Category: Statistics

Clin Rheumatol. 2026 Jan 31. doi: 10.1007/s10067-025-07754-9. Online ahead of print.

ABSTRACT

INTRODUCTION/OBJECTIVES: Psychological stress impacts rheumatoid arthritis (RA) disease activity, and California’s response to the COVID-19 pandemic created historically significant stressors for patients. This study examined factors associated with changes in RA flares during the pandemic.

METHODS: In this cross-sectional COVID-19 RA study, patients with RA ICD-9/10 codes were emailed a questionnaire in July/November of 2020 containing questions on RA disease activity, Routine Assessment of Patient Index Data 3 (RAPID3), flare number and frequency, RA Flare Questionnaire (RA-FQ), Perceived Stress Scale 4 (PSS-4), stressors, and demographics. Age, anti-cyclic citrullinated antibody, and rheumatoid factor were extracted from medical records. Analyses examined associations between current flare status, number of flares, and changes in flare frequency with PSS-4 and stressors.

RESULTS: Of 1138 respondents (22.6% response rate), 69.3% reported at least one RA flare, 43% multiple flares, and 36.3% currently experiencing a flare. Compared to pre-pandemic levels, 36.3% noted more frequent flares, while 9.2% reported fewer. Increased stress was noted across all flare groups. Regression analyses revealed significant associations between current flare and PSS-4 scores, financial stress, and sleep quality (all p < 0.03). A higher number of flares were significantly associated with PSS-4, financial stress, and home stress (p < 0.03). Increased flare frequency was associated with PSS-4, apprehension, panic, financial stress, and sleep quality (all p < 0.05). Asian race was negatively associated with the number of flares and flare frequency (both p < 0.05).

CONCLUSIONS: This study reports a link between stress and RA flares during the pandemic, underscoring the need for targeted strategies to manage RA patients at risk of flare during heightened stress. Key Points • During the COVID-19 pandemic, patient-reported RA flares increased significantly compared to pre-pandemic levels, signifying there may be value in reevaluating RA management strategies during periods of heightened stress. • Financial stress, home stress, and poor sleep were major pandemic stressors linked to current and increased frequency of RA flares. • RA patients not in remission may be more susceptible to disease exacerbations while under stress, as those experiencing flares during the pandemic were less likely to have been in remission beforehand. • Asian race was associated with fewer RA flares and reduced flare frequency, suggesting racial and ethnic differences may influence flare patterns.

PMID:41619155 | DOI:10.1007/s10067-025-07754-9

Clin Rheumatol. 2026 Jan 31. doi: 10.1007/s10067-025-07755-8. Online ahead of print.

ABSTRACT

BACKGROUND: A well-known global public health issue, osteoarthritis (OA) primarily affects the elderly. Although the etiology of OA remains unknown, immune and inflammatory factors are considered nonnegligible risk factors. This study investigated the association between the systemic immune-inflammatory index (SII) and the risk of OA.

METHODS: Based on data from the National Health and Nutrition Examination Survey (NHANES), laboratory testing, basic information, and questionnaires were collected for cross-sectional analysis from a total of 15,317 adults during 2013-2018. In this study, the exposure variable was systemic inflammatory status as defined by SII, and the outcome was OA. Due to the complex survey design and sample weighting, we employed multiple logistic regression models and stratified analyses to evaluate the association between SII and OA. In addition, using an interaction test, we examined the relationship between SII, OA, and other variables.

RESULTS: This study included a total of 15,317 participants, of whom 2207 were diagnosed with OA. Compared with the non-OA group, participants in the OA group had a significantly higher SII level. After adjusting for all covariates, log SII was positively associated with OA prevalence (OR = 1.27, 95% CI: 1.02, 1.59, P = 0.0353). Participants in the fourth SII quartile had a significantly higher OA prevalence than those in the first quartile (OR = 1.18, 95% CI: 1.00, 1.39, P = 0.0454). Subgroup analyses further confirmed the robustness of this positive association.

CONCLUSION: Our study demonstrated that SII was associated with the risk of OA, suggesting a complex correlation between immunity and inflammation in OA. SII may serve as a useful predictor of OA and offer new insights into the diagnosis and management of the condition. Key Points • Elevated systemic immune-inflammatory index (SII) is significantly associated with a higher prevalence of osteoarthritis in a large, representative US adult population. • This positive association persists after comprehensive adjustment for potential confounders and across diverse population subgroups. • SII, as a novel and integrated biomarker, may offer valuable insights for the prediction and management of osteoarthritis.

PMID:41619154 | DOI:10.1007/s10067-025-07755-8

Eur J Health Econ. 2026 Jan 31. doi: 10.1007/s10198-025-01850-y. Online ahead of print.

ABSTRACT

While a substantial body of empirical research documents the negative wellbeing and labour force participation effects of transitioning into and maintaining informal care roles, studies of transitions out of caregiving are small in number and present conflicting results. We contend that these conflicting results reflect differences in sample selection and methodological approaches. As such, we implement a novel research design known as staggered difference-in-differences to account for heterogeneities in carers’ transition dates, caregiving intensity, and demographic and socio-economic characteristics to deliver robust evidence on their post-transition wellbeing and labour force participation outcomes. Our sample is drawn from Waves 5 to 18 of the Household, Income and Labour Dynamics in Australia Survey, Australia’s largest longitudinal household survey, and comprises 6,090 respondent-Wave-level observations from respondents who transitioned out of carer roles. We find that respondents who previously devoted at least 10 hours per week to care enjoy significantly better mental health, emotional wellbeing and social functioning than those with ongoing carer duties. These benefits are immediate and generally persist for years after transitioning out of carer roles. Labour market participation outcomes follow a similar pattern: both employment rates and hours worked rise sharply upon exit and remain elevated. Our results also underscore the importance of using care intensity measures that accurately reflect the burden of caregiving, specifically, time- rather than role-based metrics.

PMID:41619144 | DOI:10.1007/s10198-025-01850-y

J Ultrasound. 2026 Jan 31. doi: 10.1007/s40477-025-01113-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Lung ultrasound (LUS) is a non-invasive imaging method that does not use ionizing radiation, making it particularly useful for evaluating children and adolescents.

OBJECTIVES: This study aimed to compare LUS findings in children and adolescents with asthma exacerbation to those with controlled asthma.

METHODS: A prospective longitudinal observational study was conducted, following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for reporting observational studies.

RESULTS: Among patients with asthma exacerbation, 33 individuals were analyzed, and the study found that 51.5% of children in the exacerbation group had positive ultrasound findings, compared to only 12.1% in the controlled group. The calculated prevalence ratio was 2.27 (95% CI 1.46-3.55), with a p-value of 0.001, indicating a statistically significant difference in ultrasound findings between the two groups.

DISCUSSION: These findings suggest that lung ultrasound may be a useful tool for identifying changes in children with asthma exacerbations. The significantly higher prevalence of positive findings in the exacerbation group (51.5%) compared to the controlled group (12.1%) suggests that LUS has the potential to detect changes associated with asthma exacerbation. Further research, including multicenter studies, is needed to validate these findings.

CONCLUSION: LUS demonstrated a higher prevalence of positive findings during asthma exacerbations, suggesting potential clinical utility as an adjunctive tool in pediatric asthma assessment.

PMID:41619141 | DOI:10.1007/s40477-025-01113-9

Clin Exp Nephrol. 2026 Jan 31. doi: 10.1007/s10157-026-02822-z. Online ahead of print.

ABSTRACT

Clinical nephrology research is increasingly challenged by the need to translate complex patient experiences, emerging biomarkers and treatments, and an expanding methodological tools into improvements in care. Clinical epidemiology provides a bridge between bedside questions and population science; however, its role is often narrowly perceived as clinical statistics rather than as a discipline centered on research conceptualization and design. In this invited review, I reflect on how clinical questions arising from routine nephrology practice can be systematically developed into clinically relevant research through a nephrologist-epidemiologist’s lens. First, drawing on our experience and illustrative examples, I describe how rethinking care processes through established frameworks-such as the structure-process-outcome model-can support clinicians in formulating answerable questions that matter to patients. Second, I expand the lens beyond traditional nephrology to incorporate perspectives from social medicine, emphasizing trust, hope, and patient-reported outcomes as integral components of chronic kidney disease care. Finally, this review highlights how clinical questions can be embedded within clinical research design frameworks to clarify research objectives across diagnosis, treatment, prognosis, and etiology. In an era of rapid methodological diversification, the nephrologist-epidemiologist’s unique contribution may lie in cultivating a sharpened lens: the ability to discern relevant clinical questions and sustain deep clinical reasoning. By doing so, clinical epidemiology can continue to guide research that advances comprehensive and patient-centered kidney care.

PMID:41619140 | DOI:10.1007/s10157-026-02822-z

J Prev (2022). 2026 Jan 31. doi: 10.1007/s10935-026-00902-0. Online ahead of print.

ABSTRACT

Insufficient individual outdoor activity is common among older adults, yet research on the association between individual outdoor activity frequency and all-cause mortality among older adults remains limited. Therefore, we aimed to explore the association between individual outdoor activity frequency and all-cause mortality among older Chinese adults. We conducted a prospective cohort study using data from 8117 participants aged 65 years or above from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Accelerated failure time (AFT) models were used to assess the longitudinal association between individual outdoor activity frequency and all-cause mortality by using time ratios (TRs) and 95% confidence intervals (CIs). Subgroup analyses of the association were conducted by age, sex and residence. In addition, sensitivity analyses were performed to assess the robustness of main results. During a median follow-up period of 5.11 years, a total of 3893 (47.96%) participants died. Compared with participants who never engaged in individual outdoor activity, those who engaged rarely or sometimes (TR: 1.24, 95% CI: 1.10-1.40) and those who engaged regularly or almost every day (TR: 1.59, 95% CI: 1.48-1.70) had a statistically significant longer survival time in the fully adjusted model. Subgroup analyses showed consistent associations in nearly all strata. Sensitivity analyses confirmed the robustness of main results. Frequent participation in individual outdoor activity was significantly associated with longer survival time among older Chinese adults. Our findings support encouraging older adults to engage in regular individual outdoor activity for longevity benefits.

PMID:41619132 | DOI:10.1007/s10935-026-00902-0

J Occup Rehabil. 2026 Jan 31. doi: 10.1007/s10926-026-10367-x. Online ahead of print.

ABSTRACT

PURPOSE: The National Workplace Psychological Health and Safety Standard (The Standard) recommends the use of a survey developed by Guarding Minds at Work (GM@W). However, its validity remains underexplored. This study has two objectives: (1) to evaluate the psychometric properties of the survey in assessing the Standard dimensions and (2) to examine validity across gender and industry.

METHODS: A Confirmatory Factor Analysis (CFA) was conducted on data from the GM@W survey to evaluate the factor structure and validity of the 13 dimensions. Group comparisons by gender and occupational groups were assessed using t-tests and ANOVA tests.

RESULTS: Across the 13 dimensions, most items demonstrated strong internal consistency and discriminant validity, with physical safety (r = 0.71) and organizational culture (r = 0.68) showing the highest internal consistency. While psychological competencies and physical safety were linked to positive mental health outcomes, challenges with workload management and balance remain prominent, especially for workers in healthcare and education. Group differences were observed, with women and workers in business, trades, and manufacturing reporting better psychosocial outcomes.

DISCUSSION: While the GM@W tool demonstrated internal consistency and improved convergent validity compared to previous versions, significant model misfit was observed across all sectors. High latent correlations and frequent violations of the Fornell-Larcker criterion reveal substantial construct overlap and empirical redundancy. The findings suggest that while individual constructs are reliable, the 13-factor structure faces challenges in achieving empirical distinctiveness. Capturing the diverse psychosocial experiences of a national workforce within a single psychometric instrument remains a complex task.

PMID:41619121 | DOI:10.1007/s10926-026-10367-x

Cogn Res Princ Implic. 2026 Jan 31;11(1):10. doi: 10.1186/s41235-026-00705-1.

ABSTRACT

When individuals collaborate, they often rely on momentary estimates of their own and their partner’s confidence (decision confidence) to guide collective decisions and achieve their goals. Through interaction, these confidence estimates tend to align over time. This process is known as confidence matching. More stable, dispositional trait confidence is also emerging as a key factor shaping the dynamics and outcomes of collaborative action. We examined how trait confidence and type of communication impact the accuracy of dyadic decisions, decision confidence, and the dynamics of decision confidence, including decision-specific confidence matching. In this study, 210 participants completed general knowledge tests individually and collaboratively, forming 105 dyads. The tests were completed under three communication conditions: isolated (no interaction), passive (viewing the partner’s response and numeric confidence rating), and active (verbal discussion). Participants assessed as high-trait or low-trait confidence were allocated to three types of dyads: low-trait (two low-trait members), mixed-trait (one low-trait and one high-trait member), or high-trait (two high-trait members) confidence dyads. Statistically controlling for cognitive ability, trait confidence moderated decision accuracy and decision confidence gains: dyads with mixed-trait or high-trait confidence showed greater decision accuracy improvements in the active than the passive communication condition compared to their individual decisions. Whereas low-trait confidence dyads benefited equally from active and passive communication. Collaboration increased decision confidence overall, especially for high-trait confidence dyads under active communication. Decision-specific confidence matching occurred rapidly in both passive and active communication but predicted decision accuracy gains only in the passive condition where participants had limited social information. Although active verbal communication led to the greatest overall decision accuracy, these gains were not driven by decision-specific confidence matching. Our findings highlight the critical role of trait confidence in shaping collaborative outcomes in dyads and extend previous research by showing that decision-specific confidence matching occurs naturally during verbal communication. SIGNIFICANCE STATEMENT: When two people collaborate to make decisions, we often assume that “two heads are better than one.” However, the benefits of dyadic decision-making depend on how effectively group members share and interpret their confidence in judgments. Our study highlights trait confidence, an individual’s stable tendency to express confidence, as a critical yet often overlooked factor that shapes the success of dyadic decisions. We found that trait confidence moderates dyadic improvements in both decision accuracy and decision confidence. Importantly, the effectiveness of dyadic collaboration depends on the type of communication: verbal discussions maximized accuracy gains for dyads with high or mixed levels of trait confidence, whereas simpler, non-verbal exchanges were sufficient for low-trait confidence dyads. Additionally, we demonstrated that dyad members naturally align their levels of confidence (a process known as confidence matching) during verbal discussions. This extends prior research showing that the language used to express confidence becomes more similar over time and that confidence matching has previously been observed only under artificial, numeric rating contexts. These insights enhance our understanding of how individual differences in trait confidence and communication modes influence collaborative decisions, providing practical guidance for effectively structuring collaborative interactions and pairing partners in applied settings.

PMID:41619118 | DOI:10.1186/s41235-026-00705-1

Support Care Cancer. 2026 Jan 31;34(2):150. doi: 10.1007/s00520-026-10342-5.

ABSTRACT

OBJECTIVES: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of chemotherapy, affecting more than half of cancer patients. This scoping review aimed to summarize the incidence and factors associated with falls in patients with CIPN and to visually map the distribution of existing evidence, thereby providing a theoretical foundation for the development of preventive measures and intervention strategies.

METHODS: A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Chinese Biomedical Literature Database (CBM), Knowledge Infrastructure (CNKI), Chongqing VIP Information (CQVIP), and Wan Fang Data. The search included articles published from database inception to August 16, 2024. To enhance the synthesis of evidence, a bubble plot-based evidence map was constructed.

RESULTS: A total of 11,649 records were identified, of which 19 studies were included. Most were quantitative non-randomized studies (n = 17): eight achieved a quality rating of 100%, eight scored 80%, and one scored 60%. Two studies were quantitative descriptive (one scored 80% and one scored 40%). Sixteen studies reported the incidence of fallers among CIPN patients, ranging from 5.6% to 57.4%. Seventeen studies examined fall-related factors in CIPN, which were categorized into 11 groups. Within the evidence map, high-quality and high-OR evidence was observed for CIPN symptoms/severity, advanced or unknown cancer stage, and chronic liver disease. CIPN-related factors were the most frequently reported, followed by demographic factors, suggesting that these domains, particularly those with both high quality and high OR, should be prioritized as targets for future intervention strategies. The adjusted odds ratios (ORs) ranged from 0.997 to 2.67.

CONCLUSION: Falls are common among patients with CIPN, with high-quality evidence primarily concentrated in the domains of CIPN-related burden, demographic and clinical characteristics of participants, and comorbidities. Future research should (1) conduct multicenter prospective longitudinal cohort studies with time-updated measurements of CIPN and treatment exposures, using standardized definitions of falls and observation windows; (2) strengthen outcome measurement by following COSMIN/Delphi recommendations, including the development of a gold-standard CIPN scale, specification of assessor qualifications, standardized training, and reporting of inter-rater reliability; and (3) re-examine currently unadjusted signals within rigorously controlled multivariable models.

PMID:41619098 | DOI:10.1007/s00520-026-10342-5

Metab Brain Dis. 2026 Jan 31;41(1):24. doi: 10.1007/s11011-026-01789-w.

ABSTRACT

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Autism Spectrum Disorder (ASD) is characterized by persistent difficulties in social communication and interaction, together with restricted and repetitive behaviors, interests, or activities. The diagnosis of ASD currently relies on comprehensive assessments of developmental history and behavioral patterns, as there are no validated laboratory tests for a definitive clinical diagnosis. While evidence-based interventions are largely restricted to educational and behavioral programs, many individuals with ASD and their caregivers explore complementary approaches, including dietary interventions. Among these, the gluten-free, casein-free (GFCF) diet is one of the most frequently adopted strategies. A leading hypothesis posits that those increased concentrations of opioid peptides such as gluteomorphin and caseomorphin derived from the incomplete digestion of gluten and casein may contribute to the severity of ASD symptoms. It is further suggested that eliminating these dietary proteins could reduce opioid peptide concentrations in biofluids and improve clinical outcomes. The present systematic review was created by reviewers who searched PubMed, Web of Science, and Scopus databases, covering the period from January 1980 to March 2025. The search strategy combined standardized keywords and Medical Subject Headings terms. The search strategy included a combination of keywords commonly used in the literature to represent ASD, opioid peptides, and GFCF diets. A systematic literature search was carried out on PubMed and Web of Science and a total of 17 articles were included. Although preliminary findings from clinical and laboratory studies are promising, conclusive evidence regarding the efficacy of the GFCF diet remains lacking. This review aims to synthesize current findings on the relationship between opioid peptides and ASD, with a particular focus on the neurological effects of food-derived peptides and their potential role in therapeutic dietary interventions.

PMID:41619084 | DOI:10.1007/s11011-026-01789-w