Tag: statistics

JMIR Public Health Surveill. 2025 Mar 12;11:e58767. doi: 10.2196/58767.

ABSTRACT

BACKGROUND: Syndromic surveillance systems are crucial for the monitoring of population health and the early detection of emerging health problems. Internationally, there are numerous established systems reporting on different types of data. In the Netherlands, the Nivel syndromic surveillance system provides real-time monitoring on all diseases and symptoms presented in general practice.

OBJECTIVE: The present article introduces the national syndromic surveillance system in primary care, emphasizing its role in providing real-time information on infectious diseases and various health problems at the population level, in the Netherlands. In addition, we report on the central role of the participating general practices in data provision, and discuss the applicability of the syndromic surveillance data in different contexts of public health research.

METHODS: The Nivel syndromic surveillance system is part of the Nivel Primary Care Database (Nivel-PCD) that collects routinely recorded data from electronic health records of about 10% of the Dutch population, on the basis of approximately 500 practices. This translates to approximately 1.9 million citizens. Since 2010, the surveillance system relies on representative, pseudonymized data collected on a weekly basis from a subset of about 400 practices in the Nivel-PCD, for the entire practice population. Health problems are registered according to the International Classification of Primary Care, applied in all general practices in the Netherlands. Prevalence rates are recalculated and reported every week in the form of figures, also stratified by age, sex, and region. Weekly rates are defined as the number of people that consulted the general practitioner in a certain week for a specific health problem, divided by the total number of registered individuals in the practice.

RESULTS: While utilizing data from general practitioners’ electronic health records, the system allows for the timely monitoring and identification of symptom and disease patterns and trends, not only among individuals who seek primary health care, but the entire registered population. Besides their use in disease monitoring, syndromic surveillance data are useful in various public health research contexts, such as environmental health and disaster research.

CONCLUSIONS: The Nivel syndromic surveillance system serves as a valuable tool for health monitoring and research, offering valuable insights into public health.

PMID:40073415 | DOI:10.2196/58767

JMIR Med Educ. 2025 Mar 12;11:e67804. doi: 10.2196/67804.

ABSTRACT

BACKGROUND: Telenursing has become prevalent in providing care to diverse populations experiencing different health conditions both in Israel and globally. The nurse-patient relationship aims to improve the condition of individuals requiring health services.

OBJECTIVES: This study aims to evaluate nursing graduates’ skills and knowledge regarding remote nursing care prior to and following a simulation-based telenursing training program in an undergraduate nursing degree.

METHODS: A cohort study assessed 114 third-year nursing students using comprehensive evaluation measures of knowledge, skills, attitudes, self-efficacy, and clinical skills regarding remote nursing care. Assessments were conducted at 2 critical time points: prior to and following a structured simulation-based training intervention.

RESULTS: Participant demographics revealed a predominantly female sample (101/114, 88.6%), aged 20-50 years (mean 25.68, SD 4.59 years), with moderate to advanced computer and internet proficiency. Notably, 91.2% (104/114) had no telenursing exposure, yet 75.4% (86/114) expressed training interest. Statistical analyses demonstrated significant improvements across all measured variables, characterized by moderate to high effect sizes. Key findings included substantial increases in telenursing awareness, knowledge, skills, attitudes and self-efficacy; significant reduction in perceived barriers to remote care delivery; and complex interrelation dynamics between variables. A multivariate analysis revealed nuanced correlations: higher awareness and knowledge were consistently associated with more positive attitudes and increased self-efficacy. Positive attitudes correlated with enhanced self-efficacy and reduced perceived barriers. Change score analyses further indicated that increased awareness and knowledge facilitated more positive attitudinal shifts, while heightened awareness and positive attitudes corresponded with decreased implementation barriers.

CONCLUSIONS: The study underscores the critical importance of integrating targeted telenursing training into nursing education. By providing comprehensive preparation, educational programs can equip students to deliver optimal remote care services. The COVID-19 pandemic has definitively demonstrated that remote nursing will be central to future health care delivery, emphasizing the urgent need to prepare nursing students for this emerging health care paradigm.

PMID:40073414 | DOI:10.2196/67804

J Int Med Res. 2025 Mar;53(3):3000605251325677. doi: 10.1177/03000605251325677. Epub 2025 Mar 12.

ABSTRACT

ObjectiveThis study aimed to assess the practicality and optimal approach for inserting an anterior occipital condyle screw, as well as to measure the screw placement characteristics.MethodsA total of 80 normal head and cervical spine computed tomography scans (40 males/40 females) were used to construct three-dimensional models. The average age of the participants was 45.18 ± 8.86 years (ranging from 25 to 65 years). Three potential entry points for the anterior occipital condyle screw were identified. A simulated screw with a radius of 1.75 mm was created to replicate the screw trajectory and adjusted to establish the maximum and minimum cranial limits for each entry point. The feasibility of screw fixation was assessed, identifying the optimal entry point and analyzing relevant screw placement measurements.ResultsThe success rates for screw placement were 95.6%, 94.4%, and 88.1% for the middle, lateral, and medial entry points, respectively. The success rate for the medial entry point was notably lower than that for the middle and lateral points. No statistically significant differences were found in the measured parameters between the left and right sides. The medial entry point exhibited the highest abduction angulation (35.72° ± 2.01°) for screw placement, followed by the middle (25.96° ± 1.86°) and lateral (15.14° ± 1.82°) points. The middle and lateral entry points displayed a considerably wider safe range of cranial angulation and screw placement length than the medial entry point. All three entry points achieved success rates exceeding 90% when the cranial angulation ranged from 2° to 6°.ConclusionThe anterior occipital condyle screw presents a workable choice for anterior craniovertebral fixation. The middle entry point is identified as the optimal approach for placing 3.5-mm diameter screws.

PMID:40073407 | DOI:10.1177/03000605251325677

Endocr Regul. 2025 Mar 12;59(1):17-23. doi: 10.2478/enr-2025-0003. Print 2025 Jan 1.

ABSTRACT

Objective. Genetic factors contribute to the development of metabolic syndrome and subsequent arterial hypertension (AH). The study of the T786C polymorphism of the endothelial nitric oxide synthase (eNOS) gene in arterial hypertension is important as its correlation with adipokine imbalance is a novelty area to find associations between hypertension development, obesity, and heredity. The purpose of the current study was to investigate serum adipokines levels, depending on the T786C polymorphism of the eNOS in patients with arterial hypertension. Methods. We examined 86 patients with arterial hypertension who underwent the determination of the T786C-gene promoter eNOS allelic polymorphism by PCR with electrophoretic detection. Additionally, the serum adipokines (resistin, leptin, adipoleptin, and ghrelin) levels were determined using enzyme-linked immunosorbent assay. Results. In the patients with arterial hypertension, a significant increase in resistin level was found only in TC and CC genotype carriers of T786C, while adiponectin and leptin levels were significantly higher in all three genotypes (TT, TC, CC) compared to control healthy group. The most severe increase in the adipokine levels was observed in CC genotype, followed by TC geno-type. The antianorexic hormone ghrelin had an opposite trend, with the lowest levels found in CC, followed by TC, and TT genotypes of T786C promoter eNOS gene. Interestingly, ghrelin level in TT genotype patients was not statistically different from control healthy group. Conclusions. We demonstrated that CC and TC, compared with TT genotype carriers of the T786C polymorphism of the promoter eNOS gene, had significantly higher levels of all adipokines, except ghrelin, where an opposite trend was observed, which suggests their higher risk in development of more severe arterial hypertension with concomitant obesity, and other associated disorders.

PMID:40073405 | DOI:10.2478/enr-2025-0003

JMIR Res Protoc. 2025 Mar 12;14:e63891. doi: 10.2196/63891.

ABSTRACT

BACKGROUND: Breast cancer is the second most common cancer in women worldwide. Treatments for this disease often result in side effects such as pain, fatigue, loss of muscle mass, and reduced quality of life. Physical exercise has been shown to effectively mitigate these side effects and improve the quality of life in patients with breast cancer.

OBJECTIVE: This randomized clinical trial aims to evaluate the efficacy of a 12-week supervised exercise program on pain, physical function, and quality of life in female patients with cancer.

METHODS: This randomized, double-blind clinical trial will recruit 325 participants, divided into an intervention group receiving the exercise program and a control group receiving standard care recommendations. Outcome measures, including pain (assessed via the Brief Pain Inventory), physical function (Disability of the Arm, Shoulder, and Hand Questionnaire), and quality of life (European Organization for Research and Treatment of Cancer QLQ-C30 and European Organization for Research and Treatment of Cancer QLQ-BR23), will be evaluated at baseline, immediately post intervention, and 12 weeks post intervention. Statistical analysis will involve repeated measures of ANOVA and MANOVA to determine the significance of the intervention’s effects across time points.

RESULTS: Recruitment and data collection will commence in February of 2025, and data analysis is scheduled for completion at the end of 2025. No results are currently available.

CONCLUSIONS: Physical exercise is anticipated to play a significant role in alleviating pain, enhancing physical function, and improving the quality of life in female patients with cancer. This study will provide robust evidence to support the integration of supervised exercise into standard care protocols for this population.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06618690; https://clinicaltrials.gov/ct2/show/NCT06618690.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/63891.

PMID:40073395 | DOI:10.2196/63891

Pediatr Infect Dis J. 2025 Mar 12. doi: 10.1097/INF.0000000000004796. Online ahead of print.

ABSTRACT

BACKGROUND: Children living with HIV are at higher risk for hearing loss compared to children with HIV-unexposed, uninfected (HUU). There is little known regarding the effects of children living with perinatally-acquired HIV (PHIV) and those living with perinatal HIV exposure but uninfected (PHEU) on central auditory function.

METHODS: Children aged 11-14 years who were participating in the Auditory Research in Children with HIV study. Children were administered the dichotic digits test (DDT) to evaluate binaural integration as a part of a comprehensive hearing protocol. Scores were recorded as percent correct for each ear.

RESULTS: Data were collected on 268 children (102 HUU, 80 with PHEU and 86 with PHIV). Children with PHIV had the lowest median DDT for the right and left ears. After adjusting for age and grade level, children with PHIV had statistically significant 8-point lower DDT right ear percent correct (95% confidence interval [CI]: -13.69 to -1.86) and a 15-point lower DDT left ear percent correct (95% CI: -23.03 to -7.45) compared to HUU children. Children with PHEU did have slightly lower DDT scores bilaterally. In children living with PHIV, no HIV disease variables were significantly associated with DDT outcomes.

CONCLUSIONS: Both peripheral hearing loss and central auditory function should be evaluated in children living with HIV. Children living with PHIV have poorer DDT outcomes compared with HUU children, while children living with PHEU had similar DDT outcomes to HUU children. Poorer binaural integration can have a significant impact on functional auditory performance and academic achievement.

PMID:40073390 | DOI:10.1097/INF.0000000000004796

Pediatr Infect Dis J. 2025 Mar 7. doi: 10.1097/INF.0000000000004788. Online ahead of print.

ABSTRACT

BACKGROUND: Congenital cytomegalovirus is the leading cause of nongenetic sensorineural hearing loss. Treatment with (val)ganciclovir improves audiologic outcomes. Neutropenia is a common adverse event, but correlates that predict who will develop neutropenia have not been identified.

METHODS: Data from 3 National Institutes of Health-funded studies of intravenous ganciclovir or oral valganciclovir were evaluated. Baseline absolute neutrophil count (ANC) was defined as high (ANC >1000 cells/mm3) or low (ANC ≤1000 cells/mm3), and neutropenia was defined as ANC <800 cells/mm3. Mean 12-hour area under the curve (AUC12) ganciclovir values were analyzed as a function of degree of neutropenia using analysis of variance. AUC12 values ≥40 mgxhr/L were defined as high drug exposure and <40 mgxhr/L as low drug exposure.

RESULTS: Of 134 subjects who had AUC12 values obtained during the first week of treatment, 61 (46%) developed neutropenia <800 cells/mm3. Infants with high drug exposure developed neutropenia more rapidly than subjects with low drug exposure (median of 28 vs. 216 days; P < 0.008). Although not significant, infants with a baseline ANC ≤1000 cells/mm3 were observed to develop neutropenia more rapidly compared with those with a high baseline ANC (estimated median of 69 vs. 216 days; P = 0.22) and in greater proportions, although not statistically significant [55.6% vs. 39.3%; P = 0.21; odds ratio, 1.9 (95% CI, 0.71-5.20)].

CONCLUSIONS: High AUC12 correlated with the development of neutropenia in infants treated for symptomatic congenital cytomegalovirus disease. Low baseline ANC also may contribute to the development of neutropenia.

PMID:40073375 | DOI:10.1097/INF.0000000000004788

Am J Public Health. 2025 Apr;115(4):519-527. doi: 10.2105/AJPH.2024.307925.

ABSTRACT

Objectives. To test the association between directly observed school masking behaviors and the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in school wastewater. Methods. We randomly sampled a subset of schools participating in a translational study on the effectiveness of passive wastewater surveillance in nonresidential K‒12 settings in San Diego County. Trained observers conducted biweekly systematic observations of masking behaviors between March 2 and May 27, 2022. Results. The proportion of individuals observed masking was a significant predictor of detecting SARS-CoV-2 in school wastewater (adjusted odds ratio = 0.91; 95% confidence interval = 0.85, 0.99; P = .034). For every 10% increase in the percentage of observed individuals who were fully masked, the odds of detecting SARS-CoV-2 in school wastewater decreased by nearly 10%. Conclusions. Masking does not need to be perfect to be effective. Mask mandates are unlikely to be reimplemented in US schools, but interventions that encourage moderate increases in masking may have an important role to play in improving children’s health and decreasing the spread of COVID-19 and other respiratory diseases. (Am J Public Health. 2025;115(4):519-527. https://doi.org/10.2105/AJPH.2024.307925).

PMID:40073362 | DOI:10.2105/AJPH.2024.307925

Am J Public Health. 2025 Apr;115(4):596-604. doi: 10.2105/AJPH.2024.307940.

ABSTRACT

Dual-harm, the co-occurrence of self- and other-harm, recognizes the overlap between these outcomes of aggressive behavior and their potential shared causes. Little progress has been made in preventing and responding to dual-harm in the broader population, and it remains understudied in public health research. We posit that the scientific investigation of dual-harm would greatly benefit from the application of public health principles and methods. In this essay, we operationalize dual-harm as a public health problem and identify gaps in knowledge, addressing its conceptual and definitional issues, prevalence estimates, methodological considerations, theoretical foundations, risk factors, and prevention strategies. We also offer a series of recommendations to advance dual-harm study and challenge the notion of conflating nonfatal dual-harm with homicide-suicide as part of a continuum, arguing that they are distinct phenomena. We identify the need for epidemiological studies to characterize those engaging in dual-harm and better understand their mechanisms and outcomes, focusing on adolescence as a critical developmental period. Future studies should develop, implement, and evaluate targeted intervention and preventive efforts for individuals involved in or at risk for dual-harm. (Am J Public Health. 2025;115(4):596-604. https://doi.org/10.2105/AJPH.2024.307940).

PMID:40073361 | DOI:10.2105/AJPH.2024.307940

Am J Public Health. 2025 Apr;115(4):579-587. doi: 10.2105/AJPH.2024.307916.

ABSTRACT

Objectives. To evaluate the impact of the COVID-19 pandemic on HIV mortality rates with a focus on demographic predictors and Medicaid access. Methods. Using Wide-Ranging Online Data for Epidemiologic Research, we conducted a descriptive study comparing HIV mortality in the United States 2 years before the COVID-19 pandemic (2018-2019) and the initial 2 years of the pandemic (2020-2021), and identifying HIV mortality factors during the pandemic. Results. During the first 2 years of the pandemic, crude HIV death rates increased and then decreased marginally. COVID-19 and HIV together contributed to 11% of the HIV death rate. While African Americans had a higher HIV mortality rate, there was a slight decrease during the pandemic. Nonelderly adults in Medicaid expansion states had lower HIV mortality than those in nonexpansion states. Conclusions. Contrary to initial concerns, we found no substantial increase in HIV mortality. A slight decrease was observed with persisting racial disparities in mortality and lower mortality in states that expanded Medicaid. Public Health Implications. The study findings can inform the development of policies to address demographic disparities in HIV mortality through targeted system-level interventions for vulnerable populations, such as Medicaid expansion and Ryan White Program services. (Am J Public Health. 2025;115(4):579-587. https://doi.org/10.2105/AJPH.2024.307916).

PMID:40073359 | DOI:10.2105/AJPH.2024.307916