Category: Statistics

Intern Emerg Med. 2026 Jun 23. doi: 10.1007/s11739-026-04422-x. Online ahead of print.

ABSTRACT

In recent years, several stakeholders in Italy have suggested a crisis of vocation for Emergency Medicine (EM). This study aimed to verify the accuracy of such claims. We conducted an observational cross-sectional study on data from the Italian national test for residency positions assignments from 2019 to 2025. We analyzed trends in the number of medicine graduates, participants in the national test and available and filled training positions. We then compared EM to other residency programs and four “competitors” considering the ratio among filled and available positions; the absolute and relative variation in available and filled positions; the rate of filled positions over the number of exams’ participants. From 2019 to 2025 training positions grew, while the number of medical school graduates remained stable, the number of candidates decrease and was outnumbered by training positions in 2023-2024. The rate of filled positions in EM dropped from 90% in 2019 to 25% in 2024, then increased to 47% in 2025. Available positions in EM increased from 391 in 2019 to 954 in 2025, at a faster rate than most residency programs. EM absolute filled positions grew from 2022 to 2025, at a faster rate than most competitors. Recent years high rates of unfilled positions in EM is related to the abrupt increase in available positions. Our findings do not confirm a vocational crisis for EM in Italy.

PMID:42334765 | DOI:10.1007/s11739-026-04422-x

Intern Emerg Med. 2026 Jun 23. doi: 10.1007/s11739-026-04398-8. Online ahead of print.

ABSTRACT

Sodium-glucose co-transporter 2 (SGLT2) inhibitors have emerged as cornerstone therapies for heart failure with reduced ejection fraction (HFrEF), owing to their cardioprotective and hematologic effects. While their impact on hemoglobin and hematocrit levels is increasingly recognized, the influence of SGLT2 inhibitors on mean platelet volume (MPV), a surrogate marker of platelet activation and cardiovascular risk, remains underexplored in HFrEF patients. While SGLT2 inhibitors’ effects on MPV have been studied in DM, this is the first study examining MPV changes specifically in HFrEF patients with adjustment for diuretic therapy. This retrospective study included 80 HFrEF patients receiving guideline-directed medical therapy to which SGLT2 inhibitors were subsequently added. Baseline and 6-month follow-up data on hematological and biochemical parameters were collected. Exclusion criteria included active infection, malignancy, advanced renal failure, hematologic disorders, and recent transfusions. MPV and platelet counts were analyzed using standardized protocols and equipment. Following 6 months of SGLT2 inhibitor therapy, MPV values decreased significantly (p < 0.05), while platelet counts increased significantly (p < 0.05). Although hemoglobin and hematocrit levels showed upward trends, these changes were not statistically significant. No significant correlation was observed between ΔMPV and ΔPLT. Other biochemical markers remained stable throughout the study period. SGLT2 inhibitor therapy was associated with a significant reduction in MPV and an increase in platelet count among patients with HFrEF. These hematological changes may represent an additional mechanism by which SGLT2 inhibitors exert cardiovascular benefit. However, prospective, randomized trials are needed to validate these findings and explore the clinical significance of MPV modulation in heart failure management.

PMID:42334763 | DOI:10.1007/s11739-026-04398-8

J Racial Ethn Health Disparities. 2026 Jun 23. doi: 10.1007/s40615-026-03080-1. Online ahead of print.

ABSTRACT

Racial and ethnic disparities in diabetes prevalence and outcomes are well documented; however less is known about whether the selection of treatment modality itself differs across racial groups after adjustment for clinical correlates of disease severity. This cross-sectional analysis used National Health and Nutrition Examination Survey (NHANES) data from the 2017-March 2020 and August 2021-August 2023 cycles. The primary analytical sample comprised 1,688 adults aged 18 years and older with physician-confirmed diabetes, after excluding 46 probable Type 1 cases. Treatment modality was categorized as insulin-only, oral medication-only (base outcome), combination therapy, or no medication, based on self-reported use of insulin and oral antidiabetic medications. Survey-weighted multinomial logistic regression adjusted for age, gender, education, income, birthplace, insurance, HbA1c, body mass index (BMI), and self-reported diabetes duration. Race and ethnicity remained a significant overall predictor of treatment modality after full adjustment (joint Wald p = 0.012). Other/Multi-Racial adults had 57% lower relative risk of insulin-only therapy than Non-Hispanic White (NHW) adults (relative risk ratio [RRR] = 0.43, 95% CI: 0.24-0.76, p = 0.005), and Other Hispanic and Other/Multi-Racial adults had lower relative risk of combination therapy (RRR = 0.56, p = 0.034 and RRR = 0.47, p = 0.043, respectively). Non-Hispanic Black (NHB) adults did not differ from NHWs at the population level. HbA1c, diabetes duration, BMI, and insurance status were the strongest predictors of treatment modality. An exploratory race-by-income interaction model produced a non-significant joint test (p = 0.259) and is reported as hypothesis-generating. Differences in modality use persist after adjustments, suggesting that structural and healthcare-system factors may contribute to treatment variation independently of measured clinical and socioeconomic characteristics.

PMID:42334756 | DOI:10.1007/s40615-026-03080-1

Stat Med. 2026 Jul;45(15-17):e70653. doi: 10.1002/sim.70653.

ABSTRACT

Brain image analysis presents significant challenges due to limitations in precision, computational efficiency, and interpretability. Although neural networks have proven effective for modeling complex patterns, they often function as black-box systems, making their predictions difficult to interpret and limiting their clinical utility. To address these challenges, we propose the adaptive spatial key-region identification (ASKRI) framework-a novel method to identify region of interest, which combines adaptive sampling based on Shannon entropy, probability-mean-driven selection, and spatial uncertainty quantified via kriging method. ASKRI integrates block-to-block kriging with statistical inference to interpolate CNN-derived classification performance, significantly reducing the computational burden of exhaustive model training without sacrificing predictive accuracy. Designed for seamless integration with convolutional neural networks (CNNs), ASKRI enhances both the accuracy and interpretability of ROI identification. Its effectiveness is demonstrated using the traumatic brain injury (TRACK-TBI) dataset, where ASKRI reliably identifies spatially consistent and biologically meaningful regions associated with aging. These results underscore the framework’s potential to advance brain image analysis, while offering transparent and resource-efficient diagnostic support in clinical settings.

PMID:42334752 | DOI:10.1002/sim.70653

J Immigr Minor Health. 2026 Jun 23. doi: 10.1007/s10903-026-01945-5. Online ahead of print.

ABSTRACT

Increasing global migration has intensified the need for culturally competent healthcare, particularly in countries with high immigrant populations. This study aimed to examine the effect of intercultural competence training on cultural sensitivity and communication skills among nursing students caring for immigrant patients. This experimental study with a control group was conducted online with 69 first-year nursing students at a public university (33 experimental, 36 control). The intercultural competence training program, delivered via online, included lectures, case-based discussions, and interactive activities over four weeks. Data were collected using the Intercultural Sensitivity Scale (ISS) and the Communication Skills Scale (CSS). Statistical analyses were performed using SPSS version 25. The experimental group demonstrated a statistically significant increase in both ISS and CSS scores following the intervention (p < 0.05), whereas no significant changes were observed in the control group. Intercultural competence training effectively improves cultural sensitivity and communication skills among nursing students. These findings highlight the importance of integrating such training into nursing education to enhance the quality and equity of healthcare for immigrant populations. Further studies with larger samples and long-term follow-up are recommended.

PMID:42334737 | DOI:10.1007/s10903-026-01945-5

Sports Med Open. 2026 Jun 23;12(1):79. doi: 10.1186/s40798-026-01054-5.

ABSTRACT

BACKGROUND: Generalized joint hypermobility (GJH) has been associated with increased risk of second anterior cruciate ligament (ACL) injury. The clinical diagnosis of GJH relies on a binary threshold of positive joint hypermobility tests, based on age and patient sex, which may overlook the degree of hypermobility.

OBJECTIVES: To analyze the association between the number of positive joint hypermobility tests on the Beighton Score and the hazard of second anterior cruciate ligament (ACL) injury in patients who return to sport (RTS) after primary ACL reconstruction, which included secondary, stratified analyses of graft rupture and contralateral ACL injury.

DESIGN: Registry study.

METHODS: Data were extracted in January 2026 from an ACL-rehabilitation-specific registry, Project ACL. Included patients were 15-50 years who underwent primary ACL reconstruction with hamstring tendon or bone-patellar tendon-bone autograft, had a documented Beighton Score, participated in knee-strenuous sports before injury, had RTS, reported second ACL injury or had ≥ 1 year follow-up without second ACL injury after RTS. Multivariable Cox proportional hazard regression was used to estimate the cause-specific hazard ratio (HR) of second ACL injury (measured from RTS) based on the Beighton Score, adjusted for age, return to pre-injury physical activity level or higher, graft choice, knee hyperextension (≥ 10° knee extension), and patient sex, accounting for competing risks.

RESULTS: The analysis included 935 patients (mean age 23.7 ± 7.8 years, 51.4% female), with median Beighton Score of 2 (interquartile range: 4). The median follow-up time was 54.4 months. The cumulative incidence of second ACL injury after RTS was 13.1%. Specifically, the cumulative incidence for graft rupture was 7.4% and 5.7% for contralateral ACL injury. For the primary outcome, each additional positive joint hypermobility test on the Beighton Score was associated with a significantly increased hazard of second ACL injury (adjusted HR: 1.10 (95% CI 1.003-1.22, p = 0.044). For the secondary outcomes, each additional test was associated with an increased hazard of graft rupture (adjusted HR: 1.15, 95% CI 1.01-1.30, p = 0.031), whereas no statistically significant association was observed for contralateral ACL injury.

CONCLUSIONS: The HR of second ACL injury (graft rupture or contralateral ACL injury) after RTS in patients who had undergone primary ACL reconstruction increased by 10%, and by 15% for isolated graft rupture, for each positive joint hypermobility test on the Beighton Score, while no association was observed for contralateral ACL injury.

PMID:42334734 | DOI:10.1186/s40798-026-01054-5

Health Care Anal. 2026 Jun 23. doi: 10.1007/s10728-026-00583-0. Online ahead of print.

ABSTRACT

Assisted reproductive technologies (ART) have expanded rapidly in India, raising significant ethical and distributive justice concerns relating to accessibility, affordability and reproductive healthcare governance. Despite growing scholarly attention to ART regulation, empirical evidence examining public perceptions of access, perceived equity barriers and ethical governance within the Indian context remains limited. This study addresses this gap through an empirical bioethics analysis of public perceptions regarding ART accessibility and governance in India. A cross-sectional survey of 560 respondents from urban, semi-urban and rural settings was conducted using a structured questionnaire. Data were analysed using descriptive statistics, reliability analysis, correlation analysis and one-way ANOVA with Tukey post hoc comparisons. The findings reveal significant geographic disparities in access to ART services, with urban respondents reporting substantially greater access than semi-urban and rural respondents (F = 35.040, p < 0.001). Descriptive findings further indicate moderate levels of awareness and regulatory trust alongside lower perceptions of access and greater perceived equity barriers. The study highlights the continuing influence of structural inequality on reproductive healthcare accessibility in India and underscores the need for policy interventions aimed at improving equitable access, institutional accountability and inclusive reproductive healthcare governance.

PMID:42334729 | DOI:10.1007/s10728-026-00583-0

Ann Biomed Eng. 2026 Jun 23. doi: 10.1007/s10439-026-04251-1. Online ahead of print.

ABSTRACT

PURPOSE: Postural control matures during childhood alongside the musculoskeletal system, though development is often asynchronous and influenced by sex. In this process, foot morphology is especially relevant, as the plantar surface provides key somatosensory input to the central nervous system. However, the role of foot-ground interaction in balance regulation remains largely unexplored. In this study, we attempted to clarify the association between foot morphology-measured via footprint-based indices-and static balance through postural sway analysis.

METHODS: Using a pressure platform, we simultaneously collected data on center of pressure (COP) trajectories during quiet upright stance and plantar pressure distribution in a sample of 178 children aged 6-11. Raw data were processed to calculate sway area and COP path length, as well as the Arch Index, which was used to categorize foot morphology as cavus, normal, or flat.

RESULTS: Among girls aged 8-9 years, statistically significant differences in postural sway parameters were observed across foot morphology groups, with individuals presenting cavus feet exhibiting greater sway area and COP path length values. A comparable tendency was also identified in those aged 10-11. In contrast, boys aged 10-11 with flat feet displayed lower sway area values under the eyes-closed condition and reduced COP path length under the eyes-open condition compared with peers presenting normal or cavus foot morphology.

CONCLUSION: Overall, these findings suggest that postural control during childhood is influenced by the mechanical and sensory characteristics of the foot-ground interface, and that sex represents a relevant moderating factor in this relationship.

PMID:42334708 | DOI:10.1007/s10439-026-04251-1

Eat Weight Disord. 2026 Jun 23. doi: 10.1007/s40519-026-01886-w. Online ahead of print.

ABSTRACT

OBJECTIVES: The present study explored affective touch in anorexia nervosa (AN) by: (a) comparing patients with AN and healthy control subjects (HCs) on the quality and quantity of affective-touch experiences across the lifespan; (b) investigating the association between affective touch and body-image-related symptoms; (c) assessing the link between affective touch and interpersonal space (IPS).

METHODS: Participants (76 patients with AN and 77 HCs) completed self-report questionnaires measuring eating-related symptoms, anxiety, depression, and affective-touch experiences. IPS was assessed with a computer-based stop-distance task with different social conditions.

RESULTS: Patients with AN had higher general (i.e., anxiety and depression), and body-image-related (e.g., body checking, body dissatisfaction) symptoms than HCs; moreover, they reported lower quantity of affective touch both in childhood and adulthood and less comfort with affective touch, with a medium to large effect size; more frequent negative affective-touch experiences were also observed in patients than in HCs, with a medium effect size. In patients, lower experienced affective touch, both in childhood and adulthood, and reduced touch-related comfort were associated with larger IPS, independent of anxiety and depression, and with a high effect size after statistical adjustment. No associations with IPS emerged in HCs.

CONCLUSIONS: The results highlighted a link between negative and reduced affective touch and social difficulties and avoidance in AN. The study remarks the relevance of affective-touch experiences and their relation with implicit body-related mechanisms, suggesting addressing early tactile experiences and interpersonal functioning in clinical interventions.

LEVEL OF EVIDENCE: Level III, case-control study based on self-report questionnaires and a behavioral task.

PMID:42334701 | DOI:10.1007/s40519-026-01886-w

Eur J Orthop Surg Traumatol. 2026 Jun 23;36(1):247. doi: 10.1007/s00590-026-04840-9.

ABSTRACT

PURPOSE: Minimally invasive plate osteosynthesis (MIPO) has been introduced as an alternative technique for distal radius fracture fixation, aiming to minimize surgical trauma while preserving soft tissue integrity. The Wide-Awake Local Anesthesia No Tourniquet (WALANT) method enables intraoperative functional assessment and early active wrist motion. Comparative evidence between MIPO and conventional volar plate fixation performed under WALANT remains limited.

METHODS: A single-center, assessor-blinded, randomized controlled trial was conducted between October 2021 and February 2023. Sixty-six patients with isolated closed distal radius fractures were randomized to MIPO (n = 33) or conventional open volar locking plate fixation via a modified Henry approach (n = 33) under WALANT. The primary outcome was first postoperative day pain measured by the visual analogue scale (VAS). Secondary outcomes included morphine usage, QuickDASH score, grip and pinch strength, range of motion, operative time, aesthetic score, radiographic parameters, and complications. Minimum follow-up was six months.

RESULTS: The MIPO group showed a statistically lower POD1 VAS pain score than the conventional group that was below the minimal clinically important difference and therefore not clinically significant (mean 3.4 [SD 0.96] vs. 4.2 [SD 1.51]; mean difference 0.8, 95% CI 0.2-1.4; p = 0.012). Cosmetic outcomes were higher in the MIPO group (mean aesthetic score 3.3 vs. 2.8). Morphine consumption, QuickDASH scores, grip and pinch strength, range of motion, operative duration, and radiographic outcomes were similar between groups, whereas intraoperative fluoroscopy use was higher in the MIPO group. All patients achieved bone union within three months, and no major complications were reported.

CONCLUSION: In this randomized controlled trial, MIPO under WALANT achieved functional, radiographic, and safety outcomes equivalent to conventional volar plate fixation. The statistically lower POD1 pain score in the MIPO group fell below the minimal clinically important difference, indicating no clinically significant difference in early postoperative pain between the two techniques; the only consistent advantages were smaller incisions and better cosmetic scores. MIPO under WALANT is therefore a safe and viable alternative-chosen for its cosmetic benefit and at the cost of greater fluoroscopy use and a steeper learning curve-rather than a clinically superior technique.

LEVEL OF EVIDENCE II: Randomized controlled trial, Therapeutic study.

PMID:42334684 | DOI:10.1007/s00590-026-04840-9