Category: Statistics

Appl Physiol Nutr Metab. 2026 Jun 24. doi: 10.1139/apnm-2025-0371. Online ahead of print.

ABSTRACT

Movement behaviour guidelines should be tailored to contextual factors influencing physical activity, sedentary behaviour, and sleep to support effective mobilization. Compared to urban areas, rural communities have distinct environmental characteristics and require context-specific strategies to promote healthy movement behaviours. This study aimed to evaluate awareness and knowledge of the Canadian 24-Hour Movement Guidelines for Adults (18-64 years) living in rural communities and explore how to adapt the Canadian 24-Hour Movement Guidelines Communications Toolkit for greater impact and relevance. We adopted an explanatory sequential mixed methods study design, in which adults living in rural communities of British Columbia, Canada, completed a cross-sectional survey (N = 76) followed by individual interviews (N = 12). Survey data were analysed for awareness and knowledge of Movement Guidelines using descriptive statistics and Chi-squared tests. Interview data were analyzed following a deductive thematic approach using the Behaviour Change Wheel to identify the barriers and facilitators to meeting guideline recommendations. Approximately half of the participants reported being aware of the guidelines (44.7%), 64.5% reported moderate knowledge of recommendations, and 27.6% of participants reported meeting guidelines for physical activity, sedentary behaviour, and sleep. Participants perceived factors associated with physical opportunities and psychological capabilities to have strong influences on their ability to meet movement behaviour guidelines. Recommendations for adapting 24-Hour Movement Guidelines for rural communities include providing additional information on being active outdoors and at home, information on discerning sedentary behaviour and inactivity, and tips to combat seasonal changes in daylight.

PMID:42341342 | DOI:10.1139/apnm-2025-0371

Oncol Nurs Forum. 2026 Jun 24;53(4):1-12. doi: 10.1188/26.ONF.e26535328.

ABSTRACT

OBJECTIVES: To examine the relationship between side effect severity and self-management ability in patients taking capecitabine and investigate whether medication beliefs mediate this relationship.

SAMPLE & SETTING: A secondary analysis was conducted using data from a descriptive study of 50 patients with gastrointestinal cancer receiving capecitabine at the University of Michigan Rogel Cancer Center.

METHODS & VARIABLES: Self-management ability was assessed using the Measure of Drug Self-Management. The severity of capecitabine-related side effects was measured using the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events. Patients’ perceived necessity of and concerns about capecitabine were evaluated using the Beliefs about Medicines Questionnaire (adapted for capecitabine). Descriptive statistics, multiple linear regression, and PROCESS macro mediation analysis were employed.

RESULTS: Self-management ability was significantly associated with total side effect severity (beta = -1.09, p = 0.003). This relationship was partially mediated by patients’ overall beliefs about capecitabine (beta = -0.74, p = 0.04) and fully mediated by concerns about its potential harms (beta = -0.6, p = 0.11).

IMPLICATIONS FOR NURSING: Oncology nurses should adopt a patient-centered approach that includes counseling about the benefits of capecitabine, addressing concerns about adverse effects, and reinforcing patients’ self-efficacy and social support networks to enhance self-management during therapy.

PMID:42341331 | DOI:10.1188/26.ONF.e26535328

JMIR Mhealth Uhealth. 2026 Jun 24;14:e69273. doi: 10.2196/69273.

ABSTRACT

BACKGROUND: Patients with Parkinson disease (PD) along with subjective cognitive decline (PD-SCD) are considered an intermediate status between those with normal cognition (PD-NC) and those with mild cognitive impairment (PD-MCI). Wearable digital monitoring technologies and machine learning models offer significant potential for assessing cognitive impairment in patients with PD.

OBJECTIVE: We aimed to evaluate the utility of wearable technology and machine learning for identifying ordinal cognitive stages (OCS) in PD based on timed up and go (TUG) tests (including single-task TUG [TUGst] and dual-task TUG [TUGdt]).

METHODS: Patients with PD along with SCD, MCI, and NC were recruited in a movement disorder clinic. Patients performed TUGst and TUGdt gait trials wearing a motor function and motor symptom quantitative assessment system. In total, 209 kinematic parameters were synthesized for individual TUG to illustrate patients’ motion profiles. We constructed dual-task cost parameters (DTC), describing the magnitude of the effect of the cognitive challenge on motion performance. Covariate-adjusted ordered logistic regression was used to compare parameter differences among 3 groups. Multiple machine learning models were used to classify the participants into 3 cognitive impairment levels, with features being selected based on P values from intergroup statistical tests. The total population was randomly divided into a training set and an independent validation set in a 7:3 ratio, and 10-fold cross-validation was used in the training set. Furthermore, this study used permutation importance and Shapley Additive Explanations (SHAP) analysis (including summary plots, bar plots, and waterfall plots) to explain the feature importance of the final model.

RESULTS: The study included 65 age-matched patients (PD-NC: PD-SCD: PD-MCI= 14:21:30). Forty-five kinematic parameters were significantly different (P<.05) among the 3 groups, distributed across TUGst (n=25), TUGdt (n=12), and DTC (n=8) paradigms. Gait phase analysis revealed 35 parameters from walking phases, 9 from stand-to-sit transitions, and 1 from sit-to-stand transitions. Feature type distribution demonstrated predominance of variability features (n=20), followed by pace (n=12) and axial (n=8) characteristics. TUGdt paradigm analysis revealed pronounced movement differences between PD-MCI and both PD-NC and PD-SCD groups, particularly in variability, amplitude, pace, and axial domains. Cross-paradigm analysis identified consistent significant differences in specific features. These findings provide objective kinematic biomarkers for early cognitive state identification in Parkinson disease, with TUGdt parameters demonstrating superior discriminative capacity.

CONCLUSIONS: This suggests patients with PD-SCD could have early kinetic signs of cognitive impairment, positioning them between PD-NC and PD-MCI, and our multiclass support vector machine classification model with kinematic parameters achieved a recall rate above 0.70 in both training and validation datasets. The feature importance analysis revealed that DTC_Trunk-Right Rotation Max, DTC_Trunk-Max Transverse Angular Velocity, and dTUG_Lumbar-Right Sway Max Std were the most critical features for distinguishing cognitive states, providing scientific evidence for cognitive function screening based on kinematic parameters.

PMID:42341295 | DOI:10.2196/69273

JMIR Mhealth Uhealth. 2026 Jun 24;14:e75308. doi: 10.2196/75308.

ABSTRACT

BACKGROUND: The global prevalence of dementia continues to rise and demands scalable, nonpharmacological interventions. Digital cognitive training has expanded, but many older adults, who have limited digital literacy, struggle to sustain use. We designed an intervention that integrates social interaction, reward-based engagement, and an artificial intelligence (AI) conversational agent, which aims to reduce these barriers and support continuous participation.

OBJECTIVE: This study examined whether a 12-week digital cognitive training program improves cognitive function in older adults. It also tested whether a group chat service, which enables interaction among participants and with an AI agent, increases engagement and social support.

METHODS: We recruited 133 participants (mean age 64.75, SD 6.76; range 55-75 years) who had no diagnosis of dementia. All participants used the Care & Cure program for 12 weeks. The program includes an AI chatbot (Sammy Talk) and a group chat service (Our Town), which supports peer interaction. We measured cognitive function using the Korean Mini-Mental State Examination-Version 2 (K-MMSE-2). We also assessed degrees of social support (Medical Outcomes Study-Social Support Survey), depression (Short Form Geriatric Depression Scale-Korean Version), and engagement (Twente Engagement with eHealth Technologies Scale), and analyzed usage logs to examine participation patterns.

RESULTS: Participants showed improved cognitive function after the intervention (Hedges g=0.350, P<.001). Active users (n=67), who engaged more frequently with the program, showed greater improvement than nonactive users (n=66), especially among those who had lower baseline cognitive scores (Hedges g=0.523, P<.001). Social support increased, particularly emotional and informational support (t132=-6.509, P<.001). Participants reported higher engagement (t132=2.008, P<.05) and lower depression scores (t132=3.093, P<.01). Regression results showed that group chat participation, which promotes interaction with the AI agent, increased engagement in cognitive training (t131=12.395, P<.001). Increased engagement was associated with higher social support (t131=4.102, P<.001) and improved cognitive function (t131=2.467, P<.05). Cognitive training alone did not produce a significant effect. Participants showed low adherence, which indicates a need for strategies that sustain long-term use.

CONCLUSIONS: The Care & Cure program improved cognitive function and strengthened social support in older adults. Social interaction, which increases engagement, played a central role. These findings suggest that digital cognitive interventions should incorporate social mechanisms to achieve meaningful effects.

PMID:42341288 | DOI:10.2196/75308

J Chem Inf Model. 2026 Jun 24. doi: 10.1021/acs.jcim.6c01192. Online ahead of print.

ABSTRACT

Protein-ligand binding affinity prediction (PLBAP) models are routinely benchmarked on the CASF-2016 data set with Pearson correlation coefficient (PCC) as a common measure of scoring power. Published PCC values are frequently reused as baselines for cross-study comparisons. This practice implicitly assumes that published pipelines remain runnable and that reported metrics can be independently verified. To examine this assumption, we conducted a systematic reproducibility audit of 50 PLBAP models published between 2021 and 2024 that reported CASF-2016 scoring power. For each model, we attempted to reproduce the authors’ CASF-2016 inference using only publicly available code, documentation, and pretrained weights. To scaffold this audit and to offer a reusable resource for the community, we introduce a minimal five-item reproducibility checklist for PLBAP pipelines, organized around the artifacts a researcher requires to independently rerun inference: (1) a license; (2) preprocessing and featurization, (3) training, and (4) inference code; and (5) pretrained model weights. We find that only 17/50 pipelines satisfied all checklist items to be consistently runnable. Of those 17 runnable models, only nine were statistically reproducible (53% of models). We propose the checklist as a lightweight community standard for future PLBAP releases, document common gaps, and highlight practices that most reliably enabled independent reproduction.

PMID:42341287 | DOI:10.1021/acs.jcim.6c01192

JMIR Med Inform. 2026 Jun 24;14:e72655. doi: 10.2196/72655.

ABSTRACT

BACKGROUND: Vital signs are objective measurements of the body’s most basic, essential functions, indicating overall health status. However, such assessments are time-consuming and so are not always prioritized. Measuring vital signs before doctor visits may, therefore, be an effective and efficient strategy.

OBJECTIVE: We piloted a preclinic vital signs assessment (PCVSA) procedure within a primary care center to determine its feasibility and acceptability.

METHODS: A mixed methods cross-sectional design was used for piloting the PCVSA procedure. Study participants included adult patients and practice staff. Patients had vital signs assessed by a primary care assistant before general practitioner (GP) visits. Collected data concerned participants’ study engagement, the timings of PCVSA/GP visits, and surveys/interviews investigating participants’ experiences.

A total of 16 patients and 4 staff participated. The mean duration for PCVSAs was 2 minutes and 23 seconds (SD 38.8 s), and the mean duration for GP visits was 9 minutes and 21 seconds (SD 252.4 s). Patients said the PCVSA was a “Positive experience” (n=14, 88%), “Helpful” (n=13, 81%), “Valuable” (n=7, 44%), and “Interesting” (n=6, 38%). The GP said the PCVSAs were either “Helpful” (8/15, 53%) or “Extremely Helpful” (7/15, 47%) in each of their consultations and that the PCVSAs improved engagement with patients (12/15, 80%), allowed them to spend more time gaining an understanding of the conditions of patients (14/15, 93%), and enhanced productivity during consultations (11/15, 73%). The GP strongly agreed that collecting PCVSA data before appointments would benefit patients over time. Qualitative interviews with practice staff yielded three themes: (1) improved patient engagement and efficient consultation, (2) time-saving potential, and (3) practicing in general practice and associated challenges.

CONCLUSIONS: The PCVSA pilot showed good feasibility and acceptability as indicated by high participant engagement, short PCVSA and GP visit times (albeit GP visit times did not measure non-patient-facing clinical activity), and positive feedback from patients and staff. Introducing PCVSAs in health care settings may have potential in terms of improving the standard and efficiency of care.

PMID:42341282 | DOI:10.2196/72655

Am J Public Health. 2026 Jul;116(S3):S210-S217. doi: 10.2105/AJPH.2026.308479.

ABSTRACT

Objectives. To explore and quantify the potential effects of financial innovations aimed at increasing investments in social drivers of health (SDH). Methods. We built a simulation model in which individuals in a health care market are served by multiple Medicaid managed care organizations (MCOs). In our model, each MCO can spend money to make SDH investments that improve patient health and reduce costs to the MCO, but patients can switch between different MCOs. Results. While SDH investments improve patient health and increase the profitability of the investing MCO, the benefits also accrue to noninvesting MCOs because of the churn of patients between MCOs, resulting in a “wrong-pocket problem” where investing MCOs bear the costs but share the benefits with competitors, resulting in worse financial returns compared with making no investments and ultimately disincentivizing SDH investments. Outcomes can be improved when all MCOs participate in a financial structure-an SDH bond-which raises money from investors and distributes the proceeds to MCOs to make SDH investments. Conclusions. An SDH bond can improve patient health and increase profits for MCOs because of cost-savings. (Am J Public Health. 2026;116(S3): S210-S217. https://doi.org/10.2105/AJPH.2026.308479).

PMID:42341273 | DOI:10.2105/AJPH.2026.308479

Am J Public Health. 2026 Jul;116(S3):S171-S180. doi: 10.2105/AJPH.2026.308580.

ABSTRACT

Objectives. To analyze whether and how the Aging and Disability Vaccination Collaborative (ADVC) counteracted seasonal vaccination disparities for Asian American, Black, Latinx, and Native American populations. Methods. We performed a cross-sectional analysis of 6032 vaccination events organized by 168 community-based organizations (CBOs) through the ADVC (2023-2025). We calculated representation ratios comparing event demographics to county demographics to identify events that counteracted disparities by overrepresenting minoritized populations. Qualitative interviews provided context. Results. Overall, 69% of events counteracted disparities for at least 1 population: 27.4% for Native Americans, 19.0% for Asian Americans, 33.7% for Black populations, and 20.8% for Latinx populations. Gift cards were associated with overrepresenting Black (odds ratio [OR] = 2.54; P < .001) and Latinx populations (OR = 2.01; P = .048). Intentional targeting was associated with overrepresentation for Native American (OR = 2.49; P = .047) and Asian American populations (OR = 6.53; P < .001). Interviews emphasized the importance of trust-based partnerships with culturally connected organizations. Conclusions. CBO-centered vaccination approaches counteracted racial/ethnic disparities through partnerships with cultural organizations and social services. Public Health Implications. ADVC provides a template for scaling up CBO-led partnerships with public health and health care that could apply to state or local levels. (Am J Public Health. 2026;116(S3): S171-S180. https://doi.org/10.2105/AJPH.2026.308580).

PMID:42341264 | DOI:10.2105/AJPH.2026.308580

JCO Glob Oncol. 2026 Jun;12(6):e2500574. doi: 10.1200/GO-25-00574. Epub 2026 Jun 24.

ABSTRACT

PURPOSE: There are now six anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) approved for first-line ALK-positive non-small cell lung cancer (NSCLC) therapy, improving survival and quality of life. However, real-world data on treatment outcomes, predictors of discontinuation, and sequencing strategies remain scarce, while direct comparisons between second- and third-generation TKIs are limited.

METHODS: This global longitudinal observational study evaluated patients with ALK-positive NSCLC, with data collected via online surveys from September 2022 to April 2025. Treatment patterns, outcomes, and factors associated with time to discontinuation (TTD) were assessed using descriptive statistics and univariable regression.

RESULTS: Overall, 1,111 patients from 71 countries were included (64% female; median age at diagnosis 53 years; 28% with a smoking history). Crizotinib was predominantly the first TKI administered, although prescribing patterns shifted over time (crizotinib before 2016, alectinib between 2017 and 2022, and lorlatinib thereafter). After the follow-up period (median of 20.7 months), 60% of patients remained on their initial TKI, with TTD varying significantly across agents. Factors associated with prolonged TTDs included radiotherapy, prior chemotherapy, delayed therapy initiation, and treatment in India (crizotinib) and retirement, prior chemotherapy, and treatment in the United Kingdom (alectinib). Gastroesophageal reflux disease, thyroid disease, TP53 mutations, and ALK V3a/b fusions were associated with a short TTD. Globally, alectinib to lorlatinib was the most common treatment sequence. Discontinuations because of toxicity were the highest with crizotinib and ceritinib and the lowest with lorlatinib and alectinib.

CONCLUSION: This multinational registry-based analysis highlights evolving global treatment patterns, supports newer TKIs’ effectiveness, and identifies clinical and molecular factors associated with treatment duration.

PMID:42341251 | DOI:10.1200/GO-25-00574

JCO Glob Oncol. 2026 Jun;12(6):e2600042. doi: 10.1200/GO-26-00042. Epub 2026 Jun 24.

ABSTRACT

PURPOSE: ALK rearrangements occur in 5.4% of Brazilian patients with non-small cell lung cancer (NSCLC). Data on treatment patterns, access to ALK inhibitors, and survival outcomes are scarce.

MATERIALS AND METHODS: LACOG/GBOT 1918 is a retrospective, observational study that included patients diagnosed with ALK-positive NSCLC between January 2015 and December 2020 in 12 Brazilian public and private centers. Data were extracted from patient records, including clinic-epidemiologic features, diagnosis, ALK testing methods, treatment patterns, and outcomes. Data were analyzed using descriptive statistical methods.

RESULTS: A total of 101 patients were enrolled. The median age was 55 years (range, 18-86), and 55.4% were female. Immunohistochemistry was the most frequently used method for ALK testing. The median time from the first symptom to diagnosis was 2 months, from diagnosis to ALK testing 1.7 months, and from diagnosis to treatment initiation 1.7 months. Among patients receiving first-line treatment, only 47.9% received ALK inhibitors (53.9% private v 22.2% public), with crizotinib being the most used. For second-line treatment, 66.0% of patients received ALK inhibitors, with alectinib being the most used (50%). Most treated patients had access to ALK inhibitors in some line of treatment (83.3% private v 72.2% public); however, in the public setting, targeted treatment was restricted to first-generation and second-generation ALK inhibitors. The 3-year overall survival (OS) rate was 82.6% (95% CI, 72.6 to 89.2), with a lower 3-year OS in the public setting (61.4% public v 87.2% private; P = .0279).

CONCLUSION: Access to targeted ALK therapy is limited in the public health care system, reflecting poor clinical outcomes. Public health measures are necessary to minimize the differences between these two systems.

PMID:42341249 | DOI:10.1200/GO-26-00042