Category: Statistics

J Am Med Inform Assoc. 2026 Feb 18:ocaf226. doi: 10.1093/jamia/ocaf226. Online ahead of print.

ABSTRACT

OBJECTIVES: To detail patient challenges, and how technology support addressed them, in a remote patient activation intervention for hemodialysis patients (n = 93) from trained patient mentors (n = 26).

MATERIALS AND METHODS: Using digital divide theory-derived codes, content analysis of: technology support program delivery data, hemodialysis clinic staff interviews, and support staff reflection papers. Descriptive statistics from postintervention mentee/mentor surveys.

RESULTS: All mentees and 46.2% of mentors received support. Motivational access was targeted with explanations, rapport, and support availability. Study-provided, data-capable tablets enhanced material access, but internet access barriers persisted. Skills access was addressed by training; password-related challenges initially dominated. For usage access, on-demand technology support was balanced by engagement support: proactive prementoring session calls and login monitoring.

DISCUSSION: Interventionists should examine internet coverage in targeted areas, potentially using multiple carriers. A balance between password usability and security is required. Engagement support may be needed.

CONCLUSION: Technology support can close patient digital divides.

PMID:41707178 | DOI:10.1093/jamia/ocaf226

JMIR Mhealth Uhealth. 2026 Feb 18;14:e70429. doi: 10.2196/70429.

ABSTRACT

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a prevalent chronic metabolic disorder that poses substantial challenges to global health care systems and patient management. Telemedicine, defined as the use of information and communication technologies to enhance health care delivery, has emerged as a potential tool to improve access to care and facilitate the management of T2DM.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the clinical effectiveness of various telemedicine interventions compared with usual care in glycemic control, and cardiovascular health in adults with T2DM.

METHODS: A comprehensive literature search was conducted across databases such as PubMed, Cochrane Library, and Web of Science for randomized controlled trials (RCTs) published up to August 23, 2024. Eligible RCTs compared telemedicine interventions with usual care in adults with T2DM. The primary outcome assessed was hemoglobin A_1c (HbA_1c) levels, while the secondary outcomes included mean glucose, fasting blood glucose, BMI, weight, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. The quality of the included studies was examined via the Cochrane risk-of-bias tool. Data were extracted and analyzed using a random-effects model, and meta-regression was performed to explore potential moderators. The quality of the evidence was assessed via the Grading of Recommendations, Assessment, Development, and Evaluation approach.

RESULTS: A total of 58 RCTs, encompassing 13,942 participants, were included in the analysis. Our findings showed that telemedicine interventions significantly improved HbA_1c levels compared with usual care (mean difference [MD] -0.38, 95% CI -0.49 to -0.27; Z=6.94; P<.001), despite high heterogeneity (I²=96%). Significant effects were also found for fasting blood glucose (MD -11.29, 95% CI -17.65 to -4.93; Z=3.48; P<.001), weight (MD -1.33, 95% CI -2.23 to -0.44; Z=2.91; P=.004), BMI (MD -0.43, 95% CI -0.72 to -0.13; Z=2.84; P=.004), systolic blood pressure (MD -2.14, 95% CI -3.02 to -1.26; Z=4.76; P<.001), and diastolic blood pressure (MD -1.24, 95% CI -2.02 to -0.46; Z=1.10; P=.002). No significant between-group differences were found in high-density lipoprotein cholesterol and low-density lipoprotein cholesterol improvement. Subgroup analyses revealed that telemedicine delivered by physicians, dietitians, and researchers achieved the most significant reductions in HbA_1c levels. Short-term and long-term interventions showed significant HbA_1c improvements, while medium-term interventions did not achieve statistical significance. Meta-regression analysis did not identify any statistically significant moderators.

CONCLUSIONS: This review highlights telemedicine’s superior effectiveness over usual care in improving HbA_1c levels in patients with T2DM, regardless of the type of intervention. Telemedicine led by physicians, dietitians, and researchers showed the greatest efficacy in managing blood glucose levels. Furthermore, telemedicine interventions show promise for monitoring weight and cardiovascular health in patients with T2DM.

TRIAL REGISTRATION: PROSPERO CRD42024608130; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=608130.

PMID:41707176 | DOI:10.2196/70429

Neurology. 2026 Mar 24;106(6):e214616. doi: 10.1212/WNL.0000000000214616. Epub 2026 Feb 18.

ABSTRACT

BACKGROUND AND OBJECTIVES: Early exposure to lead has known neurocognitive impacts in childhood, but few studies have examined the long-term impacts extending into later adulthood. We estimated associations between prenatal and early postnatal lead exposure and later adulthood cognitive function and examined specific periods of exposure and effect modification by sex.

METHODS: The St. Louis Baby Tooth-Later Life Health study (SLBT) is a prospective cohort study that re-enrolled participants of the Baby Tooth Survey, originally centered in St. Louis, MO, who had donated their deciduous teeth between 1958 and 1972. SLBT participants completed surveys and a battery of cognitive tests in later adulthood. Tooth dentin lead concentrations were assessed using laser ablation inductively coupled plasma mass spectrometry across prenatal (second and third trimesters) and early postnatal periods. Cognitive function was assessed using a computerized cognitive battery taken at home using computers or personal digital devices. We used weighted generalized estimating equations to estimate associations between lead exposure and a composite outcome of later adulthood cognitive function.

RESULTS: A total of 715 participants (52% female, mean age at cognitive testing: 62 years) had completed tooth metals analysis. The association between lead and performance on the vocabulary test was positive and statistically significantly different from the other tests. For each part per million (ppm) higher second trimester tooth dentin lead concentration, performance on a composite of tests excluding vocabulary was 0.07 SDs lower (95% CI -0.15 to 0.02). This effect was similar when coadjusting for third trimester and postnatal lead. These findings were driven by females, among whom each 1 ppm higher second trimester lead concentration was statistically significantly associated with 0.16 SD worse cognitive function (95% CI -0.29 to -0.03), equivalent to a 3-year difference in age in the same model. The results were robust to adjustment for additional potential sources of confounding and alternate methods of averaging tooth lead concentrations.

DISCUSSION: We found suggestive evidence for associations between early lead exposures and later adulthood cognitive function, although these only reached statistical significance for second trimester lead exposure among females. A coadjusted analysis suggested the second trimester may be most relevant for later cognitive function.

PMID:41707109 | DOI:10.1212/WNL.0000000000214616

JCO Clin Cancer Inform. 2026 Feb;10:e2500210. doi: 10.1200/CCI-25-00210. Epub 2026 Feb 18.

ABSTRACT

PURPOSE: Artificial intelligence (AI) is fast becoming a vital part of health care, dramatically affecting physicians’ workflows and patients’ outcomes. Understanding patients’ opinions on its use is thus essential to ensure its successful adoption. This study aims to evaluate public perceptions of AI in health care and explore patient feedback through a survey.

METHODS: From January 2023 to June 2024, a survey on AI in health care was distributed to the public via a QR code shared through social media, posters, and videos, reaching 454 participants, of whom 240 completed the survey. Adapted from a validated 2020 model by Esmaeilzadeh et al, the survey underwent careful translation and cultural adjustments for the Italian population, including forward-backward translation and pilot testing. The survey assessed topics like willingness to use AI, performance anxiety, liability concerns, privacy issues, and its effect on doctor-patient communication. Responses were scored, with lower scores indicating greater acceptance of AI.

RESULTS: The survey showed that 96% supported AI as a tool to assist radiologists and 92% were open to using AI for diagnostics and treatments. Concerns included reliability (61%) and reduced personal interaction (58%). Seventy-two percent trusted AI with data privacy. Overall, 90.4% viewed AI positively.

CONCLUSION: The study highlights a balanced perspective on AI in health care. While recognizing its potential to enhance diagnostics and treatments, participants raised concerns about reliability, accountability, and interpersonal impacts. Most supported AI as a tool to complement, not replace, human expertise, emphasizing the need for transparent, reliable systems.

PMID:41707098 | DOI:10.1200/CCI-25-00210

J Insect Sci. 2026 Jan 14;26(1):ieag011. doi: 10.1093/jisesa/ieag011.

ABSTRACT

Accurate prediction of aphid population trends depends on understanding the characteristics of aphids’ responses to high temperature and humidity. Currently, most studies on the interactive effects of high temperature and humidity on aphids focus on a single species, and whether multiple species exhibit similar response characteristics warrants investigation. This study examined the effects of combinations of temperatures (38 °C, 42 °C) and relative humidities (20%, 60%, and 90%) on the mortality and heat tolerance (characterized by LT50) of Myzus persicae (Sulzer, 1776), Acyrthosiphon pisum (Harris, 1776), Sitobion avenae (Fabricius, 1775), and Aphis craccivora Koch, 1854. Results showed that low relative humidity (20%) generally enhanced heat tolerance in aphids, although in some species, temperature combinations, the effect of humidity was not statistically significant. In contrast, high relative humidity exacerbated mortality under high-temperature conditions. Additionally, different aphid species exhibited species-specific responses to changes in temperature and humidity. A. craccivora showed the highest heat tolerance among the species tested. This study identified the temperature-humidity synergistic effect as a key factor regulating aphid survival and provided ecological insight for predicting aphid populations and formulating adaptive management strategies under climate change.

PMID:41707063 | DOI:10.1093/jisesa/ieag011

J Appl Res Intellect Disabil. 2026 Jan;39(1):e70198. doi: 10.1111/jar.70198.

ABSTRACT

BACKGROUND: People with intellectual disabilities face obstacles to their social-labour inclusion due to factors that must be identified in the Peruvian context.

METHODS: A total of 542 people with intellectual disabilities were recruited, including 250 from urban areas and 292 from the jungle. Sociodemographic information, quality of life, adaptive behaviour, caregiver burden, and risk of maltreatment were collected from caregivers, who served as the primary source of data. Two models were proposed: social inclusion and employment status, as dependent variables. In both cases, region was considered as a grouping variable to control for random intercepts.

RESULTS: The caregiver burden, along with gender, age, employment status, and self-care were predictors of social inclusion, whereas age, social inclusion, verbal communication, and self-determination were predictors of employment status.

CONCLUSIONS: The factors identified will allow improving interventions or public policies for the benefit of people with intellectual disabilities and their families.

PMID:41707054 | DOI:10.1111/jar.70198

Nurs Health Sci. 2026 Mar;28(1):e70299. doi: 10.1111/nhs.70299.

ABSTRACT

To evaluate the effectiveness of combined problem-based learning (PBL) and rational emotive behavior therapy (REBT) on Psychological Outcomes, Self-Efficacy, Adverse Events, Quality of Life, and Treatment Compliance in breast cancer care. In this non-randomized study conducted at a tertiary hospital in China, 180 patients with breast cancer treated between October 2021 and August 2022 were divided into a control group (n = 90) receiving conventional education and a study group (n = 90) receiving PBL combined with REBT. Outcomes were assessed using validated scales including the Hamilton Anxiety/Depression Rating Scales, EORTC QLQ-C30, General Self-Efficacy Scale, a hospital-designed compliance questionnaire, and adverse event follow-up. After intervention, the study group demonstrated significantly greater improvements in psychological outcomes (p < 0.05), self-efficacy (p < 0.05), lower adverse event rates (13.33% vs. 31.11%; p < 0.01), quality of life domains (p < 0.05), treatment compliance (p < 0.05), compared to the control group. The combined PBL and REBT approach enhances postoperative care for patients with breast cancer by improving psychological outcomes (e.g., reducing anxiety), enhancing self-efficacy, minimizing adverse events, improving quality of life, and promoting treatment compliance.

PMID:41707047 | DOI:10.1111/nhs.70299

Clin Transl Sci. 2026 Feb;19(2):e70501. doi: 10.1111/cts.70501.

ABSTRACT

Clinical PGx practice guidelines (PGx guidelines) may have limited generalizability for “marginalized” groups. We proposed the five-step Real-World Data for Genome-Guided Prescribing (ReGGRx) framework and, using All of Us research program (AoU) data, examined its ability to estimate disparities in concordance with and benefit from PGx guidelines for CYP2C19 testing when choosing antiplatelet and antidepressant drugs. The selected measures were intended to identify disparities in avoiding drug failure independent of following PGx guidelines, the odds of avoiding drug failure with PGx concordant treatment, and the degree to which “marginalized” groups (i.e., groups underrepresented in biomedical research [UBR] and with indeterminate CYP2C19 phenotypes) benefit from PGx concordant treatment, when compared with “non-marginalized” groups (i.e., non-UBR and known CYP2C19 phenotypes). Our findings identified disparities in the antidepressant cohort with UBRs (32% of cohort) having a lower odds of avoiding drug failure. For both cohorts, a lower probability of avoiding drug failure was observed in the indeterminate phenotype group (1% of cohorts) than in the known phenotype group, indicating a need to better characterize rare or ancestry-specific risk alleles. With PGx concordant treatment, negative equal opportunity difference values suggested that the UBR group was less likely to avoid drug failure than the non-UBR group. Overall, our findings illustrate the promise of the ReGGRx framework to assess PGx guideline generalizability and produce evidence for use in drug policy decisions.

PMID:41707036 | DOI:10.1111/cts.70501

Fam Process. 2026 Mar;65(1):e70130. doi: 10.1111/famp.70130.

ABSTRACT

Research on Asian immigrant families has primarily focused on the influence of cultural factors, such as acculturation, on parent-child relationships, yet emerging research suggests that language use may play a critical role, especially when multiple languages (e.g., English and/or a heritage language; HL) may be used in the parent-child communication context. This exploratory study investigated the associations between parent language use and perceived parent-child relationship quality (i.e., positive relationship, parent-child conflict) among Asian immigrant parents (N = 90) of early adolescents ages 9-13. A MANCOVA was conducted to examine these associations, controlling for parent and child sociodemographic factors. Results indicated that parent-reported language use was significantly associated with perceived parent-child conflict: English-speaking parents reported higher levels of parent-child conflict (M = 1.65, SE = 0.29) than their HL-speaking (M = 0.61, SE = 0.30) and bilingual counterparts (M = 0.81, SE = 0.19; F(2, 80) = 4.04, p = 0.021, partial η² = 0.09). When comparing the English language group against the bilingual language group, perceived parent-child conflict was statistically significant (p = 0.048). Parent-reported language use was not associated with perceived positive relationships. Findings highlight language use as an important mechanism in shaping parent-child relationships in Asian immigrant families, above and beyond the effects of acculturation. Greater attention to language use may strengthen future research and family interventions aimed at improving parent-child relationships in Asian immigrant families.

PMID:41707033 | DOI:10.1111/famp.70130

Clin Transl Sci. 2026 Feb;19(2):e70503. doi: 10.1111/cts.70503.

ABSTRACT

Collectively, pediatric rare diseases affect millions of children worldwide. Yet, treatment options are limited. Dose selection presents unique challenges in pediatric rare disease drug development. Traditional dose-finding approaches are impractical for these populations, and conventional pediatric dosing methods like exposure matching face limitations when insufficient adult data exists. Herein, we analyzed dosing strategies and study design characteristics used for new molecular entities (NMEs) for orphan indications approved between 2013 and 2022 that included a pediatric indication at initial approval. Among 63 evaluable products included in this analysis, initial pediatric dose selection was supported by adult data in the same indication (37%), adult healthy volunteer data (33%), nonclinical data only (14%), adult data from different indications (10%), and pediatric data from different indications (5%). The use of modeling and simulation to support initial dose selection was explicitly mentioned for 21% of products. Nearly half (48%) utilized multiple data sources for dose selection. Study design characteristics included multiple dose level evaluation (49%), intra-patient dose escalation (33%), interim pharmacokinetic evaluation (10%), pharmacokinetic/biomarker-driven dosing (5%), and age group staggering (5%). Multiple design features were incorporated in 17% of drugs. This analysis reveals diverse approaches to pediatric dose selection in rare diseases and the use of adaptive study design elements suggests recognition of the need for flexible approaches in these challenging populations. Utility of modeling and simulation, ability to leverage all available data sources, and increased implementation of adaptive trial designs could improve dose selection and optimization in pediatric rare disease drug development.

PMID:41707029 | DOI:10.1111/cts.70503