Tag: statistics

JAMA Netw Open. 2026 Jul 1;9(7):e2621713. doi: 10.1001/jamanetworkopen.2026.21713.

ABSTRACT

IMPORTANCE: Most diabetes care is managed in primary care settings, which represent a critical yet underutilized site for continuous glucose monitoring (CGM) adoption. Whether CGM initiation by primary care clinicians improves glycemic outcomes and reduces acute health care utilization remains understudied.

OBJECTIVE: To evaluate the association of primary care-initiated CGM with changes in hemoglobin A1c (HbA1c) levels and rates of hospitalizations and emergency department (ED) visits among adults with insulin-treated diabetes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was performed at 18 primary care clinics within Montefiore Medical Center, a large safety-net health system in the Bronx, New York. Adults 18 years or older with any insulin-treated diabetes who had at least 1 primary care visit between August 1, 2022, and August 1, 2025, were included. Patients were excluded if they were uninsured, if they had a CGM prescription in the prior 2 years, or if their first CGM during follow-up was prescribed outside primary care.

EXPOSURE: First CGM prescription by a primary care clinician.

MAIN OUTCOMES AND MEASURES: The primary outcomes were HbA1c level trajectories, which were analyzed using mixed-effects models, and hospitalizations and ED visits, which were analyzed using recurrent event frailty models.

RESULTS: The study included 8502 insulin-treated CGM-naive adult patients with diabetes (mean [SD] age, 62.3 [14.6] years; 4764 [56.0%] female; 3618 [42.6%] with Medicare and 2854 [33.6%] with Medicaid coverage). Of these, 2392 patients (28.1%) were prescribed CGM by primary care clinicians. Patients who initiated CGM were younger, more often English-speaking and commercially insured, and had higher baseline HbA1c levels and more microvascular complications. At 12 months, HbA1c levels decreased by 0.66 (95% CI, 0.57-0.75) percentage points (pp) in patients who initiated CGM vs 0.17 (95% CI, 0.08-0.27) pp in those who did not, with a between-group difference of -0.49 (95% CI -0.62 to -0.35) pp. CGM initiation was associated with lower risk of recurrent hospitalizations (hazard ratio, 0.87 [95% CI, 0.77-0.98]) and ED visits (hazard ratio, 0.82 [95% CI, 0.74-0.91]).

CONCLUSIONS AND RELEVANCE: In this cohort study of adults with insulin-treated diabetes, initiation of CGM by primary care clinicians was associated with clinically meaningful improvements in HbA1c and significant reductions in recurrent hospitalizations and ED visits. These findings support expanding CGM implementation in primary care settings as a scalable strategy to improve diabetes outcomes and reduce acute care utilization, particularly in underserved populations.

PMID:42406400 | DOI:10.1001/jamanetworkopen.2026.21713

JAMA Netw Open. 2026 Jul 1;9(7):e2621731. doi: 10.1001/jamanetworkopen.2026.21731.

ABSTRACT

IMPORTANCE: Postacute sequelae of SARS-CoV-2 infection include fatigue, respiratory symptoms, and cognitive dysfunction. However, the extent to which these symptoms contribute to increased health care utilization and spending among Medicare beneficiaries remains unclear.

OBJECTIVE: To quantify differences in postacute symptoms and health care utilization and spending between traditional Medicare beneficiaries with COVID-19 and matched control beneficiaries without COVID-19.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used traditional Medicare claims from February 2020 through November 2022. Beneficiaries with a documented COVID-19 diagnosis were matched 1:5 to beneficiaries without COVID-19 based on demographic and clinical characteristics. Four variant-defined cohorts (original strain and Alpha, Delta, and Omicron variants) were analyzed. Follow-up extended through 40 weeks after diagnosis. Data were analyzed from February 2020 to November 2022.

MAIN OUTCOMES AND MEASURES: Diagnosis of 21 postacute COVID-19 symptoms, all-cause health care utilization, and Medicare spending were compared between those with COVID-19 and matched control beneficiaries using logistic and linear regression models adjusted for demographic and clinical covariates.

RESULTS: The cohort study included 937 077 Medicare beneficiaries with COVID-19 and 4 808 573 matched control beneficiaries without COVID-19 (3 109 789 females [54.1%]), with most beneficiaries (4 880 497 [84.9%]) aged 65 years or older. During the acute phase of infection (diagnosis week), beneficiaries with COVID-19 were 41.71 (95% CI, 41.62-41.91) percentage points more likely to receive at least 1 postacute symptom diagnosis than control beneficiaries. This difference declined to 5.22 (95% CI, 5.11-5.32) percentage points during weeks 1 to 12 and to 1.94 (95% CI, 1.81-2.05) percentage points during weeks 13 to 40. Medicare spending was $7933.13 higher (95% CI, $7904.12-$7962.14) in the acute phase, decreasing to $232.31 (95% CI, $230.11-$234.14) per week in weeks 1 to 12 and to $28.21 (95% CI, $27.11-$30.13) per week in weeks 13 to 40. Differences in health care utilization followed a similar pattern, decreasing to 0.05 (95% CI, 0.05-0.06) visits per week in weeks 1 to 12 and to 0.03 (95% CI, 0.02-0.03) visits per week in weeks 13 to 40.

CONCLUSIONS AND RELEVANCE: In this cohort study of traditional Medicare beneficiaries across major COVID-19 variants, postacute symptom diagnoses and health care utilization and spending were substantially higher in the acute phase of COVID-19 but diminished over time, approaching levels observed in matched control beneficiaries without COVID-19 by 3 months after infection. These findings suggest limited long-term excess health care utilization or spending attributable to COVID-19 infection among older adults.

PMID:42406399 | DOI:10.1001/jamanetworkopen.2026.21731

JAMA Netw Open. 2026 Jul 1;9(7):e2621741. doi: 10.1001/jamanetworkopen.2026.21741.

ABSTRACT

IMPORTANCE: Metastatic prostate cancer (PC) incidence has increased in US men, partly due to changes in prostate-specific antigen (PSA) screening recommendations. However, few studies have examined contemporary PSA screening practices in large US health care systems.

OBJECTIVE: To describe and examine contemporary PSA testing practices associated with metastatic PC incidence.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included veterans within the Veterans Health Administration that received a prostate needle biopsy (PNB) between January 2015 and December 2023 with follow-up through 2024, excluding those with a history of PC. Data were analyzed between July 1, 2023, and November 6, 2025.

EXPOSURES: PSA tests were retrieved from the VA Corporate Data Warehouse and categorized by age at first VA PSA (<50, 50-59, and ≥60 years) and by longest interval between consecutive VA PSA tests in the 5 years before PNB (≤24 vs >24 months). Clinical, laboratory, pathological, demographic, and census block group-level socioeconomic status data were obtained from the VA Multi-OMICS Analysis Platform for Prostate Cancer database.

MAIN OUTCOMES AND MEASURES: Multivariable Cox models estimated hazard ratios (HRs) from time of first VA PSA to first PNB, evaluated risk of metastatic (regional or distant) vs localized PC or benign diagnosis, and adjusted for sociodemographic and clinical covariates.

RESULTS: There were 103 067 participants of whom 20 233 (19.6%) were younger than 50 years at first PSA, 31 546 (30.6%) were non-Hispanic Black, 58 264 (56.5%) were non-Hispanic White, and 13 277 (12.9%) had other race or ethnicity. Of all participants, 22 190 (21.5%) had a first PSA value of 1 ng/mL or less, 52 939 (51.4%) had a screening interval of 24 months or less, and 3773 (3.7%) were diagnosed with metastatic PC at time of PNB. Compared with men aged younger than 50 years at first PSA, those aged 50 to 59 years (adjusted HR [aHR], 1.27; 95% CI, 1.24-1.29) and 60 years or older (aHR, 2.37; 95% CI, 2.33-2.42) had higher risk of metastatic PC. Men with longer screening intervals had higher risk of metastatic PC (aHR, 1.14; 95% CI, 1.13-1.16). Men aged younger than 50 years with shorter screening intervals had lower rates of metastatic PC (adjusted risk ratio, 0.10; 95% CI, 0.09-0.12) compared with men aged 60 years or older with longer screening intervals.

CONCLUSIONS AND RELEVANCE: In this cohort study, few veterans had the most favorable combinations of screening factors in relation to metastatic PC, suggesting potential for further screening optimization.

PMID:42406398 | DOI:10.1001/jamanetworkopen.2026.21741

Hum Vaccin Immunother. 2026 Dec;22(1):2682486. doi: 10.1080/21645515.2026.2682486. Epub 2026 Jul 6.

ABSTRACT

Children with special health care needs (CSHCN) are at increased risk of vaccine-preventable diseases, yet concerns about safety often lead to delayed or incomplete immunization. We conducted a retrospective analysis of 1278 CSHCN attending the Special Vaccination Consultation Clinic of Kunming Children’s Hospital in Yunnan Province, China, between January 2023 to December 2024. We examined their disease spectrum, vaccination recommendations, and incidence of adverse events following immunization (AEFI). The cohort had a male-to-female ratio of 1.3:1, with infants aged 0-1 y constituting the majority (56.4%). Neurological (38.3%), neonatal (33.6%), and cardiovascular diseases (21.4%) predominated the consultation spectrum, with a marked age-dependent shift from neonatal conditions in early infancy to neurological disorders thereafter. Following specialist evaluation, 92.5% of children received vaccination advice: 76.7% were recommended for standard or single-dose sequential vaccination, and 15.8% for inactivated vaccines only; only 2.7% were advised to defer all vaccinations. Among 1182 children who were subsequently vaccinated, 174 reported AEFI, yielding an incidence of 14.7%. Fever was the predominant manifestation (70.7% of AEFI), and the vast majority (99.4%) of events occurred in children under 4 y of age. This study demonstrates that under the guidance of a specialized vaccination clinic, over 90% of CSHCN can be safely vaccinated. Individualized assessment based on age and disease characteristics is pivotal to ensuring immunization in this vulnerable population, thereby safeguarding their right to protection against vaccine-preventable diseases.

PMID:42406396 | DOI:10.1080/21645515.2026.2682486

Pain Med. 2026 Jul 6:pnag084. doi: 10.1093/pm/pnag084. Online ahead of print.

ABSTRACT

OBJECTIVE: Genicular nerve radiofrequency (gRF) treatment is a widely used intervention for chronic pain from knee osteoarthritis (KOA). This systematic review and meta-analysis focuses on RCTs utilizing image guidance to address inconsistencies in previous reviews and provide higher-quality evidence.

DESIGN, SETTING, AND METHODS: This study included RCTs that compared gRF techniques (conventional, cooled, pulsed, bipolar) to non-gRF treatments, including sham procedures, intra-articular injections, ozone therapy, and oral medications. Primary and secondary outcomes were changes in pain and total WOMAC scores at 3, 6, and 12 months post-gRF treatments. Subgroup analyses explored differences by lesion size, use of prognostic blocks, industry sponsorship, and study location. Statistical heterogeneity was assessed via I 2 statistics.

RESULTS: Eleven RCTs with 868 knee osteoarthritis patients (435 gRF, 433 non-gRF) were included. At 3 months, gRF significantly reduced pain (SMD -1.65, 95% CI: -3.20 to -0.10, I 2 = 98%, P = 0.040), but not at 6 months or 12 months. Secondary analyses showed no significant differences in total WOMAC scores between the gRF and control groups at 3, 6, and 12 months. Subgroup analysis showed that industry-sponsored studies reported significant 3-month pain reduction, whereas non-sponsored studies did not. This effect was independent of study location.

CONCLUSIONS: GRF provides short-term pain relief (up to 3 months) but neither functional improvement nor sustained pain reduction compared to non-gRF treatments. Our findings do not support the routine use of gRF for long-term chronic pain due to KOA.

PMID:42406393 | DOI:10.1093/pm/pnag084

J Drugs Dermatol. 2026 Jul 1;25(7):655-658. doi: 10.36849/JDD.10028.

ABSTRACT

BACKGROUND: Facial cleansers can disrupt the stratum corneum and cause irritation. Selecting a cleanser that is both effective and gentle is foundational to a tailored skincare routine, particularly for individuals with sensitive skin. This project assessed the relative mildness of Cetaphil&reg; Gentle Skin Cleanser (GSC; Galderma Laboratories, LP, Fort Worth, TX) vs 7 other commercially available gentle cleansers using corneosurfametry.

METHODS: Surface skin cells were collected from the volar forearms of 18 volunteer participants using D‑Squame&reg; standard sampling discs. Discs were then incubated for 10 minutes in a 10% aqueous solution of one of the 8 cleansers, 5% sodium lauryl sulfate (positive control), or water (negative control). Samples were stained with toluidine blue&ndash;basic fuchsin and measured by chromameter. Colorimetric index of mildness (CIM) least-squares means were compared pairwise versus GSC, and photographs provided qualitative corroboration. A higher CIM indicated a milder cleanser, while a lower CIM indicated a harsher cleanser.

RESULTS: The mean CIM for GSC was 63.87; pairwise comparisons indicated statistically significant differences between GSC and the mean CIM of the 7 comparators, which ranged from 46.95 to 53.32. Photographic tape appearance was concordant with CIM rankings.

CONCLUSION: GSC was significantly milder than the comparator cleansers as assessed by CIM and photographic analysis of the tape strips. These data suggest that there are differences in irritation potential among commercially available facial cleansers, which may help ensure patients and providers select a sufficiently mild cleanser for those with sensitive skin.

PMID:42406355 | DOI:10.36849/JDD.10028

J Drugs Dermatol. 2026 Jul 1;25(7):629-631. doi: 10.36849/JDD.10055.

ABSTRACT

BACKGROUND: Pigmentary disorders, particularly hyperpigmentation, disproportionately affect individuals with skin of color and are associated with significant psychosocial burden. Despite their global prevalence, real-time data on public awareness and interest remain limited. Digital tools such as Google Trends offer a novel approach to assessing public interest in dermatologic conditions.

METHODS: Google Trends was used to evaluate public interest in hyperpigmentation-related terms such as “hyperpigmentation”, “pigmentation”, “skin brightening”, “brown spots”, and “dark spot treatment” from January 2004 to October 2025. Data were analyzed for the United States (US) and globally using relative search volume (RSV), a normalized scale from 0-100 representing peak popularity within a defined region and time frame. Temporal trends, seasonal variation, and geographical distribution were assessed.

RESULTS: Across all terms, RSV demonstrated a sustained increase over time both domestically and globally. “Pigmentation” and “hyperpigmentation” consistently showed the highest search interest, with a marked spike in “hyperpigmentation” in early 2025. “Brown spots” exhibited seasonal peaks during the summer months. In the US, the highest relative search interest for “brown spots” was observed in southern states, including South Carolina, Alabama, and Tennessee. Globally, countries such as Ghana, Nigeria, and Mauritius frequently ranked highly across multiple terms.

CONCLUSION: Public interest in pigmentary disorders has increased significantly over the past two decades. Google Trends provides valuable insight into consumer awareness and information-seeking behavior, highlighting potential gaps in education and access to dermatologic care. These findings may inform targeted public health initiatives and culturally responsive interventions for populations disproportionately affected by pigmentary conditions. &nbsp.

PMID:42406343 | DOI:10.36849/JDD.10055

Neurocrit Care. 2026 Jul 6. doi: 10.1007/s12028-026-02576-2. Online ahead of print.

ABSTRACT

OBJECTIVE: In this study, we sought to conduct a systematic review and meta-analysis of mental health outcomes in survivors of neurocritical illness.

METHODS: Literature databases [PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycInfo] were searched for terms relating to critical illness, intensive care, and outcomes from January 1970 to June 2024. English-language studies of adults with critically illness with a primary neurological diagnosis were included if they reported on mental health outcomes [specifically, depression, anxiety, post-traumatic stress (PTS), or general mental health]. Data extraction was performed, in duplicate, for prespecified variables related to study outcomes. Random effects meta-analyses were conducted to estimate pooled prevalence and symptom severity.

RESULTS: Of more than 33,000 abstracts screened, 24 publications reported on mental health outcomes: 19 reported on depression outcomes, 11 on anxiety, 7 on PTS, and 8 on general mental health. The median [interquartile range (IQR)] time to first depression, anxiety, and/or PTS assessment was 3 (1.75, 12), 4.5 (1.1, 7.5), and 3 (0, 3) months, respectively. The most common assessment tools were the Hospital Anxiety and Depression Scale, Depression Subscale (HADS-D; n = 8) and the Hospital Anxiety and Depression Scale, Anxiety Subscale HADS-A (n = 8), and Post-traumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5)/Post-traumatic Stress Disorder Checklist, Civilian Version (PCL-C) for PTS (n = 4). General mental health outcomes were studied using seven unique tools at a median (IQR) follow-up time of 3 (0.5, 6) months. Pooled depression prevalence [95% confidence interval (CI)] was 24% (20-29%) among publications using HADS-D and 26% (16-38%) in publications using any assessment tool. Pooled anxiety prevalence was 37% (21-56%) using HADS-A and was 32% (18-51%) using any assessment tool. PTS prevalence was 14% (8-21%). Heterogeneity of assessment tools precluded a pooled analysis of general mental health.

CONCLUSIONS: These findings highlight the burden of mental health symptoms following neurocritical care illness, with prevalences higher than the general population. These findings were impacted by substantial between-study heterogeneity-particularly in assessment tools and timing of evaluations-limiting precise prevalence estimation.

PMID:42406307 | DOI:10.1007/s12028-026-02576-2

Discov Ment Health. 2026 Jul 6. doi: 10.1007/s44192-026-00541-1. Online ahead of print.

ABSTRACT

BACKGROUND: Psychological vulnerability reflects a heightened susceptibility to psychological distress when individuals encounter stressors, particularly in the absence of adequate coping resources. In the digital era, has emerged as a potential risk factor contributing to this vulnerability. Family functioning has been proposed as a protective factor; however, its moderating role in the relationship between and psychological vulnerability remains insufficiently examined.

METHODS: This study employed a cross-sectional quantitative design involving 284 active social media users in Pekanbaru, Indonesia, aged 18-50 years (M = 22.6, SD = 3.9), with the sample predominantly consisting of students (98.2%). Participants were recruited using a convenience sampling approach through online distribution. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) with a disjoint two-stage approach.

RESULTS: The results indicated that was positively associated with psychological vulnerability (β = 0.400, p < .001), while family functioning showed a significant negative association (β = – 0.174, p = .001). The interaction effect between and family functioning was statistically significant but very small in magnitude (β = 0.103, p = .009; f² = 0.016). Conditional effect analysis showed that the association between and psychological vulnerability was stronger at higher levels of family functioning, indicating a non-buffering moderation pattern.

CONCLUSIONS: These findings suggest that is an important risk factor for psychological vulnerability, whereas family functioning demonstrates a protective direct effect. However, its moderating role appears limited and does not operate in a buffering manner. Given the very small interaction effect and the use of convenience sampling with a predominantly student sample, the findings should be interpreted with caution. Future research employing longitudinal designs and more diverse samples is needed to further clarify these relationships.

PMID:42406304 | DOI:10.1007/s44192-026-00541-1

Dig Dis Sci. 2026 Jul 6. doi: 10.1007/s10620-026-10098-2. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Acute pancreatitis (AP) is an inflammatory disease with high morbidity and mortality, characterized by the activation of pancreatic enzymes within the pancreas, leading to autolysis. The clinical spectrum of AP ranges from edematous pancreatitis to necrotizing pancreatitis and may result in local complications such as pancreatic necrosis, pseudocysts, and peripancreatic fluid collections. In this study, we aimed to evaluate the prognostic value of daily C-reactive protein (CRP), procalcitonin, and CRP/albumin levels in predicting local complications of pancreatitis.

MATERIALS AND METHODS: The study included 350 patients with AP, who were hospitalised at Bilkent City Hospital, between 1 January 2020 and 31 December 2023. Demographic data, AP etiologies, and biochemical parameters were recorded. The daily trajectories of CRP, procalcitonin, and albumin levels were monitored over 14 days. All statistical analyses were performed using SPSS version 22.

RESULTS: To distinguish cases with and without peripancreatic fluid collection, the cutoff values for CRP on the first, second, and third days were determined as ≥ 30, ≥ 33, and ≥ 59 (AUC: 0.6574; 0.8343; 0.8897), respectively. The cutoff values for procalcitonin were ≥ 0.09, ≥ 0.07, and ≥ 0.12 (AUC: 0.6457; 0.7227; 0.7310), while for CRP/albumin, the cutoff values were ≥ 0.2609, ≥ 1.0476, and ≥ 1.7143 (AUC: 0.6586; 0.8314; 0.8856), respectively. For distinguishing acute peripancreatic fluid collection (APFC) from WON-pseudocyst, the cutoff values for CRP on the first, second, and third days were determined as ≥ 79, ≥ 124, and ≥ 131 (AUC: 0.7428; 0.8360; 0.9613), respectively. The cutoff values for procalcitonin were ≥ 0.18, ≥ 0.13, and ≥ 0.10 (AUC: 0.7403; 0.8493; 0.8967), while for the CRP/albumin ratio, the cutoff values were ≥ 2.000, ≥ 3.000, and ≥ 2.9556 (AUC: 0.7530; 0.8368; 0.9634), respectively. For distinguishing pseudocyst from walled-off necrosis (WON), the cutoff values for CRP on the first, second, and third days were determined as ≥ 234, ≥ 91, and ≥ 229 (AUC: 0.5750; 0.6285; 0.7148), respectively. The cutoff values for procalcitonin were ≥ 0.96, ≥ 0.39, and ≥ 0.69(AUC: 0.6083; 0.6813; 0.7319), while for the CRP/albumin ratio, the cutoff values were ≥ 6.50, ≥ 5.3684, and ≥ 7.3571 (AUC: 0.5603; 0.6357; 0.7456), respectively.

CONCLUSION: Our study indicated that the daily variations in CRP, procalcitonin, and CRP/albumin ratio were significantly associated with AP complications.

PMID:42406297 | DOI:10.1007/s10620-026-10098-2