Tag: statistics

Nutr Neurosci. 2025 Nov 10:1-11. doi: 10.1080/1028415X.2025.2587076. Online ahead of print.

ABSTRACT

BACKGROUND: Recent research highlights the central role of emotion in psychopathology, with Panksepp’s Affective Neuroscience Theory identifying seven primary emotional systems critical for mammalian survival. Although this framework has advanced understanding of disorders such as depression and addiction, its application to eating pathology remains limited.

OBJECTIVE: The present study integrates affective neuroscience with behavioural analysis, conceptualizing emotions not merely as neural activations but as classes of behaviour shaped by phylogenetic selection and ontogenetic contingencies.

METHODS: Eating disorders, characterized by maladaptive eating patterns that impair physical and psychological functioning, are examined here as emotional-behavioural phenomena maintained by reinforcement processes. This cross-sectional, correlational study investigated associations between emotional systems and disordered eating.

RESULTS: Weak but statistically significant correlations were found between negative emotional systems (FEAR, PANIC/GRIEF, RAGE) and disordered eating (r ≈ .15-.25, 95% CI [.07, .35]), suggesting that difficulties in emotion regulation may act as antecedents and reinforcers of maladaptive coping behaviours. Positive emotional systems (PLAY, CARE, SEEKING) showed no significant relationships, indicating heterogeneous reward contingencies among individuals with eating pathology. Exploratory gender-stratified analyses revealed small differences in emotional correlates but no moderation effects, underscoring similar functional mechanisms across sexes.

CONCLUSIONS: Findings are interpreted within a functional-analytic framework, proposing that disordered eating is maintained by negative reinforcement, reducing aversive private events such as shame, fear, or panic. Clinically, results highlight the need for integrated, context-sensitive interventions that target emotion regulation and avoidance mechanisms across genders.

PMID:41212971 | DOI:10.1080/1028415X.2025.2587076

J Refract Surg. 2025 Nov;41(11):e1162-e1167. doi: 10.3928/1081597X-20250821-03. Epub 2025 Nov 1.

ABSTRACT

PURPOSE: To investigate the ultrastructure and apoptosis of small incision lenticule extraction (SMILE) lenticules under different preservation conditions.

METHODS: A total of 104 corneal stromal lenticules of 52 patients (13 men and 39 women, age 28.85 ± 6.45 years, mean spherical error -4.27 ± 1.34 diopters [D]) were collected from small incision lenticule extraction (SMILE) surgeries, and were immediately preserved using glycerol, silicone oil, Optisol (Bausch & Lomb), and cryopreservation for 1 day, 1 week, and 1 month. Fresh lenticules were taken as control groups. Hematoxylin-eosin (HE) staining and transmission electron microscopy (TEM) were applied for evaluation of ultrastructure and terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL) for cell apoptosis ratio. Changes of quantity of collagen in TEM were evaluated in each group among all time points.

RESULTS: HE staining showed that collagen in the fresh lenticules had an orderly arrangement with few vacuoles. In each preservation group, vacuoles and changes in arrangement of collagen were observed. TEM showed that the mean density of collagen was lowest at 1 month in the glycerol, silicone oil, and cryopreservation groups and highest at 1 month in the Optisol group. Quantities of collagen of lenticules preserved for 1 day and 1 week in the Optisol group were not statistically significantly different from those in the fresh group. At the same storage time, the mean density of collagen was the highest in the cryopreservation group at 1 day and the Optisol group at 1 month, and there was no statistically significant difference among the other groups. There was no statistically significant difference in apoptotic cell ratio among groups.

CONCLUSIONS: SMILE lenticules preserved using glycerol, silicone oil, Optisol, and cryopreservation within 1 month maintain a similar cell viability level as fresh lenticules.

PMID:41212966 | DOI:10.3928/1081597X-20250821-03

J Neurophysiol. 2025 Nov 10. doi: 10.1152/jn.00067.2025. Online ahead of print.

ABSTRACT

Predictive control enables humans to anticipate future events by combining sensory feedback with internal models. In interception tasks, such mechanisms could allow the visual system to estimate future target positions, supporting timely and accurate motor responses. Here, we investigated predictive gaze behavior in a visuomotor task where participants used a joystick to intercept a moving target that rebounded within a circular arena. Eye movements were classified into fixations, smooth pursuit, and saccades using a velocity-based method. The arena’s geometry constrained rebound angles and facilitated standardized trajectory analysis. Participants consistently deployed fixations aligned with the target’s anticipated post-rebound path, as confirmed by fixations that were closer to future than to current target positions. Moreover, saccade and fixation onsets were time-locked to the rebound event, reflecting anticipatory adjustments based on the statistical regularities of the task. Gaze alignment was modulated by the target’s entry angle and velocity: steeper entries and higher speeds compressed fixation timing but increased spatial variability. Visual masking of the target disrupted predictive gaze, highlighting the critical role of target visibility in guiding anticipatory behavior. These findings demonstrate the crucial role of predictive fixations in visuomotor coordination, offering a broader understanding of anticipatory behaviors and their applications. Our task design offers a controlled platform to study anticipatory gaze strategies, with potential applications for clinical diagnostics, skill training, and human-computer interaction.

PMID:41212615 | DOI:10.1152/jn.00067.2025

J Appl Physiol (1985). 2025 Nov 10. doi: 10.1152/japplphysiol.00834.2025. Online ahead of print.

ABSTRACT

Background: Night-shift work is prevalent among healthcare workers and disrupt circadian rhythms, potentially influencing blood pressure (BP) regulation. Pregnancy itself causes significant BP fluctuations, and night shifts may exacerbate these changes, increasing the risk of hypertension disorders. However, studies on the impact of shift work on BP patterns in pregnancy in a free-living environment is currently lacking. Method: We recruited 25 pregnant nurses in their second trimester, comprising 13 on day shifts (DS) and 12 on night shifts (NS), from eight urban hospitals in Edmonton, Alberta, Canada. Resting BP (systolic – SBP; diastolic – DBP; mean arterial pressure – MAP; and pulse pressure – PP) was assessed before and after shift work. Data were analyzed to compare pre- and post- shift measurements between DS and NS workers using a Linear Mixed-Effects Model, with statistical significance set at p < 0.05. Results: NS workers showed significantly higher post-shift DBP and MAP compared to DS workers (p < 0.001). In contrast, NS workers exhibited a significant post-shift decrease in pulse pressure (PP) than the DS group (p < 0.001), indicating distinct acute hemodynamic responses to NS work. Conclusions: NS work in pregnant nurses is associated with acute elevations in DBP and MAP, along with a significant reduction in PP following the shift. These findings suggest that NS may trigger distinct hemodynamic stress responses during pregnancy, potentially increasing short-term cardiovascular load.

PMID:41212601 | DOI:10.1152/japplphysiol.00834.2025

JAMA Intern Med. 2025 Nov 10. doi: 10.1001/jamainternmed.2025.5917. Online ahead of print.

ABSTRACT

IMPORTANCE: Although risk-based payment contracts to health care organizations can reduce health care utilization, there is limited evidence on how these contracts influence the value of health care services delivered, whether effects depend on contract design features, and what these contracts achieve in Medicare Advantage, the segment of US health insurance with the most adoption of risk-based contracts.

OBJECTIVE: To assess whether voluntary transition to risk-based contracts (either upside-only, with financial bonuses possible, or 2-sided with both bonuses and penalties possible) was associated with changes in either broad domains of health care utilization or use of low-value services.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study analyzed claims from January 1, 2015, through December 31, 2021, for beneficiaries enrolled in health maintenance organization plans from Humana, a large, national Medicare Advantage insurer. A difference-in-differences analysis measured changes in outcomes for health care organizations that newly transitioned to upside-only or 2-sided risk contracts compared with organizations with stable fee-for-service (FFS) or upside-only risk contracts, respectively. Statistical analysis was conducted between April 4 and June 23, 2025.

MAIN OUTCOMES AND MEASURES: Nine utilization measures in 3 domains (inpatient encounters, outpatient visits, testing) and 26 measures of low-value service use in 6 domains (cancer screening, diagnostic and preventive testing, preoperative testing, imaging, cardiovascular testing and procedures, and other surgeries).

RESULTS: The sample included 658 organizations transitioning from FFS to upside-only risk contracts (1 042 272 beneficiary-years), 114 organizations transitioning from upside-only to 2-sided risk contracts (706 303 beneficiary-years), and 3385 control organizations (2 491 985 beneficiary-years). In difference-in-differences analyses, transitioning to upside-only risk contracts was associated with differential reductions in 4 of 9 utilization outcomes (emergency department visits, primary care visits, advanced imaging, and cardiovascular stress testing); however, when analyses accounted for differential temporal trends in outcomes prior to contract transitions, differential reductions were only detected for emergency department visits (-8.4% of baseline use; 95% CI, -15.5% to -1.3%; P = .02) and cardiovascular stress testing (-12.1%; 95% CI -23.4% to -0.7% P = .04). Transitioning to 2-sided risk contracts was associated with differential reductions in specialty visits and advanced imaging; however, neither association was detected after accounting for pretransition outcome trends. Neither type of contract adoption was associated with differential changes in total use of low-value services or differential reductions in any domain of low-value service use.

CONCLUSIONS AND RELEVANCE: This study found that voluntary transition to upside-only or 2-sided risk payment contracts in Medicare Advantage was not associated with consistent changes in health care utilization or low-value service use. It is uncertain what factors account for the lack of apparent changes.

PMID:41212579 | DOI:10.1001/jamainternmed.2025.5917

JAMA Netw Open. 2025 Nov 3;8(11):e2542147. doi: 10.1001/jamanetworkopen.2025.42147.

ABSTRACT

IMPORTANCE: Colorectal cancer (CRC) survivors frequently report bowel-related symptoms, but longitudinal data are scarce and diet has not been extensively investigated in relation to bowel-related symptoms.

OBJECTIVE: To investigate the prevalence of bowel-related symptoms as well as their association with dietary fiber intake until 5 years after CRC diagnosis.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study using data from the Colorectal Cancer: Longitudinal, Observational Study on Nutritional and Lifestyle Factors (COLON) study included CRC survivors with stage I-IV disease recruited at diagnosis from 11 hospitals in the Netherlands between August 2010 and February 2020. CRC survivors were followed up until 5 years after diagnosis. Data were analyzed between April 2024 and March 2025.

EXPOSURES: Clinical data including CRC treatment strategy, retrieved from hospital records and national registries, and habitual dietary fiber intake, assessed by a food frequency questionnaire, at 6 months, 2 years, and 5 years after CRC diagnosis.

MAIN OUTCOMES AND MEASURES: Prevalence of self-reported diarrhea, constipation, flatulence or bloating, frequent stools, mucus in stools, or false urgency at 6 months, 2 years, and 5 years after diagnosis, obtained via a questionnaire. The validated European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) was also used to evaluate prevalence of moderate-to-severe diarrhea or constipation and health-related quality of life (HRQOL) at these time points. Odds ratios (ORs) for associations between fiber intake and bowel-related symptoms (yes or no) were calculated using multivariable logistic regression.

RESULTS: Among 1751 CRC survivors who underwent surgery and were included in the analysis, median age at diagnosis was 66 years (IQR, 61-71 years), and 1115 (63.7%) were men. Bowel-related symptoms were reported by 817 of 1751 survivors (46.7%) at 6 months, 614 of 1511 (40.6%) at 2 years, and 290 of 812 (35.7%) at 5 years after diagnosis. At 6 months after diagnosis, symptoms were predominantly reported by survivors who had received chemotherapy (260 of 446 [58.3%]), whereas symptoms at 2 and 5 years occurred mostly in those who received radiotherapy (86 of 160 [53.8%] at 2 years and 47 of 92 [51.1%] at 5 years). Of the studied bowel-related symptoms, diarrhea was associated with the lowest HRQOL score (B, -9.6; 95% CI, -14.0 to -5.2) at 5 years after diagnosis. In multivariable logistic regression analyses, higher fiber intake (per 10-g/d increment) was associated with a significantly lower prevalence of moderate-to-severe diarrhea at 6 months (OR, 0.44; 95% CI, 0.28-0.70) and 2 years (OR, 0.53; 95% CI, 0.30-0.94) after diagnosis, but the association was not statistically significant at 5 years (OR, 0.43; 95% CI, 0.16-1.13).

CONCLUSIONS AND RELEVANCE: In this cohort study of CRC survivors, the prevalence of bowel-related symptoms was considerably high during the 5 years after diagnosis, highlighting a need for effective symptom management. Higher dietary fiber intake was associated with a lower prevalence of diarrhea, suggesting a potential role of diet in management of bowel-related symptoms in CRC survivors.

PMID:41212563 | DOI:10.1001/jamanetworkopen.2025.42147

JAMA Netw Open. 2025 Nov 3;8(11):e2542668. doi: 10.1001/jamanetworkopen.2025.42668.

ABSTRACT

IMPORTANCE: Gestational diabetes (GD) is a heterogeneous condition that predisposes both mother and offspring to metabolic disorders. GD subtypes defined by antepartum testing results have been associated with adverse perinatal outcomes, but little is known about their relationship to maternal metabolic outcomes soon after pregnancy.

OBJECTIVE: To evaluate early postpartum glucose tolerance reclassification of GD subtypes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined women from the Study of Women, Infant Feeding, and Type 2 Diabetes Mellitus After GD Pregnancy (SWIFT), who were recruited within the Kaiser Permanente Northern California integrated health care system between 2008 and 2011. All women were diagnosed with GD using Carpenter and Coustan criteria with complete glucose measurements at all 4 time points of the diagnostic 3-hour 100-gram oral glucose tolerance test (OGTT). Data analyses were conducted from January to July 2025.

EXPOSURE: Three subtypes of GD based on the diagnostic OGTT: (1) postload glucose intolerance (GD-P), as having elevations only at 2 or more postload time points; (2) fasting hyperglycemia (GD-F), as having elevations at fasting and 1 postload time point; and (3) both (GD-M), as having elevations at fasting and 2 or more post-load time points.

MAIN OUTCOMES AND MEASURES: At 6 to 9 weeks after delivery, glucose tolerance classification was evaluated using 2-hour, 75-g OGTTs. Modified Poisson regression models were used to estimate adjusted prevalence ratios (PRs) of postpartum prediabetes associated with GD subtypes, without and with adjustments for age, race and ethnicity, prepregnancy body mass index, educational level, and gestational weight gain.

RESULTS: This study included 1005 women with GD (median [IQR] age, 33.2 [29.8-36.7] years; 368 [36.6%] Asian, 78 [7.8%] Black, 308 [30.6%] Hispanic, 16 [1.6%] multiracial, and 235 [23.4%] White). Prevalence of postpartum prediabetes was 34.5% (347 women), with wide variation across GD subtypes; 23.9% (147 of 616), 41.9% (52 of 124), and 55.8% (148 of 265) for GD-P, GD-F, and GD-M, respectively. Compared with women with GD-P, the adjusted PR for GD-F was 1.74 (95% CI, 1.36-2.24), and for GD-M, it was 2.23 (95% CI, 1.85-2.68) (both P < .001). Pairwise comparisons between GD-F and GD-M were also statistically significant (adjusted PR, 1.28; 95% CI, 1.01-1.61; P = .04).

CONCLUSIONS AND RELEVANCE: In this cohort study, GD subtypes had distinct postpartum prediabetes risks. Early action and intervention to address dysglycemia may be most beneficial for women with fasting or mixed defects.

PMID:41212558 | DOI:10.1001/jamanetworkopen.2025.42668

JAMA Netw Open. 2025 Nov 3;8(11):e2543156. doi: 10.1001/jamanetworkopen.2025.43156.

ABSTRACT

IMPORTANCE: In the US, 1 in 5 adult suicide decedents has spent at least 1 night in jail in the year prior to death.

OBJECTIVE: To evaluate the effectiveness of the Safety Planning Intervention (SPI) with telephone follow-up as an adjunct to enhanced standard care (ESC) compared with ESC alone for reducing suicide events in the 12 months following release from pretrial jail detention.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial included individuals with past 30-day suicide risk (suicide ideation with intent and/or suicide attempt) in pretrial jail detention who were recruited from 2 jails from May 11, 2016, to November 13, 2018, with a 12-month follow-up after release. Data analysis was completed from April 2023 to May 2025.

INTERVENTIONS: All participants received ESC. The SPI included a safety planning session in jail followed by 4 to 8 telephone calls 6 months after jail release.

MAIN OUTCOMES AND MEASURES: The primary outcome was the number of suicide events (a composite of suicide attempts and behaviors, suicide-related hospitalizations, and suicide deaths). Secondary outcomes included the number of suicide attempts, weeks and severity of active suicidal ideation, time to first suicide event, psychiatric symptoms, functioning, and hypothesized mediators. Suicidal ideation and behaviors were assessed using the Columbia-Suicide Severity Rating Scale, the Longitudinal Interval Follow-Up Evaluation, and record reviews from area hospitals. Deaths were identified through hospital, state, and national death records. Hospitalizations were measured with the Treatment History Interview and hospital records.

RESULTS: Of 800 participants randomized in jail, 655 (mean [SD] age, 33.0 [10.4] years; 473 males [72%]) were released to the community and included in analyses. Of those, 593 (91%) completed at least 1 follow-up interview. Medical records were available for all 655 participants (100%). Per person-year of follow-up over 12 months, those in the SPI group compared with those in the ESC group had 42% fewer suicide events (mean [SE], 1.82 [0.18] vs 3.11 [0.32]; mean [SE] difference, -1.30 [0.37]; P < .001), 55% fewer suicide attempts (mean [SE], 1.06 [0.14] vs 2.35 [0.33]; mean [SE] difference, -1.33 [0.38]; P < .001). Differences in weeks of suicidal ideation were not statistically significant (mean [SE], 10.39 [0.78] vs 12.86 [1.02]; mean [SE] difference, -2.47 [1.28]; P = .06). There were no other observed differences in outcomes.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of the SPI compared with ESC, those in the SPI group experienced reduced suicide risk by 42% in the year after jail release. These results suggest that SPI is effective for reducing suicide risk during this high-risk period.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02759172.

PMID:41212557 | DOI:10.1001/jamanetworkopen.2025.43156

JAMA Intern Med. 2025 Nov 10. doi: 10.1001/jamainternmed.2025.5792. Online ahead of print.

NO ABSTRACT

PMID:41212549 | DOI:10.1001/jamainternmed.2025.5792

JAMA Neurol. 2025 Nov 10. doi: 10.1001/jamaneurol.2025.4347. Online ahead of print.

ABSTRACT

IMPORTANCE: Geographic variation in epilepsy incidence among older adults may reflect contextual risk factors and point to opportunities for targeted prevention. However, privacy constraints and sparse case counts have historically limited small-area analyses.

OBJECTIVE: To map incident epilepsy among older adults at the smallest geography permissible by privacy constraints and identify contextual social and environmental determinants associated with high-incidence areas.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined Medicare administrative claims from 2016 to 2019 for all counties in the contiguous United States. A random sample of 4 999 999 Medicare Fee-for-Service beneficiaries 65 years or older with non-Hispanic Black and Hispanic beneficiaries oversampled at rates of 1.50 and 1.75 times their representation in the study population. Beneficiaries with incident epilepsy were identified by claims criteria and codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, in 2019 and had no epilepsy claims during the period 2016 to 2018. Data were analyzed from January to March 2025.

EXPOSURES: Area-level social and environmental determinants of health (SEDH), obtained from publicly available sources and linked to beneficiaries’ residences.

MAIN OUTCOMES AND MEASURES: The outcome was area-level epilepsy incidence rate in 2019. To comply with data privacy requirements, the Max-P regionalization method was used to aggregate 3108 counties into 692 “MaxCounties,” each containing at least 11 incident cases. Incidence rates per 100 000 persons were mapped. Associations between SEDH variables and epilepsy incidence were estimated using random forest and multivariable logistic regression.

RESULTS: Among 4 817 147 beneficiaries, 20 263 incident epilepsy cases were identified in 2019 (mean [SD] age, 78.7 [7.5] years; 54.6% women). Incidence rates across MaxCounties varied more than 10-fold (range, 141-1476 per 100 000). In random forest models, higher incidence was associated with insufficient sleep, heat index, physical inactivity, uninsured rate, proportion of non-Hispanic Black residents, and obesity prevalence. In multivariable regression, MaxCounties in the highest tertile for insufficient sleep had nearly double the odds of high epilepsy incidence compared to the lowest tertile (odds ratio [OR], 1.99; 95% CI, 1.10-3.60). Lack of household vehicle access was similarly associated with high incidence (OR, 1.93; 95% CI, 1.16-3.25).

CONCLUSIONS AND RELEVANCE: Our findings highlight the spatial heterogeneity of epilepsy burden in the US Medicare population and underscore the importance of contextual SEDH factors, such as sleep, mobility, and infrastructure, in shaping disease patterns. These insights may help guide targeted public health interventions and resource allocation.

PMID:41212547 | DOI:10.1001/jamaneurol.2025.4347