Tag: statistics

Int J Geriatr Psychiatry. 2025 Aug;40(8):e70140. doi: 10.1002/gps.70140.

ABSTRACT

OBJECTIVES: In a sample of community-dwelling older adults, we examined the association of Alzheimer’s Disease and Related Dementias (AD/ADRD) blood-based biomarkers (BBMs) and neuropsychiatric symptoms (NPS) and whether informant type (i.e., spouse vs. child vs. other) modified that association.

METHODS: This study included 430 participants with a cognitively unimpaired or mild cognitive impairment consensus diagnosis from the Wake Forest Alzheimer’s Disease Research Center Clinical Core cohort. Informants reported NPS using the Neuropsychiatric Inventory Questionnaire. AD/ADRD BBMs included the Aβ42/40 ratio, p-tau181, p-tau217, NfL, and GFAP. Generalized linear models were used to examine the associations between AD/ADRD BBMs and NPS. Secondary models adjusted for age, sex, education, race, and cognitive status. Tertiary models adjusted for covariates in secondary models, as well as informant type. Interactions between informant type and AD/ADRD BBMs were examined.

RESULTS: Higher p-tau217 was associated with higher NPS in both unadjusted models and models adjusted for demographics and cognitive status. This association was attenuated and no longer statistically significant after additionally adjusting for informant type. Significant interactions of informant type and p-tau181 or p-tau217 on NPS were demonstrated, where p-tau181 or p-tau217 were more strongly associated with NPS reported by children compared to spouses.

CONCLUSIONS: Informant type modified the association between AD/ADRD BBMs and NPS, with stronger associations observed when symptoms were reported by child informants compared to spouse informants. These findings have important implications for earlier detection of individuals with AD/ADRD pathologies.

PMID:40828547 | DOI:10.1002/gps.70140

J Acquir Immune Defic Syndr. 2025 Aug 19. doi: 10.1097/QAI.0000000000003747. Online ahead of print.

ABSTRACT

BACKGROUND: We assessed an adaptation of a mobile HIV prevention smartphone app, HealthMindr-PrEP, to assess its effectiveness to increase pre-exposure prophylaxis (PrEP) uptake among gay and bisexual men who have sex with men (GBMSM).

SETTING: This study was conducted online among GBMSM living in Ending the HIV Epidemic priority jurisdictions, primarily in the southern United States.

METHODS: We conducted a randomized controlled trial in which participants were randomly assigned to receive the intervention app or an app that only allowed participants to track their study progress. The primary outcome was self-reported PrEP uptake. Cox proportional hazards models were used to compare the rate of PrEP uptake across study arms.

RESULTS: Although no results were statistically significant, the rate of PrEP initiation was higher among participants in the intervention arm compared to the control arm, particularly among participants with PrEP indications at baseline. Among those with PrEP indications at baseline, participants in the intervention arm had a 64% higher rate of PrEP initiation compared to the control arm (hazard ratio = 1.64, 95% CI: 0.89, 3.03). Among those without PrEP indications, the same hazard ratio was 1.05 (95% CI: 0.67, 1.66).

CONCLUSION: Our results suggest that HealthMindr-PrEP increases the rate of PrEP uptake compared to a standard of care control condition; however, we had insufficient statistical power for stratified analyses that demonstrated the strongest effect was among those who had PrEP indications at baseline.

PMID:40828543 | DOI:10.1097/QAI.0000000000003747

JAMA Netw Open. 2025 Aug 1;8(8):e2527464. doi: 10.1001/jamanetworkopen.2025.27464.

ABSTRACT

IMPORTANCE: Genetic testing is the criterion standard for diagnosing neurodevelopmental disorders (NDDs), with chromosomal microarray analysis (CMA) used as a first-line test for autism, intellectual disability, or global developmental delay. Despite advancements in genetic testing technologies and integration into health care systems, data on clinical use remain limited.

OBJECTIVE: To evaluate genetic counseling and testing rates in patients with major NDDs and these individuals’ clinical and sociodemographic characteristics.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal, retrospective, population-based cohort study analyzed electronic health records of individuals born between 2000 and 2020 and insured by Clalit Health Services, the largest health maintenance organization in Israel. Follow-up extended through December 6, 2023. Patients diagnosed with autism spectrum disorder, intellectual disability or global developmental delay, epilepsy, or cerebral palsy (major NDDs) were included.

EXPOSURE: Neurodevelopmental disorders.

MAIN OUTCOMES AND MEASURES: The outcome was the rate of genetic counseling, CMA testing, and NDD diagnosis measured using descriptive statistics.

RESULTS: Of 2 406 763 individuals born in Israel between 2000 and 2020, 25 403 (1.06%; mean [SD] age at December 6, 2023, 11.9 [4.3] years; 68.7% male) were diagnosed with a major NDD. The cohort was predominantly of middle socioeconomic status (56.5%), and autism was the most common diagnosis (40.6%). Among 18 709 children indicated for CMA (ie, those with autism, intellectual disability or global developmental delay, or multiple diagnoses), 7233 (38.7%) received genetic counseling, and 4592 (24.5%) underwent testing (63.5% of those counseled). Genetic testing rates were higher in children with multiple co-occurring NDDs (1478 of 4005 [36.9%]) compared with those with autism alone (2189 of 10 311 [21.2%]). Genetic counseling rates were lowest for cerebral palsy and epilepsy as guidelines were less established. Genetic evaluation rates increased with more recent birth cohorts. While evaluation rates were similar across subpopulations for children with a diagnosis, initial autism diagnosis rates were 54% to 83% lower in lower socioeconomic status and minority populations, limiting access to counseling and testing.

CONCLUSIONS AND RELEVANCE: A key finding of this cohort study was that more than one-third of patients who received genetic counseling did not undergo testing. Furthermore, low socioeconomic status and minority populations experienced drastic underdiagnosis of autism. These findings underscore the need for national initiatives to improve awareness and access to counseling and testing for all major NDDs and the recognition of autism in minority groups.

PMID:40828538 | DOI:10.1001/jamanetworkopen.2025.27464

Transl Vis Sci Technol. 2025 Aug 1;14(8):25. doi: 10.1167/tvst.14.8.25.

ABSTRACT

PURPOSE: This study presents an artificial intelligence (AI)-based system for measuring eyeball rotation angles, which is a key symptom in assessing eye disease severity. The system aims to accurately segment the optic disc and macula, and compute the eyeball rotation angle based on these features.

METHODS: The system consists of three modules: optic disc segmentation, macular segmentation, and measurement. The optic disc segmentation module utilizes the Efficient-UNet3+ network to address sample imbalance and irregular edge detection of the optic disc. The macular segmentation module uses the Efficient-UNet based on Dual Attention network (DA-EUNet) to enhance macular recognition and boundary feature detection while suppressing irrelevant background interference. The measurement module calculates the eyeball rotation angle by locating the centers of the optic disc and macula and determining the angle between the line connecting these centers and the horizontal vector.

RESULTS: The proposed method demonstrated high accuracy, with a correlation coefficient of 0.94 compared to expert measurements. Statistical analysis revealed no significant difference between the AI-based measurements and expert assessments (P = 0.26).

CONCLUSIONS: This system achieves high accuracy and reliability in clinical diagnostics. The segmentation techniques used significantly improve feature recognition and segmentation performance, enabling accurate measurements of eyeball rotation.

TRANSLATIONAL RELEVANCE: This AI-based system bridges the gap between basic research in medical image processing and clinical care. It provides an automated and reliable tool for ophthalmologists to assess eyeball rotation, which is crucial for diagnosing eye diseases. Eyeball rotation can occur in many eye diseases or systemic diseases, and measuring the eyeball rotation angle has been a challenging issue in clinical practice. By automating this process, the system reduces the clinicians’ workload and enhances diagnostic consistency.

PMID:40828527 | DOI:10.1167/tvst.14.8.25

Invest Ophthalmol Vis Sci. 2025 Aug 1;66(11):44. doi: 10.1167/iovs.66.11.44.

ABSTRACT

PURPOSE: To investigate the diurnal variations of episcleral venous pressure (EVP) and its relationships with IOP, blood pressure, and heart rate in healthy and systemic hypertension subjects.

METHODS: Twenty healthy adults and eight patients taking systemic antihypertensive medications were enrolled. IOP and EVP of both eyes, systolic and diastolic blood pressure (SBP and DBP), and heart rate (HR), were measured at five time points, every two hours from 8 AM to 4 PM. IOP was measured by pneumatonometry, and EVP was assessed using a computer-controlled episcleral venomanometer with video recording and image processing. Changes in measurements at each time point were compared with baseline (8 AM) by using generalized estimating equation models. Correlations between EVP and other variables were determined using linear regression analysis.

RESULTS: EVP and IOP were highest in the early morning (8 AM) and lowest in the late afternoon (4 PM), with statistically significant changes (P < 0.05) across all time points compared to baseline in normotensive subjects. Changes in EVP and IOP were correlated at all time points. In treated systemic hypertensive subjects, similar trends were observed, with significant IOP and EVP correlations at multiple time points. No clear pattern of correlation was noted between EVP, SBP, DBP, and HR in all subjects.

CONCLUSIONS: IOP and EVP follow a diurnal rhythm with the highest values in the early morning, which gradually decrease throughout the day. The relationship between IOP and EVP suggests that reduction of EVP can be an important target for clinical regulation and stability of IOP.

PMID:40828522 | DOI:10.1167/iovs.66.11.44

Int Urol Nephrol. 2025 Aug 19. doi: 10.1007/s11255-025-04724-7. Online ahead of print.

ABSTRACT

BACKGROUND: Lower urinary tract dysfunction (LUTD) is a potential late effect in childhood cancer survivors, often overlooked in survivorship care. Neurotoxic chemotherapy, pelvic tumors, and radiation exposure may contribute to its development.

OBJECTIVES: To determine the prevalence and severity of LUTD in childhood cancer survivors and identify associated risk factors.

METHODS: A prospective observational study was conducted over six months among 92 childhood cancer survivors aged ≥ 5 years to 10 years. Participants were screened using the LUTD Scoring System (DVSS). A score ≥ 9 in males and ≥ 6 in females was considered diagnostic of LUTD. Clinical and treatment-related variables were extracted from medical records and analyzed for associations. Uroflowmetry and ultrasonography were performed in children with abnormal DVSS to further assess voiding pattern and bladder parameters.

RESULTS: LUTD was identified in 20 of 92 participants (21.7%), with a higher prevalence in females (31.6%) compared to males (14.8%), though this difference was not statistically significant (p = 0.073). Significant associations were observed with pelvic tumors (p = 0.002; Φ = 0.394), pelvic irradiation (p < 0.001; Φ = 0.455), Vinca alkaloid use (p = 0.035; Φ = 0.307), and high cumulative alkylating agent dose (> 8000 mg/m²) (p = 0.017; Φ = 0.267). Uroflowmetry confirmed abnormal voiding patterns in 95% of DVSS-positive patients. Most cases were managed conservatively with bladder training, while a subset required anticholinergics or laxatives.

CONCLUSION: LUTD is prevalent among childhood cancer survivors, particularly those exposed to Vinka alkaloids and pelvic-directed therapies. Routine LUTD screening using DVSS should be integrated into long-term follow-up protocols for early detection and intervention.

PMID:40828499 | DOI:10.1007/s11255-025-04724-7

J Nephrol. 2025 Aug 19. doi: 10.1007/s40620-025-02387-2. Online ahead of print.

ABSTRACT

BACKGROUND: Person-centered care and trust in physicians influence medication adherence among dialysis patients. However, the mechanisms linking person-centered care to medication adherence, particularly the mediating effect of trust in physicians, remain unclear. This study investigated the interrelationships between person-centered care, trust in physicians, and medication adherence.

METHODS: Using a multicenter cross-sectional study of Japanese adults receiving outpatient hemodialysis at six dialysis centers, person-centered care was assessed using the 13-item Japanese Primary Care Assessment Tool-Short Form (JPCAT-SF), which included longitudinality and care coordination. Trust in physicians was measured using the five-item Wake Forest Physician Trust Scale. Medication adherence was measured using the 12-item Adherence Starts Knowledge (ASK-12) scale. General linear models examined person-centered care, physician trust, and medication adherence relationships. Mediation analysis determined how much trust in physicians mediated the person-centered care-medication adherence relationship.

RESULTS: A total of 483 patients, with median age and dialysis vintage of 71.9 and 5.7 years, respectively, were included in the analysis. High-quality person-centered care was associated with lower barriers to medication adherence in a dose-response manner across JPCAT-SF quartiles compared to no usual source of care. Trust in physicians partially mediated this relationship in a dose-response pattern, with the proportion of the indirect effect increasing from 16.1% (95% CI 4.5-33.8%) in Q2 to 33.3% (95% CI 17.4-65.5%) in Q4. Similar findings were observed for person-centered care subdomains.

CONCLUSIONS: High-quality person-centered care was associated with medication adherence, with trust in physicians playing a key mediating role. Strategies to enhance medication adherence in hemodialysis patients should incorporate multidimensional person-centered care approaches, building trust and strengthening continuity and care coordination.

PMID:40828491 | DOI:10.1007/s40620-025-02387-2

Neurosurg Rev. 2025 Aug 19;48(1):608. doi: 10.1007/s10143-025-03775-9.

ABSTRACT

PURPOSE: Traumatic vertebral artery injury (TVAI) poses a risk for ischemic stroke, often requiring prompt antithrombotic therapy. However, when concomitant neurosurgical intervention is necessary, concerns regarding perioperative bleeding frequently lead to delays in antithrombotic initiation. This study evaluates the impact of delayed antithrombotic therapy on stroke risk in TVAI patients undergoing neurosurgical interventions.

METHODS: A retrospective review was conducted of a TVAI registry over 7 years (2016-2023) at a level 1 trauma center for patients who were treated with antithrombotics for stroke prevention. Baseline demographics, vertebral artery injury characteristics, concomitant injury characteristics, acute management and outcomes were compared between surgical and non-surgical cohorts. Statistical analyses included Student’s t-test, Chi-square tests, relative risk (RR), and attributable risk (AR).

RESULTS: Among the 121 patients, 44 (36.4%) underwent neurosurgical procedures. The surgical cohort experienced an average 2-day delay in antithrombotic initiation (p < 0.001). The incidence of stroke in the neurosurgical intervention group was 20.5%, which was significantly higher than 5.19% in the control group (p = 0.016), with an associated RR of 3.94 and excess AR of 15.3%. No significant differences in baseline antithrombotic use, injury severity, or mortality were observed between cohorts.

CONCLUSION: Delayed antithrombotic initiation in TVAI patients undergoing neurosurgical intervention is associated with a nearly fourfold increased risk of stroke. Future multi-center studies should explore neurosurgical strategies allowing safer early antithrombotic initiation in this patient population.

CLINICAL TRIAL NUMBER: not applicable.

PMID:40828475 | DOI:10.1007/s10143-025-03775-9

Am J Reprod Immunol. 2025 Aug;94(2):e70143. doi: 10.1111/aji.70143.

ABSTRACT

INTRODUCTION: SARS-CoV-2 infection affects various sperm quality parameters. This study examines the impact of COVID-19 infection on sperm DNA fragmentation (SDF).

METHODS: A systematic literature search was performed across four databases for studies published between January 1, 2019, and January 1, 2025. The inclusion criteria focused on studies evaluating sperm DNA fragmentation in healthy men infected with the virus. The risk of bias was assessed using the Newcastle-Ottawa scale (NOS). A meta-analysis was conducted using a random effects model based on the tests employed in the studies to measure SDF. Data were reported as weighted mean differences (WMD) and corresponding 95% confidence intervals (CI). Out of 105 identified citations, seven articles were included in this analysis. The NOS results indicated that all studies were of high quality. Subgroup analysis revealed that all testing methods, including TUNEL, flow cytometry, and the sperm chromatin dispersion (SCD) test, demonstrated high heterogeneity, with the lowest heterogeneity found in the TUNEL test.

RESULTS: The pooled analysis indicated a statistically significant increase in SDF (random effects model, WMD = 12.558, 95% CI: 4.482 to 20.635, I² = 99%, Z = 3.05, p < 0.0001). This meta-analysis suggests a statistically significant reduction in sperm DNA integrity 2-3 months following COVID-19 infection.

CONCLUSION: However, caution is warranted when interpreting these results due to the high heterogeneity, which may affect the outcomes. A thorough analysis considering participant characteristics and infection status is recommended.

PMID:40828459 | DOI:10.1111/aji.70143

J Echocardiogr. 2025 Aug 19. doi: 10.1007/s12574-025-00704-z. Online ahead of print.

ABSTRACT

BACKGROUND: There are few studies reporting the prognostic value of three-dimensional echocardiography (3DE)-derived right ventricular ejection fraction (RVEF) in patients with ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM).

METHODS: 120 ICM and 107 DCM patients who underwent 3DE were retrospectively selected and analyzed using 3DE speckle tracking software. The primary endpoint was a composite of cardiac events, including cardiac death, heart failure hospitalization, myocardial infarction, or ventricular tachyarrhythmia.

RESULTS: During a median follow-up of 24.3 and 53.6 months, 45 patients in ICM and 39 patients in DCM, respectively, reached the primary endpoint. Univariate analysis showed that RVEF was statistically significantly associated with cardiac events in both groups [ICM, hazard ratio (HR): 0.92, 95% confidence interval (CI) 0.89-0.95; DCM, HR: 0.90, 95% CI 0.86-0.93, respectively]. In multivariable analysis, RVEF (HR: 0.89-0.92, p < 0.001) was also statistically significantly associated with cardiac events in both ICM and DCM, even after adjustment for clinical factors, left ventricular (LV) systolic and diastolic parameters, or RV systolic parameters. Kaplan-Meier curves, divided into four groups by RVEF ≥ 45% and < 45% and E/e’ ≥ 14 and < 14, showed significant risk stratification for both ICM (p = 0.0068) and DCM (p < 0.0001). RVEF had incremental prognostic value over age, E/e’, and conventional RV systolic parameters, in both ICM and DCM.

CONCLUSIONS: This study confirms the independent and incremental prognostic value of RVEF over conventional echocardiographic parameters in patients with ICM and DCM and allows detailed risk stratification of cardiac events by RVEF and E/e’.

PMID:40828458 | DOI:10.1007/s12574-025-00704-z