Category: Statistics

JAMA Psychiatry. 2026 May 13. doi: 10.1001/jamapsychiatry.2026.0668. Online ahead of print.

ABSTRACT

IMPORTANCE: Digital interventions are increasingly promoted as scalable options for reducing the treatment gap in eating disorders, with the evidence base expanding in recent years to include new populations, delivery formats, and therapeutic approaches. A comprehensive, up-to-date synthesis is needed to clarify the current evidence for digital treatment delivery formats in eating disorders.

OBJECTIVE: To evaluate the association of digital interventions for eating disorders with core and transdiagnostic symptom outcomes in the acute and longer-term phases.

DATA SOURCES: MEDLINE, PsycINFO, Web of Science, and Scopus were searched (October 2025) using terms related to eating disorder, digital health, and randomized clinical trials.

STUDY SELECTION: Randomized clinical trials evaluating a digital intervention for threshold or subthreshold eating disorders were eligible. Interventions had to be delivered via digital technologies (eg, websites, applications, chatbots), with or without support, and compared against a control.

DATA EXTRACTION AND SYNTHESIS: Two reviewers extracted data. Risk of bias was assessed using 4 Cochrane risk of bias criteria. Meta-analyses were conducted using random-effects models, calculating Hedges g for continuous outcomes and odds ratios for symptom abstinence.

MAIN OUTCOMES AND MEASURES: Primary outcomes included core eating disorder symptoms (global eating disorder psychopathology, binge eating frequency, compensatory behaviors, abstinence, and symptom-specific subscales). Secondary outcomes included comorbid mental health symptoms (depression, anxiety, general distress) and general well-being (quality of life, clinical impairment, self-esteem).

RESULTS: A total of 36 trials were included. At posttreatment assessment, digital interventions compared with controls produced significant improvements in primary eating disorder psychopathology (Hedges g = 0.49; 95% CI, 0.38-0.60) and objective binge eating (Hedges g = 0.37; 95% CI, 0.24-0.51) outcomes, as well as other symptom-specific and comorbid mental health outcomes. Effect sizes largely remained significant when adjusting for various sources of biases. Significant benefits were mostly observed across specific clinical populations (eg, bulimia nervosa, binge-eating disorder). Effect sizes were largest for trials that used a waiting list relative to other controls. At follow-up, digital interventions produced weaker but statistically significant sustained improvements for 7 of 9 outcomes.

CONCLUSIONS AND RELEVANCE: In this study, digital interventions were associated with consistent and durable benefits across numerous symptom-specific and transdiagnostic outcomes. These results highlight their potential to expand access to evidence-based support and to inform future clinical implementation efforts.

PMID:42126840 | DOI:10.1001/jamapsychiatry.2026.0668

Int J Nurs Knowl. 2026 May 13:20473087261443274. doi: 10.1177/20473087261443274. Online ahead of print.

ABSTRACT

ObjectiveTo analyze the effectiveness of a virtual educational intervention on care performance and knowledge of family caregivers of older adults with stroke sequels, when compared with usual guidance.MethodsA randomized pragmatic trial was carried out with 58 family caregivers of older adults with stroke sequels, randomized to the Intervention Group and Management Group. For Intervention Group a massive, open, online course was made available to equip caregivers with the necessary tools to assist older adults in activities of daily living after discharge. Moreover, telecommunication consultations were held on the seventh, thirtieth, sixtieth and eightieth days to check the course progress and possible difficulties. The course and telephone calls were made by research nurses. Caregiver assessment was carried out close to hospital discharge, before the intervention, and 90 days later, using three indicators of the outcome “Caregiver Performance: Direct Care” and six indicators of the outcome “Knowledge: Stroke Management” of the Nursing Outcomes Classification.ResultsA significant improvement was observed in intragroup assessment in Intervention Group for the indicator “Assists with care recipient’s activities of daily living needs” (p < 0.001) of the outcome “Caregiver Performance: Direct Care” and for the indicator “Causes and contributing factors” (p = 0.021) of the outcome “Knowledge: Stroke Management”. The indicator “Strategies to maintain skin integrity” of the outcome “Knowledge: Stroke Management” showed statistical significance in intergroup assessment, with better results for Control Group (p = 0.040), in addition to a significant improvement in intragroup assessment for Intervention Group (p = 0.008).ConclusionsThe intervention was effective for Intervention Group members, improving performance and knowledge about care for older adults when comparing baseline and final assessments.Implications for PracticeThe use of a massive, open, online course and telephone monitoring improves outcomes in care for older adults after discharge, which reflects the importance of nurses’ educational. Registered in Clinical Trials (NCT05553340).DescriptorsStroke; Family Caregiver; Educational Technology; Standardized Nursing Terminology; Geriatric Nursing; Transition from Hospital to Home.

PMID:42126820 | DOI:10.1177/20473087261443274

Oncol Ther. 2026 May 13. doi: 10.1007/s40487-026-00438-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Although the rising worldwide incidence of thyroid cancer (TC) has been largely attributed to changes in diagnostic means, the full spectrum of contributing factors remains unknown. We present a comprehensive registry-based study evaluating the impact of occupational background on the risk of TC in the Nordic countries.

METHODS: Data were from the Nordic Occupational Cancer (NOCCA) study from the Nordic countries from 1961 to 2005. Standardized incidence ratio (SIR) of TC in each occupational category was calculated using national incidence rates as reference.

RESULTS: The NOCCA cohort includes 14.9 million people (7.5 million women (50.3%), 7.4 million men (49.7%)). In total, 23,241 TCs were recorded: 16,758 (71.9%) in women and 6483 in men. Increased SIRs were observed in female farmers (SIR 1.19; 95% CI 1.07-1.30) and male fishermen (1.32;1.06-1.62), military personnel (1.29; 0.99-1.66), and clerical workers (1.19; 1.05-1.35).

CONCLUSION: Our results suggest an association between certain occupational backgrounds and TC. These findings may help elucidate new risk factors for TC to enable targeted diagnosis and surveillance of individuals most at risk.

PMID:42126815 | DOI:10.1007/s40487-026-00438-7

Updates Surg. 2026 May 13. doi: 10.1007/s13304-026-02670-2. Online ahead of print.

ABSTRACT

The development of incisional hernias (IH) is an uncommon but complex outcome following pancreatic surgery, especially through the open approaches. The etiology of this complication is multifactorial and can be related to the patient and to the surgical technique. We aimed to perform a systematic review and meta-analysis assessing the risk factors for development of IH following pancreatic surgery. Pubmed, Cochrane, and EMBASE databases were systematically searched from inception to September 2024. Observational studies and randomized controlled trials assessing patients > 18 years old undergoing pancreatic surgery and reporting data on incidence and risk factors for IH were selected. Outcomes were mean age, mean body mass index (BMI), diabetes mellitus, female and male gender, active smoking, and surgical site infections (SSI). We used RStudio for statistical analysis. 686 records were reviewed, and 7 observational retrospective studies were included, totaling 3,391 patients. The incidence of IH in the pooled analysis was 368 (10.8%), and after performing a proportional meta-analysis, we found that 12.5 per 100 (95% CI 7.1, 20.9) patients undergoing pancreatic surgery develop IH. Our pooled analysis found that older patients (MD 2.7 years; 95% CI 0.5, 4.8; p = 0.014) and patients with higher BMI (MD 1.8; 95% CI 0.9, 2.7; p < 0.001) present higher risk of developing IH. Female and male gender, active smoking, diabetes mellitus, and SSI were not significant risk factors for IH after pancreatic surgery. Our study showed that patients with older age and higher weight present a significantly higher risk of developing IH after pancreatic surgery. Considering pancreatic surgery is frequently carried out in emergent conditions, sometimes due to malignant causes, the preoperative optimization to reduce weight before surgery is not always a possible alternative. On the other hand, surgeons must consider the possibility of optimizing the patient in terms of weight loss if feasible, to reduce morbidity after the procedure.

PMID:42126783 | DOI:10.1007/s13304-026-02670-2

J Thromb Thrombolysis. 2026 May 13. doi: 10.1007/s11239-026-03306-3. Online ahead of print.

ABSTRACT

Early neurological deterioration (END) is a frequent and serious complication after intravenous thrombolysis in acute ischemic stroke (AIS), yet the clinical relevance of thrombotic molecular markers related to coagulation, fibrinolysis, and endothelial dysfunction remains incompletely understood. In this retrospective cohort study, 91 patients with AIS treated with intravenous thrombolysis were included between November 2022 and February 2025. Plasma levels of thrombin-antithrombin complex (TAT), plasmin inhibitor-plasmin complex (PIC), thrombomodulin (TM), and tissue-type plasminogen activator-plasminogen activator inhibitor-1 complex (t-PAIC) were measured before thrombolysis and at 1, 6, and 24 h thereafter. Stroke etiology was classified according to the Trial of Org 10,172 in Acute Stroke Treatment criteria into large artery atherosclerosis (LAA) and small vessel disease (SVD) subtypes, and patients were further categorized into END and non-END groups. Patients with LAA exhibited significantly higher plasma TAT levels at all time points and a higher incidence of END than those with SVD. Plasma TM levels were higher in the non-END group, with statistically significant differences observed at 24 h after thrombolysis. Multivariable analysis identified higher TM levels at 24 h as an independent protective factor against END, whereas elevated t-PAIC levels were independently associated with increased END risk. Given that END may occur early after thrombolysis, these associations should be interpreted cautiously in terms of temporal sequence. A combined model incorporating TM and t-PAIC demonstrated good discriminative performance for END, with an area under the curve of 0.849. These findings indicate distinct coagulation-endothelial response patterns between AIS subtypes and suggest that TM and t-PAIC may serve as complementary biomarkers associated with END risk following intravenous thrombolysis, although further validation is required.

PMID:42126778 | DOI:10.1007/s11239-026-03306-3

Int Urol Nephrol. 2026 May 13. doi: 10.1007/s11255-026-05196-z. Online ahead of print.

ABSTRACT

PURPOSE: Children with nephrotic syndrome (NS) receive long-term steroid therapy and hence there is an increased risk of bone mineral disease. The objective of the study was to compare the bone mineral density (BMD) in children with NS with that of healthy age-matched controls by using Dual-energy x-ray absorptiometry (DXA) and its correlation with metabolic parameters.

METHODS: A single-center cross-sectional study was conducted to assess the BMD using DXA scan in children aged 5-14 years with NS compared to age and gender-matched healthy children in a tertiary care center. Sixty-two children were included (31 with NS and 31 healthy children as controls), and BMD’s were assessed using a DXA scan. Z-scores were calculated and correlated with biochemical parameters such as serum alkaline phosphatase, calcium, phosphate, parathormone, and vitamin D.

RESULTS: Low BMD was observed in almost 64.5% of children with NS. The mean BMD and height adjusted Z score were lower in children with NS than healthy children. The mean BMD/Z-score in NS and controls were-left femur neck (- 2.18 ± 1.49 vs – 0.461 ± 0.94), right femur neck (- 2.47 ± 1.54 vs – 0.50 ± 0.88), spine (- 1.72 ± 1.16 vs – 0.603 ± 0.80), respectively and these differences were statistically significant (p < 0.05). The correlation between cumulative steroid dose and BMD/Z-score was not statistically significant.

CONCLUSION: Children with NS had lower BMD and serum vitamin D levels than healthy children despite calcium and vitamin D supplementation, and they need periodic evaluation.

PMID:42126769 | DOI:10.1007/s11255-026-05196-z

Int Urol Nephrol. 2026 May 13. doi: 10.1007/s11255-026-05187-0. Online ahead of print.

ABSTRACT

BACKGROUND: Robot-assisted radical prostatectomy (RARP) is a widely adopted and effective treatment for localized prostate cancer. The Retzius-sparing approach (RS-RARP) has been shown to significantly improve early urinary continence recovery while maintaining comparable long-term oncological outcomes relative to the anterior approach. However, the impact of body mass index (BMI) on RS-RARP outcomes remains insufficiently investigated. The present study aimed to address this gap.

METHODS: A retrospective analysis was conducted on 596 patients who underwent RS-RARP between April 2016 and December 2023, including 197 normal-weight, 287 overweight, and 112 obese individuals. Perioperative, oncological, and functional outcomes were assessed.

RESULTS: Estimated blood loss was significantly higher in obese patients. No statistically significant differences in urinary continence rates were observed at any time point. Immediate continence rates were 77%, 72%, and 79%, while one-year continence rates were 97%, 96%, and 98% in the normal-weight, overweight, and obese groups, respectively. Oncological outcomes were comparable across groups, although a non-significant trend toward a higher rate of pN1 disease was observed in obese patients (12% vs. 10% vs. 8%, p = 0.1). RS-RARP was found to be feasible and safe across all BMI categories.

CONCLUSIONS: The current study suggests that RS-RARP portends optimal early and one-year urinary continence recovery rates, regardless of BMI. No statistically significant differences were noted regarding safety and oncological outcomes among the three BMI categories.

PMID:42126768 | DOI:10.1007/s11255-026-05187-0

Int J Implant Dent. 2026 May 13;12(1):21. doi: 10.1186/s40729-026-00690-6.

ABSTRACT

PURPOSE: This pilot randomized clinical trial compared peri-implant tissue health around milled cobalt-chromium (CoCr) versus polyether ether ketone (PEEK) secondary telescopic crowns in implant-retained mandibular overdentures over 12 months.

METHODS: Twelve completely edentulous patients received two implants each. After randomization, secondary crowns were fabricated from milled CoCr (n = 6 patients) or PEEK (n = 6 patients). Assessor-blinded outcome assessments such as marginal bone loss (MBL), probing depth (PD), and plaque index (PI) were performed at baseline, 6, 9, and 12 months post-loading. Statistical analysis used the patient as the unit of analysis.

RESULTS: No statistically significant inter-group differences were found at any time point. At 12 months, mean MBL was 0.48 ± 0.15 mm for CoCr and 0.45 ± 0.16 mm for PEEK (p = 0.735). PD increased over time within groups but remained comparable between groups (CoCr: 2.58 ± 0.58 mm, PEEK: 2.33 ± 0.41 mm at 12 months; p = 0.411). PI scores also showed no significant inter-group differences (p > 0.05).

CONCLUSIONS: Over 12 months, milled PEEK and CoCr secondary telescopic crowns demonstrated comparable peri-implant tissue health. PEEK presents a viable metal-free alternative for this application. These preliminary findings warrant confirmation in larger, long-term studies.

PMID:42126762 | DOI:10.1186/s40729-026-00690-6

Environ Monit Assess. 2026 May 13;198(6):585. doi: 10.1007/s10661-026-15389-9.

ABSTRACT

Land use transformation contributes to land surface temperature (LST) change, which has been considered as one of the most critical environmental challenges. This study aim to analyze the impacts of land use dynamics on normalized difference vegetation index (NDVI) and LST between 1984 and 2024 in selected districts of Jimma Zone, southwestern Ethiopia. Landsat 5 TM (1984), Landsat 5 TM + (1997), Landsat 7 ETM + (2010), and Landsat 8 OLI-TIRS (2024) with 30 m spatial resolution were acquired from the USGS website. All spatial data were georeferenced to the UTM projection (Zone 37), and the WGS 84 datum. In this study, geospatial data were layer stacked and mosaicked using the geospatial analyst tool. The classified land use class was validated using GPS field survey points and Google Earth imagery. To realize the significant effects between NDVI and LST, correlation analysis was conducted for each year. One-way ANOVA was performed to test differences between land use classes. Mean separation analysis was performed using LSD at p= 0.05, using R statistical software to determine land use practices that are most effective. Results showed that the dense forest declined by 12.92%, indicating large-scale deforestation likely driven by agricultural expansion. In contrast, agricultural land increased by 7.09%, while open forest decreased by 4.66%. More expansion was observed in settlements, increasing by + 11.27%, underscoring intense unscientific infrastructure development that consumes surrounding landscapes. Even water bodies were reduced by 0.80%, a critical indicator of stress from drought and irrigation demands. The consistent and substantial decline in the maximum NDVI value, which has been declined from 0.51 in 1984 to a much lower 0.41 in 2024.Dense forest experienced a significant warming of 8.2 °C, diminishing its natural cooling capacity. Agricultural land had its minimum temperature rise from (18.6 °C-25.3 °C) by 6.7 °C. Open forest showed a consistent warming trend. The relationship among NDVI and LST is negative; this means that for each single unit of increase in NDVI, the LST drops. The most extreme LSTs were consistently found in settlements. The statistical test of surface temperature among LULC classes shows that settlements and agricultural land are a high level of significant warmer at the range of p = from 1.09 × 10^ (-5) to 2.24 × 10^ (-2).

PMID:42126741 | DOI:10.1007/s10661-026-15389-9

Radiol Med. 2026 May 13. doi: 10.1007/s11547-026-02212-1. Online ahead of print.

ABSTRACT

PURPOSE: Accurate differentiation of human epidermal growth factor receptor 2 (HER2)-zero, HER2-low, and HER2-positive breast cancer (BC) is crucial for guiding therapeutic decisions, particularly with the development of novel HER2-targeted treatments. This study aimed to evaluate whether intravoxel incoherent motion (IVIM) imaging histogram parameters could provide additional diagnostic value in distinguishing among these HER2 expression subtypes beyond conventional BI-RADS assessments.

MATERIALS AND METHODS: This retrospective single-center study included 181 breast cancer patients (30 HER2-zero, 107 HER2-low, and 44 HER2-positive). All patients underwent preoperative breast MRI on a 3.0-T scanner, including conventional sequences (T1-weighted, T2-weighted, dynamic contrast-enhanced and diffusion-weighted imaging) and intravoxel incoherent motion (IVIM) imaging. Histogram features derived from IVIM parameters-true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f)-were extracted and compared across the HER2 subgroups. Two diagnostic models were constructed: a conventional model based on BI-RADS features and a combined model incorporating both BI-RADS and IVIM histogram features. Statistical analyses included univariate logistic regression, Akaike information criterion (AIC), area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), net reclassification index (NRI), and DeLong test.

RESULTS: Conventional BI-RADS features alone could not distinguish between HER2-zero and HER2-low tumors. Although D_Entropy demonstrated modest discrimination (AUC = 0.569), this comparison was analyzed descriptively without constructing predictive models. Consequently, conventional and combined models were not constructed for this comparison. For HER2-low versus HER2-positive differentiation, the combined model (including D_Skewness and tumor size) achieved significantly higher performance (AUC = 0.727) than the conventional model (AUC = 0.587). Similarly, for HER2-zero versus HER2-positive, the combined model (D_Skewness, tumor size, and axillary lymph node [ALN] status) outperformed the conventional model (tumor size and ALN status), with AUCs of 0.730 versus 0.700. Improvements in diagnostic performance with the combined model were statistically confirmed by the DeLong test, NRI, and IDI metrics in the HER2-low versus HER2-positive and HER2-zero versus HER2-positive comparisons.

CONCLUSIONS: IVIM histogram parameters, particularly D_Skewness and D_Entropy, may enhance the ability to differentiate HER2 expression subtypes in breast cancer when integrated with conventional BI-RADS features. The combined model improves diagnostic performance, supporting its potential utility in refining HER2 status evaluation and optimizing personalized treatment strategies.

PMID:42126725 | DOI:10.1007/s11547-026-02212-1