Tag: statistics

Acta Obstet Gynecol Scand. 2025 Oct 27. doi: 10.1111/aogs.70071. Online ahead of print.

ABSTRACT

INTRODUCTION: Fertility after cancer represents a growing clinical concern. This study assessed childbearing outcomes among women diagnosed with cancer during reproductive age between 2012 and 2017 in Lombardy, the largest region in Italy.

MATERIAL AND METHODS: Women aged 15-45 years with a primary diagnosis of cancer recorded in hospital discharge records from regional healthcare databases were selected. Each woman diagnosed with cancer was matched with up to five cancer-free women of the same age at diagnosis. The cumulative probability of childbirth up to December 31, 2022 was estimated using the Kalbfleisch-Prentice cumulative incidence function estimator. Cox regression models were used to estimate the cause-specific hazard ratios (HRs) and the 95% confidence intervals (CIs) of childbirth according to the cancer diagnosis. Furthermore, in the group of cancer survivors, exposure to antineoplastic treatment was considered and included in the model as a time-dependent covariate. Finally, a log-binomial regression model was used to assess the association between antineoplastic therapy and medically assisted reproduction.

RESULTS: A total of 13,877 women were diagnosed with cancer at reproductive age during the study period (1.16 per 1000 person-years). The cumulative probability of childbirth was lower among women diagnosed with cancer compared to cancer-free women across all age groups: 31.4% vs 32.2% (p = 0.02) among those diagnosed under 30, 13.3% vs 22.7% (p < 0.01) among those aged 30-39, and 0.8% vs 1.6% (p < 0.01) among those aged 40 and over. The corresponding HRs were 0.93 (95% CI: 0.83-1.05), 0.58 (95% CI: 0.53-0.64), and 0.52 (95% CI: 0.40-0.68). When analyses were stratified by time since diagnosis, the reduced probability among cancer survivors was confirmed to be significant only within the first 5 years after diagnosis, also for younger individuals. Antineoplastic treatment was associated with a reduced probability of subsequent birth (HR = 0.46, 95% CI: 0.39-0.52). Moreover, the therapy was positively associated with medically assisted reproduction (RR = 1.71, 95% CI: 1.14-2.56).

CONCLUSIONS: The probability of childbearing was reduced within the first 5 years of diagnosis, regardless of the patient’s age. A more pronounced reduction was observed in women diagnosed after the age of 30. Age and antineoplastic therapy were key factors in determining childbearing in women diagnosed with cancer.

PMID:41144834 | DOI:10.1111/aogs.70071

Adv Sci (Weinh). 2025 Oct 27:e13878. doi: 10.1002/advs.202513878. Online ahead of print.

ABSTRACT

Oxidizing transition metal surfaces are generally characterized by an increasing heterogeneity at simultaneous lowering of crystalline order. This complexity eludes present-day first-principles descriptions, with predictive-quality surface phase diagrams commonly derived from comparing the stability of a small number of ordered surface structural models that are motivated by partial experimental characterization or chemical intuition. Here the computational acceleration brought by machine-learned interatomic potentials is leveraged for a systematic sampling of the configurational phase space through replica exchange molecular dynamics. Thermodynamic averaging subsequently yields grand-canonical expectation values for observables like O coverage that account for the disorder and diversity of the sampled structures. Application to the initial oxidation of the Cu(111) surface reveals the (purely entropic) stabilization of sparse O adsorbates at the onset, a plethora of energetically essentially degenerate polymeric -O-Cu-O- ring and chain networks at higher O loading, as well as the presence of experimentally discussed minority species. The in silico surface phase diagram correspondingly shows marked differences to one based merely on established ordered surface reconstructions.

PMID:41144830 | DOI:10.1002/advs.202513878

Laryngoscope. 2025 Oct 27. doi: 10.1002/lary.70222. Online ahead of print.

ABSTRACT

OBJECTIVES: Medialization thyroplasty (MT) is a procedure used to treat glottal insufficiency. It is conducted with the patient under procedural sedation for vocal feedback. The objective of this study is to evaluate the patient’s perception of pain after MT surgery.

METHODS: Prospective observational study. Patients undergoing MT completed the validated short-form McGill Pain Questionnaire (SF-MPQ) before surgery and post-operative days (PODs) 1 and 7, and Voice Handicap Index-10 questionnaire (VHI-10) before surgery and POD7. Demographic and clinical data were collected. Nonparametric tests were conducted for statistical analysis.

RESULTS: Fifty-three patients (47% male), with a median age of 67 years (IQR 15) were recruited between March 2023 and February 2025. On POD1, 74% required analgesia and 52% required opioids. Pre-operative SF-MPQ was median 0 (IQR 0), which increased significantly on POD1 to 3.0 (IQR 7.5) (p < 0.0001) and decreased significantly on POD7 to median 1.0 (IQR 3.0) (p < 0.0001). Voices significantly improved, from pre-operative VHI-10 score of 26 (IQR 14) to POD7 score of 12 (IQR 13) (p < 0.0001). None of the following factors were associated with increased pain: age, sex, BMI, anxiety diagnosis, per-operative, regular intake of pain medication, surgical time or pre-operative VHI score.

CONCLUSIONS: Although MT was completed under procedural sedation, pain was well tolerated after surgery. Half of the patients used opioids for post-operative pain, and the levels of pain were mild. There are opportunities for improved opioid stewardship in the pain management of this surgery. This study is one of the few prospective studies evaluating pain with MT.

PMID:41144815 | DOI:10.1002/lary.70222

Acta Anaesthesiol Scand. 2026 Jan;70(1):e70140. doi: 10.1111/aas.70140.

ABSTRACT

BACKGROUND: Continuous regional anesthesia (CRA) techniques are used for analgesia in patients with acute rib fractures. However, there is a paucity of evidence supporting the initiation of CRA in patients receiving mechanical ventilation (MV). We therefore performed this retrospective study to assess changes in opioid consumption and the rate of liberation from MV in patients with traumatic rib fractures.

METHODS: Patients referred to the Acute Pain Service (January 2022-July 2023) who were mechanically ventilated with acute rib fractures were included in this study. Patients received consultation either with or without CRA. Demographic and severity of injury data were collected. Mechanical ventilator requirements, pain scores, sedation use, opioids, adjunct analgesics, neurological status, and sedation status were collected for the 24 h prior to APS consultation/CRA intervention and for 48 h afterward.

RESULTS: Forty patients were included in the study, with 18 in the non-CRA group and 22 in the CRA group. There was a statistically significant decrease in overall opioid consumption (oral morphine equivalents) for the CRA group compared to the non-CRA group 0-48 h postintervention (0-24 h post-CRA [median 135 mg { 33.1-296.6}]) versus non-CRA 368.3 (121.5-727.9) (p = 0.018), 24-48 h post-CRA (31.5 mg [11.5-131.6] vs. non-CRA 342.8 [99.3-645.8]) (p = 0.001). There was no significant difference in rates of liberation from MV between groups.

CONCLUSIONS: CRA use was associated with a decrease in opioid consumption 24-48 h after CRA intervention compared to baseline. CRA did not facilitate early liberation from MV.

EDITORIAL COMMENT: This retrospective study provides evidence that CRA may reduce opioid requirements in mechanically ventilated patients with rib fractures. Although CRA did not facilitate earlier liberation from ventilation, the opioid-sparing effect is clinically relevant in this population. Larger prospective studies are warranted to define optimal timing, patient selection, and integration of CRA into critical care pathways.

PMID:41144812 | DOI:10.1111/aas.70140

J Appl Clin Med Phys. 2025 Nov;26(11):e70305. doi: 10.1002/acm2.70305.

ABSTRACT

BACKGROUND: Radiation oncology residents report a lack of understanding and confidence in assessing radiotherapy plan quality. A contributing factor is the environment in which plan review is taught during residency, that is, routine clinical practice, which does not provide ample time for self-guided practice in a low-stakes setting. Expertise in plan review requires diverse case presentation and many examples, which are often not achievable in smaller programs and for less common cancer types. As plan quality affects patient outcomes, it is important to address these pitfalls in the education of residents on plan review.

PURPOSE: To address the identified pitfalls of clinic-based training, we have developed techniques to create realistic dose distributions that appear suboptimal in a controllable way. These plans can provide many more case examples in the training curriculum and present a low-stakes technique for safe and effective education of radiation oncology residents.

METHODS: High-quality dose distributions were first generated with a pre-trained deep learning model (trained using only high-quality plans). The dose distributions were then altered directly to create three classes of suboptimal dose distributions: (1) decreased organ-at-risk sparing, (2) decreased target conformality, and (3) hotspots in the target. Experienced clinicians then reviewed a subset of these suboptimal dose distributions to assess realism.

RESULTS: We successfully decreased the quality of radiotherapy dose distributions. The decreased organ-at-risk sparing, decreased target conformality, and increased target hotspots were statistically significant (p < 0.05) when assessed by dose-volume histogram metrics for all parameters evaluated, and the magnitude of dose change was controllable. The resulting dose distributions were overall scored by experienced clinicians as realistic.

CONCLUSION: In this study, we developed techniques to generate realistic but suboptimal dose distributions. The techniques operate directly on existing dose distributions without the need for a treatment planning system and produce dose distributions that appear realistic to experienced clinicians.

PMID:41144809 | DOI:10.1002/acm2.70305

Phys Occup Ther Pediatr. 2025 Oct 27:1-15. doi: 10.1080/01942638.2025.2576746. Online ahead of print.

ABSTRACT

AIMS: To assess test-retest reliability and concurrent validity of the 1-min sit-to-stand test (1-minSTST) in children and adolescents who are overweight or obese.

METHODS: Thirty-nine overweight and obese children and adolescents were included. The 1-minSTST was administered twice with a one-hour break. Concurrent validity was evaluated by assessing correlations between 1-minSTST repetitions and six-minute walk test (6MWT) distances. The cardiorespiratory measures (blood pressure, heart rate, oxygen saturation, respiratory rate, dyspnea, and perceived fatigue) were recorded before and after each test.

RESULTS: Test-retest reliability was excellent (ICC: 0.90, 95% confidence interval 0.90-0.97). There was no relationship between scores on the 1-minSTST and 6MWT (r = -0.06, p = 0.71). No statistically significant correlation was found between scores on each test and change in cardiorespiratory responses, except for respiratory rate (r = 0.43, p = 0.006). Change in cardiorespiratory responses was similar when performing each test (p > 0.05).

CONCLUSION: While the 1-minSTST seems promising, it is not significantly related to the 6MWT, indicating they may assess different dimensions of fitness in this population. Further investigations are needed to determine the clinical implications of 1-minSTST outcomes in pediatric population.

PMID:41143870 | DOI:10.1080/01942638.2025.2576746

JMIR Res Protoc. 2025 Oct 27;14:e73366. doi: 10.2196/73366.

ABSTRACT

BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide and imposes a significant public health burden. In 2019, HPV was responsible for approximately 620,000 cancer cases in women, 70,000 in men, and more than 300,000 deaths globally. Despite the proven efficacy of the vaccine, vaccination rates remain alarmingly low in certain regions of France. In Réunion Island, only 16% of girls and 9% of boys under 16 years old were fully vaccinated in 2024. This underscores the need for increased awareness, education, and outreach programs. Peer learning is well-established in health education, whereas serious game-style card games are newer and require further research. Both methods have been shown to improve knowledge on specific topics.

OBJECTIVE: The main objective of this study is to assess the impact of 2 awareness-raising strategies on increasing HPV vaccination rates among middle school students by actively involving them in the process.

METHODS: This protocol describes the design of a randomized, open-label, controlled trial aimed at evaluating the effectiveness of 2 awareness-raising interventions-peer learning and a card-based serious game-in improving HPV vaccination rates among middle school students in Réunion Island. The study will span an entire school year, beginning in August. Approximately 3600 students from 24 middle schools in Réunion Island will be included, with schools randomized into 3 groups of 8 each: (1) a control group receiving the existing national vaccination campaign initiated by the French public health institute; (2) ambassador classes, whose students will receive education about the HPV vaccine and later educate other students in the same school; and (3) serious game card group, where students can play and learn about HPV during a science class. The primary outcome will be the proportion of teenagers who initiate the vaccination process, compared across the 3 groups using appropriate statistical methods. Anonymized data will be collected at the end of the school year using social security records. Teenagers’ knowledge of HPV will be assessed both before and 3 months after each intervention, and satisfaction will also be evaluated after the intervention in each group.

RESULTS: As of May 2025, a preliminary result enrolling 124 students showed an increase in vaccination coverage after students played a serious game. We expect higher vaccination rates in the intervention groups compared with the control group, although it is difficult to predict which strategy will be more effective. The estimated target vaccination coverage for groups b and c is 45%.

CONCLUSIONS: This study aims to improve HPV vaccination rates among teenagers in Réunion Island by evaluating the impact of 2 awareness-raising strategies using innovative and engaging tools. If successful, this approach could be adapted and implemented in other regions of France or internationally.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/73366.

PMID:41143859 | DOI:10.2196/73366

Curr Eye Res. 2025 Oct 27:1-8. doi: 10.1080/02713683.2025.2577767. Online ahead of print.

ABSTRACT

PURPOSE: Use of illicit substances such as cocaine is associated with alteration in catecholamine-mediated neurotransmission throughout the CNS, including the eye. One of the most accessible physiologic parameters associated with neuromodulatory features of substance abuse is the pupillary light reflex (PLR). In this study, we examined a domain of the PLR characterized by melanopsin-driven intrinsically photosensitive retinal ganglion cells (ipRGCs) to assess the impact of substance abuse on ipRGC function.

METHODS: An exploratory PLR examination on ten subjects with a documented history of substance use (HSU) without preexisting ocular disease was conducted with a comparator control cohort. Cases included assessment of cognitive function, depression, insomnia, and retinal nerve fiber thickness. IpRGC functionality was demonstrated by the PLR using a pedagogical-based methodology centered on response parameters with the introduction of a complementary analysis employing pseudo-one-phase modeling. Discriminant analysis employing the area under the receiver operating characteristic curve (AUC of ROC) categorized normal vs. abnormal ipRGC response.

RESULTS: There was no statistical association between ipRGC function and insomnia; however, insomnia was more prevalent among those with ipRGC abnormality. Indication of clinical depression was seen in 70% of study participants and was unrelated to ipRGC function. Pseudo-one-phase modeling demonstrated a significantly higher plateau in the HSU group as well as a slower initial rate of pupil recovery consistent with abnormal PIPR dynamics and complementary to AUC metrics. Discriminant analysis identified that 60% of HSU demonstrated ipRGC abnormality.

CONCLUSION: Abnormal ipRGC functionality was demonstrated among those with HSU in this small exploratory study utilizing both AUC-ROC analysis as well as assessment of PLR waveform characteristics using features of a pseudo-first-order model.

PMID:41143850 | DOI:10.1080/02713683.2025.2577767

JAMA Netw Open. 2025 Oct 1;8(10):e2539451. doi: 10.1001/jamanetworkopen.2025.39451.

ABSTRACT

IMPORTANCE: The Defense Health Agency Procedural Instruction (DHA-PI) 6200.02, introduced in May 2019, aimed to improve contraception access and knowledge among eligible beneficiaries. However, the policy’s association with contraception prescribing and dispensing practices has not been fully evaluated.

OBJECTIVE: To evaluate changes in contraceptive prescribing and dispensing practices associated with DHA-PI 6200.02, focusing on extended day supply of long-acting reversible contraception (LARC), short-acting reversible contraception (SARC), and permanent contraception.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted utilizing interrupted time-series analysis to examine changes in contraception care practices before and after policy implementation. The study period was between January 1, 2016, and September 30, 2022. Participants were active-duty servicewomen (ADSW) aged 18 to 55 years, with an assigned sex of female in medical records who were enrolled in TRICARE.

EXPOSURE: The implementation of the DHA-PI 6200.02 policy in May 2019.

MAIN OUTCOMES AND MEASURES: The primary outcomes included rates of extended contraceptive supply and utilization of LARC, SARC, and permanent contraception. Five performance measures were employed to assess the associations between DHA-PI 6200.02 and changes in contraceptive supply. Segmented regression models were unadjusted and used to estimate level and trend changes in monthly MOPs.

RESULTS: Among 429 194 ADSWs (mean [SD] age 24.5 [7.0] years; 148 104 [34.5%] Army, 101 299 [32.6%] Navy, 115 288 [26.86%] Air Force, and 35 352 [8.24%] Marine Corps), the proportion of SARC users receiving extended supply increased from 1.1% prepolicy to 5.3% postpolicy. Extended SARC use increased from 16.3% (95% CI, 16.0%-16.7%) at baseline to 19.7% (95% CI, 17.9%-21.6%) at the end of follow-up, and dispensed extended SARC rose from 8.2% (95% CI, 7.9%-8.5%) to 9.3% (95% CI, 7.4%-11.1%), both reflecting significant post-policy upward trends. The overall proportion of ADSW with any extended contraceptive supply showed no meaningful change and declined significantly in trend. Prescriber provision of extended supply rose modestly without sustained trend change, and among contraceptive users extended supply increased but without significant policy-related effects.

CONCLUSIONS AND RELEVANCE: In this cohort study of ADSWs, DHA-PI 6200.02 was associated with increased access to extended day supply for SARC but no corresponding increases were observed in overall extended contraceptive supply across all methods (SARC, LARC placement, and permanent contraception). These findings underscore challenges in policy uptake and highlight the need for enhanced efforts to ensure comprehensive implementation of DHA-PI 6200.02.

PMID:41143794 | DOI:10.1001/jamanetworkopen.2025.39451

AIDS. 2025 Oct 27. doi: 10.1097/QAD.0000000000004380. Online ahead of print.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitor (ICI) therapy has demonstrated safety and efficacy in a variety of malignancies, including cancers affecting patients with human immunodeficiency virus (PWH). However, there is limited data directly comparing efficacy of ICI use between cancer patients with versus without HIV.

METHODS: Real-world retrospective data were used to compare clinical outcomes between 24 PWH and cancer 24 matched cancer patients without HIV, all treated with ICI therapy.

RESULTS: Adverse event rates did not differ by HIV status. Overall response (complete or partial response) to ICI therapy was observed in 29% of PWH compared to 38% of people without HIV (PWoH), but this difference was not statistically significant. The overall survival at end of study follow-up by HIV status was similar between both groups (63% in PWH and 67% in PWoH).

CONCLUSIONS: These findings suggest that HIV status alone should not preclude use of ICI therapy to improve prognosis among PWH and cancer.

PMID:41143744 | DOI:10.1097/QAD.0000000000004380