Category: Statistics

Andrology. 2026 Aug 18. doi: 10.1111/andr.70364. Online ahead of print.

ABSTRACT

BACKGROUND: Little is known about the relative contribution of genetic and environmental factors on male reproductive function.

OBJECTIVES: We studied in a cross-sectional setting, whether testicular function and genital size correlate in father-son pairs. The study included young men from a prospective Finnish-Danish Boy cohort study and their fathers.

MATERIALS AND METHODS: We collected data on young men born between 1997 and 2002 at Turku University Hospital, Finland, and at the University Hospital of Copenhagen, Denmark. These young men were invited for an adult follow-up visit at 18-23 years together with their fathers. Altogether 38 Finnish and 79 Danish father-son pairs participated in the study. The study visits included analysis of a semen sample, measurement of serum reproductive hormones and genital size (testes, penis, anogenital distance [AGD]). Intraclass correlation coefficients (ICCs) were used to evaluate familial resemblance between fathers and sons.

RESULTS: In the adjusted analyses, weak significant positive correlations between fathers and sons were observed in testicular volume measured by ultrasonography (ICC 0.30), concentrations of inhibin B (ICC 0.25), FSH (ICC 0.24), LH (ICC 0.22), and SHBG (ICC 0.26), sperm concentration (ICC 0.21), and anopenile distance (ICC 0.19). Penile width (ICC 0.23) showed significant father-son correlation, but it was of borderline statistical significance when pairs with cryptorchidism that had required surgical correction (n = 5) were excluded. Father-son correlation for testicular size based on orchidometer (ICC 0.16) was statistically significant only when excluding pairs with a history of cryptorchidism (ICC 0.18).

CONCLUSION: In conclusion, while genetics contributes to reproductive health, the studied reproductive variables showed rather weak correlations between fathers and sons.

PMID:42612088 | DOI:10.1111/andr.70364

Nurs Open. 2026 Aug;13(8):e70751. doi: 10.1002/nop2.70751.

ABSTRACT

AIM: This study aimed to examine clinical and catheter-related factors associated with peripherally inserted central catheter-related infection, with particular attention to the association between thrombus formation and infection occurrence.

DESIGN: This was a retrospective observational study. Clinical data from 147 inpatients with peripherally inserted central catheters were analyzed. Patients were categorized into an infection group and a non-infection group according to the catheter-related infection status recorded in the available clinical records.

METHODS: Bilirubin level, white blood cell count, return pressure, heparin dose, blood flow rate, citrate level, platelet count, thrombus formation, gender, age and debilitated status were analyzed. Pearson’s chi-square test, Spearman correlation analysis and univariate and multivariable logistic regression analyses were used to evaluate factors associated with catheter-related infection.

RESULTS: Among the 147 patients with peripherally inserted central catheters, 84 were male and 63 were female, and 31 patients were classified as having recorded catheter-related infection. Pearson’s chi-square test showed a significant association between the recorded thrombus variable and catheter-related infection status (p = 0.027). Spearman correlation analysis also showed a significant correlation between these variables (ρ = 0.182, p = 0.027). In the multivariable logistic regression analysis, the recorded thrombus variable was associated with catheter-related infection status (OR = 4.185, 95% CI: 1.625-11.411, p = 0.004), while female gender was associated with lower odds of infection (OR = 0.376, 95% CI: 0.155-0.904, p = 0.030). The other analyzed variables were not statistically significant. These findings should be interpreted as observational associations rather than evidence of causality.

PATIENT OR PUBLIC CONTRIBUTION: This study was based on retrospective clinical data from patients with peripherally inserted central catheters. No direct patient or public involvement occurred in the design, conduct or reporting of the study. The findings may help inform future catheter care and nursing assessment, but they should be interpreted within the limitations of the retrospective observational design.

PMID:42612079 | DOI:10.1002/nop2.70751

JMIR Form Res. 2026 Aug 18;10:e91877. doi: 10.2196/91877.

ABSTRACT

BACKGROUND: Thailand is undergoing a rapid demographic transition, with an estimated 28% of the population expected to be aged 60 years or older by 2030. This shift creates an urgent demand for technology-enhanced solutions for older adults. Despite growing interest in Internet of Things (IoT) sensor networks and machine learning applications for older adult care, the patterns of technology acceptance and implementation readiness in Thai older adult care facilities remain underexplored.

OBJECTIVE: This study aimed to assess the readiness and adoption patterns of sensor network and machine learning technologies among older adults and care stakeholders in Thai older adult care facilities, guided by the Gerontechnology Acceptance Model (GTAM) and Service Exchange Value Creation Logic.

METHODS: A sequential explanatory mixed methods design was used. Phase 1 (quantitative) involved structured technology assessments by 12 health care technology specialists and survey administration to 120 consumer representatives (older adults, n=70; adult family members, n=50), stratified across Bangkok and Chiang Mai. Phase 2 (qualitative) comprised 20 semistructured interviews and 3 purposively selected focus groups from phase 1 participants to elaborate on the quantitative findings. The primary theoretical framework was GTAM, mapping 5 constructs (perceived usefulness, ease of use, social influence, facilitating conditions, and behavioral intention) to corresponding survey items. This study was approved by the Assumption University Institutional Review Board (AU-IRB 80/2024) and is registered under a noninterventional observational design; formal clinical trial registration was not applicable.

RESULTS: IoT fall detection systems received the highest clinical efficacy ratings from specialists (mean 4.5, SD 0.3 on a 5-point scale) and achieved 89% user acceptance. Artificial intelligence-driven early warning systems demonstrated the highest perceived clinical impact (mean 4.7, SD 0.2) but also the greatest implementation complexity (mean 4.2, SD 0.5). The consumer survey findings revealed that digital literacy level was the strongest predictor of behavioral adoption intention (β=.62; P<.001), with high-confidence participants showing 2.3 times higher acceptance rates than low-confidence participants. Significant geographic differences emerged: Bangkok respondents showed higher acceptance of medical IoT technologies (mean 4.3, SD 0.3; t₁₁₉=1.98; P=.05), while Chiang Mai respondents reported a stronger preference for environmental digital health solutions (mean 4.5, SD 0.3; t₁₁₉=4.12; P<.001) and elevated privacy concerns (mean 4.2, SD 0.4; P=.005). Qualitative analysis identified 5 themes: surveillance anxiety, family-mediated adoption, regional digital trust, training needs, and dignity-preserving technology design.

CONCLUSIONS: Smart technology integration in Thai older adult care facilities is feasible and accepted across demographic groups when implemented in phases, culturally adapted, and supported by digital literacy training. Key adoption enablers were digital confidence, family involvement, and privacy-respecting design. The GTAM-derived findings offer an evidence-based framework for deploying gerontechnology in health care contexts in developing nations. Longitudinal outcome studies are needed to validate clinical and economic projections from prior literature.

PMID:42612072 | DOI:10.2196/91877

JMIR Form Res. 2026 Aug 18;10:e96009. doi: 10.2196/96009.

ABSTRACT

BACKGROUND: Retrospective questionnaires are commonly used to assess exposure to unpleasant environmental stimuli, such as sounds and odors, but they are vulnerable to recall and salience biases. Ecological momentary assessment (EMA) is often proposed as a superior alternative because it captures experiences close in time to their occurrence. However, self-initiated, event-contingent EMA protocols require sustained participant engagement, and little is known about their feasibility, reporting completeness, and implementation challenges under naturalistic conditions.

OBJECTIVE: This study aims to evaluate a self-initiated smartphone-based EMA protocol for documenting unpleasant sound and odor exposures and to examine the implications of observed EMA use, the time between the first and last report, and reporting completeness for interpreting data obtained using the self-initiated EMA.

METHODS: Participants completed a 3-month study using a self-initiated, event-contingent smartphone-based EMA protocol alongside baseline and follow-up retrospective questionnaires. Individuals with and without self-reported environmental sensitivity to sounds or odors were offered access to a web-based EMA app for self-initiated reporting of exposure events. Reporting behavior measures included observed EMA use, the number of submitted reports, the time between the first and last submitted reports, reporting completeness (self-reported missed events), and barriers to app use. Analyses were primarily descriptive.

RESULTS: Of 104 participants (environmentally sensitive [ES], n=42; nonenvironmentally sensitive [NES], n=62), EMA reporting was limited, with 15 (36%) ES participants and 22 (35%) NES participants submitting at least one report (χ²₁=0.00, P=.98). Report submission was concentrated early in the study period, and no participant submitted reports across the full 3-month observation period. Among EMA users, the mean reporting duration (time between the first and last submitted reports) was 19.9 (SD 17.6, range: 1-51) days in the ES group and 7.9 (SD 9.5, range: 1-32) days in the NES group. Missed exposure reports were common: 14 of 15 (93%) ES users and 14 of 22 (64%) NES users reported experiencing one or more exposure events that were not recorded using EMA. In addition, many nonusers reported unrecorded exposure events during the study period (ES: 11/27, 41%; NES: 5/40, 13%).

CONCLUSIONS: Under naturalistic conditions, this 3-month self-initiated, event-contingent EMA protocol demonstrated limited observed use, declining report submissions over time, and substantial self-reported incompleteness. These findings arise from 1 specific implementation and should not be generalized to self-initiated EMA protocols using different sampling procedures, onboarding, participant support, reminders, incentives, or technologies. Nevertheless, they highlight the importance of reporting implementation characteristics when interpreting data from self-initiated, event-contingent EMA studies.

PMID:42612070 | DOI:10.2196/96009

J Vis Exp. 2026 Aug 4;(234). doi: 10.3791/70993.

ABSTRACT

Early diabetic kidney disease in type 2 diabetes is characterized by increased urinary albumin excretion despite preserved estimated glomerular filtration rate (eGFR). The roles of systemic inflammation and insulin resistance at this stage remain incompletely defined. This study evaluated the associations of high-sensitivity C-reactive protein (hs-CRP) and insulin resistance (HOMA-IR) with early renal impairment. In this single-center retrospective cross-sectional study, 126 patients with type 2 diabetes and eGFR ≥60 mL/min/1.73 m² were included; patients not using exogenous insulin formed a subgroup (n=97). The primary outcome was natural log-transformed urine albumin-to-creatinine ratio (ln-UACR). Associations were assessed using Spearman correlation and multivariable linear regression adjusted for age, sex, diabetes duration, systolic blood pressure, and glycated hemoglobin (HbA1c). Dose-response relationships, joint exposure effects, surrogate outcomes, and sensitivity analyses were also examined. Statistical analyses were performed using R (version 4.3.2). ln-UACR was positively correlated with hs-CRP in the overall sample (ρ=0.28, p=0.001) and with HOMA-IR in the subgroup (ρ=0.26, p=0.009). After adjustment, hs-CRP remained associated with ln-UACR in both the overall sample (βstd=0.23) and subgroup (βstd=0.22), and HOMA-IR remained associated in the subgroup (βstd=0.17, p=0.018). ln-UACR increased across tertiles of both exposures (p for trend <0.01). The high hs-CRP/high HOMA-IR group showed higher ln-UACR compared with the low/low group (mean difference 0.64, 95% CI 0.37-0.88), without significant interaction (p=0.173). Associations were consistent across surrogate outcomes and sensitivity analyses. In patients with type 2 diabetes and preserved eGFR, hs-CRP and HOMA-IR were independently associated with markers of early renal impairment. These findings suggest potential relevance for early risk characterization, although prospective studies are required to confirm clinical utility.

PMID:42612054 | DOI:10.3791/70993

J Med Internet Res. 2026 Aug 18;28:e95072. doi: 10.2196/95072.

ABSTRACT

BACKGROUND: Patients increasingly use generative AI to interpret symptoms and seek health information, yet limited evidence shows how AI-assisted self-diagnosis is integrated into care-seeking and related to clinical interactions and patient-physician relationships.

OBJECTIVE: This study examined how AI-assisted self-diagnosis is incorporated into care-seeking processes and how it relates to patient participation in clinical encounters and trust in physicians.

METHODS: An exploratory sequential mixed methods design was used. In the qualitative phase, Chinese adults who had used generative AI to interpret symptoms, appraise possible conditions, or seek health advice within the previous year were purposively recruited through Xiaohongshu, WeChat Moments, and WeChat groups. Semistructured interviews were conducted from August 20, 2025, to January 10, 2026, and analyzed using reflexive thematic analysis. In the quantitative phase, an anonymous web-based survey was conducted in China through Huixiang Data from January 25, 2026, through January 28, 2026. Adults who had used generative AI for health consultation involving symptom interpretation or preliminary self-diagnosis within the previous 6 months were recruited through convenience sampling. Measures included perceived AI-assisted self-diagnosis quality, calibrated illness appraisal, patient participation, diagnosis validation, diagnosis comprehension, trust in physicians, AI use frequency, trust in health information sources, and demographic characteristics. Trust in physicians was assessed using 5 adapted items covering competence, integrity, and benevolence. Descriptive statistics, Pearson correlations, and PROCESS mediation analyses were performed.

RESULTS: Qualitative findings (n=48) indicated that AI-assisted self-diagnosis was commonly used in a prediagnostic gray zone for preliminary orientation, informal triage, and interim self-management. Participants described AI as helping them appraise illness severity, prepare for consultations, ask questions, and understand physicians’ diagnoses and reasoning. Quantitative findings (n=546) were consistent with these patterns. Perceived AI quality was positively associated with calibrated illness appraisal (b=0.57, 95% CI 0.49-0.64), which was positively associated with patient participation (b=0.35, 95% CI 0.28-0.43). The indirect association was significant (estimate=0.20, 95% bootstrap CI 0.14-0.26). Perceived AI quality was also associated with diagnosis validation (b=0.69, 95% CI 0.61-0.76) and diagnosis comprehension (b=0.65, 95% CI 0.58-0.73), which were associated with trust in physicians (b=0.15, 95% CI 0.07-0.23 and b=0.20, 95% CI 0.12-0.28, respectively). The corresponding indirect associations were 0.10 (95% bootstrap CI 0.04-0.17) through diagnosis validation and 0.13 (95% bootstrap CI 0.07-0.19) through diagnosis comprehension.

CONCLUSIONS: Generative AI may function as an informational intermediary across the care-seeking process rather than undermine medical authority. By supporting illness appraisal, consultation preparation, and postconsultation understanding, AI-assisted self-diagnosis may be associated with greater patient participation and trust in physicians.

PMID:42612039 | DOI:10.2196/95072

Traffic Inj Prev. 2026 Aug 18:1-8. doi: 10.1080/15389588.2026.2711872. Online ahead of print.

ABSTRACT

OBJECTIVES: To estimate the association between moderate-to-severe generalized anxiety and past-year drink-driving in Korean adults and test whether this association differs by sex. The study addresses a road-safety question that is not captured by alcohol-use measures alone: whether a standardized anxiety signal is visible in population-level drink-driving surveillance.

METHODS: We conducted a cross-sectional complex-survey analysis of pooled 2021-2024 Korea National Health and Nutrition Examination Survey microdata. The analytic sample included 20,859 adults aged 19 years or older. The exposure was a GAD-7 score of 10 or higher, with sensitivity analyses using the 8 or higher cut point and continuous GAD-7 score. The outcome was self-reported past-12-month drink-driving, recoded as binary. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using KNHANES strata, primary sampling units, and interview weights. Models adjusted for sex, age, urban or rural residence, income, education, occupation, marital status, and family-relationship status; additional analyses examined sex interaction, depressive-symptom co-adjustment, alcohol-use adjustment, multiple imputation for missing data, and restriction to past-year drinkers.

RESULTS: Weighted drink-driving prevalence was 1.6%, and GAD-7 score of 10 or higher prevalence was 4.6%. Moderate-to-severe anxiety was associated with higher adjusted odds of drink-driving after demographic, socioeconomic, and family-context adjustment (aOR, 2.20; 95% CI, 1.08-4.45; p = 0.03). The GAD-7 by sex interaction was not statistically significant (p = 0.13). The association was directionally consistent using a GAD-7 cut point of 8 or higher (aOR, 2.06; 95% CI, 1.17-3.62; p = 0.01), a continuous GAD-7 score per 5-point increase (aOR, 1.58; 95% CI, 1.35-1.84; p < 0.001), multiple imputation of missing data (aOR, 2.23; 95% CI, 1.14-4.35; p = 0.02), and depressive-symptom co-adjustment (aOR, 3.30; 95% CI, 1.50-7.25; p = 0.003). Additional alcohol-use adjustment attenuated the estimate (aOR, 1.95; 95% CI, 0.93-4.10; p = 0.08), and the past-year-drinker analysis produced a similar point estimate. Thus, the anxiety signal weakened after alcohol-use adjustment but remained near twofold in magnitude.

CONCLUSIONS: Moderate-to-severe anxiety was associated with higher odds of self-reported drink-driving in Korean adults, but the association weakened after alcohol-use adjustment. These findings should be interpreted as hypothesis-generating rather than causal. They do not imply that anxiety alone predicts drink-driving or that anxiety screening should be used for enforcement. Instead, they suggest that drink-driving may be one point where alcohol use, anxiety, and risk behavior meet. Future drink-driving prevention research should measure anxiety, alcohol use, and driving exposure together rather than treating drink-driving only as an alcohol-use problem.

PMID:42612030 | DOI:10.1080/15389588.2026.2711872

J Vis Exp. 2026 Aug 4;(234). doi: 10.3791/71128.

ABSTRACT

This study aimed to investigate the prevalence and genotype distribution of human papillomavirus (HPV) among male outpatients in Heyuan and to compare infection rates across age groups, to inform local prevention and treatment strategies. A total of 1,559 men who underwent HPV testing at Heyuan People’s Hospital between 2021 and 2024 were enrolled, and only results from initial visits were included. Twenty-three HPV genotypes were identified by polymerase chain reaction (PCR)- reverse dot blot hybridization. A retrospective cross-sectional analysis was conducted to evaluate overall HPV prevalence, age-specific infection rates, infection patterns, subtype distribution, and vaccine-relevant genotype coverage. Statistical analyses were performed using SPSS version 23.0. The count data were summarized as numbers and percentages, and group differences were assessed using the chi-square test, with statistical significance defined as p < 0.05. The overall HPV infection rate was 45.3% (707/1,559). Infection rates across age groups (≤24, 25-34, 35-44, 45-54, 55-64, and ≥65 years) were 42.8%, 43.1%, 45.8%, 48.2%, 68.3%, and 46.4%, respectively. Single-type infections were the most common pattern, accounting for 57.0% of positive cases. The five most frequently detected high-risk genotypes were HPV52 (9.05%), 16 (5.90%), 53 (5.09%), 51 (5.01%), and 59 (4.93%), while the predominant low-risk genotypes were HPV6 (21.24%), 11 (9.85%), and 43 (5.17%). The theoretical coverage rates for the bivalent, quadrivalent, and nine-valent vaccines were 8.65%, 39.74%, and 55.41%, respectively. The prevalence of HPV infection among male outpatients in Heyuan was relatively high, with single-type infections being the dominant pattern. The most common high-risk genotypes were HPV52, 16, 53, 51, and 59, and the leading low-risk genotypes were HPV6, 11, and 43. The highest infection rate was observed in the 55-64 age group. These findings provide region-specific data that may support the development of tailored HPV prevention and vaccination strategies for males in this population.

PMID:42611985 | DOI:10.3791/71128

Traffic Inj Prev. 2026 Aug 18:1-8. doi: 10.1080/15389588.2026.2710384. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to determine the prevalence of alcohol mixed with energy drink (AmED) usage among commercial drivers in Ghana and examine associated demographic, behavioral, physical, and psychosocial work factors.

METHODS: This analytical cross-sectional study used a convenience sampling technique to recruit 7,540 commercial drivers from the Greater Accra Region. Bivariate analyses and hierarchical binary logistic regression were used to identify individual and organization factors associated with AmED use. Independent-samples t-tests were performed to compare users and non-users on safety- and mental health-related outcomes. Analysis was done using Jamovi statistical software version 2.6.23.0.

RESULTS: About 29% of drivers reported the use of AmED during work in the 30 days prior to data collection. AmED use was more prevalent among younger drivers and those with shorter driving experience, longer work hours, and reported higher job demands and job insecurity. Drivers reporting AmED use showed statistically higher rates of risky driving indicators, sleep problems, and depressive symptoms.

CONCLUSIONS: The findings indicate that AmED use is relatively common among commercial drivers in Ghana. One out of every four drivers sampled use AmED during work. It is recommended that road safety agencies in Ghana implement routine random roadside alcohol and stimulant screening (including AmED detection) among commercial drivers to enhance monitoring and early identification of potential driving impairment.

PMID:42611981 | DOI:10.1080/15389588.2026.2710384

Disabil Rehabil. 2026 Aug 18:1-12. doi: 10.1080/09638288.2026.2716895. Online ahead of print.

ABSTRACT

PURPOSE: To examine the construct validity of scores from the Godin Leisure-Time Exercise Questionnaire Health Contribution Score (GLTEQ HCS) as a measure of moderate-to-vigorous physical activity (MVPA) in adults with Crohn’s disease (CD) and healthy controls.

MATERIALS AND METHODS: Thirty-eight adults with CD (78.9% female; 41.3 ± 12.0 years) and 41 controls (73.2% female; 39.3 ± 12.0 years) completed the GLTEQ and wore an ActiGraph GT3X-BT accelerometer for 7 days. Mean differences in accelerometer outcomes across HCS categories were examined (known-groups test of construct validity). Correlations between GLTEQ HCS and accelerometer-derived MVPA (convergent validity), and light PA (LPA) and sedentary behavior (divergent validity), were examined separately by group.

RESULTS: Significant differences in accelerometer-derived MVPA across the three HCS categories were observed in controls [F(2,40)=3.90, p=.03, η²=.17], but not CD. When dichotomized (active ≥24 units versus insufficiently active <24 units), medium-to-large differences in MVPA emerged for both CD (d=.62) and controls (d=.87), though this difference did not reach statistical significance in CD. GLTEQ HCS correlated with MVPA in controls (r_s=.40, p=.01) but not in CD (r_s=.28, p=.09), and was not associated with LPA or sedentary behavior.

CONCLUSION: GLTEQ HCS demonstrated modest, context-dependent construct validity for MVPA assessment, with stronger evidence using dichotomized classification and in controls than in adults with CD.

PMID:42611980 | DOI:10.1080/09638288.2026.2716895