Category: Statistics

Sci Total Environ. 2026 Feb 12;1019:181520. doi: 10.1016/j.scitotenv.2026.181520. Online ahead of print.

ABSTRACT

Previously reported rooftop ambient aerosol measurements in Raleigh, NC, USA, detected episodic events where sub-10 nm particle number concentrations (PNC) exceeded 3.73 × 10⁵ cm^-3. Their small size and temporally stable modal diameter (sometimes persisting for days) indicated origins from nearby primary emission sources rather than mesoscale new particle formation (NPF) events. To investigate potential sources, simulations were conducted using the U.S. Environmental Protection Agency’s Gaussian plume-based model, AERMOD. Campus surveys and Google Earth analyses identified three candidate sources near the measurement site, including two combined heat and power (CHP) facilities with high-efficiency natural gas turbines and heat recovery steam generators that provide energy to NC State’s campus. Distinct point sources were modeled for each facility using an emission factor of 5 × 10^-4 g s^-1. The study explored source contributions under varying micrometeorological conditions (e.g., wind speed, wind direction, solar radiation, and planetary boundary layer height). Wind pattern analysis revealed distinct plumes from individual power plants reaching the receptor site. Statistical analyses confirmed wind direction and speed as the strongest predictors of modeled mass concentrations, and that observed PNC profiles during NPF and particle burst events are fundamentally distinct. Exceptionally high sub-10 nm particle growth rates were observed during plume transport, averaging 104-120 nm hr^-1. These findings reveal that expanding deployment of CHPs for distributed power generation may pose unrecognized health risks through sub-10 nm particle emissions with demonstrated respiratory and neurological impacts. New emission standards may be needed to address ultrafine particle production from natural gas combustion technologies.

PMID:41687154 | DOI:10.1016/j.scitotenv.2026.181520

Int J Drug Policy. 2026 Feb 12;150:105183. doi: 10.1016/j.drugpo.2026.105183. Online ahead of print.

ABSTRACT

Systemic violence is a structural feature of drug economies and a key spillover of prohibitionist drug policies. Despite its centrality, the concept is often applied in ways that obscure its distinct purposes, market levels, and organizational contexts. To address this gap, the study examines violence at the intersection of mafia activity and drug markets, focusing on its distribution across market levels (retail, national wholesale, transnational), organizational functions (governance and trade), and rivalry configurations (inter-, intra-, and extra-clan). It draws on a press-based dataset of mafia-related homicides in Italy (2014-2024) to code and analyze these dynamics. Results show that more than half of all mafia homicides are drug-related, mainly tied to governance activities and concentrated at the retail level of the market. This pattern marks a qualitative shift in mafia violence: increasingly selective, embedded in market dynamics, confined to criminal circuits. Statistical analyses reveal significant associations between activity type, market level, and rivalry configuration, indicating that coercion concentrates where regulatory control and market participation intersect. This pattern underscores the multifunctional nature of Italian mafias, which govern markets from within while actively engaging in trade. By grounding this overlap empirically, the study advances theoretical debates on organized crime’s role in shaping illicit economies. It also offers a replicable framework for analyzing drug-related violence in the absence of official statistics.

PMID:41687149 | DOI:10.1016/j.drugpo.2026.105183

J Surg Res. 2026 Feb 12;319:141-151. doi: 10.1016/j.jss.2026.01.012. Online ahead of print.

ABSTRACT

INTRODUCTION: Preoperative abnormal sodium level is suggested to increase mortality risk in surgeries, including colectomy for colorectal cancer. However, it remains unclear which age groups are most affected by this electrolyte derangement. To bridge this gap and to better risk stratify patients preoperatively, we assessed the association of age on patients with abnormal sodium level undergoing colectomy for colorectal cancer.

MATERIALS AND METHODS: We reviewed the American College of Surgeons National Safety Quality Improvement Program Procedure-Targeted Colectomy database from 2015-2020, identifying patients over the age of 18 who underwent colectomy for primary colon cancer. We dichotomized the group by age, either younger than or 65 y and older. We collected demographics, comorbidities, laboratory values, and operative variables. We performed descriptive statistics, univariate analysis, and multivariable logistic regression with interaction term analysis. Our primary outcome was the relationship between age and 30-d mortality among patients with abnormal sodium levels. We defined statistical significance using two-sided tests as P < 0.05.

RESULTS: We identified 89,745 patients who underwent colectomy for primary colon cancer, 50,528 of those were aged 65 y and older. On multivariate analysis, we found that age ≥65 y is associated with an increased risk of mortality (odds ratio [OR], 2.574, P < 0.01). We found sodium level to have a U-shaped relationship with increased risk of mortality for both hyponatremia and hypernatremia (hyponatremia OR, 1.38, P < 0.01, hypernatremia OR, 1.878, P < 0.01), controlling for demographics and comorbidities. On multivariate interaction analysis, sodium level did not pose a clinically significant higher mortality risk to patients’ age (OR, 1.002, P < 0.01).

CONCLUSIONS: Advanced age and abnormal sodium level are independently associated with 30-d mortality following colectomy for colon cancer. Furthermore, the association between abnormal sodium levels and mortality does not differ in a clinically meaningful way between younger and older patients. This finding reinforces that abnormal sodium level is associated with an increased mortality risk after colectomy for colon cancer and provides a potential target for further study.

PMID:41687140 | DOI:10.1016/j.jss.2026.01.012

Retina. 2026 Feb 3. doi: 10.1097/IAE.0000000000004800. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the relationship between sleep disorders, including insomnia and obstructive sleep apnea (OSA), personal chronotype, and age-related macular degeneration (AMD).

METHODS: We systematically reviewed articles in PubMed, EMBASE, and Web of Science that provided information on AMD and sleep disorders, whether qualitative or quantitative. We systematically screened the abstracts of potentially eligible studies and subsequently assessed the full-text reports of those deemed relevant in detail. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS: Twenty-two studies were included in our final review. OSA was associated with a higher risk of AMD, based on seven studies (HR 1.43; 95% CI 1.14-1.79 p < 0.001; I2 = 96%). The analysis showed a statistically significant association between the morning person chronotype and an increased odds of AMD (OR 1.19; 95% CI 1.10-1.30; p < 0.001; I2 = 0%). We found little to no association between sleep duration and insomnia.

CONCLUSION: Our meta-analyses, although based on a limited number of studies, indicate that sleep disorders, particularly OSA, are associated with increased odds of developing AMD. However, further research is needed to understand how sleep duration affects disease progression and to determine the benefits of treating sleep disorders for AMD.

PMID:41687120 | DOI:10.1097/IAE.0000000000004800

Acta Med Port. 2026 Feb 2;39(2):114-124. doi: 10.20344/amp.23502. Epub 2026 Feb 2.

ABSTRACT

INTRODUCTION: Red blood cell (RBC) transfusions are frequent in cardiac surgery and are associated with higher morbidity, mortality, prolonged hospitalization, and increased healthcare costs. Several patient- and procedure-related factors have been identified as transfusion predictors. Studying these predictors in specific populations allows more accurate risk stratification and tailored clinical decision-making. RBC transfusions represent a significant economic burden for healthcare systems due to increased resource utilization and hospital costs overall. The aim of this study was to identify independent risk factors of RBC transfusion, evaluate its economic impact, and estimate potential cost savings from eliminating preoperative anemia.

METHODS: We conducted a retrospective cohort study at a tertiary hospital in Portugal, including 661 adults who underwent elective cardiac surgery between April 2020 and April 2021. The primary outcome was the need for at least one RBC transfusion during hospitalization. Secondary outcomes included 30-day mortality, infection, acute kidney injury, prolonged mechanical ventilation, intensive care unit stay, hospital length of stay (LOS), and hospital costs. Independent risk factors were identified using multivariable logistic regression. An economic analysis compared costs between transfused and non-transfused patients. To estimate potential cost reductions, a simulation model was developed assuming the elimination of preoperative anemia and applying the observed transfusion patterns of non-anemic patients to the entire cohort.

RESULTS: Red blood cell transfusion occurred in 41.3% of patients. The identified predictors were preoperative anemia (OR 3.67; 2.00 – 6.74), female sex (OR 2.06; 1.22 – 3.48), higher EuroSCORE II (OR 1.15; 1.03 – 1.29), longer cardiopulmonary bypass time (OR 1.01; 1.00 – 1.02) and lower intraoperative nadir hemoglobin (OR 0.48; 0.40 – 0.58), after adjusting for postoperative hemorrhage. Transfused patients had longer hospital stays (median 10 vs 8 days) and higher costs (median increase of €2264.44). After adjustment for infection and prolonged ventilation, transfusion was no longer independently associated with LOS. Eliminating preoperative anemia could prevent 47 transfusions, reduce 94 hospital days, and save €106 429 over 13 months overall.

CONCLUSION: Red blood cell transfusion was associated with longer hospital stays, likely due to higher infection rates and prolonged mechanical ventilation. Correcting preoperative anemia could potentially reduce transfusion rates and related hospital costs in cardiac surgery.

PMID:41687115 | DOI:10.20344/amp.23502

Acta Med Port. 2026 Feb 2;39(2):104-113. doi: 10.20344/amp.23847. Epub 2026 Feb 2.

ABSTRACT

INTRODUCTION: Dementia is one of the leading causes of dependency among older people and poses a critical challenge for long-term care systems. Despite the importance of the issue, national data on the prevalence of dementia in residential care homes remain limited.

METHODS: A cross-sectional, observational, and institution-based study was conducted within the framework of the SINDIA project. The study was based on an online survey addressed to the technical directors of residential care homes for older people in Portugal, carried out between January and July 2024. The questionnaire collected information on institutional characteristics (sector, territorial location, base monthly fee, dementia specialization, and total number of residents) and on the prevalence of formally diagnosed dementia cases and of cognitive decline without a recorded diagnosis. Data were analyzed using the R software (version 4.1.2). Mean percentages and 95% confidence intervals (Student’s t-method), weighted by NUTS-2 region, were calculated. A hierarchical cluster analysis (Ward’s method) was also performed to identify distinct institutional profiles.

RESULTS: On average, 31.7% of residents had a formal dementia diagnosis and 22.3% showed signs of undiagnosed cognitive decline, resulting in 50.2% of the resident population presenting some degree of cognitive impairment, after data cleaning. The proportion varied across territories, institutional sectors, monthly fees and self-reported specialization. A cluster analysis identified three distinct institutional profiles, with a majority group of facilities characterized by lower diagnostic formalization, especially in the non-profit sector and among lower-cost institutions.

CONCLUSION: The findings are suggestive of a very high prevalence of cognitive impairment in Portuguese residential care homes. These results highlight the need for public policies aimed at improving early diagnosis, enhancing staff training, and reducing territorial and institutional inequalities in the response to dementia.

PMID:41687112 | DOI:10.20344/amp.23847

JMIR Res Protoc. 2026 Feb 13;15:e85493. doi: 10.2196/85493.

ABSTRACT

BACKGROUND: In the United States, Asian American people represent the fastest growing population group, and are highly diverse linguistically, culturally, and demographically. Yet, in most national studies, Asian American groups are aggregated, masking potential health disparities. Racial and ethnic minorities, especially first-generation immigrants, are also at a particularly elevated risk of cognitive impairment.

OBJECTIVE: The Aging in Kerala Americans Research (AKKARE) study aims to examine both positive and negative migration effects on health in the first-generation Kerala American population, focusing on cognition and dementia. We will assess the effect of immigrant and cultural factors and social relations on cognitive aging from epidemiological, biological, and vascular perspectives. This protocol describes the study design and procedures for the AKKARE study.

METHODS: The AKKARE study proposes to enroll 400 older first-generation Kerala American individuals from the tristate area. A smaller subset of these participants will complete blood tests (n=360) and neuroimaging studies (n=160). We will assess the role of immigration and cultural effects on cognitive function, mood, and quality of life, as well as biological and vascular aging. We will conduct follow-up assessments at 12-month intervals for up to 5 years.

RESULTS: The AKKARE study (grant #1R01AG084567-01) was funded by the US National Institutes of Health in 2024 and received approval from the Stony Brook University Institutional Review Board to start the study in 2025. Enrollment began in September 2025.

CONCLUSIONS: As there is presently a lack of fundamental data on the epidemiology in diseases of aging in Indian American immigrants, the AKKARE study will provide new insights into factors of risk and resilience associated with cognitive impairment in this group and in the broader older adult population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/85493.

PMID:41687108 | DOI:10.2196/85493

JMIR Public Health Surveill. 2026 Feb 13;12:e89473. doi: 10.2196/89473.

ABSTRACT

BACKGROUND: Despite major biomedical advances in HIV testing, prevention, and treatment, annual HIV transmissions in the United States remain above 30,000. Geographic access to pre-exposure prophylaxis (PrEP) is critical to HIV prevention efforts, particularly in regions with high HIV burdens, such as metro-Atlanta. Community-based organizations (CBOs) play a central role in delivering culturally competent prevention services, yet many rely on federal funding that is increasingly unstable. Understanding the potential impact of CBO closures on geographic access to PrEP is essential for anticipating inequities and informing policy.

OBJECTIVE: The aim of this study was to estimate how hypothetical closures of federally funded CBOs providing PrEP affect geographic access to PrEP clinics by car and public transit across metro-Atlanta and to assess whether impacts differ by community racial/ethnic composition.

METHODS: We identified 71 PrEP-providing clinics in metro-Atlanta (August 2025), including 12 CBOs. Using 3 simulated closure scenarios in which 25% of CBOs were randomly closed, we calculated one-way travel times from 2466 census block group (CBG) centroids to the nearest PrEP-providing clinic. Travel times were estimated for car and public transit across 3 weekdays and timepoints and then averaged per CBG. Two-sided paired t tests were used to compare the change in travel time compared to baseline. Logistic regression assessed associations between racial/ethnic plurality and increased travel times.

RESULTS: Under baseline conditions, 100% of CBGs had car access to a PrEP clinic within 30 minutes compared to only 41.6% (1027/2466) via public transit. Across closure scenarios, 732 CBGs (29.6%; representing over 1 million residents) experienced increased transit times (mean increase 1.2 minutes; range 0.0-11.6; P<.001), and 7 CBGs lost transit access entirely. For car travel, 1184 CBGs (48%; representing approximately 1.7 million residents) experienced increased drive times (mean increase 0.5 minutes; range 0.0-6.4; P=.03). Black-plurality CBGs had higher odds of increased drive times compared to White-plurality CBGs (odds ratio 1.37, 95% CI 1.15-1.63).

CONCLUSIONS: Even limited closure of CBO PrEP providers meaningfully reduces geographic access to HIV prevention services, disproportionately affecting communities already experiencing transportation and HIV-related vulnerabilities. Sustained federal investment in CBOs is essential to preserve equitable PrEP access and prevent avoidable HIV infections.

PMID:41687101 | DOI:10.2196/89473

J Particip Med. 2026 Feb 13;18:e83149. doi: 10.2196/83149.

ABSTRACT

BACKGROUND: The Veterans Health Administration is promoting patient-reported outcome measure (PROM) collection for measurement-based mental health care. Understanding veteran preferences about how and when to complete PROMs is critical to support their implementation.

OBJECTIVE: We examined veteran preferences for timing and use of different technology platforms to complete mental health-related PROMs.

METHODS: We invited a national sample of 1373 veterans to complete a survey; 858 (62.5%) responded. Surveys asked about veteran preferences for how and when to complete mental health-related PROMs. We characterized responses using descriptive statistics and estimated multiple logistic regression models to examine associations between veteran demographic and health characteristics and preferences for completing PROMs.

RESULTS: Most veterans preferred completing PROMs between appointments (607/801, 75.8%) using features of a patient portal (410/801, 51.2%), during appointments (589/801, 73.5%) verbally (413/801, 51.6%), and while at the medical center (480/801, 59.9%) on paper (189/801, 23.6%) or a tablet computer (180/801, 22.5%). Hispanic (vs non-Hispanic) veterans had 3.32 (95% CI 1.04-10.58) times higher odds of preferring to complete PROMs at the medical center, and veterans with lower (vs higher) socioeconomic status had lower odds (odds ratio 0.61, 95% CI 0.40-0.93) of preferring to complete PROMs in between appointments but 1.97 (95% CI 1.23-3.16) times higher odds of preferring to complete PROMs during appointments.

CONCLUSIONS: As the Veterans Health Administration and other health care systems seek to expand the integration of PROM data into health care services, adaptive and flexible approaches to PROM administration that align with patient preferences, including those that leverage technology platforms in the remote collection of these data, may bolster implementation. Our results indicate that such implementation efforts should consider patient ethnicity and socioeconomic status. Our findings further suggest that these efforts could benefit from incorporating PROM administration into online patient portals, developing mobile health apps that support PROM completion through patients’ personal devices in between clinical encounters, and engaging care team members in PROM administration during appointments.

PMID:41687098 | DOI:10.2196/83149

JMIR Public Health Surveill. 2026 Feb 13;12:e82496. doi: 10.2196/82496.

ABSTRACT

BACKGROUND: In France, reluctance toward hepatitis B vaccination remains high, despite the availability of a safe and effective vaccine to prevent this infection. To boost vaccination coverage, it is therefore essential to identify the factors that are likely to encourage a more favorable opinion of this vaccine. Health literacy (HL) is one such factor. It refers to the individual ability to access, understand, critically appraise, and apply health information to make informed decisions about health issues for oneself and for others.

OBJECTIVE: This study explored the mechanisms through which HL might affect opinions about hepatitis B vaccination, both directly and indirectly, by relevant factors, including opinions about vaccination in general, trust in government health agencies, and trust in medical doctors.

METHODS: The analysis used data from the SLAVACO-Wave 3 (Suivi Longitudinal des Attitudes à l’Égard d’un Vaccin Contre la COVID-19) survey, conducted in December 2021 among a representative sample of French adults (N=1932). Favorable and unfavorable opinions of hepatitis B vaccination were measured using a 5-point Likert scale, while HL was assessed using the HLS₁₉-Q12 questionnaire (12-item general health literacy questionnaire used in Health Literacy Survey 2019-2021). A structural equation model examined the relationship between HL and hepatitis B vaccination opinions, taking into account the potential mediating role of trust in the health care system (ie, government health agencies and medical doctors).

RESULTS: Findings showed that individuals with a favorable opinion of hepatitis B vaccination (1437/1932, 74.4%) had a higher HL level than those with a negative or neutral opinion (62.6 vs 57.0, P<.001). The association between HL and hepatitis B vaccination opinions was fully mediated by trust in the health care system. The indirect effect of HL was estimated at 0.068 (95% CI 0.042-0.093), accounting for 52.4% (0.068/0.1297) of the total effect. This effect was particularly pronounced in people over 50 years (0.084, 95% CI 0.042-0.126, accounting for 0.084/0.1306, 64.3% of the total effect). Goodness-of-fit indicators were satisfactory.

CONCLUSIONS: Enhancing HL might positively influence hepatitis B vaccination opinions and uptake through greater trust in the health care system. From a public health perspective, strategies should go beyond providing clear information and access to vaccines and actively work to strengthen trust in health care institutions and professionals. National campaigns correcting misconceptions about hepatitis B vaccination could be complemented by targeted interventions for groups most likely to hold negative opinions. Repeating this survey in the post-COVID-19 context could also reveal different trends, given evolving public perceptions of vaccines and health authorities.

PMID:41687090 | DOI:10.2196/82496