Tag: statistics

Scand J Prim Health Care. 2025 Mar 14:1-9. doi: 10.1080/02813432.2025.2477150. Online ahead of print.

ABSTRACT

MOTIVATION: Primary care centres are the first line of mental health service in Sweden responsible for individuals with mild to moderate severe symptoms of common mental disorders (CMD). The aim was to evaluate impact of sick leave and sick leave duration in patients diagnosed with CMD in primary care centres with a care manager organisation during the first and second year after implementation compared to usual care.

METHODS: Register data on sick leave (mean number of net and gross sick leave days) among patients with CMD was obtained per primary care centre from the national social insurance database MiDAS. Two measures of sick leave were used: impact of sick leave in total patient population with CMD, and sick leave duration among sick listed patients with CMD. Linear mixed-effects regression analysis was performed for cross-sectional differences and longitudinal changes between and within the two groups of primary care centres.

RESULTS: Primary care centres with care as usual had a lower proportion of sick listed patients with CMD at both year 1 and 2. Primary care centres with a care manager organisation (CMO) had significantly fewer mean number of sick leave days (net and gross days) among patients with CMD compared to centres with care as usual, indicating a lower impact of sick leave. Sick leave duration among sick listed patients did not show statistically significant differences between the two groups of primary care centres. Both groups of primary care centres increased their sick leave duration significantly from year 1 to year 2, congruent to Sweden as a whole.

CONCLUSION: The aim of this study was to evaluate two measures of sick leave in primary care centres with a care manager organisation compared to care as usual. There were no differences in sick leave duration. Primary care centres with a care manager organisation, designed to increase accessibility and continuity for patients with CMD, seemed to facilitate the primary care centre’s possibility to offer enhanced care taking to more patients with CMD with continued lower levels of impact of sick leave compared to care as usual.

IMPLEMENTATION: This study evaluated outcomes after implementation of CMO at primary care centres.

PMID:40084899 | DOI:10.1080/02813432.2025.2477150

J Craniofac Surg. 2025 Mar 14. doi: 10.1097/SCS.0000000000011226. Online ahead of print.

ABSTRACT

The SARS-CoV-2 (COVID-19) pandemic caused, in 2020, a serious and urgent health issue worldwide, establishing social distancing rules, which changed daily life in all its aspects. Work relationships and socialization became possible only through virtual networks. As a result, there has been an extreme increase in the exposure of people in general to their own image for many hours a day through cameras and video conferencing applications. This exacerbated exposure to self-image and greater criticism regarding own appearance raised hypotheses that the pandemic state generated in the population the desire to seek improvements in appearance and, consequently, would have caused an increase in searches for aesthetic procedures on the face and upper region of the chest. Therefore, this study aimed to elucidate these questions, using the virtual search trend analysis tool on the Google platform, called Google Trends. Analyzes of the main surgical and non-surgical facial aesthetic procedures carried out by dentistry professionals were done through statistical tests, tables, and observation of graphs generated by Google Trends. With the analysis of the results, a constant growth trend in searches by the public in relation to aesthetic procedures was observed, which may have been triggered by the pandemic, but is not related to it. The growth in Google searches continued after the pandemic state and some showed greater growth years after the declaration of social isolation.

PMID:40084868 | DOI:10.1097/SCS.0000000000011226

JMIR Form Res. 2025 Mar 13;9:e67999. doi: 10.2196/67999.

ABSTRACT

BACKGROUND: Pneumoconiosis prevalence is increasing in the United States, especially among coal miners. Contemporaneously with an increased need for specialized multidisciplinary care for miners, there is a shortage of experts to fulfill this need. Miners’ Wellness ECHO (Extension for Community Health Outcomes) is a digital community of practice based on interprofessional discussion for knowledge transfer. The program has been demonstrated to increase participants’ self-efficacy for clinical, medicolegal, and “soft” skills related to miners’ health.

OBJECTIVE: We aimed to examine characteristics associated with interprofessional discussions and suggest ways to strengthen knowledge transfer.

METHODS: This mixed methods study used an exploratory sequential design. We video-recorded and transcribed ECHO sessions over 14 months from July 2018 to September 2019 and analyzed content to examine participant discussions. We focused on participants’ statements of expertise followed by other participants’ acceptance or eschewal of these statements (utterances). We conducted quantitative analyses to examine the associations of active participation in discussion (primary outcome variable, defined as any utterance). We analyzed the association of the outcome on the following predictors: (1) participant group status, (2) study time frame, (3) participant ECHO experience status, (4) concordance of participant group identity between presenter and participant, (5) video usage, and (6) attendance frequency. We used the generalized estimating equations approach for longitudinal data, logit link function for binary outcomes, and LSMEANS to examine least squares means of fixed effects.

RESULTS: We studied 23 sessions with 158 unique participants and 539 total participants, averaging 23.4 (SD 5.6) participants per session. Clinical providers, the largest participant group, constituting 36.7% (n=58) of unique participants, were the most vocal group (mean 21.74, SD 2.11 average utterances per person-session). Benefits counselors were the least vocal group, with an average utterance rate of 0.57 (SD 0.29) per person-session and constituting 8.2% (n=13) of unique participants. Thus, various participant groups exhibited different utterance rates across sessions (P=.003). Experienced participants may have dominated active participation in discussion compared to those with less or intermediate experience, but this difference was not statistically significant (P=.11). When the didactic presenter and participant were from the same participant group, active participation by the silent group participants was greater than when both were from different groups. This association was not seen in vocal group participants (interaction P=.003). Compared to those participating by audio, those participating on video tended to have higher rates of active participation, but this difference was not statistically significant (P=.11).

CONCLUSIONS: Our findings provide insight into the mechanics of interprofessional discussion in a digital community of practice managing pneumoconiosis. Our results underscore the capacity of the novel ECHO model to leverage technology and workforce diversity to facilitate interprofessional discussions on the multidisciplinary care of miners. Future research will evaluate whether this translates into improved patient outcomes.

PMID:40080056 | DOI:10.2196/67999

Int J Oral Maxillofac Implants. 2025 Mar 13;0(0):1-36. doi: 10.11607/jomi.11225. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to investigate and compare the survival rate and the success rate of single tooth implants placed and restored immediately after extraction in non-infected, acutely infected, and chronically infected sites in the maxillary anterior area.

MATERIAL AND METHODS: Patients requiring single tooth replacement of a maxillary central incisor, lateral incisor, canine, and premolar regions were included in the study. Implant sites were divided into three groups based on the presence or absence of an infection: Group 1 (Control) non-infected sites (healthy periodontal and endodontic conditions); Group 2 (Test 1) acutely infected sites (presence of a periodontal or endodontic or combined abscess and/or fistula); Group 3 (Test 2) chronically infected sites ( presence of a periodontal pocket or a periapical lesion with no signs of acute inflamation). The protocol applied required: flapless extraction, thorough debridement of the alveolus, immediate placement of the implant, particulate graft material insertion around the implant, resorbable membrane insertion in the facial aspect of the implant for all those cases in which the buccal plate was compromised, and immediate insertion of a screw-retained provisional FDP out of occlusion. The following parameters were evaluated: Periodontal and Endodontic initial conditions: gingival recession, probing depth, presence of an abscess and/or a fistula, extraction reason, presence of a periapical lesion, alveolar buccal wall integrity, distance between the gingival margin and the alveolar bone crest at mid-buccal, and implant insertion torque. Implant conditions at the last follow up included survival rate and marginal bone loss. Periodontal conditions: recession, probing depth, and gingival index. Final esthetic results: pink esthetic score. Statistical analysis was also performed.

RESULTS: After a mean follow-up of 7 years (range 2 to 12 years), a total of 127 patients were treated, 143 single tooth implants were placed and immediately restored with a provisional FDP: 47 implants in Group 1 control (non-infected sites), 56 implants in Group 2 Test 1 (acutely infected sites), 40 implants in Group 3 Test 2 (chronically infected sites). A survival rate of 97.8% for Group 1, 96.4% for Group 2, and 95% for Group 3 were recorded with no statistical difference between groups (p-value 0.8). A total of 5 implants failed, one in Group 1, two in Group 2, and two in Group 3 resulting in a cumulative implant survival rate of 96.5%.

CONCLUSIONS: The results of this study showed comparable implant survival rate between single tooth implants placed and restored immediately in a non-infected, acutely infected or chronically infected site.

PMID:40080053 | DOI:10.11607/jomi.11225

Int J Oral Maxillofac Implants. 2025 Mar 13;0(0):1-24. doi: 10.11607/jomi.11269. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to assess the impact of subepithelial connective tissue graft (CTG) on soft tissue volume and aesthetics around implants placed in aesthetically important areas over a 4-year period.

MATERIALS AND METHODS: A total of 42 participants were divided into groups: implant+CTG (n=20) and implant only (n=22) and evaluated after 48 months using various clinical and radiographic parameters, professional aesthetic assessment, patient-centered aesthetic evaluation, and quality of life improvement measured by OHIP-14 at 12 and 48 months.

RESULTS: Eight patients were lost to follow-up, leaving 34 patients for evaluation. Intragroup comparison for the variables TTb (tissue thickness at the buccal aspect), KTW (keratinized tissue width), and BD (buccal defect) showed no statistical difference (p>0.05) in the evaluated periods. However, for PBR (proximal bone resorption), a statistical difference was observed (p<0.05). In the intergroup comparison, statistical differences (p<0.05) were observed in the variables TTb and BD in the 2 evaluated periods. In the analysis of Pink Esthetic Score/White Esthetic Score (PES/WES) and Jent index, there was no difference between or within groups in the evaluated periods. Regarding patient-centered measures, there was no difference between the groups in terms of aesthetics (VAS), but for OHIP-14, there was an intragroup difference in both groups between 12 and 48 months.

CONCLUSIONS: The association of CTG with dental implants in aesthetic areas, after a 48-month follow-up, led to an increase in TTb. Therefore, CTG is indicated due to the increase in TTb during the follow-up period. However, there were no improvements in BD, PBR, or PES/WES over time. Aesthetics and quality of life were similar between the two groups 4 years post-implant placement.

PMID:40080052 | DOI:10.11607/jomi.11269

J Med Internet Res. 2025 Mar 13;27:e65776. doi: 10.2196/65776.

ABSTRACT

BACKGROUND: The increasing number of older adults who are living alone poses challenges for maintaining their well-being, as they often need support with daily tasks, health care services, and social connections. However, advancements in artificial intelligence (AI) technologies have revolutionized health care and caregiving through their capacity to monitor health, provide medication and appointment reminders, and provide companionship to older adults. Nevertheless, the adaptability of these technologies for older adults is stymied by usability issues. This study explores how older adults use and adapt to AI technologies, highlighting both the persistent barriers and opportunities for potential enhancements.

OBJECTIVE: This study aimed to provide deeper insights into older adults’ engagement with technology and AI. The technologies currently used, potential technologies desired for daily life integration, personal technology concerns faced, and overall attitudes toward technology and AI are explored.

METHODS: Using mixed methods, participants (N=28) completed both a semistructured interview and surveys consisting of health and well-being measures. Participants then participated in a research team-facilitated interaction with an AI chatbot, Amazon Alexa. Interview transcripts were analyzed using thematic analysis, and surveys were evaluated using descriptive statistics.

RESULTS: Participants’ average age was 71 years (ranged from 65 years to 84 years). Most participants were familiar with technology use, especially using smartphones (26/28, 93%) and desktops and laptops (21/28, 75%). Participants rated appointment reminders (25/28, 89%), emergency assistance (22/28, 79%), and health monitoring (21/28, 75%). Participants rated appointment reminders (25/28, 89.3%), emergency assistance (22/28, 78.6%), and health monitoring (21/28, 75%) as the most desirable features of AI chatbots for adoption. Digital devices were commonly used for entertainment, health management, professional productivity, and social connectivity. Participants were most interested in integrating technology into their personal lives for scheduling reminders, chore assistance, and providing care to others. Challenges in using new technology included a commitment to learning new technologies, concerns about lack of privacy, and worries about future technology dependence. Overall, older adults’ attitudes coalesced into 3 orientations, which we label as technology adapters, technologically wary, and technology resisters. These results illustrate that not all older adults were resistant to technology and AI. Instead, older adults are aligned with categories on a spectrum between willing, hesitant but willing, and unwilling to use technology and AI. Researchers can use these findings by asking older adults about their orientation toward technology to facilitate the integration of new technologies with each person’s comfortability and preferences.

CONCLUSIONS: To ensure that AI technologies effectively support older adults, it is essential to foster an ongoing dialogue among developers, older adults, families, and their caregivers, focusing on inclusive designs to meet older adults’ needs.

PMID:40080043 | DOI:10.2196/65776

Eur J Prosthodont Restor Dent. 2025 Mar 13. doi: 10.1922/EJPRD_2810Michelon07. Online ahead of print.

ABSTRACT

PURPOSE: CAD/CAM feldspathic ceramic (FC) materials remain used for their low cost and ease of chairside production. The purpose of this study was to describe preliminary clinical results, reporting the success and survival of FC dental crowns in a high-demand service using a simplified CAD/CAM technique.

MATERIALS AND METHODS: A calibrated dentist fabricated indirect restorations using the CEREC method and intraoral scanning (Cerec Omnicam, Cerec MCXL) for high-demand dental care. Forty crowns were seated adhesively and evaluated after 24 months using the newly validated UERJ criteria. Statistical analysis was performed with the McNemar test (p⟨.05).

RESULTS: The survival clinical rate of FC CAD/CAM crowns after 24 months was 100%. However, 65% of indirect restorations presented reparable complications. No failure with loss of restoration was detected. Within the complications, most parts were in the proximal contact point, with statistically different significance in follow-up.

CONCLUSION: This study demonstrates that FC CAD/CAM crowns made using a simplified technique have a high clinical survival rate after 24 months, which is crucial for high-demand service. A more extended clinical evaluation period using the same criteria is necessary to draw further conclusions.

PMID:40080034 | DOI:10.1922/EJPRD_2810Michelon07

JAMA Netw Open. 2025 Mar 3;8(3):e250572. doi: 10.1001/jamanetworkopen.2025.0572.

ABSTRACT

IMPORTANCE: Inequitable access to transplant in the US is well recognized, yet the nature and extent of upstream disparities in care prior to transplant are unknown.

OBJECTIVE: To understand patterns of referral for lung transplant by race, ethnicity, and neighborhood-level socioeconomic status.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included adults aged 18 to 80 years with obstructive and restrictive lung disease from a single large-volume transplant center in Cleveland, Ohio, who were diagnosed between January 1, 2006, and May 11, 2023.

EXPOSURES: Neighborhood resources.

MAIN OUTCOMES AND MEASURES: The main outcome was the transition to the next stage of the transplant care continuum, death, or a lapse in care. Cause-specific Cox proportional hazards regression models were used to account for death as a competing risk, adjusting for age at index encounter (respective to each cohort), diagnosis, and sex as covariates.

RESULTS: This study included 30 050 patients with obstructive and restrictive lung disease with primary care encounters (mean [SD] age, 65 [13] years; 56.1% female), 73 817 with a pulmonary medicine encounter, 4198 undergoing lung transplant evaluation, and 1378 on the lung transplant waiting list. In a multivariable model including age, diagnosis, sex, area deprivation index, and race and ethnicity (including 3.3% Hispanic, 15.2% non-Hispanic Black, and 81.5% non-Hispanic White individuals), patients residing in the least-resourced neighborhoods were 97% more likely to die without transitioning to pulmonary medicine (hazard ratio [HR], 1.97 [95% CI, 1.78-2.17]), 90% more likely to die prior to lung transplant evaluation (HR, 1.90 [95% CI, 1.77-2.04]), 40% more likely to die prior to placement on the waiting list (HR, 1.40 [95% CI, 1.11-1.76]), and 97% more likely to die prior to transplant (HR, 1.97 [95% CI, 1.18-3.29]) compared with patients residing in the most-resourced neighborhoods. These patients were also 13% less likely to transition to pulmonary medicine (HR, 0.87 [95% CI, 0.82-0.92]) and 45% less likely to be placed on the waiting list (HR, 0.55 [95% CI, 0.44-0.68]) despite a 69% increased likelihood of transplant evaluation (HR, 1.69 [95% CI, 1.36-2.09]). While non-Hispanic Black patients had lower risks of death across all stages of care, they experienced a 39% lower likelihood of proceeding to lung transplant evaluation (HR, 0.61 [95% CI, 0.51-0.74]). Racial differences in the cumulative incidence of waiting list placement were found, but differences were not consistent across levels of neighborhood resources.

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study of patients diagnosed with restrictive and obstructive pulmonary disease, increased mortality risks and decreased likelihood of care escalations for patients who were socioeconomically disadvantaged and for racial and ethnic minority patients were found. These results suggest potential interventions for advancing equitable access to lung transplant.

PMID:40080022 | DOI:10.1001/jamanetworkopen.2025.0572

JAMA Netw Open. 2025 Mar 3;8(3):e250695. doi: 10.1001/jamanetworkopen.2025.0695.

ABSTRACT

IMPORTANCE: Evidence-based, patient-centered treatment for alcohol use disorder (AUD) can include pharmacotherapy with naltrexone, acamprosate, or disulfiram; however, these medications are rarely used. Medicaid managed care plans (MCPs) manage health services for nearly 80% of Medicaid enrollees and are the largest payer for addiction treatment services. Little is known about Medicaid MCP policies for AUD medications.

OBJECTIVES: To describe Medicaid MCPs’ coverage and management of acamprosate, naltrexone, and disulfiram for AUD and examine associations of plan characteristics and state policies with medication coverage.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a content analysis was performed of 2021 insurance benefit data for 241 comprehensive Medicaid MCPs in states using Medicaid managed care, as well as secondary sources. Data were analyzed from May to August 2024.

MAIN OUTCOMES AND MEASURES: Medicaid MCP-reported medication coverage and utilization management requirements (eg, prior authorization, quantity limit requirements) for acamprosate, disulfiram, and oral and injectable naltrexone together and for each medication separately. Independent variables included plan characteristics (profit status, market share) and the state policy environment in which plans are embedded (Section 1115 substance use disorder waiver, state-defined preferred drug list). Regressions examined associations of plan characteristics and state policies with medication coverage.

RESULTS: In this cross-sectional content analysis of 241 comprehensive Medicaid MCPs in 2021, 217 (90.0%) covered at least 1 medication for AUD: 132 (54.7%) covered acamprosate, 203 (84.2%) covered oral naltrexone, 175 (72.6%) covered injectable naltrexone, 152 (63.0%) covered disulfiram, and 103 (42.7%) covered all 4 medications. Prior authorization and quantity limits were rarely applied, except for injectable naltrexone, for which 75 plans (42.8%) imposed at least 1 of these utilization management requirements.

CONCLUSIONS AND RELEVANCE: This study suggests that efforts to expand AUD medication prescribing may be limited by gaps in health insurance coverage. Medicaid MCPs and states can support AUD medication utilization by covering these medications without applying utilization management strategies.

PMID:40080021 | DOI:10.1001/jamanetworkopen.2025.0695

JAMA Netw Open. 2025 Mar 3;8(3):e250708. doi: 10.1001/jamanetworkopen.2025.0708.

ABSTRACT

IMPORTANCE: Previously published literature found that 28.6% of surgical residents have or are expecting children, yet little information exists regarding the financial demands of childcare during residency.

OBJECTIVE: To evaluate surgical residents’ net financial balance after childcare costs at various postgraduate years and child ages.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study, conducted from June 14 to August 2, 2024, examined surgical residency programs across the US using publicly available data. Programs were categorized into US regions based on the Association of American Medical Colleges classifications: Northeast, Midwest, South, and West. Childcare costs were obtained from the National Database of Childcare Prices, and annual expenditure data came from the Bureau of Labor Statistics.

MAIN OUTCOMES AND MEASURES: The primary outcome was residents’ net income by year of residency, calculated using salaries and expenditures. To compare costs by region and child age, net income was determined by subtracting mean expenditures and childcare costs from residency salaries. Calculations were validated using the Massachusetts Institute of Technology Living Wage Calculator.

RESULTS: Of 351 US surgical residency programs, 295 with publicly available salaries for postgraduate years 1 through 5 met inclusion criteria. A total of 290 programs (98.3%) showed a negative net income when expenditures and childcare costs were deducted. This finding held true across all child age groups and US regions. The West had the most negative mean net income (-$18 852 [range, -$35 726 to $766]), followed by the Northeast (-$15 878 [range, -$37 310 to $3589]), Midwest (-$12 067 [range, -$26 111 to $1614]), and South (-$8636 [range, -$18 740 to $4826]). Parents of school-aged children in the South had the lowest mean negative net income (-$8453 [range, -$16 377 to $3417]), while parents of infants in the West had the highest mean negative net income (-$21 278 [range, -$35 726 to -$5112]).

CONCLUSIONS AND RELEVANCE: This cross-sectional study of surgical residents’ net income found that, after accounting for mean annual expenditures and childcare costs, a surgical resident’s salary was insufficient to cover living expenses and childcare costs for single resident parents. This financial obstacle may deter individuals from pursuing surgical residency or from starting families as surgical residents.

PMID:40080020 | DOI:10.1001/jamanetworkopen.2025.0708