Category: Statistics

JMIR Hum Factors. 2026 Jul 2;13:e84802. doi: 10.2196/84802.

ABSTRACT

BACKGROUND: Effective health monitoring is essential for personalized care and comprehensive health assessment. Personal health indices and profiles offer a concise summary of an individual’s overall health, supporting both clinical decision-making and self-management. However, global standardization remains challenging due to diverse practices and data formats across countries.

OBJECTIVE: This study aimed to present a novel model for computing a personal health index and health profile using the International Classification of Functioning, Disability and Health (ICF) framework. The model was designed to handle incomplete and heterogeneous datasets and aimed to provide standardized, interpretable health metrics.

METHODS: We developed a recursive algorithm that calculates the health index based on the hierarchical structure of the ICF, using all available measurements. The model incorporates time decay and linkage reliability to weight input data. Preliminary validation was conducted on data from 505 individuals, using statistical correlation analyses with self-assessed health measures (EuroQol Visual Analogue Scale and pain ratings), and a sensitivity analysis was performed to assess model robustness.

RESULTS: The computed health index showed moderate positive correlations with EuroQol Visual Analogue Scale scores (all P<.001) and negative correlations with maximum pain trajectories, supporting its validity. Sensitivity analysis confirmed predictable behavior in response to input changes, and the model demonstrated resilience to missing data.

CONCLUSIONS: The proposed model offers a flexible and scientifically grounded approach to computing personal health indices and profiles within the ICF framework. It enables the integration of diverse health data sources and supports the visual representation for clinical and personal use. This model has potential applications in health monitoring, rehabilitation planning, and machine learning-based health informatics.

PMID:42391635 | DOI:10.2196/84802

JMIR Form Res. 2026 Jul 2;10:e93934. doi: 10.2196/93934.

ABSTRACT

BACKGROUND: Digital health offers opportunities to facilitate symptom assessments and communication for children with cancer, particularly after discharge. However, access to these tools must be established to ensure that they effectively support the user. PicPecc (Pictorial Support in Person-Centered Care for Children) is a mobile health tool developed to enable children to remotely assess symptoms and communicate with health care professionals. Understanding access to PicPecc is essential for evaluating its use in pediatric oncology.

OBJECTIVE: The aim was to test a digital intervention with PicPecc in pediatric oncology care through the lens of access to technology.

METHODS: This study uses a triangulation approach to determine access to digital technology through an intervention, PicPecc outside hospital. Fourteen children (6-17 y), 5 parents, and 6 nurses from 2 pediatric oncology units in Sweden participated. Children were encouraged to use PicPecc for 2 weeks (achieving a median of 14, IQR 9.75-16 days) following hospital discharge to assess pain, nausea, sleep disturbances, and feelings using an assessment scale, pictures, personal notes, and a chat function. Nurses monitored assessments and responded via the administrative interface. Access was analyzed through interviews and an instrument, and by recording the consumption of PicPecc. Data analysis was based on the 5 dimensions of access (availability, accessibility, accommodation, affordability, and acceptability).

RESULTS: The intervention, PicPecc outside hospital, supported availability by enabling children to communicate symptoms in a safe and structured way. Children and parents mentioned feeling safe when they were discharged from the hospital, and nurses perceived it as a valuable complement to follow-up after discharge. PicPecc outside hospital was generally accessible, although initial challenges with log-in procedures related to the PIN code were common. Barriers related to accommodation included interpreting the scale and obtaining an overview of assessments. Affordability was high, as internet access and device availability were not barriers; however, children’s motivation varied depending on symptom burden. Acceptability was strong among children up to 12 years of age, who appreciated the design and gaming function, while the older children found the visual design less age-appropriate.

CONCLUSIONS: Access to the mobile health tool, PicPecc outside hospital, appears promising for supporting remote symptom assessment in pediatric oncology, particularly among children up to 12 years of age. However, identified barriers, such as motivational factors and integration into the health care system, need to be addressed.

PMID:42391633 | DOI:10.2196/93934

Obstet Gynecol. 2026 Jul 2. doi: 10.1097/AOG.0000000000006363. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess associations between pregestational and early-gestational exposure to glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and maternal pregnancy complications.

DATA SOURCES: A comprehensive search across the PubMed and EMBASE databases was conducted from inception to November 2025.

METHODS OF STUDY SELECTION: Eligibility criteria for inclusion were 1) exposure to GLP-1 RAs before or during gestation; 2) cohort, case-control, or randomized controlled trial (RCT) study reporting quantitative data on maternal obstetric outcomes; and 3) study population greater than 10. Two reviewers independently abstracted study data and assessed quality and risk of bias using the Newcastle-Ottawa Quality Assessment Scale for observational studies and the Risk of Bias for Randomized Crossover Trials tool for RCTs. Odds ratios (ORs) were pooled using random effects with the Knapp-Hartung adjustment to reduce chance of false-positives and the restricted maximum likelihood estimator for heterogeneity testing.

TABULATION, INTEGRATION, AND RESULTS: Eight studies totaling 186,598 pregnancies (47,159 exposed) were included. No statistically significant differences were seen for gestational diabetes (OR 0.99, 95% CI, 0.61-1.61), preterm birth (OR 1.01, 95% CI, 0.76-1.33), preeclampsia (OR 1.05, 95% CI, 0.60-1.84), or hypertensive disorder of pregnancy (OR 0.79, 95% CI, 0.34-1.83), although results from leave-one-out sensitivity testing suggest that GLP-1 RA exposure may have a protective effect against developing gestational diabetes (OR 0.81, 95% CI, 0.67-0.98). Newcastle-Ottawa Quality Assessment Scale results demonstrated variability in study quality and high heterogeneity attributable to differences in exposure and outcome definitions, cohort selection, and control for confounders.

CONCLUSION: Use of a GLP-1 RA in the peri-fertilization period was not associated with change in odds of maternal pregnancy complications. Exploratory sensitivity results suggest that peri-fertilization exposure may lower odds of gestational diabetes. Further research is necessary to explore these hypotheses-generating results.

PMID:42391628 | DOI:10.1097/AOG.0000000000006363

JMIR AI. 2026 Jul 2;5:e92193. doi: 10.2196/92193.

ABSTRACT

BACKGROUND: Clinician burnout has reached crisis levels in emergency medicine, with clinical documentation burden identified as a central contributing factor. Ambient artificial intelligence (AI) scribes offer a promising approach to reduce this burden, but objective evidence in the emergency department (ED) setting remains limited, and prior reports have been constrained by short observation windows and low adoption.

OBJECTIVE: This study aimed to evaluate the association between ambient AI scribe use and on-shift documentation time during a 13-month staged rollout in a busy ED, accounting for physician- and patient-level factors.

METHODS: We conducted a retrospective cohort study at a tertiary academic ED from February 2025 to March 2026. The analytic cohort comprised 10,344 encounters managed by 100 attending physicians across 4 ED care settings. We restricted analysis to encounters managed by a single attending physician and excluded those with human scribes. The comparison group comprised encounters in which the ambient AI scribe was not used; use was determined entirely at attending physician discretion on an encounter-by-encounter basis. The primary outcome was on-shift documentation time derived from electronic health record audit logs. We used mixed-effects linear models with physician random intercepts to adjust for patient and encounter characteristics.

RESULTS: Ambient AI scribe use was associated with a 72.6-second reduction in on-shift documentation time per encounter (95% CI 63.8-81.4; P<.001). The effect was similar in magnitude for high-use physicians (use rates of ≥18.2%, which was the cohort mean; -71.6 seconds) and low or moderate users (-64.2 seconds), with no statistically significant difference (P=.51). Note character count decreased by 690 characters (95% CI 273-1107; P=.001); after-shift documentation time increased modestly by 9.1 seconds (95% CI 2.9-15.3; P=.004). Negative control outcomes were largely null, and a within-clinician placebo permutation test yielded a distribution centered at 0 (mean -0.8 seconds), inconsistent with the observed effect arising from confounding alone.

CONCLUSIONS: In this single-center analysis, ambient AI scribe use was associated with a statistically significant reduction in on-shift documentation time (P<.001), equivalent to approximately 24 minutes per 8-hour shift if used across 20 encounters. These findings extend prior descriptive work with adjusted inferential evidence and support the clinical relevance of ambient AI scribes for ED documentation burden, although the magnitude of benefit varies by physician, patient, and workflow factors.

PMID:42391625 | DOI:10.2196/92193

Toxicol Sci. 2026 Jul 2:kfag063. doi: 10.1093/toxsci/kfag063. Online ahead of print.

ABSTRACT

Ethylene oxide (EtO) is a highly reactive industrial chemical and known human carcinogen with a mutagenic mode of action (MOA). Its genotoxicity is primarily mediated through alkylation of DNA, forming the mutagenic adduct O6-(2-hydroxyethyl)-2′-deoxyguanosine (O6-HE-dG), albeit in small quantities, and the more abundant but less- or non-mutagenic N7-(2-hydroxyethyl)guanine (N7-HE-G) adduct. However, dose-response relationships of these DNA adducts, particularly at low inhalation exposure levels (< 3 ppm), remain unknown. These data are necessary to inform the biological plausibility of different statistical dose-response models that have been applied to human or animal data used for cancer risk assessment. In this study, B6C3F1 mice were exposed to EtO (0-200 ppm) for 6 hours/day over 28 consecutive days. DNA adducts in lung, liver, bone marrow, and mammary gland were quantified using highly sensitive mass spectrometry platforms. N7-HE-G was detected in all tissues and exposure groups, showing linear dose-response relationships in the low-dose range (≤ 1 ppm) and increased sharply and exposure-disproportionately in the high-dose range (≥ 50 ppm). Despite high sensitivity, O6-HE-dG was undetectable in any tissue at exposure < 50 ppm, reflecting adduct levels that are below the current quantifiable limit. At higher exposures (≥ 50 ppm), O6-HE-dG exhibited a dose-response pattern of N7-HE-G. Notably the mammary gland, despite being anatomically distant from the site of inhalation, exhibited the second-highest levels of both adducts at higher doses. This study provides the first reliable quantitative dose-response evidence of DNA adducts in tumor target and non-target (liver) tissues across a wide range of EtO exposures. The two DNA adducts differ markedly in their abundance, repairability and mutagenic potential and together provide a molecular MOA dose-response framework to provide the biological foundation for informing quantitative cancer risk assessment and genotoxic hazard characterization.

PMID:42391620 | DOI:10.1093/toxsci/kfag063

JCO Clin Cancer Inform. 2026 Jul;10(3):e2600041. doi: 10.1200/CCI-26-00041. Epub 2026 Jul 2.

ABSTRACT

PURPOSE: Survivorship care models that extend beyond recurrence surveillance to ones that also address treatment-related symptoms are needed. Using data obtained in routine clinical care, we aimed to examine patient-reported symptom burden among adult thyroid cancer survivors.

METHODS: Between September 2019 and September 2022, adults were electronically administered the MDASI-Thy, a patient-reported outcome measure that measures symptom severity and interference, within 7 days before their visit at a dedicated thyroid cancer survivorship clinic. The MDASI-Thy generates (1) core symptom severity, (2) thyroid-specific symptom severity, and (3) symptom interference scores, where lower is better. High alert values (HAVs) were defined for four symptoms: Distress (Upset), Pain, Sad, and Shortness of Breath. Multivariable generalized linear models examined associations of patient, cancer, and treatment factors with scores and any HAV.

RESULTS: Among 1,557 thyroid cancer survivors, 864 (55.5%) responded. Respondents were a median of 5 years from diagnosis (IQR, 4-8) and predominantly female (79.1%), and most had papillary thyroid carcinoma (92.5%). Mean (standard deviation) scores were 1.20 (1.34) for core severity, 0.99 (1.26) for thyroid-specific severity, and 1.07 (1.80) for interference. Fatigue (11.5%) and Disturbed Sleep (11.3%) were the most common severe symptoms. HAVs occurred in 72 survivors (8.3%), of whom 54 (75%) had a documented plan addressing the HAV. Higher symptom burden was associated with female sex, Black race, greater comorbidity, active smoking, and total thyroidectomy.

CONCLUSION: Routine patient-reported symptom screening in thyroid cancer survivorship identified generally low symptom burden but meaningful variations, with a subset reporting severe symptoms, functional interference, and HAVs requiring action.

PMID:42391597 | DOI:10.1200/CCI-26-00041

Am J Public Health. 2026 Jul 2:e1-e8. doi: 10.2105/AJPH.2026.308488. Online ahead of print.

ABSTRACT

Objectives. To evaluate site-specific testing and isolation procedures for preventing on-site SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infections among unaccompanied migrant children in federal congregate care settings. Methods. From August 2021 to May 2023, the Increasing Community Access to Testing, Treatment, and Response (ICATT) program administered 385 234 rapid antigen and nucleic acid amplification tests to 68 674 children at 2 emergency intake sites in Texas. We used logistic regression, the χ² test, and Kaplan-Meier survival analysis to estimate the number of infections acquired on-site and the number of cases prevented via implementation of ICATT comprehensive testing and isolation protocols. Results. ICATT protocols identified 83% of cases at intake, and our analyses projected that 92% of cases were isolated before on-site transmission could occur. Testing and isolation measures prevented an estimated 1335 to 2377 on-site infections, reducing caseloads by 15% to 23% and transmission by 68% to 79%. Conclusions. Site-specific, algorithmic testing and isolation protocols substantially reduced SARS-CoV-2 transmission among children in federal congregate care settings. Public Health Implications. Enhanced testing and isolation strategies should be considered to mitigate within-facility transmission among temporary residents in congregate care settings. (Am J Public Health. Published online ahead of print July 2, 2026:e1-e8. https://doi.org/10.2105/AJPH.2026.308488).

PMID:42391588 | DOI:10.2105/AJPH.2026.308488

J Gerontol Nurs. 2026 Jul;52(7):7-11. doi: 10.3928/00989134-20260608-03. Epub 2026 Jul 1.

ABSTRACT

PURPOSE: To examine the readability and linguistic characteristics of Alzheimer’s disease and related dementias (ADRD) prevention, symptom, and treatment information from generative artificial intelligence (GenAI) chatbots.

METHOD: We analyzed 66 outputs from free-to-use GenAI chatbots. We extracted readability (word count, Fleisch Reading Ease, and Fleisch-Kincaid Grade Level) and linguistic scores (analytical thinking, clout, authenticity, and emotional tone) using Microsoft Word and the Linguistic Inquiry and Word Count software. Data were analyzed using descriptive statistics, t tests, analysis of variance, and multivariate analysis of variance.

RESULTS: ADRD information from GenAI chatbots, especially treatment information, had college-level readability. Linguistic analyses indicate a high analytical thinking score and low scores for clout, authenticity, and emotional tone.

CONCLUSION: Our sample of ADRD GenAI information exceeded recommended reading levels for patient education materials. Although the outputs exhibited logical thinking, they also included uncertain, inauthentic, and negative tones. ADRD caregivers should be aware of these characteristics when using GenAI chatbots for ADRD information-seeking.

PMID:42391577 | DOI:10.3928/00989134-20260608-03

Age Ageing. 2026 Jul 2;55(7):afag198. doi: 10.1093/ageing/afag198.

ABSTRACT

AIM: This study aimed to explore the prevalence of these overlapping premorbid geriatric conditions and examine the association between the number of these conditions and the risk of mortality and major cardiovascular events within 1 year after acute stroke.

METHODS: In this single-centre prospective cohort study, consecutive stroke patients admitted between November 2020 and September 2024 were enrolled. Premorbid frailty was assessed using the 33-item Rockwood Frailty Index. Multimorbidity was defined as the presence of two or more chronic comorbidities other than stroke. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition criteria. Patients were categorised according to the number of overlapping conditions (NOCs), ranging from 0 to 3. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular events within 1 year after admission. Cox proportional hazards regression models adjusted for potential confounders were used to estimate adjusted hazard ratios.

RESULTS: Among 781 patients (mean age 77.9 ± 12.6 years; 390 [49.9%] female), 226 patients (28.9%) were NOC 0, 289 (37.0%) were NOC 1, 161 (20.6%) were NOC 2 and 105 (13.4%) were NOC 3. Compared with NOC 0, the adjusted hazard ratios for the composite outcome were 1.52 (95% CI 0.86-2.68) for NOC 1, 2.64 (95% CI 1.44-4.85) for NOC 2 and 5.20 (95% CI 2.77-9.73) for NOC 3.

CONCLUSIONS: One-third of patients with acute stroke had overlapping premorbid geriatric conditions. The NOCs was significantly associated with a composite event in a dose-response manner.

PMID:42391556 | DOI:10.1093/ageing/afag198

Traffic Inj Prev. 2026 Jul 2:1-11. doi: 10.1080/15389588.2026.2688905. Online ahead of print.

ABSTRACT

OBJECTIVES: Motorcyclists face high risk of severe and long-term injuries, yet the use of personal protective equipment (PPE) beyond helmets remains inconsistent across European cities. This study examined determinants of motorcycle PPE use to understand barriers and enablers influencing protective behavior.

METHODS: A cross-sectional survey was conducted in five European cities (Athens, Barcelona, Copenhagen, London, and Rome). Data were collected through an online questionnaire designed using the COM-B model of behavior (Capability, Opportunity, Motivation). The survey examined ownership and use of multiple motorcycle PPE types beyond helmets (protective jackets and leg protection). Additional measures captured riding context (e.g., urban/non-urban riding, trip purpose, and riding frequency), perceived barriers to PPE, and social norms. Statistical analyses examined associations between PPE use and behavioral determinants across the COM-B domains. Awareness and interest in innovative PPE were also analyzed.

RESULTS: Among the 905 respondents, helmet ownership and use were high, whereas ownership and use of non-mandatory PPE such as jackets and leg protection were lower. A gap emerged between access to PPE and consistent use, particularly for jackets and leg protection. Multivariable analyses showed that physical opportunity factors played a central role in PPE use: riders reporting greater comfort when wearing protective equipment and greater convenience in carrying it had significantly higher odds of consistent use. Among riders who did not always wear PPE, the most frequently reported barriers were heat, discomfort, and inconvenience when not riding. Reflective motivation also influenced behavior. Although most riders recognized the protective value of jackets and leg protection, many reported that such equipment is less necessary for short journeys or urban riding, indicating context-dependent risk perceptions. Social opportunity factors were also present: perceptions that other riders commonly use non-mandatory PPE were relatively low. Respondents also showed interest in innovative PPE, particularly upper-body protection, although affordability, comfort, and usability were identified as key considerations for adoption.

CONCLUSIONS: Among riders participating in the study, PPE use is shaped by interacting opportunity-, and motivation-related factors, with practical barriers such as heat, discomfort, and inconvenience playing a central role in limiting consistent use of non-mandatory equipment. The findings also highlight the importance of context-specific risk perceptions, as many riders consider PPE less necessary for short or urban trips, and of social influences linked to the perceived behavior of other riders. Improving PPE adoption requires behaviorally informed strategies addressing usability and comfort of protective equipment, strengthening risk communication in everyday riding contexts, and promoting social normalization of PPE use. Interest in innovative PPE concepts suggests opportunities for further uptake, prioritizing affordability, comfort, and ease of use alongside protection.

PMID:42391532 | DOI:10.1080/15389588.2026.2688905