Tag: statistics

Eur J Pediatr. 2025 Aug 7;184(8):535. doi: 10.1007/s00431-025-06326-y.

ABSTRACT

Since its delayed re-emergence after non-pharmaceutical interventions (NPIs) against the COVID-19 pandemic, Mycoplasma pneumoniae has caused community-acquired pneumonia outbreaks worldwide. In this study, we aimed to investigate how the clinical characteristics and severity of M. pneumoniae infections have changed after COVID-19 pandemic restriction, in order to enable adequate interpretation of clinical features and response to future M. pneumoniae epidemics. This retrospective, comparative cohort study compared clinical features and severity of children with M. pneumoniae detection by PCR during the periods April 1, 2015, to March 31, 2020 (pre-NPI); April 1, 2020, to March 31, 2022 (NPI); and April 1, 2022, to March 31, 2025 (post-NPI). Clinical features were compared between periods by Kruskal-Wallis rank sum test or Fisher’s exact test, as appropriate. Moreover, we compared hospitalization and intensive care unit (ICU) admission using generalized linear models. In total, 321 patients were included in the study. Since the first detection of M. pneumoniae after the COVID-19 pandemic in summer 2023, the re-emergence has shown a bimodal curve with two distinct peaks (post-NPI first-year and second-year). The median age of patients was higher in the post-NPI than the pre-NPI period (9.05 vs 8.20 years), particularly during the first-year peak (11.00 years). Obstructive diseases were observed more frequently post-NPI compared to pre-NPI (18.6% vs 9.6%). Moreover, more patients presented with chest pain (8.9% vs 2.4%) and pleural effusions (45.7% vs 28.9%) post-NPI than pre-NPI. Conversely, extrapulmonary manifestations were less frequent post-NPI (18.6% vs 30.1%), particularly dermatological (15.7% vs 25.3%) and neurological (1.3% vs 4.8%) manifestations. Hospitalization rate (38.6% post-NPI vs 43.9% pre-NPI) and length of stay (median, 4 [IQR, 2-5] vs 4 [IQR, 3-6] days) were similar, while generalized linear models showed a trend toward fewer hospitalizations post-NPI (odds ratio [OR], 0.72 [95% CI, 0.42-1.23]; P = 0.22). The same applied to ICU admission rate (5.1% post-NPI vs 4.9% pre-NPI), with a trend toward fewer ICU admissions post-NPI (OR, 0.90 [95% CI, 0.29-3.34]; P = 0.86).

CONCLUSION: We observed notable changes in the clinical presentation of re-emerging M. pneumoniae infections compared to the pre-COVID-19 pandemic period, particularly an increase in obstructive phenotypes and pleural effusions. However, overall disease severity appeared to remain largely unchanged.

WHAT IS KNOWN: • The delayed re-emergence of M. pneumoniae in late 2023 was substantial in terms of case numbers across many geographical locations. • No statistically increased proportion of severe or worse outcomes of re-emerging M. pneumoniae infections could be observed globally compared with pre-COVID-19 pandemic epidemics.

WHAT IS NEW: • Clinical features of M. pneumoniae infections in children partly changed following COVID-19 pandemic restrictions, with new signs like obstructive phenotypes and pleural effusions. • The findings suggest that there has been no overall increase in disease severity; in fact, extrapulmonary manifestations were fewer, with trends toward reduced hospitalizations and ICU admissions.

PMID:40770147 | DOI:10.1007/s00431-025-06326-y

Neurochirurgie. 2025 Aug 5;71(5):101709. doi: 10.1016/j.neuchi.2025.101709. Online ahead of print.

ABSTRACT

OBJECTIVE: Chronic subdural hematoma (CSDH) is a well-documented imaging finding in spontaneous intracranial hypotension (SIH) and is often managed conservatively. While large hematomas identified on imaging traditionally prompt early surgical intervention, this approach still seems unclear. This study aims to clarify optimal management strategies by reviewing our clinical experience.

METHODS: We retrospectively analyzed 14 consecutive cases of CSDH associated with SIH treated at our institution between 2010 and 2024. Patient demographics, clinical symptoms, and imaging findings were extracted from medical records and statistically analyzed.

RESULTS: Seven patients with persistent headaches underwent hematoma drainage in addition to SIH treatment, whereas seven patients with positional headaches were successfully managed with SIH treatment alone. The persistent headache group had a larger median hematoma volume than the positional headache group (88.9 cm³ vs. 38.9 cm³). However, the persistent headache group had a significantly lower median Glasgow Coma Scale score than the positional headache group (13 vs. 15, p = 0.011). Papilledema was observed in five of the seven patients in the persistent headache group, but was absent in the positional headache group (p = 0.079).

CONCLUSIONS: Our study demonstrates that clinical indicators-particularly papilledema, altered consciousness, and headache characteristics-are essential for guiding the need for hematoma drainage in CSDH associated with SIH. Radiological features such as hematoma volume were not sufficient predictors of surgical need.

PMID:40768803 | DOI:10.1016/j.neuchi.2025.101709

J Gastrointest Surg. 2025 Aug 5;29(10):102161. doi: 10.1016/j.gassur.2025.102161. Online ahead of print.

ABSTRACT

BACKGROUND: Gastrointestinal (GI) and abdominal wall surgical procedures are core components of general surgery. Increasingly, residents are pursuing fellowship after completing general surgery residency for reasons, including desired subspecialty and/or perceived readiness for practice. This study aimed to determine what proportion of graduating general surgery residents pursue fellowships related to the GI tract and abdominal wall.

METHODS: Publicly available data from the American Board of Surgery (ABS) were used to quantify the rates of ABS-certified surgeons with fellowship training. Data were categorized by the degree of fellowship-level GI-specific training: (i) no fellowship, (ii) all GI (advanced GI, bariatric, colon and rectal, endoscopy, hepatobiliary, and minimally invasive), (iii) most GI (acute care, complex general surgical oncology, and oncology), (iv) some GI (pediatric, thoracic, and transplantation), and (v) non-GI (breast, critical care, endocrine, hand, other, plastic, trauma burns, and vascular). Trends were statistically analyzed using Mann-Kendall tests and 2-sample proportion t tests.

RESULTS: In 1980, 5.8% of applicants for initial ABS fellowship certification were made up of GI-related surgeons (ie, all GI + most GI + some GI), whereas 84.5% of surgeons did not pursue any fellowship training. By 2023, the number of surgeons applying for initial ABS fellowship certification had substantially increased to 39.6%, whereas the number of surgeons pursuing no fellowship had fallen to a mere 18.2%. There were statistically significant increasing trends over time for each fellowship, and a significant decreasing trend for no fellowship (P <.0001). When comparing all, most, and some GI training, all GI training demonstrated the largest increase of fellowships between 1980-1980 (3.2%) and 2014-2023 (20.3%) (P <.0001). The largest increases in enrollment in individual GI fellowships between 1980-1989 and 2014-2023 were in colon and rectal surgery (CRS: 1.7% in 1980-1989 vs 7.5% in 2014-2023; P <.0001) and minimally invasive surgery (MIS: 0.3% in 1980-1989 vs 7.4% in 2014-2023; P <.0001) fellowships.

CONCLUSION: Over time, there has been a significant increase in surgeons pursuing additional training in GI-related fields, especially CRS and MIS. Additional investigation is necessary to determine whether this is secondary to exposure in residency and/or increasing complexity of operations. However, our data suggest that even with the increase in fellowships, general surgery residents continue to seek careers focused on the GI tract, which remains at the core of the surgical field.

PMID:40768792 | DOI:10.1016/j.gassur.2025.102161

Gait Posture. 2025 Jul 23;122:279-285. doi: 10.1016/j.gaitpost.2025.07.327. Online ahead of print.

ABSTRACT

BACKGROUND: Foot structure and function may change over time. Different foot types have been associated with a higher incidence of certain foot pathologies. Injury prevalence in the military can affect readiness for deployment and effectiveness in combat. It is currently unknown if measures of foot structure and function change in response to intensive exercise or aggressive military training in young adults.

RESEARCH QUESTION: Does foot structure and function change longitudinally from baseline (onset of intensive basic military training) to 8-week follow-up on a sample of United States Military Academy (USMA) cadets?

METHODS: Measures of foot structure (arch height index (AHI), arch height flexibility (AHF)) and function (center of pressure excursion index (CPEI), peak pressure (PP), maximum force (MF), pressure time-integral (PTI), force-time integral (FTI), and contact area (CA)) were obtained at baseline and after 8-weeks in 106 USMA cadets. Foot function variables were measured with a plantar pressure measuring device using a 12-region masking algorithm. Generalized estimation equation (GEE) models were used for statistical analysis to account for potential dependence in bilateral foot data.

RESULTS: AHI for sitting and standing significantly increased. PP significantly reduced beneath the overall foot, hallux, and 2nd metatarsal head. MF significantly increased beneath the 3rd metatarsal head and decreased beneath the lateral heel. PTI significantly increased beneath the overall foot and the 1st-5th metatarsal heads, medial heel, and medial arch. FTI significantly increased beneath the overall foot, 1st-5th metatarsal heads, and the medial heel. After co-varying for body weight, all these findings remained, suggesting changes in weight had no effect on foot structure and function.

SIGNIFICANCE: Foot structure changed to a higher arch while foot function demonstrated less over-pronation. Future research should investigate changes in foot structure and function over larger time frames and examine the risk for subsequent musculoskeletal injuries.

PMID:40768790 | DOI:10.1016/j.gaitpost.2025.07.327

Gait Posture. 2025 Jul 17;122:272-278. doi: 10.1016/j.gaitpost.2025.07.319. Online ahead of print.

ABSTRACT

BACKGROUND: Knee osteoarthritis (KOA) is a debilitating condition affecting knee function and mobility. Lateral wedge insoles (LWIs) are used to manage KOA, but their effects in different footwear types need further investigation. This study aimed to evaluate the effects of LWIs on lower-limb joint kinematics in KOA patients, comparing walking barefoot (Bare), conventional sandals with LWIs (SAN), and combo slipper socks with LWIs (SOC), a novel footwear design.

METHODS: 23 female patients with bilateral medial compartment KOA (K-L grades II-III), aged 45-65 years, walked in three conditions: Bare, SAN, and SOC. Assessments included comfort levels (Likert scale), pain severity (Visual Analog Scale), and lower-limb joint kinematics. Statistical analysis utilized paired t-tests with Statistical Parametric Mapping. Results are presented as means ± standard deviations, with comparisons between conditions done via mean differences (MD) and Cohen’s d (d).

RESULTS: Our analysis revealed SOC provides greatest comfort and lowest pain, followed by SAN, with Bare condition exhibited the lowest comfort and highest pain levels. Hip flexion angles during mid-swing were significantly greater in SOC (M=22.07 ± 12.29°) compared to Bare (M=19.80 ± 11.95°; p < 0.01; MD = 2.27°, d=-0.10). Knee flexion during terminal stance was significantly lower in SOC (24.38 ± 1.30°) than in Bare (27.65 ± 1.27°; p < 0.01, MD=-3.27°, d=2.54). Hip external rotation angles during pre-swing were significantly reduced in SAN (-15.36 ± 0.92°) and SOC (-14.82 ± 0.64°) relative to Bare (-17.85 ± 1.04°; p < 0.01, [Bare vs. SAN] MD=2.49, d=-2.54; [Bare vs. SOC] MD=3.09, d=-3.6). SAN also demonstrated significantly lower ankle plantarflexion angles during both stance (1.97 ± 3.71°) and swing (-19.45 ± 4.76°) compared to Bare stance (6.49 ± 3.42°, MD= -4.52°, d=1.27) and swing (-13.33 ± 4.83°;p < 0.001, MD=-6.12°, d=1.27).

CONCLUSION: A unique LWI-integrated design (SOC), improved comfort, reduced pain, and altered joint kinematics during walking in females with medial KOA. These findings demonstrate the potential of SOC for conservative KOA management. Further studies should explore SOC’s impact on joint loading and long-term clinical outcomes.

PMID:40768789 | DOI:10.1016/j.gaitpost.2025.07.319

JMIR Form Res. 2025 Aug 6;9:e70672. doi: 10.2196/70672.

ABSTRACT

BACKGROUND: Increasing reliance on digital health resources can create disparities among older patients. Understanding health-related, mobility, and socioeconomic factors associated with the use of eHealth technologies is important for addressing inequitable access to health care.

OBJECTIVE: We sought to assess digital health literacy among patients aged ≥65 years and identify factors associated with their ability to access, understand, and use digital health resources.

METHODS: We developed a survey instrument grounded in the Technology Acceptance Model and conducted a cross-sectional, mixed-mode survey of patients aged ≥65 years from an integrated, multispecialty medical center. Digital health literacy was measured using the eHeals health literacy scale, and responses were analyzed across self-rated health, self-reported mobility, and socioeconomic deprivation assessed with the Area Deprivation Index (ADI). Counts (n) and frequencies (%) are reported across response groups, and analyses for differences are performed using the χ2 test for independence or the Fisher exact test.

RESULTS: Analyses included 878 responses (response rate=878/2847; 30.8%). There was a significant difference in the distribution of race between responders and nonresponders (P<.001) but no significant differences were observed by age (P=.053) or gender (P=.73). Respondents with lower self-rated health had lower levels of digital health literacy; only 54.2% (n=13/25) participants with poor self-rated health were able to send a message to their doctor compared to 89.5% (n=68/77) of patients with excellent self-rated health. All comparisons across the digital health literacy domains revealed significant differences across self-rated health groups (P<.05). Respondents with mobility restrictions had lower levels of digital health literacy, including lower frequencies of reporting knowledge of what health resources are available on the internet (mobility restricted, n=92/182; 52.0% vs no mobility restriction, n=433/688; 64.7%), knowledge of how to find health resources on the internet (mobility restricted, n=120/182; 67.4% vs no mobility restriction, n=513/688; 76.8%), and ability to use a camera or video with a doctor easily (mobility restricted, n=58/182; 32.6% vs no mobility restriction, n=321/688; 48.0%). Older adults experiencing increased socioeconomic deprivation, as measured by the ADI, reported lower rates of digital health literacy across most categories, including knowledge of how to find health resources on the internet (high ADI, n=28/49; 59.6% vs low ADI, n=551/751; 75.5%) and the ability to send an electronic message to their doctor easily (high ADI, n=27/49; 57.4% vs low ADI, n=584/751; 80.2%).

CONCLUSIONS: Our findings highlight the need for targeted interventions to improve engagement with eHealth among patients aged ≥65 years, who are impacted by poor health, limited mobility, and socioeconomic deprivation. Enhancing digital health literacy can help bridge the gap in access to digital health resources and improve overall health outcomes for this population.

PMID:40768764 | DOI:10.2196/70672

J Med Internet Res. 2025 Aug 6;27:e72607. doi: 10.2196/72607.

ABSTRACT

BACKGROUND: Ovarian follicles and endometrial thickness are monitored repeatedly for assisted reproduction, burdening patients and clinics. Self-scans with a home ultrasound device can relieve this.

OBJECTIVE: We aimed to evaluate the reliability of self-scans using the smartphone-based Pulsenmore follicle count vaginal self-scan device (FC) versus in-clinic (IC) sonographies, in ovarian stimulation for in-vitro fertilization or fertility preservation.

METHODS: This study is a single-center, interventional, controlled, prospective study including 44 patients without pelvic pathologies undergoing stimulation for in-vitro fertilization (2022-2024). Following training, patients used a vaginal home ultrasound device to scan their uterus and ovaries with remote guidance by a sonographer in each cycle check-point. Clinical decisions were based on standard IC sonographies. FC and IC results were compared for image quality, endometrial thickness, and follicle count or size. Aspirated oocyte numbers were compared to the follicles recorded at the last visit by home and IC scans. Absolute differences in follicular count and endometrial thickness between IC and FC scans were compared using means, SDs, and 95% CIs. The Spearman correlation (r) analyzed the relations between IC and FC outcomes. All tests applied were 2-tailed, with a P value of ≤5% considered statistically significant. Patient and sonographer satisfaction were assessed via surveys.

RESULTS: Of 44 patients, 34 completed this study. The mean age was 34.7 (SD 4.0) years, and BMI was 25.8 (SD 5.0) kg/m². A total of 65% (22/34) pursued fertility preservation and 35% (12/34) aimed to conceive. The image quality scores of all home scans were at a minimum suitable level, with most of better quality. FC measurements closely matched IC findings for key clinical parameters: antral follicle count (mean FC 11.94, SD 6.62 vs mean IC 15.23, SD 10.2, ρ=0.86, P<.001); number of stimulated follicles ≥10 mm (FC 12.19, SD 6.27 vs IC 13.5, SD 8.87, ρ=0.84, P<.001); identification of the leading follicle >14 mm (achieved in 87% of FC scans); and follicular number or size pretriggering. The aspirated oocyte or last-visit stimulated follicles (>10 mm; FC 1.12, SD 0.6 vs IC 1.06, SD 0.56, ρ=0.82, P<.001), mature oocytes or follicles >13 mm ratios (FC 1.28, SD 1.11 vs IC 1.04, SD 0.77, ρ=0.88, P<.001), and endometrial thickness pretriggering (FC 9.87, SD 2.2 mm vs IC 9.63, SD 2.7 mm, ρ=0.54, P=.002) were well-correlated between the home and standard scans, with 87.1% concordance in identifying endometrial adequacy (≥7 mm). In the patient survey, 82% (28/34) expressed interest in future use of the FC device. In the sonographer survey, 91% (31/34) demonstrated patient improvement.

CONCLUSIONS: The home ultrasound device was feasible, comparable, and well-correlated with standard IC scans, laying the basis for remote home-based monitoring of follicular development during ovarian stimulation. We believe this also applies to monitoring milder stimulations and even natural cycles.

PMID:40768762 | DOI:10.2196/72607

JMIR Aging. 2025 Aug 6;8:e70040. doi: 10.2196/70040.

ABSTRACT

BACKGROUND: The demand for home medical care services has increased in aging societies. Therefore, allocating health care resources optimally to meet the needs of each community is essential. Geographical accessibility is an important factor affecting access to home medical care services; however, little research has been conducted on regional disparities in geographical accessibility.

OBJECTIVE: This study aims to analyze the regional disparities in geographical accessibility to home medical care services using the Kokuho database (KDB), a comprehensive medical claims database for a prefecture in Japan.

METHODS: This study included 39 municipalities in Nara Prefecture, Japan. Using a geographical information system, accessibility to home medical care services, that is, travel distance and time from hospitals and clinics to hypothetical patients, was analyzed in two scenarios: (1) an ideal scenario, where we assumed that all hospitals or clinics in Nara Prefecture provided those services and (2) an actual scenario, where hospitals or clinics in Nara Prefecture that actually provided home medical care services, identified from KDB data analysis, were used in the analysis. Hypothetical patients were randomly distributed on the geographical information system in accordance with the usage rates of home medical care services and with the distributions of the population aged ≥75 years. The usage rate by municipalities was aggregated from the analysis of KDB data of Nara Prefecture in FY2019.

RESULTS: The median travel distance was longer than 16 km, the reference limit value specified in the Japanese fee table, and the median travel time exceeded 30 min in certain rural municipalities in the southern part of Nara Prefecture, in the actual scenario, whereas the travel distance and time were improved in the ideal scenario. The differences in travel time between the ideal and actual scenarios were the largest in the depopulated municipalities in the southern part, such as Totsukawa (32.6 vs 5.8 min), Kawakami (30.1 vs 11.8 min), Kurotaki (21.3 vs 5.2 min), and Kamikitayama (20.7 vs 3.5 min). The usage rates were also lower in rural municipalities in the southern part.

CONCLUSIONS: The results revealed that geographical accessibility was lower in depopulated municipalities in the southern part, and the disparity could be partly solved in the ideal scenario, especially in that area, highlighting the necessity of increasing supply in the southern areas. KDB is a comprehensive database that includes medical claims information for home medical care patients and details of the provision of medical institutions, enabling geographical analysis that reflects actual health care usage.

PMID:40768758 | DOI:10.2196/70040

Medwave. 2025 Aug 6;25(7):e3088. doi: 10.5867/medwave.2025.07.3088.

ABSTRACT

INTRODUCTION: In Chile, the number of migrants affected by tuberculosis has experienced a significant increase from 7.1% in 2014 to 29.7% in 2023, ranking as the first group at risk. The objective was to estimate the time to diagnosis of tuberculosis from arrival in Chile in a series of migrants undergoing treatment between January 2021 and March 2022.

METHODS: We analyzed a cohort of migrants over 18 years of age with a diagnosis of tuberculosis treated in the communes of Recoleta and Independencia. Those who agreed to participate and signed the informed consent form were included. Cases with non-tuberculous mycobacteria and residents outside the Metropolitan Region were excluded. Sociodemographic, clinical, and arrival dates, as well as symptoms and diagnoses, were recorded. Proportional hazards models in STATA v.18 were used to analyze times according to independent variables. A p value < 0.05 was considered significant.

RESULTS: The median time to diagnosis was 93.5 months, varying by subgroup. The recent migration subgroup without Chilean documentation had a hazard ratio of 13.1, which indicates that, at any time after arrival, these individuals have a 13-fold increased risk of tuberculosis diagnosis compared to the reference subgroup (traditional migration with Chilean identity documents). This hazard ratio is reduced by 2.4 times when these types of migrants have documentation from Chile (95% confidence interval: 1.2 to 4.5).

CONCLUSIONS: There is a wide range of time from arrival in Chile to the diagnosis of tuberculosis. Factors such as the type of migration and the type of identity document have an impact on the development of this disease. It is necessary to expedite the legal administrative process for migrants and implement timely screening policies, along with follow-up and improved access to healthcare, to reduce exposure and risk of tuberculosis.

PMID:40768753 | DOI:10.5867/medwave.2025.07.3088

Chaos. 2025 Aug 1;35(8):083114. doi: 10.1063/5.0244302.

ABSTRACT

The Dansgaard-Oeschger events are sudden and irregular warmings of the North Atlantic region that occurred during the last glacial period. A key characteristic of these events is a rapid shift to warmer conditions (interstadial), followed by a slower cooling toward a colder climate (stadial), resulting in a saw-tooth pattern in regional proxy temperature records. These events occurred many times during the last 100 000 years and have been hypothesized to result from various mechanisms, including millennial variability of the ocean circulation and/or nonlinear interactions between ocean circulation and other processes. Our starting point is a non-autonomous, conceptual, but process-based, model of Boers et al. [Proc. Natl. Acad. Sci. 115, E11005-E11014 (2018)] that includes a slowly varying non-autonomous forcing represented by reconstructed global mean temperatures. This model can reproduce Dansgaard-Oeschger events in terms of shape, amplitude, and frequency to a reasonable degree. However, the model of Boers et al. has instantaneous switches between different sea-ice evolution mechanisms on crossing thresholds and, therefore, cannot show early warning signals of the onset or offset of these warming events. In this paper, we regularize this model by adding a fast dynamic variable so that the switching occurs smoothly and in finite time. This means the model has the potential to show early warning signals for sudden changes. However, the additional fast timescale means these early warning signals may have short time horizons. Nonetheless, we find some evidence of early warning for the transition between slow and rapid cooling for the model.

PMID:40768746 | DOI:10.1063/5.0244302