Category: Statistics

Disabil Rehabil Assist Technol. 2026 Jul 22:1-12. doi: 10.1080/17483107.2026.2704991. Online ahead of print.

ABSTRACT

AIM: Globally, access to menstrual cycle and hygiene information is limited, especially for women who are largely hearing impaired. Interactive games offer a promising approach as they increase knowledge about menstrual health. This study was conducted to determine the effect of an interactive game played with women of reproductive age with hearing disabilities on their perception of the menstrual cycle and hygiene.

METHOD: This quasi-experimental pre-test-post-test study was conducted between May 30 and August 31, 2025, with 82 women with hearing disabilities (40 control, 42 intervention). In the intervention group, the interactive game was played once, and the post-test was administered four weeks later. No intervention was applied to the control group. Data were collected using a questionnaire including demographic information and sections on menstrual cycle and hygiene perception. Analyses were performed using the Independent Sample T-Test, ANOVA, Paired T-Test, and Mixed ANOVA.

FINDINGS: The mean post-test scores of menstrual cycle and hygiene perceptions were statistically significantly higher in the intervention group compared to the control group (F: 126.197, p < 0.001, ηp²: 0.612). It was also determined that all women in the intervention group (100%) were satisfied with the interactive game.

CONCLUSION: This study found that the interactive game had a significant effect on the menstrual cycle and hygiene perception of women with hearing disabilities. Therefore, it is recommended that health professionals use the interactive game-based training model when providing menstrual cycle education and counselling, to support the knowledge levels of women with hearing disabilities.

PMID:42485092 | DOI:10.1080/17483107.2026.2704991

JAMA Netw Open. 2026 Jul 1;9(7):e2622227. doi: 10.1001/jamanetworkopen.2026.22227.

ABSTRACT

IMPORTANCE: Extant diagnostic and screening tools struggle to accommodate the diverse features of autism spectrum disorder (ASD) while balancing psychometric properties with respondent burden. Bifactor multidimensional item response theory (MIRT)-based computerized adaptive testing (CAT) can increase accuracy and accessibility of diagnostic assessments.

OBJECTIVE: To develop, calibrate, and validate the CAT-Autism tool for children and adolescents.

DESIGN, SETTING, AND PARTICIPANTS: This diagnostic study used National Institute of Mental Health Data Archive data available February 2024 from neurodevelopmental studies including children and adolescents with item-level responses for measures relevant to domains related to autism phenotype features. Based on reported scores from clinical assessments or measures, individuals were grouped by diagnosis as neurotypical and ASD (all levels of severity). Data were analyzed from February 2024 to February 2026.

MAIN OUTCOMES AND MEASURES: Valid CAT-based estimates in 10 subdomains (restricted to those in sample completing 200 items or more) compared with full item-bank scores; predictive performance was evaluated in discrimination, calibration, and clinical utility analyses against clinician-assigned diagnostic status.

RESULTS: A total of 490 questions to parents and caregivers were considered for potential item bank inclusion. The final sample included 10 309 children and adolescents for calibration (mean [SD] age, 9.3 [6.4] years; 7716 male [74.9%]); 2055 children and adolescents diagnosed as neurotypical (19.9%) and 8254 with ASD (80.1%). Of 490 items, 424 fit the bifactor structure with loadings higher than 0.3 on the primary dimension (ASD). Correlation between observed and estimated item-category proportions was r = 0.98, indicating exceptional fit of the model to the data. With age and sex included as external predictors, the CAT-Autism model yielded outstanding diagnostic predictive accuracy for differentiating neurotypical from ASD results with an AUC of 0.95 (95% CI, 0.92-0.98) for 1-to-5-year-olds and 0.94 (95% CI, 0.92-0.97) for 6-to-18-year-olds. Correlation between full item-bank scores and CAT scores (mean, 13 items; range, 6-45 items) was r = 0.95 for 1-to-5-year-olds and r = 0.94 for 6-to-18-year-olds.

CONCLUSIONS AND RELEVANCE: In this development and validation of our prediction model, CAT-Autism surpassed full item-bank scores with an average of 13 questions; these findings demonstrated that adaptively administering a small, statistically optimal subset of items can yield comparable (or better) results while reducing respondent burden. Next steps will be to test implementation parameters and confirm efficacy of CAT-Autism in clinical and community settings.

PMID:42485044 | DOI:10.1001/jamanetworkopen.2026.22227

JAMA Netw Open. 2026 Jul 1;9(7):e2624382. doi: 10.1001/jamanetworkopen.2026.24382.

ABSTRACT

IMPORTANCE: Concerns regarding weight changes during hormonal contraceptive use may influence health care-seeking behavior and contraceptive use patterns. While semaglutide use for weight management has increased substantially among women of reproductive age, the association of hormonal contraception use with semaglutide initiation remains unexplored.

OBJECTIVE: To investigate the association between hormonal contraception use and subsequent initiation of semaglutide therapy among females of reproductive age.

DESIGN, SETTING, AND PARTICIPANTS: This nested case-control study used Danish health registers to identify all females aged 12 to 49 years from January 1, 1996, to December 31, 2023. Eligible participants included females who filled their first prescription for semaglutide with no prior fill of prescriptions for drugs to lower glucose levels (semaglutide users). The date of first semaglutide prescription fill was the index date. Semaglutide users were each matched by birth year to 10 nonusers (nonuser controls) with no prior use of drugs to lower glucose levels. Data were analyzed from November 25, 2025, to May 18, 2026.

EXPOSURE: Hormonal contraception use was summarized based on the chronological order of all hormonal contraceptives for which individuals had filled prescriptions from 12 years of age (or study entry) until the index date.

MAIN OUTCOME AND MEASURE: First filled prescription of semaglutide of any dose.

RESULTS: A total of 22 694 cases and 229 640 matched controls (249 634 participants; median age, 37 [IQR, 30-44] years) were included in the analysis. All hormonal contraception utilization patterns were associated with semaglutide initiation compared with nonuser controls. Among utilization patterns involving a single contraceptive type, adjusted hazard ratios ranged from 1.42 (95% CI, 1.34-1.51) for combined oral tablets to 1.63 (95% CI, 1.46-1.82) for progestin-only intrauterine devices. For utilization patterns involving 2 or more contraceptive types, adjusted hazard ratios ranged from 1.64 (95% CI, 1.47-1.82) for combined oral tablets followed by progestin-only oral tablets to 2.11 (95% CI, 1.97-2.25) for other utilization patterns. Adjustment for body mass index attenuated but did not eliminate associations. Subgroup analyses by age, educational attainment, income, parity, immigrant status, and semaglutide type showed consistent associations across most utilization patterns.

CONCLUSIONS AND RELEVANCE: In this nationwide case-control study, use of hormonal contraception was associated with subsequent semaglutide initiation across all utilization patterns compared with controls, highlighting a need to examine factors associated with weight management in females.

PMID:42485041 | DOI:10.1001/jamanetworkopen.2026.24382

JAMA Netw Open. 2026 Jul 1;9(7):e2624391. doi: 10.1001/jamanetworkopen.2026.24391.

ABSTRACT

IMPORTANCE: Some drinking water contaminants, including disinfection byproducts, are known or suspected carcinogens with endocrine-disrupting properties. Few epidemiologic studies have evaluated associations with uterine cancer.

OBJECTIVE: To investigate prospective associations between multiple regulated contaminants in drinking water and the risk of uterine cancer.

DESIGN, SETTING, AND PARTICIPANTS: The California Teachers Study is a prospective cohort of female California educators. Participants who were cancer-free and had not undergone hysterectomy at enrollment (1995-1996) were followed up through December 31, 2020. Data were analyzed from November 2024 to October 2025.

EXPOSURES: The 15-year mean concentrations (1990-2005) of individual and total trihalomethanes (THMs) and haloacetic acids (HAAs), nitrate, arsenic, and uranium were calculated. The mixture effects of individual THMs, arsenic, uranium, and nitrate were also evaluated using quantile-based g-computation.

MAIN OUTCOMES AND MEASURES: Associations with incident uterine cancer overall, endometrioid tumors, and nonendometrioid tumors were analyzed categorically by tertile and continuously per log2 increase in water contaminant exposures, using Cox models adjusted for age, body mass index, and smoking status.

RESULTS: This study included 53 100 women (median [IQR] age, 50 [43-60] years) with enrollment addresses linked to a community water supply among women with residential duration at enrollment of 10 years or more. Higher levels of total THMs were associated with a higher risk of uterine cancer (hazard ratio [HR], 1.18 [95% CI, 1.02-1.38]; P for trend = .06) and endometrioid tumors specifically (HR, 1.23 [95% CI, 1.05-1.46]; P for trend = .01). Positive associations were found for the individual THM chloroform. Higher levels of the sum of 5 HAAs were associated with nonendometrioid tumors (HR, 1.86 [95% CI, 1.06-3.25]; P for trend = .01), with similar associations for the HAA monochloroacetic acid. No associations were observed with nitrate, arsenic, or uranium levels. Associations per IQR increase in the drinking water contaminant mixture composed of individual THMs, nitrate, arsenic, and uranium were 1.21 (95% CI, 0.96-1.53) and 1.34 (95% CI, 1.04-1.74) for uterine and endometrioid histotypes, respectively. The THMs chloroform and dibromochloromethane were the major contributors.

CONCLUSIONS AND RELEVANCE: In this cohort study of female California educators, associations between drinking water THMs and uterine cancer overall and with endometrioid tumors specifically were consistent with findings from the only prior study, conducted in the midwestern US. Further investigation of drinking water contaminants as modifiable risk factors for this common gynecologic cancer is warranted.

PMID:42485040 | DOI:10.1001/jamanetworkopen.2026.24391

JAMA Netw Open. 2026 Jul 1;9(7):e2624553. doi: 10.1001/jamanetworkopen.2026.24553.

ABSTRACT

IMPORTANCE: The number of older adults living with frailty who undergo surgery is rapidly increasing worldwide. Life-space mobility (LSM) can capture physical and social dimensions of recovery and has been linked to functional decline and reduced quality of life.

OBJECTIVE: To examine postoperative recovery using LSM among older adults living with frailty and to identify factors associated with restricted mobility and readmission.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study within the larger Functional Improvement Trajectories After Surgery study used a convergent mixed-methods exploratory design. Seventeen hospitals across Canada included older adults aged 65 years or older with a clinical frailty score (CFS) of 3 or more who underwent major elective noncardiac surgery from March 2021 to June 2023. Data were analyzed from September to October 2025.

EXPOSURE: Elective noncardiac surgery among older adults.

MAIN OUTCOMES AND MEASURES: LSM (range 0-120, with higher scores indicating more mobility) was measured at 1 to 2 months and 6 months postoperatively, with retrospective presurgery LSM captured at 1 to 2 months. Multivariable linear mixed-effects models and multivariable mixed-effects logistic regression were used to identify factors associated with LSM trajectories, restricted mobility (ie, LSM < 60), and hospital readmission.

RESULTS: This study included 204 participants (mean [SD] age, 72.8 [5.6] years; 108 males [53%]). The mean (SD) LSM was 65.1 (26.7) presurgery, 56.6 (26.7) at 2 months postsurgery, and 64.9 (25.9) at 6 months postsurgery. Eighty participants (39.2%) had restricted mobility presurgery, 114 (56.4%) at 2 months postsurgery, and 84 (41.2%) at 6 months postsurgery. Restricted mobility was associated with being a woman (odds ratio [OR], 4.72; 95% CI, 2.27-9.84), greater frailty (OR, 10.42; 95% CI, 3.56-30.49), and concurrent need for support from formal or informal caregivers (OR, 5.43; 95% CI, 2.72-10.86). Elevated-risk surgery was associated with hospital readmission at 6 months (OR, 3.18; 95% CI, 1.48-7.25).

CONCLUSIONS AND RELEVANCE: In this nested cohort study, mean LSM recovered by 6 months postsurgery, but 41% of older adults still had restricted mobility. Being a woman, having greater frailty, and needing support from caregivers were associated with poor recovery. Integrating life-space assessments into individualized perioperative care planning may enhance evaluation of functional recovery, inform shared decision-making, and guide support strategies.

PMID:42485039 | DOI:10.1001/jamanetworkopen.2026.24553

JAMA Netw Open. 2026 Jul 1;9(7):e2624561. doi: 10.1001/jamanetworkopen.2026.24561.

ABSTRACT

IMPORTANCE: Despite the increasing prevalence of autism spectrum disorder (ASD) in the US, underlying temporal trends in newly recorded diagnoses remain poorly understood.

OBJECTIVE: To evaluate age- and sex-specific incidence trends of ASD from 2016 to 2024 and quantify the temporal patterns before and after the COVID-19 pandemic and diagnostic substitution.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used electronic health record data from a large US health care system. Analyses were conducted from October to December, 2025. The study population included 171 134 participants (stratified as children [0-9] years, adolescents [10-18] years, and adults [≥19] years) who maintained continuous engagement with the health care system, defined as having at least 1 clinical encounter annually from 2016 to 2024.

MAIN OUTCOMES AND MEASURES: The primary outcome was the annual incidence of newly recorded diagnoses of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes F84.0 and F84.5. Temporal trends were analyzed using joinpoint regression to calculate annual percentage changes (APCs) and identify significant inflection points.

RESULTS: Among 171 134 participants (mean [SD] age, 26.78 [16.38], 63.8% female), females received autism diagnoses a mean (SD) of 3.4 years later than males (age at diagnosis, 15.7 years for female individuals vs 12.3 years for male individuals; P < .001). Male autism incidence remained stable or declined 2016 to 2024; female incidence increased significantly post-2020 (APC, 19.0%; 95% CI, 12.1% to 33.4%). In the pediatric cohort, decreasing annual incidence among males (APC, -2.0%; 95% CI, -3.7% to -0.3%; to APC, -2.0%, 95% CI, -3.7% to -0.3%) alongside increasing incidence for females since 2020 (APC, 17.4; 95% CI, 9.0% to 45.3%). In adolescent males, incidence declined from 2016 to 2018 (APC, -29.6%; 95% CI, -48.9% to -1.2%), and stabilized from 2018 to 2024. In adolescent females, autism incidence increased significantly between 2020 and 2024 (APC, 22.3%; 95% CI, 6.1% to 62.8%). In adult males, autism incidence showed a downward trend in the 2016 to 2024 period, while in adult females, the APC from 2016 to 2024 was positive, but the finding was not statistically significant (APC, 8.0%; 95% CI, -0.9% to 20.0%).

CONCLUSIONS AND RELEVANCE: In this cohort study, ASD diagnoses increased disproportionately among females after 2020 while remaining stable or declining among males. These patterns suggested that increasing ASD prevalence reflected improved identification of historically underrecognized presentations rather than a uniform population-level increase. These findings highlight the need for screening strategies that address sex-specific presentations.

PMID:42485038 | DOI:10.1001/jamanetworkopen.2026.24561

Curr Protoc. 2026 Jul;6(7):e70412. doi: 10.1002/cpz1.70412.

ABSTRACT

This unit provides information to aid in the selection and proper use of a laboratory balance. Laboratory balances are used for measuring the mass of an object and come in two main types: mechanical and electronic. Electronic balances generally come with a computer interface to facilitate the collection, storage, and manipulation of the data. In addition to weighing objects, electronic balances also perform a range of computations, including counting objects, measuring density, statistics, and pipet volume calibration. Balances vary widely in terms of their capacity (how heavy an object they can accurately weigh), precision, accuracy, repeatability, and robustness. Understanding the various characteristics of a laboratory balance is necessary to be sure that the balance is well suited for your particular scientific or industrial needs. This unit also discusses the proper use and maintenance of a laboratory balance. In general, laboratory balances are relatively easy to use and require little maintenance. © 2026 Wiley Periodicals LLC. Basic Protocol 1: Measuring mass using a top-loading balance Basic Protocol 2: Measuring mass using an analytical balance.

PMID:42485036 | DOI:10.1002/cpz1.70412

JAMA Psychiatry. 2026 Jul 22. doi: 10.1001/jamapsychiatry.2025.3698. Online ahead of print.

ABSTRACT

IMPORTANCE: No recent study has examined whether method of abortion is associated with psychotropic medication use, an indicator of mild mental health problems.

OBJECTIVE: To examine whether medication or procedural abortions were associated with increased risk of psychotropic medication use.

DESIGN, SETTING, AND PARTICIPANTS: This population-based Danish registry cohort study followed the psychotropic medication redemptions of females aged 12 to 38 years having elective, first first-trimester abortions between January 1, 2000, and December 31, 2018, from 1 year before their medication or procedural abortion until their first psychotropic medication prescription claim (redemption), December 31, 2018, emigration from Denmark, or death, whichever came first. Analyses were conducted between June 2023 and June 2025.

EXPOSURE: First abortion method (first medication abortion or first procedural abortion).

MAIN OUTCOMES AND MEASURES: Any first psychotropic medication prescription redemption, first antidepressant medication redemption, and first antianxiety medication redemption during the study period. Incidence rate ratios (IRRs) were calculated in adjusted regression models. Bonferroni-corrected P values were used to account for multiple tests.

RESULTS: Of 67 390 females included in this study (mean [SD] age, 21.8 [4.6] years), 4575 (6.8%) had a prior psychiatric diagnosis; 33 793 had a record of a first medication abortion, 33 597 had a record of a first procedural abortion, and 19 979 (29.6%) had a first psychotropic medication redemption during the study period. In fully adjusted models, using the conventional P value level of .05, compared with the year before a medication or procedural abortion, there were small increased risks of any first psychotropic medication redemption in the first year after medication abortion (IRR, 1.10; 95% CI, 1.02-1.19; P = .01) and procedural abortion (IRR, 1.09; 95% CI, 1.01-1.16; P = .02). There were no statistically significant associations in 1 to 2 years and 2 to 5 years after abortion relative to the year before an abortion for each abortion method. There were decreased risks of any first psychotropic medication redemption more than 5 years after medication abortion (IRR, 0.85; 95% CI, 0.78-0.91; P < .001) and more than 5 years after procedural abortion (IRR, 0.83; 95% CI, 0.78-0.88; P < .001). Using the Bonferroni-corrected P value of .002, the small increased risks of psychotropic medication redemption observed in the first year after an abortion no longer met the criteria for statistical significance, while the lower risks for more than 5 years after abortion continued to meet the criteria for statistical significance.

CONCLUSIONS AND RELEVANCE: In this Danish population-based cohort study, compared with the year before a medication or procedural abortion, small increased risks of psychotropic medication prescription redemptions were observed during the first year after abortion, and decreases in risk of psychotropic medication prescription redemptions were observed more than 5 years after abortion when using conventional levels of statistical significance. The small increased risks observed in the first year after an abortion no longer met the criteria for statistical significance following Bonferroni adjustment for multiple statistical tests. Additional research may be needed to replicate and understand these results.

PMID:42485031 | DOI:10.1001/jamapsychiatry.2025.3698

Mem Cognit. 2026 Jul 22. doi: 10.3758/s13421-026-01919-w. Online ahead of print.

ABSTRACT

This study investigated how aging affects the perceptual span, the spatial limit of visual processing, in traditional Chinese with the gaze-contingent moving-window paradigm. The viewing was either unrestricted or involved varying window sizes where a constant one-character left window was paired with a manipulated right window that revealed two, three, or four upcoming characters. Older readers had slower reading speed, although they did not differ from young readers in gaze durations. In addition, while reading performance was statistically comparable between the four-character window and full-line conditions in both groups, the two groups differed in their reliance on near- and far-foveal information. In particular, there was a larger boost in reading performance for the older readers than for the young readers when the window increased from two to three upcoming characters. In contrast, the young readers exhibited a larger gain than the older readers when the window included the fourth upcoming characters. Together, older Chinese readers appear to be more sensitive to information within three upcoming characters, but were less so to further ones. These findings highlight the interplay between script characteristics and cognitive aging in reading and constrain the range of parameters in developmentally valid computational models of eye-movement control in reading.

PMID:42484992 | DOI:10.3758/s13421-026-01919-w

Spine Deform. 2026 Jul 22. doi: 10.1007/s43390-026-01513-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Lumbar spondylolysis is a common cause of pediatric low back pain. Although CT is highly sensitive, MRI is often used first to avoid radiation. Pars defects may be missed on MRI, potentially delaying care. The frequency and clinical impact of these missed diagnoses remain poorly defined. The purpose of this study is to assess how often spondylolysis is missed on MRI reports.

METHODS: A single-institution retrospective review was performed of pediatric patients with lumbar spondylolysis treated between 2021 and 2024. All patients underwent MRI for evaluation of low back pain. MRI reports were reviewed to determine whether spondylolysis was identified. STIR sequences were examined for pars hyperintensity. Demographic variables, radiologist fellowship training, and time from symptom onset to orthopaedic treatment were recorded. Groups with and without missed MRI diagnoses were compared using independent t tests and Chi-square analyses.

RESULTS: Among 102 patients with spondylolysis, 21 (20.6%) had MRI reports that failed to identify the pars defect. Among missed cases, 13/21 (61.9%) demonstrated hyperintense pars signal on STIR sequences that was not reported. Patients with missed MRI diagnoses had significantly longer delays to treatment initiation compared with those correctly diagnosed (10.6 ± 7.6 vs 6.7 ± 6.4 months from symptom onset; p = 0.042). Fellowship-trained musculoskeletal or neuroradiologists identified spondylolysis in 82.3% of cases compared with 64.7% among non-fellowship-trained radiologists, though this difference was not statistically significant (p = 0.100).

CONCLUSION: Lumbar spondylolysis is missed in ~ 20% of MRI reports, of which the majority demonstrate pathognomonic edema on the STIR sequence. This was associated with significant delays in treatment. There should be a high index of suspicion in pediatric patients with clinical histories suggestive of spondylolysis, even if MRI reports are negative.

PMID:42484990 | DOI:10.1007/s43390-026-01513-9