Tag: statistics

JAMA Netw Open. 2025 Aug 1;8(8):e2525336. doi: 10.1001/jamanetworkopen.2025.25336.

ABSTRACT

IMPORTANCE: Enrollment in Medicare Advantage (MA) is expected to continue growing. Previous studies have examined differences in the use and quality of home health care between MA and traditional Medicare, but less is known about outcomes among patients receiving care from agencies with greater exposure to MA patients.

OBJECTIVE: To examine the association between home health agency (HHA) experience with caring for MA patients and quality of care delivered.

DESIGN, SETTING, PARTICIPANTS: This cohort study included patients continuously enrolled in MA and who received HHA care in 2019. The data analysis was performed between July 16, 2024, and January 16, 2025.

EXPOSURE: Medicare beneficiaries who received home health care from agencies with differing levels of MA specialization.

MAIN OUTCOMES AND MEASURES: Primary outcomes included hospitalizations during the HHA episode and after HHA discharge (at 30 and 90 days), length of stay, and total number of visits. Secondary outcomes included postdischarge mortality and nursing home admission. The outcomes were measured using instrumental variable analysis. The treatment variable was a continuous measure of the HHA-level share of MA patients. The instrumental variable was the differential distance from the nearest MA-specialized HHA to nearest non-MA-specialized HHA (based on the 75th percentile of the HHA-level share of MA patients from January 1 to December 31, 2019 [ie, ≥36.4%]).

RESULTS: The study included 749 719 MA patients who received HHA care in 2019 (mean [SD] age, 76.2 [10.4] years; 61.6% female; 26.3% with dual eligibility), of whom 65.4% received care from an MA-specialized HHA and 34.6% received care from a non-MA-specialized HHA. A 1-mile increase in differential distance was associated with a lower likelihood of admission to more MA-specialized HHAs (0.3 percentage points; SE, 0.015 percentage points; F statistic, 450.73). In the instrumental variable analysis, receiving care from more specialized HHAs was associated with a shorter length of stay (coefficient [SE], -15.14 [2.84] days) and fewer total HHA visits (coefficient [SE], -9.40 [1.15] visits) alongside more hospitalizations and nursing home admissions after discharge from the HHA.

CONCLUSION AND RELEVANCE: In this cohort study of MA patients who received HHA care, those receiving care from more MA-specialized HHAs had lower service use during the HHA episode, but no clear differences compared with non-MA-specialized HHAs were observed in care use after discharge. These findings are important given the costs associated with delivering HHA care and the expected growth in MA enrollment.

PMID:40758348 | DOI:10.1001/jamanetworkopen.2025.25336

Infect Dis (Lond). 2025 Aug 4:1-10. doi: 10.1080/23744235.2025.2533319. Online ahead of print.

ABSTRACT

BACKGROUND: Many Greenlanders move from Greenland, a tuberculosis (TB) high-incidence country, to Denmark, a TB low-incidence country. Surprisingly, according to official statistics, the TB incidence among Greenlanders in Denmark is much higher than in Greenland.

OBJECTIVES: This study investigates factors contributing to the extraordinarily high TB incidence among Greenlanders residing in Denmark.

METHODS: Retrospective, register-based cohort study including all Greenlanders ≥18 years notified with TB in Denmark and Greenland, and Danes ≥18 years with TB in Denmark, 2006-2022. Demographic and microbiological characteristics were compared across groups using parametric and non-parametric statistical tests.

RESULTS: The TB incidence was extraordinarily high among Greenlanders in Denmark (341/100,000; n = 813), compared to Danes in Denmark (2/100,000; n = 1799) and Greenlanders in Greenland (149/100,000; n = 1088). Additionally, they were more often part of a TB cluster (75.6%) compared to Danes in Denmark (53.3%) and Greenlanders in Greenland (64.0%) and demonstrated very high rates of recurrent TB (23.9%), with 75.6% of cases being reinfections involving new Mycobacterium tuberculosis strains.

CONCLUSION: TB poses a significant public health challenge for Greenlanders in Denmark. Their high incidence combined with elevated clustering and reinfection rates suggest substantial active TB transmission, and their cluster distribution indicates that many infections are locally acquired rather than reactivations of infection acquired in Greenland. Greenlanders with TB in Denmark are likely part of a socially marginalised minority with TB high-risk behaviours similar to Danes developing TB. These findings highlight the need for targeted TB prevention and control strategies for Greenlanders residing in Denmark.

PMID:40758341 | DOI:10.1080/23744235.2025.2533319

Eur J Psychotraumatol. 2025 Dec;16(1):2534310. doi: 10.1080/20008066.2025.2534310. Epub 2025 Aug 4.

ABSTRACT

Background: Individuals with pre-existing heavy alcohol use, prior traumatic exposures, and psychiatric disorders were considered an at-risk group for increased alcohol use and problems in the context of the COVID-19 pandemic.Objective: This study recruited from a multi-centre longitudinal cohort study of US military service members/veterans with combat exposure to examine the trajectories of alcohol use and problems in the context of a prolonged stressor.Methods: Individuals who endorsed heavy drinking and completed a measure of PTSD symptoms prior to the pandemic were invited to participate in a longitudinal survey study at three time points, three months apart, during the second year of the pandemic. Participants (N = 44) completed surveys assessing alcohol consumption and alcohol-related problems (via the AUDIT), PTSD symptoms (via the PCL-5), and infection mitigation behaviours (via a COVID-19 specific survey). Random intercept models were fitted to the longitudinal data for each of these outcomes, covarying for demographics, pandemic quarantine/physical distancing experience, pre-pandemic baseline alcohol consumption and PTSD symptoms, and time-varying alcohol consumption and alcohol-related problems as well as PTSD symptoms.Results: We did not find an increase in alcohol consumption or problems over time. However, pre-pandemic alcohol consumption predicted alcohol consumption over time (B = 0.52, SE = 0.11, p < .01). Time-varying alcohol consumption and PTSD symptoms predicted alcohol problems over time (B = 0.84, SE = 0.18, p < .01; B = 0.04, SE = 0.02, p < .05, respectively).Conclusions: Findings highlight the relevance of pre-existing hazardous alcohol consumption prior to stressors as well as ongoing consumption and PTSD symptoms as risk factors for alcohol-related problems. Findings captured more chronic impacts of pandemic stressors and demonstrated that heavy drinking and PTSD are notable risk factors for alcohol-related problems even if in the context of stabilizing, albeit still high, alcohol use.

PMID:40758273 | DOI:10.1080/20008066.2025.2534310

Clin Transplant. 2025 Aug;39(8):e70267. doi: 10.1111/ctr.70267.

ABSTRACT

BACKGROUND: To examine national trends and regional variability in the procurement of solid organs recovered for research from deceased donors in the United States.

METHODS: A retrospective cohort study of the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) deceased donor registry data was conducted, including all deceased donors who underwent surgery for organ recovery from April 2015 to December 2023. The study classified each donated organ (liver, heart, pancreas, lung, kidney, and intestine) into four categories: not recovered, recovered for transplant, recovered for research, recovered for other purposes/discarded, with a focus on organs recovered for research.

RESULTS: Among 107,485 deceased organ donors across 58 organ procurement organizations (OPOs), organs recovered for research included 2491 intestines, 6494 hearts, 6627 livers, 9098 kidneys, 10,711 pancreata, and 13,025 lungs. Research organ recovery showed an upward trend, particularly for pancreata. Median percentage of organ recovery for research across the OPOs, varied significantly by organ type: intestines (65.4%), pancreata (36.1%), lungs (28.3%), heart (11.3%), liver (7.1%), and kidneys (3.8%), with no significant correlation between OPO donor organ volumes and research organ recovery rates. Analysis of the 2021 data showed a higher median percentage of research organ recovery in Tier 1 OPOs (13.8%) compared to Tier 2 (10.8%) and Tier 3 (11.4%), though these differences were not statistically significant (p = 0.18).

CONCLUSION: Given the opacity of existing practices and unrealized potential of research organs, our findings warrant the need for improved surveillance, centralized tracking, and a robust framework for research organ recovery.

PMID:40758272 | DOI:10.1111/ctr.70267

Clin Rheumatol. 2025 Aug 4. doi: 10.1007/s10067-025-07620-8. Online ahead of print.

ABSTRACT

OBJECTIVES: The prevalence of sedentary behavior, hyperuricemia, and gout is increasing worldwide. However, the relationships between sedentary behavior and the risk of hyperuricemia and gout in American adults remain unclear. Therefore, we aim to investigate the association between sedentary behavior and the risk of hyperuricemia and gout.

METHODS: Adults aged ≥ 20 years from the 2007-2016 National Health and Nutrition Examination Survey (NHANES) were analyzed, with sedentary time assessed via questionnaires and serum uric acid levels measured through laboratory tests. Gout was confirmed by a physician or health professional. Hyperuricemia was defined as a serum uric acid level of ≥ 7.0 mg/dL in men and ≥ 5.7 mg/dL in women. Weighted logistic regression models and restricted cubic spline analyses were used to examine the associations between sedentary time and hyperuricemia and gout. Mediation analysis was used to explore the potential mediating role of hyperuricemia.

RESULTS: A total of 17,634 participants were included in the analysis. The prevalence of hyperuricemia was 20.24% (3569/17,634), and gout was 4.11% (725/17,634). After adjusting for multiple covariates, weighted logistic regression indicated that higher sedentary time (> 8 h/day) was associated with increased risk of hyperuricemia and gout, with adjusted odds ratios (OR) of 1.18 (95% CI: 1.01, 1.39) and 1.41 (95% CI: 1.04, 1.93), respectively. Restricted cubic spline analysis revealed a nonlinear association between sedentary time and the risks of hyperuricemia and gout. Subgroup analyses showed that chronic kidney disease (CKD) stage (P = 0.012) and sex (P = 0.04) modified the association between sedentary time and hyperuricemia, while sex alone modified the association with gout (P = 0.04). The results of the sensitivity analyses remained robust. The results of the mediation analysis showed that hyperuricemia played a mediating role between sedentary time and gout, with a mediation proportion of 15.93%.

CONCLUSION: Sedentary time increases the risk of hyperuricemia and gout in US adults, especially in men and those with advanced CKD, with hyperuricemia acting as a key mediator. Key Points • Sedentary time of more than 8 h per day is significantly associated with an 18% increased risk of hyperuricemia and a 41% increased risk of gout, compared to less than 4 h per day among US adults. • The association between sedentary time and hyperuricemia is more pronounced among males and individuals with advanced stages of chronic kidney disease, while the association with gout is significantly modified by sex, with a stronger effect observed in males. • Hyperuricemia plays a mediating role between sedentary time and gout, with a mediation proportion of 15.93%.

PMID:40758258 | DOI:10.1007/s10067-025-07620-8

J Bronchology Interv Pulmonol. 2025 Aug 4;32(4):e01022. doi: 10.1097/LBR.0000000000001022. eCollection 2025 Oct 1.

ABSTRACT

BACKGROUND: This study aimed to evaluate the trends in the use of endobronchial valve (EBV) and video-assisted thoracoscopic surgery (VATS) for bronchopulmonary fistula (BPF) between 2016 and 2021, and to compare their clinical and economic outcomes.

METHODS: We conducted a retrospective analysis of national inpatient data from 2016 to 2021 to identify patients (age ≥18 y) with BPF who underwent EBV or VATS. Patients who had both EBV and VATS were excluded. We examined the annual procedure volumes, mean costs, length of stay (LOS), and in-hospital mortality rates. Statistical analyses were performed to compare outcomes between the 2 interventions.

RESULTS: Out of 13,245 patients with BPF, 660 underwent EBV and 535 underwent VATS. The total number of yearly EBV increased from 65 to 230 (P=0.043) and the total number of yearly VATS increased from 65 to 180 (P=0.854). Mortality rate (P=0.843), total cost (P=0.735), and LOS (P=0.337) remained stable for EBV patients. We observed a reduced mortality trend for VATS patients (P=0.041), while total cost (P=0.839), and LOS (P=0.886) remained stable.

CONCLUSION: EBV has become significantly more prevalent in BPF management. This could be due to increasing expertise and demand for a procedure for patients too critical to undergo VATS. VATS was associated with a mortality reduction between 2016 and 2021, which could be attributed to more strict patient selection.

PMID:40758241 | DOI:10.1097/LBR.0000000000001022

Fam Syst Health. 2025 Jun;43(2):210-224. doi: 10.1037/fsh0000954.

ABSTRACT

BACKGROUND: The prevalence of type 2 diabetes (T2D) is increasing globally, especially among South Asian (SA) adults, and requires innovative solutions. Traditional T2D prevention and management programs focus on lifestyle change but this is often challenging for caregivers with competing priorities and may not fit a family’s needs. Utilizing social support has been promising for supporting diabetes prevention and management. We aim to explore how the social networks of SA caregivers with diabetes can influence their health and inform interpersonal and community-level health interventions for this community.

METHOD: Participants lived in Peel Region, Ontario were diagnosed with T2D, prediabetes, or gestational diabetes and were SA caregivers of children under 24 years old. Caregivers completed a semistructured interview to discuss (a) their experiences, perceptions, and beliefs about T2D, (b) their caregiving roles in their diabetes management, (c) how the social determinants of health impact diabetes management, and (d) the individuals and resources influencing their diabetes management. We used network analysis to explore network size and composition in relation to social supports.

RESULTS: Twenty-one caregivers completed interviews. We identified three network typologies for caregivers, including (a) healthcare and community program focused, (b) isolated, and (c) family and diverse social support and explored how caregivers describe the network actors as supporting or not supporting their diabetes management.

CONCLUSION: This study advances our understanding of the social networks and supports that SA caregivers use to support diabetes management and further emphasizes the importance of leveraging existing community supports. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40758233 | DOI:10.1037/fsh0000954

Front Surg. 2025 Jul 18;12:1584238. doi: 10.3389/fsurg.2025.1584238. eCollection 2025.

ABSTRACT

OBJECTIVE: To identify specific factors predicting functional outcomes, pain reduction, and patient satisfaction following knee arthroplasty through systematic review and meta-analysis.

METHODS: A comprehensive search of multiple databases (Pubmed, Embase, OVID, Medline, Cochrane Library, CNKI, Wanfang, VIP) was conducted for studies published from database inception to December 2024. Studies reporting associations between preoperative factors and standardized outcomes after knee arthroplasty were included. Two reviewers independently screened articles, extracted data, and assessed study quality using modified Jadad scale for randomized trials and MINORS for non-randomized studies. Random-effects meta-analyses were performed for pain duration and red blood cell distribution width (RDW), with meta-regression to assess their prognostic value for functional outcomes measured by standardized knee scores. Heterogeneity was assessed using I² statistics, and publication bias was evaluated using Egger’s and Begg’s tests.

RESULTS: Eight studies were included in the final analysis: Four studies examining pain duration (n = 576 patients) and four studies examining RDW (n = 612 patients) met inclusion criteria. Significant heterogeneity was observed in both analyses (I² = 87% and I² = 91%, respectively, p < 0.01). Meta-regression revealed that shorter pain duration (<3 years) was significantly associated with better functional outcomes at 12-month follow-up [Weighted Mean Difference (WMD) = -4.532, 95%CI = (-6.439,-2.626), p < 0.001]. Normal preoperative RDW values (11.5-14.5%) were also significantly associated with improved functional outcomes [WMD = -1.742, 95%CI = (-2.371,-1.114), p < 0.001]. Subgroup analyses indicated that the predictive value of these factors was consistent across different surgical techniques (p = 0.42). Publication bias assessment showed no significant bias (Egger’s test p = 0.2094, Begg’s test p = 0.0833). The high heterogeneity limits the direct clinical application of these pooled estimates and necessitates cautious interpretation.

CONCLUSION: This meta-analysis identified shorter preoperative pain duration and normal RDW values as independent predictors of better functional outcomes following knee arthroplasty. However, the small number of included studies and high heterogeneity observed warrant cautious interpretation of these findings. These findings can help clinicians identify patients at risk of suboptimal outcomes and potentially guide personalized perioperative interventions. Further research is needed to establish optimal cutoff values and to evaluate the combined predictive power of these factors in clinical practice.

PMID:40755482 | PMC:PMC12315344 | DOI:10.3389/fsurg.2025.1584238

J Plast Reconstr Surg. 2025 Jan 24;4(3):127-136. doi: 10.53045/jprs.2024-0044. eCollection 2025 Jul 27.

ABSTRACT

OBJECTIVES: This study aimed to compare the quality of scarring of DERMABOND PRINEO (Ethicon, Inc., Somerville, NJ, USA)^Ⓡ by conducting a half-side test on the same wound to determine its superiority. If the utility of DERMABOND PRINEO^Ⓡ is established, its use can be expanded for more cases and higher quality medical care can be provided.

METHODS: Patients who underwent two-stage breast reconstruction were included. The first surgery was half closed with DERMABOND PRINEO^Ⓡ and nylon threads, and the time was measured. At the second surgery, all scars were removed, and a histopathological examination was done. Scars were evaluated with the Vancouver Scar Scale (VSS) and visual analogue scale (VAS), and statistical analysis was performed.

RESULTS: Time to closure was significantly shorter in the DERMABOND PRINEO^Ⓡ group. Postoperative VSS scores for pliability were significantly lower in the suture group, and the total VSS score was significantly lower in the suture group from 3 to 6 months postoperatively. Patients rated postoperative wound pain, itching, appearance, and satisfaction with the VAS, but no significant differences were observed between the two groups. The scars were compared with hematoxylin-eosin staining and Elastica van Gieson staining. Differences were seen in the increase of elastic fibers in the dermal reticular layer, a characteristic difference between the two groups.

CONCLUSIONS: The use of DERMABOND PRINEO^Ⓡ leads to a reduction in operative time and impacts the maturity of the scar. It is expected that the indications for DERMABOND PRINEO^Ⓡ can be further expanded in the future.

PMID:40755474 | PMC:PMC12310342 | DOI:10.53045/jprs.2024-0044

Drug Alcohol Rev. 2025 Aug 4. doi: 10.1111/dar.70011. Online ahead of print.

ABSTRACT

INTRODUCTION: Understanding the experiences of women participating in residential alcohol and other drug (AOD) treatment is important in ensuring treatment effectively meets women’s needs. Patient-reported experience measures aid in assessing women’s experiences of treatment but are often used to quantify women’s treatment satisfaction without additional context regarding specific treatment experiences. This study examined the relationship between the domains of the Patient Reported Experience Measure for Addiction Treatment (PREMAT) and overall treatment satisfaction, including whether relationships differed by gender.

METHODS: N = 138 participants (30.9% women) from a not-for-profit residential AOD treatment service completed a survey regarding their experiences of and satisfaction with treatment, including the PREMAT. Descriptives, chi-square and Mann-Whitney U statistics examined gender differences in demographics. A generalised linear model assessed the relationship between PREMAT domain scores and overall treatment satisfaction (Client Satisfaction Questionnaire), controlling for age and weeks in treatment, including whether relationships differed by gender. Relative weight statistics examined the relative statistical importance of each PREMAT domain to overall satisfaction.

RESULTS: There were no gender differences on PREMAT item, domain or total scores. Controlling for age and weeks in treatment, significant predictors of overall treatment satisfaction were the PREMAT ‘self-determination and empowerment’ and ‘personal responsibility’ domains. The impact of ‘personal responsibility’ on overall satisfaction was weaker for women compared to men.

DISCUSSION AND CONCLUSIONS: Fostering individualised care and support, self-determination, empowerment and personal responsibility for care, are important aspects of residential treatment for both men and women. Further development of women-specific PREMs that address gendered experiences of treatment is warranted.

PMID:40755442 | DOI:10.1111/dar.70011