Tag: statistics

JAMA Netw Open. 2025 Mar 3;8(3):e250274. doi: 10.1001/jamanetworkopen.2025.0274.

ABSTRACT

IMPORTANCE: Benefits of breastfeeding are extensive, but racial and ethnic disparities persist. Mama Sana (Spanish for healthy mother) is a bilingual, culturally tailored program that aims to reduce breastfeeding inequities.

OBJECTIVE: To examine differences in lactation support and breastfeeding outcomes among Spanish-speaking Hispanic birthing parents who participated in Mama Sana compared with a historical control (pre-Mama Sana) group.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, patients who participated in the Mama Sana program during their delivery hospitalization from January 2022 to September 2023 were compared with a historical control group who delivered prior to the implementation of the program (July 2019 to December 2021). The study took place at an academic medical center in Boston with a high-risk obstetric service. Data were analyzed from January to September 2024.

EXPOSURE: Beginning in January 2022, a bilingual native Spanish-speaker licensed as a registered dietitian and certified lactation counselor provided lactation support to participants during their delivery hospitalization with follow-up phone calls after discharge (until 6 months post partum).

MAIN OUTCOMES AND MEASURES: The primary outcome was exclusive breastfeeding at discharge. Secondary outcomes included any breastfeeding at discharge, any breastfeeding and exclusive breastfeeding at 6 weeks post partum, and change in maternal body mass index (BMI). Process measures included inpatient lactation consult placement and receipt of any and language-concordant lactation support. The χ2 test was used to analyze outcomes, process measures, and balancing measures.

RESULTS: In this study, 417 patients were included (Mama Sana group, 175 patients; mean [SD] age, 28.9 [6.1] years; pre-Mama Sana group: 242 patients; mean [SD] age, 29.8 [6.1] years). Sociodemographic characteristics including age and BMI were similar between groups. Mama Sana participants were less likely to be multiparous or to have diabetes compared with the pre-Mama Sana group. At hospital discharge, 36 of 175 Mama Sana participants (20.6%) were exclusively breastfeeding compared with 39 of 242 pre-Mama Sana (16.1%) (adjusted risk difference [aRD], 2.5%; 95% CI, -1.2 to 6.4). Significantly more Mama Sana participants engaged in any breastfeeding prior to hospital discharge (172 of 175 [98.3%] vs 222 of 242 [91.7%]; aRD, 7.1%; 95% CI, 2.8% to 11.5%) and at the 6 week postpartum visit (81 of 102 [79.4%] vs 109 of 170 [64.1%]; aRD, 15.6%; 95% CI, 4.8% to 26.4%) compared with the pre-Mama Sana group. More Mama Sana participants had a lactation consult placed (109 of 175 [62.3%] vs 108 of 242 [44.6%]; P < .001) and received lactation support in Spanish (175 of 175 [100%] vs 49 of 242 [20.3%]; P < .001) than those in the pre-Mama Sana group.

CONCLUSIONS AND RELEVANCE: In this cohort study, Mama Sana’s language-concordant, culturally tailored lactation program was associated with higher rates of lactation support and some breastfeeding outcomes, which suggests the program may be a useful approach to perinatal care equity.

PMID:40053351 | DOI:10.1001/jamanetworkopen.2025.0274

JAMA Netw Open. 2025 Mar 3;8(3):e250283. doi: 10.1001/jamanetworkopen.2025.0283.

ABSTRACT

INTRODUCTION: Mass shootings, defined as incidents where 4 or more people are shot with a firearm, have become a significant public health concern in the US.

OBJECTIVE: To estimate the prevalence of direct exposure to mass shootings among US adults and identify the sociodemographic groups most affected.

DESIGN, SETTING, AND PARTICIPANTS: A survey was administered in January 2024 to a sample of 10 000 respondents (18 years or older) designed to be representative of US adults using a multistage matched sampling design. In addition to exposure to mass shootings, the survey also collected sociodemographic information, including age, gender, self-reported race and ethnicity, and socioeconomic status.

EXPOSURE: Survey respondents were asked about their lifetime presence at the scene of a mass shooting, any physical injuries sustained (including being shot or trampled or experiencing a related physical injury), and the features of such incidents.

MAIN OUTCOME AND MEASURES: Multivariable logistic regression was used to generate adjusted odds ratios (AORs) of the associations between sociodemographic measures and being present on the scene of and injured in a mass shooting. All analyses undertaken to generate population and relational inferences were weighted to achieve representativeness of US adults.

RESULTS: Of the 10 000 respondents included in the analysis, 51.34% (95% CI, 50.27%-52.40%) were female. In terms of race and ethnicity, 3.04% (95% CI, 2.71%-3.38%) were Asian, 12.46% (95% CI, 11.81%-13.12%) were Black, 16.04% (95% CI, 15.10%-16.98%) were Hispanic, 62.78% (95% CI, 61.73%-63.84%) were White, and 5.67% (95% CI, 5.23%-6.11%) were other race or ethnicity. The findings indicated that 6.95% (95% CI, 6.39%-7.50%) of respondents were present at the scene of a mass shooting, and 2.18% (95% CI, 1.85%-2.50%) sustained physical injuries, such as being shot or trampled, during such incidents. A total of 54.89% of mass shootings to which respondents were exposed occurred in 2015 or more recently, and 76.15% took place in respondents’ local communities. Mass shootings were most likely to occur in neighborhoods. Younger individuals (eg, AOR for Baby Boomer and Silent generations vs Generation Z, 0.12; 95% CI, 0.09-0.18) and males (AOR, 1.55; 95% CI, 1.29-1.85) were more likely to report exposure compared with those from older generations or female individuals, respectively. Black respondents reported higher rates of being present at mass shootings (AOR, 1.87; 95% CI, 1.49-2.34), while Asian respondents reported lower rates (AOR, 0.36; 95% CI, 0.19-0.66), compared with White respondents, but there were no racial and ethnic differences in injuries sustained.

CONCLUSIONS AND RELEVANCE: The findings from this survey study of US adults underscore the extensive and often overlooked regular exposure to mass shootings in this country. The demographic disparities in exposure highlight the need for targeted interventions and support for the most affected groups, particularly younger generations and males. Understanding these patterns is essential for addressing the broader impacts of gun violence on public health and community well-being.

PMID:40053350 | DOI:10.1001/jamanetworkopen.2025.0283

JAMA Netw Open. 2025 Mar 3;8(3):e250295. doi: 10.1001/jamanetworkopen.2025.0295.

ABSTRACT

IMPORTANCE: Surgical cancer treatments may be delayed for patients who smoke over concerns for increased risk of complications. Quantifying risks for people who had recently smoked can inform any trade-offs of delaying surgery.

OBJECTIVE: To investigate the association between smoking status or smoking cessation time and complications after cancer surgery.

DATA SOURCES: Embase, CINAHL, Medline COMPLETE, and Cochrane Library were systematically searched for studies published from January 1, 2000, to August 10, 2023.

STUDY SELECTION: Observational and interventional studies comparing the incidence of complications in patients undergoing cancer surgery who do and do not smoke.

DATA EXTRACTION AND SYNTHESIS: Two reviewers screened results and extracted data according to the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Data were pooled with a random-effects model and adjusted analysis was performed.

MAIN OUTCOMES AND MEASURES: The odds ratio (OR) of postoperative complications (of any type) for people who smoke currently vs in the past (4-week preoperative cutoff), currently smoked vs never smoked, and smoked within shorter (2-week cutoff) and longer (1-year cutoff) time frames.

RESULTS: The meta-analyses across 24 studies with a pooled sample of 39 499 participants indicated that smoking within 4 weeks preoperatively was associated with higher odds of postoperative complications compared with ceasing smoking for at least 4 weeks (OR, 1.31 [95% CI, 1.10-1.55]; n = 14 547 [17 studies]) and having never smoked (OR, 2.83 [95% CI, 2.06-3.88]; n = 9726 [14 studies]). Within the shorter term, there was no statistically significant difference in postoperative complications between people who had smoked within 2 weeks preoperatively and those who had stopped between 2 weeks and 3 months in postoperative complications (OR, 1.19 [95% CI, 0.89-1.59]; n = 5341 [10 studies]), although the odds of complications among people who smoked within a year of surgery were higher compared with those who had quit smoking for at least 1 year (OR, 1.13 [95% CI, 1.00-1.29]; N = 31 238 [13 studies]). The results from adjusted analyses were consistent with the key findings.

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of smoking cessation and complications after cancer surgery, people with cancer who had stopped smoking for at least 4 weeks before surgery had fewer postoperative complications than those smoking closer to surgery. High quality, intervention-based evidence is needed to identify the optimal cessation period and inform clinicians on the trade-offs of delaying cancer surgery.

PMID:40053349 | DOI:10.1001/jamanetworkopen.2025.0295

JAMA Netw Open. 2025 Mar 3;8(3):e250314. doi: 10.1001/jamanetworkopen.2025.0314.

ABSTRACT

IMPORTANCE: Studies of brain imaging and movements during rapid eye movement sleep indicate basal ganglia involvement in pediatric acute-onset neuropsychiatric syndrome (PANS). Characterizing neurological findings that commonly present among patients with PANS could improve diagnostic accuracy.

OBJECTIVES: To evaluate the prevalence of neurological soft signs (NSSs) that may be associated with basal ganglia dysfunction among youths presenting with PANS and assess whether clinical characteristics of PANS correlate with NSSs that may be associated with basal ganglia dysfunction.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 135 new patients who met strict PANS criteria and were evaluated at the Stanford Children’s Immune Behavioral Health Clinic between November 1, 2014, and March 1, 2020. Data on these patients were retrospectively reviewed between December 13, 2020, and September 25, 2023. Sixteen patients were excluded because they had no neurological examination within the first 3 visits and within 3 months of clinical presentation. Statistical analysis was conducted between September 26, 2023, and November 22, 2024.

MAIN OUTCOMES AND MEASURES: The following NSSs that may be associated with basal ganglia dysfunction were recorded from medical record review: (1) glabellar tap reflex, (2) tongue movements, (3) milkmaid’s grip, (4) choreiform movements, (5) spooning, and (6) overflow movements. Data from prospectively collected symptoms and impairment scales (Global Impairment Score [GIS; score range, 1-100, with higher scores indicating greater impairment] and Caregiver Burden Inventory [score range, 0-96, with higher scores indicating greater caregiver burden]) were included.

RESULTS: The study included 119 patients; the mean (SD) age at PANS onset was 8.2 (3.6) years, the mean (SD) age at initial presentation was 10.4 (3.6) years, and 66 (55.5%) were boys. At least 1 NSS that may be associated with basal ganglia dysfunction was observed in 95 patients (79.8%); the mean (SD) number of NSSs was 2.1 (1.6). Patients with 4 or more NSSs had higher GISs (mean [SD] score, 56.0 [22.6] vs 40.6 [26.7]; P = .05) and more symptoms (mean [SD] number, 15.1 [4.9] vs 11.5 [4.2]; P = .008) than patients with 0 NSSs. There was no significant difference in age at visit or in Caregiver Burden Inventory score. On Poisson and linear regression, the number of NSSs was associated with global impairment, with 1 more sign increasing the GIS by 2.86 (95% CI, 0.09-5.62; P = .04), and with the number of symptoms, with 1 more sign increasing the number of symptoms by 5% (1.05; 95% CI, 1.02-1.08; P = .002), but not with age or duration of PANS at presentation.

CONCLUSIONS AND RELEVANCE: This cohort study of patients with PANS found a high prevalence of NSSs that may be associated with basal ganglia dysfunction and an association between these NSSs and disease severity that was not associated with younger age. PANS may have a unique profile, suggesting that targeted neurological examinations may support PANS diagnosis.

PMID:40053347 | DOI:10.1001/jamanetworkopen.2025.0314

JAMA Health Forum. 2025 Mar 7;6(3):e250054. doi: 10.1001/jamahealthforum.2025.0054.

ABSTRACT

IMPORTANCE: Parental substance use is a primary driver of child welfare system involvement, and child welfare services primarily seek to address caregiver challenges, including connecting parents to treatment. Although research highlights that formal child welfare services connect children to health care professionals, less is known about how the system affects caregivers’ substance use treatment.

OBJECTIVE: To examine the prevalence of maternal substance use disorder (SUD) in the Pennsylvania child welfare system and the association between formal child welfare system response and mothers’ take-up of SUD treatment.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used linked Medicaid claims and child welfare system records for mothers enrolled in Medicaid and involved in the Pennsylvania child welfare system between 2015 and 2018, followed by 12 months postsystem contact. The study applied a difference-in-differences framework to estimate associations between child welfare system intervention and maternal SUD treatment utilization. Data were analyzed from January to September 2024.

EXPOSURE: Child welfare system intervention was defined in 3 categories: no formal services, in-home services, and foster care services.

MAIN OUTCOMES AND MEASURES: Maternal SUD was defined by International Classification of Diseases, Ninth Revision or Tenth Revision diagnosis codes. Dependent variables were mothers’ monthly and cumulative use of inpatient and outpatient SUD treatment, defined by procedure and service location codes.

RESULTS: Among 46 484 mothers, the prevalence of maternal SUD was estimated at 62% within the child welfare system population, predominantly involving opioid and polysubstance use. Compared with mothers who did not receive a formal child welfare system response, those who received a formal intervention had a statistically significant higher probability of monthly outpatient (in-home services: 24%; 95% CI, 18%-28%; foster care: 63%; 95% CI, 55%-75%) and inpatient (in-home services: 36%; 95% CI, 23%-48%; foster care: 130%; 95% CI, 103%-156%) SUD treatment in the 12 months after referral.

CONCLUSIONS AND RELEVANCE: This cohort study demonstrates that formal child welfare services can facilitate substance use treatment for caregivers. As states seek to reduce the role of formal child welfare system responses in responding to parental substance use, alternative strategies to engage and retain parents in treatment are needed.

PMID:40053337 | DOI:10.1001/jamahealthforum.2025.0054

Sex Transm Dis. 2025 Apr 1;52(4):248-254. doi: 10.1097/OLQ.0000000000002106. Epub 2024 Nov 25.

ABSTRACT

BACKGROUND: Sexually transmitted infections (STIs) and HIV disproportionately affect young people; gay, bisexual, queer, and other men who have sex with men (GBQMSM); transgender women; and persons of color. Our community-based participatory research partnership developed and implemented Impact Triad, a bilingual multilevel intervention harnessing peer navigation and mHealth to increase STI/HIV preventive behaviors and address 4 community-prioritized social determinants of health-education, employment, social support, and discrimination-among young African American/Black and Latine GBQMSM and transgender women.

METHODS: Fifteen community-based peer navigators were trained to work within their social networks for 12 months. Each navigator engaged 5 social network members who completed baseline and immediate post-intervention assessments (retention rate, 97.3%). Regression modeling was used to assess changes in outcomes between baseline and follow-up.

RESULTS: Among 74 enrolled social network members, the average age was 27.8 years; 61% identified as African American/Black, 31% as Latine, and 8% as multiracial/multiethnic. The majority self-identified as cisgender men and 8% as transgender women; 78% identified as gay. About half reported monthly income below $1000.Compared with baseline, at follow-up, social network members increased: STI screening (P = 0.001), HIV testing (P = 0.001), condom use (P = 0.03), and preexposure prophylaxis use (P = 0.02). Knowledge of preexposure prophylaxis (P < 0.0001) and of community-based educational (P = 0.047), job-training (P = 0.002), and job-finding resources (P = 0.02) also increased. Social support increased (P < 0.0001) and perceived discrimination decreased (P < 0.01).

CONCLUSIONS: Pilot findings suggest that Impact Triad is promising in increasing STI/HIV protective behaviors and addressing social determinants of health among young GBQMSM and transgender women of color; further testing is warranted.

PMID:40053327 | DOI:10.1097/OLQ.0000000000002106

Blood Coagul Fibrinolysis. 2025 Mar 7. doi: 10.1097/MBC.0000000000001354. Online ahead of print.

ABSTRACT

This study compared the efficacy of therapeutic anticoagulation guided by anti-Xa levels vs. a D-dimer-based protocol in ICU patients with COVID-19. Given the heightened risk of thrombosis despite anticoagulation therapy in some cases, we hypothesised that anti-Xa measurement improves anticoagulation effectiveness and clinical outcomes in this population. We retrospectively analysed data from ICU patients at COVID Hospital Karaburma between April 2020 and December 2021. The primary outcome was the incidence of failed noninvasive ventilation necessitating intubation. Secondary endpoints included mortality rates, thromboembolic and bleeding complications, and anticoagulation effectiveness assessed by antifactor Xa activity. The analysis included 395 patients – 137 in the anti-Xa group and 258 in the D-dimer group. The D-dimer group showed a higher rate of failed noninvasive ventilation requiring intubation (65.7% vs. 50%, P = 0.009). The overall mortality was 48.3%, significantly higher in the D-dimer group (52.7%) compared to the anti-Xa group (40.1%, P = 0.02). Thromboembolic complications were lower in the anti-Xa group (2.9%) than in the D-dimer group (9.7%, P = 0.014), with no significant difference in bleeding. Following the first LMWH administration, 70.8% of patients had anti-Xa levels below the therapeutic and 11.7% below the prophylactic range. Anti-Xa-guided anticoagulation improves survival and reduces thromboembolic complications compared to D-dimer-based treatment without increasing bleeding risk. This study highlights the potential of the anti-Xa assay in managing anticoagulation in critically ill COVID-19 patients. Our findings provide a foundation for future research on using anti-Xa measurements as a guiding tool to optimise anticoagulation therapy in other critically ill populations.

PMID:40053316 | DOI:10.1097/MBC.0000000000001354

Obes Surg. 2025 Mar 7. doi: 10.1007/s11695-025-07749-0. Online ahead of print.

ABSTRACT

BACKGROUND: Bariatric surgical tourism is a rapidly growing sector. The aim of this study was to evaluate the preoperative surgical fear, anxiety, and satisfaction levels regarding bariatric surgery tourism processes and to examine the relationships between these variables.

METHODS: This descriptive, cross-sectional study was conducted between July and November 2024 with foreign patients who visited the general surgery clinic of a healthcare institution for bariatric surgery within the scope of health tourism. Data were collected through face-to-face interviews using the Patient Information Form, Surgical Fear Scale, and Surgical Anxiety Scale. All results were evaluated within a 95% confidence interval, with statistical significance set at p < 0.05.

RESULTS: The mean age of the patients was 39.39 ± 9.35 years, and 88.5% were from the UK. Additionally, 88.5% reported choosing bariatric surgery tourism due to high surgical costs in their home country. The mean score for surgical fear was 37.68 ± 20.58, while the mean score for surgical anxiety was 19.53 ± 12.90. Patients who lacked prior knowledge about bariatric surgery tourism had significantly higher surgical fear and anxiety scores (p < 0.05). Age, fear and anxiety associated with undergoing surgery in a foreign country, and total surgical anxiety scale score were identified as independent predictors of patients’ satisfaction with their bariatric surgery tourism experience (R² = 0.130; p < 0.01).

CONCLUSIONS: Preoperative knowledge levels and satisfaction with the information provided significantly impacted surgical fear and anxiety levels among bariatric surgery tourism patients.

PMID:40053303 | DOI:10.1007/s11695-025-07749-0

Int J Clin Pharm. 2025 Mar 7. doi: 10.1007/s11096-025-01893-4. Online ahead of print.

ABSTRACT

BACKGROUND: The relationship between statin therapy and tendon injuries, particularly Achilles tendinopathy, which is the body’s largest and strongest tendon, remains controversial.

AIM: This study employed Mendelian Randomization (MR) analysis to explore the causal link between statin therapy and Achilles tendinopathy (ATP).

METHOD: Summary statistics were obtained from genome-wide association studies on statin medication and four specific statin drugs from public databases, as well as data related to two ATP phenotypes, namely Achilles tendinitis and Achilles tendon injury. Furthermore, a two-sample bidirectional MR analysis was conducted to investigate the association between statin therapy and ATP. The primary method used was the inverse variance weighted (IVW) method, supplemented by four other validation methods. Heterogeneity analysis, pleiotropy assessment, and leave-one-out sensitivity analysis were further conducted to validate the robustness of the results.

RESULTS: Based on our comprehensive investigation, all MR analyses in this study found no significant causal relationship between statin therapy and ATP (IVW, p > 0.05). Notably, the MR findings regarding pravastatin, rosuvastatin, and ATP were limited by a small pool of instrumental variables, necessitating further research. Moreover, no association was observed between the two in the reverse MR analysis (IVW, p > 0.05). All results passed heterogeneity tests, pleiotropy tests, and sensitivity analyses.

CONCLUSION: Our results do not establish a causal connection between statin therapy and ATP, indicating that individuals with ATP should consider alternative pathogenic contributors. Moreover, these findings highlight the safety profile of statin medications.

PMID:40053301 | DOI:10.1007/s11096-025-01893-4

Epilepsia Open. 2025 Mar 7. doi: 10.1002/epi4.70019. Online ahead of print.

ABSTRACT

OBJECTIVES: Genetic-associated epilepsy in the Indonesian population is rarely discussed, and no study was specifically studied about photosensitive epilepsy. The fundamental goal of this research endeavor was to evaluate whether the single nucleotide polymorphism (SNP) of the Bromodomain-Containing Protein 2 (BRD2) gene gives vulnerability to photosensitive epilepsy among Indonesian descent.

METHODS: This observational case-control study includes patients of Indonesian descent with Javanese ancestry. Clinical and neurophysiological data, along with electroencephalographic (EEG) recordings, were used to diagnose epilepsy and photosensitive epilepsy. Blood samples were collected and analyzed for BRD2 gene SNPs (rs206781, rs188245, and rs15912) using polymerase chain reaction (PCR), electrophoresis, and the Sanger sequencing method.

RESULTS: This study included 27 participants, consisting of 17 patients in the epilepsy group (nine patients with photosensitive epilepsy and eight patients without photosensitive epilepsy) and 10 patients in the non-epilepsy group. Significant statistical differences were found in genotype (rs206781, p = 0.008 and rs188245, p = 0.004) and allele frequencies (rs206781, p < 0.001 and rs188245, p < 0.001) of the BRD2 gene in Indonesian descent with Javanese race patients diagnosed with photosensitive epilepsy and in those without this condition.

SIGNIFICANCE: Our study corroborates the observation that genetic diversity within the BRD2 locus (rs206781 and rs188245) is associated with PE in Indonesian descendants of the Javanese race. To acquire a complete knowledge of the development of photosensitive epilepsy, further polymorphism studies at other SNP locations or genes are necessary.

PLAIN LANGUAGE SUMMARY: This study investigated whether genetic differences in the BRD2 gene were linked to photosensitive epilepsy (a type of epilepsy triggered by visual stimuli like flashing lights) in individuals of Indonesian Javanese descent. We analyzed deoxyribonucleic acid (DNA) samples from patients with epilepsy, including those with photosensitive epilepsy, and found that certain variations in the BRD2 gene were significantly more common in people with photosensitive epilepsy. These findings imply that genetic factors, specifically variations in the BRD2 gene, could elevate the risk of individuals in this population experiencing photosensitive epilepsy.

PMID:40053300 | DOI:10.1002/epi4.70019