Category: Statistics

JMIR Public Health Surveill. 2026 May 19;12:e88473. doi: 10.2196/88473.

ABSTRACT

BACKGROUND: Rural US communities experience disproportionately high rates of visual disability yet have limited access to ophthalmologists. Teleophthalmology may help address these gaps, but its effectiveness depends on broadband connectivity. The relationship between broadband access and ophthalmologist density has not been well characterized.

OBJECTIVE: The aim of this study is to quantify the association between household broadband access-defined as subscription rates or connection prevalence-and county-level ophthalmologist density and to identify sociodemographic predictors of access.

METHODS: We conducted an ecological study of all 3141 US counties using 2019 data from the American Community Survey, Area Health Resources File, and National Center for Health Statistics (NCHS). Broadband access was the primary exposure; ophthalmologist count with county population as an offset was the outcome. The primary analysis used negative binomial regression, adjusting for urbanicity, income, education, age, sex, race/ethnicity, unemployment, and insurance status. Sensitivity analyses included population-weighted linear regression and state fixed effects models. County-level heatmaps illustrated geographic patterns.

RESULTS: Median household broadband access was 56.6%, ranging from 72.2% in the most urban counties (NCHS category 1) to 49.1% in the most rural (NCHS category 6). In unadjusted negative binomial regression, each 10-percentage-point increase in broadband access was associated with a 68% higher ophthalmologist rate (incidence rate ratio=1.68, 95% CI 1.61-1.76; P<.001). After adjustment, each 10-percentage-point increase was associated with a 46% higher rate (incidence rate ratio=1.46, 95% CI 1.37-1.56; P<.001). Sensitivity analyses were consistent with primary analysis. Regions with both low broadband access and zero ophthalmologist density were concentrated in the South, Mountain West region, and Alaska.

CONCLUSIONS: Broadband access is strongly associated with ophthalmologist availability across US counties, independent of sociodemographic factors. Areas lacking ophthalmologists also tend to lack broadband adoption, creating compounded barriers to both in-person and teleophthalmic care. Efforts to expand broadband may support more equitable access to vision services in underserved regions.

PMID:42155086 | DOI:10.2196/88473

Adv Skin Wound Care. 2026 May 18. doi: 10.1097/ASW.0000000000000465. Online ahead of print.

ABSTRACT

OBJECTIVE: The Canadian Wound Program Information, Services, and Evaluation (CAN-WISE) questionnaire was developed to assess and evaluate acute wound care programs across Canada, addressing variations in service accessibility and program effectiveness.

METHODS: An expert panel of 9 acute care wound management program leads reviewed and assessed the CAN-WISE questionnaire. Content Validity Ratios (CVR), Scale Content Validity Index (S-CVI), Modified Kappa, Gwet’s AC1, and Brennan-Prediger tests were utilized to evaluate the relevance and reliability of both questions and responses. Percentage agreement metrics were also used to assess the clarity and vocabulary of the questions and responses.

RESULTS: The results of this validation study demonstrated high consensus among the expert panel for the final questionnaire, with question CVRs ranging from 0.777 to 1, elevated I-CVI scores of 0.888 to 1, and high, statistically relevant inter-rater reliability scores (AC1=0.966, Brennan-Prediger=0.934), demonstrating that the questions included were both essential and well constructed. Questionnaire responses demonstrated similarly high CVR scores (0.777 to 1), I-CVI scores (0.888 to 1), and statistically relevant reliability (AC1=0.988, Brennan-Prediger=0.976). Clarity and vocabulary analysis showed high absolute agreement levels of 95.88% and 98.96%, respectively. These reliability metrics were further supported by high, statistically relevant Gwet’s AC1 and Brennan-Prediger test results for clarity and vocabulary, confirming the tool’s comprehensibility.

CONCLUSIONS: The CAN-WISE questionnaire has demonstrated validity and reliability in its ability to evaluate acute care wound management programs in Canada. It provides a valuable tool for assessing program strengths and areas for improvement to improve acute wound care programs throughout the nation.

PMID:42155084 | DOI:10.1097/ASW.0000000000000465

Arch Endocrinol Metab. 2026 Aug 1;70(4). doi: 10.20945/2359-4292-2026-0047.

ABSTRACT

OBJECTIVE: To assess the relationship between night work, metabolic syndrome (MS) prevalence, and dietary patterns in healthcare workers at a large hospital in southern Brazil.

SUBJECTS AND METHODS: A cross-sectional study was conducted with 156 healthcare workers (90 day-shift and 66 night-shift) from July 2023 to March 2024. Sociodemographic and occupational, sleep, dietary patterns, meal timing, anthropometric data, blood pressure, and lab test data were collected.

RESULTS: Night-shift workers had higher blood pressure, lower HDL cholesterol, and 135% greater likelihood of developing MS than those who worked during the day. They consumed more fats and less fiber. Chrononutrition analysis showed night workers had later last meals (p < 0.001), longer intervals between first and last meals (p < 0.001), and shorter night fasting (p < 0.001). Ultra-processed food consumption was similar across shifts. A shorter interval between the first and last meal in night workers was linked to a 7% lower risk of MS. Findings suggest an association between night work and higher MS prevalence, with hypertension, abdominal obesity, unfavorable lipid profile, and disrupted eating timing. Circadian rhythm disruption and misaligned eating patterns, particularly prolonged eating windows and reduced nocturnal fasting, may contribute to the increased metabolic risk.

CONCLUSION: Interventions targeting diet and chrononutrition are essential. Occupational health programs should address the specific challenges of night work.

PMID:42155078 | DOI:10.20945/2359-4292-2026-0047

J Strength Cond Res. 2026 May 20. doi: 10.1519/JSC.0000000000005468. Online ahead of print.

ABSTRACT

Aguila Camacho, A, Ochoa Ahmed, F, Rowlett, M, Ríos-Gallardo, PT, Cabarkapa, DV, Cabarkapa, D, and Montalvo, S. Longitudinal changes in countermovement jump and isometric mid-thigh pull metrics and their relationship with on-court basketball performance in elite female collegiate basketball players. J Strength Cond Res XX(X): 000-000, 2026-To quantify within-subject relationships among countermovement jump (CMJ) and isometric mid-thigh pull (IMTP) variables, describe their temporal behavior across a competitive season, and examine their association with game performance in female collegiate basketball. Eighteen athletes (21.6 ± 1.9 years; 69.9 ± 9.1 kg; 171.6 ± 8.2 cm) completed CMJ and IMTP testing for 33 weeks. Within-subject (demeaned) Spearman correlation matrices were used to identify functional clusters. Representative CMJ (jump height, peak power, contraction time, reactive strength index(mod) and IMTP (peak force, impulse 100 ms, rate of force development [RFD] 50 ms) variables were modeled longitudinally with linear mixed-effects models (random intercepts; autoregressive (1) for a week). Game outcomes from 24 contests were linked to the nearest prior test and evaluated with bivariate Spearman correlations and leave-one-out cross-validated (LOOCV) linear models. Countermovement jump variables clustered into (a) force-production measures (e.g., impulses/peak power; moderate-high positive associations), (b) performance outcomes (jump height with relative power), and (c) temporal measures (contraction/phase durations). Isometric mid-thigh pull variables formed tight early impulse and RFD clusters, with peak-force measures grouping separately. Cross-test associations were generally small (|ρ| ≤ ∼0.30), indicating complementary constructs. Mixed-model marginal means showed modest, nonuniform seasonal trends-modified reactive strength index (mRSI) tended to increase and contraction time to decrease late season, while IMTP peak force exhibited a mid-season rise-amid substantial within-player variability. For game performance, only mRSI showed a statistically significant positive correlation with point differential (ρ = 0.46, p = 0.024); other variables were small and nonsignificant. Single-variable LOOCV models explained little variance in point differential (R2_cv ≤ 0.04). Countermovement jump and IMTP capture largely independent neuromuscular qualities and exhibit modest, test-specific seasonal changes. Although mRSI relates positively to game point differential, single neuromuscular metrics showed limited standalone predictive value, supporting their use primarily for monitoring readiness in conjunction with contextual factors rather than for game-to-game prediction.

PMID:42155075 | DOI:10.1519/JSC.0000000000005468

JCO Oncol Pract. 2026 May 19:OP2501275. doi: 10.1200/OP-25-01275. Online ahead of print.

ABSTRACT

PURPOSE: Over 70% of cancer survivors also have chronic conditions requiring coordinated care throughout survivorship. Few intervention studies have focused on improving care coordination between oncology and primary care during active treatment, specifically among under- and uninsured survivors. This study evaluated the effectiveness of Project CONNECT, a system-level intervention using an EHR-based registry and an oncology nurse coordinator, in improving patient-reported care coordination among breast and colorectal cancer survivors with at least one chronic condition seen in a large, urban, safety-net health system.

METHODS: Using a pre-post quasi-experimental design, 294 patients diagnosed with stage I to III breast or colorectal cancer and ≥1 chronic condition were administered a telephone survey before intervention and 6 and 12 months after intervention to measure patient-reported care coordination. Summary statistics described patient characteristics, and generalized estimating equation assessed adjusted population-average changes in care coordination.

RESULTS: The mean age of eligible patients was 56 years (standard deviation = 9.54). The majority of the survivors were women (78.6%). Race/ethnicity distribution of the sample represented the patient population of the safety-net health system with 45% White, 34% Black, and 51% Hispanic. Nearly 80% had ≥1 chronic conditions. After the intervention, patient-reported care coordination scores demonstrated significant improvement (β = -.05, P = .016). Notably, the proportion of survivors reporting never or rarely receiving confusing or differing information about their health or treatments decreased by 11% after the intervention.

CONCLUSION: An EHR-based registry of cancer survivors with chronic conditions supported by an oncology nurse coordinator assisting survivors to establish or maintain primary care during active cancer treatment is a promising strategy to bridge the transition between oncology and primary care for cancer survivors receiving care in a safety-net heath system.

PMID:42155068 | DOI:10.1200/OP-25-01275

J Pediatr Hematol Oncol. 2026 May 18. doi: 10.1097/MPH.0000000000003211. Online ahead of print.

ABSTRACT

Pediatric hematology/oncology fellows at our institution lacked formal training in prescribing chemotherapy and supportive care. This pilot study aimed to assess the feasibility of implementing a structured curriculum in a fellowship program and to gain preliminary insights into its impact on fellows’ confidence and competence in placing chemotherapy and supportive care orders in the Epic Beacon system. We developed Beacon Bootcamp using Kern 6-Step Approach to Curriculum Development. General and targeted needs assessments informed the learning objectives. We held individual practice sessions, grounded in Kolb experiential learning theory, as one of our educational strategies and piloted a near-peer teaching model. The curriculum was implemented during the 2024 to 2025 academic year, and outcomes were compared with a baseline cohort from the prior academic year. Fellows who participated in Beacon Bootcamp reported higher levels of comfort with prescribing chemotherapy and supportive care compared with the previous cohort, which did not receive formal training. We observed a lower rate of order corrections required following the intervention (21% vs. 38%); however, the small sample size limited statistical analysis. Our findings suggest that Beacon Bootcamp improves fellows’ confidence and may reduce prescribing errors. Its impact could be greater if implemented during the first quarter of the fellowship. Further evaluation in a larger cohort is needed to more definitively assess its effectiveness.

PMID:42154508 | DOI:10.1097/MPH.0000000000003211

Quintessence Int. 2026 May 19;0(0):0. doi: 10.3290/j.qi.b7011446. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Peri-implant mucositis (PiM) is a reversible inflammatory condition that may progress to peri-implantitis if untreated. Professional mechanical plaque removal (PMPR) is the standard therapy, although complete resolution is not always achieved. This review aimed to evaluate the effectiveness of chemical and pharmacological adjunctive therapies to PMPR in PiM management.

MATERIALS AND METHODS: A literature search was conducted in PubMed and Scopus up to March 2025. Randomized controlled trials (RCTs) including adult patients with PiM, reporting bleeding on probing (BoP) changes, and with a minimum follow-up of 3 months were included. Nine RCTs (414 patients) were qualitatively analyzed.

RESULTS: PMPR alone resulted in significant reductions in BoP and probing depth (PD), but complete disease resolution was inconsistent. Adjunctive therapies, including chlorhexidine, local antibiotics, sodium hypochlorite, probiotics, and bioactive agents, showed intra-group improvements. However, additional benefits over PMPR alone were limited and often not statistically significant. Study heterogeneity in diagnostic criteria, outcome definitions, and treatment protocols limited comparability.

CONCLUSIONS: PMPR remains the gold standard for PiM treatment. Adjunctive therapies may provide additional clinical benefits in selected cases, but their routine use is not supported by consistent evidence. Standardized RCTs with long-term follow-up are needed.

PMID:42154501 | DOI:10.3290/j.qi.b7011446

Acta Otolaryngol. 2026 May 19:1-9. doi: 10.1080/00016489.2026.2667889. Online ahead of print.

ABSTRACT

BACKGROUND: Overlapping signal intensities in conventional MRI limit parotid tumor characterization, necessitating advanced techniques like arterial spin labeling (ASL) to assess physiological parameters such as vascularity.

OBJECTIVES: To evaluate the diagnostic performance of ASL in differentiating parotid gland tumors by quantifying tumor blood flow ASLm (mean) and ASLmax (maximum) and determining optimal cutoff values correlated with histopathological findings.

METHODS: Forty-seven patients (20 pleomorphic adenomas [PA], 20 Warthin tumors [WT], 7 malignant) underwent standardized 1.5 T MRI protocols and ASL prior to parotidectomy. Quantitative ASL values were obtained from lesions and contralateral tissue. Statistical comparisons and ROC analyses were performed to identify diagnostic cutoff values.

RESULTS: ASLm and ASLmax values were higher in WT compared to PA (p < 0.01). No significant side-to-side differences were found in PA and malignant groups. For PA differentiation, ASLm and ASLmax yielded AUCs of 0.766 (p = 0.002) and 0.742 (p = 0.005), respectively. For WT differentiation, both parameters showed excellent performance, yielding AUCs of 0.774 (p < 0.001) and 0.769 (p = 0.002).

CONLUSIONS: While ASL perfusion MRI effectively differentiates common benign parotid tumors, its limitations in malignancy evaluation necessitate its integration into a multiparametric MRI protocol for a more reliable preoperative diagnosis.

PMID:42154491 | DOI:10.1080/00016489.2026.2667889

Plast Reconstr Surg. 2026 May 19. doi: 10.1097/PRS.0000000000013206. Online ahead of print.

ABSTRACT

BACKGROUND: Hematoma remains a major complication following breast surgery. While tranexamic acid (TXA) efficacy is established in reduction mammaplasty, its utility across other breast procedures remains unclear.

METHODS: This retrospective cohort study included 5,202 consecutive procedures (2019-2025) performed by multiple surgeons at a single private hospital: primary augmentation (n=3,738), reduction mammaplasty (n=943), explantation with mastopexy (n=358), and explantation alone (n=163). TXA administration was at surgeon discretion. Inverse Probability of Treatment Weighting controlled for temporal adoption bias and confounders. Primary outcome was hematoma requiring surgical intervention within 30 days; isolated ecchymosis without palpable collection was not classified as hematoma.

RESULTS: TXA adoption increased from 7.0% (2019) to 93.0% (2025). After achieving covariate balance (all SMD <0.2), procedure-specific effects emerged. In reduction mammaplasty, TXA significantly reduced hematoma (2.2% vs 7.2%; adjusted OR 0.28, 95% CI 0.14-0.58, p<0.001; NNT=20). Explantation with mastopexy showed similar benefit (1.6% vs 6.0%; OR 0.42, 95% CI 0.20-0.88, p<0.001). Primary augmentation demonstrated no statistically detectable difference (1.2% vs 1.2%; OR 0.94, 95% CI 0.36-2.42, p=0.905), regardless of implant plane. No thromboembolic events occurred. Surgical site infection showed a nominally significant difference (OR 0.47, p=0.02) but should be considered exploratory given small event counts and absence of a plausible biological mechanism. Seroma and wound dehiscence showed no significant differences.

CONCLUSIONS: TXA efficacy is procedure-dependent. It provides significant protection in reduction mammaplasty and mastopexy involving extensive parenchymal dissection, but shows no statistically detectable benefit in primary augmentation. These findings support procedure-specific practice guidance rather than universal prophylaxis.

PMID:42154472 | DOI:10.1097/PRS.0000000000013206

JAMA Netw Open. 2026 May 1;9(5):e2613571. doi: 10.1001/jamanetworkopen.2026.13571.

NO ABSTRACT

PMID:42154470 | DOI:10.1001/jamanetworkopen.2026.13571