Category: Statistics

Soc Sci Med. 2026 Jun 23;404:119519. doi: 10.1016/j.socscimed.2026.119519. Online ahead of print.

ABSTRACT

BACKGROUND: Type 2 diabetes (T2DM) and depression often co-occur, generating substantial health burdens. Social determinants may shape vulnerability to both conditions. Using a syndemic framework, this study examines the clustering of T2DM, depression, education, and place of birth in a large cohort in Piedmont, Italy.

METHODS: We analysed 861,300 males and 917,545 females aged 45-75 years from the Piedmont Longitudinal Study. T2DM and depression were identified from electronic health records; education was classified into three levels, and place of birth as Italy/high-income countries (HIC) versus low- and middle-income countries (LMIC). Latent class analysis identified patterns of clustering. Cox proportional hazards models estimated associations of latent classes (LC) with emergency room (ER) access and all-cause mortality over five years.

RESULTS: Three LC were identified in both sexes. In both, the class with high comorbidity and low education had the poorest outcomes. Among males, this group had 31% higher ER use (95% CI 1.29-1.33) and 60% higher mortality (95% CI 1.55-1.66) than the reference. Among females, risks were 30% higher for ER use (95% CI 1.28-1.33) and 43% higher for mortality (95% CI 1.37-1.49). Migration background influenced outcomes differently: males from LMIC had lower mortality without higher ER use, while females showed slightly higher ER use but lower mortality.

CONCLUSIONS: T2DM and depression cluster with low educational level, with patterns differing by sex and migration background. The syndemic framework highlights the need for integrated interventions addressing both conditions and social determinants to promote health equity.

PMID:42364280 | DOI:10.1016/j.socscimed.2026.119519

Vaccine. 2026 Jun 27;88:128769. doi: 10.1016/j.vaccine.2026.128769. Online ahead of print.

ABSTRACT

BACKGROUND: This open-label randomised phase 2 study aimed to determine whether a single versus two-dose BNT162b2 primary vaccination regimen in children 5 to 11 years old with prior SARS-CoV-2 infection was non-inferior in terms of immunogenicity and superior in terms of safety and reactogenicity.

METHODS: Participants were randomly assigned (1:1) to receive either one or two doses, spaced 3 to 12-weeks. The primary endpoint was geometric mean ratio (GMR) of neutralizing antibodies against wild-type SARS-CoV-2 at 28 days post-vaccination with non-inferiority margin defined as a 1.5-fold change in geometric mean titers (GMT). Secondary endpoints included safety and reactogenicity profile and immunogenicity up to 12 months against wild-type and Variants of Concern (VOCs).

RESULTS: In total 31 participants from 3 European countries (median age 9, IQR7-10) were enrolled from May 2022 to January 2024, when the trial was prematurely terminated due to declining interest in COVID-19 vaccination among age-eligible children. Of these, 15 received two doses, and 16 received one. At day 28, GMT of neutralizing antibodies against wild-type SARS-CoV-2 was 1801.1 IU/mL(95%CI:1357.9-2388.9) in the two-dose arm and 1715.5 IU/mL(95%CI:1064.2-2765.4) in the single-dose arm. However, the non-inferiority of the single-dose could not be demonstrated (GMR:0.9; 95%CI:0.5-1.6). Titers remained above 100 IU/mL in both groups at 6 and 12 months. Both schedules elicited high anti-RBD IgG titers against wild-type and neutralizing titers against BA.5 variant at day 28. Eight participants (53%) in the two-dose arm and five (31%) in the single-dose reported a systemic adverse event grade ≥ 2 (P = 0.18) within 7 days of vaccination.

CONCLUSIONS: Both regimens induced robust and sustained immune responses consistent with the possibility that, in children with prior infection, a single dose functions immunologically as a booster of the humoral response. However, the premature termination renders the primary non-inferiority comparison statistically underpowered. The vaccine was well tolerated in both groups. EudraCT registration: 2021-005043-71.

PMID:42364277 | DOI:10.1016/j.vaccine.2026.128769

Am J Surg. 2026 Jun 27;260:117121. doi: 10.1016/j.amjsurg.2026.117121. Online ahead of print.

ABSTRACT

INTRODUCTION: Constipation following bariatric surgery decreases patient satisfaction and quality of life while increasing healthcare utilization. We evaluate the impact of a preoperative educational handout on constipation-related communication (CRC) and emergency department (ED) visit frequency.

METHODS: Adult patients who underwent bariatric surgery between 2022 and 2023 who either received or did not receive the handout were analyzed. Baseline demographics, medical comorbidities, and rates of CRC and ED visits within 180 days postoperatively were compared using inferential statistics. Number needed-to-treat (NNT) analyses were performed.

RESULTS: 400 patients were included (n = 176 No Handout, n = 224 Handout). Baseline characteristics were comparable. CRCs decreased from 18.8% to 9.4% (p = 0.006), and ED visits decreased from 5.7% to 1.8% (p = 0.035). The NNT for CRC and ED visits were 11 and 26 handouts, respectively.

CONCLUSIONS: Implementation of a low-cost preoperative educational handout significantly reduced postoperative healthcare use, representing a high-value intervention to improve patient outcomes and reduce system burden.

PMID:42364269 | DOI:10.1016/j.amjsurg.2026.117121

J Pediatr Nurs. 2026 Jun 27;90:271-277. doi: 10.1016/j.pedn.2026.06.022. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to examine the effect of psychological resilience on the caregiver burden among parents of children with special needs and the mediating role of internalized stigma.

METHOD: A descriptive, cross-sectional, correlational research design was used. The population consisted of 250 primary caregivers of children with special needs attending a Special Education and Rehabilitation Centre. A total of 235 parents (94%) voluntarily participated. Data were collected through face-to-face interviews between January-April 2025 using the Personal Information Form, the Brief Resilience Scale, the Affiliate Stigma Scale, and the Zarit Burden Interview. IBM SPSS v23 and AMOS v24 were used for statistical analyses. Mediation was tested using path analysis with the Maximum Likelihood estimation. The significance level was p < 0.05.

RESULTS: Psychological resilience showed a weak negative correlation with caregiver burden (r = -0.329) and a moderate negative correlation with internalized stigma (r = -0.412), while internalized stigma showed a moderate positive correlation with caregiver burden (r = 0.446) (p < 0.001). Internalized stigma significantly mediated the relationship (indirect effect = 0.188; p < 0.001).

CONCLUSION: Enhancing psychological resilience reduces caregiver burden both directly and indirectly by decreasing internalized stigma.

PRACTICE IMPLICATIONS: Strengthening psychological resilience and reducing internalized stigma are critical for the sustainability of the caregiving process. Nurses can facilitate the establishment of social support networks among mothers/fathers who share similar experiences by forming parent support groups. Psychiatric and pediatric nurses can cooperate with psychologists, special education specialists, and social service workers to draw up a care plan that takes into account psychosocial factors such as psychological resilience and stigma.

PMID:42364267 | DOI:10.1016/j.pedn.2026.06.022

J Pediatr Nurs. 2026 Jun 27;90:264-270. doi: 10.1016/j.pedn.2026.06.020. Online ahead of print.

ABSTRACT

PURPOSE: This study examined the relationship between parental phubbing and social ostracism among adolescents.

METHODS: This correlational cross-sectional study was conducted between April 2025 and June 2025 using a cluster sampling method with 597 adolescents aged 11-15 living in a province in eastern Turkey. Data were collected using a ‘Personal Information Form,’ the ‘Parental Phubbing Scale,’ and the ‘Ostracism Scale for Adolescents’.

RESULTS: The mean total score for parental phubbing among adolescents was 20.72 ± 8.44; the mean total score for social ostracism was 22.32 ± 8.42. A significant difference was found in the relationship between parental phubbing levels and the number of siblings and family type (p < 0.05). A significant difference was found in the relationship between social ostracism levels and family income, the individuals with whom they lived, participation in school activities, and school success (p < 0.05). A strong, positive, and significant relationship (r = 0.667) was found between parental phubbing and social ostracism (p < 0.01). Parental phubbing was found to predict social ostracism at a significant level (β = 0.239, p = 0.001).

CONCLUSIONS: Levels of parental phubbing and perceived social ostracism were low among adolescents. It was concluded that there was a statistically positive and strong relationship between parental phubbing and social ostracism. It was determined that as parental phubbing increased, social ostracism among adolescents increased.

PRACTICAL IMPLICATIONS: Interventions and strategies that help parents balance phubbing behavior with parental responsibilities should be prioritized to support children’s healthy development and overall well-being.

PMID:42364266 | DOI:10.1016/j.pedn.2026.06.020

Clin Radiol. 2026 Jun 1;99:107403. doi: 10.1016/j.crad.2026.107403. Online ahead of print.

ABSTRACT

AIM: To qualitatively and quantitatively compare dual-energy computed tomography (DECT)-derived 55 keV virtual monochromatic images (VMIs) using deep learning image reconstruction (DLIR) with 70 keV VMIs using adaptive statistical iterative reconstruction (ASiR-V) in the Gastrointestinal (GI) system tumors and to investigate whether DLIR can influence the measured iodine parameters.

MATERIALS AND METHODS: This prospective, observational study included 47 patients with GI system tumors who underwent DECT. Qualitative and quantitative assessment was performed on 70 keV VMIs using ASiR-V40%, and 55 keV VMIs using DLIR at low (DLIR-L), medium (DLIR-M), and high strength (DLIR-H). Quantitative evaluation included calculation of the contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR). Overall image quality, lesion conspicuity, and diagnostic confidence were evaluated qualitatively by 2 radiologists. Iodine parameters of tumor lesions were compared among four groups of algorithms.

RESULTS: There were no significant differences in the image noise between DLIR-M and ASiR-V40%, whereas image noise was significantly lower in DLIR-H than ASiR-V40% and DLIR-M (both phases, P < 0.001). DLIR-M and DLIR-H had significantly higher CNR and SNR compared with ASiR-V40% on both phases (all P ≤ 0.001). When compared to ASiR-V40%, DLIR-M and DLIR-H had similar or improved qualitative assessment metrics. DLIR-L yielded the highest image noise and the lowest overall image quality score among these algorithms. Lastly, the measured iodine parameters were equivalent among different algorithms (all P > 0.1).

CONCLUSION: Abdominal DECT at 55 keV with DLIR (-M and -H) provided qualitative and quantitative performance for GI tumor evaluation comparable to or exceeding that of ASiR-V 40% at 70 keV.

PMID:42364263 | DOI:10.1016/j.crad.2026.107403

Eurasian J Med. 2026 May 12;58(3):1-6. doi: 10.5152/eurasianjmed.2026.25961.

ABSTRACT

BACKGROUND: Psychiatric intensive care units have significant implications for patient safety and clinical outcomes. Understanding the demographic and clinical characteristics of restrained patients is essential for developing evidence-based protocols and reducing unnecessary restraint use. The aim of this retrospective descriptive cross-sectional study was to determine the clinical and demographic characteristics of patients subjected to physical restraint in a psychiatric intensive care unit.

METHODS: This descriptive cross-sectional study analyzed 138 patients subjected to physical restraint in a psychiatric intensive care unit between January 2023 and December 2023. Data were collected through systematic chart review using a standardized physical restraint monitoring form from the Hospital Quality and Standards System, designed specifically for type 2 (behavioral safety) restraint documentation. Variables included demographic characteristics, primary diagnoses, restraint indications, and clinical outcomes. Statistical analysis was performed using SPSS, version 28.0. The study followed STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Statistical analysis was performed using descriptive statistics.

RESULTS: Out of 138 patients, 95 (68.8%) were male with a mean age of 51.48 Å} 15.02 years. Primary restraint indications included noncompliance with medical treatment (39 patients, 28.3%), severe agitation (37 patients, 26.8%), orientation disturbances (32 patients, 23.2%), and self-harm behaviors (30 patients, 21.7%). The most common primary diagnoses were nonorganic psychosis (55 patients, 39.9%), bipolar disorder (30 patients, 21.7%), and delirium tremens (20 patients, 14.5%). Mean intensive care unit length of stay was 11.87 Å} 14.04 days.

CONCLUSION: This study provides essential baseline data on physical restraint use in psychiatric intensive care, demonstrating male predominance and identifying key clinical indicators. These findings support the development of targeted interventions and evidence-based restraint protocols to optimize patient care while minimizing restrictive practices. Cite this article as: Cengisiz C, Nehir S. Clinical and demographic characteristics of patients subjected to physical restraint in a psychiatric intensive care unit: A retrospective descriptive cross-sectional study. Eurasian J Med. 2026, 58(3), 0961, doi: 10.5152/ eurasianjmed.2026.25961.

PMID:42364235 | DOI:10.5152/eurasianjmed.2026.25961

Acta Orthop Traumatol Turc. 2026 Apr 8;60(2). doi: 10.5152/j.aott.2026.25618.

ABSTRACT

The primary objective of this study is to compare the quality and readability of patient education materials generated by a general-purpose large language model (ChatGPT-5) versus a guideline-based, fine-tuned model (the Gonarthrosis Advisor). The study aims to quantify the performance gains achieved through domain-specific, fine-tuning, and reinforcement learning using osteoarthritis clinical guidelines. Methods: Thirty frequently asked patient questions regarding knee osteoarthritis were compiled from Google’s “People Also Ask” feature and outpatient clinical observations in May 2025. Responses were generated in Turkish by both the Gonarthrosis Advisor and ChatGPT-5 to reflect real-world patient education materials. Content quality was assessed by 2 independent orthopedic surgeons who were blinded to model identity to minimize bias. Both reviewers were co-authors of the article yet did not participate in model construction or data analysis. The assessments utilized the DISCERN instrument, a validated 16-item measure for evaluating the reliability and quality of treatment-related information. Readability was analyzed using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), and Turkish specific indices (Ateşman and Çakır-Demir). For comparability, English-based indices were applied to translated versions of the responses, whereas Turkish indices were applied to the original texts. All responses were anonymized and randomized prior to evaluation. Model identifiers were removed, and each response was presented in a standardized format to ensure blinding of reviewers. Inter-rater reliability was measured using Cronbach’s α. Normality assumptions were tested, and Wilcoxon signed-rank tests were used for statistical comparisons. As no human subjects or personal data were involved, ethical approval was not required. Results: Mean DISCERN scores corresponded to the “good” category (66.4) for the Gonarthrosis Advisor and the ‘moderate’ category (54.2) for ChatGPT-5, according to established cut-off thresholds. The Gonarthrosis Advisor achieved significantly higher DISCERN scores than ChatGPT-5 (66.4 ± 4.8 vs. 54.2 ± 5.6; P < .001) with high inter-rater reliability (Cronbach’s α = 0.86). Readability metrics favored the Gonarthrosis Advisor across all indices: lower FKGL (7.8 ± 0.7 vs. 9.6 ± 0.9) and higher FRES (54.3 ± 3.4 vs. 46.7 ± 3.7), Ateşman (92.0 ± 4.2 vs. 84.3 ± 4.9), and Çakır-Demir (111.7 ± 5.1 vs. 106.9 ± 5.4) scores (all P <.001). Conclusion: Fine-tuning large language models with guideline-based content and reinforcement learning improves the quality, neutrality, and accessibility of artificial intelligence-generated patient education materials, offering a scalable tool to enhance health literacy and support shared decision-making in knee osteoarthritis care. Cite this article as: Öner SK, Demirkiran ND, Canlı EA, Bilir A. Gonarthrosis Advisor vs ChatGPT-5: quality and readability of AI-generated patient education for knee osteoarthritis. Acta Orthop Traumatol Turc., 2026, 60(2), 0618, doi: 10.5152/j.aott.2026.25618.

PMID:42364231 | DOI:10.5152/j.aott.2026.25618

Urol Res Pract. 2026 May 20;52:1-6. doi: 10.5152/tud.2026.26015.

ABSTRACT

OBJECTIVE: Renal stone formation is closely linked to disturbances in urinary and serum mineral metabolism. Analysis of stone composition along with biochemical parameters is essential for understanding the pathogenesis of different stone types.

METHODS: A prospective observational study was conducted among 371 patients with renal stones. Stone composition was analyzed using Fourier transform infrared spectroscopy, X-ray diffraction, and scanning electron microscopy- Energy-Dispersive X-ray Spectroscopy techniques. Serum and 24-hour urinary biochemical parameters, including calcium, oxalate, citrate, phosphate, uric acid, pH, and urine volume, were evaluated. Statistical analysis was performed to assess differences and correlations between stone types and biochemical variables.

RESULTS: The mean age was 45.3 years, with male predominance and 39.9% recurrence. Calcium oxalate monohydrate was most common. Stone types differed significantly in urinary volume, pH, and mineral excretion. Uric acid stones showed low urine pH and volume, while calcium phosphate stones had higher calcium excretion and alkaline pH, with related serum differences.

CONCLUSION: Renal stone composition is strongly associated with specific urinary and serum biochemical abnormalities. Metabolic evaluation is crucial for identifying etiological factors and for guiding individualized preventive strategies in stone disease management. Cite this article as: Prakash P, Agarwal S, Sarpal R, Dogra AK, Prakash A. Composition and biochemical determinants of renal stones: A comprehensive analysis of urinary and serum mineral profiles. Urol Res Pract. 2026, 52, 0015, doi: 10.5152/tud.2026.26015.

PMID:42364224 | DOI:10.5152/tud.2026.26015

Eurasian J Med. 2026 Jun 11;58(4):1-5. doi: 10.5152/eurasianjmed.2026.261359.

ABSTRACT

BACKGROUND: Deaths due to lightning strikes are rare but of great forensic importance because of their sudden and fatal nature. This study aimed to evaluate the demographic characteristics, scene findings, and autopsy results of fatal lightning strike cases examined in Kars and Ardahan provinces.

METHODS: This retrospective study included 13 cases of death by lightning strike, identified from 847 autopsies performed in 2 climatically similar provinces between 2019 and 2025 via the National Judicial Network Project (UYAP) database. The research evaluates the victims’ demographic data, incident location characteristics, and macroscopic autopsy findings, alongside negative toxicological and histopathological examination results. The data were analyzed using the SPSS software, utilizing descriptive statistical methods such as frequency, percentage distribution, and mean values.

RESULTS: Between 2019 and 2025, 1.53% (n = 13) of forensic autopsies in Kars and Ardahan were attributed to lightning strikes, with all cases involving male victims and a mean age of 31.3 years. The majority of cases were shepherds (69.2%), and deaths occurred most frequently in rural pastures during the spring and summer months, particularly in May and June. While all cases exhibited first- and second-degree burns and singed body hair, characteristic Lichtenberg figures were detected in 46.1% of the victims alongside various internal hemorrhages in some instances. Crime scene investigations provided critical diagnostic evidence, including the presence of deceased livestock near the victims and partially burned or torn personal belongings.

CONCLUSION: Lightning-related deaths show a strong association with seasonal, occupational, and environmental factors. Scene investigation and the recognition of Lichtenberg figures play a crucial role in the forensic diagnosis of lightning strike fatalities. Cite this article as: Sancı A, Karaalp E, Baltacı AS, Vural T. Evaluation of lightning strike fatalities: a retrospective autopsy study from 2 centers in eastern Türkiye. Eurasian J Med. 2026, 58(4), 1359, doi: 10.5152/eurasianjmed.2026.261359.

PMID:42364222 | DOI:10.5152/eurasianjmed.2026.261359