Category: Statistics

Nurs Crit Care. 2026 Jul;31(4):e70528. doi: 10.1111/nicc.70528.

ABSTRACT

BACKGROUND: Intensive care nurses are frequently exposed to emotionally demanding and ethically challenging situations, which may affect their emotional awareness and moral functioning. Alexithymia, characterised by difficulties in identifying and expressing emotions, may be an important factor contributing to moral distress in intensive care settings.

AIM: This study aimed to examine the relationship between alexithymia and moral distress among intensive care nurses and to compare their levels according to sociodemographic and professional characteristics.

STUDY DESIGN: A descriptive and correlational design was employed. Data were collected from intensive care nurses in Sivas, Türkiye, using the Personal Information Form, the Toronto Alexithymia Scale-20 (TAS-20) and the Moral Distress Scale-Revised (MDS-R). Data were analysed using Pearson’s correlation analysis, independent samples t-test, one-way ANOVA and Welch’s ANOVA (p < 0.05).

RESULTS: Among the 146 intensive care nurses included in the study, 34 (23.3%) were classified as alexithymic, 37 (25.3%) as possibly alexithymic, and 75 (51.4%) as non-alexithymic. A moderate, positive and statistically significant correlation was found between total alexithymia and moral distress scores (r = 0.623, p < 0.001). Moral distress was positively associated with all alexithymia subdimensions, including difficulty identifying feelings, difficulty describing feelings and externally oriented thinking (p < 0.001). Higher levels of alexithymia and moral distress were observed among female nurses, single nurses, those with postgraduate education, longer intensive care experience and nurses with prior or current intentions to leave the profession (p < 0.05).

CONCLUSION: Alexithymia was significantly associated with higher levels of moral distress among intensive care nurses. Interventions aimed at enhancing emotional awareness and adaptive coping may help mitigate moral distress in intensive care settings.

RELEVANCE TO CLINICAL PRACTICE: Integrating emotion-focused support strategies into intensive care practice may strengthen nurses’ psychological resilience and contribute to workforce sustainability.

PMID:42227230 | DOI:10.1111/nicc.70528

Int J Biostat. 2026 Jun 1. doi: 10.1515/ijb-2025-0066. Online ahead of print.

ABSTRACT

In right-skewed count data, the mean is disproportionately affected by a long upper tail, whereas the median remains a more representative measure of central tendency. Discrete Weibull (DW) regression links covariates to a shifted median, which in turn induces the exact integer median; however, a single DW component can fit poorly when the observed count distribution has a markedly heavier upper tail than a single-component model can accommodate. We propose a contaminated DW (cDW) regression that augments the baseline DW distribution with a more dispersed secondary component within a finite mixture while retaining a single shifted-median link. This mixture accommodates extreme counts more effectively, thereby stabilizing the median-based regression coefficients. The model accommodates general lower truncation at an arbitrary threshold c, including c = 1 for strictly positive outcomes and c = 0 for nonnegative counts, and is estimated using a straightforward Bayesian Markov chain Monte Carlo algorithm implemented in JAGS; R code accompanies the paper. Applied to hospital length-of-stay data, the cDW regression reduces the influence of outliers and achieves superior predictive performance relative to a single-component DW model, as demonstrated by leave-one-out cross-validation and a Kullback-Leibler influence diagnostic. Simulation experiments show that, under strongly heavy-tailed mixture settings, the cTDW model accurately recovers the regression coefficients and improves on the single-component TDW model. Because the added tail component can increase probability mass at both extremes, we further recommend embedding the cDW in a hurdle framework when structural zeros are present: the zero probability is modeled separately, and the heavy-tail mixture is applied only to positive counts. The cDW regression model provides a robust, median-centered alternative for analyzing skewed, possibly truncated count outcomes.

PMID:42227217 | DOI:10.1515/ijb-2025-0066

J Palliat Med. 2026 Jun 2:10966218261448973. doi: 10.1177/10966218261448973. Online ahead of print.

ABSTRACT

BACKGROUND: Population-level data on palliative care need remain limited in many regions. Cancer mortality is commonly used as a proxy indicator of population-level palliative care demand. Gulf Cooperation Council (GCC) countries have undergone rapid demographic and epidemiological transition, highlighting the need for evidence-informed planning.

OBJECTIVES: To examine long-term trends in cancer mortality across six GCC countries (Saudi Arabia, United Arab Emirates, Kuwait, Qatar, Bahrain, and Oman) and assess implications for palliative care planning.

DESIGN: Ecological time-trend analysis.

SETTING/SUBJECTS: National mortality data from six GCC countries (2000-2022).

MEASUREMENTS: Age-standardized cancer mortality rates (ICD-10 C00-C97) were obtained from the World Health Organization Global Health Observatory. Trends were evaluated using annual percentage change estimates, segmented (joinpoint) regression, and models accounting for between-country variability.

RESULTS: Data availability varied substantially across countries. Bahrain, Kuwait, and Qatar had sufficient longitudinal data and demonstrated statistically significant declines in age-standardized cancer mortality (p < 0.001), with the largest reduction observed in Bahrain. Nonlinear, phase-dependent trends were identified. Countries with limited data were analyzed descriptively.

CONCLUSIONS: Cancer mortality trends in GCC countries vary according to data completeness. Declining mortality does not necessarily indicate reduced palliative care need. Cancer mortality remains a pragmatic population-level indicator for planning in settings with limited direct measures of need. Strengthening mortality surveillance and integrating palliative care into national cancer control strategies are essential.

PMID:42227184 | DOI:10.1177/10966218261448973

Health Educ Behav. 2026 Jun 2:10901981261453327. doi: 10.1177/10901981261453327. Online ahead of print.

ABSTRACT

Southeast Asian cancer screening rates are alarmingly the lowest across all racial and ethnic groups in the United States. This paper examines barriers to breast cancer screening among Southeast Asian women, an understudied and underserved subgroup within the broader Asian American population, participating in a culturally tailored navigation intervention. A total of 194 women were randomly assigned to either the intervention-Tailored Messaging System^© group (n = 103) or the information-reminder only group (n = 91). The intervention group received tailored messages addressing barriers, beliefs, perceived risks, and self-efficacy, along with guidance to complete mammograms, delivered by trained community health advisors over 10 weeks. The information group received screening information by mail. Barriers were evaluated via a questionnaire at baseline in both groups. Results showed statistically significant differences in mammography screening by ethnicity, but not by intervention group. The Lao constituted the largest group, with 20 (37.7%) screened, followed by Cambodians at 7 (26.1%), whereas only 5 (8.5%) of the Vietnamese and none (0.0%) of the Filipina women completed mammograms. Findings indicate that some Southeast Asian women are less likely to get screened for breast cancer due to modifiable factors such as health insurance, doctors’ recommendations, fears, and perceptions. Disaggregating data for Southeast Asian women subgroups is an essential step for uncovering barriers in cancer screening uptake. Public health interventions and campaigns should consider these barriers and the importance of using disaggregated data.

PMID:42227134 | DOI:10.1177/10901981261453327

Mol Biol (Mosk). 2026 Mar-Apr;60(2):266-275. doi: 10.7868/S3034555326020056.

ABSTRACT

Nowadays, against the backdrop of a global increase in cancer incidence, the search for prognostic markers to assess individual risks is particularly relevant. Early identification of altered DNA methylation patterns may serve as a reliable indicator of malignant transformation and be used for diagnostic purposes. The objective of this study was to assess the methylation level of CpG dinucleotides in the promoter regions of DNA repair genes (AKT1, DDB2, GADD45A, XPC and XRCC3) in the blood of chronically exposed individuals who subsequently developed cancers. The study was conducted in individuals who were affected by chronic low dose-rate exposure in 1950-1960s in the Southern Urals. The main group included exposed individuals in the latent period of cancer development-104 people, the comparison group consisted of exposed individuals without cancers-188 people. The methylation level was assessed in bisulfite-converted DNA samples using methylation-specific high-resolution melting. It was established that in exposed individuals from the main group, there was a statistically significant decrease in the methylation level in the AKT1 and GADD45A gene promoter, relative to the comparison group (4.37 versus 7.23%, p < 0.001 and 10.73 versus 19.58%, p < 0.001, respectively). As for the XRCC3 gene, there was an increase in the methylation level of CpG dinucleotides in the promoter in individuals from the main group relative to the comparison group (5.38 versus 6.18%, p < 0.001). When the prognostic potential of methylation parameters of the AKT1, GADD45A, XRCC3 gene promoters was assessed for the purposes of early diagnosis of cancer development risk, it was found that when these loci were analyzed together, the AUC was 0.89 (95% CI: 0.85-0.93) at p < 0.001.

PMID:42227125 | DOI:10.7868/S3034555326020056

Clin Trials. 2026 Jun 2:17407745261449668. doi: 10.1177/17407745261449668. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: The Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results trial randomized patients with diabetes to liraglutide or placebo. The per-protocol analysis conditioned on post-baseline adherence and therefore lacked a well-defined estimand. This study sought to evaluate a subset of Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results to estimate the effect of sustained liraglutide exposure corresponding to a well-defined per-protocol analysis.

METHOD: We used the roadmap of targeting learning to define the estimand for the sustained treatment analysis and estimated it with longitudinal targeted minimum loss-based estimation, accounting for protocol deviations and censoring using post-baseline confounders. The results were compared to the intention-to-treat analysis. We report 3.5-year risks of the primary composite outcome (myocardial infarction, stroke, or cardiovascular mortality) and secondary outcomes (each of the primary outcome’s components, revascularization, unstable angina pectoris, heart failure, and all-cause mortality).

RESULTS: The intention-to-treat analysis estimated 3.5-year risks for the primary composite outcome of 11.8% (95% confidence interval: 10.8 to 12.8) in the liraglutide arm and 13.3% (95% confidence interval: 12.3 to 14.3) in the placebo arm, with a risk difference of 1.5% (95% confidence interval: 0.1 to 2.9). Accounting for post-baseline confounders, the sustained treatment analysis estimated 3.5-year risks of 11.4% (95% confidence interval: 10.4 to 12.5) for sustained exposure to liraglutide versus 12.6% (95% confidence interval: 11.5 to 13.7) for sustained exposure to placebo, yielding a risk difference of 1.1% (95% confidence interval: -0.4 to 2.6). Sustained exposure to liraglutide showed no statistically significant difference compared with sustained exposure to placebo for any secondary outcomes at 3.5 years.

CONCLUSION: We used contemporary methods for causal inference to define and estimate the sustained treatment effects of the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results study by accounting for both baseline and time-varying confounders. The results were consistent with the findings of the original Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results trial.

PMID:42227113 | DOI:10.1177/17407745261449668

Probl Endokrinol (Mosk). 2026 May 20;72(2):86-97. doi: 10.14341/probl13704.

ABSTRACT

BACKGROUND: Hypoparathyroidism (HypoPT) and pseudohypoparathyroidism (PHP) are rare, predominantly genetically determined diseases in children with similar complications, characterized by hypocalcemia and hyperphosphatemia. PHP and HypoPT have similar complications: brain and lens calcification. In HypoPT, there is also an increased risk of developing nephrocalcinosis. Data on the frequency and structure of complications in affected children in Russia are limited, and comparative studies are lacking.

AIM: To compare the prevalence of chronic complications and to identify factors associated with their development in children with PHP and congenital forms of HypoPT.

MATERIALS AND METHODS: A retrospective study with a prospective component included 135 children with PHP and congenital forms of HypoPT. The results of laboratory and instrumental studies were evaluated.

RESULTS: At least one complication associated with HypoPT/PHP was identified in 82% of children. Nephrocalcinosis was most frequently detected in patients with autoimmune polyendocrine syndrome type 1 (APS-1) (67%) and autosomal dominant hypocalcemia type 1 (ADH1), and much less often in patients with PHP (22%) and unspecified forms of HypoPT (18%). Disease duration, as well as the duration of therapy with active vitamin D analogs and calcium supplements, was significantly longer in patients with nephrocalcinosis (p &lt; 0.001). An association between nephrocalcinosis and cataracts was established (p=0.005). Hypercalciuria persisted in 60% of patients despite medical compensation, was most prevalent in APS-1 and ADH1, and was not observed in PHP (p &lt; 0.001). No statistically significant relationship was identified between hypercalciuria and the development of nephrocalcinosis (p=0.567). A decrease in eGFR corresponding to CKD stage 2 was observed in 48.9% of patients. Fahr’s syndrome was detected in 76% of cases, predominantly involving the basal ganglia, and the presence of mineral deposits was associated with hyperphosphatemia (p=0.010). Cataract and micronephrolithiasis were less frequent (18.6% and 3.9%, respectively), with no significant differences between nosological groups. The most common lens opacities observed were cortical (68%) and posterior subcapsular (41%). The duration of the disease was longer in patients with cataracts (p = 0.018).

CONCLUSION: Among the complications observed in children, nephrocalcinosis, hypercalciuria, and Fahr’s syndrome were the most frequent. Renal complications predominated in patients with APS-1 and ADH1. Hypercalciuria persisted despite optimal serum calcium levels in most patients.

PMID:42227095 | DOI:10.14341/probl13704

Probl Endokrinol (Mosk). 2026 May 20;72(2):78-85. doi: 10.14341/probl13645.

ABSTRACT

BACKGROUND: Type 1 diabetes mellitus (T1DM) is a chronic progressive autoimmune disease characterized by destruction of pancreatic betta cells leading to insulin deficiency, measured by C-peptide testing. C-peptide secretion has been studied in diagnostic, prognostic and therapeutic aspects in patients with already manifested T1DM. Insulin secretion assessed by the level of C-peptide at the preclinical stage remains under-studied.

AIM: The aim of the study was to assess the possibility of predicting the development of T1DM in healthy siblings based on dynamic measurements of C-peptide concentration.

MATERIALS AND METHODS: A multicenter prospective longitudinal study involving 532 individuals was conducted. Median follow-up duration was 5.6 years. Group 1 (n=325) included children aged 0-18 years with newly diagnosed T1DM; group 2 (n=201) consisted of healthy brothers and sisters (siblings) who did not develop T1DM until the end of the study; group 3 (n=6) comprised healthy siblings who developed T1DM before the study completion. All participants underwent dynamic testing of blood analysis for C-peptide using solid-phase chemiluminescent immunoassay. RESULTS: In groups 1 and 3, the actual median concentration of baseline C-peptide was below reference values: 0.31 ng/mL [95% CI 0.10-1.39] and 0.56 ng/mL [95% CI 0.32-0.85], respectively. In group 2, it corresponded to the lower limit of reference values: 0.88 ng/mL [95% CI 0.28-2.69]. The observed differences were statistically significant between groups 1 and 2 (χ2 =168.29, df=1, p &lt; 0.001) and between groups 2 and 3 (χ2 =4.2292, df=1, p=0.040). Regression modeling revealed a nonlinear positive relationship between C-peptide concentration and age. At any age category, the median initial C-peptide concentration in groups 1 and 3 was lower than that in group 2 above the average level (“intercept”) characteristic for the cohort of specific age. The association between C-peptide concentration and time since observation onset was statistically significant (p &lt; 0.05) and bidirectional: over time, concentrations decreased in groups 1 and 3 and increased in group 2.

CONCLUSION: Measurement of baseline C-peptide levels followed by dynamic monitoring may serve as an additional screening tool for predicting the risk of T1DM development in healthy siblings.

PMID:42227094 | DOI:10.14341/probl13645

Phlebology. 2026 Jun 2:2683555261458164. doi: 10.1177/02683555261458164. Online ahead of print.

ABSTRACT

ObjectivePhlebolymphedema is a progressive condition caused by combined venous and lymphatic dysfunction. Although complete decongestive therapy (CDT) is widely used in clinical practice, objective evidence regarding its effectiveness across different disease stages is limited. This study aimed to evaluate the short-term effectiveness of CDT in patients with lower extremity phlebolymphedema and to examine the influence of disease stage and body mass index (BMI) on treatment response.MethodsThis retrospective study included patients with phlebolymphedema treated at a tertiary lymphedema clinic between 2020 and 2024. Chronic venous insufficiency was diagnosed by lower-extremity venous duplex Doppler ultrasonography, and lymphatic dysfunction was confirmed by lymphoscintigraphy. All patients completed a standardized intensive CDT program consisting of manual lymphatic drainage, multilayer compression bandaging, and therapeutic exercises for 10 sessions over 2 weeks. Extremity volume was measured using circumferential measurements and calculated with the truncated cone formula. Pre- and post-treatment volumes were compared, and associations with disease stage and BMI were analyzed.Results62 patients (72.2% female), corresponding to 108 affected lower extremities, were analyzed. The mean BMI was 36.5 ± 6.3 kg/m². CDT resulted in a statistically significant reduction in extremity volume (median reduction: 0.55 L; p < .001). Treatment response differed across disease stages, with greater absolute volume reduction observed in Stage 3 disease (p = .007). A positive correlation was identified between BMI and volume reduction (ρ = 0.322, p = .0007). Age, sex, and history of venous surgery were not associated with treatment response.ConclusionCDT is an effective treatment modality for achieving a significant short-term reduction in extremity volume in patients with phlebolymphedema. Clinically meaningful volume reduction can be achieved across all disease stages, including patients with advanced-stage disease and elevated BMI. These findings support the role of CDT as a primary conservative treatment option in routine phlebolymphedema management.

PMID:42227080 | DOI:10.1177/02683555261458164

J Sex Marital Ther. 2026 Jun 2:1-22. doi: 10.1080/0092623X.2026.2680162. Online ahead of print.

ABSTRACT

Infidelity is one of the most devastating events in a relationship, yet many couples choose to reconcile and stay together in its aftermath. There is scarce research on how likely such an outcome is amongst individuals motivated to achieve it as well as on pathways to and predictors of relationship preservation, defined as remaining in the original relationship. This study administered the Pathways Through Infidelity Survey to individuals who have had an affair (“commitment-breaking partners”) and whose partner has had an affair (“betrayal-experiencing partners”) recruited through the social media profiles of three mental health professionals enabling post-infidelity recovery and reconciliation. Analysis was performed using descriptive statistics and Classification and Regression Trees (CART). Analyzable responses were obtained from 1151 commitment-breaking and 2278 betrayal-experiencing partners. The strongest predictors of relationship preservation were love for commitment-breaking partners and formalization of the relationship (marriage, engagement, long-term relationship) for betrayal-experiencing partners. Relationship preservation after infidelity was found to follow neither a linear, nor uniform, nor a necessarily complex trajectory. A variety of pathways to it were identified, some brief and direct and others long and convoluted. Amongst individuals accessing social media contents about recovery and reconciliation after infidelity, relationship preservation is likely and predictable.

PMID:42227060 | DOI:10.1080/0092623X.2026.2680162