Tag: statistics

J Med Internet Res. 2025 Jun 25;27:e71211. doi: 10.2196/71211.

ABSTRACT

BACKGROUND: Colorectal cancer (CRC) screening rates remain disproportionately low among Hispanic and Latino populations compared to non-Hispanic White populations. While artificial intelligence (AI) shows promise in health care delivery, concerns exist that AI-based interventions may disadvantage non-English-speaking populations due to biases in development and deployment.

OBJECTIVE: This study aimed to evaluate the effectiveness of a multilingual AI care agent in engaging Spanish-speaking patients for CRC screening compared to that with English-speaking patients.

METHODS: This retrospective analysis examined an AI-powered outreach initiative at WellSpan Health in Pennsylvania and Maryland during September 2024. The study included 1878 patients (517 Spanish-speaking, 1361 English-speaking) eligible for CRC screening who lacked active web-based health profiles. A multilingual AI conversational agent conducted personalized telephone calls in the patient’s preferred language to provide education about CRC screening and facilitate fecal immunochemical test (FIT) kit requests. The primary outcome was the FIT test opt-in rate, with secondary outcomes including connect rates and call duration. Statistical analysis included descriptive statistics, bivariate comparisons, and multivariate logistic regression.

RESULTS: Spanish-speaking patients demonstrated significantly higher engagement across all measures than English-speaking patients with respect to FIT test opt-in rates (18.2% vs 7.1%, P<.001), connect rates (69.6% vs 53.0%, P<.001), and call duration (6.05 vs 4.03 minutes, P<.001). Demographically, Spanish-speaking patients were younger (mean age 57 vs 61 years, P<.001) and more likely to be female (49.1% vs 38.4%, P<.001). In multivariate analysis, Spanish language preference remained an independent predictor of FIT test opt-in (adjusted odds ratio 2.012, 95% CI 1.340-3.019; P<.001) after controlling for demographic factors and call duration.

CONCLUSIONS: AI-powered outreach achieved significantly higher engagement among Spanish-speaking patients, challenging the assumption that technological interventions inherently disadvantage non-English-speaking populations. The 2.6-fold higher FIT test opt-in rate among Spanish-speaking patients represents a notable departure from historical patterns of health care disparities. These findings suggest that language-concordant AI interactions may help address longstanding disparities in preventive care access. Study limitations include its single health care system setting, short duration, and lack of follow-up data on completed screenings. Future research should assess long-term adherence and whether higher engagement translates to improved clinical outcomes.

PMID:40561471 | DOI:10.2196/71211

Brief Bioinform. 2025 May 1;26(3):bbaf297. doi: 10.1093/bib/bbaf297.

ABSTRACT

Protein side-chain packing (PSCP), the problem of predicting side-chain conformations given a fixed backbone structure, has important implications in the modeling of structures and interactions. However, despite the groundbreaking progress in protein structure prediction pioneered by AlphaFold, the existing PSCP methods still rely on experimental inputs, and do not leverage AlphaFold-predicted backbone coordinates to enable PSCP at scale. Here, we perform a large-scale benchmarking of the predictive performance of various PSCP methods on public datasets from multiple rounds of the Critical Assessment of Structure Prediction challenges using a diverse set of evaluation metrics. Empirical results demonstrate that the PSCP methods perform well in packing the side-chains with experimental inputs, but they fail to generalize in repacking AlphaFold-generated structures. We additionally explore the effectiveness of leveraging the self-assessment confidence scores from AlphaFold by implementing a backbone confidence-aware integrative approach. While such a protocol often leads to performance improvement by attaining modest yet statistically significant accuracy gains over the AlphaFold baseline, it does not yield consistent and pronounced improvements. Our study highlights the recent advances and remaining challenges in PSCP in the post-AlphaFold era.

PMID:40561466 | DOI:10.1093/bib/bbaf297

Alcohol Alcohol. 2025 May 14;60(4):agaf034. doi: 10.1093/alcalc/agaf034.

ABSTRACT

BACKGROUND: Lithuania, a European country, has a history of high alcohol consumption per capita. To reduce harm, Lithuania has implemented the World Health Organization ‘best buys’ for alcohol control policies, notably two taxation policies in 2008 and 2017. Taxation may affect segments of the population differently; to explore this question, we investigated the effects on liver cirrhosis.

AIMS: To analyze the effect of taxation on liver cirrhosis hospitalizations and mortality across four age groups in Lithuania.

METHODS: Using a general additive mixed model, we tested taxation on monthly hospitalization and mortality rates between 2001 and 2022 (n = 264 months) across four age groups (young adults: 15-34, middle-aged adults: 35-54, older adults: 55-74, and seniors: 75+ years of age, respectively). We computed standardized hospitalizations and mortality rates (admissions and deaths per 100 000 people) based on summed counts of alcoholic liver disease and fibrosis and cirrhosis of the liver according to the International Classification of Diseases 10th Revision.

FINDINGS: Taxation was associated with the largest downward trend in liver cirrhosis mortality among middle-aged and older adults, equivalent to two fewer deaths per 100 000 individuals. In older adults and seniors, taxation was associated with downward trends in hospitalizations, but effects were less robust.

CONCLUSION: Taxation may lead to decreases in liver cirrhosis mortality across all age groups but appears to be less consistently impactful for hospitalizations. Younger and middle-aged individuals may experience increased hospitalizations. Taxation appears to impact subsections of the population differently.

PMID:40561461 | DOI:10.1093/alcalc/agaf034

Plast Reconstr Surg. 2025 Jul 1;156(1):147e-156e. doi: 10.1097/PRS.0000000000011864. Epub 2024 Nov 11.

ABSTRACT

BACKGROUND: Assessing the methodologic and reporting quality of randomized controlled trials (RCTs) in plastic surgery is crucial in maintaining the standards of evidence-based practice. Previous evaluations underscored deficiencies in reporting and methodology, prompting a call for improvement. This review scrutinizes the methodologic and reporting standards of RCTs published in Plastic and Reconstructive Surgery (PRS) from 2013 to 2022.

METHODS: The authors conducted a review of RCTs published in PRS from 2013 to 2022. Methodologic quality of RCTs was assessed using the Jadad score and a modified Cochrane risk-of-bias tool. Additional relevant data were gathered to assess reporting quality, ascertain predictors of methodologic quality, and identify temporal trends.

RESULTS: A total of 146 RCTs were reviewed. The mean Jadad score was 2.96 ± 1.21, and the average risk-of-bias score was 5.65 ± 2.14, indicating moderate methodologic quality. Trials assessing surgical techniques or medical devices were associated with poorer methodologic quality compared with drug interventions. Breast trials showed one of the highest methodologic scores, but this declined over time. Overall reporting standards were suboptimal, with nearly half of the trials failing to explicitly state primary outcomes or analysis sets. No significant temporal trends were observed.

CONCLUSIONS: RCTs published in PRS between 2013 and 2022 exhibited moderate methodologic quality. The authors’ findings underscore the importance of transparent reporting and methodologic rigor in advancing evidence-based practices in plastic surgery. By adhering to established methodologic standards and reporting guidelines, researchers can enhance the reliability and impact of their studies.

PMID:40561451 | DOI:10.1097/PRS.0000000000011864

Plast Reconstr Surg. 2025 Jul 1;156(1):11e-24e. doi: 10.1097/PRS.0000000000011861. Epub 2024 Nov 18.

ABSTRACT

BACKGROUND: In small-breasted individuals with gender dysphoria (GD), the concentric periareolar approach is typically the preferred method for mastectomy. However, this method carries a notable risk of hypertrophic scars and changes in areolar dimensions. In this article, the authors introduce the periareolar interlocking suture (PIS) as a new scar-minimizing procedure with a low complication rate and high level of patient satisfaction.

METHODS: The corresponding author (A.W.) performed a concentric periareolar mastectomy combined with PIS and waterjet-assisted liposuction in patients with small breasts (A to B cup) and good skin quality and elasticity. Outcome measures included complication rates, patient satisfaction (based on the BODY-Q Chest and Nipples scales and scar appearance), nipple sensitivity, and rate of surgical corrections.

RESULTS: Between April of 2017 and December of 2023, the corresponding author (A.W.) conducted 2312 mastectomies in 1156 individuals with GD, with 410 breasts treated using concentric periareolar mastectomy combined with PIS and waterjet-assisted liposuction. The mean patient age was 23 years; the mean hospital stay was 4 days; and the mean operative time was 96.1 minutes. The overall complication rate was 7.8%, with acute hematomas occurring in 4.6% of cases. Secondary revisions were necessary in 2.2% of cases. Patient satisfaction, measured using the BODY-Q scale, was statistically significant and very high.

CONCLUSIONS: Individuals with GD are well informed and increasingly demand aesthetically pleasing outcomes. Whenever feasible, procedures with minimal scarring are preferred. The technique presented here resulted in a high level of patient satisfaction, preserved nipple sensitivity, and a low rate of complications and secondary aesthetic corrections in a carefully selected cohort of patients with small breasts.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

PMID:40561441 | DOI:10.1097/PRS.0000000000011861

Otol Neurotol. 2025 Jun 12. doi: 10.1097/MAO.0000000000004583. Online ahead of print.

ABSTRACT

OBJECTIVES: To identify the clinical features of sensorineural tinnitus patients who achieved complete symptom resolution or “cure” after tinnitus retraining therapy (TRT) and to determine significant factors that influence tinnitus resolution duration after TRT.

METHODS: A retrospective analysis of sensorineural tinnitus patients who underwent TRT and achieved a cure between January 2017 and January 2022 was performed. Cure of tinnitus was defined as patients experiencing symptoms for less than 5 minutes of awareness per day. Clinical information, including demographics, tinnitus duration, audiometric results, and therapeutic response, was examined.

RESULTS: A total of 1,027 patients who achieved a cure for tinnitus were included, with more females (65.4%, n = 672) than males (35.6%, n = 355). The median age was 57 years (range, 12-92), with most having unilateral tinnitus (73.3%, n = 753). More than half had tinnitus with hearing loss (53.3%, n = 549), and the majority was under Jastreboff’s tinnitus category 2 (38.7%, n = 397). The median duration of tinnitus before consult was 12 months in range (range, 1-480), whereas the median duration before tinnitus resolution after TRT was 17 months (range, 1-96). In Jastreboff’s tinnitus categories, category 4 had the longest resolution time (median, 18 months) and category 1 the shortest (median, 15 months), but the difference was not statistically significant. A moderate correlation was observed between age and tinnitus resolution duration (Spearman correlation coefficient = 0.391, p < 0.05) and between tinnitus duration before consult and tinnitus resolution duration (Spearman correlation coefficient = 0.355, p < 0.05).

CONCLUSION: TRT seems to be a promising treatment option for patients with sensorineural tinnitus. The time to achieve this cure may range from a few months to years after TRT, indicating the heterogeneity of the mechanism and therapeutic response. The younger patients and the earlier management after the onset of tinnitus seem to be good prognostic factors for a shorter tinnitus cure time after TRT.

PMID:40561436 | DOI:10.1097/MAO.0000000000004583

Cell Transplant. 2025 Jan-Dec;34:9636897251349377. doi: 10.1177/09636897251349377. Epub 2025 Jun 25.

ABSTRACT

Obesity is a well-known risk factor for many diseases, but the impact of baseline body mass index (BMI) on the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains controversial. To elucidate the influence of pretransplant BMI on post-allo-HSCT outcomes including graft-versus-host disease (GVHD), overall survival (OS), relapse-free survival (RFS), and nonrelapse mortality (NRM), we conducted a retrospective study using registry data which comprised 1092 adult patients who underwent allo-HSCT between 2015 and 2023. Among the 1092 eligible patients (53.2% male), 56.5% were normal-weight; 24.8% were overweight and 9.1% were obese. Multivariable analyses revealed that compared with normal-weight patients, obese individuals had a higher risk of grade II-IV and III-IV acute GVHD (aGVHD), especially in the gastrointestinal system, with aHRs of 2.08 (95% CI, 1.47-2.94), 2.60 (95% CI, 1.52-4.44), and 3.71 (95% CI, 2.00-6.88), respectively. The probability of OS and RFS was significantly lower in overweight (P = 0.034, P = 0.015, respectively) and obese patients (P = 0.033, P = 0.024, respectively) as compared with normal-weight patients, with aHRs increasing by ~38% (aHR, 1.38; 95% CI, 1.03-1.86), ~40% (aHR, 1.40; 95% CI, 1.07-1.83), ~58% (aHR, 1.58; 95% CI, 1.04-2.40), and ~56% (aHR, 1.56; 95% CI, 1.06-2.29), respectively. Furthermore, the NRM of obese patients was statistically higher than normal-weight patients (P = 0.02, sHR, 2.19; 95% CI, 1.12-4.27). A subgroup analysis revealed that the adverse effects of obesity on OS, RFS, and NRM were primarily observed in the subgroup of patients aged < 40 years and patients with acute lymphoblastic leukemia. The increased risk of grade II-IV aGVHD due to obesity was observed across all subgroups. In conclusion, Obesity prior to allo-HSCT increases the risk of aGVHD and NRM, leading to poorer OS. These findings underscore the importance of closely monitoring high-risk patients and offering opportunities for early intervention.

PMID:40560651 | DOI:10.1177/09636897251349377

JAMA Cardiol. 2025 Jun 25. doi: 10.1001/jamacardio.2025.1865. Online ahead of print.

ABSTRACT

IMPORTANCE: In the original validation, the Predicting Risk of Cardiovascular Disease (CVD) Events (PREVENT) equations demonstrated good discrimination and calibration among racial and ethnic groups, but the model performance among Asian and Hispanic disaggregated subgroups has not been previously described.

OBJECTIVE: To assess the performance of the PREVENT equations by race and ethnicity, including disaggregated Asian and Hispanic subgroups.

DESIGN, SETTING, AND PARTICIPANTS: This was an electronic health record-based retrospective cohort study of primary care patients aged 30 to 79 years across Sutter Health, a large integrated health system in Northern California, from January 2010 to September 2023. Patients who had at least 2 primary care visits during the study period were eligible for the study (1 484 582). Those outside of the study age range, with prior CVD events in the washout period, missing key predictors, or having at least 1 predictor out of the allowed normal range for the American Heart Association’s PREVENT equations, were excluded, leaving a study population of 361 778.

EXPOSURE: Eligible patients had complete baseline data required for the PREVENT equations, including non-high-density lipoprotein cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, body mass index, estimated glomerular filtration rate (or creatinine), diabetes, and current smoking status, and were free from CVD at baseline.

MAIN OUTCOMES AND MEASURES: The primary outcomes were CVD events, identified using International Classification of Diseases, Ninth and Tenth Revisions, codes described in the PREVENT derivation.

RESULTS: Among 361 778 patients who met the inclusion criteria, mean (SD) age was 54.6 (12.2) years; 191 151 (53%) were female; and 81 424 (22%) were non-Hispanic Asian and 40 897 (11%) were Hispanic. Over a mean (SD) follow-up of 8.1 (3.2) years, there were 22 648 (6.3%) CVD events. The C statistic for total CVD was 0.83 (95% CI, 0.82-0.84) for the Asian population and 0.80 (95% CI, 0.79-0.81) for the Hispanic population. The calibration slopes were 0.84 (95% CI, 0.78-0.90) and 1.02 (95% CI, 0.94-1.10) for Asian and Hispanic patients, respectively. Within the Asian population, C statistics for total CVD among disaggregated Asian subgroups ranged from 0.79 (95% CI, 0.77-0.81) in Filipino patients to 0.85 (95% CI, 0.83-0.87) in Asian Indian patients. The calibration slope for total CVD was less than 1 for all Asian subgroups except Asian Indian. Among disaggregated Hispanic subgroups, the C statistics were similar and between 0.80 and 0.82 for total CVD, and the calibration slope for total CVD included 1 for all subgroups. There were small differences in the performance of atherosclerotic CVD and heart failure PREVENT equations among racial and ethnic groups and subgroups.

CONCLUSIONS AND RELEVANCE: The PREVENT equations appropriately predicted risk in contemporary diverse Asian and Hispanic subgroups with modest variation in performance across disaggregated subgroups.

PMID:40560603 | DOI:10.1001/jamacardio.2025.1865

JAMA Netw Open. 2025 Jun 2;8(6):e2517291. doi: 10.1001/jamanetworkopen.2025.17291.

ABSTRACT

IMPORTANCE: While epinephrine is commonly administered in children with out-of-hospital cardiac arrest (OHCA) via an intraosseous (IO) or intravenous (IV) route, the optimal route of epinephrine delivery is unclear.

OBJECTIVE: To evaluate the association between the route of epinephrine administration (IO or IV) and patient outcomes after pediatric OHCA.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of pediatric patients (aged <18 years) with nontraumatic OHCA treated by emergency medical services who received prehospital epinephrine either via an IO or IV route. Patients were included in the Resuscitation Outcomes Consortium Epidemiologic Registry, a prospective OHCA registry at 10 sites in the US and Canada from April 2011 to June 2015. Data analysis was performed from May 2024 to April 2025.

EXPOSURE: Epinephrine administration route: IO or IV route.

MAIN OUTCOMES AND MEASURES: The primary outcome was survival to hospital discharge. The secondary outcome was return of spontaneous circulation (ROSC) before hospital arrival. Propensity scores were calculated and inverse probability of treatment weighting (IPTW) was performed with stabilized weights to control imbalances in measured patient demographics, cardiac arrest characteristics, and bystander and prehospital interventions.

RESULTS: Of 739 eligible patients (median [IQR] age, 1 [0-11] years), 449 (60.8%) were male. Epinephrine was administered via an IO route for 535 (72.4%) and via an IV route for 204 (27.6%) patients. In the IPTW pseudopopulation (740 weighted cases), there was no significant difference in survival to hospital discharge (IO epinephrine: 28 of 528 patients [5.3%] vs IV epinephrine: 12 of 212 patients [5.7%]; risk ratio [RR], 0.92; 95% CI, 0.41-2.07) or prehospital ROSC (IO epinephrine: 76 of 528 patients [14.4%] vs IV epinephrine: 46 of 212 patients [21.7%]; RR, 0.66; 95% CI, 0.42-1.03) between the IO and IV epinephrine groups.

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study of pediatric patients with OHCA in the US and Canada, the route of epinephrine administration was not associated with survival to hospital discharge or prehospital ROSC. This may support the practice of administering epinephrine via IO or IV route.

PMID:40560587 | DOI:10.1001/jamanetworkopen.2025.17291

JAMA Netw Open. 2025 Jun 2;8(6):e2517402. doi: 10.1001/jamanetworkopen.2025.17402.

ABSTRACT

IMPORTANCE: SARS-CoV-2 continues to evolve, population immunity changes, and COVID-19 vaccine formulas have been updated, necessitating ongoing COVID-19 vaccine effectiveness (VE) monitoring.

OBJECTIVES: To evaluate the VE of 2023-2024 COVID-19 vaccines against COVID-19-associated emergency department (ED) and urgent care (UC) encounters, hospitalizations, and critical illness, including during XBB- and JN.1-predominant periods.

DESIGN, SETTING, AND PARTICIPANTS: This test-negative design VE case-control study was conducted using data from September 21, 2023, to August 22, 2024, from EDs, UC centers, and hospitals in 6 US health care systems. Eligible adults 18 years or older with COVID-19-like illness and molecular or antigen testing for SARS-CoV-2 were studied. Case patients were those with a positive molecular or antigen test result; control patients were those with a negative molecular test result.

EXPOSURE: Receipt of 2023-2024 (monovalent XBB.1.5) COVID-19 vaccination with products approved or authorized for use in the US.

MAIN OUTCOMES AND MEASURES: Main outcomes were COVID-19-associated ED and UC encounters, hospitalizations, and critical illness (admission to the intensive care unit or in-hospital death). VE was estimated comparing the odds of receipt of the 2023-2024 COVID-19 vaccine with no receipt among case and control patients.

RESULTS: Among 345 639 eligible ED and UC encounters in immunocompetent adults 18 years or older with COVID-19-like illness and available test results (median [IQR] age, 53 [34-71] years; 209 087 [60%] female), 37 096 (11%) had a positive SARS-CoV-2 test result. VE against COVID-19-associated ED and UC encounters was 24% (95% CI, 21%-26%) during 7 to 299 days after vaccination. Among 111 931 eligible hospitalizations in immunocompetent adults 18 years or older with COVID-19-like illness and available test results (median [IQR] age, 71 [58-81] years), 10 380 (9%) had a positive SARS-CoV-2 test result. During 7 to 299 days after vaccination, VE was 29% (95% CI, 25%-33%) against COVID-19-associated hospitalization and 48% (95% CI, 40%-55%) against COVID-19-associated critical illness. VE was highest 7 to 59 days after vaccination (VE against ED and UC encounters 49%; 95% CI, 46%-52%; hospitalization, 51%; 95% CI, 46%-56%; critical illness, 68%; 95% CI, 56%-76%) and then waned (VE 180-299 days after vaccination against ED and UC encounters, -7% [95% CI, -13% to -2%]; hospitalization, -4% [95% CI, -14% to 5%]; and critical illness, 16% [95% CI, -6 to 34%]).

CONCLUSIONS AND RELEVANCE: In this case-control study of VE, 2023-2024 COVID-19 vaccines were estimated to provide additional effectiveness against medically attended COVID-19, with the highest and most sustained estimates against critical illness. These results highlight the importance of receiving recommended COVID-19 vaccination for adults 18 years or older.

PMID:40560584 | DOI:10.1001/jamanetworkopen.2025.17402