Category: Statistics

Alzheimers Dement. 2026 Feb;22(2):e70992. doi: 10.1002/alz.70992.

ABSTRACT

INTRODUCTION: Vascular cognitive impairment (VCI), a major cause of cognitive impairment, remains underdiagnosed due to varying non-amnestic manifestations. It is important to detect VCI at the mild cognitive impairment (MCI) stage or earlier. We aimed to develop and validate ReCOGnAIze, a tablet-based, gamified, and interpretable app to detect VCI and MCI.

METHODS: A multi-phase, cross sectional study in an Asian community cohort with development phase (n = 200) and validation with 235 independent participants having comprehensive neuroimaging and neuropsychological data.

RESULTS: In differentiating VCI, ReCOGnAIze achieved strong performance (n = 154, AUC = 0.85), identifying digital features: processing speed and response time variability, consistent with known VCI impairments of executive functioning. Additionally, a generalizable ReCOGnAIze composite score distinguished MCI from cognitively healthy (CH) (n = 235, AUC = 0.90), outperforming the Montreal Cognitive Assessment (MoCA) (AUC = 0.70).

DISCUSSION: ReCOGnAIze is a scalable, explainable artificial intelligence (AI) tool that accurately detects VCI and MCI, with gamified, tablet-based, interpretable tasks.

HIGHLIGHTS: Non-significant differences on Montreal Cognitive Assessment (MoCA) for vascular cognitive impairment (VCI). ReCOGnAIze artificial intelligence (AI) models identify VCI with area under the curve (AUC) of 0.85. ReCOGnAIze games detect mild cognitive impairment (MCI) with AUC of 0.90, outperforming MoCA (AUC = 0.7). Processing speed and response time variability are key VCI markers.

PMID:41685533 | DOI:10.1002/alz.70992

J Med Virol. 2026 Feb;98(2):e70834. doi: 10.1002/jmv.70834.

ABSTRACT

BACKGROUND: Biliary atresia (BA) is a severe infantile hepatobiliary disorder of unknown etiology. Perinatal rotavirus (RV) infection has been implicated in animal models of BA; however, supporting human data remains limited. The study investigated the serological evidence of recent RV infection in infants with BA using RV-specific immunoglobulin (Ig)-A, a marker of primary infection unaffected by maternal antibodies.

METHODS: Serum samples from 17 infants with BA and 30 age-matched controls without gastrointestinal symptoms or prior RV vaccination were retrospectively analyzed. Anti-RV-IgA titers were measured by enzyme-linked immunosorbent assay using purified WA-strain virions. Cytomegalovirus (CMV)-IgM and Epstein-Barr virus (EBV)-viral capsid antigen (VCA)-IgM levels were assessed using commercial enzyme immunoassays.

RESULTS: RV-IgA was detected in 70.6% (12/17) of the patients with BA versus 3.4% (1/29) of the controls (p < 0.001). RV-IgA titers were significantly higher in the BA group (median: interquartile range 2^8.0:2^6.0-2^10.0) than in the control group (2^3.5:2^2.0-2^4.8) (p = 0.004). Among patients diagnosed with BA after 14 days of age, 84.6% (11/13) were RV-IgA-positive. CMV-IgM was detected in three patients in the BA group and one individual in the control group, while EBV-VCA-IgM was negative in BA patients and positive in two controls; neither difference was statistically significant.

CONCLUSIONS: The study findings support the potential association between RV infection and BA pathogenesis. However, the lack of an epidemiological reduction in BA following the introduction of the RV vaccine warrants caution in other studies. Further prospective multicenter studies are required to elucidate the causal role of RV infection in BA development.

PMID:41685501 | DOI:10.1002/jmv.70834

Stud Health Technol Inform. 2026 Feb 12;334:127-128. doi: 10.3233/SHTI260033.

ABSTRACT

Refugee populations in Canada experience disproportionately high rates of trauma-related mental health conditions. We conducted 15 semi-structured interviews across six stakeholder groups to explore mental healthcare gaps. Findings reveal three major barriers: fragmented regulatory frameworks; unsustainable funding models; and failure to integrate end-user needs.

PMID:41685489 | DOI:10.3233/SHTI260033

Stud Health Technol Inform. 2026 Feb 12;334:83-87. doi: 10.3233/SHTI260021.

ABSTRACT

Healthcare systems have invested heavily in interoperability, yet adoption by clinicians has been inconsistent. Despite the availability of mature technical standards, many providers continue to rely on fax and other low-tech methods for information exchange. This paper explores whether the barriers to adoption are primarily technical or economic in nature. Using e-prescribing as a comparative case, we examine three jurisdictions that adopted similar technologies but experienced very different outcomes: Canada, the United States, and Denmark. Canada pursued a voluntary model and saw limited uptake. The United States initially struggled but achieved significant adoption once penalties were tied to Medicare Part D. Denmark achieved near-universal adoption by mandating use nationwide. These contrasting outcomes suggest that interoperability adoption hinges on how costs and benefits are distributed among stakeholders, rather than on technology alone. Drawing on economic theories of transaction costs, externalities, Coase’s theorem, and information asymmetry, we offer an early framework for interpreting adoption outcomes. While our analysis is limited to e-prescribing and related cases, the findings suggest that economic design principles may be critical for sustainable interoperability. Future work should extend this framework to other domains of health data exchange.

PMID:41685478 | DOI:10.3233/SHTI260021

Stud Health Technol Inform. 2026 Feb 12;334:73-77. doi: 10.3233/SHTI260019.

ABSTRACT

This environmental scan examined commercially available AI clinical decision support solutions (AI-CDSS) across three domains: knowledge base, AI methodology, and privacy. Over half of vendors disclosed some information on their knowledge base, yet few demonstrated rigorous appraisal or alignment with Quality Standards or other evidence-based guidelines. Transparency on AI methods was limited as most cited proprietary algorithms but rarely described training data. Privacy information was more commonly reported but often high-level, with limited detail on compliance, storage location, or restrictions on secondary use. These gaps reveal the obstacles facing decision makers: without standardized, transparent information, organizations and governments cannot reliably evaluate AI-CDSS or provide the support clinicians need for responsible and informed implementation.

PMID:41685476 | DOI:10.3233/SHTI260019

Stud Health Technol Inform. 2026 Feb 12;334:35-41. doi: 10.3233/SHTI260011.

ABSTRACT

Challenges in access to specialty care in Canada lead to long wait times and poorer outcomes. The eConsult Centre of Excellence at The Ottawa Hospital (TOH) developed Triaging Referrals to eConsult (TReC), embedding specialist advice into routine referral workflows within health information systems (HIS). Following a successful proof-of-concept, TReC expanded to Women’s College Hospital (WCH) in 2023 and the Children’s Hospital of Eastern Ontario (CHEO) in 2025. We applied the RE-AIM framework to evaluate implementation across study the three study sites. Reach was assessed by utilization; effectiveness by response times and surveys; adoption by specialist participation; implementation by delivery and cost; maintenance by ongoing use. Data sources included administrative data and surveys of patients and providers. Specialist participation included 160 at TOH, 22 at WCH, and 26 at CHEO. Since launch, >10,000 eConsults were completed at TOH, >880 at WCH, and >360 at CHEO, spanning 15, 8, and 10 clinical areas, respectively. Median response times ranged from 2-8 days across sites, versus Ontario’s 23-week average for in-person care. Median cost per TReC case was $37 CAD (10 minutes spent per case), substantially lower than in-person visits. Surveys showed high acceptability: 84% of referring providers at TOH and 91% at WCH found advice actionable; 70% of TOH patients felt concerns were addressed; and 91% of TOH specialists perceived TReC to improve access. TReC scaled successfully across three hospitals and improved timely access. High acceptability supports expansion and potential to improve equitable access across Ontario. Future evaluation will assess post-TReC healthcare utilization.

PMID:41685469 | DOI:10.3233/SHTI260011

J Adolesc. 2026 Feb 13. doi: 10.1002/jad.70119. Online ahead of print.

ABSTRACT

INTRODUCTION: Parental education has been linked to childhood health and wellbeing outcomes. Intergenerational transfer of parental education into childhood health and wellbeing outcomes operates through multiple pathways, however the mediating influence of neighbourhood conditions remains understudied.

METHODS: Drawing on data from the Longitudinal Study of Australian Children (LSAC) (n = 6432, 51% male, ages 14-15 years) we conduct a causal mediation analysis using a Regression-with-Residuals (RWR) approach to examine the mediating effect of neighbourhood social environment, neighbourhood built environment, and neighbourhood socio-economic advantage in the relationship between parental education and children’s health and wellbeing at age 14 years.

RESULTS: The results show neighbourhood quality, in particular neighbourhood social environment and neighbourhood advantage, mediates a small but statistically significant proportion of the association between parental education and child health and wellbeing.

CONCLUSIONS: Our findings suggest that spatial stratification during childhood is likely to play an important role in the intergenerational reproduction of socio-economic gradients in health.

PMID:41685451 | DOI:10.1002/jad.70119

Stroke. 2026 Feb 13. doi: 10.1161/STROKEAHA.125.054073. Online ahead of print.

ABSTRACT

BACKGROUND: Poststroke dysphagia is associated with poor functional recovery and psychological consequences, including depression and fatigue, which may impede successful rehabilitation. Here, we investigate whether antidepressants may improve dysphagia recovery after acute ischemic stroke.

METHODS: In this prospective cohort study, patients with acute ischemic stroke (aged ≥18 years; consecutively enrolled in the STROKE-CARD trial 2014 to 2019 and registry 2020 to 2023 in Innsbruck, Austria) were examined for poststroke dysphagia (by standardized clinical and instrumental examinations) and antidepressant intake at hospital admission, discharge, and inpatient 3-month follow-up. The outcome was full oral diet resumption 3 months poststroke. Associations were analyzed using multivariable logistic regression and are presented as adjusted odds ratios, adjusting for age, sex, stroke severity, dysphagia severity, depression severity, stroke localization, thrombolysis, cognitive impairment, functional disability before stroke and at hospital discharge, and study type.

RESULTS: Poststroke dysphagia affected 380 (18.6%) of the total cohort of 2046 patients at hospital admission (mean age, 72.7±14.1 years; 37.8% females) and persisted in 290 (14.7%) and 95 (4.6%) patients until hospital discharge and 3-month follow-up, respectively. Among the 290 patients with persistent dysphagia at discharge included in the outcome analysis, antidepressant intake increased from 4.8% before stroke to 27.6% at hospital discharge and 49.0% at 3 months (P<0.001). A total of 195 (67.2%) of 290 patients with persistent dysphagia regained full oral diet by 3 months, with significantly higher recovery rates in those who were discharged on antidepressants (78.8% versus 62.9%; P=0.010). Antidepressant intake at hospital discharge was independently associated with improved dysphagia recovery at 3 months (adjusted odds ratio, 2.98 [95% CI, 1.51-5.87]; P=0.002).

CONCLUSIONS: Antidepressant intake was associated with better dysphagia recovery after acute ischemic stroke. As these findings are observational, randomized trials are required to clarify whether antidepressants can support dysphagia rehabilitation.

PMID:41685445 | DOI:10.1161/STROKEAHA.125.054073

Alzheimers Dement. 2026 Feb;22(2):e71146. doi: 10.1002/alz.71146.

ABSTRACT

INTRODUCTION: Cerebrovascular dysfunction may contribute to Alzheimer’s disease (AD) pathogenesis. We examined how novel cerebral hemodynamic markers relate to neuroimaging phenotypes associated with AD dementia in cognitively impaired and unimpaired older adults.

METHODS: Statistical hemodynamic indices were computed for each participant from stochastic dynamic models relating resting-state spontaneous arterial blood pressure and end-tidal CO₂ fluctuations to transcranial doppler-derived blood velocity and near infrared spectroscopy-derived cortical tissue oxygenation. Linear regressions related these hemodynamic indices to hippocampal volume, WMH volume, cortical thickness in an AD-signature region, and brain amyloid burden measured by PET.

RESULTS: Higher hemodynamic indices, indicating proximity to normal cerebrovascular function correlated with neuroimaging phenotypes typically associated with better cognitive status: greater hippocampal volume and lower amyloid burden.

DISCUSSION: Our findings provide further support for the role of cerebrovascular dysfunction in AD pathogenesis and for the potential clinical utility of model-based indices of cerebral hemodynamics.

PMID:41685442 | DOI:10.1002/alz.71146

Cancer Med. 2026 Feb;15(2):e71564. doi: 10.1002/cam4.71564.

ABSTRACT

BACKGROUND: Same-day discharge following radical prostatectomy has become increasingly common, with single-institution series suggesting it reduces healthcare costs without increasing adverse events. However, this practice has not been studied nationally, outside of specialized centers. This study assesses 30-day readmissions, observation stays, and emergency department visits among men with prostate cancer undergoing prostatectomy.

STUDY DESIGN: We used national Medicare data to identify men undergoing prostatectomy for prostate cancer between 2016 and 2021. We focused on patients discharged either the same day or the day after surgery to include only those with an uneventful postoperative course presumably eligible for same-day discharge. We used multivariable logistic regression to measure relationships between discharge day (same-day vs. next-day) and 30-day readmissions, adjusted for patient factors. We also assessed the association between the day of discharge and a secondary outcome, a composite of readmission, observation stay, or emergency department visits within 30 days.

RESULTS: Our cohort included 528 men discharged the same day and 11,513 discharged the next day. By 2021, same-day discharges rose to 9.2%. Same-day discharge was associated with an almost two-fold increase in the odds of a readmission within 30 days (adjusted OR: 1.93; 95% CI 1.35-2.76; p < 0.01). However, the odds of an acute care event, measured by a composite of any readmission, observation stay, or emergency department visit, were similar in both groups (adjusted OR: 1.16; 95% CI 0.90-1.50; p = 0.27).

CONCLUSIONS: Same-day discharges after prostatectomy have increased substantially but were associated with a two-fold increase in odds of a readmission within 30 days. However, global adverse events, as measured by our composite outcome, were similar.

PMID:41685432 | DOI:10.1002/cam4.71564