Category: Statistics

Prim Care Companion CNS Disord. 2026 May 26;28(3):25m04143. doi: 10.4088/PCC.25m04143.

ABSTRACT

Objective: To compare the efficacy of lorazepam and diazepam in managing alcohol withdrawal and associated anxiety and depressive symptoms in alcohol dependence syndrome.

Methods: Sixty male patients diagnosed with alcohol dependence syndrome (International Classification of Diseases, Eleventh Revision) were randomly assigned to receive lorazepam or diazepam using a symptom-triggered oral detoxification protocol. Baseline assessments included the Severity of Alcohol Dependence Questionnaire (mean score = 22.6 ± 4.81) and the Clinical Institute Withdrawal Assessment for Alcohol-Revised (mean CIWA-Ar score= 10.98±2.45). Anxiety and depression were measured using the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) at baseline, postdetoxification, and 12 weeks. Benzodiazepines were gradually tapered and stopped after detoxification.

Results: Participants (mean age of 40.85 ± 8.30 years) showed comparable baseline withdrawal severity (CIWA-Ar P = .795) and similar reductions after detoxification (P = .999) and at 12 weeks (P = .321). Time to >50% symptom reduction was slightly shorter with diazepam (4.6 vs. 4.97 days; P = .241). Both groups demonstrated improvement in anxiety and depression, with slightly greater reductions in the lorazepam group, though differences were not statistically significant (HAM-A: P = .146; HAMD-D: P = .103).

Conclusions: Lorazepam and diazepam are equally effective in managing alcohol withdrawal.

Trial Registration: Clinical Trial Registry-India identifier: CTRI/2023/09/057998.

Prim Care Companion CNS Disord 2026;28(3):25m04143.

PMID:42214083 | DOI:10.4088/PCC.25m04143

JMIR Biomed Eng. 2026 May 29;11:e91138. doi: 10.2196/91138.

ABSTRACT

BACKGROUND: Family caregivers experience significant stress due to intensive caregiving activities, making them highly susceptible to adverse psychosocial health conditions. Early detection of this stress is crucial for timely interventions to prevent disease progression and long-term disability.

OBJECTIVE: This study aimed to develop and validate the Linguistic and Acoustic Speech Analytics Program, a novel machine learning approach capable of providing a fusion analysis of linguistic and acoustic speech features to enhance the effectiveness of psychosocial stress assessment.

METHODS: This quantitative study analyzed speech data collected from 100 Chinese family caregivers. Participants responded to 12 open-ended questions, and their voices were recorded for linguistic and acoustic feature extraction. Various machine learning classifiers, including support vector machine, were developed to process speech data. A key methodological step was the application of an orthogonalization procedure to decorrelate acoustic features from linguistic features before fusion analysis. The classifiers were then trained to evaluate psychosocial stress levels based on the processed and fused linguistic and acoustic speech features. Model performance was measured using receiver operating characteristic-area under the curve, F1-score, and accuracy.

RESULTS: The linear support vector machine model emerged as the top performer, achieving a receiver operating characteristic-area under the curve of 78.28%, an F1-score of 75.27%, and an accuracy of 73%. These results demonstrate the model’s strong capability in identifying stressed participants based on their speech. Critically, the fusion of linguistic and acoustic features significantly outperformed models using either feature type alone. Furthermore, the orthogonalization procedure proved essential, as decorrelating features before fusion markedly enhanced classification accuracy compared to using non-orthogonalized features.

CONCLUSIONS: This study demonstrates that fusion analysis of linguistic and acoustic features effectively identifies psychosocial stress among family caregivers. It also emphasizes the importance of proper feature processing when combining multiple features extracted from the same audio sample. These findings provide valuable insights for developing machine learning models for psychosocial stress assessment and addressing various psychosocial conditions in different contexts, supporting population mental health management.

PMID:42214077 | DOI:10.2196/91138

J Med Internet Res. 2026 May 29;28:e91338. doi: 10.2196/91338.

ABSTRACT

BACKGROUND: The comprehensive effects of multicomponent digital health interventions (DHIs) on multidimensional physical activity indicators and sedentary behavior (SB) remain controversial.

OBJECTIVE: This systematic review aimed to evaluate the impact of multicomponent DHIs on daily steps, moderate-to-vigorous physical activity (MVPA), light physical activity, total physical activity, and SB in older adults.

METHODS: PubMed, Web of Science, Embase, The Cochrane Library, and CINAHL were searched up to February 20, 2026. Randomized controlled trials concerning multicomponent DHIs for promoting exercise behavior in older adults were included. RoB 2.0 was used to evaluate study quality. Meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman random-effects model, and 95% prediction intervals (PIs) were calculated via Nagashima adjustment to evaluate effect dispersion. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system was used to evaluate evidence certainty.

RESULTS: A total of 26 randomized controlled trials (n=4129) were included. The results showed that multicomponent DHIs significantly improved daily steps (mean difference [MD] 822.8, 95% CI 198.3 to 1447.3 steps/d; 95% PI -1452.4 to 3098.0) and MVPA (MD 45.9, 95% CI 23.9 to 67.9 min/wk; 95% PI -9.4 to 101.2). However, the improvements in SB (MD -283.7, 95% CI -610.8 to 43.5 min/wk; 95% PI -984.5 to 417.1), total physical activity (MD 104.4; 95% CI -109.2 to 318.0 min/wk; 95% PI -444.4 to 653.2), and light physical activity (MD 39.3, 95% CI -96.2 to 174.7 min/wk; 95% PI -227.6 to 306.2) did not reach statistical significance. As some included studies combined digital tools with human support, the independent contribution of digital technology remains uncertain. PIs indicated a certain degree of dispersion across different clinical contexts. Subgroup analysis showed higher effect sizes for standalone wearables, human-assisted interventions, and populations with chronic disease risks. Meta-regression showed that effect sizes remained stable across different ages and durations. The trim-and-fill method confirmed the robustness of MVPA results. GRADE assessment indicated “moderate” certainty for MVPA and “low” for daily steps and other indicators.

CONCLUSIONS: This systematic review suggests that multicomponent DHIs may serve as an effective means for enhancing daily steps and MVPA in older adults. The innovation lies in evaluating the true effect distribution of multicomponent DHIs through Hartung-Knapp-Sidik-Jonkman random-effects models and Nagashima PIs. Compared with previous studies, this review identified the impact of population characteristics and control group differences on effect estimates using PI and subgroup models, confirming that advanced age did not significantly diminish the good adaptability of older adults to DHIs. Evidence limitations include high heterogeneity, lack of long-term follow-up, and differences between objective and subjective measurement tools. In practice, priority should be given to hardware carriers with simplified interaction and integrated human support, with tailored strategies developed for different risk subgroups.

PMID:42214075 | DOI:10.2196/91338

J Med Internet Res. 2026 May 29;28:e89067. doi: 10.2196/89067.

ABSTRACT

BACKGROUND: Reducing 30-day hospital readmissions has been a long-standing goal across health systems in the United States. While nurse-led phone outreach has been widely adopted to support transitional care, its reach is constrained by staffing and time limitations. Mobile health (mHealth) interventions, such as automated SMS text messaging and patient portals, offer scalable alternatives but have shown mixed effectiveness in reducing readmissions. Understanding how patients engage with mHealth after discharge may help optimize these tools for postdischarge care.

OBJECTIVE: This study aimed to characterize patients in an mHealth transitional care program who experienced hospital revisits within 30 days of discharge, comparing demographic and clinical characteristics, intervisit interactions, and revisit features between those who engaged with mHealth and those who did not.

METHODS: We conducted a secondary analysis of patients in the intervention arm of the Mobile Outreach to Reduce Emergencies-Primary Care randomized clinical trial. Participants received automated SMS text messages for 30 days after discharge alongside usual transitional care. We identified patients with a 30-day hospital revisit and conducted manual chart reviews to assess mHealth engagement and other forms of health care contact. We compared patient characteristics, intervisit interactions, and revisit features (time to revisit, relatedness to index hospitalization, and predictability of revisit) between mHealth users and nonusers.

RESULTS: Among 496 patients with a 30-day revisit, 185 (37%) engaged with mHealth before their return. mHealth users were younger (n=47, 26% aged <50 years vs n=41, 14% among nonusers; P=.004) and more likely to have commercial insurance (n=43, 23% mHealth users vs n=35, 11% mHealth nonusers; P=.005). Revisits were more likely to be rated highly or somewhat predictable among mHealth users compared to nonusers (n=105, 56% vs n=152, 49%; P=.04), while relatedness to the index hospitalization was similar (n=98, 53% vs n=173, 55%; P=.09). mHealth users had a longer mean time to revisit than nonusers (15.2, SD 8.1 vs 11.3, SD 8.4 days; P<.001) and were more likely to contact their practices via telephone (n=100, 54% vs n=136, 44%; P=.03) or attend a clinic visit (n=112, 61% vs n=131, 42%; P<.001).

CONCLUSIONS: Among patients enrolled in an mHealth postdischarge program who experienced hospital revisits, fewer than half engaged with mHealth prior to their return. Revisits among mHealth users occurred later and were more predictable, suggesting that engagement may enhance situational awareness but not necessarily prevent revisits. Future work should focus on strategies to increase engagement across groups and integrate mHealth with existing transitional care infrastructure.

PMID:42214074 | DOI:10.2196/89067

JMIR Infodemiology. 2026 May 29;6:e82221. doi: 10.2196/82221.

ABSTRACT

BACKGROUND: The COVID-19 pandemic highlighted the importance of effective health communication and reliable information for crisis management, particularly following the introduction of vaccinations. Varied attitudes toward COVID-19 vaccination and an overwhelming amount of online information complicated communication and pandemic management. Previous studies have often focused on general vaccination behavior and its correlation with vaccination attitudes, establishing a link between information-seeking and vaccination decisions. However, there is insufficient analysis distinguishing specific user groups based on their actual online information behavior regarding COVID-19 vaccination and examining its correlation with vaccination behavior.

OBJECTIVE: This study aims to fill this research gap by identifying user groups based on their information behavior and investigating its influence on vaccination uptake.

METHODS: As part of the “Internetnutzung zur COVID-19-Impfung” (INCOVI) study, 1000 individuals in Germany were surveyed online (November 26 to December 8, 2021) regarding their internet usage related to COVID-19 vaccination. A hierarchical cluster analysis was conducted to identify user groups. Logistic regression analyses were then used to explore correlations among the user groups and their demographic characteristics, readiness to vaccinate, knowledge of vaccination, and health literacy. Additionally, a logistic regression analysis was performed to identify the influence of user groups and other factors on vaccination behavior.

RESULTS: A total of 3 user groups were identified: frequent and critical information evaluators (454/778, 58.4%), who primarily relied on official information sources, exhibited a higher level of health literacy, and were older than the other groups; infrequent and passive recipients (222/778, 28.5%), who rarely sought information actively and were younger than the other groups; and frequent and multichannel, interaction-focused users (102/778, 13.1%), who actively searched across multiple channels and engaged in information exchange. Notably, the user groups did not significantly differ in knowledge or willingness to vaccinate. User group affiliation, knowledge, and health literacy did not significantly influence vaccination behavior. The strongest predictor of vaccination was preexisting willingness to vaccinate. Additionally, women were more likely to be vaccinated than men, and individuals with medium or higher education levels were 6-11 times more likely to be vaccinated compared to those with only a basic level of education.

CONCLUSIONS: Segmenting the population into different user groups allows for more targeted communication tailored to the specific needs and beliefs of each group. Because these groups stem from observable usage patterns, they constitute a transferable framework for other health topics. For frequent and critical information evaluators, providing well-founded and detailed information on public channels is important. Infrequent and passive recipients benefit from straightforward formats, such as short explanatory videos, while frequent and multichannel, interaction-focused users are better reached through interactive offerings on social media. By specifically targeting these groups, informed decision-making about vaccinations can be supported.

PMID:42214069 | DOI:10.2196/82221

JMIR Res Protoc. 2026 May 29;15:e92574. doi: 10.2196/92574.

ABSTRACT

BACKGROUND: Physical activity (PA) is safe and beneficial for children and adolescents diagnosed with cancer, yet most engage in low levels of PA. We developed IMPACT (IMplementation of Physical Activity for Children and adolescents on Treatment), a PA intervention delivered by videoconference to enhance PA among young people during treatment for cancer and blood disorder diagnoses. IMPACT is being evaluated in a type II hybrid effectiveness-implementation trial in Alberta, Canada. While referral rates are high and early visual analyses suggest IMPACT may enhance PA and aspects of quality of life and physical function, participation, retention, and adherence rates are low. Findings signal the positive effect of IMPACT for those who participate and underscore the necessity of implementation adaptations. On the basis of these early findings, a demonstrated desire, and funding for PA at sites across Canada, we must first reimagine IMPACT through active collaboration with research users-those who will refer to and/or use or benefit from the intervention.

OBJECTIVE: Over the next 5 years, our larger research program will (1) co-adapt IMPACT and prepare for scaling (phase 1) and (2) implement and evaluate co-adapted IMPACT across additional provinces in Canada (phase 2). Specific aims for phase 1 are detailed herein and include (1) identifying necessary IMPACT modifications, (2) examining site-specific factors influencing IMPACT implementation, and (3) developing an implementation research logic model to guide continued scaling.

METHODS: An integrated knowledge translation and patient-oriented research approach and pragmatic orientation have been adopted. A multiple-perspective mixed methods study is underway. Descriptive surveys and interviews, guided by the Consolidated Framework for Implementation Research 2.0, are being conducted with key research user groups, including children and adolescents diagnosed with cancer and blood disorders (on- and off-treatment), carers, health care providers, and support organization personnel. Data will be analyzed using descriptive statistics and framework analysis. An implementation research logic model will be developed with participants and IMPACT co-adaptation advisory board members and program partners and collaborators.

RESULTS: Funding was secured, and initial ethics approval was granted on June 10, 2025. Additional administrative and full approvals were secured subsequently. Recruitment started in July 2025 in British Columbia and is commencing across sites in a staggered manner. Full results (ie, all site-specific modifications and implementation strategies and the final version of the implementation research logic model) are expected to be submitted for publication late 2026.

CONCLUSIONS: Co-adaptation of IMPACT with research users will enhance the likelihood of relevance, acceptability, and uptake nationally. The resulting data will inform a model to guide continued scaling and a larger trial evaluating the co-adapted IMPACT intervention across British Columbia, Ontario, and the Maritime provinces. This work reimagines IMPACT for broader applicability across varied Canadian contexts..

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/92574.

PMID:42214066 | DOI:10.2196/92574

JCO Oncol Pract. 2026 May 29:OP2501244. doi: 10.1200/OP-25-01244. Online ahead of print.

ABSTRACT

PURPOSE: Information regarding treatment toxicity obtained from phase I clinical trials is crucial to inform drug development and patient care, yet no mandatory standards exist for adverse event (AE) reporting within early-phase studies, nor any uniform criteria that define tolerability. Management of plasma cell dyscrasias has changed dramatically in recent years, because of development of novel therapies, which may have unexpected and potentially severe side effects. Outcomes-based reporting is therefore critical to ensure the safety of new treatment regimens in plasma cell dyscrasia (PCD) and all other cancer diagnoses. We sought to assess the current practices in toxicity reporting in phase I PCD abstracts.

METHODS: Toxicity reporting was analyzed in 250 plasma cell dyscrasia phase I trial abstracts from the American Society of Hematology, ASCO, or the European Hematology Association annual conferences between 2019 and 24.

RESULTS: Significant variation in reporting was seen. Only 70.4% of abstracts reported all-grade toxicity, 80% grade ≥3 toxicity, and 36.8% reported deaths. We observed statistically significant differences in reporting of toxicity grades, deaths, severe AEs, and AEs of special interest according to study sponsor type (industry versus investigator-initiated), timing of analysis (interim versus other), and type of investigational agent. Minimizing language was identified in 77.6% of abstracts. Only 27.3% of these reported all-grade toxicity, of which 66% had an AE rate of ≥90%. Within studies using minimizing language, deaths occurred in up to 15% of patients and treatment discontinuations in up to 28%.

CONCLUSION: Toxicity reporting in phase I PCD studies demonstrates marked heterogeneity. Minimizing language is used in the majority of abstracts despite significant toxicity. Minimum standards for toxicity reporting in early phase hemato-oncology clinical trial abstracts are urgently required to improve accuracy and transparency.

PMID:42214053 | DOI:10.1200/OP-25-01244

JCO Glob Oncol. 2026 May;12(5):e2600114. doi: 10.1200/GO-26-00114. Epub 2026 May 29.

ABSTRACT

PURPOSE: Lung cancer remains the leading cause of cancer-related mortality worldwide. Immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 pathway have significantly improved survival outcomes in non-small cell lung cancer (NSCLC), and treatment selection is influenced by the degree of PD-L1 expression. Although ICI use began in 2017, there is a lack of data on PD-L1 expression in NSCLC among Jordanian patients. This study aimed to estimate the prevalence of PD-L1 expression and its association with demographic, clinical, and molecular characteristics, including EGFR mutation and ALK rearrangements.

METHODS: This retrospective observational study reviewed electronic medical records for all patients with lung cancer diagnosed at King Hussein Cancer Center from January 1, 2017, to April 1, 2024. Included patients had histologically confirmed NSCLC and were tested for PD-L1 expression. PD-L1 expression was considered positive if the tumor proportion score (TPS) was ≥1%. Descriptive statistics were performed to summarize patient characteristics. Comparisons between TPS 1%-49% and TPS ≥50% groups were performed using chi-square tests.

RESULTS: Of the 1,872 screened patients, 1,508 met the inclusion criteria and were included in the analysis. In this sample, the majority of patients were male (79%), former smokers (70%), presented with advanced disease (stage III/IV, 86%), and had adenocarcinoma histology (71%). Approximately 25% presented with squamous cell carcinoma. The prevalence of PD-L1 positivity was 68% (n = 1,022). Among the PD-L1-positive patients, 59% had TPS 1%-49% and 41% had TPS ≥50%. Among patients tested for EGFR mutation and ALK fusion, alterations were identified in 16.6% and 8.4% of tested patients, respectively. In PD-L1-positive tumors, EGFR wild-type status was significantly associated with high PD-L1 expression (TPS ≥50%) compared with EGFR-mutated tumors (56% v 44%, P = .007).

CONCLUSION: This first comprehensive analysis of PD-L1 prevalence in patients with NSCLC in Jordan demonstrates a relatively high prevalence of both PD-L1 positivity (≥1%) and high expression (≥50%) compared with reported data from other regions. Distinct molecular associations were observed, with higher PD-L1 expression in ALK-rearranged and EGFR wild-type tumors. These findings underscore the need for prospective and multicenter studies to further identify the biologic and clinical implications of PD-L1 expression in Jordanian patients with NSCLC.

PMID:42214046 | DOI:10.1200/GO-26-00114

JCO Glob Oncol. 2026 May;12(5):e2600137. doi: 10.1200/GO-26-00137. Epub 2026 May 29.

ABSTRACT

PURPOSE: Cancer represents a growing public health challenge in Kyrgyzstan, with increasing incidence and cumulative prevalence in recent years. This study aimed to evaluate national cancer prevalence and incidence trends in Kyrgyzstan between 2020 and 2026 and to assess epidemiologic patterns and public health implications.

METHODS: A population-based descriptive analysis was conducted using publicly available national oncology registry reports, Ministry of Health statistical publications, and international cancer databases. Annual incidence, prevalence, and crude incidence rates per 100,000 population were calculated using national demographic estimates. Temporal trends were evaluated using joinpoint regression modeling.

RESULTS: Annual newly diagnosed cancer cases increased from approximately 5,471 in 2020 to 6,651 in 2024. Crude incidence rates rose from 83 per 100,000 population in 2020 to more than 92 per 100,000 in 2024. National registry estimates indicate that over 35,000 individuals will be living with a cancer diagnosis by 2025. Stomach, breast, lung, cervical, and colorectal cancers accounted for the largest proportion of cases. A temporary stabilization in incidence was observed between 2022 and 2023, followed by an increase again in 2024.

CONCLUSION: Cancer burden in Kyrgyzstan increased steadily during the study period, with rising incidence and expanding national prevalence. These findings highlight the importance of strengthening national cancer surveillance systems, expanding screening programs, and improving oncology care infrastructure.

PMID:42214045 | DOI:10.1200/GO-26-00137

J Magn Reson Imaging. 2026 May 29. doi: 10.1002/jmri.70356. Online ahead of print.

ABSTRACT

BACKGROUND: MRI is sensitive for detecting hepatocellular carcinoma (HCC), but its routine use is hindered by low accessibility.

PURPOSE: To evaluate the performance of non-contrast abbreviated MRI (NC-AMRI) alone and in combination with alpha-fetoprotein (AFP) and protein induced by vitamin K absence II (PIVKA-II) compared to a complete MRI protocol for intrahepatic recurrent HCC detection.

STUDY TYPE: Retrospective.

POPULATION: 190 patients (male = 167, mean age 56.7 ± 11.2 years) undergoing post-hepatectomy MRI surveillance, including 88 with recurrent HCCs.

FIELD STRENGTH/SEQUENCE: T2-weighted fast spin echo (conventional and PROPELLER), diffusion-weighted imaging (DWI), and dynamic T1-weighted gradient echo sequences at 1.5 T and 3.0 T.

ASSESSMENT: The NC-AMRI set consisted of T2WI and DWI data and was extracted from the complete MRI study. Three radiologists independently evaluated the presence of recurrent HCC in two separate reading sessions (NC-AMRI and complete MRI). Pairwise comparisons were then made among three strategies: a combination of NC-AMRI, AFP, and PIVKA-II; NC-AMRI alone; and complete MRI.

STATISTICAL TESTS: The diagnostic performance of the three strategies was compared using a marginal logistic regression with generalized estimating equations and McNemar test. Significance level was p < 0.05.

RESULTS: The sensitivity of NC-AMRI was not significantly different to that of complete MRI for detecting recurrent HCC (Reviewer 1: 94.3% vs. 95.5%, p = 0.655; Reviewer 2: 96.6% vs. 96.6%, p > 0.999; Reviewer 3: 95.5% vs. 94.3%, p = 0.655), including small and medium size HCCs (p > 0.999 for all comparisons). Adding tumor markers to NC-AMRI did not significantly improve HCC detection compared to NC-AMRI alone or complete MRI.

DATA CONCLUSION: NC-AMRI demonstrated no significant difference in diagnostic performance compared to that of complete MRI in detecting intrahepatic recurrent HCCs, including small-sized lesions. Additionally, the incorporation of AFP and PIVKA-II did not significantly improve the diagnostic sensitivity of NC-AMRI.

EVIDENCE LEVEL: 3.

TECHNICAL EFFICACY: Stage 2.

PMID:42214033 | DOI:10.1002/jmri.70356