Category: Statistics

Commun Med (Lond). 2026 May 19;6(1):285. doi: 10.1038/s43856-026-01634-2.

NO ABSTRACT

PMID:42156971 | DOI:10.1038/s43856-026-01634-2

Sci Rep. 2026 May 19. doi: 10.1038/s41598-026-52979-6. Online ahead of print.

ABSTRACT

The aim of this study was to investigate the effect of sterilization cycles on the flexural strength (FS) of titanium mini-screws used in orthodontics. The study was conducted between 2024 and 2025 at the Department of Orthodontics, Faculty of Dentistry, Van Yüzüncü Yıl University, using 1.8 × 8 mm titanium mini-screws. A total of 30 specimens were used and divided into three equal groups: Group 1 received one sterilization cycle; Group 2 received 10 sterilization cycles; and Group 3 received 25 sterilization cycles. The screws were then embedded in acrylic blocks and tested. FS measurements were performed using a universal testing machine. Mini-screws fixed in acrylic blocks were placed parallel to the ground, and a force perpendicular to the length was applied to induce deformation. The significance of the results was assessed at p < 0.05. The mean FS values ​​were 278.00 ± 61.62 N in Group 1, 243.80 ± 51.26 N in Group 2, and 286.60 ± 41.91 N in Group 3. The FS values ​​of sterilized miniscrews did not differ statistically significantly according to the number of sterilization cycles (p > 0.05). The study found that the FS of titanium miniscrews, which have a wide range of applications in orthodontic practice, was not affected by repeated sterilization cycles of up to 25 cycles.

PMID:42156963 | DOI:10.1038/s41598-026-52979-6

Sci Rep. 2026 May 19. doi: 10.1038/s41598-026-52741-y. Online ahead of print.

ABSTRACT

Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder marked by chronic abdominal discomfort and altered bowel habits, including constipation, diarrhea, or a combination of both. It significantly impacts quality of life and is often linked to psychological stress and dietary factors. Given the scarcity of multi-university data from Jordan, this study aimed to determine the prevalence of IBS among medical students across three Jordanian universities and to identify associated lifestyle, psychological, and demographic risk factors using validated instruments. A cross-sectional survey was conducted among medical students from the University of Jordan, Mutah University, and Jordan University of Science and Technology across all academic levels. The Rome III criteria were employed to diagnose IBS. Sleep quality was evaluated using the SATED (Satisfaction, Alertness, Timing, Efficiency, and Duration) scale, and mental health status was assessed using the Hospital Anxiety and Depression Scale (HADS). A total of 572 students completed the questionnaire. IBS was identified in 33.74% of respondents. Among those with IBS, 31.1% had the constipation-predominant subtype, 18.1% had the diarrhea-predominant subtype, and 50.8% experienced mixed symptoms. Binary logistic regression revealed that a family history of IBS significantly increased the likelihood of having the disorder (OR: 1.95; 95% CI: 1.34-2.83). Other significant risk factors included smoking (OR: 1.43; 95% CI: 1.08-2.40) and anxiety borderline anxiety (OR: 1.76; 95% CI: 1.11-2.80; p = 0.01). Established anxiety (OR: 1.53; p = 0.06) did not reach statistical significance. Sixth-year students were found to be at highest risk (OR: 5.16; 95% CI: 1.84-14.41), possibly due to greater academic pressure. Regular physical activity was associated with lower IBS odds, though this did not reach statistical significance (OR: 0.6; p = 0.07). No significant association was found with gender, BMI, sleep quality, junk food consumption, or depression. IBS is prevalent among Jordanian medical students and is associated with both genetic predisposition and lifestyle factors. These findings underscore the importance of targeted mental health and lifestyle interventions – particularly for sixth-year students – and highlight the need for longitudinal research to establish causal pathways. To our knowledge, this is the first multi-university study in Jordan to simultaneously assess psychological, sleep, and lifestyle correlates of IBS in medical students using validated instruments, providing a foundation for evidence-based student health policy in the region.

PMID:42156949 | DOI:10.1038/s41598-026-52741-y

Sci Rep. 2026 May 19;16(1):15514. doi: 10.1038/s41598-026-52963-0.

ABSTRACT

Postural orthostatic tachycardia syndrome (POTS) is associated with multiple autonomic symptoms, including gastrointestinal (GI) complaints, and has been linked to insulin resistance. We aimed to explore HbA1c, circulating metabolic hormones (insulin, C-peptide, GIP, GLP-1, glucagon, leptin, and peptide YY) and cortisol, and their associations with hemodynamic parameters and GI symptoms in POTS. Two POTS cohorts were studied and compared with matched controls. In the fasting cohort, blood samples were drawn in 42 patients and 41 controls, followed by active standing tests with measurement of pulse and blood pressure (BP) in supine and standing positions. In the non-fasting cohort, questionnaires assessed GI symptoms and HbA1c was measured in 43 patients and 52 controls. Fasting C-peptide and insulin levels correlated with BP in POTS (q = 0.002) but not in controls. Fasting insulin tended to be higher in POTS but was not statistically significant after adjustment for BMI (β = 6.85; 95% CI: -1.04-14.74; p = 0.085). Morning cortisol was comparable between groups. In the non-fasting cohort, HbA1c and metabolic hormones were comparable between groups, with no associations with GI symptoms. Together, these findings suggest a potential link between insulin-related pathways and BP regulation in POTS. Future studies are warranted to further investigate insulin dynamics in POTS.

PMID:42156945 | DOI:10.1038/s41598-026-52963-0

Bone Marrow Transplant. 2026 May 19. doi: 10.1038/s41409-026-02908-y. Online ahead of print.

ABSTRACT

Extramedullary disease (EMD) is a rare presentation in Acute Myeloid Leukaemia (AML). On behalf of PDWP/EBMT we studied the effect of EMD compared to isolated BM involvement in the outcomes following non-TBI conditioning hematopoietic stem cell transplantation (HCT) for AML in children. Patients were grouped into three categories: BM involvement only (Group A), BM + CNS involvement only (Group B) and BM+ other EMD+/- CNS (Group C). A total of 958 patients were included, 685 (71.5%) in Group A, 135 (14.1%) in Group B and 138 (14.4%) in Group C. The median post HCT follow-up was 5.4 years. Five years LFS, OS, RI and NRM were 62%, 68.4%, 26.4% and 11.6%, respectively. Multivariate analysis showed higher RI in Group C compared to Group A (HR = 1.45 (1.01-2.06) p = 0.04). In the multivariate analysis patients with EMD had no significant difference in LFS, OS and NRM. Our findings suggest that children with AML and BM with EMD+/- CNS involvement (group C) have a higher incidence of relapse after HCT compared to those with BM only or BM + CNS only disease. However, the presence of EMD did not have an impact on overall, leukaemia-free survival or non-relapse mortality.

PMID:42156943 | DOI:10.1038/s41409-026-02908-y

Urol Oncol. 2026 May 19;44(7):243-247. doi: 10.1016/j.urolonc.2026.04.287. Online ahead of print.

ABSTRACT

Many patients who receive prostate magnetic resonance imaging are classified as Patient Imaging Reporting and Data Systems level 3 (PI-RADS 3), which is inconclusive for cancer. An important question is whether PI-RADS 3 patents should receive a biopsy. Prostate biopsy has a 4.6% chance of complications including a 1.3% chance of a hospital or emergency room visit. I critically examine the literature on the standard endpoint for PI-RADS 3 decision-making, namely clinically significant prostate cancer (csPCa) determined on biopsy. Some methods for estimating the probability of csPCa are statistically flawed. Importantly, even if there were no methodological flaws, these estimates have limited information for decision-making because the benefit of detecting csPCa on biopsy is not well established. Therefore, PI-RADS 3 patients should consider events after biopsy. The prostate testing for cancer and treatment trial of patients with localized prostate cancer found similar probabilities of prostate cancer death among patients randomized to active monitoring, prostatectomy, and radiotherapy. Adding perspective, based on calculations from the results of this trial, the probability of prostate cancer death is much smaller than the probability of death from other causes, particularly in older patients. Therefore, for PI-RADS 3 patients who would choose active monitoring if diagnosed with csPCa on biopsy, a reasonable decision is no biopsy with active monitoring.

PMID:42155163 | DOI:10.1016/j.urolonc.2026.04.287

J Clin Densitom. 2026 May 7;29(3):101714. doi: 10.1016/j.jocd.2026.101714. Online ahead of print.

ABSTRACT

BACKGROUND: Postmenopausal osteoporosis (PMO), a major cause of fractures and disability, places a burden on healthcare systems. Erxian Decoction (EXD), a traditional Chinese herbal formula, is commonly used to support bone health. However, its efficacy and safety in treating PMO remain uncertain. This study assessed the efficacy and safety of EXD combined with conventional treatments in PMO.

METHODOLOGY: Following PRISMA guidelines, we systematically searched MEDLINE, Embase, CENTRAL, CNKI, Wanfang, SinoMed, and Chongqing VIP database through July 2025 for randomized controlled trials (RCTs). Two reviewers independently conducted study selection, data extraction, and risk-of-bias assessment (RoB 2). Random-effects meta-analyses were performed using mean differences (MDs), odds ratios (ORs), relative risks (RRs), and 95 % confidence intervals (CIs).

RESULTS: Thirteen RCTs comprising 1,269 women were included. All studies were conducted in China and published between 2012 and 2025. EXD significantly improved lumbar spine bone mineral density (BMD) (MDs 0.05 g/cm² and 0.09 g/cm² in pharmacological and calcium-vitamin D settings), femoral neck BMD (MD 0.06 g/cm² in both settings), and pain intensity (VAS MDs -1.17 and -0.88). Biochemical outcomes showed improvements in CTX within pharmacological settings, and in serum calcium, BGP, and E2 within calcium-vitamin D settings. Clinical response showed consistent improvements (ORs 3.62 and 3.56). Adverse events were reported in five studies. Pooled analyses suggested fewer events with EXD (RR = 0.68), with statistical significance in one trial. Fracture incidence (reported in one study) favored EXD but was not statistically significant. Heterogeneity was substantial across outcomes but was partly reduced in sensitivity analyses after excluding studies at high risk-of-bias.

CONCLUSION: EXD combined with conventional therapy may improve BMD, reduce pain in patients with PMO, though the evidence regarding safety remains insufficient to draw firm conclusions. However, the current evidence is limited to small, single-country RCTs with methodological limitations. Confirmation requires larger, rigorously designed trials across diverse populations.

PMID:42155162 | DOI:10.1016/j.jocd.2026.101714

J Clin Virol. 2026 May 19;184:105952. doi: 10.1016/j.jcv.2026.105952. Online ahead of print.

ABSTRACT

BACKGROUND: Capillary blood self-collection devices offer a minimally invasive alternative to venipuncture, potentially expanding access to serologic studies in outpatient and remote settings. We aimed to evaluate the concordance of influenza HAI titers between capillary blood collected using a minimally invasive device and venous blood collected via standard venipuncture.

METHODS: We compared three paired samples collected from participants during a single visit: venipuncture, staff-assisted capillary device collection (clinic-collect), and participant self-collected capillary device with 72-hour delayed processing (self-collect) to simulate both on-site and at-home blood collection conditions. We compared HAI titers against influenza A(H1N1) antigen across collection methods using Pearson correlation coefficients, Bland-Altman plots, and paired t-tests. Sample volume adequacy and correlation thresholds for clinical interpretability were also assessed.

RESULTS: Among 27 participants, HAI titers correlated strongly between venipuncture and both minimally invasive device approaches (clinic-collect: r = 0.955; self-collect: r = 0.937). Venipuncture titers were modestly higher, with mean differences of + 0.26 log₂ units (clinic-collect) and + 0.35 log₂ units (self-collect); these differences were below the 1-dilution (2-fold) threshold and not clinically meaningful. Most device samples (89-96%) fell within ±1 log₂ unit of venipuncture. On first attempt, 78% of device collections met the ≥ 600 μL volume threshold, increasing to > 93% with use of a second device.

CONCLUSION: Minimally invasive devices yielded influenza HAI titers highly comparable to venipuncture, with clinically acceptable differences in adults. Self-collection with a minimally invasive device could serve as a practical, scalable alternative for serologic studies.

PMID:42155157 | DOI:10.1016/j.jcv.2026.105952

JMIR Form Res. 2026 May 19;10:e78563. doi: 10.2196/78563.

ABSTRACT

BACKGROUND: The COVID-19 pandemic was marked by rapidly evolving and inconsistent public health messaging, contributing to confusion regarding recommended preventive behaviors. Knowledge, attitudes, and practices (KAP) and perceived risk frameworks offer a structured approach to examine how education, personal beliefs, and contextual factors influence health behaviors during public health emergencies. Vulnerable populations, such as patients with multiple sclerosis (MS), experience heightened risk perception compared with the general population, which may further shape behavioral responses.

OBJECTIVE: This study aimed to examine COVID-19-related KAP and perceived risk among patients with MS, health care providers, and laypeople during the first 6 months of the pandemic. The aim of mixed methods was to explore quantitative factors associated with KAP and perceived risk and to qualitatively describe participants’ perceptions and emotional responses to the pandemic.

METHODS: A descriptive, cross-sectional, partially mixed methods explanatory sequential design was used. Participants were recruited using convenience sampling and completed an online demographic questionnaire and a COVID-19 KAP instrument that included perceived risk items. Quantitative data were analyzed using descriptive statistics and inferential analyses to examine group differences and associations between perceived risk and preventive behaviors. Chi-square testing was applied to compare perceived risk across groups, and correlational analyses were used to examine the relationships between perceived risk and behavioral practices. Qualitative comments provided by participants were analyzed using thematic analysis to further contextualize quantitative findings and to explore perceived risk experiences.

RESULTS: A total of 148 participants were included, comprising 43 (29%) individuals with MS, 50 (33.8%) health care providers, and 55 (37.2%) laypeople. Overall, 90% (n=133) of participants demonstrated basic knowledge of COVID-19 transmission and prevention. Attitudes toward public health guidance and self-reported preventive behaviors varied across groups. Lay participants most frequently reported a moderate perceived risk of COVID-19 infection, whereas participants with MS and health care providers more commonly reported high perceived risk (χ²6=12.65, P=.049). Neither immunosuppressive treatment status nor vaccine hesitancy significantly predicted perceived risk. However, higher perceived risk was significantly associated with greater avoidance of crowded and public places. Qualitative analysis yielded 5 interrelated themes describing participants’ perceived risk experiences: uncertainty related to evolving scientific information; anxiety regarding personal and family safety; fear of infection and long-term consequences; vulnerability, particularly among individuals with chronic illness and frontline exposure; and accountability toward protecting others through adherence to preventive measures. These themes provided contextual insight into the emotional and cognitive processes underlying reported attitudes and behaviors.

CONCLUSIONS: Knowledge of COVID-19 is associated with favorable attitudes and engagement in preventive practices across populations. Differences in perceived risk highlight the importance of tailoring risk communication and educational strategies to specific populations. KAP-focused educational interventions that explicitly address uncertainty, emotional responses, and behavioral translation may strengthen preparedness and promote sustained protective behaviors during future public health emergencies.

PMID:42155141 | DOI:10.2196/78563

JMIR Mhealth Uhealth. 2026 May 19;14:e66151. doi: 10.2196/66151.

ABSTRACT

BACKGROUND: Previous research suggests that 14.4% of the general population is affected by tinnitus. For some of those affected, the ear noise is bothersome or associated with severe distress. There are various treatment options such as cognitive behavioral therapy (CBT), sound therapy, or hearing aids. In addition to browser-based online interventions, mobile apps have been introduced as novel treatment approaches. Previous studies have identified several apps aimed at supporting users with tinnitus. Yet, knowledge about the content of tinnitus apps is limited.

OBJECTIVE: This study aimed to provide an overview of apps specifically developed for tinnitus by analyzing general app characteristics, as well as app content, focusing on intervention components and behavior change techniques (BCTs).

METHODS: A systematic search using 7 search terms (eg, tinnitus and ear noise) was conducted in the Google Play Store and the Apple App Store. Apps designed specifically for tinnitus and available in German or English met the inclusion criteria. Two independent trained raters assessed general app characteristics (eg, age group and costs) using the app description section of the German version of the Mobile App Rating Scale. In addition, raters analyzed app content using the BCT taxonomy (v1) and a list of typical intervention components in tinnitus treatment. Differences in ratings were discussed, and a third trained rater was consulted if no consensus was reached.

RESULTS: A total of 1198 apps were identified in the systematic search. Of those, 69 apps were included in the final analysis. Fifty-two apps were available for free, 23 of which offered in-app purchases. Among the 17 paid apps, costs ranged between €0.69 (US $0.81) and €450 (US $527) per 12 months. Fifty-eight of 69 apps provided sounds (eg, white noise and nature sounds). Many apps assessed tinnitus characteristics (n=38) and provided information about tinnitus (n=27). The most frequently used BCTs were “instruction on how to perform the behavior” (n=25; eg, audio instructions for relaxation techniques), “feedback on behavior” (n=11), “behavioral practice/rehearsal” (n=11), “information about health consequences” (n=11), “information about emotional consequences” (n=11), and “prompts/cues” (n=11). The number of BCTs implemented varied widely across apps (0-18 per app).

CONCLUSIONS: Most tinnitus apps offer sound-based interventions (eg, white noise and nature sounds). Notably, CBT elements (eg, cognitive restructuring, attention training, and relaxation training) are implemented less frequently, despite CBT being recommended in tinnitus treatment guidelines. Further research on the efficacy of tinnitus apps is needed. Transparent reporting of intervention techniques may help clarify mechanisms of action and support the replication of effective interventions. Given the large number of readily accessible apps, this study provides an overview relevant to both researchers and health care professionals.

PMID:42155139 | DOI:10.2196/66151