Tag: statistics

JAMA Netw Open. 2025 Nov 3;8(11):e2540170. doi: 10.1001/jamanetworkopen.2025.40170.

ABSTRACT

IMPORTANCE: The Planetary Health Diet (PHD) integrates health and environmental sustainability, yet its association with chronic disease outcomes remains underexplored, particularly among women with a history of gestational diabetes (GD), who are at elevated risk of type 2 diabetes (T2D) and cardiovascular disease (CVD).

OBJECTIVE: To investigate the associations of adherence to the PHD with risks of T2D, CVD, and long-term weight change among women with a history of GD.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Nurses’ Health Study II. A subset of participants with a history of GD was followed up from June 1991 to June 2021. Data were analyzed from February 1, 2024, to April 9, 2025.

EXPOSURES: Adherence to the PHD was assessed using the Planetary Health Diet Index (PHDI), which was derived from food frequency questionnaires administered every 4 years.

MAIN OUTCOMES AND MEASURES: Cox proportional hazards regression models were used to assess hazard ratios (HRs) and 95% CIs for the risk of T2D and CVD. Associations between PHDI changes and concurrent 4-year weight changes were evaluated using multivariable marginal models with generalized estimating equations.

RESULTS: During 120 465 person-years of follow-up among 4633 women with a history of GD (mean [SD] age, 38.9 [6.1] years), 90 incident CVD cases (38 myocardial infarction [MI] and 52 stroke) and 1053 incident T2D cases were observed. Women in the highest tertile of the PHDI had a 63% lower risk of MI (HR, 0.37; 95% CI, 0.16-0.86; P for trend = .01) compared with those in the lowest tertile, independent of body mass index (BMI) and other covariates. Higher PHDI was also associated with a lower risk of overall CVD and T2D; however, mediation analysis indicated that BMI accounted for 79.6% (95% CI, 16.5%-98.7%; P < .001) of the association with T2D and 15.1% (95% CI, 2.8%-52.5%; P = .02) of the association with CVD. Notably, decreasing PHDI was associated with greater weight gain (P for trend < .001), with the group experiencing the largest 4-year decrease in PHDI showing a mean weight gain of 2.3 (95% CI, 2.0-2.6) kg.

CONCLUSIONS AND RELEVANCE: In this cohort study of women with a history of GD, higher PHDI was associated with lower risk of myocardial infarction and better weight management. These findings also emphasize the importance of postpartum weight management to reduce the risk of progression from GD to T2D and CVD.

PMID:41201804 | DOI:10.1001/jamanetworkopen.2025.40170

JAMA Netw Open. 2025 Nov 3;8(11):e2542269. doi: 10.1001/jamanetworkopen.2025.42269.

ABSTRACT

IMPORTANCE: With a warming climate, it is essential to have up-to-date and spatiotemporally resolved quantification of the national mortality burden attributable to nonoptimal temperatures.

OBJECTIVE: To investigate the mortality burden associated with heat and cold in the entire contiguous US from 2000 to 2020.

DESIGN, SETTING, AND PARTICIPANTS: This case series assessed death records from the National Center for Health Statistics for all counties within the contiguous US from January 1, 2000, to December 31, 2020. The study used 2-stage modeling, with the first stage being a case-crossover design with county-specific conditional logistic regression of mortality on daily mean temperature incorporating distributed lag nonlinear models and the second stage pooling the estimates by metaregression. Based on the estimated exposure-response functions for temperature and mortality, attribution analyses for low and high temperatures were performed. Calendar time trends were analyzed, and stratified analyses by cause of death and demographic factors (ie, age, sex, and marital status) were performed. This analysis was conducted from August 9, 2024, to June 16, 2025.

EXPOSURES: Daily mean temperature and dewpoint temperature at a 4-km resolution for the contiguous US from the Parameter-Elevation Relationships on Independent Slopes Model (PRISM) climate database.

MAIN OUTCOMES AND MEASURES: All-cause mortality and 7 specific causes, including endocrine, nutritional and metabolic diseases; mental, behavioral and neurodevelopmental disorders; nervous system diseases; circulatory diseases; respiratory diseases; digestive diseases; and external causes.

RESULTS: A total of 54 223 429 deceased individuals were included in the analyses. Most decedents were 65 years or older (73.4%); 50.2% were male, 37.4% were married, and 35.1% were widowed. Both low and high temperatures were associated with increased odds of death within 0 to 6 days. Compared with the minimum mortality temperature, temperatures at the 5th and 95th percentiles were associated with odds ratios (ORs) of 1.057 (95% CI, 1.051-1.064) and 1.011 (95% CI, 1.009-1.013), respectively. The excess annual deaths attributable to low and high temperatures were estimated to be 45 992 (95% CI, 28 639-63 202) and 3414 (95% CI, 1650-5173), respectively, with regional variations and an increase in the high temperature burden from 2670 annual deaths during the 2000-2009 period to 4091 during the 2010-2020 period. Heterogeneity existed by cause of death, age, sex, and marital status.

CONCLUSIONS AND RELEVANCE: In this case series, nonoptimal temperatures were critical environmental contributors associated with mortality burden, with differential vulnerability by geographic location, cause of death, and demographic factors. These findings highlight the need for urgent actions against temperature-related health burdens through tailored climate and public health strategies, considering the local context and demographic profiles.

PMID:41201802 | DOI:10.1001/jamanetworkopen.2025.42269

JAMA Netw Open. 2025 Nov 3;8(11):e2542330. doi: 10.1001/jamanetworkopen.2025.42330.

ABSTRACT

IMPORTANCE: The American Cancer Society (ACS) Guideline Score captures collective adherence to health behavior recommendations, including a healthy diet, physical activity (PA), alcohol intake, and body mass index (BMI). Exploring the role of social determinants of health (SDoH) in health behavior engagement may present opportunities for improving health equity.

OBJECTIVE: To identify SDoH associated with co-occurring health behaviors captured by the ACS Guideline Score in a large US cohort.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included adults in the Cancer Prevention Study-3 who enrolled between 2006 and 2013 at ACS community events across 35 US states, the District of Columbia, and Puerto Rico using data from comprehensive follow-up surveys administered in 2015. Data were analyzed from June to September 2024.

EXPOSURES: Self-reported race and ethnicity, marital status, education, household income, secondhand smoke exposure, and work status were examined. Rural-Urban Commuting Area codes and food desert status were classified according to US Department of Agriculture definitions.

MAIN OUTCOMES AND MEASURES: Co-occurring health behaviors were measured using a 0-to-8-point score quantifying adherence to the 2020 ACS Guidelines for Diet and PA for Cancer Prevention on diet, alcohol, healthy BMI maintenance, and PA. Scores of 8 represent complete adherence. Ordinal logistic regression models were used to cross-sectionally assess SDoH factors associated with co-occurring health behaviors measured by ACS Guideline Scores.

RESULTS: Of 142 085 participants (mean [SD] age, 52.0 [9.6] years; 111 694 women [78.6%]), 2415 identified as Asian, Native Hawaiian, or Pacific Islander (1.7%), 3267 identified as Black (2.3%), 7814 identified as Latino (5.5%), 126 739 identified as non-Hispanic White (89.2%), and 1989 identified as another racial and/or ethnic group (1.4%). The mean (SD) ACS Guideline Score was 4.6 (1.7). Compared with White participants, Asian, Native Hawaiian, and Pacific Islander participants had increased odds of higher ACS Guideline Scores (odds ratio [OR], 1.99; 95% CI, 1.86-2.14). Holding a graduate degree was associated with a 33% higher likelihood of a higher ACS Guideline Score (OR, 1.33; 95% CI, 1.30-1.36) compared with college graduates. Compared with working full-time, working part-time (OR, 1.62; 95% CI, 1.57-1.66) or being retired (OR, 1.26; 95% CI, 1.22-1.30) was associated with a higher score.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, multiple SDoH factors associated with co-occurring health behaviors for diet, PA, BMI, and alcohol consumption were identified. These findings may aid in identifying populations most vulnerable to poor health behaviors, guiding future approaches for advancing health equity.

PMID:41201801 | DOI:10.1001/jamanetworkopen.2025.42330

Sports Med. 2025 Nov 7. doi: 10.1007/s40279-025-02342-y. Online ahead of print.

ABSTRACT

BACKGROUND: Both maximal strength and speed-strength are considered key aspects of rugby league and rugby union match-play yet represent distinct physical qualities. Establishing whether maximal strength or speed-strength has a greater association with game performance in these sports can help direct resistance training interventions towards the physical quality most likely to transfer to the outcome of interest. It is therefore important to develop a clearer understanding of whether it is maximal strength or speed-strength that has stronger links to key aspects of rugby union and rugby league competition.

OBJECTIVES: To systematically review and meta-analyse the literature to compare maximal strength versus speed-strength measures in their associations with within-game key performance indicators (KPIs) in rugby union and rugby league. Further, sub-group analysis was undertaken to determine whether the type of KPI (tackles, rucks, line breaks, carries/hit-ups, errors, and miscellaneous) moderated the extent to which the observed effect favoured maximal strength or speed-strength for a given KPI.

METHODS: A systematic search, conducted in accordance with PRISMA guidelines, of Web of Science, PubMed, and SportDiscus was conducted up to December 2024. Studies meeting the inclusion criteria provided correlation coefficients that were converted into Fisher’s z-transformed effect sizes to standardise the measures and allow for consistent comparison across studies. These effect sizes were analysed using a multivariate meta-analysis framework.

RESULTS: Six studies containing 41 maximal strength versus speed-strength comparisons and 134 players were included in the final analysis. Of the 786 studies initially identified, 28 underwent full-text screening, with 22 ultimately excluded. The overall pooled effect was 0.24 [0.11: 0.37] in favour of strength; however, the prediction interval ranged from g = – 0.58 to g = 1.06. The moderator analysis revealed a statistically significant effect of type (p = 0.038), indicating stronger associations for maximal strength compared to speed-strength. Residual heterogeneity (p = 0.005) suggested substantial variability in effect sizes across studies that was not fully explained by the model.

CONCLUSIONS: Within-game rugby union and rugby league KPIs typically have stronger links to maximal strength than to speed-strength. However, the wide prediction interval underscores that the observed maximal strength advantage may not generalise across all types of KPIs or predictably translate to all future settings.

PMID:41201787 | DOI:10.1007/s40279-025-02342-y

Eur Arch Paediatr Dent. 2025 Nov 7. doi: 10.1007/s40368-025-01130-6. Online ahead of print.

ABSTRACT

INTRODUCTION: The Dutch guideline “Oral care for children: prevention and treatment of caries” describes how to prevent, stabilise, or treat caries lesions using minimally invasive methods in children. The objectives of the present study were to 1) evaluate to what extent oral healthcare professionals (OHCPs) in the Netherlands apply preventive and minimally invasive caries management according to the guideline, 2) evaluate their attitudes towards these treatments, and 3) assess differences between OHCPs in general oral health practice and paediatric dentistry.

METHODS: In this cross-sectional survey study, OHCPs completed questions on guideline knowledge, and practice regarding primary (5 items), secondary and tertiary (9 items) caries prevention was asked using a 5-point Likert scale (1 = never, 5 = always). Attitude towards minimally invasive caries treatments was evaluated as sum score over six statements (range 6 [negative] to 30 [positive]).

RESULTS: Amongst 187 participants (36.7% paediatric dentists; 79.1% female), 134 (71.7%) OHCPs reported being familiar with the guideline content. OHCPs working in paediatric dentistry applied statistically significantly more primary and (partially) secondary and tertiary prevention than OHCPs in general oral health practice. Median score of attitude towards minimally invasive caries treatments was neutral at 17.2 (SD = 2.6).

CONCLUSION: The majority of OHCPs in the present study reported being familiar with the guideline. However there is room for improvement in its implementation in practice. OHCPs working in paediatric dentistry reported greater familiarity with the guideline. Generally, OHCPs had a neutral attitude towards preventive caries management.

PMID:41201776 | DOI:10.1007/s40368-025-01130-6

Obes Surg. 2025 Nov 7. doi: 10.1007/s11695-025-08354-x. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study is to compare the mid- and long-term results after laparoscopic sleeve gastrectomy (LSG) according to the distance of the first staple from the pylorus.

METHODS: This study is a retrospective analysis of prospectively collected data of patients who underwent LSG. While the distance of the first staple from the pylorus was 2-3 cm in group A, the distance of the first staple to the pylorus was 5-6 cm in group B. Laboratory parameters, comorbidity resolution, anthropometric measurements, and complications were documented at the end of the first, third, and fifth postoperative years.

RESULTS: Of the total 376 patients, 127 were excluded for various reasons, 102 patients were lost to follow-up, and 147 patients were included in the final analysis. Upon examining the follow-up data at the 1st, 3rd, and 5th years, a statistically significant difference was observed between the groups in terms of total weight loss (TWL%), excess body mass index loss (EBMIL%), and recurrent weight gain (RWG)%, with group A showing an advantage. The majority of the patients requiring conversional metabolic and bariatric surgery (MBS) were in group B, and the difference was significant (p = 0.017).

CONCLUSION: The distance of the first staple from the pylorus may significantly influence the outcomes related to RWG%, TWL%, and type 2 diabetes mellitus (T2DM) resolution in the medium-long-term. Furthermore, additional research is needed to determine the optimal positioning for enhanced patient results.

PMID:41201754 | DOI:10.1007/s11695-025-08354-x

J Cancer Surviv. 2025 Nov 7. doi: 10.1007/s11764-025-01899-x. Online ahead of print.

ABSTRACT

PURPOSE: Selecting patient-reported outcome measures (PROMs) that accurately reflect the unmet needs of cancer survivors (CSs) remains a challenge in oncology, as current processes lack a structured methodology. This study aimed to develop and test the feasibility of a replicable, patient-centred framework for PROM selection, ensuring alignment between survivors’ lived experiences and standardised outcome measures across diverse healthcare settings.

METHODS: Our methodology integrated qualitative and quantitative approaches, mapping patient-expressed unmet needs onto the International Classification of Functioning, Disability, and Health (ICF). The process involved three steps: (1) identifying survivors’ needs through focus groups, interviews and questionnaires, (2) linking these needs to ICF categories using validated methodologies and (3) systematically evaluating existing PROMs based on their coverage of these categories.

APPLICATION AND RESULTS: To demonstrate feasibility, we conducted a feasibility study involving 35 CSs and seven caregivers within the Italian healthcare context. Among the 14 PROMs analysed, the Cancer Rehabilitation Evaluation System (CARES) covered 94.3% of ICF-linked needs, emerging as the most suitable option. The framework’s adaptability allows clinicians and researchers to identify context-specific PROMs for diverse populations and healthcare systems.

CONCLUSIONS: This study provides a robust, evidence-based methodology for optimising PROM selection, bridging the gap between patient narratives and standardised measurement. This feasibility study demonstrates the framework’s practical applicability in clinical practice, with potential for broader implementation across diverse healthcare contexts. Its global applicability ensures that survivorship care remains patient-centred, data-driven and contextually relevant.

IMPLICATIONS FOR CANCER SURVIVORS: By facilitating the selection of tailored PROMs, this framework enhances patient-centred survivorship care, ensuring that outcome assessments remain relevant to survivors’ experiences and improving care quality across different settings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06236373.

PMID:41201742 | DOI:10.1007/s11764-025-01899-x

Odontology. 2025 Nov 7. doi: 10.1007/s10266-025-01243-w. Online ahead of print.

ABSTRACT

The objective of this study was to assess the color stability of multilayer resin composite (RC) blocks by immersing them in staining solutions. Four RC blocks, Cerasmart Layer (CL), Block HC Hard AN (HC), KZR-CAD HR4 E-VA (EV), and Katana Avencia N (KA), were tested, with a ceramic block, Vita Mark II, serving as the control. All specimens were prepared using #2000 SiC paper and stored in ultrapure water. The immersion tests were performed using five staining solutions (coffee, Coke, tea, red wine, and Milli-Q) at 37 °C, with measurements taken at 24 h; 1, 2, 3, and 4 weeks; and 3, 6, 9, and 12 months. Color parameters (L*, a*, b*) were measured, and the color differences (∆E) were calculated using the color parameters obtained before immersion tests and at each interval. Statistical analysis was performed using three-way ANOVA (α = 0.05). Results showed that red wine caused the most significant ΔE (16.6) across all materials, followed by tea (2.19), Coke (1.94), coffee (1.73), and Milli-Q (0.99), with significant differences (p < 0.05). Several RCs demonstrated color differences compared with ceramic, particularly EV and KA in coffee, all RC blocks in Coke, CL in tea, CL and KA in red wine, and EV and KA in Milli-Q. The changes in color parameters over time differed between the solutions; notably, red wine showed the most significant color changes in all beverages. These findings suggest that multilayer RC blocks exhibit discoloration resistance comparable to that of ceramic materials.

PMID:41201740 | DOI:10.1007/s10266-025-01243-w

Ann Nucl Med. 2025 Nov 7. doi: 10.1007/s12149-025-02127-3. Online ahead of print.

ABSTRACT

BACKGROUND: Lutetium-177 (¹⁷⁷Lu)-PSMA-617, a targeted radioligand therapy, has demonstrated significant survival benefits in patients with metastatic castration-resistant prostate cancer (mCRPC). Its application in patients with a superscan pattern, indicative of extensive skeletal metastases, is less studied due to concerns about hematologic toxicity from bone marrow involvement.

METHODS: This study analyzed 133 mCRPC patients treated with ¹⁷⁷Lu-PSMA-617, divided into Superscan and Non-superscan groups. PSA response (≥ 50% decline), PSA progression free survival (PFS), overall survival (OS), and treatment safety were assessed.

RESULTS: Among 133 patients, 17 (12.8%) exhibited a superscan pattern. The overall PSA response rate was 45.8%, (47.0% in the superscan group versus 45.6% in the non-superscan group; p = 0.485). Median PSA PFS was 8 months overall (95% CI: 5.5-10.4), with 4 months (95% CI: <1-10.5) in the superscan group and 8 months (95% CI: 5.6-10.3) in the non-superscan group (p = 0.311). Median OS was 13 months overall (95% CI: 8.6-17.3), with 6 months (95% CI: <1-18.7) in the superscan group and 14 months (95% CI: 9.3-18.6) in the non-superscan group (p = 0.052). Significant but manageable decreases were seen in platelet (PLT) and Alkaline phosphatase (ALP), and no significant changes in Hemoglobin (Hb), white blood cells (WBC), Lactate dehydrogenase (LDH), or creatinine, with no differences between superscan and non-superscan groups. Baseline hemoglobin was a significant predictor of OS (HR = 0.6, p = 0.001), while superscan pattern did not show statistical differences (HR = 1.0, p = 0.949).

CONCLUSION: This retrospective study suggests that ¹⁷⁷Lu-PSMA-617 is a feasible and safe radioligand therapy for mCRPC patients with a superscan pattern, showing comparable PSA response rates to non-superscan patients.

PMID:41201730 | DOI:10.1007/s12149-025-02127-3

Ir J Med Sci. 2025 Nov 7. doi: 10.1007/s11845-025-04154-5. Online ahead of print.

ABSTRACT

AIMS: To evaluate patient and clinician preferences for communicating dermatology test results (skin biopsies, swabs and blood results) with a focus on differences in preferred methods for normal and abnormal findings.

METHODS: A cross-sectional study was conducted involving two anonymised surveys. A structured questionnaire was distributed to 100 consecutive dermatology outpatients attending a dermatology centre over a four-week period from May to June 2025. Concurrently, an electronic survey was distributed nationally to dermatology clinicians, including consultants and registrars (n = 25). Descriptive statistics and chi-square testing were used to analyse differences.

RESULTS: For abnormal results, both patients (64%) and clinicians (60%) preferred face-to-face appointments, a further 33% of patients favoured mobile contact compared with 20% of clinicians. A statistically significant difference was observed in preferences for normal result communication between patients and clinicians (χ2 = 92.6, p < 0.001) with patients preferring mobile phone contact (53%) and text message (19%) and clinicians overwhelmingly preferring postal letters (72%). 59% reported that their preference would change depending on whether the result was normal or abnormal. Speed of communication was rated “very important” by 73% of patients. Concerns about digital confidentiality were moderate, with mean ratings of 2.33 for text and 2.32 for email on a 5-point scale.

CONCLUSIONS: Patients favour fast, digital methods for receiving normal results, while clinicians largely continue using traditional postal communication. Greater alignment exists for abnormal result delivery. These findings support a stratified approach to result communication that balances patient preferences, clinical context and confidentiality considerations.

PMID:41201726 | DOI:10.1007/s11845-025-04154-5