Category: Statistics

J Man Manip Ther. 2026 Apr 23:1-9. doi: 10.1080/10669817.2026.2662609. Online ahead of print.

ABSTRACT

BACKGROUND: Competency-based education (CBE) emphasizes mastery of defined competencies rather than time-based progression. Within orthopedic manual physical therapy (OMPT), the evolving evidence supports person-centered, evidence-informed care, requiring fellowship training standards that reflect this shift. Among the seven proposed domains of competence, Systems-Based Practice (SBP) and Patient Management (PM) are essential. SBP focuses on navigating healthcare systems, interprofessional collaboration, and advocacy, while PM emphasizes delivering comprehensive, value-based care through evidence-informed, person-centered approaches. Consensus on competencies for these domains in OMPT fellowship training remains unclear.

OBJECTIVE: To achieve an international consensus on competencies and graduation milestones for OMPT fellowship training in SBP and PM.

METHODS: A modified three-Round Delphi study was conducted. In Round I, nine content experts drafted competencies and milestones. Rounds II and III invited stakeholders from the International Federation of Manual and Musculoskeletal Physical Therapists (IFOMPT) member organizations via web-based surveys. Consensus was defined a priori as ≥ 80% agreement. Descriptive statistics and composite scores were used to assess the strength of agreement. The reporting in this study follows guidelines from the Accurate Consensus Reporting Document (ACCORD).

RESULTS: Systems-Based Practice (SBP): Five competencies and 19 milestoneswere proposed; four competencies achieved consensus (health screening, healtheducation, healthcare system navigation, health policy and advocacy). PatientManagement (PM): Six competencies and 17 milestones achieved consensus,with the strongest support for evidence-informed treatment implementation,person-centered care, cultural and social sensitivity, and outcomeoptimization. Lesser support was observed for applying the human movementsystem framework.

CONCLUSIONS: Findingsunderscore the importance of competencies that promote leadership, advocacy,and evidence-informed, person-centered care in OMPT fellowship training. Gapsin consensus regarding quality improvement and the application of movementsystems highlight areas for future study or development. These resultscontribute to a global framework for advanced OMPT fellowship-level education.

PMID:42024886 | DOI:10.1080/10669817.2026.2662609

Obstet Gynecol. 2026 Apr 23. doi: 10.1097/AOG.0000000000006298. Online ahead of print.

ABSTRACT

Inequalities in severe maternal morbidity (SMM) and mortality in high-income countries are persistent, socially patterned, and evident across multiple dimensions, including socioeconomic deprivation, race and ethnicity, and migration status. These inequalities are not fully explained by individual clinical risk factors but arise from the interaction of structural disadvantage, intermediate social conditions, and health systems. Many determinants of risk are established before pregnancy; however, variation in access to care, quality of care, and responsiveness to symptoms during pregnancy and childbirth can either mitigate or exacerbate vulnerability. Identifying social and structural determinants, ensuring equitable access to care, providing culturally responsive care, and promoting timely, unbiased clinical decision making are essential components of clinician efforts to reduce inequalities in SMM and mortality.

PMID:42024879 | DOI:10.1097/AOG.0000000000006298

JMIR Aging. 2026 Apr 23;9:e75920. doi: 10.2196/75920.

ABSTRACT

BACKGROUND: Digital exclusion posed a significant challenge, especially in middle-aged and older adults, which affected their health outcomes. However, the evidence regarding the associations of digital exclusion on physical or cognitive function outcomes was controversial, and no systematic review had been performed to synthesize the pooled associations.

OBJECTIVE: This study aimed to explore the relationship between digital exclusion and physical or cognitive function in middle-aged and older adults.

METHODS: We conducted a systematic review and meta-analysis of cohort and cross-sectional studies, including Chinese or English publications retrieved from PubMed, Embase, Web of Science, PsycINFO, Scopus, CNKI, and Wanfang databases up to August 31, 2024. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS). The pooled effect size was calculated based on odds ratios (ORs), hazard ratios, risk ratios, and 95% CIs. This study was registered on PROSPERO (CRD42024585459).

RESULTS: Nineteen studies met the inclusion criteria, including 13 cohort studies and 6 cross-sectional studies, which had moderate-to-low risk of bias. The pooled analysis indicated that digital exclusion had prospective associations with decreased basic activities of daily living (incidence rate ratio 1.35, 95% CI 1.12-1.64, I2=94.7%) and instrumental activities of daily living (incidence rate ratio 1.46, 95% CI 1.13-1.89, I2=96.2%), or cross-sectional association with activities of daily living (OR 1.23, 95% CI 0.41-3.73, I2=91%), with no statistical significance in the prospective association with frailty (OR 1.21, 95% CI 0.92-1.59, I2=95.2%). There were prospective associations between digital exclusion and dementia (hazard ratio 1.78, 95% CI 1.43-2.22, I2=0%), decreased Mini-Mental State Examination scores (OR 1.96, 95% CI 1.39-2.75, I2=0%), as well as cross-sectional associations with Mini-Mental State Examination scores (OR 2.90, 95% CI 2.07-4.07, I2=0%), and no statistical significance in the prospective association with cognitive impairment (risk ratio 2.08, 95% CI 0.98-4.44, I2=78.2%).

CONCLUSIONS: Our findings indicated the negative associations of digital exclusion with physical and cognitive functions. Future research and clinical practice should consider designing digital interventions and services that match the physical and cognitive capacities and preferences of middle-aged and older adults, thereby improving digital engagement and reducing the harms associated with digital exclusion. Policies should focus on expanding access, reducing financial barriers, and improving digital literacy. However, due to the presence of heterogeneity and publication bias, the results should be interpreted cautiously.

PMID:42024876 | DOI:10.2196/75920

J Med Internet Res. 2026 Apr 23;28:e82902. doi: 10.2196/82902.

ABSTRACT

BACKGROUND: The growing number of survivors of cancer in China has created an increasing need for survivorship care as many survivors face ongoing physical, psychological, and social challenges after treatment. Mobile health (mHealth) services, which are delivered through mobile devices and apps, have emerged as potential tools to support self-management, facilitate access to care, and improve quality of life. However, evidence on the prevalence, use patterns, and determinants of mHealth adoption among Chinese survivors of cancer remains limited.

OBJECTIVE: This study aimed to examine the prevalence and patterns of mHealth use among adult survivors of cancer in China and identify sociodemographic and clinical factors associated with adoption.

METHODS: We conducted a multicenter cross-sectional survey study between February 13, 2024, and September 21, 2024, at 4 tertiary cancer care centers in China. Adult survivors of cancer were recruited using convenience sampling. Data were collected through structured face-to-face questionnaires assessing sociodemographic and clinical characteristics, mHealth use, perceived needs, concerns, and user experience. Missing data were limited and handled using complete-case analysis after the Little test supported consistency with missing completely at random. Descriptive analyses summarized participant characteristics and mHealth-related variables. Group differences were examined using chi-square tests and 2-tailed independent-sample t tests. Significant variables in univariate analyses were entered into a multivariable logistic regression model.

RESULTS: Of 1152 participants, 364 (31.6%) reported prior mHealth use. Use was concentrated in practical functions, particularly appointment booking (301/364, 82.7%), online consultation (244/364, 67%), and viewing examination or laboratory reports (215/364, 59.1%), with WeChat-based platforms being the most commonly used access channel (244/364, 67%). Participants reported high demand for clinical guidance (917/1152, 79.6%) and direct communication with health care professionals (901/1152, 78.2%), whereas common concerns included leakage of private information (694/1152, 60.2%) and inaccurate illness judgment (633/1152, 54.9%). In multivariable analysis, mHealth use was significantly associated with younger age, higher educational level, annual household income of at least ¥100,000 (US $14,527.90), widowed or divorced marital status, living alone, and treatment dissatisfaction; cancer type and time since diagnosis were not significant predictors.

CONCLUSIONS: mHealth use among adult survivors of cancer in China is established but uneven, with use concentrated in practical service functions rather than comprehensive survivorship support. Uptake was significantly associated with age, socioeconomic position, social circumstances, and treatment experience but not with clinical characteristics. Survivors reported a strong demand for clinically relevant and communication-oriented functions but also expressed substantial concerns about privacy, accuracy, reimbursement, and physician authenticity. Future survivorship mHealth services should prioritize clinical relevance, trust, integration with formal care, and equitable implementation to achieve broader and more meaningful use.

PMID:42024873 | DOI:10.2196/82902

JMIR Public Health Surveill. 2026 Apr 23;12:e73659. doi: 10.2196/73659.

ABSTRACT

BACKGROUND: Modifiable unhealthy behaviors account for over two-thirds of new cases of noncommunicable diseases. Behavioral risk factor reduction is a potentially cost-effective means to improve long-term health outcomes. Although family serves as a pivotal cornerstone for fostering and maintaining individuals’ health, the associations between family health (FH) and the proactive health risk management index (PHRMI) remain unclear.

OBJECTIVE: This study aimed to construct a comprehensive index to measure the PHRMI and examine the mediating effect of health literacy on the association between FH and the PHRMI, as well as the moderating effect of family communication on the associations among the PHRMI, health literacy, and FH.

METHODS: A cross-sectional questionnaire survey was conducted with 30,044 participants from 34 provinces or regions in China who were recruited using a multistage stratified sampling strategy from June 20, 2023, to August 31, 2023. This study constructed the PHRMI for the general population by encompassing BMI, physical activity (International Physical Activity Questionnaire-Short Form), depression (Patient Health Questionnaire-9), sleep quality (Brief version of the Pittsburgh Sleep Quality Index), smoking behavior, and drinking behavior. Further, we assessed FH (Short Form of the Family Health Scale), health literacy (Short-Form Health Literacy Questionnaire-4), and family communication (Family Communication Scale-Short Form). In addition, we collected the sociodemographic characteristics of the participants. We used model 4 of the IBM SPSS macro PROCESS to verify the mediating effect of health literacy between FH and the PHRMI, while model 7 was adopted to test the moderated mediation of family communication among the PHRMI, health literacy, and FH.

RESULTS: Higher levels of FH were significantly associated with higher PHRMI levels (β=.710, 95% CI 0.669-0.752). Health literacy significantly mediated the association between FH and the PHRMI (β=.207, 95% CI 0.168-0.245), playing a partial mediating role. Family communication significantly moderated the association between FH and health literacy (β=.117, 95% CI 0.105-0.130). The simple slope analysis showed that higher levels of family communication exacerbated the effects of FH on health literacy. Subsequently, we performed a sensitivity analysis, and the main results aligned with the findings of prior studies. Nevertheless, the subgroup analysis revealed that the mediating effect of health literacy was not significant in the group aged >60 years (β=.066, 95% CI -0.024 to 0.157).

CONCLUSIONS: FH can be an important target that appears to be positively linked to proactive health risk management and health literacy. FH promotion for older adults should pay more attention to family or intergenerational communication.

PMID:42024872 | DOI:10.2196/73659

JMIR Public Health Surveill. 2026 Apr 23;12:e75094. doi: 10.2196/75094.

ABSTRACT

BACKGROUND: With the advent of new vaccines, including the COVID-19 vaccines introduced during the recent pandemic, the need for near real-time active surveillance has increased to support timely regulatory decision-making.

OBJECTIVE: This study aimed to assess the feasibility of sequential monitoring for potential adverse events following immunization in Korea, focusing on COVID-19 vaccines.

METHODS: This population-based study used a linked database that combined the COVID-19 registry with national health insurance claims data. Participants included individuals older than 12 years who received either monovalent or bivalent COVID-19 vaccines in Korea between February 2021 and March 2023. Monthly retrospective sequential testing was performed for 3 prespecified outcomes (acute myocardial infarction, myocarditis, and anaphylaxis) as well as a negative control event (colonic diverticulitis). A Poisson-based maximized sequential probability ratio test was applied to compare postvaccination incidence rates with historical background rates, accounting for multiple testing and claims processing delays. Analyses were stratified by age group, vaccine platform, and dose.

RESULTS: This study included over 43 million monovalent and 6.3 million bivalent vaccine recipients. Sequential analyses identified statistical signals for myocarditis following mRNA vaccines in individuals aged 12 to 64 years and protein subunit vaccines in those aged 40 to 64 years. Signals for anaphylaxis were observed following mRNA and nonreplicating viral vector vaccines in individuals older than 18 years. No safety signals were identified for acute myocardial infarction or colonic diverticulitis. Sequential monitoring detected signals for myocarditis and anaphylaxis before regulatory authorities took safety actions, with the earliest signals observed on September 30, 2021, and April 30, 2021, respectively.

CONCLUSIONS: Near real-time sequential testing detected statistical safety signals for myocarditis and anaphylaxis following COVID-19 vaccination. These signals were recognized by the regulatory authority as being associated with the vaccines, demonstrating the potential of this approach to detect signals requiring further causality assessments, particularly for newly introduced vaccines at an early stage.

PMID:42024871 | DOI:10.2196/75094

JMIR Hum Factors. 2026 Apr 23;13:e79930. doi: 10.2196/79930.

ABSTRACT

BACKGROUND: The integration of robots into industrial settings has rapidly advanced, aiming to reduce human involvement in demanding tasks while improving overall efficiency. As collaborative robots (cobots) become more prevalent, assessing the physical strain during joint tasks is essential to promote long-term well-being in the workplace.

OBJECTIVE: This study aimed to investigate how human-robot collaboration influences workers’ postural control and musculoskeletal load during manipulation tasks performed in parallel.

METHODS: Fourteen healthy male participants performed manipulation tasks under 3 conditions: without robotic assistance, with a cobot providing load support (Robot Free [RF]) and a cobot constrained to horizontal movement (Robot Plane [RP]). Center of pressure trajectories were computed, and nonlinear recurrence quantification analysis indicators (recurrence rate [REC], determinism [DET], and their ratio) were calculated in the anteroposterior, mediolateral, and anteroposterior-mediolateral planes.

RESULTS: Statistical analysis showed greater postural sway in robot-assisted conditions compared to Free. Mean distance increased from 1.7 (SD 0.6) cm in Free to 2.4 (SD 0.6) cm in RF (P<.001) and 2.3 (SD 0.6) cm in RP (P<.001). Mean velocity increased from 2.9 (SD 0.9) cm/s in Free to 4.3 (SD 1.4) cm/s in RF and RP. Confidence ellipse area increased from 7.6 (SD 4.1) cm2 in Free to 24.9 (SD 14.2) cm2 in RF and 23.1 (SD 13.4) cm2 in RP. Sway area increased from 1.5 (SD 0.7) cm2/s in Free to 2.9 (SD 1.2) cm2/s in RF and RP. Nonlinear metrics revealed lower recurrence rates in robot-assisted conditions, decreasing from 0.31 (SD 0.08) in Free to 0.2 (SD 0.08) in RF and 0.2 (SD 0.04) in RP in the anteroposterior-mediolateral plane (P<.001), from 0.33 (SD 0.08) in Free to 0.28 (SD 0.07) in RF (P=.02) and 0.16 (SD 0.03) in RP (P=.007) in the mediolateral direction, and from 0.36 (SD 0.07) in Free to 0.3 (SD 0.06) in RF (P=.009) and 0.26 (SD 0.03) in RP (P<.001) in the anteroposterior direction. Determinism remained stable (values close to 1), leading to higher determinism-to-recurrence ratios for robot-assisted conditions, increasing from 3.41 (SD 0.87) in Free to 5.41 (SD 1.69) in RF and 5.51 (SD 1.11) in RP in the anteroposterior-mediolateral plane (P<.001), from 3.11 (SD 0.63) in Free to 3.64 (SD 0.72) in RF (P=.02) and 3.92 (SD 0.48) in RP (P=.007) in the mediolateral direction, and from 2.82 (SD 0.48) in Free to 3.47 (SD 0.57) in RF (P=.009) and 3.46 (SD 0.45) in RP (P<.001) in the anteroposterior direction. No significant differences were found between the robot-assisted conditions.

CONCLUSIONS: Interaction increases postural sway, indicating reduced stability and higher physical demand. This could reflect impaired balance or adaptation. Nonlinear analysis reveals that postural control remains structured. Results also suggest that the mere presence of the cobot is the primary driver of these postural changes.

PMID:42024870 | DOI:10.2196/79930

J Glob Health. 2026 Apr 24;16:04121. doi: 10.7189/jogh.16.04121.

ABSTRACT

BACKGROUND: Weak opioids are often prescribed for osteoarthritis (OA), yet their comparative psychiatric risks are not well established. We aimed to comprehensively compare the composite psychiatric risks associated with codeine and tramadol in patients diagnosed with hip OA.

METHODS: We conducted a nationwide, population-based retrospective cohort study, using Korean Health Insurance Review and Assessment Service database on patients diagnosed with hip OA between 2014 and 2017. We included patients who received either opioid, with a total of 22 651 patients (of whom 4533 codeine and 18 118 tramadol users) after 1:4 propensity score matching (PSM). We applied Cox proportional hazards models to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for incident psychiatric outcomes.

RESULTS: Codeine use was associated with a significantly lower hazard of composite psychiatric disorders (aHR = 0.86; 95% CI = 0.78-0.96), particularly anxiety (aHR = 0.81; 95% CI = 0.69-0.95), and showed a borderline reduction in sleep disorders (aHR = 0.81; 95% CI = 0.65-1.00, P = 0.048) after adjustment for age, sex, comorbidities, and concomitant medications. Subgroup analyses revealed consistently lower psychiatric risk among patients with a high comorbidity burden (Charlson’s comorbidity index ≥3), cardiovascular disease, or those without concomitant psychotropic medications. Sensitivity analyses using inverse probability treatment weighting and 1:1 PSM demonstrated broadly similar patterns, although statistical significance varied across models. No clear duration-response relationship was observed.

CONCLUSIONS: Codeine was associated with lower hazards of anxiety and sleep disorders in several analyses. These findings suggest that strengthening opioid stewardship through structured psychiatric risk assessment and individualised prescribing may enhance patient safety. Further controlled studies incorporating detailed clinical data are warranted to validate these associations and to better define their implications for long-term opioid management and policy development.

PMID:42024864 | DOI:10.7189/jogh.16.04121

JMIR Public Health Surveill. 2026 Apr 23;12:e85244. doi: 10.2196/85244.

ABSTRACT

BACKGROUND: Acute respiratory infections (ARIs) remain a significant global health challenge and are the second leading cause of disease burden and mortality. Early warning systems (EWS) play a key role in detecting clinical deterioration, alerting health care providers (HCPs), and supporting pandemic surveillance. While existing literature highlights HCPs’ positive experiences with EWS in confirming clinical assessments and guiding escalation, perspectives on how these systems can be optimized for ARI management remain underexplored.

OBJECTIVE: As Canada continues to develop and operationalize EWS for outbreak and pandemic preparedness, this study aims to explore the experiences and insights of primary care providers, emergency department (ED) physicians, and researchers regarding the use of EWS for ARI management in Canada.

METHODS: Eleven participants, including primary care providers, ED physicians, and researchers from urban and rural settings across 5 Canadian provinces (Ontario, Newfoundland and Labrador, Quebec, British Columbia, and Manitoba), were recruited in 2024. All participants regularly managed patients with ARIs or played key roles in pandemic response. A codebook thematic analysis was conducted to identify patterns and themes, with subthemes organized under broader thematic categories. Data saturation was assessed during the analysis phase. The study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines.

RESULTS: Among the 11 participants, there was approximately equal representation across gender and age groups, and more than 90% had over ten years of experience in ARI management. Three overarching themes emerged. First, participants demonstrated general awareness of the use of EWS in ARI management, including outbreak detection, screening and triage support, and informing clinical decision-making. Technologies and surveillance tools used during the COVID-19 pandemic were frequently referenced; however, understanding of specific EWS and their application to ARI management was often limited. Second, participants identified key attributes of an effective EWS as accuracy, timeliness, integration, and equity, emphasizing the need for seamless integration into existing Canadian health care workflows without increasing administrative burden. Third, anticipated challenges were described across 4 stages of EWS development, including initiation (funding and privacy concerns), implementation (outdated data systems and limited legislation), use (staff shortages and capacity constraints), and evaluation (lack of standardized and innovative evaluation approaches).

CONCLUSIONS: This study engaged 11 experienced HCPs and researchers who were directly involved in patient care and public health response to ARI outbreaks and qualitatively explored their perspectives on EWS for ARI management and pandemic preparedness. The findings identified 3 overarching themes regarding the general knowledge, desired attributes, and anticipated challenges of EWS in ARI management, highlighting the importance of co-designing EWS with clinicians, researchers, and other key stakeholders to improve their effectiveness and integration into clinical practice and pandemic preparedness across Canada.

PMID:42024857 | DOI:10.2196/85244

JCO Glob Oncol. 2026 Apr;12(4):e2500483. doi: 10.1200/GO-25-00483. Epub 2026 Apr 23.

ABSTRACT

PURPOSE: In 2023, the G7 Cancer Initiative was launched by Australia, Canada, France, Germany, Japan, the United Kingdom, and the United States with the aim of enhancing global cancer control, and with poor-prognosis cancers as a priority. To facilitate effective collaboration among G7 Cancer, we aimed to address the lack of standardized definitions and coordinated initiatives across countries.

METHODS: We examined how the G7 Cancer Initiative countries defined poor-prognosis cancers, objectively classified them, quantified their burden, and assessed national response strategies. A review of national cancer plans was conducted together with an expert email survey to evaluate definitions and classifications. Poor-prognosis cancers were identified based on 5-year net survival (NS) below 30% and a mortality-to-incidence (M/I) ratio over 0.75 using CONCORD-3 and Global Cancer Observatory 2022 data.

RESULTS: Pancreatic cancer was consistently categorized as a poor-prognosis cancer, while some countries also included liver, esophageal, stomach, and some brain cancers. For lung cancer, classification varied depending on the definition used. These six cancers accounted for a major share of cancer deaths, with lung (18%-23%) and pancreatic (6%-10%) cancers contributing the most. National strategies differed, with Australia, France, and Japan implementing specific policies for poor-prognosis cancers, while others addressed them indirectly or not at all.

CONCLUSION: To enhance cancer outcomes for poor-prognosis cancers, the G7 Cancer Initiative should coordinate efforts through joint programs focused on early detection, treatment, and policy alignment. Standardized definitions and collaborative action are essential to strengthening the global poor-prognosis cancer response.

PMID:42024847 | DOI:10.1200/GO-25-00483