Tag: statistics

J Med Internet Res. 2025 Apr 28;27:e59037. doi: 10.2196/59037.

ABSTRACT

BACKGROUND: As populations age, the demand for long-term care services steadily increases. The effectiveness of government-promoted long-term care policies and the public’s access to relevant service information are demonstrably influenced by media representation. In addition, prior research has suggested that news framing can mitigate the negative influence (the Werther effect) with a more hopeful framing (the Papageno effect), thereby reducing the public’s susceptibility to negative news.

OBJECTIVE: This study investigates the phenomenon of suicides and homicides in long-term care reported in the news, in which family caregivers or care receivers died by suicide or homicide. We examined changes in the media’s reporting framework before and after the implementation of Taiwan’s Long-Term Care Plan 2.0 in 2017. We further examined the consistency between the content of news reports and the information provided by the media on long-term care services and suicide prevention (eg, hotlines).

METHODS: Content analysis and text-mining techniques were used to analyze 433 news reports covering 95 cases of suicides and homicides in long-term care in Taiwan from 2009 to 2021. A random-effects model was applied to examine term frequency transition post implementation.

RESULTS: The majority (>60%) of the cases involved family caregivers’ homicide-suicide. The term “family moral tragedy” has been replaced by “long-term care tragedy” in recent discourse. This shift is evident in a decline in the frequency of “family moral tragedy” since 2017, with usage decreasing by 32.4% in headlines and by 24% in news content. The term frequency of “care burden” has significantly increased from 0.0006 (SD 0.0008) to 0.017 (SD 0.0461; t₃₃₇=3.006; P=.003). While linguistic characteristics of the content have remained consistent, there were statistically significant differences in medical and ethics-related terms. The media tends to provide more suicide prevention information (eg, hotlines; >50%), offering relatively limited coverage on long-term care services (<25%).

CONCLUSIONS: The news media have the potential to change the public’s response to specific issues. Our findings suggest that government efforts to encourage media coverage of positive experiences with long-term care services can be a preventative measure against caregiving suicides and homicides. Moreover, government initiatives should focus on strengthening media publicity and enhancing media literacy within the long-term care sector. By empowering the media to provide readers with clear channels for seeking help, such as hotlines, the media will contribute positively to the mental health of family caregivers. Finally, an annual database on family caregiver homicide-suicide should be established. In that case, the government could identify potential risk factors and inform the formulation and revision of relevant policies and services via this database, ultimately contributing to preventing suicides and homicides in long-term care and achieving public health goals.

PMID:40293785 | DOI:10.2196/59037

J Med Internet Res. 2025 Apr 28;27:e66231. doi: 10.2196/66231.

ABSTRACT

BACKGROUND: A substantially lower proportion of female individuals participate in sufficient daily activity compared to male individuals despite the known health benefits of exercise. Investment in female sports and exercise medicine research may help close this gap; however, female individuals are underrepresented in this research. Hesitancy to include female participants is partly due to assumptions that biological rhythms driven by menstrual cycles and occurring on the timescale of approximately 28 days increase intraindividual biological variability and weaken statistical power. An analysis of continuous skin temperature data measured using a commercial wearable device found that temperature cycles indicative of menstrual cycles did not substantially increase variability in female individuals’ skin temperature. In this study, we explore physical activity (PA) data as a variable more related to behavior, whereas temperature is more reflective of physiological changes.

OBJECTIVE: We aimed to determine whether intraindividual variability of PA is affected by biological sex, and if so, whether having menstrual cycles (as indicated by temperature rhythms) contributes to increased female intraindividual PA variability. We then sought to compare the effect of sex and menstrual cycles on PA variability to the effect of PA rhythms on the timescales of days and weeks and to the effect of nonrhythmic temporal structure in PA on the timescale of decades of life (age).

METHODS: We used minute-level metabolic equivalent of task data collected using a wearable device across a 206-day study period for each of 596 individuals as an index of PA to assess the magnitudes of variability in PA accounted for by biological sex and temporal structure on different timescales. Intraindividual variability in PA was represented by the consecutive disparity index.

RESULTS: Female individuals (regardless of whether they had menstrual cycles) demonstrated lower intraindividual variability in PA than male individuals (Kruskal-Wallis H=29.51; P<.001). Furthermore, individuals with menstrual cycles did not have greater intraindividual variability than those without menstrual cycles (Kruskal-Wallis H=0.54; P=.46). PA rhythms differed at the weekly timescale: individuals with increased or decreased PA on weekends had larger intraindividual variability (Kruskal-Wallis H=10.13; P=.001). In addition, intraindividual variability differed by decade of life, with older age groups tending to have less variability in PA (Kruskal-Wallis H=40.55; P<.001; Bonferroni-corrected significance threshold for 15 comparisons: P=.003). A generalized additive model predicting the consecutive disparity index of 24-hour metabolic equivalent of task sums (intraindividual variability of PA) showed that sex, age, and weekly rhythm accounted for only 11% of the population variability in intraindividual PA variability.

CONCLUSIONS: The exclusion of people from PA research based on their biological sex, age, the presence of menstrual cycles, or the presence of weekly rhythms in PA is not supported by our analysis.

PMID:40293784 | DOI:10.2196/66231

Pain Med. 2025 Apr 28:pnaf051. doi: 10.1093/pm/pnaf051. Online ahead of print.

ABSTRACT

OBJECTIVES: There are no updated systematic reviews examining the prevalence of persistent pain among head and neck cancer survivors. This systematic review aims to identify the prevalence and characteristics of persistent pain across locations among head and neck cancer survivors.

METHODS: A systematic review was conducted according to PRISMA guidelines on December 14th, 2023 (PROSPERO reference CRD42024494926). The MEDLINE via PubMed, Scopus, Web of Science, CINAHL, Ovid and Cochrane Library databases were searched. Studies had to report prevalence data on persistent pain in head and neck cancer survivors who completed cancer treatment at least 3 months ago. Quality of the included studies was assessed using the critical appraisal tool developed by the Joanna Briggs Institute. Statistical heterogeneity was assessed prior to performing the meta-analysis using τ2, I2, and Q. Univariate meta-regression analyses were used to examine sources of heterogeneity.

RESULTS: 1713 records were retrieved. After removing duplicates 1385 articles were screened.Ultimately, 182 articles were assessed for full-text screening, of which 17 manuscripts were included for review. The prevalence of the studies was 31% (95% CI: 20-42). The meta-regression explained approximately 40% of the observed heterogeneity (R2 = 40.57).

CONCLUSION: This systematic review highlights that almost third of head and neck cancer survivors are under persistent pain after finishing cancer treatment. No final conclusions can be drawn as to which extent cancer location, cancer treatment, pain measurement method and timing of pain assessments could modify this prevalence. Results should be interpreted with caution since there is considerable variability in the methods.

PMID:40293769 | DOI:10.1093/pm/pnaf051

JAMA Netw Open. 2025 Apr 1;8(4):e256558. doi: 10.1001/jamanetworkopen.2025.6558.

ABSTRACT

IMPORTANCE: Limited research explores within-group and between-group differences in the prevalence of and factors associated with psychological distress among Black or African American adults, especially by nativity.

OBJECTIVE: To estimate the prevalence of moderate-to-severe (hereafter, moderate-severe) psychological distress and to assess factors associated with increased risk among Black or African American adults according to nativity.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study drew data from the 2005 to 2018 National Health Interview Surveys. The study analyzed national household probability samples of the civilian noninstitutionalized Black or African American adult population aged 18 years or older, including US-born and non-US-born subgroups, between January to December 2005 and January to December 2018. Data analysis was performed from November 2023 to January 2025.

EXPOSURES: Birthplace (ie, US-born if born in the US; non-US-born if born outside the US, including US territories). Risk factors included sociodemographic, socioeconomic, and health behavior factors.

MAIN OUTCOMES AND MEASURES: The primary outcome was moderate-severe psychological distress status based on self-reported responses to the Kessler Psychological Distress Scale. Odds ratios (ORs) with 95% CIs were reported as estimates to determine the computed associations across logistic regression models.

RESULTS: A total of 49 820 individuals (43 885 born in the US and 5935 born outside the US) were analyzed. Overall, 21.9% of the sample (11 079 individuals) experienced moderate-severe psychological distress, with a higher prevalence among US-born (10 037 individuals [22.6%]) than non-US-born (1042 individuals [17.4%]) individuals. Individuals aged 65 years or older (especially US-born; OR, 0.51; 95% CI, 0.44-0.58) and male individuals (especially non-US-born; OR, 0.68; 95% CI, 0.56-0.82) had lower odds of experiencing moderate-severe psychological distress. Unemployment (OR, 1.91; 95% CI, 1.80-2.03) and having less than a college education were associated with higher odds of moderate-severe psychological distress across the subgroups, especially among US-born individuals. Current and former smoking was associated with higher odds of moderate-severe psychological distress, with greater odds among non-US-born individuals than among US-born and overall Black or African American individuals. Current and former alcohol drinking was associated with higher odds among only the general population (current drinking, OR, 1.37 [95% CI, 1.29-1.47]; former drinking, OR, 1.26 [95% CI, 1.16-1.37]) and US-born individuals (current drinking, OR, 1.45 [95% CI, 1.36-1.56]; former drinking, OR, 1.29 [95% CI, 1.19-1.41]), with higher ORs among US-born population.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of differences in moderate-severe psychological distress by nativity among Black or African American adults, more pronounced risks were observed among US-born individuals. Longitudinal studies and data disaggregation could further elucidate health differences to improve cultural competence and adaptability in mental health research and interventions.

PMID:40293749 | DOI:10.1001/jamanetworkopen.2025.6558

JAMA Netw Open. 2025 Apr 1;8(4):e257695. doi: 10.1001/jamanetworkopen.2025.7695.

ABSTRACT

IMPORTANCE: Although overall US mortality rates declined from 1969 to 2020, they vary considerably by state and generation, especially when evaluated by birth cohort. Trends in mortality and life expectancy by birth cohort for US states and Washington, DC, have yet to be characterized.

OBJECTIVE: To estimate cohort mortality trends for each state and Washington, DC, and quantify life expectancy at birth and 40 years of age and the rate of increase after 35 years of age.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, all-cause mortality rates by single years of age (0-119) and birth cohort (1900-2000) were estimated for each state in January 2025. Mortality data and population estimates were obtained from the National Center for Health Statistics, the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research website, and the Surveillance, Epidemiology, and End Results database for each state and Washington, DC, by single years of ages 0 to 84 and calendar years 1969 to 2020. An age-period-cohort model with constrained cubic splines for temporal effect estimates was used to estimate mortality from 1900 to 2000.

MAIN OUTCOMES AND MEASURES: Life expectancy for each cohort from birth or 40 years of age was estimated by sex and state, along with doubling time for the death rate after 35 years of age.

RESULTS: Analyses included 179 million deaths (77 million female and 102 million male). In the West and Northeast, cohort life expectancy improved from 1900 to 2000, but in some Southern states, it changed less than 3 years since 1900 in females and less than 2 years since 1950 in males. Washington, DC, had the lowest life expectancy in the 1900 birth cohort but a greater increase than the other states (from 61.1 to 72.8 years of age). After 35 years of age, the highest rate-doubling time in a state was 9.39 years in New York for females and 11.47 years for males in Florida. The shortest rate-doubling times were 7.96 years for females in Oklahoma and 8.95 years for males in Iowa.

CONCLUSIONS AND RELEVANCE: Cohort-specific patterns across states reveal wide disparities in mortality. Some states have experienced little or no improvements in life expectancy from the 1900 to 2000 birth cohorts. Understanding how mortality patterns vary by birth cohort within each state can inform decision-making around resource allocation and public health interventions.

PMID:40293748 | DOI:10.1001/jamanetworkopen.2025.7695

JAMA Netw Open. 2025 Apr 1;8(4):e257733. doi: 10.1001/jamanetworkopen.2025.7733.

ABSTRACT

IMPORTANCE: Clinical trials represent the gold standard to test the safety and efficacy of new or updated approaches to treatments that will inform quality cancer care. However, cancer trials enroll few patients in low- and middle-income countries (LMICs), are often led by investigators from high-income countries, and do not adequately reflect global disease burden or population diversity.

OBJECTIVE: To identify key challenges and strategies to advance contextually relevant, quality cancer trials in LMICs.

DESIGN, SETTING, AND PARTICIPANTS: The survey used in this survey study was available in English, Arabic, French, Portuguese, and Spanish and was conducted by the US National Cancer Institute from October 18 to December 22, 2023. Clinicians with experience in cancer therapeutic clinical trials in LMICs were eligible. The survey covered their professional background and views on challenges and strategies for improving clinical trial opportunities in LMICs. Analysis was performed from April 2 to August 26, 2024.

MAIN OUTCOMES AND MEASURES: Respondents were asked to rate 34 challenges by impact on their ability to conduct cancer trials using a 4-point Likert scale and 8 strategies by importance using a 5-point Likert scale. Descriptive statistics summarized participants’ backgrounds, challenges, and priorities.

RESULTS: Of 453 respondents who began the survey, a total of 223 (49%) were eligible for inclusion, and 131 of those (59%) completed the survey in full. Among the 133 respondents who provided gender data, 81 (61%) were male. In all, 107 of 130 respondents (82%) were affiliated with LMIC institutions, 65 of 223 (29%) were medical oncologists, and 52 of 133 (39%) were midcareer. Financial challenges were rated as the most impactful, with 133 of 170 respondents (78%) rating difficulty obtaining funding for investigator-initiated trials as having a large impact on ability to carry out a trial. Human capacity issues followed, with 105 of 192 respondents (55%) rating lack of dedicated research time as having a large impact. Increasing opportunities for funding and improving human capacity were reported as key strategies to advance capacity to conduct clinical trials in LMICs.

CONCLUSIONS AND RELEVANCE: This survey study of clinicians with clinical trial experience in LMICs suggests that adequate funding and a well-trained research workforce are 2 predominant challenges to advancing cancer therapeutic clinical trials in LMICs. Understanding these obstacles can inform efforts to support cancer clinical trials that better reflect worldwide needs and diversity by prioritizing and sustaining research led by LMIC investigators.

PMID:40293747 | DOI:10.1001/jamanetworkopen.2025.7733

JAMA Netw Open. 2025 Apr 1;8(4):e257766. doi: 10.1001/jamanetworkopen.2025.7766.

ABSTRACT

IMPORTANCE: Older children awaiting a heart transplant (HT) sometimes receive a heart offer from a donor with a history of drug use (HDU). The effect of using such donor hearts on posttransplant survival in pediatric recipients is unclear.

OBJECTIVE: To assess the association of using hearts from donors with HDU on posttransplant graft survival in pediatric HT recipients.

DESIGN, SETTING, AND PARTICIPANTS: For this retrospective cohort study, all pediatric HT recipients (aged <18 years) in the Organ Procurement and Transplantation Network database during January 1, 2000, to December 31, 2020, were identified. Among the recipients who received a heart from a donor with HDU, nearly all donors were aged 11 years or older. A propensity score (PS) model was developed to assess the probability of receiving a heart from a donor with HDU using baseline recipient and donor variables, limiting the study cohort to donors aged 11 years or older. Data were analyzed from October 2023 to November 2024.

EXPOSURE: HT using a heart from a donor with HDU (exposure group) vs from a donor without HDU (control group).

MAIN OUTCOMES AND MEASURES: The main outcome was graft loss (death or retransplant) assessed at 90 days after transplant and long term among 90-day survivors. Kaplan-Meier survival curves and a Cox proportional hazards regression model that accounted for matching of exposure and control groups were used to compare risk of graft loss.

RESULTS: This study included 2730 pediatric HT recipients. Their median age at HT was 14 years (IQR, 11-16 years), and most (1642 [60.1%]) were male. Overall, the exposure group comprised 822 children who received a heart from a donor with HDU; of these, 765 (93.1%) were PS matched to the control group. There was no difference in risk of graft loss within 90 days (hazard ratio [HR], 0.93 [95% CI, 0.55-1.57]; P = .78) or at long-term follow-up (HR, 1.04 [95% CI, 0.87-1.25]; P = .68) between PS-matched groups. Risk of graft loss within 90 days was not significantly different in children who received a heart from a donor with a history of cocaine use (157 pairs) vs children in the control group (HR, 0.55 [95% CI, 0.19-1.54]; P = .25); however, the risk of long-term graft loss among 90-day survivors was significantly higher (HR, 2.03 [95% CI, 1.35-3.06]; P = .001).

CONCLUSIONS AND RELEVANCE: In this cohort study of pediatric HT recipients, there was no association of 90-day graft survival with donor HDU; however, donor history of cocaine use was associated with a higher risk of long-term graft loss. These findings may be important when considering a donor with HDU for pediatric HT candidates.

PMID:40293746 | DOI:10.1001/jamanetworkopen.2025.7766

Environ Toxicol Chem. 2025 Apr 28:vgaf111. doi: 10.1093/etojnl/vgaf111. Online ahead of print.

ABSTRACT

Microplastics (MPs) are pervasive pollutants due to their extensive dispersion across terrestrial, marine, freshwater environments, and even the atmosphere. Beyond the common sources of MPs from the degradation of larger plastic items, an often-overlooked primary source is glitter. Widely incorporated into everyday products, glitter not only poses a significant environmental risk due to its ease of dispersion but also holds cultural importance in regions like Brazil, where it is extensively used in festivities. Understanding glitter as a type of microplastic can offer valuable insights into the effects of MPs on aquatic ecosystems, particularly concerning freshwater macroinvertebrates. Given the ecological significance of this issue, our study investigated the ingestion and potential bioaccumulation of MPs by macroinvertebrates in the phytotelmata of Aechmea blanchetiana bromeliads. Organisms were exposed to a microplastic treatment (0.1 g/L glitter) for seven days, followed by taxonomic identification and analysis of MP distribution across body segments. Statistical tests assessed variations in MP distribution among taxa and body regions. Results revealed significant MP ingestion, with the highest concentrations in Culicidae and Chironomidae, suggesting that their generalist feeding behaviors facilitate MP intake. Observations also pointed to preferential accumulation of MPs in certain body parts, indicating potential bioaccumulation. Additionally, the presence of fragmenting MP particles within these taxa highlights their potential role in enhancing MP bioavailability in aquatic environments. Chironomidae and Culicidae, through ingestion and fragmentation, may increase MP dispersal across trophic levels, which could exacerbate bioaccumulation risks within the food web. This evidence supports the use of Chironomidae and Culicidae as effective biomonitors for MPs and calls attention to the ecological implications of glitter pollution in tropical freshwater ecosystems.

PMID:40293741 | DOI:10.1093/etojnl/vgaf111

J Pediatr Orthop B. 2025 Apr 29. doi: 10.1097/BPB.0000000000001253. Online ahead of print.

ABSTRACT

Opioids are the mainstay of pain management in scoliosis surgery. We hypothesized that in adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) surgery, perioperative intravenous (IV) lidocaine would reduce postoperative opioid requirement and pain scores. In this retrospective observational before-and-after study, we identified AIS patients who underwent single-stage PSF at a tertiary university hospital from 2020 to 2022. All patients received total intravenous anesthesia. The Lidocaine group received a bolus of 1.5 mg/kg IV lidocaine prior to induction, followed by infusion at 2 mg/kg/h. At wound closure, the rate was reduced to 1 mg/kg/h and continued for 30 min in recovery. All patients received patient-controlled analgesia (PCA) morphine postoperatively. The primary outcome was total morphine consumption in the first 24 h. The secondary outcome was mean pain scores over 48 h using a numerical rating scale. We included 115 patients: 59 in the Usual Care group and 56 in the Lidocaine group. Postoperative morphine use in the first 24 h showed no significant difference (Lidocaine: 13.5 ± 8.9 mg vs Usual Care: 13.9 ± 10.6 mg; P = 0.821). The cumulative morphine milligram equivalents per kilogram bodyweight at 48 h was 0.43 mg/kg. Mean pain scores were higher in the Lidocaine group in the first 48 h (4.25 ± 0.37 vs 3.67 ± 1.46; P = 0.03). Perioperative IV lidocaine administered as an analgesic adjunct for AIS surgery did not reduce postoperative morphine requirement. Although pain scores were statistically higher in patients receiving intravenous lidocaine, the difference was minimal and lacked clinical significance.

PMID:40293731 | DOI:10.1097/BPB.0000000000001253

J Strength Cond Res. 2025 Apr 29. doi: 10.1519/JSC.0000000000005116. Online ahead of print.

ABSTRACT

Nakamura, H, Yamashita, D, Nishiumi, D, Nakaichi, N, and Hirose, N. Factors influencing change of direction performance in youth soccer players: velocity-time profile analysis of the Pro-Agility test. J Strength Cond Res XX(X): 000-000, 2025-The purpose of this study was to assess factors influencing change of direction (COD) deficit (CODD) and total time completion (CODTT) in adolescent soccer players through velocity-time profile analysis of the Pro-Agility Test. We enrolled 71 junior high school male soccer players and measured the 20-m sprint time and CODTT of the Pro-Agility Test, calculating CODD by subtracting the 20-m sprint time from CODTT. In addition, 3-dimensional motion data were collected using a markerless motion capture system during the Pro-Agility Test. Each section (5 m in the first, 10 m in the second, and 5 m in the third) was divided into acceleration and deceleration phases based on center of mass (COM) velocity, which were further divided into early and late halves. The mean COM acceleration during the acceleration phase (Acc) and deceleration during the deceleration phase (Dec) were calculated. Stepwise multiple regression analysis was performed to identify phases affecting CODTT and CODD. Statistical significance was set at p < 0.05. Total time completion of a COD task was explained by the second early Acc (β = -0.500), second late Dec (β = 0.433), and 20-m sprint time (β = 0.226) (adjusted R2 = 0.858), whereas CODD was explained by the second late Dec (β = 0.561) and second early Acc (β = -0.271) (adjusted R2 = 0.459). Maturity offset significantly correlated with CODTT (r = -0.456) but not with CODD (r = -0.119). The results indicated that deceleration and reacceleration during the Pro-Agility Test can be evaluated in adolescents by combining CODTT and CODD.

PMID:40293724 | DOI:10.1519/JSC.0000000000005116