for radiation oncologists, surpassing current staffing expansion estimates. Enhancing radiation oncology (RO) recruitment is essential to ensure high-quality cancer care. This study evaluates a 2024 Canadian Association of Radiation Oncology (CARO) Annual Scientific Meeting workshop aimed at increasing medical student interest in RO by assessing current initiatives, identifying barriers and proposing strategies. The workshop was guided by Kern’s curriculum development model, which involved medical students, RO residents, staff, and program directors. It was comprised of an interactive presentation on existing scholarship and a group discussion. Data was collected through polls, observational notes, and a post-workshop survey. Thematic analysis and descriptive statistics were used for analysis. Twenty-seven attendees participated, including six workshop leaders. Amongst 21 survey respondents, there were 8 (38%) medical students, 6 (29%) RO residents, 5 (24%) RO staff, 1 (5%) RO fellow, and 1 (5%) clinical research coordinator. Participants represented six Canadian cancer centers across five provinces. Key motivators for pursuing RO included mentorship (“local champion”), work variety, team-based environment, technology, and patient population. Barriers included underexposure in the medical curriculum, misconceptions about job prospects, and the impact of artificial intelligence. Workshop evaluations were highly positive. Proposed initiatives included mentorship from “local champions” and mandatory shadowing. The workshop highlighted the importance of early mentorship and exposure in fostering medical student interest in RO. Implementing strategies mentorship and structured shadowing may help facilitate medical students’ professional identity formation and their decision to pursue RO as a career.

PMID:40408068 | DOI:10.1007/s13187-025-02650-x

Updates Surg. 2025 May 23. doi: 10.1007/s13304-025-02253-7. Online ahead of print.

ABSTRACT

Chemotherapy (CT) has improved cancer treatment, particularly for locally advanced or metastatic diseases. However, CT systemic effects complicate surgical management, especially in emergency scenarios like acute abdomen. This study evaluates outcomes of emergency abdominal surgery in patients undergoing CT. A retrospective analysis was conducted at the Surgical Department of Cardinal Massaia Hospital, Italy, from January 2019 to June 2024. Patients aged ≥ 18 years undergoing emergency surgery for acute abdomen within 30 days of CT were included. Data on demographics, CT regimens, surgical and postoperative outcomes, and survival were analyzed using statistical software. Ethical approval was obtained. Thirty patients (15 males, 15 females; mean age 64.2 ± 10.3 years) were included. Indications for surgery included intestinal obstruction (80%), gastrointestinal perforation (13.3%), and colovesical fistula (6.7%). Peritoneal carcinomatosis was present in 66.7%, and R0 resection was achieved in only one case. Derivative colostomies were performed in 30% of cases. Postoperative complications occurred in 20%, but no re-operations or ICU admissions were required. The 30-day mortality rate was 6.7%. CT was resumed in 46.7% of patients, with median survival of 249 days for obstruction cases. Emergency surgery during CT is rare but feasible, with acceptable morbidity and mortality rates. Prompt resolution of acute conditions allows for CT resumption, improving overall survival. Multicenter studies are needed to validate these findings and establish standardized protocols.

PMID:40408064 | DOI:10.1007/s13304-025-02253-7

Drugs R D. 2025 May 23. doi: 10.1007/s40268-025-00510-z. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: During the coronavirus disease-2019 (COVID-19) pandemic there was the uncertainty that the long-term immune response generated upon natural infection or triggered by available severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) vaccines could impact the clinical endpoints of ongoing clinical trials, in particular, whether the immunogenicity of biotherapeutics could be affected.

METHODS: Here, we describe the different stages to build an adequate COVID-19 serology testing strategy to ultimately assess whether the presence of anti-SARS-CoV-2 antibodies could impact the immunogenicity data of a clinical trial supporting the approval of GP2411 (Jubbonti^®/Wyost^®; a denosumab biosimilar to Prolia/XGeva) conducted during the pandemic. We first assessed the sensitivity and specificity of US Food and Drug Administration Emergency Use Authorization (FDA EUA)-approved commercial SARS-CoV-2 anti-IgG enzyme-linked immunosorbent (ELISA) assay. Then, we validated the assay in accordance with bioanalytical guidelines and demonstrated that the analysis of validation parameters as singlicates met all bioanalytical acceptance criteria and showed comparable results to those of duplicate analyses. Lastly, we report data on anti-SARS-CoV-2 IgG antibody responses in healthy participants treated with a single dose of a biotherapeutic.

RESULTS: SARS-CoV-2 serology was assessed in 1970 serum samples collected from 499 healthy participants who were dosed throughout a clinical study that was conducted during the COVID-19 pandemic. Anti-SARS-CoV-2 IgG antibodies triggered by natural infection and/or vaccination were detected in 1165 serum samples from 82% of the study participants. Anti-SARS-COV-2 IgG responses were of comparable magnitude in study participants who were vaccinated during the course of the study or had a confirmed COVID-19 infection. A total of 6408 serum samples from the same study were evaluated for the presence of anti-drug antibodies (ADAs), with 64% of the participants being positive. Independent of the presence of anti-SARS-CoV-2 IgG antibodies, all ADA-positive study participants showed ADAs of very low magnitude. Neutralizing ADAs were detected in less than 1% of study participants without an association to anti-SARS-CoV-2 IgG responses.

CONCLUSIONS: The established bioanalytical strategy allowed the reliable detection of COVID-19 adaptive responses in study participants. The development of anti-SARS-CoV-2 IgG responses (triggered by either a natural infection or a vaccine) did not have any clinically meaningful impact on the immunogenicity of the biotherapeutic administered in the study.

PMID:40408051 | DOI:10.1007/s40268-025-00510-z

Discov Oncol. 2025 May 23;16(1):877. doi: 10.1007/s12672-025-02618-9.

ABSTRACT

BACKGROUND: Dysbiosis of the gut microbiota (GM) has been reported to be associated with cancers, including bladder cancer (BLCA). However, the specific causal relationship between GM and BLCA, as well as the mediating role of circulating metabolic biomarkers (CMBs), has remained unclear. Therefore, we aimed to elucidate the causal relationship among GM, CMBs, and BLCA, through a mendelian randomization (MR) approach.

METHOD: The summary statistics of 473 GM (n = 5959) and 233 CMBs (n = 136,016) from the NHGRI-EBI GWAS Catalog, and BLCA (cases n = 2053 and controls n = 287,137) from the FinnGen study were leveraged for our research. Bidirectional MR analysis was conducted to investigate the causal link between GM and BLCA, and two-step MR (TSMR) was employed to identified potential mediating CMBs. The inverse-variance weighted (IVW) was primarily utilized for effect estimation. Additionally, the Cochrane’s Q test was used to evaluate heterogeneity, and the MR-Egger method was employed to evaluate pleiotropy.

RESULT: The study revealed that 15 GM and 12 CMBs were causally associated with BLCA (p < 0.05). Specially, dorea was found to significantly increase the risk of developing BLCA (OR = 2.20, 95% CI: 1.29-3.75). Furthermore, TSMR analysis indicated that total cholesterol levels in small HDL and cholesterol esters in small HDL mediate the causal relationship between dorea and BLCA, with mediated proportions of 2.46% and 2.14%, respectively.

CONCLUSION: The findings of this study provide compelling evidence supporting the mediating role of CMBs in the causal relationship on GM and BLCA.

PMID:40408003 | DOI:10.1007/s12672-025-02618-9

Lifetime Data Anal. 2025 May 23. doi: 10.1007/s10985-025-09656-z. Online ahead of print.

ABSTRACT

To investigate pairwise interactions arising from recurrent event processes in a longitudinal network, the framework of the stochastic block model is followed, where every node belongs to a latent group and interactions between node pairs from two specified groups follow a conditional nonhomogeneous Poisson process. Our focus lies on discrete observation times, which are commonly encountered in reality for cost-saving purposes. The variational EM algorithm and variational maximum likelihood estimation are applied for statistical inference. A specific method based on the defined distribution function F and self-consistency algorithm for recurrent events is used when estimating the intensity functions of edges. Numerical simulations illustrate the performance of our proposed estimation procedure in uncovering the underlying structure in the longitudinal networks with recurrent event processes. The dataset of interactions between French schoolchildren for influenza monitoring is analyzed.

PMID:40407998 | DOI:10.1007/s10985-025-09656-z

Obes Surg. 2025 May 23. doi: 10.1007/s11695-025-07917-2. Online ahead of print.

ABSTRACT

BACKGROUND: Laparoscopic surgery offers benefits like reduced bleeding, pain, and shorter hospital stays but poses port-site complications, especially in patients with obesity. Postoperative pain is less severe than in open surgery. Multimodal analgesia is promising, while the impact of fascial closure on complications remains debated. This study aims to compare the incidence of port-site complications in patients undergoing laparoscopic bariatric surgery, with or without fascial closure of the right working port.

METHODS: This randomized clinical trial was reported based on the CONSORT checklist. Seventy patients with severe obesity were compared in terms of fascial closure versus non-closure of the right working port during laparoscopic bariatric surgery. Thorough clinical, radiological, and nutritional assessment was done. Postoperative pain (using VAS) and port-site complications were assessed. Ethical approval was obtained, and informed consent was guaranteed.

RESULTS: Patients who underwent fascial closure of the right working port demonstrated significantly higher rates of moderate (85.7% vs. 5.7%) and severe pain (14.3% vs. 2.9%, p < 0.001) compared to the non-closure group. Port-site complications-bleeding (8.6% vs. 2.9%, p = 0.303), infection (11.4% vs. 14.3%, p = 0.721), and hernia (11.4% vs. 2.9%, p = 0.178)-were statistically comparable, suggesting that fascial closure may increase postoperative pain without significant impacts on other complications.

CONCLUSIONS: Fascial closure of the right working port after laparoscopic bariatric surgery in patients with obesity increases postoperative pain without reducing port-site complications like bleeding, infection, or herniation. Non-closure appears safer and effective in minimizing pain and adverse outcomes. Routine fascial closure may not be justified, warranting further research to optimize surgical techniques for patients with obesity.

PMID:40407981 | DOI:10.1007/s11695-025-07917-2