Tag: statistics

JAMA Netw Open. 2025 May 1;8(5):e2511009. doi: 10.1001/jamanetworkopen.2025.11009.

ABSTRACT

IMPORTANCE: Ocular point-of-care ultrasonography (POCUS) may be a clinically useful method to evaluate shunt dysfunction for children with hydrocephalus presenting to the emergency department (ED).

OBJECTIVE: To evaluate whether a change in the optic nerve sheath diameter (ONSD) from prior asymptomatic baseline was associated with shunt failure.

DESIGN, SETTING, AND PARTICIPANTS: Participants in this prospective single-center observational cohort study at a tertiary care children’s hospital were enrolled from January 5, 2018, to March 2, 2022. Children 18 years or younger with cerebrospinal fluid (CSF) shunts were consecutively recruited during routine asymptomatic visits in the outpatient neurosurgery clinic. The institution sees approximately 1000 children with shunts. Children with comorbid eye pathologic conditions known to increase the ONSD were excluded, as were those with shunt interventions between baseline and symptomatic ocular POCUS. Data analysis was completed in May 2024.

EXPOSURES: Baseline ocular POCUS was performed on asymptomatic children with CSF shunts recruited in the outpatient neurosurgery clinic; a second ocular POCUS was performed if the patient subsequently presented to the ED with symptoms of shunt failure. Change in ONSD from prior asymptomatic baseline to symptomatic presentation was the main study exposure.

MAIN OUTCOMES AND MEASURES: Shunt failure was defined as intraoperative confirmation of inadequate CSF flow through the shunt system associated with identifiable shunt complications, including catheter or valve obstruction, shunt tubing fracture or disconnection, or proximal catheter migration out of the ventricle within 96 hours from presentation to the ED.

RESULTS: Seventy-six pairs of baseline and symptomatic ultrasonograms from 58 patients (mean [SD] age, 6.6 [4.7] years; 36 of 58 boys [62%]) were included. Twenty patients (35%) had 2 or more prior shunt revisions, and 29 (50%) had communicating hydrocephalus. The primary outcome of intraoperatively confirmed shunt failure was observed in 14 of 76 ED patient presentations (18%). The mean (SD) change in ONSD among patients with shunt failure was 0.89 (0.66) mm vs 0.16 (0.40) mm among patients without shunt failure (mean difference, 0.73 mm [95% CI, 0.47-0.99 mm]; P < .001). The odds of full shunt failure were 1.4 times higher (95% CI, 1.21-1.78; P < .001) for every 0.1-mm increase in ONSD. The area under the receiver operating characteristic curve was 0.86, with an optimal cutoff of 0.4 mm or more, yielding a sensitivity of 0.93, specificity of 0.73, positive predictive value of 0.43, and negative predictive value of 0.98, for a disease prevalence of 15%, with a positive likelihood ratio of 3.39 and negative likelihood ratio of 0.10.

CONCLUSIONS AND RELEVANCE: In this single-center, prospective cohort study of symptomatic children with CSF shunts, a change in ONSD measured by ocular POCUS was associated with shunt failure. A change in ONSD from prior asymptomatic baseline to symptomatic presentation of less than 0.4 mm identified a population at low risk of true shunt failure. Further research is warranted to validate these findings, the presented change in ONSD threshold, and to risk stratify low-risk patients for cross-sectional neuroimaging.

PMID:40377937 | DOI:10.1001/jamanetworkopen.2025.11009

JAMA Netw Open. 2025 May 1;8(5):e2511063. doi: 10.1001/jamanetworkopen.2025.11063.

ABSTRACT

IMPORTANCE: Personal and professional development are integral to students’ professional identity formation.

OBJECTIVES: To examine the association between race, ethnicity, family income, and growing up in an underresourced neighborhood with perception of medical school support of professional and personal development.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cross-sectional study using deidentified data of medical graduates who completed the Association of American Medical Colleges Graduation Questionnaire in 2018 to 2022. Statistical analysis was performed from October 1 to November 1, 2024.

MAIN OUTCOMES AND MEASURES: Perception of medical school support of professional and personal development. Multivariate logistic regression models to assess the association of family income, race, ethnicity, and underresourced neighborhood status with perception of medical school support of professional and personal development during medical school, adjusting for students’ sex, age at graduation in quartiles, and clustered by school to account for school-to-school variability.

RESULTS: Among 66 898 respondents in the study cohort, 34 731 identified as female (51.9%), 14 100 as Asian (21.1%), 3594 as Black or African American (5.4%), 3419 as Hispanic (5.1%), and 38 483 as White (57.5%). The mean (SD) age of respondents was 27.5 (2.6) years and 10 088 were from households with incomes less than $50 000 a year (15.1%). Students from families with incomes in the lowest 2 quintiles were significantly less likely to report medical school support of professional and personal development than students from household incomes of more than $200 000 (less than $50 000: 69.5% vs 75.1%; relative risk [RR], 0.96; 95% CI, 0.94-0.98; $50 000-$74 999: 71.0% vs 75.1%; RR, 0.96; 95% CI, 0.94-0.98). Compared with White students, Asian students (aRR, 0.97; 95% CI, 0.96-0.98) and Black students (adjusted relative risk [aRR], 0.97; 95% CI, 0.95-0.99) were less likely to report medical school support of professional development, and Black students were less likely to report medical school support of personal development (aRR, 0.93; 95% CI, 0.89-0.97). Compared with their peers, students who reported growing up in an underresourced neighborhood were significantly less likely to report medical school support of professional and personal development. Intersectionality analysis of family income, race, ethnicity, and underresourced neighborhood status suggested that perception of medical school support of professional and personal development decreased with increasing number of minoritized identities, with students who were URIM, from a low-income family, and reported growing up in underresourced neighborhoods the least likely to report medical school support of professional and personal development.

CONCLUSION AND RELEVANCE: In this cross-sectional study of medical graduates, students who were URIM, low-income, and students who reported growing up in underresourced neighborhood were significantly less likely to report medical school support of professional and personal development. It is therefore critical for medical schools and accreditation bodies to evaluate current curriculum and practices to foster professional and personal development that are equitable for all students.

PMID:40377935 | DOI:10.1001/jamanetworkopen.2025.11063

JAMA Health Forum. 2025 May 2;6(5):e250756. doi: 10.1001/jamahealthforum.2025.0756.

ABSTRACT

IMPORTANCE: Advances in diabetes detection and treatment have mitigated the risks of serious complications and death, but little is known about whether economic outcomes for people with diabetes have similarly improved.

OBJECTIVE: To assess whether associations between diagnosed diabetes and labor market outcomes have changed over time.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed data from the National Health Interview Survey from 1998 to 2018. The sample was nationally representative of the US population aged 40 to 64 years. Average marginal effects, the regression-adjusted difference in probability of outcomes between people with and without diabetes, pooled by 3-year periods (1998-2000 to 2016-2018), were estimated with controls for demographics, education, and comorbid health risks. Behavioral Risk Factor Surveillance (BRFSS) data from 1993 to 2023 were included in robustness analyses. Data were analyzed from September 2023 to November 2024.

EXPOSURE: Diagnosed diabetes, defined based on respondents’ self-report that they have ever been diagnosed by a medical professional.

MAIN OUTCOMES AND MEASURES: The main outcomes were labor force participation and any Supplemental Security Income or Social Security Disability Insurance income receipt. Secondary outcomes included reporting health limitations for any activities, health limitations for work, any nights in hospital, and receiving health care 10 or more times in the past year.

RESULTS: The study included 249 712 individuals, 25 177 with diabetes. The weighted population was 50% female, 12% Hispanic, 11% non-Hispanic Black, 72% non-Hispanic White, and 5% multiracial or other race (Alaska Native or American Indian, Asian, or nonspecified). In the weighted population from 1998 to 2000, 46% of people with diabetes were 55 years and older, while 27% of people without diabetes were 55 years and older. In the weighted population from 2016 to 2018, 56% of people with diabetes were 55 years and older, while 38% of people without diabetes were 55 years and older. The average marginal effect of diabetes on probability of labor force participation was -10.9 percentage points (95% CI, -13.0 to -8.9) from 1998 to 2000 and -11.0 percentage points (95% CI, -13.0 to -9.1) from 2016 to 2018; for people who received Supplemental Security Income or Social Security Disability Insurance income, it was 4.4 percentage points (95% CI, 3.3-5.5) and 4.9 percentage points (95% CI, 3.7-6.0) from 1998 to 2000 and 2016 to 2018, respectively. During the same period, average marginal effects for all examined health outcomes significantly improved. Similar patterns were observed using BRFSS data, but with a slight improvement in labor force participation between 2017 to 2019 and 2021 to 2023.

CONCLUSIONS AND RELEVANCE: This cross-sectional study demonstrated that while people with diabetes experienced meaningful health improvements, they saw little progress in economic performance. Changing patient selection appears to play a role. Future research is needed to disentangle the paradox.

PMID:40377930 | DOI:10.1001/jamahealthforum.2025.0756

Gen Thorac Cardiovasc Surg. 2025 May 16. doi: 10.1007/s11748-025-02157-8. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the effectiveness of a cadaver surgical training program at the Clinical Anatomy Laboratory Nagoya (CALNA), focusing on its impact on procedural skills, confidence, and anatomical understanding among young and mid-career thoracic surgeons.

METHODS: From 2016 to 2024, 13 cadaver surgical training sessions were conducted, divided into basic, advanced, and specialized courses. The program included hands-on practice using cadavers preserved with Thiel or hypertonic saline methods. The surveys were administered post-training to assess confidence, satisfaction, and practical applicability. Statistical analysis was performed on the survey results.

RESULTS: A total of 100 participants attended the training sessions (mean: 12.5/session). The survey responses indicated that 92% of participants rated the training content as “good” or “excellent,” and 88% found the training “applicable” or “highly applicable” to clinical practice. Reflective discussions following each session facilitated iterative program refinement. The key improvements included enhanced surgical instrument availability and optimized trainee-to-instructor ratios.

CONCLUSIONS: Our cadaver surgical training program was shown to significantly enhance surgical skills, boost confidence, and deepen thoracic anatomical understanding, demonstrating its value in advancing thoracic surgical education. Further development of standardized programs across institutions is needed to enable novice surgeons to acquire advanced skills efficiently.

PMID:40377896 | DOI:10.1007/s11748-025-02157-8

Environ Geochem Health. 2025 May 16;47(6):208. doi: 10.1007/s10653-025-02517-6.

ABSTRACT

Groundwater in Wadi Ranyah, the main water source for local communities, was analyzed using 77 samples to evaluate physicochemical properties, major ions, and heavy metal concentrations. While most parameters met World Health Organization (WHO) standards, levels of arsenic, lead, cadmium, chromium, and nickel exceeded permissible limits. Hydrochemical analyses were conducted using Piper and Durov diagrams, alongside health risk assessments based on statistical ratios established by the United States Environmental Protection Agency (US EPA). The analysis identified two dominant water types (SO₄·Cl-Ca·Mg and HCO₃-Ca·Mg), influenced by ion exchange, evaporite dissolution, and silicate weathering. Health risk assessment, based on US EPA models, revealed significant non-carcinogenic and carcinogenic risks, particularly for children. Oral ingestion accounted for the majority of exposure, with arsenic and lead being the most hazardous. Dermal exposure risks were comparatively lower. The identified health threats include potential dermatological, cardiovascular, and neurological effects, and an increased cancer risk. Based on these findings, groundwater in Wadi Ranyah is unsuitable for drinking without treatment. Mitigation strategies such as reverse osmosis, ion exchange filtration, and continuous monitoring are recommended to reduce heavy metal contamination and protect public health.

PMID:40377859 | DOI:10.1007/s10653-025-02517-6

Pain Ther. 2025 May 16. doi: 10.1007/s40122-025-00745-3. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aims to evaluate the efficacy and safety of Crisugabalin in patients with diabetic peripheral neuropathic pain (DPNP), with a focus on its rapid onset of action.

METHODS: All the analyses in this study were based on data from a phase 2/3 adaptive randomized clinical trial that enrolled 596 patients. Participants were categorized into four treatment groups according to the intervention received: Crisugabalin 40 mg/day, Crisugabalin 80 mg/day, placebo, and Pregabalin 300 mg/day. The primary endpoint was the change in the average daily pain score (ADPS) over a 13-week treatment period. Secondary endpoints included changes in the Numeric Rating Scale (NRS) and the daily sleep interference score (DSIS) during the first two weeks of treatment.

RESULTS: Both Crisugabalin treatment groups (40 mg/day and 80 mg/day) demonstrated statistically significant reductions in ADPS compared to the placebo group starting from week 1 and continuing through week 13 (P < 0.05). Significant differences in pain relief for the Pregabalin group were observed only from week 6. Improvements in NRS and DSIS scores were also noted in both Crisugabalin groups, with statistically significant enhancements evident as early as day 2 of administration. Safety assessments indicated that Crisugabalin was well-tolerated, with a low incidence of serious adverse events and no significant increase in dropout rates among participants.

CONCLUSION: The findings suggest that Crisugabalin offers effective pain relief with an acceptable safety profile, highlighting its rapid onset in patients with DPNP.

CLINICAL TRIAL REGISTRATION: Clinical trial registration number derived from our parent project, we have retained the original registration identifier: NCT04647773.

PMID:40377855 | DOI:10.1007/s40122-025-00745-3

Aging Clin Exp Res. 2025 May 16;37(1):155. doi: 10.1007/s40520-025-03061-0.

ABSTRACT

OBJECTIVES: This study aimed to assess the effectiveness of Comprehensive Geriatric Assessment (CGA) compared to standard of care in improving pain, physical function, and stiffness in older adults with knee osteoarthritis (OA) over six months. Secondary outcomes included multidimensional frailty and quality of life.

DESIGN: An exploratory, multicentre, randomized controlled trial (RCT).

SETTING: Five European geriatric centres in Italy, Germany, Turkiye and the Czech Republic.

PARTICIPANTS: Seventy older adults (mean age 76.1 ± 6.8 years; 80% female) with knee OA (Kellgren-Lawrence Grades 1-2) were randomized into two groups: CGA (n = 35) or standard of care (n = 35).

INTERVENTION: The CGA group underwent a multidimensional geriatric assessment and intervention, identifying impairments and tailoring interventions accordingly, while the control group received standard of care.

MAIN OUTCOME MEASURES: The primary endpoint was improvement in pain, stiffness, and functional limitations measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) over six months. Secondary outcomes included changes in multidimensional frailty (Multidimensional Prognostic Index, MPI), quality of life (SF-36), and adherence to interventions.

RESULTS: The CGA group showed a non-significant improvement in total WOMAC scores (-4.49 ± 3.40, p = 0.19), with slight reductions in pain (-1.12 ± 0.96) and functional limitations (-3.26 ± 2.21). MPI slightly improved (-0.02 ± 0.04, p = 0.69), but no significant changes were observed in SF-36 scores. No falls, hospitalizations, or severe adverse events were reported.

CONCLUSIONS: CGA may offer potential benefits for managing knee OA in older adults, particularly for pain and function, though statistical significance was not achieved. Larger studies with longer follow-up are warranted to confirm these findings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05659979.

PMID:40377819 | DOI:10.1007/s40520-025-03061-0

Prog Orthod. 2025 May 16;26(1):18. doi: 10.1186/s40510-025-00565-3.

ABSTRACT

BACKGROUND: Observational studies indicate that obesity correlates with jaw development and remodeling; however, causality remains unclear. This study aimed to examine the potential causal relationship between life-course adiposity and jaw anomalies.

METHODS: Utilizing summary statistics from genome-wide association studies predominantly of European ancestry, we conducted univariable and multivariable Mendelian randomization (MR) to estimate overall and independent effects of six obesity traits (birth weight, childhood body size, childhood body mass index [BMI], adult BMI, adult body fat percentage, and adult waist circumference) on seven jaw anomalies, including bimaxillary hypoplasia, prognathism, retrognathism, and jaw asymmetry. Comprehensive sensitivity analyses verified robustness, assessed heterogeneity, and examined pleiotropy.

RESULTS: In univariate analyses, genetically predicted thinner childhood body size (inverse variance weighted [IVW] OR: 0.41, 95% CI: 0.27-0.62, p < 0.001), adult BMI (IVW OR: 0.65, 95% CI: 0.53-0.80, p < 0.001), and waist circumference (IVW OR: 0.60, 95% CI: 0.45-0.82, p = 0.001) were significantly associated with the risk of mandibular retrognathia following Bonferroni correction. Multivariable MR analysis revealed a direct causal effect of childhood body size on mandibular retrognathia, independent of birth weight, adult adiposity, growth hormones, and lifestyle factors. No evidence was found for causal associations between life-course adiposity and other jaw anomalies. Sensitivity analyses produced broadly consistent findings.

CONCLUSIONS: This MR study provides new evidence on the direct causal effects of thin childhood body size on the risk of mandibular retrognathia, emphasizing the critical role of early childhood nutrition and weight management in craniofacial development.

PMID:40377818 | DOI:10.1186/s40510-025-00565-3

Obes Surg. 2025 May 16. doi: 10.1007/s11695-025-07858-w. Online ahead of print.

ABSTRACT

BACKGROUND: Obesity and type 2 diabetes mellitus (T2DM) are global health crises, with bariatric surgery emerging as a key intervention. However, the comparative efficacy of Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG) in achieving diabetes remission remains debated.

METHODS: This PRISMA-compliant meta-analysis included three randomized controlled trials (RCTs, n = 613 patients) comparing RYGB and SG in adults with severe obesity (BMI ≥30 kg/m²) and T2DM.

PRIMARY OUTCOME: diabetes remission (HbA1c 6.0%). Risk of bias was assessed via Cochrane RoB-2 tool; statistical analysis used fixed-effect models (I²=0%).

RESULTS: RYGB demonstrated superior diabetes remission rates vs. SG (OR 2.77, 95% CI 1.83-4.20, p0.001), with no heterogeneity. Subgroup analyses confirmed consistency across studies. Mean follow-up was ≤5 years; baseline demographics were comparable (mean age 46.2 years, 53.4% male).

CONCLUSION: RYGB significantly outperforms SG in achieving T2DM remission, likely due to its combined restrictivemalabsorptive mechanisms and metabolic hormonal effects. These findings support RYGB as the preferred surgical option for obese patients with T2DM, though long-term studies are needed to assess durability.

PMID:40377815 | DOI:10.1007/s11695-025-07858-w

Aging Clin Exp Res. 2025 May 16;37(1):156. doi: 10.1007/s40520-025-03053-0.

ABSTRACT

BACKGROUND: Tooth loss is common among the elderly and often correlates with aging. Existing studies on the link between tooth loss and frailty in older adults yield inconsistent results. This systematic review and meta-analysis aims to clarify the relationship.

METHODS: A comprehensive search of PubMed, Web of Science, Embase, and Cochrane Library was conducted to find observational studies on tooth count and frailty in older adults. Study quality was assessed using the Newcastle-Ottawa scale. Heterogeneity was evaluated using Cochran’s Q and I² statistics, and subgroup analyses identified factors influencing outcomes. Publication bias and sensitivity analysis confirmed result stability.

RESULTS: From 1,903 articles, 22 comprising 25 studies with 36,406 participants were included. The meta-analysis showed a pooled odds ratio (OR) of 0.98 (95% CI: 0.97 – 0.99) for tooth count and frailty. Individuals with 20 or fewer teeth had a higher risk of frailty (pooled OR = 1.99, 95% CI: 1.57 – 2.53). The highest frailty risk was observed in Japan (pooled OR = 3.02), followed by China (2.27), the UK and USA (1.90), and other regions (1.25). Subgroup analyses revealed no significant differences by country, study design, setting, adjustment model, or frailty assessment tool (P > 0.05).

CONCLUSIONS: There is a significant association between tooth count and frailty, particularly in those with 20 or fewer teeth. Policymakers should prioritize oral health within aging populations by promoting early preventive care and education to mitigate frailty risk. Robust, large-scale studies are needed to guide evidence-based interventions and public health policy.

PMID:40377807 | DOI:10.1007/s40520-025-03053-0