Tag: statistics

Asian J Psychiatr. 2025 Oct 28;114:104758. doi: 10.1016/j.ajp.2025.104758. Online ahead of print.

ABSTRACT

OBJECTIVE: This meta-analysis aimed to systematically evaluate the specific, adjunctive efficacy of repetitive transcranial magnetic stimulation (rTMS) when combined with non-pharmacological interventions-namely, transcranial direct current stimulation (tDCS), Tai Chi, or cognitive training (CT)-in patients with Alzheimer’s disease (AD) or mild cognitive impairment (MCI). The goal is to isolate the net therapeutic contribution of rTMS beyond the effects of the base interventions alone.

METHODS: A comprehensive search of Chinese and English databases was conducted from their inception until April 26, 2025. Randomized controlled trials (RCTs) that compared “a non-pharmacological intervention plus active rTMS” versus “the same non-pharmacological intervention plus sham rTMS”.This “add-on” study design was selected to precisely isolate the effect of rTMS. The risk of bias was assessed using the PEDro scale and Cochrane tools. Statistical analyses were performed using Review Manager 5.4 software.

RESULTS: 9 studies involving 391 participants were included. The pooled analysis revealed that the adjunctive use of rTMS was significantly superior to the sham control in improving global cognitive function at the immediate post-treatment assessment (SMD=0.38, 95 %CI[0.20,0.56], P < .001, n = 9). This benefit was consistent across the MMSE (SMD=0.38, n = 6), MoCA (SMD=0.37, n = 2), and ADAS-cog (SMD=0.39, n = 3) scores. Subgroup analysis suggested that the rTMS-tDCS combination might offer a short-term advantage in improving MMSE scores (MD=4.67, P = .008). Furthermore, the adjunctive effect of rTMS was sustained, as particularly evidenced by the ADAS-cog at follow-up (SMD=0.74, P = .02). The pooled analysis indicated that rTMS combined with non-pharmacological therapy demonstrated a short-term, sustained (4-8weeks) improvement in global cognitive function (SMD=0.34, 95 % CI[0.07, 0.60], P = .01). Subgroup analysis revealed that this sustained benefit reached statistical significance on the ADAS-cog scale (SMD = 0.41, 95 %CI[0.01, 0.81], P = .04) but showed a non-significant positive trend on the MMSE (SMD=0.26, 95 %CI[-0.19, 0.72], P = .26). However, a key limitation was that most studies did not systematically report outcomes related to activities of daily living or behavioral function.

CONCLUSION: The evidence indicates that rTMS as an adjunct to non-pharmacological interventions provides a significant specific effect on global cognitive function in patients with AD and MCI shortly after treatment, which may be sustained in the short-term. However, long-term follow-up data are extremely limited, and the effect on activities of daily living remains to be validated. The combination of rTMS and tDCS shows promise,but conclusions are constrained by the small number of studies,limited sample sizes,and heterogeneity in intervention protocols. Future large-scale studies incorporating long-term, standardized follow-up and assessments of daily living abilities are warranted to confirm the specific clinical value of rTMS as an augmentative therapy.

PMID:41192010 | DOI:10.1016/j.ajp.2025.104758

Int J Rheum Dis. 2025 Nov;28(11):e70449. doi: 10.1111/1756-185X.70449.

ABSTRACT

BACKGROUND: Ankylosing spondylitis (AS) is a chronic inflammatory disorder that imposes a significant economic burden through high healthcare costs. Prior studies have explored AS-related expenditures, but a comprehensive analysis of cost-related factors is lacking. This study aims to fill this gap.

METHODS: We analyzed data from 6149 AS patients (2018-2024) at two tertiary hospitals in Guangxi, China, and classified them as surgical or non-surgical; inpatients were categorized by catastrophic health expenditures (CHE; > 50% of household income). Descriptive statistics and the Kruskal-Wallis test were used to assess patient characteristics and cost differences, whereas propensity score matching and multivariable logistic regression were used to identify independent CHE predictors.

RESULTS: A total of 6149 AS patients were included. Surgical patients were older and incurred significantly higher inpatient costs (USD 9457.21 vs. USD 1177.10 for non-surgical patients). General medical service costs, imaging examination costs, Western medicine costs, and medical supply costs are risk factors affecting CHE in hospitalized patients.

CONCLUSION: AS imposes a substantial economic burden, particularly on surgical patients. Key cost drivers, including general medical services, imaging, pharmaceuticals, and medical supplies, markedly increase the risk of catastrophic expenditures. Implementing policy reforms to enhance insurance coverage, alongside clinical cost-control strategies such as rational imaging use, adoption of generic medicines, and optimized management of medical supplies, is essential to alleviate financial strain and improve the sustainability of AS care.

PMID:41191978 | DOI:10.1111/1756-185X.70449

JMIR Form Res. 2025 Nov 5;9:e71971. doi: 10.2196/71971.

ABSTRACT

BACKGROUND: Over the past two decades, use of social media has grown among US adults. Common social media platforms include Facebook, YouTube, Instagram, X, LinkedIn, and TikTok. People proactively use social media for a variety of purposes including searching for health information, peer-to-peer social support, and health-related information sharing. As these platforms often serve as sources of health information, understanding how, if at all, people use them may inform future behavioral interventions delivered via social media. Additionally, a better understanding of social engagement may have implications for public health messaging and patient-centered communication.

OBJECTIVE: Using a nationally representative sample of US adults, we explored how factors including subjective numeracy (ie, ease of understanding medical statistics), interpersonal communication with family and friends, and perceived discrimination influence whether people ever watched versus never watched health-related videos on social media platforms.

METHODS: We analyzed the National Cancer Institute’s Health Information National Trends Survey data, which were collected from March to November 2022 (n=6252). After excluding participants who did not have complete data for all variables of interest, we analyzed responses from 4543 participants. Respondents were asked, “In the past 12 months, how often did you watch a health-related video on a social media site (eg, YouTube)?” Response options included: almost every day, at least once a week, a few times a month, less than once a month, and never. We collapsed answers into ever or never watched. Odds ratios (OR), 95% CIs, and P values were calculated. A multivariate logistic regression model was considered using all factors that were univariately significant (P<.10). Using backward elimination, factors that were not significant with P>.05 were removed one by one until remaining factors were all significant collectively (P<.05).

RESULTS: Of 4543 adults analyzed, 61.5% reported watching at least one health-related video in the past 12 months, whereas 38.5% had never watched one. In the multivariable analysis, all age group categories over 50 years were less likely to watch health-related videos compared to those aged 18-34 years, with respondents aged ≥75 years having the lowest odds of all groups for watching a health-related video (OR 0.16, P<.001). Higher odds of watching health-related videos were observed among respondents who were Black (OR 1.59, P<.01), Hispanic (OR 1.54, P=.01), and from “Other” minority groups (OR 2.07, P=.01) compared to White respondents. College graduates (OR 1.71, P<.01) and those who found medical statistics easy to understand (OR 1.29, P=.04), talked about health with friends or family (OR 1.68, P<.01), or experienced racial discrimination in medical care (OR 1.59, P=.02) also had higher odds of watching health-related videos on social media.

CONCLUSIONS: Findings from this study may help target health communication campaigns on social media designed to improve screening, lifestyle changes, medication adherence, and disease management.

PMID:41191957 | DOI:10.2196/71971

Med Sci Sports Exerc. 2025 Nov 4. doi: 10.1249/MSS.0000000000003883. Online ahead of print.

ABSTRACT

PURPOSE: Physical activity (PA) is a key strategy in preventing and treating metabolic syndrome (MetS). The purpose is to investigate the associations of leisure-time PA (LTPA) trajectories across adulthood and current PA with MetS at age 61.

METHODS: Participants were 159 Finnish adults (52% women). LTPA frequency was assessed at ages 27, 42, 50, and 61 with a single question. Current PA at age 61 included self-reported vigorous, muscle-strengthening, commuting, and occupational PA. Cardiometabolic risk factors at age 61 included waist circumference, blood pressure, high-density lipoprotein (HDL) cholesterol, triglycerides, and glucose. MetS was defined based on the ATP III criteria. LTPA trajectories were conducted using k means for longitudinal data.

RESULTS: Of the three LTPA trajectories found, consistently inactive (N=34) and increasingly active (N=58) had a higher risk of MetS compared to consistently active (N=67) (odds ratio [95% confidence interval]: 3.93 [1.55, 10.01] and 2.39 [1.14, 4.99], respectively). Only the difference between consistently inactive and consistently active remained statistically significant when the current PA indicators were included in the model. Considering the individual components of MetS, those who were consistently inactive and increasingly active had higher waist circumference, lower HDL, and higher triglyceride levels compared to consistently active. These differences did not remain statistically significant when current PA was included.

CONCLUSIONS: Although consistently inactive and increasingly active individuals had higher cardiometabolic risk at age 61 compared to those who were consistently active across adulthood, current PA participation at the beginning of late adulthood attenuated these risks. These findings emphasize the importance of promoting and sustaining PA throughout life to reduce the burden of MetS in the aging population.

PMID:41191956 | DOI:10.1249/MSS.0000000000003883

Rheumatology (Oxford). 2025 Nov 4:keaf585. doi: 10.1093/rheumatology/keaf585. Online ahead of print.

ABSTRACT

OBJECTIVES: It is unclear whether clinicians agree which manifestations of AAV are associated with necrotizing granulomas or if their presence affects clinical decision-making.

METHODS: We surveyed physicians experienced in caring for individuals with AAV, querying: experience with AAV; beliefs concerning how granulomas affect the diagnosis, treatments, and outcomes of AAV; beliefs concerning the frequency with which granulomas are found in 36 manifestations of AAV; and degree to which granulomas change choice of induction therapy for specific manifestations of AAV. We analyzed responses using descriptive statistics and multivariable linear regression.

RESULTS: We received 142 responses from 35 countries. Responses had a median Likert response ≥5 on a 7-point scale (equal to ‘partially agree’) that granulomatous manifestations respond differently to therapy, increase risk of relapse, and increase organ damage. Four of 36 manifestations were believed to be caused by granulomas in a median of ≥ 75% of cases (on a scale of 0 = never to 100 = always caused by granuloma), 19 in a median of ≤ 25% of cases, and 13 in intermediate medians. The perceived degree to which granulomas caused manifestations was not associated with changes in therapy to induce remission in severe AAV (p-values 0.26-0.93 across scenarios).

CONCLUSIONS: Physicians experienced in vasculitis generally agree on which manifestations of AAV are and are not caused by granulomas and that granulomatous inflammation alters the natural history and treatment of AAV. However, the presence of granulomatous manifestations did not alter treatment choices to induce remission in severe AAV.

PMID:41191924 | DOI:10.1093/rheumatology/keaf585

JMIR Form Res. 2025 Nov 5;9:e69103. doi: 10.2196/69103.

ABSTRACT

BACKGROUND: Cardiopulmonary resuscitation (CPR) is vital for improving patient outcomes in medical emergencies. Both laypersons and health care professionals often seek guidance on performing CPR. In today’s digital age, many turn to easily accessible platforms such as YouTube for practical skills.

OBJECTIVE: This study evaluates the didactic and content quality of CPR videos on YouTube using comprehensive checklists and investigates the association between the assigned quality scores and type of publisher, view count, and video rankings.

METHODS: Videos were included based on defined search terms and exclusion criteria. Two emergency physicians rated each video independently using validated checklists concerning content and didactic quality. Linear regression analysis was performed to assess the relationships between video quality scores and view counts, as well as video rankings.

RESULTS: Of the 250 videos identified, 74 (29.6%) met the inclusion criteria. On the content checklist, videos scored an average of 56.5% (SD 19.2%), and on the didactic checklist, they scored 66.6% (SD 14.3%); none achieved the maximum score. Videos from official medical institutions scored significantly higher in content quality compared to nonofficial sources (P=.04). Video quality scores were not associated with video rankings or view counts.

CONCLUSIONS: The study highlights substantial variability in the didactic and content quality of CPR-related videos on YouTube. For medical educators, this underlines the need to curate and recommend reliable online resources or to develop new high-quality content aligned with established checklists. For the general public, the findings caution against relying on popularity metrics as indicators of accuracy and emphasize the importance of guidance from trusted institutions.

PMID:41191922 | DOI:10.2196/69103

Rheumatology (Oxford). 2025 Nov 4:keaf580. doi: 10.1093/rheumatology/keaf580. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to describe annual trends in sodium-glucose cotransporter-2 inhibitor (SGLT2i) prescriptions among patients with rheumatoid arthritis (RA) and diabetes mellitus (DM), and to assess whether SGLT2i use increases urinary tract infection (UTI) risk, emulating a target trial.

METHODS: An administrative claim database identified RA patients aged ≥18 years with type 2 DM from April 2015 to April 2023. Population 1 included RA patients with DM for assessing diabetes medication status. Population 2 included those with newly initiated first- or second-line antidiabetic medications. The primary outcome was UTI, defined using diagnostic code and antibiotic prescription. For intention-to-treat (ITT) analysis, we used quasi-Poisson regression, whereas for as-treated (AT) analysis, we applied Poisson mixed-effects models.

RESULTS: Among the 26 754 patients in Population 1, SGLT2i prescriptions notably increased, while traditional diabetes medications decreased. Population 2 included 9,772 patients (mean age 69.8 years, 60% women, 13% SGLT2i initiators, 42% on glucocorticoids). During a mean 34-month follow-up, 2,269 UTI events occurred in 1,373 patients. ITT analysis showed no significant difference between SGLT2i and other antidiabetic drug. However, AT analysis demonstrated statistically significant association (adjusted incidence rate ratio 1.64, 95% CI 1.26-2.13). The SGLT2i- daily glucocorticoid dose interaction was not significant in either model.

CONCLUSIONS: Among RA patients with DM, SGLT2i use may inherently increase the risk of UTI compared with other antidiabetics. However, the ITT analysis findings support the safety of SGLT2i selection in routine clinical practice, including in patients receiving glucocorticoids.

PMID:41191914 | DOI:10.1093/rheumatology/keaf580

JMIR Med Inform. 2025 Nov 5;13:e77603. doi: 10.2196/77603.

ABSTRACT

BACKGROUND: In the rapidly evolving landscape of health informatics, adopting a standardized common data model (CDM) is a pivotal strategy for harmonizing data from diverse sources within a cohesive framework. Transitioning regional databases to a CDM is important because it facilitates integration and analysis of vast and varied health datasets. This is particularly relevant in China, where unique demographic and epidemiologic profiles present a rich yet complex data landscape. The significance of this research from the perspective of the Chinese population lies in its potential to bridge gaps among disparate data sources, enabling more comprehensive insights into health trends and outcomes.

OBJECTIVE: This study aimed to understand biomedical professionals’ and trainees’ acceptance of the CDM in medical data management in China and to explore potential advantages and challenges associated with its promotion, implementation, and development in the country.

METHODS: We conducted a questionnaire survey using Sojump and distributed it on WeChat to evaluate the Chinese population’s acceptance of transitioning from local databases to a standardized CDM. The survey assessed participants’ understanding of the CDM and the Observational Medical Outcomes Partnership CDM, as well as their views on the importance of CDM for regional databases in China. Analysis of the survey results revealed the current state, challenges, and trends in CDM application within Chinese health care, providing a foundation for future efforts in data standardization and sharing. The reliability of the questionnaire data was assessed using Cronbach α and Guttman Lambda 6 to determine internal consistency.

RESULTS: Our survey of 418 participants revealed that 41.9% (175/418) were aware of the CDM. Recognition of CDM increased with higher education levels and was notably higher among professionals in contract research organizations and the pharmaceutical industry. Knowledge of CDM was primarily gained through literature and conferences, with formal education less common. Logistic regression analysis indicated that individuals with doctoral degrees, researchers, executives, medical professionals, data engineers, Centers for Disease Control and Prevention staff, and statisticians were more likely to be aware of CDM. Subgroup analyses showed higher awareness among doctoral versus nondoctoral and Beijing-based versus non-Beijing respondents, while perceived necessity was broadly comparable across subgroups. Overall, 94.7% (396/418) of respondents believed CDM integration in China is necessary for standardization and efficiency. Despite 60.7% (254/418) optimism for the Observational Medical Outcomes Partnership as the preferred CDM, challenges such as mapping traditional Chinese medicine or Chinese medical insurance remain.

CONCLUSIONS: A large proportion of respondents expressed a favorable view of implementing the CDM in regional databases in China, with notable endorsement from the doctoral group and professionals in contract research organizations or pharmaceutical sectors; subgroup differences were concentrated in awareness rather than perceived necessity. Participants suggested enhancing CDM-related education and establishing clear data-sharing regulations to support CDM advancement in China.

PMID:41191912 | DOI:10.2196/77603

J Med Internet Res. 2025 Nov 5;27:e77721. doi: 10.2196/77721.

ABSTRACT

The rapid uptake of supervised machine learning (ML) in clinical prediction modelling, particularly for binary outcomes based on tabular data, has sparked debate about its comparative advantage over traditional statistical logistic regression. Although ML has demonstrated superiority in unstructured data domains, its performance gains in structured, tabular clinical datasets remain inconsistent and context dependent. This viewpoint synthesizes recent comparative studies and simulation findings to argue that there is no universal best modelling approach. Model performance depends heavily on dataset characteristics (eg, linearity, sample size, number of candidate predictors, minority class proportion) and data quality (eg, completeness, accuracy). Consequently, we argue that efforts to improve data quality, not model complexity, are more likely to enhance the reliability and real-world utility of clinical prediction models.

PMID:41191908 | DOI:10.2196/77721

JMIR Res Protoc. 2025 Nov 5;14:e73356. doi: 10.2196/73356.

ABSTRACT

BACKGROUND: With current data supporting an increasing population of older people experiencing homelessness (OPEH) requiring unique spatial and placemaking considerations in end-of-life care, understanding the environmental factors that influence their well-being is crucial.

OBJECTIVE: This protocol paper provides a comprehensive overview for evaluating hospice environments tailored to the needs of OPEH.

METHODS: The Aging in the Right Place study aims to address this gap by developing and implementing the Aging in the Right Place-Hospice Environmental Assessment Protocol (AIRP-HEAP) and AIRP-HEAP secondary observation tools. The AIRP-HEAP tool evaluates the built and natural environment within hospice settings. Adaptations were made to ensure alignment with the unique needs of OPEH, such as reconceptualizing spiritual care and expanding the definition of family accommodation. Additionally, the AIRP-HEAP secondary observation tool supplements this by capturing contextual data on the surrounding neighborhood of the hospice site, providing a holistic understanding.

RESULTS: Data were collected at Maggie’s Lodge hospice between November and December 2024 using the AIRP-HEAP and AIRP-HEAP secondary observation tools. The dataset is currently being cleaned, with analysis planned between May and December 2025. The anticipated results will highlight the importance of considering environmental factors in hospice environments and inform recommendations to improve end-of-life care for OPEH.

CONCLUSIONS: Data collected using these audit tools can guide environmental modifications in hospice settings to facilitate aging and end-of-life care in the right place. Thus, this protocol paper aims to promote the adoption of best practices in hospice design to better support this marginalized population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/73356.

PMID:41191906 | DOI:10.2196/73356