Category: Statistics

JMIR Diabetes. 2026 Feb 6;11:e83448. doi: 10.2196/83448.

ABSTRACT

BACKGROUND: Older adults with diabetes frequently access their electronic health record (EHR) notes but often report difficulty understanding medical jargon and nonspecific self-care instructions. To address this communication gap, we developed Support-Engage-Empower-Diabetes (SEE-Diabetes), a patient-centered, EHR-integrated diabetes self-management support tool designed to embed tailored educational statements within the assessment and plan section of clinical notes.

OBJECTIVE: This study aimed to validate the clarity, relevance, and alignment of SEE-Diabetes content with the Association of Diabetes Care & Education Specialists 7 Self-Care Behaviors framework from the perspectives of older adults and clinicians.

METHODS: An interdisciplinary team conducted expert reviews and qualitative interviews with 11 older adults with diabetes and 8 clinicians practicing in primary care (family medicine) and specialty diabetes care settings at a Midwestern academic health center. Patients evaluated the readability and relevance of the content, while clinicians assessed clarity, sufficiency, and potential clinical utility. Interview data were analyzed using inductive thematic analysis, and descriptive statistics were used to summarize participant characteristics.

RESULTS: Patients (mean age 72, SD 4.9 y; mean diabetes duration 26, SD 15 y) reported that the SEE-Diabetes statements were clear, relevant, and written in plain language that supported understanding of self-care recommendations. Clinicians (mean 13, SD 9.5 y of diabetes care experience) viewed the content as concise, clinically appropriate, and well aligned with patient self-management goals and the Association of Diabetes Care & Education Specialists 7 Self-Care Behaviors framework. Both groups identified the tool’s potential to enhance patient engagement and patient-clinician communication, while noting opportunities to improve the specificity of language, particularly within medication-related content.

CONCLUSIONS: SEE-Diabetes demonstrated content validity as a practical, patient-centered digital health tool for supporting diabetes self-management communication within EHR clinical notes. The findings support its use as a complementary approach to reinforce self-care communication in routine clinical practice and highlight areas for refinement to enhance personalization.

PMID:41650468 | DOI:10.2196/83448

JMIR Form Res. 2026 Feb 6;10:e80783. doi: 10.2196/80783.

ABSTRACT

BACKGROUND: Human papillomavirus (HPV) vaccination is a proven and effective tool for preventing several types of cancers, yet vaccination rates among young adults remain suboptimal, particularly among those not enrolled in 4-year colleges. This population can be more difficult to reach due to fewer established institutional touchpoints, limited engagement with campus-based health services, and greater variability in access to preventive care. At the same time, social media has become a dominant source of information for young adults, with TikTok (ByteDance) emerging as one of the most widely used platforms. Approximately 41% of TikTok’s users are between the ages of 16 and 24 years, making it a potentially important channel for public health communication. However, little is known about how noncollege young adults perceive HPV-related content on TikTok, or how influencers themselves view their role in communicating about vaccination.

OBJECTIVE: This study explored the perspectives of young adults and TikTok influencers regarding the dissemination and reception of HPV vaccine information on TikTok. The goal was to assess the potential of leveraging influencers as trusted messengers for this hard-to-reach population.

METHODS: Researchers conducted 5 focus groups with noncollege young adults, stratified by gender and vaccination status. Each group included 5-8 participants, resulting in a total of 34 individuals. Participants who reported being extremely hesitant about the HPV vaccine were excluded to focus on those more receptive to information. In parallel, researchers recruited 9 TikTok influencers who reached audiences aged 18-25 years and conducted in-depth individual interviews. Influencers represented a diverse mix of identities, follower counts, and content genres, providing varied perspectives on engagement with health-related topics.

RESULTS: Across the focus groups, young adults described regularly encountering or actively seeking health-related information online, with TikTok emerging as a primary or supplementary source for some. However, very few participants reported seeing content specifically related to HPV vaccination. Despite this gap, most expressed openness to such content if it was delivered in a relatable, authentic manner and included concise, relevant facts. Influencers echoed the importance of authenticity, emphasizing that their credibility is grounded in genuine connections with their audiences. Many described frequent, meaningful exchanges with followers about sensitive issues, suggesting comfort in addressing health topics. Influencers noted that they would be willing to share HPV-related content under certain conditions, including alignment with existing content, personal relevance, or participation in a structured campaign or partnership.

CONCLUSIONS: Findings suggest that TikTok may be a promising platform to engage noncollege young adults in HPV vaccination messaging. The strong parasocial relationships influencers maintain with their audiences could position them as effective messengers on sensitive health topics. Strategic collaborations with influencers, coupled with carefully crafted, authentic content, may help bridge communication gaps and support increased awareness of HPV vaccination in this underserved population.

PMID:41650455 | DOI:10.2196/80783

J Neurosurg. 2026 Feb 6:1-7. doi: 10.3171/2025.9.JNS25902. Online ahead of print.

ABSTRACT

OBJECTIVE: Stroke care disparities related to race and ethnicity have been well-documented, with African American populations experiencing higher stroke incidence and receiving less timely treatments like intravenous tissue plasminogen activator (tPA). Telemedicine, particularly telestroke, has emerged as a potential solution to address geographic and racial disparities in acute stroke care, yet some studies have reported persistent racial differences in treatment. This retrospective study was conducted to analyze data from a telestroke network consisting of a hub hospital and 38 spoke centers in Pennsylvania.

METHODS: Patients who had presented with acute ischemic stroke and required a virtual consult with a neurovascular specialist were included in the study. The data collected from electronic medical records included baseline characteristics, stroke-related variables, treatment details, and outcomes. Descriptive statistics, chi-square tests, and a Kruskal-Wallis test were used to analyze the data. In addition, univariate and multivariable logistic regression analyses were performed to evaluate the association between race and key outcomes.

RESULTS: A total of 4256 patients were included, of whom 2925 were White and 1122 were African American. On multivariable logistic regression, African American patients, as compared to White patients, were less likely to undergo mechanical thrombectomy (OR 0.58, 95% CI 0.35-0.96, p = 0.03) and were more likely to be discharged to rehabilitation (OR 1.39, 95% CI 1.06-1.84, p = 0.01), with no significant differences in tPA administration or death between the two racial groups.

CONCLUSIONS: The study results suggest that African American patients are significantly less likely to undergo mechanical thrombectomy and more likely to be discharged to rehabilitation compared with their White counterparts, despite similar rates of tPA administration and death. These findings highlight persistent disparities in advanced stroke interventions and postacute care, emphasizing the need to address structural and socioeconomic barriers to ensure equitable treatment and recovery for all patients.

PMID:41650447 | DOI:10.3171/2025.9.JNS25902

JMIR Public Health Surveill. 2026 Feb 6;12:e87800. doi: 10.2196/87800.

ABSTRACT

BACKGROUND: Alcohol is a widely used psychoactive substance, and its use constitutes a major public health challenge due to its immediate and long-term adverse effects on various health-related outcomes. Adolescence has been identified as a particularly vulnerable phase regarding alcohol use. Although consumption rates in this age group have declined in Germany over the past decades, a plateau has been reached, and there is a continued need for interventions to further reduce consumption rates.

OBJECTIVE: This study aimed to assess problematic alcohol use among adolescents in Germany and explore associations with sociodemographic and psychosocial characteristics, particularly with health literacy, to inform future interventions tailored to the specific needs of this target group.

METHODS: In a cross-sectional quota-based survey, 2006 adolescents (aged 12-17 years) completed an online survey (n=1406) or face-to-face interview (n=600) assessing the frequency of weekly alcohol use, the presence of problematic alcohol use (German version of the Car-, Relax-, Alone-, Forget-, Friends-, Trouble- questionnaire [CRAFFT-d]), sociodemographic information, and health literacy (European Health Literacy Survey instrument [HLS-EU-Q16]). Based on their CRAFFT-d and HLS-EU-Q16 scores, participants were identified as exhibiting problematic alcohol use (vs no problematic alcohol use) and inadequate or problematic health literacy levels (vs adequate health literacy levels), respectively. Chi-square tests were computed to analyze differences between different groups (as defined by the sociodemographic factors, weekly alcohol consumption frequency, and health literacy) in terms of problematic alcohol use (binary CRAFFT-d outcome).

RESULTS: Approximately 20% (390/2006) of the participants reported consuming alcohol on at least 1 day per week, and 12.7% (255/2006) of the sample met the CRAFFT-d screening criterion for problematic alcohol use. Problematic alcohol use was significantly associated with gender (χ²₁=20.96, V=0.10; P<.001), age (χ²₂=85.88, V=0.21; P<.001), subjective social status (χ²₂=8.23, V=0.06; P=.02), and migration background (χ²₁=5.60, V=0.05; P=.02), but there were no significant associations with level of education (χ²₁=3.43, V=0.04; P=.06), and health literacy (χ²₁=1.54, V=0.03; P=.21). In addition, participants who reported more frequent alcohol consumption per week, also met the screening criterion for problematic alcohol consumption more frequently (χ²₇=698.65, V=0.59; P<.001).

CONCLUSIONS: The findings demonstrate that problematic alcohol use is more common in boys than girls, in older vs younger adolescents, in those with high or low (vs intermediate) social status, in individuals with (vs without) a migration background, and in those who drink alcohol more frequently. These results emphasize the necessity of implementing targeted prevention strategies that address the specific risk profiles of adolescents concerning alcohol consumption.

PMID:41650444 | DOI:10.2196/87800

J Acquir Immune Defic Syndr. 2026 Feb 6. doi: 10.1097/QAI.0000000000003845. Online ahead of print.

ABSTRACT

BACKGROUND: F/TAF was shown to be non-inferior to F/TDF as pre-exposure prophylaxis (PrEP) in men, but approval was not extended to cisgender women. We report the results of PrEPVacc, in which a predominantly female population was randomly allocated to receive daily oral F/TDF or F/TAF for ∼6 months within a HIV-1 prophylactic vaccine trial.

SETTING: Five study sites in three African countries (Uganda, Tanzania, South Africa).

METHODS: The two regimens were compared by the averted infections ratio (AIR) – the proportion of infections averted by F/TAF relative to F/TDF. The counterfactual HIV incidence, an essential component of this metric, was derived from a preceding registration cohort. Dried blood spots (DBS) were collected at regular timepoints for later assessment of tenofovir diphosphate levels in selected sub-populations.

RESULTS: 1380 participants (697 F/TDF, 683 F/TAF) were included in the primary analysis (total follow-up 709.2 person-years); 87% were cisgender women. Three HIV infections (0.86/100 person-years) occurred in the F/TAF group versus two in the F/TDF group (0.56/100 person-years). The counterfactual HIV incidence was estimated to be 2.59/100 person-years (90% CI 1.86-3.52), giving an AIR of 0.85 (90% CI 0.31-1.66). Based on the week 8 DBS sample , only an estimated 14% of participants were classified as taking 2-3 tablets per week and 9% ≥4 tablets per week.

CONCLUSIONS: Despite similar HIV incidence rates, the non-inferiority of F/TAF was not demonstrated, probably due to low statistical power primarily driven by low adherence. However, there is compelling evidence from multiple studies supporting the efficacy of F/TAF as PrEP regardless of sex.

PMID:41650395 | DOI:10.1097/QAI.0000000000003845

JMIR Diabetes. 2026 Feb 6;11:e82635. doi: 10.2196/82635.

ABSTRACT

BACKGROUND: Sulfonylureas are commonly prescribed for managing type 2 diabetes, yet treatment responses vary significantly among individuals. Although advances in machine learning (ML) may enhance predictive capabilities compared to traditional statistical methods, their practical utility in real-world clinical environments remains uncertain.

OBJECTIVE: This study aimed to evaluate and compare the predictive performance of linear regression models with several ML approaches for predicting glycemic response to sulfonylurea therapy using routine clinical data, and to assess model interpretability using Shapley Additive Explanations (SHAP) analysis as a secondary analysis.

METHODS: A cohort of 7557 individuals with type 2 diabetes who initiated sulfonylurea therapy was analyzed, with all patients followed for 1 year. Linear and logistic regression models were used as baseline comparisons. A range of ML models was trained to predict the continuous change in hemoglobin A1c (HbA1c) levels and the achievement of HbA1c <58 mmol/mol at follow-up. These models included random forest, extreme gradient boosting, support vector machines, a conventional feedforward neural network, and Bayesian additive regression trees. Model performance was assessed using standard metrics including R² and root mean squared error for regression tasks and area under the receiver operating characteristic for classification. In a subset of 2361 patients, nonfasting connecting peptide (C-peptide) was analyzed as a proxy for β-cell function. SHAP analysis was performed to identify and compare key predictors driving model performance across methods.

RESULTS: All models exhibited similar performance, with no significant advantages of ML techniques over linear regression. For continuous outcomes, Bayesian additive regression trees demonstrated the highest R² (0.445) and lowest root mean squared error (0.105), though the differences among models were minimal. For the binary outcome, extreme gradient boosting achieved the highest area under the receiver operating characteristic curve (0.712), with CIs overlapping those of other models. Across all models, baseline HbA1c was consistently the primary predictor, explaining the majority of the variance. SHAP analyses confirmed that baseline HbA1c, age, BMI, and sex were the most influential predictors. Sensitivity analyses and hyperparameter tuning did not significantly improve model performance. In the C-peptide subset, higher C-peptide levels were associated with greater glycemic improvement (β=-3.2 mmol/mol per log(C-peptide); P<.001).

CONCLUSIONS: In this large, population-based cohort, ML models did not outperform traditional regression for predicting glycemic response to sulfonylureas. These findings suggest that limited gains from ML likely reflect an absence of strong nonlinear or high-order interactions in routine clinical data and that available features may not capture sufficient biological heterogeneity for complex models to confer added benefit. The inclusion of a C-peptide subset provides additional mechanistic insight by linking preserved β-cell function with treatment response.

PMID:41650391 | DOI:10.2196/82635

Int J Prosthodont. 2026 Feb 6;0(0):1-18. doi: 10.11607/ijp.9519. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to compare patient satisfaction and oral health impact between individuals receiving complete dentures made by digital methods and those utilizing conventional techniques.

MATERIALS AND METHODS: In this randomized crossover clinical trial, 23 patients aged 40 and older with completely edentulous arches were enrolled at three treatment centers. Each participant received two sets of complete dentures: one set created using conventional methods (selective pressure impression) and the other through digital techniques (mucostatic digital impression). The order of denture placement was randomized, with each set used for four weeks. A trained specialist administered treatments, alongside research tools, including a general information questionnaire, a denture satisfaction survey, and the OHIP-14 interview tool. Statistical analysis was conducted using the Mann-Whitney U Test.

RESULTS: Participants with digital dentures reported significantly higher satisfaction regarding treatment duration, comfort, confidence, chewing ability, aesthetics, and overall satisfaction compared to those with conventional dentures. There were no significant differences in satisfaction concerning speech and pronunciation. Overall, the oral health impact on quality of life was similar between denture types, but participants indicated improved quality of life while using dentures compared to being edentulous.

CONCLUSIONS: Patients with digital dentures exhibited greater satisfaction across various domains compared to those with conventional dentures, despite similar satisfaction levels in speech and pronunciation. The impact on quality of life was comparable between both types, as measured by the OHIP-14.

PMID:41650382 | DOI:10.11607/ijp.9519

Int J Prosthodont. 2026 Feb 6;0(0):1-15. doi: 10.11607/ijp.9693. Online ahead of print.

ABSTRACT

PURPOSE: To investigate patterns of social media (SM) use among dental specialists and to assess SM’s perceived role in daily practice and patient care.

MATERIALS AND METHODS: A cross-sectional pilot paper survey was administered to specialist dentists in Greece (May-June 2024). The 23-item questionnaire covered four domains: demographics, personal SM use, professional-patient communication, and perceived impact on patient care. Descriptive statistics were reported as frequencies, medians (IQR), or means ± SD. Exploratory associations used Fisher’s exact or χ² tests for categorical variables and Kruskal-Wallis or Wilcoxon tests for ordinal outcomes, with 95% confidence intervals. Statistical significance was set at p<0.05; all analyses were exploratory.

RESULTS: Forty-five dentists participated (66.7% women; median age 30 [IQR 10]); 64.4% were prosthodontists and 35.6% orthodontists. Most respondents (97.8%) had ≥1 SM.

PMID:41650381 | DOI:10.11607/ijp.9693

Int J Prosthodont. 2026 Feb 6;0(0):1-29. doi: 10.11607/ijp.9578. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate how specific anatomical and planning-related parameters affect the accuracy of immediate implant placement using static guided surgery in the anterior maxilla.

MATERIALS AND METHODS: This investigation included 29 patients and 40 immediate implants placed in one of the six anterior maxillary teeth using a fully digital static guided protocol. Preoperative planning was performed using STL and CBCT data, and implant positions were planned for screw-retained restorations. Surgical guides were tooth-supported and 3D printed. Postoperative intraoral scans were superimposed onto the virtual plan to measure implant deviation. Angular deviation and 3D offsets at the platform and apex were calculated. Additional variables included the number of socket walls in contact with the first and last drill, drilling depth, and planned alignment relative to the socket’s long axis. Non-parametric tests were used for statistical analysis.

RESULTS: Among the 40 implants, 38 showed buccal deviation at the implant platform. Angular deviation averaged 3.03° ± 1.7°, and mean 3D offsets at the platform and apex were 0.98 ± 0.50 mm and 1.23 ± 0.64 mm, respectively. Implants planned outside the socket’s axis exhibited significantly greater deviation regarding the angular deviation and the 3D deviation at the implant apex (p < 0.05). A higher number of socket walls in contact with the drill also correlated with increased angular and apex deviation. Drilling depth showed a weak but non significant correlation with angular deviation.

CONCLUSION: Both anatomical and planning-related factors influence the accuracy of immediate implant placement in the anterior maxilla using static guided surgery. Buccal deviation was consistently observed, and greater deviations occurred when multiple socket walls were engaged or when the implant was not aligned with the socket’s natural axis. Careful planning is critical to improve surgical precision.

PMID:41650377 | DOI:10.11607/ijp.9578

Neurology. 2026 Mar 10;106(5):e214656. doi: 10.1212/WNL.0000000000214656. Epub 2026 Feb 6.

ABSTRACT

BACKGROUND AND OBJECTIVES: fMRI has proven useful in dissecting the neurobiological underpinnings of migraine. However, the existing evidence is limited by small samples, use of suboptimal statistical thresholds, and different methods of clinical data acquisition. Given these limitations, we hypothesized that a large, well-characterized sample would allow a clearer distinction between resting-state functional connectivity (rs-FC) alterations specific to migraine and those related to migraine subtypes.

METHODS: Adults with migraine and age-matched and sex-matched healthy controls (HCs) underwent a single 3T rs-fMRI scan. We compared rs-FC between migraine and HCs, and across migraine subtypes, using multi-voxel pattern and seed-based analysis. General linear models and analysis of covariance tests with Bonferroni-adjusted cluster-wise family-wise error correction (pFWE-Bonferroni ≤0.001) were applied. rs-FC measures, expressed as Z scores, were also compared across migraine subtypes using general linear models (pBonferroni < 0.05).

RESULTS: We analyzed rs-fMRI data from 264 participants with migraine (mean age 42 ± 12 years, 234 women) and 151 HCs (mean age 41 ± 11 years, 130 women). The multi-voxel pattern analysis identified significant rs-FC differences in a cluster within the bilateral middle cingulate cortex when comparing participants with migraine to HCs (pFWE-Bonferroni <0.001). The seed-based analysis revealed that participants with migraine had increased rs-FC between the cluster in the bilateral middle cingulate cortex and both the right lateral occipital cortex and bilateral occipital pole (both pFWE-Bonferroni <0.001), compared with HCs. Furthermore, increased rs-FC was identified between the limbic lobe and the right occipital pole (pFWE-Bonferroni = 0.0014) and precuneus (pFWE-Bonferroni <0.001). The cingulate-occipital rs-FC was consistently increased in participants with migraine, irrespective of the migraine subtype (pBonferroni <0.001). In addition, ictal participants who were scanned during attacks exhibited an increased hypothalamic rs-FC with the bilateral precuneus, compared with HCs (pBonferroni <0.001). No significant associations emerged between rs-FC and clinical features in migraine.

DISCUSSION: The identified rs-FC alterations between the middle cingulate cortex and occipital regions might represent a migraine-specific trait, suggesting an integration of nociceptive and visual processing. This discovery provides novel insights into the neurobiological underpinnings of migraine and proposes that altered cingulate-occipital rs-FC might serve as a potential biomarker for migraine.

PMID:41650361 | DOI:10.1212/WNL.0000000000214656