Category: Statistics

Surg Laparosc Endosc Percutan Tech. 2026 Feb 4. doi: 10.1097/SLE.0000000000001447. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the impact of preoperative nasopancreatic duct stent placement on local resection of benign pancreatic tumors, particularly its efficacy in reducing secondary surgeries due to postoperative pancreatic fistula.

METHODS: The clinical data of 306 patients with benign pancreatic tumors larger than 2 cm who underwent local resection at the Department of Pancreatic Surgery, Hubei Provincial People’s Hospital, over the past 6 years were retrospectively analyzed. Propensity score matching was used to minimize the selection bias.

RESULTS: The incidence of grade C pancreatic fistula in the nasopancreatic duct placement group was 5% (2/40), significantly lower than the 20% (32/160) observed in the non-nasopancreatic duct placement group, with a statistically significant difference (Fisher exact test, P=0.02). In addition, the rate of secondary surgery in the nasopancreatic duct placement group was 5% (2/40), significantly lower than the 16% (29/160) in the non-nasopancreatic duct placement group (Fisher exact test, P=0.04). However, there was no significant difference in the incidence of postoperative complications such as septic shock, overall pancreatic fistula, and postoperative mortality between the 2 groups.

CONCLUSION: Preoperative nasopancreatic duct stent placement is a safe and effective procedure that significantly reduces the incidence of grade C pancreatic fistula following surgery for benign pancreatic tumors. Consequently, this decreases the necessity for secondary interventions related to grade C pancreatic fistula, ultimately enhancing patient prognosis and quality of life.

PMID:41707215 | DOI:10.1097/SLE.0000000000001447

JMIR Public Health Surveill. 2026 Feb 18;12:e79720. doi: 10.2196/79720.

ABSTRACT

BACKGROUND: The growing use of artificial intelligence (AI) chatbots for seeking health-related information is concerning, as they were not originally developed for delivering medical guidance. The quality of AI chatbots’ responses relies heavily on their training data and is often limited in medical contexts due to their lack of specific training data in medical literature. Findings on the quality of AI chatbot responses related to health are mixed. Some studies showed the quality surpassed physicians’ responses, while others revealed occasional major errors and low readability. This study addresses a critical gap by examining the performance of various AI chatbots in a complex, misinformation-rich environment.

OBJECTIVE: This study examined AI chatbots’ responses to human papillomavirus (HPV)-related questions by analyzing structure, linguistic features, information accuracy and currency, and vaccination stance.

METHODS: We conducted a qualitative content analysis following the approach outlined by Schreier to examine 4 selected AI chatbots’ (ChatGPT 4, Claude 3.7 Sonnet, DeepSeek V3, and Docus [General AI Doctor]) responses to HPV vaccine questions. These questions, simulated by young adults, were adapted from items on the Vaccine Conspiracy Beliefs Scale and Google Trends. The selection criteria for AI chatbots included popularity, accessibility, countries of origin, response update methods, and intended use. Two researchers, simulating a 22-year-old man or woman, collected 8 conversations between February 22 and 28, 2025. We used a deductive approach to develop initial code groups, then an inductive approach to generate codes. The responses were analyzed based on a comprehensive codebook, with codes examining response structure, linguistic features, information accuracy and currency, and vaccination stance. We also assessed readability using the Flesch-Kincaid Grade Level and Reading Ease Score.

RESULTS: All AI chatbots cited evidence-based sources from reputable health organizations. We found no fabricated information or inaccuracies in numerical data. For complex questions, all AI chatbots appropriately deferred to health care professionals’ suggestions. All AI chatbots maintained a neutral or provaccine stance, corresponding with scientific consensus. The mean and range of response lengths varied [word count; ChatGPT: 436.4 (218-954); Claude: 188.0 (138-255); DeepSeek: 510.0 (325-735); and Docus: 159.4 (61-200)], as did readability [Flesch-Kincaid Grade Level; ChatGPT: 10.7 (6.0-14.9); Claude: 13.2 (7.7-17.8); DeepSeek: 11.3 (7.0-14.7); and Docus: 12.2 (8.9-15.5); and Flesch-Kincaid Reading Ease Score; ChatGPT: 46.8 (25.4-72.2); Claude: 32.5 (6.3-67.3); DeepSeek: 43.7 (22.8-67.4); and Docus: 40.5 (19.6-58.2)]. ChatGPT and Claude offered personalized responses, while DeepSeek and Docus lacked this. Occasionally, some responses included broken or irrelevant links and medical jargon.

CONCLUSIONS: Amidst an online environment saturated with misinformation, AI chatbots have the potential to serve as an alternative source of accurate HPV-related information to conventional online platforms (websites and social media). Improvements in readability, personalization, and link accuracy are still needed. Furthermore, we recommend that users treat AI chatbots as complements, not replacements, to health care professionals’ guidance on clinical settings.

PMID:41707197 | DOI:10.2196/79720

JMIR Mhealth Uhealth. 2026 Feb 18;14:e81779. doi: 10.2196/81779.

ABSTRACT

BACKGROUND: Goal personalization features integrated into mobile health apps have the potential to enhance physical activity, as some evidence shows that the personalized goals generated by algorithms are more effective than default or fixed goals. However, it remains unclear whether goals set by users are more effective than fixed goals and which personalization strategy is more effective for different user segments.

OBJECTIVE: This field study aimed to evaluate (1) the efficacy of 2 step goal personalization strategies-personalized-by-you and personalized-by-the-algorithm-and (2) which strategy is more effective among users with different activity levels.

METHODS: All users of SamenGezond, a Dutch mobile health app, have a default goal of 2000 steps per day, 5 days a week. For this study, 2 random groups were selected, totaling 5800 users. Subsequently, an email was sent to 3800 users in group 1, asking whether they were satisfied with their current goal. Those who were not satisfied were offered 2 personalization options: to set a goal themselves or to have the algorithm integrated in the app set goals for them. In total, 1399 users responded: 230 chose to set their own goals (personalized-by-you group), 236 opted for setting the goal by the algorithm (personalized-by-the-algorithm group), and 933 chose to keep the default goal (not-changed group). The algorithm used a moving-window percentile rank method based on step data from the previous 4 weeks. Users who did not personalize retained the default goal. The remaining 2000 users in group 2 did not receive the email and also retained the default goal. To evaluate the effectiveness of step goal personalization strategies, we used propensity score matching and difference-in-difference analysis.

RESULTS: Users in the personalized-by-you group increased weekly step count by 3793 a week, while those in the personalized-by-the-algorithm group increased by 4315 steps a week, compared with the not-changed group (users with default goals). The 2 strategies appear to have a similar effect. Interestingly, users in the not-changed group also increased their weekly steps by 1759. Furthermore, the effectiveness of each strategy varied by baseline activity level. The personalized-by-you strategy was effective for medium- (increase of 5842 steps) and high-active users (increase of 4266 steps) but not for low-active users (increase of 384 steps; P=.82). Conversely, the personalized-by-the-algorithm strategy was effective for low- (increase of 5095 steps) and medium-active users (increase of 5278 steps) but not for high-active users (increase of 1446 steps; P=.51).

CONCLUSIONS: Step goal personalization demonstrates short-term effectiveness. However, their impact varies by users’ baseline activity levels, indicating the need for a tailored approach for different user segments. Future studies should examine the long-term effects of such interventions to design sustainable health behavior change strategies.

PMID:41707195 | DOI:10.2196/81779

JMIR Res Protoc. 2026 Feb 18;15:e84610. doi: 10.2196/84610.

ABSTRACT

BACKGROUND: HIV/AIDS is a disease associated with stigma and discrimination. This can hinder the adoption of preventive and treatment methods, especially in vulnerable populations, such as the transgender community.

OBJECTIVE: The primary objectives of this study are to explore awareness barriers related to HIV/AIDS, develop and pilot a mobile-based HIV awareness app, and evaluate its acceptability and usability within the transgender community.

METHODS: The research will employ a quasi-experimental design, utilizing a pre- and posttest comparison between an intervention group that will use the mobile app and a comparison group that will not. Phase 1 involves a situational analysis, including key informant interviews, focus group discussions, and a cross-sectional survey. An app will be designed and developed in Phase 2. Phase 3 will comprise a preintervention assessment recruiting 150 transgender people, implementation of the app on the cell phones of 75 transgender people, and a postapp assessment. Statistical techniques will be employed to analyze the captured data and assess the effectiveness of the app.

RESULTS: The recruitment began on August 25, 2025, for the first phase, with the subsequent phases to follow. The data collection and analysis will be completed and finalized by August 31, 2026, following the intervention deployment. No funding was received from any external source for this study.

CONCLUSIONS: The results of this study will reveal the effectiveness of a mobile app for the transgender community. These results will determine the continuation and further scale-up of this intervention. The findings will create evidence to inform favorable strategies for vulnerable populations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/84610.

PMID:41707188 | DOI:10.2196/84610

JMIR Hum Factors. 2026 Feb 18;13:e85412. doi: 10.2196/85412.

ABSTRACT

BACKGROUND: Although fitness apps could promote healthier lifestyles, evidence on the effectiveness of app-based interventions remains inconsistent. Previous studies have used affordance theory to identify the factors that generate exercise-related value for users. However, many fitness app affordance studies have examined multiple fitness apps collectively, assuming similar design intentions across platforms. Moreover, most have relied on predefined affordances rather than investigating emergent or novel ones that may reveal unique user-fitness app interactions.

OBJECTIVE: This study aimed to identify the common affordances actualized by Fitbit users and uncover novel affordances that emerge from their interactions with this specific app, thereby extending the understanding of how affordances contribute to user engagement and health outcomes.

METHODS: We used a 2-stage mixed methods design. First, a cross-sectional web-based survey was conducted with 442 US-based Fitbit users engaging in regular exercise. The participants selected affordances from a list identified in prior literature and could report additional affordances in open-text responses. To corroborate and extend the survey findings, 15,000 user reviews were collected from the Google Play Store, of which 2674 (17.8%) comments were automatically categorized into affordance themes and 1182 (7.9%) were manually validated as relevant. Reviews were thematically classified into affordance categories via a generative pretrained transformer-based approach guided by survey-identified affordances.

RESULTS: The survey revealed that the most frequently actualized affordances were updating (351 participants and 749 review mentions; total=1100) and reminding (319 participants and 143 mentions; total=462), underscoring Fitbit’s role in tracking progress and sustaining routines. Competing (99 participants and 88 mentions; total=187) and rewards (133 participants and 32 mentions; total=165) highlighted gamification, whereas comparing (151 participants and 8 mentions; total=159) and guidance (118 participants and 25 mentions; total=143) reflected benchmarking and instructional support. Other affordances such as searching (135 participants and 2 mentions; total=137), encouraging (75 participants and 19 mentions; total=94), and watching others (68 participants and 3 mentions; total=71) were less common, whereas recognizing (58 participants and 0 mentions; total=58) and self-presentation (47 participants and 1 mention; total=50) were the least common. The novel affordances included encouraging others (14 participants and 1 mention; total=15), accountability (3 participants and 9 mentions; total=12), and self-comparison (3 participants and 5 mentions; total=8).

CONCLUSIONS: Most Fitbit users actualized updating and reminding affordances, whereas a limited number of users actualized the other affordances. Moreover, few Fitbit users actualized novel affordances that reflect self-regulation, an extension of social connection, and personal meaning. This study emphasizes that Fitbit should focus on core tracking and reminding for most users while providing optional features that foster guidance, community, accountability, and personal relevance. Designing features that facilitate the actualization of common and novel affordances may improve app effectiveness and, ultimately, the health benefits of fitness technologies.

PMID:41707184 | DOI:10.2196/85412

JMIR Hum Factors. 2026 Feb 18;13:e70370. doi: 10.2196/70370.

ABSTRACT

BACKGROUND: Antenatal care has been crucial in reducing maternal mortality. Currently, screening programs of pregnant women include blood pressure (BP) measurements, urine protein tests, and the identification of risk factors. Home monitoring can enhance the early detection and management of pregnancy-related hypertension, while also empowering women to take an active role in their own health care.

OBJECTIVE: This study aimed to evaluate the reliability and accuracy of contactless BP monitoring using the Anura smartphone app and to compare it to conventional manual cuff measurements. This was done in normotensive and high-risk pregnancies, as well as in women diagnosed with preeclampsia. A secondary objective was to assess women’s experience using the Anura app.

METHODS: Pregnant women with normotensive or high-risk pregnancies were enrolled from pregnancy weeks 8-14, and women with preeclampsia were enrolled at the time of diagnosis. The 3 study groups consisted of 132 women with normotensive pregnancies, 40 women with high-risk pregnancies, and 87 women with preeclampsia. They were instructed to use the Anura smartphone app and perform a 30-second facial scan, alongside manual BP measurements, throughout pregnancy. Differences between the 2 methods were analyzed with linear mixed models accounting for repeated measures, reporting beta coefficients with 95% CIs, stratified by patient group and trimester. Outliers were detected visually in the Bland-Altman plots. A digital survey was answered in the Anura app at gestational weeks 37-39, about their experiences using the Anura app.

RESULTS: A total of 4932 BP measurements were recorded with Anura, of which 539 had corresponding manual measurements. In normotensive pregnancies, Anura consistently showed slightly higher diastolic values (approximately 5-7 mm Hg) and lower systolic values, with significant differences in the second and third trimesters. In high-risk pregnancies, both the systolic and diastolic BP were generally lower with Anura, especially in the second and third trimesters, while women with preeclampsia showed the largest differences, with Anura clearly showing lower systolic and diastolic values. Bland-Altman analyses confirmed these patterns and showed increasing variability and wider limits of agreement in the high-risk pregnancies with preeclampsia. Of 172 women with normotensive and high-risk pregnancies, 56 (32.5%) evaluated their experiences that were predominantly positive, with high perceived safety, better control, and a feeling of increased responsibility for their own health. Some experienced the measurement as somewhat uncomfortable.

CONCLUSIONS: The Anura app is well accepted by pregnant women and supported them to take an active role in their own health care. Agreement with manual BP measurements was acceptable in normotensive pregnancies but lower in high-risk and preeclamptic pregnancies. These findings indicate potential for Anura as a complementary self-monitoring tool. Further development is needed to improve the app’s accuracy in high-risk groups before broader implementation can be recommended.

PMID:41707183 | DOI:10.2196/70370

J Am Med Inform Assoc. 2026 Feb 18:ocaf226. doi: 10.1093/jamia/ocaf226. Online ahead of print.

ABSTRACT

OBJECTIVES: To detail patient challenges, and how technology support addressed them, in a remote patient activation intervention for hemodialysis patients (n = 93) from trained patient mentors (n = 26).

MATERIALS AND METHODS: Using digital divide theory-derived codes, content analysis of: technology support program delivery data, hemodialysis clinic staff interviews, and support staff reflection papers. Descriptive statistics from postintervention mentee/mentor surveys.

RESULTS: All mentees and 46.2% of mentors received support. Motivational access was targeted with explanations, rapport, and support availability. Study-provided, data-capable tablets enhanced material access, but internet access barriers persisted. Skills access was addressed by training; password-related challenges initially dominated. For usage access, on-demand technology support was balanced by engagement support: proactive prementoring session calls and login monitoring.

DISCUSSION: Interventionists should examine internet coverage in targeted areas, potentially using multiple carriers. A balance between password usability and security is required. Engagement support may be needed.

CONCLUSION: Technology support can close patient digital divides.

PMID:41707178 | DOI:10.1093/jamia/ocaf226

JMIR Mhealth Uhealth. 2026 Feb 18;14:e70429. doi: 10.2196/70429.

ABSTRACT

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a prevalent chronic metabolic disorder that poses substantial challenges to global health care systems and patient management. Telemedicine, defined as the use of information and communication technologies to enhance health care delivery, has emerged as a potential tool to improve access to care and facilitate the management of T2DM.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the clinical effectiveness of various telemedicine interventions compared with usual care in glycemic control, and cardiovascular health in adults with T2DM.

METHODS: A comprehensive literature search was conducted across databases such as PubMed, Cochrane Library, and Web of Science for randomized controlled trials (RCTs) published up to August 23, 2024. Eligible RCTs compared telemedicine interventions with usual care in adults with T2DM. The primary outcome assessed was hemoglobin A_1c (HbA_1c) levels, while the secondary outcomes included mean glucose, fasting blood glucose, BMI, weight, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. The quality of the included studies was examined via the Cochrane risk-of-bias tool. Data were extracted and analyzed using a random-effects model, and meta-regression was performed to explore potential moderators. The quality of the evidence was assessed via the Grading of Recommendations, Assessment, Development, and Evaluation approach.

RESULTS: A total of 58 RCTs, encompassing 13,942 participants, were included in the analysis. Our findings showed that telemedicine interventions significantly improved HbA_1c levels compared with usual care (mean difference [MD] -0.38, 95% CI -0.49 to -0.27; Z=6.94; P<.001), despite high heterogeneity (I²=96%). Significant effects were also found for fasting blood glucose (MD -11.29, 95% CI -17.65 to -4.93; Z=3.48; P<.001), weight (MD -1.33, 95% CI -2.23 to -0.44; Z=2.91; P=.004), BMI (MD -0.43, 95% CI -0.72 to -0.13; Z=2.84; P=.004), systolic blood pressure (MD -2.14, 95% CI -3.02 to -1.26; Z=4.76; P<.001), and diastolic blood pressure (MD -1.24, 95% CI -2.02 to -0.46; Z=1.10; P=.002). No significant between-group differences were found in high-density lipoprotein cholesterol and low-density lipoprotein cholesterol improvement. Subgroup analyses revealed that telemedicine delivered by physicians, dietitians, and researchers achieved the most significant reductions in HbA_1c levels. Short-term and long-term interventions showed significant HbA_1c improvements, while medium-term interventions did not achieve statistical significance. Meta-regression analysis did not identify any statistically significant moderators.

CONCLUSIONS: This review highlights telemedicine’s superior effectiveness over usual care in improving HbA_1c levels in patients with T2DM, regardless of the type of intervention. Telemedicine led by physicians, dietitians, and researchers showed the greatest efficacy in managing blood glucose levels. Furthermore, telemedicine interventions show promise for monitoring weight and cardiovascular health in patients with T2DM.

TRIAL REGISTRATION: PROSPERO CRD42024608130; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=608130.

PMID:41707176 | DOI:10.2196/70429

Neurology. 2026 Mar 24;106(6):e214616. doi: 10.1212/WNL.0000000000214616. Epub 2026 Feb 18.

ABSTRACT

BACKGROUND AND OBJECTIVES: Early exposure to lead has known neurocognitive impacts in childhood, but few studies have examined the long-term impacts extending into later adulthood. We estimated associations between prenatal and early postnatal lead exposure and later adulthood cognitive function and examined specific periods of exposure and effect modification by sex.

METHODS: The St. Louis Baby Tooth-Later Life Health study (SLBT) is a prospective cohort study that re-enrolled participants of the Baby Tooth Survey, originally centered in St. Louis, MO, who had donated their deciduous teeth between 1958 and 1972. SLBT participants completed surveys and a battery of cognitive tests in later adulthood. Tooth dentin lead concentrations were assessed using laser ablation inductively coupled plasma mass spectrometry across prenatal (second and third trimesters) and early postnatal periods. Cognitive function was assessed using a computerized cognitive battery taken at home using computers or personal digital devices. We used weighted generalized estimating equations to estimate associations between lead exposure and a composite outcome of later adulthood cognitive function.

RESULTS: A total of 715 participants (52% female, mean age at cognitive testing: 62 years) had completed tooth metals analysis. The association between lead and performance on the vocabulary test was positive and statistically significantly different from the other tests. For each part per million (ppm) higher second trimester tooth dentin lead concentration, performance on a composite of tests excluding vocabulary was 0.07 SDs lower (95% CI -0.15 to 0.02). This effect was similar when coadjusting for third trimester and postnatal lead. These findings were driven by females, among whom each 1 ppm higher second trimester lead concentration was statistically significantly associated with 0.16 SD worse cognitive function (95% CI -0.29 to -0.03), equivalent to a 3-year difference in age in the same model. The results were robust to adjustment for additional potential sources of confounding and alternate methods of averaging tooth lead concentrations.

DISCUSSION: We found suggestive evidence for associations between early lead exposures and later adulthood cognitive function, although these only reached statistical significance for second trimester lead exposure among females. A coadjusted analysis suggested the second trimester may be most relevant for later cognitive function.

PMID:41707109 | DOI:10.1212/WNL.0000000000214616

JCO Clin Cancer Inform. 2026 Feb;10:e2500210. doi: 10.1200/CCI-25-00210. Epub 2026 Feb 18.

ABSTRACT

PURPOSE: Artificial intelligence (AI) is fast becoming a vital part of health care, dramatically affecting physicians’ workflows and patients’ outcomes. Understanding patients’ opinions on its use is thus essential to ensure its successful adoption. This study aims to evaluate public perceptions of AI in health care and explore patient feedback through a survey.

METHODS: From January 2023 to June 2024, a survey on AI in health care was distributed to the public via a QR code shared through social media, posters, and videos, reaching 454 participants, of whom 240 completed the survey. Adapted from a validated 2020 model by Esmaeilzadeh et al, the survey underwent careful translation and cultural adjustments for the Italian population, including forward-backward translation and pilot testing. The survey assessed topics like willingness to use AI, performance anxiety, liability concerns, privacy issues, and its effect on doctor-patient communication. Responses were scored, with lower scores indicating greater acceptance of AI.

RESULTS: The survey showed that 96% supported AI as a tool to assist radiologists and 92% were open to using AI for diagnostics and treatments. Concerns included reliability (61%) and reduced personal interaction (58%). Seventy-two percent trusted AI with data privacy. Overall, 90.4% viewed AI positively.

CONCLUSION: The study highlights a balanced perspective on AI in health care. While recognizing its potential to enhance diagnostics and treatments, participants raised concerns about reliability, accountability, and interpersonal impacts. Most supported AI as a tool to complement, not replace, human expertise, emphasizing the need for transparent, reliable systems.

PMID:41707098 | DOI:10.1200/CCI-25-00210