Tag: statistics

Am J Public Health. 2026 Jun 4:e1-e10. doi: 10.2105/AJPH.2026.308439. Online ahead of print.

ABSTRACT

Objectives. To estimate associations of fatherhood with cardiovascular health (CVH), incident cardiovascular disease (CVD), and all-cause mortality. Methods. The Coronary Artery Risk Development in Young Adults (CARDIA) study is a US-based cohort that enrolled Black and White individuals aged 18 to 30 years at baseline (1985-1986). CVH was defined by Life’s Essential 8 scores. Models included multivariable linear regression and Cox proportional hazards. Results. Among 1648 men with fatherhood data, there was a statistical interaction between age at fatherhood onset and race on CVH (P < .05) in adjusted models. Among Black men, fathers had lower death rates than nonfathers (hazard ratio [HR] = 0.5; 95% confidence interval [CI] = 0.3, 0.9). Black fathers who were younger than 25 years (HR = 4.2; 95% CI = 1.2, 14.6) and those aged 25 to 29 years (HR = 4.2; 95% CI = 1.2, 14.8) at fatherhood onset had higher death rates compared with Black fathers who were aged 30 years or older. White fathers who were younger than 25 years and those aged 25 to 29 years at fatherhood onset had worse total CVH compared with White fathers who were aged 30 years or older (69.2 and 69.9 vs 73.3 points; P < .05). Conclusions. Fatherhood may be a protective health factor for Black men and adverse influence for young fathers, offering insight for public health programming. (Am J Public Health. Published online ahead of print June 4, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308439).

PMID:42241661 | DOI:10.2105/AJPH.2026.308439

Am J Public Health. 2026 Jun 4:e1-e12. doi: 10.2105/AJPH.2025.308416. Online ahead of print.

ABSTRACT

Objectives. To describe trends in US community health worker (CHW) place of employment and wages and the impact of state certification programs and Medicaid reimbursement. Methods. Using 2012 to 2023 Bureau of Labor Statistics data, we performed tests of proportions to describe CHWs’ changes in employment in different industries, linear regression to compare their wages between industries, and staggered difference-in-differences to evaluate the impact of certification and Medicaid reimbursement on the proportion of CHWs in each industry and wages. Results. CHW employment in health care and government has increased (P < .001), and CHWs are paid the least in social assistance agencies (P < .001). Certification was associated with a decreased proportion of government and public health CHWs (-9.4%; P = .003) but was not associated with wages. Medicaid reimbursement was not associated with place of employment or wages. Conclusions. Substantial wage differences exist across industries employing CHWs, and neither Medicaid reimbursement nor certification was associated with higher wages. Certification may influence workforce distribution, particularly in government settings. Public Health Implications. Improved Medicaid reimbursement rates and billing procedures and optimized payment models could grow and sustain the CHW workforce. Decreases in government employment after certification warrant further research. (Am J Public Health. Published online ahead of print June 4, 2026:e1-e12. https://doi.org/10.2105/AJPH.2025.308416).

PMID:42241658 | DOI:10.2105/AJPH.2025.308416

JCO Glob Oncol. 2026 Jun;12(6):e2600117. doi: 10.1200/GO-26-00117. Epub 2026 Jun 4.

ABSTRACT

PURPOSE: In Brazil, diagnosing and treating non-small cell lung cancer (NSCLC) with actionable molecular alterations pose substantial challenges because of health care disparities. Anaplastic lymphoma kinase (ALK) rearrangements represent a clinically relevant subset with highly effective targeted therapies. However, real-world access to ALK diagnostics and treatments across different Brazilian health care sectors remains inadequately characterized.

METHODS: We conducted a cross-sectional survey of Brazilian oncologists between October 2024 and March 2025 to assess the availability of ALK testing and targeted therapies, alongside perceived implementation barriers. Of 197 responses collected, 156 were included in the final analytic cohort. Data were analyzed using descriptive statistics, and categorical variables were reported as proportions with 95% CIs.

RESULTS: Within the final analytic cohort (N = 156), 93.9% of the respondents practicing in the private sector (n = 147) reported access to ALK testing, whereas only 43.9% of those practicing in the public health care system (n = 107) had access. Access to ALK-targeted therapies was limited for the public health care population: 7.1% received crizotinib and <2% received newer-generation ALK-targeted therapies available in the first-line setting. By contrast, in the private sector, 75.6% and 60.9% reported access to alectinib and lorlatinib, respectively. Chemotherapy remained predominant in the public health care system. Main barriers included lack of reimbursement (58.3%), insufficient tissue (40.4%), and urgency to initiate treatment (36.5%).

CONCLUSION: Despite robust evidence supporting ALK-targeted therapies, this study highlights substantial disparities in access to diagnostics and treatment for ALK-rearranged NSCLC in Brazil, particularly among patients reliant on the public health care system. Findings underscore the need for policies to strengthen testing infrastructure, ensure equitable access to guideline-recommended therapies, and enhance provider education. Addressing these gaps is essential for equitable precision oncology and improved outcomes.

PMID:42241650 | DOI:10.1200/GO-26-00117

Nurs Open. 2026 Jun;13(6):e70600. doi: 10.1002/nop2.70600.

ABSTRACT

AIMS: To explore the effectiveness of a systematic epidemic prevention programme on the coping response of nursing staff caring for high-risk COVID-19 patients.

DESIGN: A one-group pre-post-test pre-experimental design was used.

METHODS: Through purposive sampling, a total of 84 nursing staff were recruited from a teaching hospital who had experiences in caring for high-risk COVID-19 patients. The participants underwent a systematic epidemic prevention programme. Before the intervention and 1 month, 3 months, and 6 months after the intervention at four time points, the coping response of the nursing staff was measured through three scales-the Impact of Event Scale-Revised, the General Health Questionnaire (GHQ), and the Brief Coping Orientations to Problems Experienced (Brief-COPE). The data were analyzed using descriptive and inferential statistics including generalised estimating equations, Pearson’s correlation coefficient, independent samples t-test, and analysis of variance.

RESULTS: The systematic epidemic prevention programme significantly improved nursing staff’s coping responses. IES-R scores decreased over time but did not reach statistical significance. GHQ scores showed a significant time effect, with reductions observed at 1 and 3 months post-intervention, and the greatest improvement at 3 months. Emotional coping significantly increased at 3 months post-intervention. Overall, the findings demonstrate a sustained improvement in coping responses across time points following the intervention.

REPORTING METHOD: The study followed the TREND and TIDieR checklists.

PATIENT OR PUBLIC CONTRIBUTION: None.

PMID:42241051 | DOI:10.1002/nop2.70600

Cornea. 2026 Jun 3. doi: 10.1097/ICO.0000000000004101. Online ahead of print.

ABSTRACT

PURPOSE: To determine whether there is an altered risk of specific cancers among individuals with Fuchs Endothelial Corneal Dystrophy (FECD).

METHODS: Retrospective, case-control study using data from the Utah Population Database, Utah Cancer Registry, and associated records. Cases were defined as individuals ≥40 years with a diagnosis of FECD. Controls were matched approximately 3:1 with cases on birth year, sex, whether born in Utah, and duration of follow-up in Utah. Twenty-two types/locations of cancer that were diagnosed between 1996 and 2022 were recorded. Cancer risk models were calculated using mixed-effect logistic regression, with adjustments for obesity, diabetes, tobacco use, race, ethnicity, and sex (except for sex-specific cancers). The main outcome measure was the odds of specific cancer diagnoses among FECD cases compared with matched controls.

RESULTS: A total of 4129 FECD cases and 12,371 controls were studied in the final analysis. A total of 885 (21.4%) FECD cases and 2514 (20.3%) controls were diagnosed with any cancer (P = 0.126). After adjusting for covariates, FECD cases did not have an altered likelihood of having a diagnosis of cancer overall (OR: 1.06; 95% CI, 0.97-1.16; P = 0.174), or according to any of the specific cancer sites/subtypes. There was a slightly higher likelihood of thyroid cancer among FECD cases (OR: 1.55; 95% CI, 1.00-2.38; P = 0.048) and prostate cancer among male FECD cases (OR: 1.20; 95% CI, 1.01-1.43; P = 0.036) that was not statistically significant after accounting for multiple comparisons.

CONCLUSIONS: Individuals with FECD did not have a significantly altered risk of any of the studied cancers.

PMID:42241014 | DOI:10.1097/ICO.0000000000004101

Knee Surg Sports Traumatol Arthrosc. 2026 Jun 4. doi: 10.1002/ksa.70470. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to evaluate the direct and indirect costs of anterior cruciate ligament (ACL) injuries and assess their effects on career trajectories, market value, and potential associations with the age of the head coach at the time of injury in European professional football.

METHODS: A retrospective Transfermarkt.com cohort study was conducted on 211 professional male footballers who underwent ACL reconstruction. Primary outcomes related to demographics, career outcomes, market value, and coaching profiles were analysed. Data were analysed using SPSS 30, employing analysis of variance, Mann-Whitney U tests, Wilcoxon signed-rank tests, and independent-samples t-tests. Post-hoc power analysis (G Power) confirmed statistical power > 0.99 for the primary outcome.

RESULTS: The mean recovery period was 256.6 days (standard deviation [SD]: 91.9; median: 241; interquartile range [IQR]: 102; range: 109-674). ACL injuries were associated with a mean market value depreciation of approximately 2.5% (Value Drop Ratio [VDR]: 1.0; SD: 0.1; 95% confidence interval [CI]: 1.0159-1.033). Age was significantly associated with financial loss (F = 6.2, p < 0.001; Cohen’s f = 0.332); players ≥ 30 years showed a 5.5% decline compared to 0.9% for those aged ≤ 22 years. Post-injury, 16.0% transitioned to a lower-tier league and 7.3% to a higher-tier league. Players who transitioned to lower tiers had shorter mean recovery durations (221.6 vs. 264.1 days; p = 0.011). In an exploratory analysis (n = 38 coaches), teams coached by managers < 40 years had lower ACL injury rates among newly transferred players (p = 0.004). After Bonferroni correction (p < 0.007), only Scottish and Dutch subgroup findings remained significant.

CONCLUSION: ACL injuries in professional male footballers impose a substantial economic burden on clubs through market value depreciation, prolonged recovery and continued salary obligations. Older player age is the strongest determinant of financial impact, while a meaningful proportion of injured players transition to lower-tier leagues, with shorter recovery paradoxically associated with downward career mobility. These findings suggest that ACL injury constitutes a multidimensional risk encompassing medical, financial and career consequences.

LEVEL OF EVIDENCE: Level III, retrospective cohort study.

PMID:42241013 | DOI:10.1002/ksa.70470

JAMA Netw Open. 2026 Jun 1;9(6):e2616654. doi: 10.1001/jamanetworkopen.2026.16654.

ABSTRACT

IMPORTANCE: Noneconomic damage caps, a form of medical malpractice law, remain controversial, as several states have enacted such laws since 2010, whereas others have repealed them. The clinical consequences of repealing these caps are poorly understood, and understanding these associations can inform the ongoing debate about medical malpractice reform.

OBJECTIVE: To examine whether repealing noneconomic damage caps is associated with changes in maternal care and infant health outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study adopted a difference-in-differences design, comparing between 2 treated states (Georgia and Illinois) that repealed their noneconomic damage caps in 2008 to 2009 and 16 control states that retained their caps during the entire study period between 2005 and 2019. The Centers for Disease Control and Prevention All-County Natality Files were used to estimate multivariate linear models, controlling for maternal and infant characteristics and county-level and state-level covariates. Estimates were stratified by county rurality and birth risk conditions. Data were analyzed from April 1, 2024, to April 9, 2026.

MAIN OUTCOMES AND MEASURES: The primary outcomes were 4 measures of maternal care and procedures (physician-attended births, inductions, cesarean delivery births, and prenatal visits) and 3 birth outcomes (low Apgar score, low birth weight, and preterm births). Difference-in-differences models with 2-way fixed effects were estimated, and linear models for the study outcomes were specified.

RESULTS: The sample included 20 426 267 live births (mean [SD] gestational age, 38.55 [1.35] weeks). Compared with their counterparts in the control states, rural counties in the treated states experienced a statistically significant increase of 2.92 percentage points (pp) (95% CI, 1.40-4.50 pp; Bonferroni-adjusted P = .01) in physician-attended births. The increase held for both low-risk (3.10 pp; 95% CI, 1.33-4.90 pp; P = .004) and high-risk (2.56 pp; 95% CI, 0.77-4.34 pp; P = .01) births in rural counties. There was no difference between treated and control states for physician-attended births overall or in urban counties. No statistically significant associations were observed for cesarean deliveries, inductions, prenatal visits, or infant health outcomes after adjusting for multiple comparisons.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of 20 426 267 live births across 18 states, repealing noneconomic damage caps was associated with increased physician-attended births in rural counties but was not associated with statistically significant changes in other maternal care measures or infant health outcomes. These findings suggest that increased liability risk after repealing the caps may shift the composition of birth attendants in resource-constrained settings without demonstrable changes in infant health.

PMID:42241001 | DOI:10.1001/jamanetworkopen.2026.16654

JAMA Netw Open. 2026 Jun 1;9(6):e2616711. doi: 10.1001/jamanetworkopen.2026.16711.

ABSTRACT

IMPORTANCE: Community resources may benefit children’s long-term health, but the lasting impact of public spending in childhood is unclear. Identifying policies to address residential wealth and opportunity disparities could promote long-term health equity.

OBJECTIVE: To assess whether childhood exposure to public spending on community resources (public primary and secondary education, libraries, parks and recreation, and community development and housing) is associated with subsequent adult health.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used linked national datasets from 1977 through 2019. US cities with at least 150 000 residents in 1980 were included. Childhood public finance data covered 1977 through 2017, and adult health was measured in 2019. Included adults were in the 2019 Panel Study of Income Dynamics, were born between 1960 and 2000, and lived in a medium to large city before 18 years of age. Analyses were performed from August 2024 to March 2026.

EXPOSURE: Total per capita operational spending on community resources, summed across city, county, and school district levels for the year and city when the respondent was 9 years of age.

MAIN OUTCOMES AND MEASURES: The main outcome was overall adult health rated as fair or poor. Secondary outcomes included cardiovascular disease (CVD), anxiety, and depression diagnoses. Data were analyzed using weighted linear probability models adjusted for demographics. Estimated margins compared the 25th and 75th percentiles of spending.

RESULTS: Among 2214 adults (mean [SD] age in 2019, 38.9 [10.2] years; 1223 [52%] female), 389 (17%) reported fair or poor health, 458 (22%) reported CVD, and 184 (10%) reported anxiety or depression. A 1% increase in childhood community resource spending was associated with a 0.20 (95% CI, 0.04-0.35) percentage point decrease in adult fair or poor health and a 0.25 (95% CI, 0.07-0.44) percentage point decrease in adult CVD. To contextualize the magnitude, shifting from the 25th to 75th spending percentile decreased the estimated probability of reporting adult fair or poor health from 19.38% to 12.87%, a reduction of 6.51 (95% CI, 1.38-11.64) percentage points. A 1% increase in education (0.15 [95% CI, 0.02-0.29] percentage points) or library (0.05 [95% CI, 0.01-0.10] percentage points) spending was correlated with better overall health. Education (0.23 [95% CI, 0.07-0.39] percentage points) and community development and housing (0.04 [95% CI, 0.01-0.08] percentage points) spending were associated with lower CVD. No association was found for overall community resource spending or its individual four component sectors and anxiety or depression.

CONCLUSIONS AND RELEVANCE: In this cohort study of US urban adults, greater childhood exposure to community resource spending was associated with improved overall and cardiovascular health in adulthood. Variation in public spending levels may partially explain geographic differences in US health outcomes.

PMID:42240999 | DOI:10.1001/jamanetworkopen.2026.16711

Biometrics. 2026 Apr 9;82(2):ujag098. doi: 10.1093/biomtc/ujag098.

ABSTRACT

Recent advancements in immuno-oncology have significantly improved cancer treatments. Compared with traditional clinical trials, the toxicity of these novel therapies is generally low and tolerable, shifting the focus from solely managing toxicity to improving efficacy. Furthermore, such treatments can be costly, and thus it is crucial to identify a low-dose regimen with a good therapeutic effect for broader drug accessibility. Instead of solely identifying the optimal biological dose (OBD) in a phase I/II trial, we emphasize finding a more economical but effective dose. Current methods typically aim to determine the minimum effective dose (MED) based on a predefined efficacy target, which may not reflect the best balance between efficacy and dosage. This paper introduces the minimum noninferiority dose (MND), derived from the OBD, which eliminates the need for artificially setting an efficacy target. The MND ensures the dose maintains efficacy within a reasonable range below the OBD while keeping the dosage as low as possible. Through leveraging the calibration-free odds (CFO) design to monitor toxicity, we further propose a novel Bayesian two-stage design, called CFO-MND, by incorporating a trade-off between dose and efficacy as well as adaptive randomization. Our model-free approach is versatile and applicable to a wide range of scenarios. Furthermore, we incorporate causal inference into the CFO-MND design by introducing the placebo equivalent dose. This allows for preliminary estimation of the drug’s average treatment effect at the MND, which provides valuable information for subsequent trials.

PMID:42240965 | DOI:10.1093/biomtc/ujag098

Sports Med. 2026 Jun 4. doi: 10.1007/s40279-026-02463-y. Online ahead of print.

ABSTRACT

BACKGROUND: Burnout syndrome in sports is receiving increasing attention in the empirical literature applying psychometric tools. Since 2019, the number of scientific publications has doubled. This growth has increasingly dissociated athletes from their status as workers and burnout is rarely conceived as a phenomenon emerging from a working relationship. This study aims to meta-analyze the empirical measurements of burnout using scales in athletes and occupations related to professional sports during 2014-2023.

RESULTS: The initial search detected 996 studies. After a screening guided by PRISMA principles, we meta-analyzed 113 independent studies comprising 133 burnout measurements from 35,059 athletes, coaches, and referees across 29 countries. The results show a generalized use of the Athlete Burnout Questionnaire (ABQ), a notable heterogeneity in the estimates, signs of publication biases in some specific subscales, higher mean scores in personal accomplishment than other burnout dimensions, a decreasing trend in global scores over time, a higher burnout prevalence in developed countries, and different mean scores according to the scale applied.

CONCLUSIONS: The results highlight the need to continue improving the existing psychometric tools and focus interventions on the perception of accomplishment to reduce burnout incidence.

PMID:42240930 | DOI:10.1007/s40279-026-02463-y