Category: Statistics

Expert Rev Pharmacoecon Outcomes Res. 2026 Jun 16. doi: 10.1080/14737167.2026.2691188. Online ahead of print.

ABSTRACT

BACKGROUND: Minimal important difference (MID) thresholds distinguish noticeable from meaningful health gains, yet reimbursement decisions often fund high-cost therapies with marginal benefit. Clarifying meaningful patient-reported improvement is important for interpreting evidence and allocating resources.

RESEARCH DESIGN AND METHODS: We reviewed how MID concepts are defined and used across outcomes research, clinical trials and health technology assessment (HTA), and estimated Croatia’s first EuroQol Visual Analogue Scale (EQ-VAS) MID in a representative sample (n = 401), examining whether thresholds vary by baseline health and a €100/month co-payment. Respondents stated the smallest noticeable and meaningful EQ-VAS improvement for a free intervention and the same intervention requiring a co-payment for one year. Analyses combined descriptive statistics, rank-based tests and multivariable regression.

RESULTS: Mean MID was 7.9 EQ-VAS points when treatment was free and increased to 8.7 with co-payment, with higher thresholds among those with poorer baseline health. The co-payment scenario is interpreted cautiously as reflecting a worthwhile-improvement threshold rather than a pure intrinsic MID.

CONCLUSIONS: Elicited thresholds were context-sensitive; however, the co-payment scenario captures what respondents considered worth paying for, arguing against universal MID cutoffs. In HTA, MIDs should serve as patient-centered interpretive benchmarks complementing cost-effectiveness evidence and considerations such as equity and societal preferences.

PMID:42299727 | DOI:10.1080/14737167.2026.2691188

Monaldi Arch Chest Dis. 2026 Jun 15. doi: 10.4081/monaldi.2026.3852. Online ahead of print.

ABSTRACT

Coronary artery disease (CAD) continues to be a major global health burden, and its effective management depends on optimal treatment adherence, realistic illness perception, and adequate acceptance of illness. However, evidence examining these psychosocial and behavioral factors remains limited. This study assessed treatment adherence, illness perception, and acceptance of the illness and explored their associations among CAD patients. A descriptive correlational cross-sectional study was conducted among 250 CAD patients selected through convenience sampling. Data were collected using standardized tools: the Morisky Medication Adherence Scale (MMAS-8), the Brief Illness Perception Questionnaire (IPQ-B), and the Acceptance of Illness Scale (AIS) with the relative ranges (MMAS-8: 0-8, IPQ-B: 0-80, AIS: 8-40). Descriptive statistics (mean, standard deviation, frequency, and percentage) were used to summarize the data, Pearson’s correlation was applied to examine relationships among variables, and the chi-square test was used to assess associations between outcome variables and selected sociodemographic factors. Treatment adherence was predominantly low (59%), with a mean score of 5.69±1.58. Illness perception scores indicated that most participants (82%) experienced a high perceived illness threat (mean = 54.93±8.78). Acceptance of illness was moderate in 57.6% of participants, with a mean score of 25.09±6.07. A weak but statistically significant positive correlation was observed between acceptance of illness and treatment adherence (r=0.245, p<0.001). Illness perception showed no significant relationship with other variables. Significant associations were identified between treatment adherence and socioeconomic status (χ²=19.97, p=0.003); acceptance of illness and educational status (p<0.001), physical activity (χ²=12.98, p=0.011), and past medical history (χ² =29.51, p=0.003); and illness perception with socioeconomic status (χ²=16.18, p=0.013) and area of residence (χ²=16.88, p=0.002). CAD patients showed low treatment adherence, high perceived illness threat, and moderate illness acceptance. Strengthening patient education, addressing illness perceptions, and enhancing psychological support may improve adherence and long-term disease management.

PMID:42299708 | DOI:10.4081/monaldi.2026.3852

Prim Health Care Res Dev. 2026 Jun 16;27:e64. doi: 10.1017/S1463423626101297.

ABSTRACT

AIM: To determine the frequency and nature of referrals for children with acute or chronic otorrhoea from primary care to secondary care ENT services in the UK.

BACKGROUND: Middle ear infections in children are common; if the ear drum bursts discharge leaks out (otorrhoea). This causes hearing loss during a critical developmental period. Managing these children in an appropriate time frame to prevent disease repercussions is vital. There is currently no evidence demonstrating referral patterns and management strategies across primary and secondary care services.

METHOD: Children with otorrhoea were identified amongst a cohort of 2,100 paediatric ENT (age 0-16 years) referrals from primary care at two secondary care hospital trusts in England in 2023. Chi-squared statistical analysis was performed to compare referral urgency for those with or without hearing loss.

FINDINGS: Of the paediatric ENT referrals, 228 (10.9%) had otorrhoea (mean age: 6.4 years, female: n = 110). The most frequent symptom duration at time of referral was >3-6 months (21.1%). Children with hearing loss were not referred more urgently compared to those without reported hearing loss (28.1% vs. 29.4%, p = 0.832). Antibiotic use in primary care was predominantly using oral antibiotics compared to topical antibiotics in secondary care. This study has shown that children with otorrhoea make up a significant proportion of paediatric referrals to the ENT secondary care services in the UK. Current management is heterogenous and could contribute to treatment failure. Standardized management pathways for these patients should be formulated.

PMID:42299707 | DOI:10.1017/S1463423626101297

Dermatol Reports. 2026 Jun 16. doi: 10.4081/dr.2026.10853. Online ahead of print.

ABSTRACT

This systematic review and meta-analysis aimed to comprehensively evaluate the efficacy and safety of topical sofpironium bromide in patients with primary axillary hyperhidrosis (PAH) in various published randomized controlled trials (RCTs). The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched PubMed, Scopus, Web of Science, Embase, and Medline databases through April 30, 2025, using keywords related to sofpironium and PAH. The odds ratio (OR) or mean difference (MD) was calculated using a random effects model with 95% confidence interval (CI). Three RCTs of sofpironium were included in the meta-analysis, with 1,209 patients with PAH. Sofpironium, compared to the vehicle, showed statistically significant improvement in the Hyperhidrosis Disease Severity Measure-Axillary (HDSM-Ax) score (OR=2.35, 95% CI [1.82 to 3.04]), Hyperhidrosis Disease Severity Scale (HDSS) score (OR=2.02, [1.46 to 2.79]), Dermatology Life Quality Index (DLQI) score (MD=-2.75, [-3.58 to -1.92]), and gravimetric sweat production (MD=-26.39, [-44.65 to -8.12]). The incidences of anticholinergic adverse events (AEs) and application site AEs were statistically higher in patients treated with sofpironium. Sofpironium is an effective treatment for PAH associated with significant improvements in sweat reduction and QOL for patients, although the drug also has risks of anticholinergic or application-site AEs.

PMID:42299704 | DOI:10.4081/dr.2026.10853

Prim Health Care Res Dev. 2026 Jun 16;27:e67. doi: 10.1017/S1463423626101327.

ABSTRACT

AIM: We aimed to examine advice interactions among family physicians using social network analysis (SNA) by categorizing advice interaction according to the five advice dimensions.

BACKGROUND: Inter-individual interactions for information exchange is a powerful tool for the pursuit of solutions to issues. These interactions may involve advice-seeking.

METHODS: The whole network approach was adopted and face-to-face research was conducted with 139 family physicians. Data were analysed using social network software, UCINET and visualized using the NETDRAW software. To examine the multidimensional advice networks, the frequency, density, reciprocity (dyad) measures were used. The Quadratic Assignment Procedure was used in UCINET to measure the correlations between the dimensions of advice. The Girvan-Newman algorithm was used to examine clustering in the advice network.

FINDINGS: Density values in the advice dimensions were very low. This indicates that the network was sparse, with limited interactions among family physicians in terms of giving and receiving advice. The strength of the ties in the dimensions was realized through validation, solutions, problem reformulation, meta-information, and legitimization, respectively. The results showed that the relationships between the dimensions were moderately, positively and significantly correlated. The advice network exhibited high modularity. Family physicians tended to seek advice from colleagues at the family health centers where they worked. We presented a visual representation of advice networks in primary healthcare settings. Identifying multidimensional advice networks through social network analysis can provide insight into how information is disseminated among family physicians. Our findings could contribute to decision makers in developing solution-oriented processes.

PMID:42299703 | DOI:10.1017/S1463423626101327

Geospat Health. 2026 Feb 2;21(1). doi: 10.4081/gh.2026.1451. Epub 2026 Jun 16.

ABSTRACT

This study presents the first Knowledge Attitudes, and Practices (KAP) survey on malaria in Djibouti City. It was conducted among 1,344 household heads across nine neighbourhoods in Djibouti City. Composite scores were calculated for each KAP dimension. Analysis of variance and multinomial logistic regression identified socio-demographic predictors and Local Indicators of Spatial Association (LISA) characterised the spatial clustering of the KAP scores. No significant association was found between sociodemographic or economic factors and malaria knowledge. Prevention practices varied notably across neighbourhoods, driven by place of residence, mother tongue, and education-underlining the primacy of spatial determinants. Attitudes were found to be linked to gender and income. Despite high disease awareness, 60% of respondents misidentified transmission routes, nearly two-thirds of respondents failed to adopt effective preventive behaviours, while Long-Lasting Insecticidal Net (LLIN) ownership far exceeded correct use. The gap between awareness and practice suggests that information-deficit approaches have reached their limits; future interventions should target motivational norm-based determinants of behaviour, spatially concentrated in the highest-risk neighbourhoods. Language and cultural barriers require tailored communication strategies beyond standard broadcast campaigns. Strengthened vector control and active surveillance remain essential complements to any behavioural intervention.

PMID:42299701 | DOI:10.4081/gh.2026.1451

J Adolesc. 2026 Jun 16. doi: 10.1002/jad.70206. Online ahead of print.

ABSTRACT

INTRODUCTION: The relationship between psychological distress and problematic mobile phone use (PMPU) is a significant concern for adolescent mental health. However, the longitudinal dynamics of this relationship and the specific cognitive mechanisms driving it remain insufficiently understood. This study aimed to examine the bidirectional relationship between psychological distress and PMPU, and to test the parallel mediating roles of positive and negative metacognitive beliefs.

METHODS: A two-wave longitudinal study was conducted over a 6-month interval in 2023 with 830 Chinese adolescents (48.6% boys; M_age = 15.18, SD = 1.92) in Zhejiang Province, China. Participants completed self-report measures of psychological distress, PMPU, and metacognitive beliefs. A latent cross-lagged panel model (L-CLPM) was used to test for bidirectional effects. The mediating pathways were tested using a longitudinal path model with bootstrapping.

RESULTS: The L-CLPM confirmed a significant bidirectional relationship between psychological distress and PMPU. The mediation analysis revealed that the pathway from T1 psychological distress to T2 PMPU was significantly and simultaneously mediated by both T2 positive and negative metacognitive beliefs. The direct effect was nonsignificant in the presence of the mediators, and the strengths of the two mediation pathways did not statistically differ.

CONCLUSION: Psychological distress and PMPU showed reciprocal prospective associations in adolescents. The pathway from distress to PMPU was accounted for by parallel positive and negative metacognitive beliefs, which may promote engagement and hinder disengagement. Interventions may therefore need to address both emotional distress and these metacognitive beliefs to disrupt this cycle.

PMID:42299685 | DOI:10.1002/jad.70206

Ethn Health. 2026 Jun 16:1-15. doi: 10.1080/13557858.2026.2688762. Online ahead of print.

ABSTRACT

OBJECTIVE: Black men experience the highest incidence and mortality rates from colorectal cancer (CRC) in Louisiana. Limited awareness of screening guidelines, low perceived risk, and structural barriers to care contribute to delayed detection. This study assessed CRC awareness, risk perceptions, screening intentions, and communication preferences among Black men aged 30-44 in Louisiana to inform targeted intervention strategies.

METHODS: We conducted a statewide cross-sectional survey of English-speaking individuals who identified as male, African American or Black, were aged 30-44 and resided in Louisiana. Measures included CRC awareness, perceived risk, prior screening recommendations, screening intentions, exposure to CRC-related messaging, social media use, and trusted sources of health information. Descriptive statistics were used to summarize responses.

RESULTS: We analyzed a total of 403 responses. Most participants did not perceive CRC as a significant personal health threat. Although 40% reported receiving a physician’s recommendation for screening, only 70% of those individuals completed screening. Fewer than half recalled exposure to CRC-related messages, and message recall was generally low. Social media use was widespread (97%), with 58% reporting regular engagement with influencers. Doctors, teachers, coaches, and pastors were identified as the most trusted sources of health information.

CONCLUSION: Findings highlight low perceived risk of CRC alongside high engagement with digital platforms. These results support the development of culturally tailored, lead-time messaging strategies that increase both perceived severity and susceptibility, leverage trusted messengers, and utilize digital media to promote timely CRC screening among young Black men.

PMID:42299682 | DOI:10.1080/13557858.2026.2688762

Clin Rehabil. 2026 Jun 16:2692155261459227. doi: 10.1177/02692155261459227. Online ahead of print.

ABSTRACT

ObjectiveTo examine the association between increased energy and protein intake through oral nutritional supplements and mortality and hospital admissions in older hip fracture patients at nutritional risk, using a preplanned secondary analysis of a randomised controlled trial.SettingDepartment of Orthopaedic Surgery, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark.ParticipantsHip fracture patients aged ≥65 at nutritional risk.InterventionParticipants were randomised to receive two cans daily of high-energy, high-protein oral nutritional supplements enriched with vitamin D and omega-3 fatty acids for 12 weeks after discharge or standard care.Main MeasuresAll-cause mortality and hospital admissions during a pre-planned 38-week follow-up after discharge, including time to first admission and length of hospital stay.ResultsAll-cause mortality was low, with no difference between intervention and control groups 2 (3%) versus 3 (5%). During follow-up, 31% (n = 19) of intervention participants was admitted to hospital compared with 47% (n = 29) in the control group. The difference approached significance in the intention-to-treat analysis (Risk ratio 0.72, 95% CI 0.51-1.03, p = 0.075) and was statistically significant in the per-protocol analysis (18% vs. 44%; Risk ratio 0.69, 95% CI 0.52-0.92, p = 0.019). No significant differences were observed in admissions frequency, length of hospital stay, or time to first admission.ConclusionPost-discharge oral nutritional supplementation was associated with a trend towards fewer hospital admission, with the strongest effect among adherent participants. No significant effects were observed in mortality, admission frequency, length of hospital stay or time to admission.ClinicalTrials.gov: NCT05556876. Date of registration: 2022-09-23.URL: https://clinicaltrials.gov/study/NCT05556876.

PMID:42299674 | DOI:10.1177/02692155261459227

J Intensive Care Med. 2026 Jun 16:8850666261460825. doi: 10.1177/08850666261460825. Online ahead of print.

ABSTRACT

ObjectiveTo compare the efficacy and safety of etomidate versus ketamine as induction agents for rapid sequence intubation in critically ill adults, focusing on 28-day mortality and post-intubation hypotension.Data SourcesPubMed, Embase, and the Cochrane Library were systematically searched from inception to January 2026. Reference lists of included studies were also manually screened.Study SelectionWe included randomized controlled trials (RCTs) comparing single-dose intravenous ketamine versus etomidate for emergency rapid sequence intubation in critically ill adults (≥ 18 years) in non-operating room settings (eg, intensive care unit or emergency department).Data ExtractionTwo investigators independently screened records, extracted data using a standardized form and assessed the risk of bias using the RoB 2 tool. The certainty of evidence was evaluated using the GRADE framework.Data SynthesisSix RCTs comprising 4108 randomized patients (2046 assigned to ketamine and 2062 to etomidate) were included. For the primary outcome, the pooled analysis evaluated 4102 patients and showed no statistically significant difference in 28-day mortality between the ketamine and etomidate groups (28.7% vs 29.9%; relative risk [RR] 0.96; 95% CI, 0.87-1.05; I² = 13.8%). In a prespecified subgroup analysis of patients with sepsis (n = 1546), mortality also did not differ significantly (RR 1.04; 95% CI, 0.91-1.19). However, ketamine was associated with a statistically significant increase in the incidence of post-intubation hypotension (14.2% vs 11.3%; RR 1.25; 95% CI, 1.01-1.53; I² = 0%). Conversely, ketamine significantly reduced the risk of adrenal suppression compared to etomidate (5.3% vs 14.7%; RR 0.36; 95% CI, 0.17-0.75). No significant differences were observed regarding peri-intubation cardiac arrest or first-attempt intubation success.ConclusionsFor emergency intubation in critically ill adults, including those with sepsis, 28-day mortality is similar between etomidate and ketamine. However, ketamine may increase post-intubation hypotension, whereas etomidate may increase adrenal suppression.

PMID:42299661 | DOI:10.1177/08850666261460825