Category: Statistics

JMIR Form Res. 2026 Jul 3;10:e83548. doi: 10.2196/83548.

ABSTRACT

BACKGROUND: Determining the appropriate dosage of pediatric occupational therapy, physical therapy, and speech-language pathology services is important when supporting families of children with disabilities. However, therapy dosage is inconsistently reported, and caregiver-delivered practice between sessions is rarely documented. Ecological momentary assessment (EMA) offers a method to capture caregiver practice in real time and to examine factors that influence it.

OBJECTIVE: This study aims to pilot the use of EMA to measure caregiver practices between therapy sessions and to compare EMA-reported practices with caregiver recall.

METHODS: This pilot prospective cohort study used convenience sampling to recruit caregivers of children receiving therapy services. During September 2024, participants completed a confidential baseline Qualtrics survey in their homes, which included recall of home practice from the previous week. Participants were then invited to complete 30 days of EMA logging of daily practice. Five participants enrolled in the EMA phase, which began 24 to 72 hours after baseline survey completion and took place during October and November 2024. Semistructured follow-up interviews were conducted immediately after the 30-day EMA period.

RESULTS: Of the 34 survey participants, 5 continued to the EMA phase, contributing 150 days of data, with 82 completed entries (82/150, 55%). Caregivers primarily completed EMA logs on days when practice occurred; missing entries were coded as zero practice based on caregiver reports. Recalled practice averaged 4.5 (SD 5.65) bouts/day and 11.6 (SD 6.35) minutes/bout, totaling 71.2 (SD 121.02) minutes/day. EMA-reported practice across all days (n=150) averaged 2.7 (SD 4.39) bouts/day and 6.5 (SD 6.45) minutes/bout, totaling 23.2 (SD 14.12) minutes/day, which was substantially lower than recalled estimates. On days when practice was reported (n=82), EMA-documented practice averaged 5.2 (SD 3.28) bouts/day and 6.5 (SD 6.45) minutes/bout, totaling 23.9 (SD 14.72) minutes/day. Variability in recalled practice was high (mean 71.19, SD 121.02 min/d). Caregivers described practice as occurring in short, frequent bouts embedded within daily routines, with routine integration, child engagement, and recall of therapist strategies identified as key facilitators.

CONCLUSIONS: Caregiver-delivered practice occurred in short, frequent bouts integrated into daily routines. EMA-reported practice was substantially lower than caregiver recall, suggesting that retrospective recall and prospectively reported EMA data may differ substantially. These findings highlight the importance of teaching strategies that are brief, engaging, and easily incorporated into daily routines. Despite the small sample, EMA was acceptable to a subset of caregivers who completed participation; however, substantial attrition between survey enrollment and EMA initiation suggests significant feasibility and participation barriers that warrant further investigation.

PMID:42398065 | DOI:10.2196/83548

JMIR Form Res. 2026 Jul 3;10:e75251. doi: 10.2196/75251.

ABSTRACT

BACKGROUND: Virtual reality (VR) is increasingly used for adjunctive relaxation training in psychiatric care. However, evidence remains limited among hospitalized patients with depressive disorders, particularly in routine inpatient settings in China, and little is known about whether improvement varies by session frequency.

OBJECTIVE: This retrospective study examined whether adjunctive VR-based relaxation training was associated with changes in depressive and anxiety symptoms among inpatients with depressive disorders and whether improvement differed by session frequency.

METHODS: We conducted a retrospective, nonrandomized natural-group comparison using complete anonymized medical records from patients hospitalized in Lishui Second People’s Hospital between January 1 and December 31, 2022. Patients met International Classification of Diseases, Tenth Revision (ICD-10) diagnostic criteria for depressive episodes or recurrent depressive disorders and were screened using predefined criteria. The analytic sample included 133 inpatients: 63 (47.4%) received adjunctive VR-based relaxation training plus usual care and 70 (52.6%) received usual care only. Usual care included pharmacotherapy and physiotherapy. The VR intervention consisted of 25-minute immersive relaxation sessions delivered approximately 3 times per week. Symptoms were assessed at admission and discharge using the 17-item Hamilton Depression Scale and Hamilton Anxiety Rating Scale. Response was defined as a reduction of 50% or more from baseline, and remission was defined as a total score of 7 or less. Baseline characteristics, outcome scores, response and remission rates, and exploratory session-frequency subgroups were compared. All analyzed variables were checked against complete medical records; no missing values were identified, and no imputation was performed.

RESULTS: The VR and control groups did not differ significantly in baseline depressive or anxiety scores. At discharge, adjunctive VR-based relaxation training was associated with lower depressive and anxiety symptom scores than usual care alone. The VR group also showed higher response rates for both depressive and anxiety symptoms and a higher anxiety remission rate, whereas depression remission was similar. Exploratory session-frequency analyses suggested that anxiety improvement may be more consistently associated with VR exposure than depression remission; however, the pattern was not strictly linear and should be interpreted cautiously because treatment frequency was linked to hospitalization duration and routine care factors.

CONCLUSIONS: This study is innovative in evaluating structured VR-based relaxation training as an adjunct to routine inpatient depression care and in providing preliminary observations on session-frequency patterns in a real-world Chinese psychiatric setting. Unlike many previous VR studies conducted in noninpatient, nonclinical, or short-term experimental contexts, this study reflects everyday clinical practice among hospitalized patients with depressive disorders. The findings contribute practical evidence for integrating immersive relaxation into comprehensive inpatient care, particularly when additional anxiety relief is desired. Because the study was retrospective and nonrandomized, the findings indicate associations rather than causal effects and should be confirmed in prospective randomized controlled trials.

PMID:42398063 | DOI:10.2196/75251

JMIR Res Protoc. 2026 Jul 3;15:e85437. doi: 10.2196/85437.

ABSTRACT

BACKGROUND: Clinical triage requires integrating multiple information sources to identify patients at risk of deterioration. Tools capturing global health assessments beyond disease-specific scores are being developed using either bottom-up aggregation of simple indicators or top-down machine learning from large datasets. Their alignment with expert clinical judgment remains poorly characterized.

OBJECTIVE: This study evaluates 2 latent health measurement approaches: Frailty Index-laboratory, a transparent bottom-up tool aggregating laboratory abnormalities via deficit accumulation theory, and ETHOS-ARES (Enhanced Transformer for Health Outcome Simulation-Adaptive Risk Estimation System), a transformer-based foundation model generating multidimensional patient representations from electronic health records. We assess whether each tool’s severity rankings align with clinical consensus and whether they offer utility in triage decisions.

METHODS: In this 3-phase mixed methods study, at least 30 clinicians across hospital specialties reviewed 20 emergency department presentations derived from Medical Information Mart for Intensive Care IV-Emergency Department. Phase 1 compared unaided clinician severity and urgency judgments against model outputs using Spearman rank correlation, with a Turing-inspired indistinguishability test assessing whether model rankings fell within the distribution of clinician assessments. Phase 2 allocated clinicians to receive Frailty Index-laboratory or ETHOS-ARES outputs, measuring anchoring effects via within-person pre-post comparisons and exploring clinical utility through semistructured interviews analyzed using the Framework Method.

RESULTS: Ethics approval was granted in June 2025 (KCL Research Ethics Office; MRSP-24/25-48707). Recruitment began in October 2025 (32 clinicians recruited as of manuscript submission), with data collection expected to be completed in January 2026 and analysis planned for March or April 2026.

CONCLUSIONS: This study will quantify model-clinician agreement, measure anchoring effects, and generate qualitative insights on utility, trust, and adoption. The findings will inform the implementation of latent health measurement tools in clinical practice and provide a framework for the early-stage evaluation of artificial intelligence-based clinical decision support systems.

PMID:42398056 | DOI:10.2196/85437

JMIR Form Res. 2026 Jul 3;10:e92967. doi: 10.2196/92967.

ABSTRACT

BACKGROUND: Informal caregivers of people living with dementia often experience high rates of caregiver burnout while providing care. Although there are many websites and mobile apps available to help caregivers, many do not use digital tools. The Olera platform was developed to be an easily adoptable web-based support tool, connecting caregivers with long-term services and supports, financial assistance, and educational resources. The platform was developed based on the Build-Measure-Learn framework with input from caregiver needs assessments and usability studies.

OBJECTIVE: This study aims to evaluate the quantitative and qualitative feedback of informal caregivers of people living with dementia on the second iteration of the Olera platform. The primary objective was to assess caregivers’ acceptance of this caregiving platform. The secondary objective was to use qualitative methods to explore (1) the study cohort’s challenges in daily caregiving to determine and compare them with prior literature, (2) their experience when using the Olera platform, and (3) their attitudes toward integrating artificial intelligence in caregiver services for future studies and platform development.

METHODS: Caregivers were recruited through various sources and screened for eligibility through an initial survey. Participants used the platform for 4 weeks and completed a survey with an adapted Technology Acceptance Survey (TAS) and qualitative open-ended questions at the end of the testing period. TAS responses were summarized with descriptive statistics, while ANOVAs, t tests, and linear regressions were used to compare the differences in the overall TAS scores by caregiver characteristics. Qualitative feedback data on the platform’s usefulness were analyzed via a thematic analysis framework approach.

RESULTS: A total of 65 caregivers in the United States completed the study, with a mean age of 59.9 (SD 9.8) years. The majority were female (61/65, 95.3%), non-Hispanic or Latino White (45/65, 69.2%), and the adult child of their care recipient (42/65, 64.6%). Evaluation of the Olera platform showed a high acceptance rate, with each TAS item scoring above 5.0 and an overall TAS score of 5.83 (SD 0.85) out of 7. Higher platform use frequency was associated with higher TAS ratings in technology acceptance (F3,61=7.88, P<.001). Thematic analyses elicited the caregiving challenges, evaluation of the Olera platform, and feedback on artificial intelligence-assisted support.

CONCLUSIONS: The Olera platform is an example of a beneficial web-based tool, though key features were requested to be included in the next iteration. Additionally, data supported prior findings regarding informal caregiver challenges and the insufficiency of conventional support mechanisms, indicating a need for more innovative digital solutions. Future research and development efforts using the Build-Measure-Learn approach are necessary to further iterate the platform’s key features, enhance the tool, involve more informal caregivers in its improvements, and serve as a model for customizable, person-centered online care support.

PMID:42398038 | DOI:10.2196/92967

JMIR Mhealth Uhealth. 2026 Jul 3;14:e85986. doi: 10.2196/85986.

ABSTRACT

BACKGROUND: Nurse burnout is a pervasive global problem. Cognitive behavioral therapy (CBT) has been shown to reduce burnout; however, most digital CBT programs use standardized approaches that overlook individual differences in burnout profiles. With advances in artificial intelligence (AI), algorithm-based recommendation systems now enable personalized intervention delivery by matching specific CBT modules to users.

OBJECTIVE: This study aimed to test the effects of an AI-selected mobile CBT-based intervention on nurse burnout and to describe participants’ experiences with the intervention. Specifically, it evaluated whether an AI-selected CBT-based intervention differentially reduced burnout subdomains compared with an information-only control group and explored how nurses perceived and engaged with the AI-selected program.

METHODS: This study adopted a mixed methods design, integrating a 2-group randomized controlled trial and qualitative content analysis exploring participants’ experiences. For this randomized controlled trial, a total of 125 nurses were enrolled and randomly assigned to either the experimental group (n=62) or the control group (n=63) between October 2024 and December 2024. The experimental group received an AI-selected mobile CBT-based intervention, in which an AI algorithm assigned CBT modules based on participants’ burnout profiles (client-related, personal, and work-related), job stress, and coping characteristics. The control group received information related to burnout management. Primary outcomes, client-related, personal, and work-related burnout, were assessed at baseline, 2 weeks, and 4 weeks. Secondary outcomes, including coping strategies, job stress, and stress response, were assessed at baseline and 4 weeks. Between-group differences in burnout over time were examined using repeated measures analysis of variance, with adjustment for job stress and stress response. Within-group changes and postintervention group differences were analyzed using t tests. Open-ended survey responses and follow-up interviews (n=5 in the experimental group) were analyzed using thematic content analysis.

RESULTS: Follow-up completion rates were 84.6% (137/162) at both 2 and 4 weeks. The experimental group showed a greater reduction in client-related (F1,121=7.548; P=.007), personal (F1,121=6.533; P=.01), and work-related burnout (F1,121=38.194; P<.001) than the control group, reflecting more pronounced within-group improvements over time. No significant between-group differences were observed for coping strategies, job stress, or stress response. Qualitative findings suggested that some participants were receptive to the AI-selected CBT-based intervention and reported increased self-awareness and reflective engagement with coping strategies that they might not have selected independently.

CONCLUSIONS: The findings suggest that participants were receptive to AI-selected CBT-based interventions, suggesting the potential of such interventions as a supportive approach for alleviating nurse burnout. Future research should explore the sustainability of these effects and optimize the intervention duration to enhance engagement and impact.

PMID:42398032 | DOI:10.2196/85986

Arh Hig Rada Toksikol. 2026 Jun 30;77(2):96-101. doi: 10.2478/aiht-2026-77-4035. eCollection 2026 Jun 1.

ABSTRACT

Nasal carriage plays a key role in Staphylococcus aureus transmission, particularly among individuals working in the food sector. The aim of this cross-sectional study was to investigate the relationship between personal hygiene and nasal carriage of S. aureus among workers in food production, distribution, and trade. It was conducted in Skopje from November 2021 to March 2022 and included 289 workers undergoing mandatory health and hygiene examinations. Data were collected through a structured questionnaire and microbiological testing of nasal swabs. The overall prevalence of S. aureus nasal carriage was 12.5 % (95 % CI: 8.7-16.3 %). Methicillin-susceptible S. aureus (MSSA) prevailed in 11.8 % (95 % CI: 8.1-15.5 %) and the methicillin-resistant variety (MRSA) in only 0.7 % (95 % CI: 0-1.7 %). We found no significant associations between nasal carriage and demographic or hygiene variables (assessed using the chi-squared test) but did observe higher carriage rates among men (15.7 %), cooks (28.6 %), and individuals with untidy nails (17 %). However, our findings should be interpreted with caution, and future studies should address the limitations of the present study. Targeted training, routine screening, and consistent adherence to good hygiene practices remain important for minimising colonisation and reducing the risk of S. aureus transmission.

PMID:42398011 | DOI:10.2478/aiht-2026-77-4035

Int Braz J Urol. 2026 Nov-Dec;52(6):e20260196. doi: 10.1590/S1677-5538.IBJU.2026.0196.

ABSTRACT

INTRODUCTION: Nephrolithiasis is a prevalent and recurrent condition affecting approximately 10-11% of the population. Percutaneous nephrolithotomy (PCNL) and mini-PCNL are established treatments for large renal stones. Outcomes are influenced by the choice of lithotripsy energy source. Available technologies include pneumatic, ultrasonic, Holmium:YAG (Ho:YAG), and thulium fiber laser (TFL), each with specific advantages and limitations. This review summarizes current evidence on these energy sources in PCNL and mini-PCNL.

MATERIALS AND METHODS: A narrative review was performed using PubMed and Cochrane Library, including studies published between 2014 and 2024. The search included terms related to PCNL and lithotripsy energy sources. Studies involving pediatric populations, anomalous kidneys, or non-standard energy sources were excluded. After screening 95 articles, 32 studies were included, of which 13 provided comparative data on different energy sources and were analyzed.

RESULTS: Differences were observed in operative time, stone-free rates (SFR), bleeding, transfusion rates, complications, and hospital stay. In PCNL, ultrasonic and Ho:YAG lithotripsy showed comparable outcomes, while pneumatic demonstrated slightly lower SFR. In mini-PCNL, ultrasonic and laser technologies yielded similar efficacy. TFL displayed shorter operative time and reduced bleeding and transfusion rates compared to Ho:YAG, although many differences did not reach statistical significance.

CONCLUSION: Ultrasonic and Holmium:YAG lithotripsy provide comparable outcomes in PCNL, while pneumatic devices may correlate with slightly lower stone-free rates. In mini-PCNL, ultrasonic and laser modalities show similar outcomes. TFL demonstrates potential advantages in operative time and bleeding, however, evidence remains heterogeneous, and further high-quality studies are needed.

PMID:42397984 | DOI:10.1590/S1677-5538.IBJU.2026.0196

BJS Open. 2026 Jul 3;10(4):zrag093. doi: 10.1093/bjsopen/zrag093.

ABSTRACT

BACKGROUND: Post-thyroidectomy hypocalcaemia is the most common complication after total thyroidectomy. Although perioperative calcium and vitamin D supplementation is widely used, the comparative effectiveness of different prophylactic strategies remains uncertain.

METHODS: A systematic review and Bayesian network meta-analysis of randomized clinical trials was performed according to PRISMA guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched from inception to 7 May 2026. Adult patients undergoing total or near-total thyroidectomy were included. Three strategies were compared: no routine supplementation, calcium alone, and calcium combined with vitamin D analogues. Primary outcomes were clinical hypocalcaemia, biochemical hypocalcaemia, and need for intravenous calcium supplementation; length of hospital stay was secondary. Random-effects network meta-analysis estimated odds ratios with 95% credible intervals. Risk of bias was assessed using RoB 2. The protocol was registered in PROSPERO (CRD420251068837).

RESULTS: Twenty randomized trials including 3669 patients were analysed. Calcium plus vitamin D significantly reduced clinical hypocalcaemia versus no supplementation (odds ratio 0.31, 95% credible interval 0.17 to 0.51) and calcium alone (odds ratio 0.52, 0.25 to 1.04). Combination therapy also reduced biochemical hypocalcaemia compared with no supplementation (odds ratio 0.27, 0.17 to 0.42) and calcium alone (odds ratio 0.44, 0.22 to 0.83), and markedly decreased intravenous calcium requirements (odds ratio 0.15, 0.05 to 0.32). Calcium monotherapy showed no significant benefit. Combination therapy ranked as most effective and was associated with shorter length of hospital stay (mean difference 0.44 days).

CONCLUSIONS: Perioperative calcium combined with vitamin D is the most effective strategy for preventing post-thyroidectomy hypocalcaemia and reducing intravenous calcium use, supporting routine postoperative implementation despite heterogeneity in supplementation protocols.

PMID:42397982 | DOI:10.1093/bjsopen/zrag093

Eur J Public Health. 2026 Jun 10;36(4):ckag087. doi: 10.1093/eurpub/ckag087.

ABSTRACT

Depressive disorders represent the second leading cause of disability globally, and Portugal reports the second highest prevalence in Europe. Nevertheless, the role of socioeconomic factors, behavioural determinants, and potential differences in treatment remain underexplored. This study assessed socioeconomic inequalities in depression and inequity in mental healthcare utilization among Portuguese adults aged 25-65 years, and evaluated whether health behaviours mediate the socioeconomic status (SES) and depression association. We used microdata from the 2019 Portuguese National Health Interview Survey. Depression was measured through self-report and PHQ-8 (≥10, moderate and moderately-severe; ≥20, severe). Concentration curves and indices, standardized by sex and age, assessed SES-related inequality in depression; horizontal inequity in mental healthcare utilization was estimated by adjusting for morbidity. Logistic regression models estimated the SES-depression association, and mediation by health behaviours (smoking, alcohol, sedentary lifestyle, diet, BMI) was evaluated using attenuation analysis. Overall, 13.0% reported depression in the previous year and 6.8% met PHQ-8 criteria. Both were disproportionately concentrated among lower-income groups, with the strongest inequality observed for severe depression. Horizontal inequity was also observed: specialist consultations were disproportionately used by higher-income groups when adjusting for self-reported depression, whereas medication was more concentrated among lower-income individuals meeting PHQ-8 criteria. Sedentarism, BMI, and alcohol drinking partially mediated SES-depression association, reducing effect estimates by up to 23.9%. Marked socioeconomic inequalities exist in depression and mental healthcare utilization in Portugal. Strengthening equitable access to evidence-based mental healthcare and addressing upstream behavioural and socioeconomic determinants are critical to reducing the national mental health burden.

PMID:42397976 | DOI:10.1093/eurpub/ckag087

J Cardiovasc Nurs. 2026 Jul 3. doi: 10.1097/JCN.0000000000001340. Online ahead of print.

ABSTRACT

BACKGROUND: Prolonged intensive care unit (ICU) stay after heart valve surgery may delay recovery and increase complications; however, the risk factors remain underexplored.

OBJECTIVE: In this study, we aimed to identify pre-, intra-, and postoperative clinical factors associated with prolonged ICU stay after heart valve surgery.

METHODS: A retrospective case-control analysis was conducted on 498 patients admitted to the cardiovascular surgical ICU of a tertiary hospital in Seoul from January 1, 2021, to December 31, 2022. Patients were grouped based on ICU length of stay: ≤72 hours (nonprolonged, n = 332) and >72 hours (prolonged, n = 166), matched by age, sex, and surgery date. Data were obtained from the electronic medical records. Statistical analyses included t tests, Mann-Whitney U test, chi-square test, Fisher’s exact test, and logistic regression.

RESULTS: Significant predictors of prolonged ICU stay included New York Heart Association class (NYHA) II (odds ratio [OR] = 3.33, 95% confidence interval [CI] = 1.79-6.18), higher EuroSCORE II (OR = 1.29, 95% CI = 1.10-1.53), fluid imbalance (OR = 1.27, 95% CI = 1.01-1.59), and longer intubation duration (OR = 1.01, 95% CI = 1.01-1.02). Additional factors included postoperative arrhythmia, red blood cell transfusion, neurological complications, hemodialysis, and fever.

CONCLUSIONS: Multiple clinical and postoperative factors were associated with a prolonged ICU stay after valve surgery. These findings can inform nursing protocols and targeted interventions to enhance recovery and reduce ICU burden.

PMID:42397975 | DOI:10.1097/JCN.0000000000001340