Tag: statistics

JMIR Mhealth Uhealth. 2025 Mar 24;13:e56296. doi: 10.2196/56296.

ABSTRACT

BACKGROUND: Smoking cessation apps are increasingly being used to help smokers quit smoking. In China, whether behavioral science-based techniques are being incorporated into smoking cessation apps remains unknown.

OBJECTIVES: This study aims to describe the usage of behavior change techniques (BCTs) among smoking cessation apps available in China and to evaluate the relationship between BCT utilization and the quality of available smoking cessation apps.

METHODS: We searched eligible smoking cessation apps twice on September 12 and October 4, 2022. We coded them with BCTs and assessed their quality by the Mobile App Rating Scale (MARS) and rating score in the App Store. We described the quality of each app (ie, engagement, function, esthetic, and information) and the BCTs used within it, as well as the amount and proportion of all BCTs used. Correlation analysis and linear regression analysis were used to assess the association between the number of BCTs used and the quality of apps.

RESULTS: Nine apps were included in the final analyses. The average number of BCTs being used was 11.44 (SD 2.57), ranging from 5 to 29. Only 1 app used more than 20 BCTs. The most frequently used BCTs were providing feedback on current smoking behavior (9/9, 100%), prompting review of goals (8/9, 88.89%), prompting self-monitoring of one’s smoking behavior (7/9, 77.78%), and assessing current and past smoking behavior (7/9, 77.78%). The most commonly used BCTS specifically focus on behavior, including BM (B refers to behavior change, M focuses on addressing motivation; 4.44/11, 40.36%) and BS (B refers to behavior change, S refers to maximizing self-regulatory capacity or skills; 3.78/11, 34.36%). The average score of MARS for the apps was 3.88 (SD 0.38), ranging from 3.29 to 4.46, which was positively correlated with the number of BCTs used (r=0.79; P=.01). Specifically, more usage of BCTs was associated with higher engagement score (β=.74; P=.02; R2=0.52) and higher information score (β=.76; P=.02; R2=0.52).

CONCLUSIONS: The quality of smoking cessation apps assessed by MARS was correlated with the number of BCTs used. However, overall, the usage of BCTs was insufficient and imbalanced, and the apps demonstrated low quality of engagement and information dimensions. Coordinated efforts from policy makers, technology companies, health behavior professionals, and health care providers should be made to reduce tobacco consumption and to develop high-quality, widely accessible, and effective smoking cessation apps to help smokers quit smoking.

PMID:40127456 | DOI:10.2196/56296

Ann Intern Med. 2025 Mar 25. doi: 10.7326/ANNALS-24-01770. Online ahead of print.

NO ABSTRACT

PMID:40127446 | DOI:10.7326/ANNALS-24-01770

JMIR Res Protoc. 2025 Mar 24;14:e63584. doi: 10.2196/63584.

ABSTRACT

BACKGROUND: The tobacco industry has a history of targeting minority communities, including Hispanic individuals, by promoting vaping through social media. This marketing increases the risk of vaping among Hispanic young adults, including college students. In Texas, college enrollment among Mexican Americans has significantly increased over recent years. However, little research exists on the link between social media and vaping and the underlying mechanisms (ie, outcome expectations, attitudes, and beliefs) explaining how vaping-related social media impacts vaping among Mexican American college students. Moreover, there is limited knowledge about how acculturation moderates the association between social media and vaping. Hispanic individuals, particularly Mexican Americans, are the largest ethnic group in Texas colleges; thus, it is crucial to understand the impact of social media and acculturation on their vaping behaviors.

OBJECTIVE: We outline the mixed methods used in Project Vaping, Acculturation, and Media Study (VAMoS). We present descriptive analyses of the participants enrolled in the study, highlight methodological strengths, and discuss lessons learned during the implementation of the study protocol related to recruitment and data collection and management.

METHODS: Project VAMoS is being conducted with Mexican American students attending 1 of 6 Texas-based colleges: University of Texas (UT) Arlington, UT Dallas, UT El Paso, UT Rio Grande Valley, UT San Antonio, and the University of Houston System. This project has 2 phases. Phase 1 included an ecological momentary assessment (EMA) study and qualitative one-on-one interviews (years 1-2), and phase 2 includes cognitive interviews and a 4-wave web-based survey study (years 2-4) with objective assessments of vaping-related social media content to which participants are exposed. Descriptive statistics summarized participants’ characteristics in the EMA and web-based survey.

RESULTS: The EMA analytic sample comprised 51 participants who were primarily female (n=37, 73%), born in the United States (n=48, 94%), of middle socioeconomic status (n=38, 75%), and aged 21 years on average (SD 1.7 years). The web-based survey cohort comprised 1492 participants self-identifying as Mexican American; Tejano, Tejana, or Tejanx; or Chicano, Chicana, or Chicanx heritage who were primarily female (n=1042, 69.8%), born in the United States (n=1366, 91.6%), of middle socioeconomic status (n=1174, 78.7%), and aged 20.1 years on average at baseline (SD 2.2 years). Of the baseline cohort, the retention rate in wave 2 was 74.7% (1114/1492).

CONCLUSIONS: Project VAMoS is one of the first longitudinal mixed methods studies exploring the impact of social media and acculturation on vaping behaviors specifically targeting Mexican American college students. Its innovative approach to objectively measuring social media exposure and engagement related to vaping enhances the validity of self-reported data beyond what national surveys can achieve. The results can be used to develop evidence-based, culturally relevant interventions to prevent vaping among this rapidly growing minority population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63584.

PMID:40127433 | DOI:10.2196/63584

J Vet Emerg Crit Care (San Antonio). 2025 Mar 24:e13453. doi: 10.1111/vec.13453. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the variables associated with unsuccessful tracheal decannulation in brachycephalic breeds after upper airway surgery.

DESIGN: Retrospective study from 2010 to 2022.

SETTING: University teaching hospital.

ANIMALS: Fifty-one client-owned dogs requiring a temporary tracheostomy after upper airway surgery for brachycephalic obstructive airway syndrome (BOAS).

PROCEDURES: Medical records of dogs receiving a temporary tracheostomy after upper airway surgery for BOAS were reviewed. Dogs that underwent a tracheostomy decannulation attempt were included. Data were extracted from the medical record, including signalment, patient size, type of airway surgery, presence of hypoplastic trachea, presence of laryngeal collapse, prophylactic versus emergency tracheostomy, frequency of cannula suctioning, and time from tracheostomy to decannulation attempt. The association of these factors with successful decannulation and the number of decannulation attempts were evaluated.

RESULTS: Of 699 dogs with BOAS that had upper airway surgery, 54 (7.7%) had a temporary tracheostomy performed. Dogs with an increased frequency of tracheostomy tube suctioning in the 24-h period before the first decannulation attempt were less likely to have a successful decannulation (P = 0.03). Dogs with laryngeal collapse were less likely to have a successful decannulation at first attempt (P = 0.04). The overall probability of successful decannulation was 88.2% at a median of 50 postoperative hours. Forty-five percent of patients had a successful first decannulation.

CONCLUSIONS: Results indicated that an increased frequency of tracheostomy tube suctioning or a diagnosis of laryngeal collapse was negatively associated with successful decannulation. The use of alternative methods to reduce respiratory secretions and the development of specific suctioning protocols may be warranted. Patients with laryngeal collapse requiring temporary tracheostomy may have a poorer prognosis. Multiple statistical comparisons were made without correction, so these data should be considered preliminary, and future studies are required to confirm these risk factors.

PMID:40127420 | DOI:10.1111/vec.13453

J Clin Hypertens (Greenwich). 2025 Mar;27(3):e70038. doi: 10.1111/jch.70038.

ABSTRACT

We analyzed the usefulness of the carotid-femoral pulse wave velocity (cfPWV) as an integrated marker for hypertension (HTN)-mediated organ damage (HMOD) and cardiovascular (CV) risk in a cohort with repeated measurements. A total of 1031 patients, 80% of whom had HTN, underwent cfPWV determinations by SphygmoCor. An HMOD score was developed, including microalbuminuria, left ventricular hypertrophy (LVH), intima-media thickness (IMT), and carotid plaques. CV complications included atrial fibrillation (AF), heart failure (HF), stroke, ischemic heart disease (IHD), peripheral artery disease (PAD), or CV death. Survival curves based on Cox regression adjusted for age and systolic blood pressure (SBP), along with Harrell’s C statistic, were assessed. There was a trend toward higher cfPWV across categories of the HMOD score. Significant correlations were found among different AS parameters and blood pressure (BP) levels. Age and SBP were highly correlated with cfPWV. Among the 174 patients with at least two cfPWV measurements, there were 12 CV complications over a follow-up period of 2.4 years. The first and second cfPWV measurements, as well as the delta values, were significantly higher in those with CV complications, with most patients experiencing an increase in PWV during follow-up of ≥ 1 m/s. Survival curves significantly differed among tertiles of PWV and the delta, particularly for the second PWV determination, which also showed the highest predictive value (Harrell’s C = 0.86). The optimal threshold to predict complications was 9.10 m/s. Our findings suggest that cfPWV represents a promising integrated marker of HMOD, potentially serving as a surrogate endpoint for CV risk.

PMID:40127411 | DOI:10.1111/jch.70038

Blood Adv. 2025 Mar 24:bloodadvances.2024015594. doi: 10.1182/bloodadvances.2024015594. Online ahead of print.

ABSTRACT

Disease shift of chronic lymphocytic leukemia (CLL) to diffuse large B-cell lymphoma (DLBCL), so-called Richter transformation (RT), is a catastrophic clinical event. Rarely survival can outperform expectations and accurate prognostication for patients may affect therapeutic choices. To date, prognosis has relied on readily available factors such as TP53 disruption, prior CLL treatment status and performance score. Recently, shared clonality assessment by immunoglobulin heavy-chain variable (IgHV) region sequencing of the CLL and RT has been considered therapeutically relevant, but this is infrequently performed. We performed a systematic review of peer-reviewed manuscripts where outcomes in relation to clonal relatedness and lack thereof (clonally-related and -unrelated RT-DLBCL) were examined. Fifteen manuscripts which included 336 patients were found, of which six compared survival outcomes between the two groups in a statistically meaningful way. Two analyses showed no difference in survival outcomes with four studies reporting a significantly poorer prognosis with clonally-related RT-DLBCL. In two of these studies the baseline characteristics of clonally-related and -unrelated groups were compared and the clonally-related cases were enriched for underlying CLL which was TP53 disrupted, IgHV unmutated, more heavily pretreated and exhibiting stereotyped B-cell receptor VH CDR3, as well as RT-DLBCL which was MYD88wt. We demonstrate that although clonal relatedness of the underlying CLL confers a poorer survival, this is not demonstrated in any study to be independent of other well-described clinical and genomic variables known to influence outcome in RT-DLBCL. Further independent validation of this prognostic factor is required to help guide universal adoption into clinical practice.

PMID:40127387 | DOI:10.1182/bloodadvances.2024015594

JCO Glob Oncol. 2025 Mar;11:e2400504. doi: 10.1200/GO-24-00504. Epub 2025 Mar 24.

ABSTRACT

PURPOSE: Optimal survival outcomes of prostate cancer are best achieved through high-quality care for curable disease. In Nigeria, various barriers may impede the curative treatment of prostate cancer, yet their impact on care and patient outcomes remains anecdotal. This study assessed treatment quality, survival outcomes, and interhospital differences of these metrics among patients with clinically localized prostate cancer in Nigeria.

METHODS: A retrospective study of patients with clinical stage T1-T3a, M0 prostate cancer at three tertiary hospitals in Nigeria over a 3-year period was conducted. Data on hospital sites, sociodemographics, clinicopathologic characteristics, quality metrics, imaging used, treatment, and survival status were collected. The primary end point was time from diagnosis to first treatment. Secondary end points were time from presentation to diagnosis, other prostate cancer quality metrics, all-cause survival, and interhospital differences in these metrics. Quality of diagnostics, treatments, and other outcomes were described and compared using Cox regression.

RESULTS: This study included 110 patients with a median age of 67 years. Most (n = 66, 61%) had high-risk disease. The median time from tertiary hospital presentation to diagnosis was 31 days. Median time from diagnosis to first treatment of any type was 68 days, with radical radiotherapy was 117 days, and with radical prostatectomy was 104 days. Eighteen percent (n = 20) had guideline-concordant imaging for tumor staging, 67 patients (61%) received any treatment or active surveillance, and retention in care was 42%. Three-year all-cause survival was 41%. There was a significant difference in most quality metrics including guideline-concordant imaging and treatment across the hospital sites.

CONCLUSION: Time to treatment was delayed beyond international benchmarks; quality of staging, treatment, and care process were suboptimal; and survival was poor amid geographical disparities in care.

PMID:40127382 | DOI:10.1200/GO-24-00504

JCO Glob Oncol. 2025 Mar;11:e2400408. doi: 10.1200/GO-24-00408. Epub 2025 Mar 24.

ABSTRACT

PURPOSE: The utilization of complementary medicine (CM) in patients with cancer brings substantial challenges to optimal cancer care by posing a risk of side effects and drug interaction, and might delay cancer care delivery. We aimed to characterize the patterns and predictors of CM utilization in patients with breast cancer (BC) and patients with colorectal cancer (CRC), and the impact on presentation and diagnosis interval.

METHODS: We interviewed patients with BC and patients with CRC using a semistructured questionnaire to gather sociodemographic, clinical, presentation and diagnosis interval, and CM utilization data. The domains of CM used were categorized according to the classification of the National Institutes of Health/National Center for Complementary and Integrative Health.

RESULTS: One hundred forty-two patients with BC and 227 patients with CRC (N = 369) were included. The prevalence of CM utilization was 69.9%, with biologically based therapies being the most commonly used type. Younger age, higher educational attainment, and a greater number of health facility visits before diagnosis were significantly associated with higher odds of CM utilization (odds ratio [OR], 2.05 [95% CI, 1.19 to 3.54]; P = .010; OR, 1.07 [95% CI, 1.02 to 1.11]; P = .007, respectively). The diagnosis interval was significantly longer in patients who used CM compared to nonusers (incidence rate ratio [IRR], 2.74 [95% CI, 1.77 to 4.26]; P < .001). A greater number of CM modalities used were significantly associated with longer presentation and diagnosis intervals (IRR, 1.68 [95% CI, 1.06 to 2.66]; P = .027; IRR, 1.62 [95% CI, 1.04 to 2.52]; P = .033, respectively).

CONCLUSION: A significant portion of the local patients with BC and patients with CRC used CM. CM utilization was associated with age, education, number of health facility visits, and prolonged diagnosis interval. These findings underscore the need for CM disclosure among patients for better patient education and monitoring.

PMID:40127381 | DOI:10.1200/GO-24-00408

PLoS One. 2025 Mar 24;20(3):e0314714. doi: 10.1371/journal.pone.0314714. eCollection 2025.

ABSTRACT

The experiment evaluated a method for statistically assessing the accuracy of technologies that measure intramuscular fat percentage (IMF%), enabling referencing against accreditation accuracy thresholds. To compare this method to the existing rules-based industry standard we simulated data for 4 separate devices that predicted IMF% across a range between 0.5-9.5% for sheep meat. These devices were simulated to reflect increasingly inaccurate predictions, and the two methods for statistically assessing accuracy were then applied. We found that for the technology which only just meets the accreditation accuracy standards, as few as 25 samples were required within each quarter of the IMF% range to achieve 80% likelihood of passing accreditation. In contrast, using the rules based approach at least 200 samples were required within each quarter of the IMF% range, and this increased the likelihood of passing to only 50%. This method has been developed into an on-line analysis App, which commercial users can freely access to test the accuracy of their technologies.

PMID:40127377 | DOI:10.1371/journal.pone.0314714

Vasc Endovascular Surg. 2025 Mar 24:15385744251330017. doi: 10.1177/15385744251330017. Online ahead of print.

ABSTRACT

ObjectiveThe purpose of this study is to investigate the impact of social determinants of health on access to high volume centers and clinical outcomes in fenestrated abdominal aortic endografting. Further, the effect of center volume in fenestrated endografting on outcomes will be sought as this is ill defined. The data herein have the potential to affect referral patterns and locations of complex fenestrated aortic aneurysm care. If lower volume centers achieve equivalent outcomes to higher volume centers, then limiting access to a small number of centers may not be justified.MethodsVascular Quality Initiative (VQI) was utilized as the data source. Four adverse outcomes categories were investigated : (1) Lack of follow up data in the VQI database at 1 year postoperatively; (2) Thirty day operative mortality; (3) Composite perioperative adverse event outcome; and (4) Twelve month mortality. Social determinants of health exposure variables included rural status, non-metropolitan living area, highest and lowest decile and quintile area deprivation index, insurance status, and non-home living status. Designated categories were created for patients operated on in centers within the top 25% of case volume, centers in the bottom 25% of case volume, and in centers with less than 10 total fenestrated endograft cases. Univariable analyses were performed with Chi-squared testing for categorical variables and t test for comparison of means. Multivariable binary logistic regression was performed to identify risks for the composite adverse perioperative event.ResultsThere was no statistically significant association with the composite adverse perioperative event category, 30-day mortality or 12-month mortality for any of the social determinants of health or center volume categories. Patients who live in rural areas (P = .029) and patients with Military/VA insurance (P < .001) were significantly more likely to be lost to follow up at their index VQI center at 1 year. When accounting for all standard co-morbidities, none of the following variables had any significant association with the composite adverse perioperative event on multivariable analysis: absolute center volume as an ordinal variable (P = .985); procedure at a bottom 25^th percentile volume center (P = .214); procedure at a center with less than 10 total fenestrated cases in the database (P = .521); rural home status (P = .622); remote from metropolitan home status (P = .619); highest 10% ADI (P = .903); highest 20% ADI (P = .219); Lowest 10% of ADI (P = .397). The variables that had a statistically significant multivariable association with the composite adverse event were 3 or 4 visceral vessels stented vs 2 vessels (P < .001), baseline renal insufficiency (P < .001), female sex (P < .001), ESRD on dialysis (P = .002), and history of coronary revasculizaiton (P = .047). There was noted to be a statistically significant (P < .01) increase in 30 day mortality, composite adverse perioperative event, and 12 month mortality in moving from 2 to 3 to 4 fenestrated stented vessels. However, amongst patients who were treated with 3 and 4 vessel fenestrated stenting, patients treated at bottom 25^th percentile centers and centers with less than 10 total cases did not experience a higher rate of composite adverse perioperative event, 30 day mortality, or 12 month mortality relative to top 25% volume centers indicating safety of these procedures in lower volume centers.ConclusionsSocial determinants of health and center volume do not impact outcomes in fenestrated visceral segment aortic endograft procedures performed at centers participating in the Vascular Quality Initiative. There is progressive morbidity and mortality in moving from 2 to 3 to 4 visceral stents and fenestrations, however lower volume centers within VQI achieve equivalent outcomes to high volume centers in performing 3 and 4 vessel visceral fenestrated stent cases. Female sex, ESRD, prior coronary revascularization, and baseline renal insufficiency portend an increased risk for perioperative morbidity for fenestrated visceral segment aortic endografting.

PMID:40127376 | DOI:10.1177/15385744251330017