Category: Statistics

JMIR Mhealth Uhealth. 2026 Jul 3;14:e85986. doi: 10.2196/85986.

ABSTRACT

BACKGROUND: Nurse burnout is a pervasive global problem. Cognitive behavioral therapy (CBT) has been shown to reduce burnout; however, most digital CBT programs use standardized approaches that overlook individual differences in burnout profiles. With advances in artificial intelligence (AI), algorithm-based recommendation systems now enable personalized intervention delivery by matching specific CBT modules to users.

OBJECTIVE: This study aimed to test the effects of an AI-selected mobile CBT-based intervention on nurse burnout and to describe participants’ experiences with the intervention. Specifically, it evaluated whether an AI-selected CBT-based intervention differentially reduced burnout subdomains compared with an information-only control group and explored how nurses perceived and engaged with the AI-selected program.

METHODS: This study adopted a mixed methods design, integrating a 2-group randomized controlled trial and qualitative content analysis exploring participants’ experiences. For this randomized controlled trial, a total of 125 nurses were enrolled and randomly assigned to either the experimental group (n=62) or the control group (n=63) between October 2024 and December 2024. The experimental group received an AI-selected mobile CBT-based intervention, in which an AI algorithm assigned CBT modules based on participants’ burnout profiles (client-related, personal, and work-related), job stress, and coping characteristics. The control group received information related to burnout management. Primary outcomes, client-related, personal, and work-related burnout, were assessed at baseline, 2 weeks, and 4 weeks. Secondary outcomes, including coping strategies, job stress, and stress response, were assessed at baseline and 4 weeks. Between-group differences in burnout over time were examined using repeated measures analysis of variance, with adjustment for job stress and stress response. Within-group changes and postintervention group differences were analyzed using t tests. Open-ended survey responses and follow-up interviews (n=5 in the experimental group) were analyzed using thematic content analysis.

RESULTS: Follow-up completion rates were 84.6% (137/162) at both 2 and 4 weeks. The experimental group showed a greater reduction in client-related (F1,121=7.548; P=.007), personal (F1,121=6.533; P=.01), and work-related burnout (F1,121=38.194; P<.001) than the control group, reflecting more pronounced within-group improvements over time. No significant between-group differences were observed for coping strategies, job stress, or stress response. Qualitative findings suggested that some participants were receptive to the AI-selected CBT-based intervention and reported increased self-awareness and reflective engagement with coping strategies that they might not have selected independently.

CONCLUSIONS: The findings suggest that participants were receptive to AI-selected CBT-based interventions, suggesting the potential of such interventions as a supportive approach for alleviating nurse burnout. Future research should explore the sustainability of these effects and optimize the intervention duration to enhance engagement and impact.

PMID:42398032 | DOI:10.2196/85986

Arh Hig Rada Toksikol. 2026 Jun 30;77(2):96-101. doi: 10.2478/aiht-2026-77-4035. eCollection 2026 Jun 1.

ABSTRACT

Nasal carriage plays a key role in Staphylococcus aureus transmission, particularly among individuals working in the food sector. The aim of this cross-sectional study was to investigate the relationship between personal hygiene and nasal carriage of S. aureus among workers in food production, distribution, and trade. It was conducted in Skopje from November 2021 to March 2022 and included 289 workers undergoing mandatory health and hygiene examinations. Data were collected through a structured questionnaire and microbiological testing of nasal swabs. The overall prevalence of S. aureus nasal carriage was 12.5 % (95 % CI: 8.7-16.3 %). Methicillin-susceptible S. aureus (MSSA) prevailed in 11.8 % (95 % CI: 8.1-15.5 %) and the methicillin-resistant variety (MRSA) in only 0.7 % (95 % CI: 0-1.7 %). We found no significant associations between nasal carriage and demographic or hygiene variables (assessed using the chi-squared test) but did observe higher carriage rates among men (15.7 %), cooks (28.6 %), and individuals with untidy nails (17 %). However, our findings should be interpreted with caution, and future studies should address the limitations of the present study. Targeted training, routine screening, and consistent adherence to good hygiene practices remain important for minimising colonisation and reducing the risk of S. aureus transmission.

PMID:42398011 | DOI:10.2478/aiht-2026-77-4035

Int Braz J Urol. 2026 Nov-Dec;52(6):e20260196. doi: 10.1590/S1677-5538.IBJU.2026.0196.

ABSTRACT

INTRODUCTION: Nephrolithiasis is a prevalent and recurrent condition affecting approximately 10-11% of the population. Percutaneous nephrolithotomy (PCNL) and mini-PCNL are established treatments for large renal stones. Outcomes are influenced by the choice of lithotripsy energy source. Available technologies include pneumatic, ultrasonic, Holmium:YAG (Ho:YAG), and thulium fiber laser (TFL), each with specific advantages and limitations. This review summarizes current evidence on these energy sources in PCNL and mini-PCNL.

MATERIALS AND METHODS: A narrative review was performed using PubMed and Cochrane Library, including studies published between 2014 and 2024. The search included terms related to PCNL and lithotripsy energy sources. Studies involving pediatric populations, anomalous kidneys, or non-standard energy sources were excluded. After screening 95 articles, 32 studies were included, of which 13 provided comparative data on different energy sources and were analyzed.

RESULTS: Differences were observed in operative time, stone-free rates (SFR), bleeding, transfusion rates, complications, and hospital stay. In PCNL, ultrasonic and Ho:YAG lithotripsy showed comparable outcomes, while pneumatic demonstrated slightly lower SFR. In mini-PCNL, ultrasonic and laser technologies yielded similar efficacy. TFL displayed shorter operative time and reduced bleeding and transfusion rates compared to Ho:YAG, although many differences did not reach statistical significance.

CONCLUSION: Ultrasonic and Holmium:YAG lithotripsy provide comparable outcomes in PCNL, while pneumatic devices may correlate with slightly lower stone-free rates. In mini-PCNL, ultrasonic and laser modalities show similar outcomes. TFL demonstrates potential advantages in operative time and bleeding, however, evidence remains heterogeneous, and further high-quality studies are needed.

PMID:42397984 | DOI:10.1590/S1677-5538.IBJU.2026.0196

BJS Open. 2026 Jul 3;10(4):zrag093. doi: 10.1093/bjsopen/zrag093.

ABSTRACT

BACKGROUND: Post-thyroidectomy hypocalcaemia is the most common complication after total thyroidectomy. Although perioperative calcium and vitamin D supplementation is widely used, the comparative effectiveness of different prophylactic strategies remains uncertain.

METHODS: A systematic review and Bayesian network meta-analysis of randomized clinical trials was performed according to PRISMA guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched from inception to 7 May 2026. Adult patients undergoing total or near-total thyroidectomy were included. Three strategies were compared: no routine supplementation, calcium alone, and calcium combined with vitamin D analogues. Primary outcomes were clinical hypocalcaemia, biochemical hypocalcaemia, and need for intravenous calcium supplementation; length of hospital stay was secondary. Random-effects network meta-analysis estimated odds ratios with 95% credible intervals. Risk of bias was assessed using RoB 2. The protocol was registered in PROSPERO (CRD420251068837).

RESULTS: Twenty randomized trials including 3669 patients were analysed. Calcium plus vitamin D significantly reduced clinical hypocalcaemia versus no supplementation (odds ratio 0.31, 95% credible interval 0.17 to 0.51) and calcium alone (odds ratio 0.52, 0.25 to 1.04). Combination therapy also reduced biochemical hypocalcaemia compared with no supplementation (odds ratio 0.27, 0.17 to 0.42) and calcium alone (odds ratio 0.44, 0.22 to 0.83), and markedly decreased intravenous calcium requirements (odds ratio 0.15, 0.05 to 0.32). Calcium monotherapy showed no significant benefit. Combination therapy ranked as most effective and was associated with shorter length of hospital stay (mean difference 0.44 days).

CONCLUSIONS: Perioperative calcium combined with vitamin D is the most effective strategy for preventing post-thyroidectomy hypocalcaemia and reducing intravenous calcium use, supporting routine postoperative implementation despite heterogeneity in supplementation protocols.

PMID:42397982 | DOI:10.1093/bjsopen/zrag093

Eur J Public Health. 2026 Jun 10;36(4):ckag087. doi: 10.1093/eurpub/ckag087.

ABSTRACT

Depressive disorders represent the second leading cause of disability globally, and Portugal reports the second highest prevalence in Europe. Nevertheless, the role of socioeconomic factors, behavioural determinants, and potential differences in treatment remain underexplored. This study assessed socioeconomic inequalities in depression and inequity in mental healthcare utilization among Portuguese adults aged 25-65 years, and evaluated whether health behaviours mediate the socioeconomic status (SES) and depression association. We used microdata from the 2019 Portuguese National Health Interview Survey. Depression was measured through self-report and PHQ-8 (≥10, moderate and moderately-severe; ≥20, severe). Concentration curves and indices, standardized by sex and age, assessed SES-related inequality in depression; horizontal inequity in mental healthcare utilization was estimated by adjusting for morbidity. Logistic regression models estimated the SES-depression association, and mediation by health behaviours (smoking, alcohol, sedentary lifestyle, diet, BMI) was evaluated using attenuation analysis. Overall, 13.0% reported depression in the previous year and 6.8% met PHQ-8 criteria. Both were disproportionately concentrated among lower-income groups, with the strongest inequality observed for severe depression. Horizontal inequity was also observed: specialist consultations were disproportionately used by higher-income groups when adjusting for self-reported depression, whereas medication was more concentrated among lower-income individuals meeting PHQ-8 criteria. Sedentarism, BMI, and alcohol drinking partially mediated SES-depression association, reducing effect estimates by up to 23.9%. Marked socioeconomic inequalities exist in depression and mental healthcare utilization in Portugal. Strengthening equitable access to evidence-based mental healthcare and addressing upstream behavioural and socioeconomic determinants are critical to reducing the national mental health burden.

PMID:42397976 | DOI:10.1093/eurpub/ckag087

J Cardiovasc Nurs. 2026 Jul 3. doi: 10.1097/JCN.0000000000001340. Online ahead of print.

ABSTRACT

BACKGROUND: Prolonged intensive care unit (ICU) stay after heart valve surgery may delay recovery and increase complications; however, the risk factors remain underexplored.

OBJECTIVE: In this study, we aimed to identify pre-, intra-, and postoperative clinical factors associated with prolonged ICU stay after heart valve surgery.

METHODS: A retrospective case-control analysis was conducted on 498 patients admitted to the cardiovascular surgical ICU of a tertiary hospital in Seoul from January 1, 2021, to December 31, 2022. Patients were grouped based on ICU length of stay: ≤72 hours (nonprolonged, n = 332) and >72 hours (prolonged, n = 166), matched by age, sex, and surgery date. Data were obtained from the electronic medical records. Statistical analyses included t tests, Mann-Whitney U test, chi-square test, Fisher’s exact test, and logistic regression.

RESULTS: Significant predictors of prolonged ICU stay included New York Heart Association class (NYHA) II (odds ratio [OR] = 3.33, 95% confidence interval [CI] = 1.79-6.18), higher EuroSCORE II (OR = 1.29, 95% CI = 1.10-1.53), fluid imbalance (OR = 1.27, 95% CI = 1.01-1.59), and longer intubation duration (OR = 1.01, 95% CI = 1.01-1.02). Additional factors included postoperative arrhythmia, red blood cell transfusion, neurological complications, hemodialysis, and fever.

CONCLUSIONS: Multiple clinical and postoperative factors were associated with a prolonged ICU stay after valve surgery. These findings can inform nursing protocols and targeted interventions to enhance recovery and reduce ICU burden.

PMID:42397975 | DOI:10.1097/JCN.0000000000001340

Eur J Pain. 2026 Jul;30(6):e70317. doi: 10.1002/ejp.70317.

ABSTRACT

BACKGROUND: Obesity is considered a risk factor for pain, and comorbid obesity and pain have a cumulatively worse impact on function and quality of life than either condition alone. The aim of this study was to estimate the prevalence of pain and describe the multidimensional biopsychosocial pain profiles of people with obesity (PwO).

METHODS: This pre-specified cross-sectional study reports the baseline data from a longitudinal cohort study. We recruited 519 PwO from three specialist obesity clinics in Ireland. Participants completed pain-, obesity- and health-related questionnaires to capture the multidimensional biopsychosocial characteristics of their pain experience. Data were analysed using descriptive and inferential statistics.

RESULTS: Pain prevalence was 77% (95% CI: 73.1%-80.6%) (70.7% female; mean age 46.6 ± 12.7 years). Participants’ pain characteristics reflected heterogeneity in the pain experiences of PwO, including (mean; SD): pain intensity (0-10 numerical rating scale) (3.97 ± 2.9), number of pain locations (0-35) (5.06 ± 5.3), levels of pain-related disability and self-efficacy. The prevalence of nociplastic pain was 54% (95% CI: 49.3%-58.6%) and neuropathic pain was 30% (95% CI: 25.6%-34.8%). Clinically significant levels of pain-related worrying and kinesiophobia were reported by 20.9% (95% CI: 17.3%-24.8%) and 49.9% (95% CI: 45%-54.7%) of participants.

CONCLUSION: The majority (77%) of PwO attending specialist obesity treatment services report experiencing pain. The intensity, nature, and impact of their pain vary. Over half reported nociplastic pain, one-third neuropathic pain, one-fifth significant pain-related worrying, and half kinesiophobia. These findings have implications for pain management in PwO.

SIGNIFICANCE STATEMENT: This is the first multicentre prospective cohort study to investigate the multidimensional pain profiles of PwO. Pain prevalence was 77%. This is the first study to estimate (i) baseline prevalence of nociplastic-dominant pain in PwO (54%); (ii) baseline prevalence of neuropathic pain in PwO (30%); (iii) clinically significant levels of pain-related fear (20.9%); and (iv) clinically significant levels of kinesiophobia (49.9%), in PwO attending specialist obesity treatment services. These findings have clinical implications for the treatment of pain in PwO.

PMID:42397681 | DOI:10.1002/ejp.70317

JMIR Res Protoc. 2026 Jul 3;15:e96094. doi: 10.2196/96094.

ABSTRACT

BACKGROUND: Atopic dermatitis (AD) is a common inflammatory skin disease associated with substantial disease burden. Traditional Chinese medicine (TCM) has shown beneficial effects in improving AD symptoms and reducing recurrence. Inflammation Formula Number 1 (IFN-1), a TCM prescription consisting of 10 herbal ingredients, has demonstrated favorable efficacy in clinical practice. However, traditional decoction preparation is time-consuming and inconvenient for long-term standardized use. Granule formulations may improve convenience, stability, and quality control, but their dose-response relationship and equivalence to traditional decoction remain unclear.

OBJECTIVE: This multicenter, prospective, randomized equivalence trial aims to evaluate the efficacy, safety, and dose-response relationship of IFN-1 granule formulations compared with traditional decoction in patients with mild to moderate AD.

METHODS: A total of 300 patients with mild to moderate AD aged 18 to 60 years will be recruited from 5 hospitals between April 2026 and January 2027. Participants will be randomly assigned in a 2:2:1:1 ratio to the traditional decoction group (n=100, 33.3%), standard-dose granule group (n=100, 33.3%), two-thirds dose granule group (n=50, 16.7%), or one-tenth dose granule group (n=50, 16.7%). All groups will receive 4 weeks of treatment. The primary end point is the proportion of patients achieving at least 50% improvement in the Eczema Area and Severity Index (EASI) at week 4. Secondary outcomes include EASI75, EASI90, Investigator Global Assessment score of 0 or 1, body surface area involvement, Dermatology Life Quality Index, pruritus numerical rating scale, Patient-Oriented Eczema Measure, and TCM syndrome scores. Outcomes will be assessed at baseline and weeks 1, 2, and 4. Statistical analyses will be conducted using SAS (version 9.4). Equivalence will be evaluated using a 2-sided 95% CI approach with a predefined equivalence margin of -15% to +15%.

RESULTS: Funding for this study was obtained in 2025. Ethical approval was granted by the Ethics Committee of Shanghai Skin Disease Hospital in December 2025, and the trial was registered with the International Traditional Medicine Clinical Trial Registry (ITMCTR2026000452). Participant recruitment is scheduled to begin in April 2026 and continue through January 2027. No patients were recruited at the time of manuscript submission. Data analysis is expected to commence in March 2027, and the primary study findings are anticipated to be published in 2028.

CONCLUSIONS: This trial will determine whether IFN-1 granules achieve efficacy comparable to traditional decoction while improving treatment convenience. The findings may provide evidence for dose optimization and standardized clinical application of TCM granule formulations in AD management.

PMID:42397675 | DOI:10.2196/96094

JMIR Form Res. 2026 Jul 3;10:e95867. doi: 10.2196/95867.

ABSTRACT

BACKGROUND: In recent years, artificial intelligence (AI) has ushered in a promising era in medicine, particularly in medical education. However, studies assessing the knowledge, attitudes, and practices related to AI among medical students in Vietnam remain limited.

OBJECTIVE: This study aimed to evaluate AI knowledge, attitudes, and practices among Vietnamese medical students in learning and research, and to identify factors associated with their AI practices.

METHODS: A cross-sectional study was conducted among medical students at Thai Binh University of Medicine and Pharmacy from November to December 2025. Data were collected using an online structured questionnaire covering demographic characteristics and AI knowledge, attitudes, and practices. The main outcome of interest was AI practices in learning and research. Descriptive statistics and multivariable linear regression were used to examine associated factors. Regression coefficients (β), 95% CIs, and P values are reported.

RESULTS: A total of 1002 medical students (mean age 21.00, IQR 19.00-23.00 years; n=596, 59.5% female) were included. The median percentage of maximum possible (POMP) score of AI knowledge was 66.67 (IQR 33.33-83.33), with a high level of familiarity with common tools (n=798, 79.6%). AI attitudes were generally positive (median POMP score 70.00, IQR 53.33-76.67). AI-related practices were lower (median POMP score 50.00, IQR 46.88-71.88), with AI being used primarily for information retrieval and literature research support. In the multivariable analysis, knowledge POMP score (β=0.12, 95% CI 0.08-0.16) and attitudes POMP score (β=0.42, 95% CI 0.34-0.51) were significantly associated with AI practices POMP score (P<.001). Age, gender, major, grade point average classification, and having participated in an AI seminar or training were not associated with AI practices.

CONCLUSIONS: Medical students showed favorable knowledge and positive attitudes, but their AI practices remained limited. Integrating AI into medical curricula, including fundamentals, applications, and ethical aspects, is essential to prepare future physicians for AI-driven health care.

PMID:42397674 | DOI:10.2196/95867

Curr Psychiatry Rep. 2026 Jul 3;28(1):46. doi: 10.1007/s11920-026-01697-x.

ABSTRACT

PURPOSE OF REVIEW: The Far East is highly vulnerable to natural disasters and mass trauma, underscoring the critical need for child and adolescent psychiatrists (CAPs) equipped to deliver disaster mental health care. To understand regional capacity and preparedness, we conducted the third wave of a 12-year longitudinal survey tracking CAP postgraduate training systems and workforce trends in the Far East.

RECENT FINDINGS: In 2024, representatives from 16 of 17 countries and functionally self-governing areas completed a standardized online questionnaire. Data regarding CAP training structures, specialty recognition, and workforce size were descriptively compared with previous survey waves (2012 and 2017). The CAP workforce has steadily increased, with new specialists emerging in Cambodia, Mongolia, and Myanmar. By 2024, 75% (12/16) of regions offered postgraduate CAP training-up from 59% in 2017-and recognition of CAP as a distinct specialty increased to 75%. Curricula have diversified, frequently integrating school consultation (83%) and forensic psychiatry (58%). However, national guidelines, board certification (44%), and institutional support remain highly uneven across the region. While CAP training in the Far East has significantly expanded, persistent workforce disparities limit the region’s ability to deploy skilled specialists during humanitarian emergencies. Strengthening CAP training systems is an essential public health measure to fortify regional resilience and address child and family disaster psychiatry needs.

PMID:42397655 | DOI:10.1007/s11920-026-01697-x