Category: Statistics

Comput Inform Nurs. 2026 Jul 10. doi: 10.1097/CIN.0000000000001601. Online ahead of print.

ABSTRACT

The aging population, particularly women, faces complex biopsychosocial health and social challenges, necessitating whole-person approaches and innovative research methods to better understand health and well-being to guide effective interventions. The objective of this pilot comparative cross-sectional study was to examine whole-person health and resilience of older adult women ages 65 and older in the United States and Türkiye. Data were collected from adult women in the United States (n=25) and Türkiye (n=25) between March and August 2024. Whole-person health was evaluated using the MyStrengths+MyHealth application, and resilience was measured using the 14-item Resilience Scale. Data were analyzed using descriptive and inferential statistics to examine between-group differences. The average age for the US participants was 78 (SD=6.2), and the average age for the Turkish participants was 68 (SD=2.8). There were significant differences in average self-reported strengths (P<0.001), challenges (P<.001), and needs (P<.001) between US and Turkish participants. US participants had a higher mean Resilience score [88.0 (SD=5.3)] versus Turkish participants [74.9 (SD=14.7)] (P<.001). The study revealed that both groups had above-average resilience and had both common strengths and differences in health challenges and needs. These findings highlight the importance of prioritizing a whole-person health approach when developing strengths-based interventions to address the complex and diverse needs of older women.

PMID:42430772 | DOI:10.1097/CIN.0000000000001601

J Am Acad Orthop Surg Glob Res Rev. 2026 Jul 1;10(7). doi: 10.5435/JAAOSGlobal-D-25-00375. eCollection 2026 Jul 1.

ABSTRACT

PURPOSE: Periarticular multimodal analgesia is a standard pain relief method for total knee arthroplasty (TKA) patients. Recent studies have demonstrated that intraosseous injections of pain relievers and antifibrinolytic agents provide statistically significant reductions in pain and blood loss. This study aimed to compare the outcomes of multimodal intraosseous femoral injections with those of tibial injections in patients undergoing bilateral TKA.

METHODS: A double-blind, randomized controlled trial was done in 40 individuals. Patients received multimodal intraosseous injections at either the femur or tibia for each TKA, with the site alternating between groups. Postoperative outcomes assessed included Visual Analog Scale (VAS) pain score, postoperative blood loss, amount of painkiller used after surgery, range of motion, adverse effects, and complications.

RESULTS: The primary outcomes were postoperative pain and blood loss. No significant differences were observed in VAS pain scores between groups at any time point; for example, at 12 hours, the mean difference was 0.06 (95% CI, -0.63 to 0.51, P = 0.149). However, the femoral site demonstrated significantly lower postoperative blood loss through drainage with a mean difference of -60.8 mL (95% CI, -98.54 to -23.06, P < 0.001) and lower total blood loss (mean difference -61.9 mL, 95% CI, -101.89 to -21.90, P < 0.001).

CONCLUSION: Multimodal intraosseous injection at the femoral site seemed to be as effective for pain management as at the tibial site, but it resulted in markedly reduced postoperative blood loss in patients undergoing TKA. Additional research is required to explore long-term benefits of this technique and confirm its safety profile.

PMID:42430771 | DOI:10.5435/JAAOSGlobal-D-25-00375

Arch Clin Neuropsychol. 2026 May 29;41(5):acag048. doi: 10.1093/arclin/acag048.

ABSTRACT

OBJECTIVE: Symptom overreporting is often considered to be moderated by external incentives, such as financial or legal advantages, although other factors may also play a role. Preliminary studies have suggested a connection between symptom overreporting and alexithymia, that is, trait-like difficulties in recognizing and describing internal sensations. This study aimed to further clarify the relationships among external gain expectations, alexithymia, and symptom overreporting. Specifically, we examined whether alexithymia is related to overreporting in patients without self-reported external gain expectations.

METHOD: Using a cross-sectional design, patients referred for psychological assessments in a hospital setting completed a questionnaire about external gain expectations (e.g., regarding work, housing, legal issues). We differentiated between those with self-reports of external gain expectations (n = 73) and those without (n = 84). Both subsamples were administered the Toronto Alexithymia Scale-20 (TAS-20), the Structured Inventory of Malingered Symptomatology (SIMS), and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF).

RESULTS: Across the full sample, alexithymia showed a positive and statistically significant association with symptom overreporting on the SIMS and the Infrequent somatic responses scale (Fs) of the MMPI-2-RF: r = 0.44 and r = 0.31, respectively. These positive associations were also evident in the subgroup without self-reported external gain expectations (i.e., r = 0.35, 95% CI [0.14, 0.52] and r = 0.35, 95% CI [0.15, 0.53], respectively). Regression analysis indicated that self-reported external gain expectations did not account for the relationship between symptom overreporting and alexithymia.

CONCLUSION: These findings suggest that alexithymia is associated with symptom overreporting independently of self-reported external gain expectations. More broadly, the results raise the possibility that alexithymic traits may compromise the accuracy of symptom reporting itself. If so, this has implications not only for the interpretation of symptom validity tests, but also for the broader use of self-report measures in clinical assessment.

PMID:42430770 | DOI:10.1093/arclin/acag048

JMIR Med Educ. 2026 Jul 10;12:e70400. doi: 10.2196/70400.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has placed a significant burden on health professionals (HPs). They face higher infection risks due to the nature of their work environment and patient care responsibilities. Their ability to access and apply reliable COVID-19 information affects their own preventive behavior and that of those around them. In this context, health literacy (HL) has become increasingly important. Despite extensive research, information to foster COVID-19-related HL in HPs remains limited.

OBJECTIVE: This systematic review aimed to identify, appraise, and synthesize intervention studies on the effectiveness of COVID-19-related HL interventions in HPs.

METHODS: Five electronic databases (eg, PubMed (MEDLINE), Embase), six clinical trials registries (eg, ISRCTN registry), one preprint server (MEDRXIV), published conference proceedings, and five gray literature databases (eg, opengrey.eu, ProQuest) were searched in May 2022 and updated in August 2025. Reference lists of included studies were screened manually. Two reviewers independently screened titles, abstracts, and full-texts according to eligibility criteria and extracted data; disagreements were resolved by discussion or consultation with a third reviewer. We included randomized controlled trials (RCTs), nonrandomized studies of interventions, and uncontrolled before-and-after studies evaluating the effectiveness of any COVID-19-related HL intervention. Primary outcomes include COVID-19-related HL, its four facets (access, understand, appraise, and apply COVID-19 information), and indicators (eg, COVID-19-related knowledge), assessed at postintervention and follow-up. When studies were sufficiently similar, random-effects meta-analyses were performed; otherwise, a narrative synthesis was provided. Risk of bias was assessed using validated tools based on study design, and the overall certainty of the evidence was evaluated by the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.

RESULTS: We included 15 RCTs (2034 participants), 4 nonrandomized studies of interventions (291 participants), 74 uncontrolled before-and-after studies (327,298 participants), 5 ongoing studies, and 1 study with awaiting classification. Interventions targeted a broad range of health occupational groups. Intervention type, delivery mode, methods, settings, and comparator varied widely. No outcome measure explicitly referred to an HL model. Most studies aimed to enhance COVID-19-related knowledge and skills, and had a high risk of bias. COVID-19-related interventions may increase knowledge of vaccines (standardized mean difference 1.00; 95% CI 0.33 to 1.67, I2=24%), and the infection prevention control skills, such as donning and doffing of personal protective equipment (standardized mean difference 1.95; 95% CI 1.82 to 3.09, I2=46%), but the evidence remains very uncertain.

CONCLUSIONS: COVID-19-related HL interventions may promote HP’s short-term competencies in infection control. However, the evidence remains uncertain, primarily due to the low quality of studies, characterized by a high risk of bias. Interventions specifically designed to enhance the full COVID-19 HL operationalized by its four facets are lacking. High-quality RCTs with sufficient statistical power, grounded in HL theoretical principles, are needed to achieve precise understanding.

PMID:42430764 | DOI:10.2196/70400

Plast Reconstr Surg. 2026 Jul 9. doi: 10.1097/PRS.0000000000013317. Online ahead of print.

ABSTRACT

BACKGROUND: Triple nerve transfer (TNT) combines cross-face nerve grafts, masseteric-to-facial nerve transfer, and hypoglossal-to-facial nerve transfer to restore facial function in long-standing facial paralysis. However, its efficacy in patients with severe soft tissue laxity or atrophy may be limited. This study evaluates whether adding autologous fascia lata suspension (TNTF) to TNT improves functional and psychosocial outcomes.

METHODS: A retrospective study compared 22 patients with chronic unilateral facial paralysis, treated with either TNT alone (n=14) or TNT plus fascia lata suspension (TNTF, n=8). All patients completed the Facial Clinimetric Evaluation (FaCE) Scale pre- and postoperatively (≥12 months). Statistical analyses included Wilcoxon signed-rank tests, Mann-Whitney U tests, ANCOVA, and repeated-measures ANOVA to adjust for baseline differences.

RESULTS: Both groups showed significant improvements in FaCE scores postoperatively (TNT: +18, p<0.001; TNTF: +24, p<0.01). The TNTF group had worse preoperative scores (median 25 vs. 37, p=0.006), but postoperatively, scores were comparable (49.1 vs. 55.1, p=0.095). The mean improvement was greater in TNTF (Cohen’s d ≈ 0.82, p=0.09), with significantly greater gains in oral function and social appearance (e.g., FaCE item Q15: +3 vs. +1, p=0.02). Correlation between EMG severity and baseline FaCE scores was significant (ρ ≈ 0.57, p<0.01).

CONCLUSION: TNT restores facial function, but adding fascia lata suspension improves static tone and symmetry in patients with severe soft tissue laxity, offering superior functional and psychosocial outcomes in complex cases.

PMID:42430759 | DOI:10.1097/PRS.0000000000013317

Kidney360. 2026 Jul 10. doi: 10.34067/KID.0000001265. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical trials in rare glomerular disease may establish short-term treatment efficacy but are limited by small sample sizes and short study duration. Observational data are needed to assess longer-term outcomes and can provide insights into real-world prescribing practices. This study applied modern statistical methods to real-world data from the Cure Glomerulonephropathy (CureGN) network to compare the effectiveness of rituximab and calcineurin inhibitors on long-term primary membranous nephropathy outcomes.

METHODS: CureGN participants with biopsy-confirmed primary membranous nephropathy who initiated either of the two treatments at least 6 months after any previous immunosuppressant exposure were eligible. Inverse-probability-of-treatment weighting balanced covariates at treatment initiation. Inverse-probability-of-censoring weights accounted for censoring individuals if another immunosuppressant was started during follow-up. Outcomes included time from treatment initiation to composite kidney disease progression (40% decline in eGFR, kidney replacement therapy, or eGFR <15), proteinuria remission, and relapse following remission. Hazard ratios and differences in restricted mean survival times were estimated.

RESULTS: 325 treatment initiations across 250 unique participants were eligible, with median follow-up 53 months (25th-75th percentile: 24-79). Participants on calcineurin inhibitors had significantly higher risks of disease progression (HR=2.81; 95% CI: 1.16, 6.80). Hazard ratios for proteinuria remission (HR=0.77; 95% CI: 0.50, 1.17) and relapse (HR=1.42, 95% CI: 0.69, 2.92) had wide confidence intervals.

CONCLUSIONS: Rituximab was associated with better kidney function preservation than calcineurin inhibitors over long follow-up. Proteinuria remission and relapse results favored rituximab but did not reach statistical significance. Long-term treatment comparative effectiveness in rare diseases can be evaluated with real-world data.

PMID:42430748 | DOI:10.34067/KID.0000001265

Dermatol Surg. 2026 Jul 7. doi: 10.1097/DSS.0000000000005260. Online ahead of print.

ABSTRACT

BACKGROUND: Procedures have traditionally been delayed 6 to 12 months after isotretinoin because of concerns about abnormal scarring; evidence for fractional ablative CO2 laser is limited in higher Fitzpatrick skin types.

OBJECTIVE: To assess the safety and effectiveness of ablative fractional CO2 laser (AFCL) for atrophic acne scars during and after oral isotretinoin.

METHODS: This was a single-center retrospective cohort of 106 patients (188 AFCL sessions) grouped as concurrent isotretinoin, ≤90 days since discontinuation, 91 to 180 days, or >180 days (control). Outcomes included abnormal scarring, delayed re-epithelialization (>14 days), postinflammatory hyperpigmentation (PIH) at 1 and 3 months, and scar-score change. Overall group comparisons and adjusted patient-level and session-level models were performed.

RESULTS: Abnormal scarring occurred in 3/106 patients (2.8%) with no significant between-group difference (p = .762). Delayed re-epithelialization >14 days occurred in 11/106 patients (10.4%) and was numerically highest in the concurrent isotretinoin group (6/31 [19.4%]); however, the overall four-group comparison was not significant (p = .243), and concurrent isotretinoin was not statistically significant in an adjusted session-level generalized estimating equation model (OR: 4.79, 95% confidence interval: 0.79-29.13; p = .089). PIH at 3 months was higher in the ≤90-day group versus controls (adjusted OR: 6.03, 95% confidence interval: 1.55-23.52; p = .010). Concurrent isotretinoin was not associated with increased PIH or abnormal scarring. Higher density predicted delayed re-epithelialization.

CONCLUSION: AFCL during low-dose isotretinoin or within 6 months after isotretinoin discontinuation was not associated with increased abnormal scarring. Because delayed re-epithelialization was numerically more frequent during concurrent isotretinoin and density was associated with slower healing, conservative density selection and careful counseling remain appropriate. PIH risk was elevated when treatment occurred within 90 days after discontinuation.

PMID:42430738 | DOI:10.1097/DSS.0000000000005260

J Med Internet Res. 2026 Jul 10;28:e101388. doi: 10.2196/101388.

ABSTRACT

BACKGROUND: Parenting interventions can improve parental and child outcomes across diverse settings. However, less is known about how family size, including the number of children, shapes baseline conditions, and how intervention effects unfold over time. Most studies also focus on average treatment effects, with limited attention to heterogeneity across family contexts and trajectories of change.

OBJECTIVE: This study examined whether the number of children was associated with baseline differences in parental and child outcomes, moderated immediate postintervention effects, and shaped postintervention trajectories over 6- and 12-month follow-up periods.

METHODS: We conducted secondary analysis of a pragmatic cluster randomized controlled trial evaluating a universal digital-human parenting intervention delivered through the preschool system in China (N=541). Families were categorized by the number of children (1, 2, 3, or more). We examined (1) baseline differences in parental and child outcomes, (2) moderation of intervention effectiveness at immediate postintervention, and (3) trajectories of change over 6- and 12-month follow-up periods using mixed-effects models.

RESULTS: Of the 541 enrolled families, 494 were included in the complete-case baseline analysis. Compared with 1-child families, 2-child families, and families with 3 or more children, reported lower levels of baseline early learning and stimulation and proactive parenting, as well as greater endorsement of corporal punishment and higher parenting stress. We found no statistically significant evidence that the number of children moderated immediate postintervention effects. In intervention-group trajectory analyses, 2-child families showed greater improvement in early learning and stimulation at the 6-month follow-up (b=3.966, 95% CI 1.468-6.463). Families with 3 or more children showed a similar pattern (b=5.749, 95% CI 0.536-10.962), although estimates for this subgroup were less precise because of the small sample size. This subgroup also showed larger but more variable reductions in selected child behavioral outcomes over follow-up.

CONCLUSIONS: Family size might not always be associated with short-term intervention effectiveness but was associated with divergence in longer-term trajectories. These findings suggest that caregiving demands are relevant for the sustainability of intervention effects. By integrating baseline differences, short-term effects, and longitudinal trajectories within a single framework, this study highlights the importance of moving beyond average treatment effects to more dynamic, context-sensitive evaluations. Designing parenting interventions, particularly scalable digital-human programs, that incorporate sustained and context-responsive support may be critical for addressing variation in family structure and enhancing long-term effectiveness.

PMID:42430727 | DOI:10.2196/101388

JMIR Res Protoc. 2026 Jul 10;15:e94010. doi: 10.2196/94010.

ABSTRACT

BACKGROUND: Kidney transplant recipients present reduced physical function and a high prevalence of cardiometabolic complications, which increase cardiovascular risk and compromise long-term graft outcomes. Resistance training has demonstrated beneficial effects in this population; however, previous interventions have shown heterogeneity in load prescription and have not incorporated objective monitoring of movement velocity. Velocity-based resistance training (VBT) allows precise regulation of exercise intensity and fatigue, potentially improving the safety and individualization of exercise prescription in clinical populations.

OBJECTIVE: This study aims to evaluate the effects of a 12-week VBT program on renal function and metabolic health in kidney transplant recipients and to compare 2 different load-control strategies based on movement velocity.

METHODS: This pilot randomized controlled trial will include adult kidney transplant recipients with stable graft function. Participants will be randomly assigned (1:1) to either a maximal velocity group, in which sets will be terminated at a 20% velocity loss threshold, or a constant submaximal velocity group, in which participants will perform repetitions at 50% of the participant’s individual maximal velocity. Both groups will complete 3 supervised training sessions per week for 12 weeks with real-time velocity monitoring. Primary outcomes will include renal and metabolic health domains assessed through venous blood analysis. Serum creatinine will be the prespecified hierarchical primary renal end point, and high-density lipoprotein cholesterol will be the prespecified hierarchical primary metabolic end point. Estimated glomerular filtration rate will be calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Secondary outcomes will include blood pressure, body composition, muscular strength, metabolic syndrome criteria, and the force-velocity profile. Data will be analyzed using analysis of covariance and linear mixed-effects models following a predefined hierarchical inferential strategy.

RESULTS: The study was initiated in September 2025. Participant recruitment and the intervention phase have been completed. All 14 participants completed the 12-week training program, and no participants were lost to follow-up. Preintervention and postintervention data collection has been completed according to the study protocol. The study database has been cleaned and locked, and statistical analyses are currently underway. Publication of the primary study results is anticipated in late 2026.

CONCLUSIONS: This study introduces the implementation of VBT in kidney transplant recipients. The findings are expected to provide evidence on the feasibility and potential benefits of this approach and may support the integration of exercise professionals into multidisciplinary transplant care teams.

TRIAL REGISTRATION: ClinicalTrials.gov NCT07370727; https://clinicaltrials.gov/study/NCT07370727.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/94010.

PMID:42430723 | DOI:10.2196/94010

JMIR Med Inform. 2026 Jul 10;14:e91249. doi: 10.2196/91249.

ABSTRACT

BACKGROUND: Psychiatric clinical notes in electronic health records (EHRs) provide rich longitudinal information that can support clinical decision-making. Using historical medical data can enable earlier identification of mental illness, better characterization of disease trajectories, and more personalized treatment planning. Natural language processing (NLP) transforms these unstructured notes into analyzable representations for research and care.

OBJECTIVE: This study aims to systematically summarize NLP methodologies for psychiatric clinical notes, compare major modeling paradigms and application areas, and highlight emerging large language model (LLM) trends, key challenges, and future research directions.

METHODS: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, a literature search was conducted for articles on NLP methods based on psychiatric clinical notes published from January 2021 to December 2025 in Ovid MEDLINE, Ovid EMBASE, PubMed, Scopus, Web of Science, the ACM Digital Library, and ScienceDirect. This scoping review analyzed NLP methods applied to psychiatric clinical notes, focusing on major trends, identifying suitable features for traditional machine learning (ML)-based models, applications of pretrained language models (PLMs), and key challenges. Approaches were categorized as rule-based, traditional ML, hybrid, deep learning (DL), and LLM-based methods across information extraction and text classification tasks.

RESULTS: In total, 101 studies were eligible for inclusion. Rule-based methods (n=36) and hybrid approaches (n=34) remained the most widely used techniques, largely favored for their interpretability in handling nuanced, subjective clinical notes. These were followed by DL (n=15), traditional ML (n=10), and LLM-based approaches (n=6). Traditional ML studies relied heavily on engineered features, which could be grouped into 5 broad categories: domain knowledge features, lexical and statistical features, vector-based semantic features, emotion-related features, and temporal features. PLMs improved performance mainly through domain adaptation and task-specific fine-tuning, enhancing the handling of psychiatric language, medical terminology, and clinical note structure. LLM-based studies, although still limited in number, indicated a growing shift toward generative and reasoning-based applications.

CONCLUSIONS: Hybrid NLP approaches remain dominant, combining domain rules with ML for extraction and classification. DL approaches continue to advance, with domain adaptation supporting medical terminology and clinical semantics. LLMs may further automate complex workflows via zero-shot capabilities and reasoning, alongside growing interest in temporal modeling and multimodal integration. Key future needs include improved generalizability across institutions, privacy protection, and careful attention to ethical implications in clinical deployment.

PMID:42430721 | DOI:10.2196/91249