Category: Statistics

J Clin Psychol. 2026 Aug 11. doi: 10.1002/jclp.70207. Online ahead of print.

ABSTRACT

OBJECTIVES: While some research suggests that increases in anxiety symptoms drive changes in insomnia and depression symptoms, other studies support that these relations may be bidirectional. The present study therefore aimed to further examine how anxiety, insomnia and depression symptoms predict changes in these symptoms over time.

METHODS: Participants were recruited via an online participant database, social media advertisements, and other online sites, resulting in a large sample (N = 2,666) of adults from across the United States. Well validated instruments were used to measure symptoms of depression (CES-D), anxiety (STAI), and insomnia (ISI). Data were collected via a series of Qualtrics surveys administered online at two time points: March-June 2020 (baseline) and January-March 2021 (follow-up).

RESULTS: Insomnia symptoms (β = 0.142, p < 0.001) but not anxiety symptoms (β = 0.019, p = 0.445) significantly predicted depression symptoms. Depression symptoms (β = 0.077, p = 0.001) but not anxiety symptoms (β = 0.039, p = 0.075) significantly predicted insomnia symptoms. Both insomnia (β = 0.060, p = 0.001) and depression symptoms (β = 0.281, p < 0.001) significantly predicted anxiety symptoms. Although multiple cross-lagged paths were statistically significant, effect sizes were generally small, and no single pathway was meaningfully stronger than others. Additionally, secondary exploratory mediation models revealed significant indirect effects between anxiety and depression through insomnia (model 1 indirect β = 0.027, p = 0.007; model 2 indirect β = 0.008, p = 0.036).

CONCLUSIONS: Findings suggest that insomnia symptoms were prospectively associated with subsequent depressive and anxiety symptoms. Depression symptoms also predicted later anxiety symptoms, highlighting the complex longitudinal associations among these symptom domains. However, results did not support a temporal pathway in which anxiety precedes the development of comorbid insomnia. Future studies should assess temporal order more closely, using high density longitudinal sampling strategies (i.e., more than two data collection points) to further clarify the temporal ordering of these symptom domains.

PMID:42579862 | DOI:10.1002/jclp.70207

Genetics. 2026 Aug 11:iyag204. doi: 10.1093/genetics/iyag204. Online ahead of print.

ABSTRACT

Predicting phenotypes from genetics and environmental inputs is a long-standing challenge in genetics and plant breeding. Deep neural networks are a promising approach due to their capacity to approximate nonlinear biological processes. Despite initial expectations, recent studies have found that deep neural networks under-perform compared to linear methods, even on continent-scale datasets. We attribute this to several failure modes of deep learning, including greedy learning, the tendency to over-emphasize a single type of input data. As a solution, we present the Structured Interaction Neural Network (SINN), which combines statistical decomposition of genetic, environmental and interaction effects with deep neural networks. SINN dissects phenotype prediction into isolated component modeling tasks, revealing poor generalization of learned representations to new environments as the main limitation for prediction of genotype-by-environment interactions and overall yield. We reach competitive performance on yield prediction in the next cycle of 2 maize multi-environment trial datasets, including new genotypes and environments. In the Genomes to Fields (United States) dataset, SINN achieved higher overall accuracy (0.63) than BLUP-based methods (0.43) and a neural network from previous literature (0.48), and surpassed previous top-performing models with a lower RMSE (2.40 vs. 2.46 Mg/ha, mean yield 9.51 Mg/ha). Similar gains were observed in a secondary dataset consisting of Chinese national maize variety trials (MaizeGEP). SINN achieved higher overall accuracy (0.79) than BLUP-based methods (0.49) and a neural network from previous literature (0.76). By combining statistical genetics and modern deep learning, SINN enables accurate, modular and scalable genomic prediction in new environments.

PMID:42579860 | DOI:10.1093/genetics/iyag204

J Occup Environ Med. 2026 Aug 11. doi: 10.1097/JOM.0000000000003850. Online ahead of print.

ABSTRACT

OBJECTIVE: : Our aim was to determine the association between exposure to chromium compounds and the respiratory health of workers in ferrochromium and stainless steel production.

METHODS: : The study included 333 workers occupationally exposed/non-exposed to chromium compounds. Respiratory health was assessed using a questionnaire and spirometry. Bronchial and alveolar nitric oxide (NO) production, inflammatory markers in exhaled breath condensate, and serum samples were analyzed.

RESULTS: : There were no differences in symptoms or lung function between the study groups. Alveolar NO, 8-isprostane in exhaled breath and interleukin-8 in serum were higher in the study groups than in the controls. However, no consistent associations were found between inflammatory markers and exposure levels of air impurities.

CONCLUSIONS: : Although the differences in some inflammatory markers were statistically significant, further research is needed to ascertain the clinical significance of the finding.

PMID:42579848 | DOI:10.1097/JOM.0000000000003850

J Clin Oncol. 2026 Aug 11:JCO2600852. doi: 10.1200/JCO-26-00852. Online ahead of print.

ABSTRACT

Daromun (L19IL2/L19TNF) was investigated as a neoadjuvant, intralesional therapy for patients with fully resectable stage III melanoma in the phase III PIVOTAL trial (ClinicalTrials.gov identifier: NCT02938299). The trial enrolled 256 patients in the European Union and met its primary end point, demonstrating a statistically significant improvement in recurrence-free survival (RFS; hazard ratio, 0.59; P = .005) for daromun followed by surgery versus up-front surgery, at a median follow-up (FU) of 21 months from random assignment. PIVOTAL included two clinically distinct subgroups, namely, patients with de novo diagnosed metastatic disease (n = 34; 13%) and patients with recurrence(s) after surgery with or without radiotherapy and/or adjuvant systemic therapies (n = 222; 87%). Here, we present an updated analysis of the primary and secondary end points, including safety data, at a median FU of 36.8 months from random assignment (database cutoff: November 28, 2025), alongside new sensitivity analyses of event-free survival (EFS). The updated analysis confirms the clinically and statistically meaningful improvements in RFS and distant metastasis-free survival recorded in the neoadjuvant daromun versus control arm. The EFS post hoc analysis, conducted in both the overall population and the recurrent patient subgroups (with or without prior systemic therapies), provides consistency and robustness to the benefit of neoadjuvant daromun observed for the primary efficacy end point. No new safety signals of concern were recorded.

PMID:42579833 | DOI:10.1200/JCO-26-00852

JMIR Public Health Surveill. 2026 Aug 11;12:e87597. doi: 10.2196/87597.

ABSTRACT

BACKGROUND: COVID-19 profoundly affected emergency department (ED) services and patient outcomes. However, changes in ED length of stay (LOS) and intensive care unit (ICU) admission risk before, during, and after the pandemic remain poorly understood.

OBJECTIVE: We investigated and compared ED LOS and ICU admission risk among patients in the ED resuscitation area in 2019, 2021, and 2023, respectively before, during, and after the pandemic.

METHODS: This single-center retrospective cohort study enrolled patients in the ED resuscitation area of a regional emergency center in central China. ED LOS was compared across pandemic phases using the Kruskal-Wallis H test with Bonferroni correction. Cox proportional hazards models were applied to evaluate the association between phases and ICU admission risk. Sensitivity analyses included 2021 stratification, exclusion of extreme ED LOS values, and E-value analysis to validate result robustness.

RESULTS: A total of 44,161 patients were included. Stratified analyses demonstrated significant temporal variations in ED LOS across disposition groups. Among discharged patients, median ED LOS increased from a prepandemic 248 (IQR 149-404.8) minutes to a midpandemic 262.0 (IQR 153-423.8) minutes (P=.047) and remained elevated in the postpandemic phase (median 258, IQR 152-451 minutes; P<.001). Among patients admitted to general wards, median ED LOS nearly doubled during the pandemic (from 186, IQR 96-431 to 350, IQR 188-610 minutes) and partially decreased to a postpandemic 293 (IQR 113-840) minutes (all P<.001). Among ICU-admitted patients, median ED LOS increased from a prepandemic 95 (IQR 57-169) minutes to a midpandemic 171 (IQR 77-306) minutes and a postpandemic 105 (IQR 50-215) minutes (all P<.003). The overall ICU admission rate was 15.8% (6982/44,161). Multivariate Cox regression with 2019 as the reference showed that the postpandemic phase was independently associated with an increased ICU admission risk (hazard ratio [HR] 1.079, 95% CI 1.012-1.150; P=.02), whereas the pandemic phase was not (HR 1.032, 95% CI 0.967-1.100; P=.34). In female patients, the postpandemic phase was associated with a higher ICU admission risk (HR 1.143, 95% CI 1.027-1.273; P=.02). All sensitivity analyses verified the robustness of the main findings (all P<.05).

CONCLUSIONS: The COVID-19 pandemic exerted differential effects on ED LOS across disposition groups. The postpandemic period was associated with an increased risk of ICU admission, especially among female patients, whereas no significant change was observed during the pandemic. As a novel gender-stratified analysis covering the full pandemic timeline, this study distinguishes itself from prior research by revealing the sustained impacts of pandemic control policies on emergency care. Our findings deliver key evidence for patient risk stratification and offer practical guidance to optimize health care resource allocation in the postpandemic era. Health care systems should strengthen early identification of high-risk ED patients and rationalize critical care resource deployment accordingly.

PMID:42579810 | DOI:10.2196/87597

JMIR Form Res. 2026 Aug 11;10:e93017. doi: 10.2196/93017.

ABSTRACT

BACKGROUND: Electronic health record (EHR) data are being increasingly used for retrospective observational research through large, robust databases, and advanced data extraction tools.

OBJECTIVE: We sought to assess the reliability of vital sign, ventilator, and continuous medication data captured in the EHR in a pediatric intensive care unit.

METHODS: We conducted a prospective concordance study of children receiving invasive mechanical ventilation in June 2025. Data sources included (1) a bedside clinical researcher, (2) automated EHR extraction, and (3) a continuous vital sign monitoring system. Vital signs from the EHR were compared to those obtained through the continuous vital sign monitoring system. Ventilator and medication data were compared to the bedside observations. Differences were measured as means with SDs or median differences with IQRs, and a 10% error rate was used as a concordance adequacy threshold.

RESULTS: We obtained 110 bedside observations from 27 unique patients. Five of 8 measured vital signs in the EHR met the 10% concordance adequacy threshold (respiratory rate, 2.0/20.4, 9.8%; cuff systolic blood pressure, 8.3/99.4, 8.4%; invasive systolic blood pressure, 4.0/88.0, 4.5%; invasive diastolic blood pressure, 3.8/50.0, 7.6%; and oxygen saturation, 2/96, 2.1%), with heart rate (11.4/113, 10.1%), cuff diastolic blood pressure (9/58.6, 15.3%), and end-tidal carbon dioxide (4.0/36.6, 10.9%) failing to meet concordance. Occasional rare clinically meaningful outliers were observed, such as a systolic blood pressure difference of 31 mm Hg, a heart rate difference of 87 beats per minute, and a respiratory rate difference of 18 breaths per minute. All 6 ventilator settings met concordance adequacy criteria between the EHR and the bedside observations, with a median difference of 0.0 (IQR 0-0). Outliers were less common but included differences such as a respiratory rate of 34 breaths per minute and an inspiratory time of 0.3 seconds. Continuous medication dosing concordance was variable, with an overall low concordance between 30.8% (339.3/11) and 31.4% (345.4/11).

CONCLUSIONS: EHR data captured in the pediatric intensive care unit in our single-center sample were mostly concordant with other measured observations for vital signs and ventilator settings, but less concordant for continuous medications.

PMID:42579809 | DOI:10.2196/93017

JMIR Infodemiology. 2026 Aug 11;6:e91422. doi: 10.2196/91422.

ABSTRACT

BACKGROUND: Sexuality discourse in Ghana has become more divided, especially around gender and lesbian, gay, bisexual, transgender, and queer rights, leading to new antigay laws criminalizing lesbian, gay, bisexual, transgender, and queer activities, and other forms of sexual practices. One of the most controversial pieces of legislation, previously titled “The Promotion of Proper Human Sexual Rights and Family Values Bill,” proposed in 2021, sought to criminalize the use of sex toys, sparking opposition from leading political figures. The then minister of communication, Ursula Owusu-Ekuful, a staunch women’s rights advocate, publicly opposed the clause criminalizing sex toys, stating that such initiatives infringed on women’s sexual autonomy. Her stance sparked heated debates on several social media platforms, reflecting the broader tensions surrounding conversations about sexuality in Ghana. To better understand the public’s reactions to the minister’s counterproposal, we analyzed comments from various social media platforms.

OBJECTIVE: Specifically, we (1) investigated public perceptions and sentiments regarding the criminalization of sex toys as expressed on social media, and (2) identified whether sentiments differed across social media platforms (eg, are comments on X [X Corp] more negative compared to Instagram or Facebook [Meta Platforms, Inc]?).

METHODS: Using Python (Python Software Foundation) as a web scraping tool, we extracted public comments from Instagram, Facebook, X, and YouTube (YouTube, LLC). Comments were analyzed using natural language processing to categorize sentiments (positive, negative, and neutral, indicating support for opposition to the bill, support for introducing the bill, and no clear stance in either direction, respectively), and text network analysis was used to identify keywords and their relationships to central themes. We used conditional probability analyses to determine the likelihood that a given comment was classified as negative, positive, or neutral, depending on its source (Instagram, X, Facebook, or YouTube).

RESULTS: A total of 951 comments were retrieved: 62.7% (n=596) from Instagram, 28.2% (n=268) from X, 6.2% (n=59) from Facebook, and 2.9% (n=28) from YouTube. Negative sentiments dominated (n=631, 66.4%), with only 13.3% (n=126) positive and 20.4% (n=196) neutral sentiments. Strongly disapproving language-some directed towards the minister-was common. This included terms such as “lesbian,” “disgrace,” and “disgusting.” X showed the highest proportion of negative sentiment (190/268, 70.9%), followed by Facebook (41/59, 69.5%), YouTube (18/28, 64.3%), and Instagram (382/596, 64.1%). Conditional probability analysis showed that Facebook and X had the highest likelihood of negative comments (0.7), and sentiment distribution differed significantly across platforms (P<.001). Text network analysis revealed recurring themes of morality, politics, stigma, and gender.

CONCLUSIONS: Our findings highlight deep-rooted cultural resistance to non-heteronormative sexual behaviors in Ghana and also suggest that women’s advocacy for sexual autonomy may elicit patriarchal backlash. However, emerging positive voices suggest gradual shifts toward recognizing sexual pleasure as a right, pointing to the need for comprehensive sexuality education that emphasizes positive sexuality and the multifaceted nature of the human sexual experience.

PMID:42579807 | DOI:10.2196/91422

Arch Endocrinol Metab. 2026 Aug 11;70(5):e260090. doi: 10.20945/2359-4292-2026-0090.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the impact of coexisting autoimmune thyroiditis (HT) on the clinicopathological characteristics and prognosis of patients with papillary thyroid carcinoma (PTC).

SUBJECTS AND METHODS: This prospective study included patients diagnosed with papillary thyroid carcinoma who underwent thyroid surgery. Patients were divided into two groups according to the presence or absence of histologically confirmed thyroiditis. Demographic data, tumor characteristics, pathological features, and postoperative outcomes were analyzed. Statistical comparisons were performed to assess differences between the two groups.

RESULTS: Thyroiditis was observed in a significant proportion of patients with PTC. Patients with associated thyroiditis showed smaller tumors and more favorable clinicopathological characteristics compared to those without thyroiditis. However, no significant differences were observed in major oncological outcomes. Recurrence rates were lower in the thyroiditis group. The presence of thyroiditis was associated with more favorable prognostic features.

CONCLUSION: The coexistence of thyroiditis in patients with PTC was associated with more favorable clinicopathological features. However, no significant differences were observed in major oncological outcomes, and the short follow-up period limits the assessment of long-term prognosis. These findings suggest an association with less aggressive initial presentation rather than a definitive prognostic impact.

PMID:42579753 | DOI:10.20945/2359-4292-2026-0090

Arch Endocrinol Metab. 2026 Aug 11;70(5):e260087. doi: 10.20945/2359-4292-2026-0087.

ABSTRACT

OBJECTIVE: To quantify the societal burden of obesity in Brazil by estimating years of life lost (YLL) due to premature mortality.

SUBJECTS AND METHODS: Given the Brazilian life expectancy of 76.4 years, premature death was defined as occurring before the age of 60. A quantitative epidemiological approach was applied to estimate obesity-attributable YLL in Brazil from 2014 to 2023. Mortality data were obtained from the Mortality Information System, and demographic projections were sourced from the Brazilian Institute of Geography and Statistics. The YLL was calculated by multiplying the number of deaths by the remaining life expectancy (using 2021 Global Burden of Disease reference tables), stratified by age and sex. Statistical analyses were conducted using R software and Python, with results presented as rates per 100,000 population.

RESULTS: The total number of events exhibited an upward trend over the decade, with a pronounced peak after 2020, coinciding with the COVID-19 pandemic. The 50-59 and 60-69-year age groups consistently demonstrated the highest event frequencies. Sex-specific analyses revealed variations across age groups and years. Events were rare among those aged 1-14 but increased from age 15-19 onwards. Among older age groups (40-69 years), females exhibited higher rates than males, particularly in the 60-69-age bracket.

CONCLUSION: This study demonstrates an increasing trend in obesity-related premature mortality in Brazil, disproportionately affecting older populations and necessitating targeted public health interventions.

PMID:42579750 | DOI:10.20945/2359-4292-2026-0087

Arch Endocrinol Metab. 2026 Aug 11;70(5):e260086. doi: 10.20945/2359-4292-2026-0086.

ABSTRACT

OBJECTIVE: Transgender individuals often face structural barriers and adverse health outcomes. Provider-to-provider (P2P) consultations may improve the quality of care for this population. This study describes the characteristics, clinical questions, and care provided to transgender population in the Brazilian public primary health care (PHC) system, using data from a P2P telephone consultation service based in Rio Grande do Sul State.

SUBJECTS AND METHODS: This cross-sectional study included all consultations classified as related to transgender health care conducted between TelessaúdeRS consultants and PHC professionals from 2015 to 2023. We extracted patient characteristics and clinical questions from each consultation. Continuous data are reported as means ± standard deviations or medians (interquartile ranges), and categorical data as absolute and relative frequencies.

RESULTS: Between 2015 and 2023, 752 of the 422,972 total consultations were classified as related to transgender health care. Regarding sex assigned at birth, 47.3% of patients were male, 43.4% were female, and 9.3% were unreported. The mean patient age was 24.5 years (±9.1). The most frequent consultation topics were laboratory monitoring (64.9%), hormone therapy (49.7%), and mental health (28.9%). Nonprescription hormone use was reported by 41.0% of patients. Referrals to specialized care were recommended in 68.4% of cases, and clinical guidance was provided in 71.4%.

CONCLUSION: The growing number of P2P consultations reflects an increasing demand for support regarding transgender care within PHC. Frequently asked questions reveal knowledge gaps among PHC providers, and the high rate of unsupervised hormone use suggests persistent barriers to appropriate care. P2P consultations can support PHC professionals in providing safer, more timely transgender health care.

PMID:42579749 | DOI:10.20945/2359-4292-2026-0086