Tag: statistics

JCO Glob Oncol. 2025 Jan;11:e2400326. doi: 10.1200/GO-24-00326. Epub 2025 Jan 23.

ABSTRACT

PURPOSE: Patients with adolescent and young adult (AYA) cancer are recognized as a vulnerable subpopulation in high-income countries (HICs). Although survival gaps between HIC and low- and middle-income country (LMIC) children with cancer are well described, LMIC AYAs have been neglected. We conducted a systematic review to describe cancer outcomes among LMIC AYAs.

METHODS: We captured English language studies published from 2010 onward reporting LMIC AYA cancer survival outcomes. LMICs were defined according to World Bank 2019 classifications, whereas AYAs were defined as diagnosed between age 15 and 39 years. Cohorts were considered AYA if >75% of patients were AYA, the mean/median age and standard deviation were between 15 and 39 years, or the range was within 5 years of the AYA range (ie, 10-45 years). Cohort characteristics were abstracted, including country, cancer type, and cancer outcomes.

RESULTS: Of 6,207 studies identified by the search strategy, 658 underwent full-text review; 60 met inclusion criteria. No low-income countries were represented. Forty-four (73.3%) studies were conducted in upper-middle-income countries (UMICs) although these represented only 12 of 55 countries currently classified as UMICs. The most common cancers studied were acute lymphoblastic leukemia (n = 13 studies), breast cancer (n = 5), and osteosarcoma (n = 3). Five-year overall survival was highly variable, ranging from 39% to 63% for ALL, 60%-85% for breast cancer, and 47%-83% for osteosarcoma.

CONCLUSION: Although three billion AYAs reside in LMICs, their cancer outcomes are neglected in the current literature. Existing data indicate variable survival, ranging from comparable with HIC outcomes to substantially inferior. These studies, however, represent only a limited number of LMICs and are biased toward UMICs. Systematic efforts to describe and improve LMIC AYA cancer outcomes are required.

PMID:39847745 | DOI:10.1200/GO-24-00326

JCO Glob Oncol. 2025 Jan;11:e2400275. doi: 10.1200/GO-24-00275. Epub 2025 Jan 23.

ABSTRACT

PURPOSE: We aimed to evaluate the impact of COVID-19 on breast cancer care in terms of the stage at presentation, treatment delays, and follow-up in a tertiary care center in Lebanon.

MATERIALS AND METHODS: This retrospective study compared patients with breast cancer who presented to a tertiary care center in Lebanon before (September 2019-December 2019) and during (September 2020-December 2020) the COVID-19 pandemic. We extracted data from the electronic medical records of patients with breast cancer who had their initial presentation, were under treatment, or were on follow-up during our period of interest.

RESULTS: Of the 333 patients, 186 visited the hospital in the pre-COVID-19 period and 147 during the pandemic, showing almost a 12% reduction in the number of patients during the COVID-19 pandemic. In the pre-COVID period, more patients were presented for screening (52%); however, more symptomatic patients were presented during the pandemic (51.4%). Almost 54% had an advanced stage at presentation during the pandemic compared with 48% before the pandemic but with no statistical significance (P = .50). Significantly fewer patients came for chemotherapy in the COVID-19 period (38.1%) compared with the pre-COVID-19 period (52.2%). Fewer patients underwent surgery during the pandemic, although the difference was not statistically significant. Multivariate analysis showed that the COVID-19 pandemic was not associated with having an advanced stage at presentation (P = .24).

CONCLUSION: The management of breast cancer was not substantially affected by the COVID-19 pandemic in a sample of Lebanese patients. However, 4 months might not be sufficient to draw a solid conclusion.

PMID:39847743 | DOI:10.1200/GO-24-00275

N Z Med J. 2025 Jan 24;138(1608):107-117.

ABSTRACT

BACKGROUND AND AIM: Dysmenorrhea affects the majority of young women worldwide, but geographical and cultural differences can influence the reporting, impact and management of symptoms. Aotearoa New Zealand is a culturally diverse country, with a high proportion of Māori and Pacific peoples. The aim of this scoping review was to assess the current literature on the prevalence, impact and management strategies for dysmenorrhea in Aotearoa New Zealand.

METHOD: The Joanna Briggs Institute (JBI) scoping review methodology was used to systematically map the evidence of prevalence, severity and symptoms, impact and management strategies for dysmenorrhea in Aotearoa New Zealand. Eight electronic databases were searched in August 2024.

RESULTS: Ten studies met the inclusion criteria. Our findings show that the current data for the prevalence, impact and management strategies for dysmenorrhea in Aotearoa New Zealand are both limited and outdated.

CONCLUSION: The results from this scoping review highlight the need for updated data on dysmenorrhea in Aotearoa New Zealand, with particular focus on Māori and Pacific peoples, and geographical diversity.

PMID:39847740

N Z Med J. 2025 Jan 24;138(1608):94-106. doi: 10.26635/6965.6500.

ABSTRACT

BACKGROUND: The prevalence of diabetes has been increasing in Aotearoa New Zealand by approximately 7% per year, and is three times higher among Māori and Pacific peoples than in Europeans. The depth of the diabetes epidemic, and the expansive breadth of services required for its management, elevate the need for high-quality evidence on the projected future burden of this complex disease.

METHODS: In this manuscript we have projected the prevalence of diabetes (type 1 and type 2 combined) out to 2040-2044 using age-period-cohort modelling. National-level data from central government on diabetes prevalence (Virtual Diabetes Register) were used to describe recent diabetes prevalence trends (2006-2019) by age group, calendar period and birth cohort, with these trends used to project diabetes prevalence out from 2020 to 2044.

RESULTS: Aotearoa New Zealand will experience a significant increase in the absolute volume of prevalent diabetes, rising by nearly 90% to more than 500,000 by 2044. The age-standardised prevalence of diabetes will increase from around 3.9% of the population (268,248) to 5.0% overall (502,358). The prevalence and volume of diabetes diagnoses will increase most drastically for Pacific peoples, most notably Pacific females for whom diabetes prevalence is projected to increase to 17% of the population by 2044.

CONCLUSIONS: The increases in the future burden of diabetes mellitus projected here will heighten pressure on health services. Immediate action is required to reduce new cases of diabetes and other obesity-related illnesses. Fiscal policies to prevent these diseases, coupled with population-level interventions to more effectively manage and control diabetes, are effective tools for reducing disease burden.

PMID:39847739 | DOI:10.26635/6965.6500

N Z Med J. 2025 Jan 24;138(1608):84-93. doi: 10.26635/6965.6621.

ABSTRACT

AIM: There are limited data on the prevalence of calcific aortic valve disease (CAVD) in Māori and known inequities in outcomes after aortic valve intervention. Our study aimed to investigate the prevalence of CAVD in Māori.

METHODS: Data from initial clinically indicated echocardiograms performed between 2010 to 2018 in patients aged ≥18 years were linked to nationally collected outcome data. Ethnicity was defined using protocols from the Ministry of Health.

RESULTS: Of the 23,635 patients, 1,312 (5.6%) identified as Māori, and 22,323 (94.4%) as European. Prevalence of aortic stenosis was 5.3% in Māori and 9.9% in Europeans. Age-specific prevalence did not differ between the two groups. Māori with CAVD were more than twice as likely to have advanced cardiac impairment (right ventricular dysfunction) than Europeans (10.1% vs 4.6, p<0.001).

CONCLUSIONS: Age-specific CAVD rates did not differ between Māori and Europeans, though Māori had a higher proportion of advanced cardiac impairment, which is likely unrelated to CAVD. Differences in population structure likely explain the difference in overall prevalence of CAVD. The improving life expectancy in Māori may lead to increasing incidence of CAVD, thus strategies to improve detection and medical management of CAVD should begin as soon as possible.

PMID:39847738 | DOI:10.26635/6965.6621

N Z Med J. 2025 Jan 24;138(1608):24-30. doi: 10.26635/6965.6681.

ABSTRACT

The hypothesis that lunar cycles influence human behaviour, particularly incidents recorded by police or coroners, has been a topic of public and media interest around the world for decades. While connections between lunar cycles and numerous cultural practices are well-documented, claims that lunar cycles influence crime or suicide statistics have not been consistently supported. There have been recent media claims that suicide rates in New Zealand follow a lunar cycle, correlating with the Māori Maramataka lunar calendar. Building on prior research, this study scrutinises the postulated association between lunar phases and suicide rates, for general and Māori populations. Utilising 2 decades (2000-2022) of data from the National Coronial Information System (NCIS) and the New Zealand Ministry of Health – Manatū Hauora, the study employs Poisson regression models and cosine curve analyses. Results reveal no significant correlation between lunar phases and suicide rates for the overall population or the Māori sub-group. The absence of a lunar effect persists across univariate and multivariate analyses, incorporating annual, seasonal and day-of-the-week variations. Contrary to claims linking lunar phases to Māori suicide rates, this study provides a robust analysis of comprehensive suicide data. While acknowledging potential limitations, such as the diversity among Maramataka systems and unaccounted external factors, this study emphasises the need for evidence-based practices in mental health interventions. Further research is warranted to explore potential lunar influences on less severe mental health indicators and to substantiate claims supporting traditional Māori Maramataka-based treatments.

PMID:39847735 | DOI:10.26635/6965.6681

N Z Med J. 2025 Jan 24;138(1608):13-23. doi: 10.26635/6965.6653.

ABSTRACT

AIM: Electronic cigarette use (vaping) has increased rapidly among adolescents globally. Most electronic cigarettes (e-cigarettes) contain nicotine, which is addictive and can cause behaviour problems and mood dysregulation. We sought to assess whether an educational intervention increased knowledge about vaping-related health risks and desire to quit among high school students. We assessed whether the effects differed between in-person or online intervention.

METHOD: The analysis included 332 students from four high schools in Ōtautahi Christchurch. Students were randomly assigned to an in-person or online group and completed pre- and post-intervention questionnaires. Risk factors for smoking and vaping were assessed with logistic regression. Schools’ socio-economic status was imputed from their Equity Index rank. Intervention effects were assessed with and without demographic covariates using mixed-effect linear regression.

RESULTS: Students attending schools in lower socio-economic areas and those with Māori ethnicity were at greater risk of smoking and vaping. Risk of smoking increased with year level; however, risk of vaping did not. There was significant improvement in responses to 3 out of 10 knowledge questions, and there was no evidence that post-intervention scores were affected by participant characteristics. The in-person group showed higher percentage improvements than the online group. Expressed desire to quit vaping increased from 61.7% to 68.8%; however, there was significantly greater desire to quit vaping in students from years 9 and 10 than years 11 and 12 (P=0.043).

CONCLUSION: Our educational intervention improved the knowledge of high school students on vaping-related health risks and increased expressed desire to quit vaping.

PMID:39847734 | DOI:10.26635/6965.6653

Invest Radiol. 2025 Jan 24. doi: 10.1097/RLI.0000000000001157. Online ahead of print.

ABSTRACT

OBJECTIVE: Respiratory motion can affect image quality and thus affect the diagnostic accuracy of CT images by masking or mimicking relevant lung pathologies. CT examinations are often performed during deep inspiration and breath-hold to achieve optimal image quality. However, this can be challenging for certain patient groups, such as children, the elderly, or sedated patients. The study aimed to validate a dedicated triggering algorithm for initiating respiratory-triggered high-pitch computed tomography (RT-HPCT) scans in end inspiration and end expiration in complex and irregular respiratory patterns using an anthropomorphic dynamic chest phantom. Additionally, a patient study was conducted to compare the image quality and lung expansion between RT-HPCT and standard HPCT.

MATERIALS AND METHODS: The study utilized an algorithm that processes the patient’s breathing motion in real-time to determine the appropriate time to initiate a scan. This algorithm was tested on a dynamic, tissue-equivalent chest motion phantom to replicate and simulate 3-dimensional target motion using 28 breathing motion patterns taken from patient with irregular breathing. To evaluate the performance on human patients, prospective RT-HPCT was performed in 18 free-breathing patients. As a reference, unenhanced HPCT of the chest was performed in 20 patients without respiratory triggering during free-breathing. The mean CTDI was 1.73 mGy ± 0.1 mGy for HPCT and 1.68 mGy ± 0.1 mGy for RT-HPCT. For phantom tests, the deviation from the target position of the phantom inlay is known. Image quality is approximated by evaluating stationary versus moving acquisitions. For patient scans, respiratory motion artifacts and inspiration depth were analyzed using expert knowledge of lung anatomy and automated lung volume estimation. Statistical analysis was performed to compare image quality and lung volumes between conventional HPCT and RT-HPCT.

RESULTS: In phantom scans, the average deviation from the desired excursion phase was 1.6 mm ± 4.7 mm or 15% ± 24% of the phantom movement range. In patients, the overall image quality significantly improved with respiratory triggering compared with conventional HPCT (P < 0.001). Quantitative average lung volume was 4.0 L ± 1.1 L in the RT group and 3.6 L ± 1.0 L in the control group.

CONCLUSIONS: This study demonstrated the feasibility of using a patient-adaptive respiratory triggering algorithm for high-pitch lung CT in both phantom and patients. Respiratory-triggered high-pitch CT scanning significantly reduces breathing artifacts compared with conventional nontriggered free-breathing scans.

PMID:39847727 | DOI:10.1097/RLI.0000000000001157

Environ Health Perspect. 2025 Jan;133(1):17007. doi: 10.1289/EHP14285. Epub 2025 Jan 23.

ABSTRACT

BACKGROUND: Millions worldwide are exposed to elevated levels of arsenic that significantly increase their risk of developing atherosclerosis, a pathology primarily driven by immune cells. While the impact of arsenic on immune cell populations in atherosclerotic plaques has been broadly characterized, cellular heterogeneity is a substantial barrier to in-depth examinations of the cellular dynamics for varying immune cell populations.

OBJECTIVES: This study aimed to conduct single-cell multi-omics profiling of atherosclerotic plaques in apolipoprotein E knockout (ApoE^-/-) mice to elucidate transcriptomic and epigenetic changes in immune cells induced by arsenic exposure.

METHODS: The ApoE^-/- mice were fed a high-fat diet and were exposed to either 200 ppb arsenic in drinking water or a tap water control, and single-cell multi-omics profiling was performed on atherosclerotic plaque-resident immune cells. Transcriptomic and epigenetic changes in immune cells were analyzed within the same cell to understand the effects of arsenic exposure.

RESULTS: Our data revealed that the transcriptional profile of macrophages from arsenic-exposed mice were significantly different from that of control mice and that differences were subtype specific and associated with cell-cell interaction and cell fates. Additionally, our data suggest that differences in arsenic-mediated changes in chromosome accessibility in arsenic-exposed mice were statistically more likely to be due to factors other than random variation compared to their effects on the transcriptome, revealing markers of arsenic exposure and potential targets for intervention.

DISCUSSION: These findings in mice provide insights into how arsenic exposure impacts immune cell types in atherosclerosis, highlighting the importance of considering cellular heterogeneity in studying such effects. The identification of subtype-specific differences and potential intervention targets underscores the significance of understanding the molecular mechanisms underlying arsenic-induced atherosclerosis. Further research is warranted to validate these findings and explore therapeutic interventions targeting immune cell dysfunction in arsenic-exposed individuals. https://doi.org/10.1289/EHP14285.

PMID:39847705 | DOI:10.1289/EHP14285

Pain. 2025 Jan 21. doi: 10.1097/j.pain.0000000000003511. Online ahead of print.

ABSTRACT

Rapid declines in opioid analgesics dispensed in American communities since 2011 raise concerns about inadequate access to effective pain management among patients for whom opioid therapies are appropriate, especially for those living in racial/ethnic minority and socioeconomically deprived communities. Using 2011 to 2021 national data from the Automated Reports and Consolidated Ordering System and generalized linear models, this study examined quarterly per capita distribution of oxycodone, hydrocodone, and morphine (in oral morphine milligram equivalents [MMEs]) by communities’ racial/ethnic and socioeconomic profiles. Communities (defined by 3-digit-zip codes areas) were classified as “majority White” (≥50% self-reported non-Hispanic White population) vs “majority non-White.” Community socioeconomic deprivation was measured by quartiles of population-weighted Social Deprivation Index. Overall, majority non-White communities had at least 40% lower mean adjusted per capita distribution than majority White communities across all levels of socioeconomic deprivation. Among the least deprived communities, the adjusted mean per capita distribution was 46.0 (95% confidence interval [CI], 40.0-52.0) for majority non-White vs 82.8 (95% CI, 78.5-87.1) MMEs for majority White communities. Among the most deprived communities, the distribution was 78.0 (95% CI, 70.8-85.1) for majority non-White vs 134.4 (95% CI, 125.4-143.4) MMEs for majority White communities. The lower distribution in majority non-White communities was statistically significant across all socioeconomic deprivation levels and over all study years. Availability of commonly prescribed opioid analgesics was substantially lower in majority non-White communities than in majority White communities across all levels of socioeconomic deprivation. Policies governing opioid analgesic availability warrant careful consideration and potential adjustments.

PMID:39847449 | DOI:10.1097/j.pain.0000000000003511