Tag: statistics

JAMA Netw Open. 2025 Mar 3;8(3):e250715. doi: 10.1001/jamanetworkopen.2025.0715.

ABSTRACT

IMPORTANCE: Community pharmacies are crucial for public health, providing essential services such as medication dispensing, vaccinations, and point-of-care testing. Addressing disparities in pharmacy access, particularly in underserved rural and low-income areas, is critical for health equity.

OBJECTIVE: To identify areas in the US at risk of becoming pharmacy deserts through the development of a novel pharmacy vulnerability index.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study in the contiguous 48 states performed geographic information systems analysis of pharmacy data from the National Council for Prescription Drug Programs (NCPDP) dataQ. Participants included all open-door pharmacies (community or retail pharmacies open to the general public without restrictions on who can access its services) in the US as of February 2024. Statistical analysis was performed from July to August 2024.

EXPOSURE: The primary exposure was travel time to pharmacies across the US.

MAIN OUTCOMES AND MEASURES: A pharmacy desert was defined as a census tract where the travel time to the nearest pharmacy exceeds the supermarket access time for that region and urbanicity level. Building on this definition, a pharmacy vulnerability index was developed, which indicates the number of pharmacies that would need to close for a census tract to become a pharmacy desert. Tracts with a pharmacy vulnerability index of 1, depending solely on a single pharmacy for access, were identified as at risk of becoming deserts. Subpopulation totals and percentages living in pharmacy deserts or relying on keystone pharmacies were computed, and then stratified by urbanicity and race.

RESULTS: Among 321.3 million individuals (39.7 million [12.3%] Black, 59.0 million [18.2%] Hispanic, 195.0 million [60.3%] White) in the contiguous US, 57.1 million (17.7%) were identified as living in pharmacy deserts, with 28.9 million (8.9%) additionally relying on a single pharmacy for access. Small rural areas were particularly affected, with a higher dependency on single pharmacies (4.1 million individuals [14.3%]).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of pharmacy access in the US, significant disparities in pharmacy access were identified, especially pronounced in small rural areas. Targeted policy interventions, such as incremental reimbursement rates or other monetary incentives, are needed to ensure the financial sustainability of pharmacies that serve as the sole source of pharmacy services in at-risk areas.

PMID:40080019 | DOI:10.1001/jamanetworkopen.2025.0715

JAMA Netw Open. 2025 Mar 3;8(3):e250747. doi: 10.1001/jamanetworkopen.2025.0747.

ABSTRACT

IMPORTANCE: Although evaluation of geographic area inequities in vaccination is crucial to identify areas that need community-based interventions, knowledge of disparities in human papillomavirus (HPV) vaccination uptake remains limited in Japan.

OBJECTIVE: To investigate the association of female cumulative HPV vaccination uptake with neighborhood-based socioeconomic status and access indicators in Osaka City, Japan.

DESIGN, SETTING, AND PARTICIPANTS: This population-based, cross-sectional study included HPV vaccination data for fiscal year (April 1 to March 31) 2013 to fiscal year 2022 provided by Osaka City. The study population comprised the total number of girls eligible for HPV vaccination born between fiscal years 1997 and 2010.

EXPOSURE: The area deprivation index (ADI) was used as a neighborhood-based socioeconomic status indicator, and the number of medical facilities providing HPV vaccination within a 500-m range of a representative point in each geographic area was used as an access indicator.

MAIN OUTCOMES AND MEASURES: The primary outcome was cumulative uptake, defined as the cumulative number of girls receiving at least 1 dose and those completing all doses (3 doses until March 2023), by neighborhood ADI and access indicators. A Poisson regression model with robust variance was applied to assess the association of neighborhood-level indicators with cumulative HPV vaccination uptake.

RESULTS: In Osaka City, 185 373 girls (median [IQR] age at vaccination, 16 [14-19] years) were eligible for HPV vaccination, of whom 18 688 (10.1%) received at least 1 dose of HPV vaccine. Compared with girls living in areas with the most deprivation (2539 of 28 078 [9.0%]), those living in areas with the least deprivation (4889 of 42 170 girls [11.6%]) had a greater cumulative HPV vaccination uptake (prevalence ratio [PR], 1.25; 95% CI, 1.16-1.34). In addition, compared with girls living in areas with low medical facility access (5128 of 55 055 [9.3%]), those residing in high-access areas (5862 of 54 740 [10.7%]) had a greater cumulative vaccination uptake (PR, 1.09; 95% CI, 1.03-1.16). Cumulative HPV vaccination was significantly associated with ADI in routine vaccination (least vs most deprivation: PR, 1.46; 95% CI, 1.33-1.61) but not in catch-up vaccination (least vs most deprivation: PR, 1.01; 95% CI, 0.92-1.11).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of area deprivation, vaccination access, and HPV vaccination status, higher socioeconomic status and higher medical facility access were associated with higher cumulative HPV vaccination uptake. These findings suggest that further strategies, including a socioecologic approach, are needed to increase HPV vaccination and reduce disparities in uptake.

PMID:40080018 | DOI:10.1001/jamanetworkopen.2025.0747

JAMA Netw Open. 2025 Mar 3;8(3):e250778. doi: 10.1001/jamanetworkopen.2025.0778.

ABSTRACT

IMPORTANCE: Contact days-days with health care contact outside the home-are a measure of how much of a patient’s life is consumed by health care. Clinical trials, with a more uniform patient mix and protocolized care, provide a unique opportunity to assess whether burdens differ by individuals’ sociodemographic backgrounds.

OBJECTIVE: To characterize patterns of contact days for older adults with cancer participating in clinical trials.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, data from 6 SWOG Cancer Research Network trials across prostate, lung, and pancreatic cancers that recruited patients aged 65 years or older from 1999 to 2014 were linked with Medicare claims data. Data were analyzed from December 14, 2023, to September 26, 2024.

EXPOSURES: Demographic variables, including age, sex, self-reported race and ethnicity, and insurance status; clinical factors, such as cancer type and study-specific prognostic risk score; and social factors, such as neighborhood socioeconomic deprivation.

MAIN OUTCOMES AND MEASURES: Number of contact days, defined as number of days with contact with the health care system, percentage of health care contact days (number of contact days divided by follow-up), and sources of contact days (eg, ambulatory or inpatient) in the first 12 months after trial enrollment. Sociodemographic and clinical factors associated with contact days were examined using negative binomial regression, including an offset variable for duration of observation.

RESULTS: The study included 1429 patients (median age, 71 years [range, 65-91 years]; 1123 men [78.6%]; and 332 patients [23.5%] with rural residence). The median number of contact days was 48 (IQR, 26-71), of a median of 350 days (IQR, 178-365 days) of observation; the median percentage of contact days was 19% (IQR, 13%-29%). The most common sources of contact days were ambulatory clinician visits (median, 17 [IQR, 7-25]), tests (median, 12 [IQR, 3-24]), and treatments (median, 11 [IQR, 3-22]). A median of 70% (IQR, 50%-88%) of ambulatory contact days had only a single service performed on that day (eg, only tests). In multivariable regression, factors associated with increased contact days included age (relative risk [RR] per year, 1.02 [95% CI, 1.01-1.02]), insurance type (Medicare alone or with Medicaid or private insurance vs other: RR, 2.47 [95% CI, 2.16-2.83]), prognostic risk score (above the median vs at or below the median: RR, 1.14 [95% CI, 1.04-1.25]), and type of cancer (pancreatic vs prostate cancer: RR, 1.69 [95% CI, 1.51-1.89]; lung vs prostate cancer: RR, 1.69 [95% CI, 1.54-1.85]).

CONCLUSIONS AND RELEVANCE: In this cohort study of older adults with advanced stage cancer participating in phase 3 randomized clinical trials, patients spent nearly 1 in 5 days with health care contact. These findings highlight the need to simplify trial requirements to minimize participant burden.

PMID:40080017 | DOI:10.1001/jamanetworkopen.2025.0778

J Agric Saf Health. 2024 Feb 6;30(1):17-34. doi: 10.13031/jash.15680.

ABSTRACT

HIGHLIGHTS: Microbial assessment of dairy workers in Arizona, U.S. Provides demographic and working information of an underserved group. Highlights the need for health and safety assessments and solutions in the dairy industry.

ABSTRACT: The dairy industry in Arizona, like many other agricultural industries in the United States, is dependent on the labor that migrant farm workers provide. Infections caused by zoonotic pathogens are commonly underreported or misdiagnosed, and possibly more so in migratory workers that face cultural, structural, legal, financial, and geographic barriers to health services. The objectives of this project were to: assess the demographics of Arizona dairy workers, determine the exposure potential of Arizona dairy workers to zoonotic organisms, and inform best management practices. A questionnaire including demographics, work tasks, and household characteristics was administered. Swab samples were collected from the shoulders, knees, and foreheads of employees at two dairy operations at the end of the work shift. The swabs were cultured for E.coli O157:H7 and Salmonella. Molecular DNA isolated from Salmonella and Cryptosporidium was quantified using droplet-digital Polymerase Chain Reaction (ddPCR). Twenty dairy workers were recruited, and 60 samples were collected. The majority of workers were male, preferred to speak Spanish, and identified as Latino/Hispanic (68.8%, 93.8%, and 93.8%, respectively). E. coli O157:H7 was detected in 13% of cultured knee and forehead samples. Salmonella spp. gene copies were detected on 60.0% of samples collected from forehead skin samples; 40.0% of shoulder clothing samples; and 15% of knee clothing samples, as measured via ddPCR. The positive cultural and molecular samples indicate the need for improved post-workday sanitation practices at farms. This study provides surveillance of a largely invisible population, including insights that can be used to create site-specific health and safety protocols for the dairy industry, inform risk assessment models, and foster preventive practices in the dairy industry.

PMID:40080011 | DOI:10.13031/jash.15680

JAMA Oncol. 2025 Mar 13. doi: 10.1001/jamaoncol.2025.0110. Online ahead of print.

ABSTRACT

IMPORTANCE: Whether the conventional 1.5-month to 2.0-month time interval following radical prostatectomy (RP) for prostate cancer (PC) is sufficient to accurately document a persistent prostate-specific antigen (PSA) remains unanswered.

OBJECTIVE: To evaluate the time necessary to accurately document a persistent PSA level after RP.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study evaluated whether a significant interaction existed between (1) a pre-RP PSA level greater than 20 ng/mL vs 20 ng/mL or less and (2) persistent PSA vs undetectable PSA after RP on PC-specific mortality (PCSM) risk and all-cause mortality (ACM) risk, adjusting for known PC prognostic factors, age at RP, year of RP, and the time-dependent use of post-RP radiation therapy (RT) and androgen deprivation therapy (ADT). Whether an increasing persistent PSA level was associated with a worse prognosis was also investigated. Patients with T1N0M0 to T3N0M0 PC treated with RP between 1992 and 2020 at 2 academic centers were included. Follow-up data were collected until November 2023. Data were analyzed from July 2024 to January 2025.

EXPOSURE: RP.

MAIN OUTCOMES AND MEASURES: Adjusted hazard ratio (aHR) of ACM and PCSM risk.

RESULTS: Of 30 461 patients included in the discovery cohort, the median (IQR) age was 64 (59-68) years; of 12 837 patients included in the validation cohort, the median (IQR) age was 59 (54-64) years. Compared with patients with undetectable PSA, among patients with persistent PSA, a pre-RP PSA level greater than 20 ng/mL vs 20 ng/mL or less was significantly associated with reduced ACM risk (aHR, 0.69; 95% CI, 0.51-0.91; P = .01; P for interaction < .001) and PCSM risk (aHR, 0.41; 95% CI, 0.25-0.66; P < .001; P for interaction = .02). This result remained after adjustment for prostate volume and was confirmed in the validation cohort for PCSM risk and may represent a higher proportion of patients with a pre-RP PSA greater than 20 ng/mL vs 20 ng/mL or less who could have reached an undetectable PSA level if additional time for PSA assessment occurred before initiating post-RP therapy for presumed persistent PSA. Notably, there was more frequent and a shorter median time to post-RP RT plus ADT or ADT use in patients with a pre-RP PSA greater than 20 ng/mL (244 of 446 [54.7%] at a median [IQR] of 2.68 [1.51-4.40] months) vs 20 ng/mL or less (338 of 972 [34.8%] at a median [IQR] of 3.30 [2.00-5.39] months). These treatment times were shorter than the times to an undetectable PSA in observed patients (median [IQR] of 2.96 [1.84-3.29] months vs 3.37 [2.35-4.09] months, respectively). Increasing persistent PSA level was associated with an increased ACM risk (aHR, 1.14; 95% CI, 1.04-1.24; P = .004) and PCSM risk (aHR, 1.27; 95% CI, 1.12-1.45; P < .001).

CONCLUSIONS AND RELEVANCE: PSA level assessed for at least 3 months after RP may minimize overtreatment, and in this study, a higher persistent PSA level was associated with a worse prognosis.

PMID:40080000 | DOI:10.1001/jamaoncol.2025.0110

J Contemp Dent Pract. 2024 Dec 1;25(12):1179-1189. doi: 10.5005/jp-journals-10024-3799.

ABSTRACT

BACKGROUND: This systematic review and meta-analysis aimed to determine whether reciprocating file systems reduce postoperative pain more effectively than rotary file systems.

MATERIALS AND METHODS: This review followed the preferred reporting items for systematic review guidelines to ensure rigorous and transparent reporting. The databases searched included MEDLINE, Cochrane Library, and Google Scholar, targeting articles published in English between January 2000 and April 2024. Randomized controlled trials involving children aged 4-12 years requiring pulpectomy, comparing reciprocating file systems with rotary systems. Outcomes included quality of obturation, instrumentation time, and postoperative pain. The participants, settings, interventions, comparators, outcome measures, study designs, statistical analyses, results, and all other relevant data were meticulously and accurately extracted from all included studies. Data extraction was performed and recorded in Excel sheets, with separate documentation maintained for each primary outcome.

RESULTS: Out of 279 studies initially identified, 272 were excluded due to duplication, non-English language, or not meeting criteria. Seven studies that met the necessary criteria were included in the systematic review. Among them are five comparisons for instrumentation time, four for postoperative pain, and two comparisons for quality of obturation. Results of the meta-analysis showed that instrumentation time was lower in the rotary file systems than in reciprocating file systems. Postoperative visual analogue scale (VAS) scores after 6 hours and 24 hours were almost similar among both file systems.

CONCLUSION: Given the limitations of this review, it can be said that the postoperative pain scores were comparable between reciprocating and rotary file systems. The root canal preparation time was significantly shorter with the reciprocating system compared to the rotary system.

CLINICAL SIGNIFICANCE: In pediatric dentistry, behavior management plays a vital role in successful treatment. Therefore, opting for the correct file system is fundamental and helps in minimizing pain and instrumentation time, thereby enhancing the overall patient experience. How to cite this article: Sawant S, Kalaskar R, Chandanakunnummal A, et al. Comparative Evaluation of Effectiveness of Reciprocating and Rotary Files in Children: A Systematic Review and Meta-analysis. J Contemp Dent Pract 2024;25(12):1179-1189.

PMID:40079998 | DOI:10.5005/jp-journals-10024-3799

J Contemp Dent Pract. 2024 Dec 1;25(12):1156-1161. doi: 10.5005/jp-journals-10024-3795.

ABSTRACT

AIM: This study aims to clinically evaluate whether the local administration of vitamin D3 enhances postorthodontic tooth stability over a period of 3 months immediately after debonding.

MATERIALS AND METHODS: Patients aged 15-30 years with dental malocclusion and moderate crowding in the lower arch (Little’s irregularity score of 4-6) were selected and randomly split into the experimental and the control groups. After complete alignment and leveling, vitamin D3 injection was delivered to the experimental group and the control group was given a placebo injection with 0.9% normal saline mixed with 2% lignocaine. Fourteen days after the injection, the lower archwires were removed from the control and experimental groups.

RESULTS: Relapse was significantly higher in control than in the experimental group at all-time intervals. Statistically significant values of relapse were observed at T2 and T3 intervals between the two groups, with greater relapse in the control group than in the experimental group. Inter-canine width, arch perimeter, and intermolar width showed mild changes over 3-month period, but there were no significant differences between the two groups.

CONCLUSION: Relapse was seen in both the control and the experimental in the first 4 weeks of the study. Still, the control group showed a greater relapse rate in the following 8th week and 12th week when compared to the experimental group. How to cite this article: Kothandaraman T, Anbarasu P, Dinesh SPS, et al. Impact of Vitamin D3 on Postorthodontic Treatment Stability: A Randomized Controlled Trial. J Contemp Dent Pract 2024;25(12):1156-1161.

PMID:40079995 | DOI:10.5005/jp-journals-10024-3795

J Contemp Dent Pract. 2024 Dec 1;25(12):1148-1155. doi: 10.5005/jp-journals-10024-3790.

ABSTRACT

AIM: The tenet of the study is to evaluate the efficacy of low-level laser therapy (LLLT) as an adjunct to surgical periodontal therapy [open flap debridement (OFD)] on clinical parameters, gingival crevicular fluid (GCF) alkaline phosphatase (ALP) levels in GCF and wound healing.

MATERIALS AND METHODS: Thirty subjects afflicted with chronic periodontitis showing evidence of horizontal bone loss on the radiograph, pocket probing depth (PPD) between 4 and 7 mm, and ≥20 natural teeth present in the oral cavity were included in the study. In every patient, OFD+LLLT was done in one quadrant and OFD in another was performed. The clinical parameters were assessed at baseline, 3 and 6 months visits while the GCF sample was collected at baseline visit and 6 months recall. Wound healing indices were recorded 1-week post-op surgery for each group.

RESULTS: The results showed an evident improvement in all the clinical parameters [pocket probing depth, gingival index (GI), plaque index (PI), and CAL] from baseline-6 months values; however, no statistically significant difference was seen on the intergroup comparison. Wound healing was statistically significantly superior in the OFD + LLLT group in comparison to the OFD group, indicating a positive effect of lasers on healing. Gingival crevicular fluid ALP levels in the two groups decreased after 6 months and a statistically significant reduction in the laser group indicated an anti-inflammatory effect.

CONCLUSION: The results clearly indicated the efficacy of lasers in terms of acceleration of wound healing and control of inflammation.

CLINICAL SIGNIFICANCE: Lasers as an adjunct to surgical periodontal therapy evidently have an anti-inflammatory effect (decrease in GCF ALP levels) as well as accelerate the wound healing process. How to cite this article: Gupta R, Arora SA, Gupta G, et al. Effect of Open Flap Debridement with and without LLLT in Patients with Periodontitis on Wound Healing, GCF ALP Levels, and Clinical Parameters. J Contemp Dent Pract 2024;25(12):1148-1155.

PMID:40079994 | DOI:10.5005/jp-journals-10024-3790

J Contemp Dent Pract. 2024 Dec 1;25(12):1141-1147. doi: 10.5005/jp-journals-10024-3797.

ABSTRACT

AIM: The study aims to assess the long-term clinical outcomes and biocompatibility of resin-modified glass ionomer cement and light-curable tricalcium silicate cement in preserving pulp vitality and preventing further carious progression in deep carious lesions.

MATERIALS AND METHODS: A total of 46 participants with deep carious lesions and reversible pulpitis were selected and divided into two groups (n = 23): Group I was treated with resin-modified glass ionomer cement (RMGIC) and group II was treated with TheraCal LC (a light-curable tricalcium silicate cement). Once the indirect pulp capping (IPC) material was placed on the pulpal/axial walls, the cavity was temporized using intermediate restorative material, while the permanent restoration was done at 3rd-week recall period. Clinical and radiographic assessments were evaluated at intervals of 24 hours, 3 weeks, 3 months, and 6 months. Data were recorded and statistically analyzed.

RESULTS: The mean visual analog scale (VAS) scores for the RMGIC group were 20.21, 12.90, 1.33, 0.00, and 0.00 at baseline, 24 hours, 3 weeks, 3 months, and 6 months, respectively, while the TheraCal LC group showed mean scores of 12.60, 5.95, 2.58, 1.50, and 0.00 at the same intervals. The Mann-Whitney U-test revealed no significant difference in VAS scores between the two groups at any time point (p > 0.05). Intragroup comparisons using the Friedman test indicated statistically significant reductions in VAS scores over time within both groups (p < 0.001). At the 6-month follow-up, there were no significant differences between the groups regarding pain on palpation, swelling, percussion, or mobility (p > 0.05 for all comparisons using the Chi-square test). All teeth in the RMGIC group remained vital at the end of the study, while the vitality rate in the TheraCal LC group was 81%.

CONCLUSION: The study concluded that both RMGIC and TheraCal LC are effective as IPC materials for deep carious lesions with reversible pulpitis, though RMGIC showed a slight advantage in maintaining pulp vitality, reducing symptoms, and minimizing periapical changes over time.

CLINICAL SIGNIFICANCE: The clinical significance of this study is to offer evidence-based guidance for dental practitioners in choosing suitable materials for IPC in cases of deep carious lesions with reversible pulpitis. This research aims to support clinicians in making informed decisions that promote optimal patient care and improve the success and longevity of restorative treatments. How to cite this article: Deshmukh SN, Shenoy VU, Margasahayam SV, et al. Comparative Evaluation of Efficacy of Resin-modified Glass Ionomer Cement and Light-curable Tricalcium Silicate Cement as Indirect Pulp Capping Materials: A Randomized Clinical Trial. J Contemp Dent Pract 2024;25(12):1141-1147.

PMID:40079993 | DOI:10.5005/jp-journals-10024-3797

J Contemp Dent Pract. 2024 Dec 1;25(12):1127-1134. doi: 10.5005/jp-journals-10024-3787.

ABSTRACT

AIM AND BACKGROUND: The balance between mechanical properties, esthetics, and therapeutic benefits in restorative materials, especially for high-risk patients, is lacking. Effective comparative study designs are required. This randomized clinical trial evaluated the clinical performance of Alkasite bioactive restorative material vs resin-modified glass ionomer (RMGI) in cervical carious lesions according to United States Public Health Service (USPHS) criteria over 1 year.

MATERIALS AND METHODS: Twenty-eight high-risk adult patients with Class V cavities in anterior or premolar teeth were randomly assigned to two groups (n = 14 each). The first group received restorations with an RMGI. In contrast, using a selective etching technique and a universal adhesive, the second group was restored with a bulk-fill alkasite. All materials were applied according to the manufacturer’s instructions. The restorations were evaluated at baseline (1 week), after 6 months, and after 12 months using modified USPHS criteria. Data were recorded and statistically analyzed.

RESULTS: Regarding the primary outcome of marginal integrity, no statistically significant difference was found between the alkasite and RMGI restorations at any follow-up interval. However, within the RMGI group, a statistically significant change in marginal integrity was observed across different follow-up periods. All secondary outcomes showed no statistically significant differences in either intragroup or intergroup comparisons at the various follow-up intervals, except for anatomic form, where a statistically significant difference was observed within the RMGI group over different follow-up periods.

CONCLUSION: Both restorations have shown similar clinical performance over a year, indicating their effectiveness in cervical restorations. Alkasite restoration can successfully replace RMGI for cervical restorations in patients with a high caries index.

CLINICAL SIGNIFICANCE: This study addressed the need for restorative materials that balance mechanical strength, esthetics, and therapeutic benefits in high-risk patients. Alkasite restorations are promising alternatives to RMGI. The findings will guide material selection for enhanced functionality, esthetics, and long-term caries prevention.

CLINICAL TRIAL REGISTRATION NUMBER: NCT04716517. How to cite this article: Al-Salamony H, Akah M, Naguib EA, et al. Clinical Evaluation of Bulk-fill Alkasite Restoration vs Resin-modified Glass Ionomer in Class V Carious Lesions: 1-year Randomized Clinical Trial. J Contemp Dent Pract 2024;25(12):1127-1134.

PMID:40079991 | DOI:10.5005/jp-journals-10024-3787