Category: Statistics

Tech Coloproctol. 2026 Apr 22. doi: 10.1007/s10151-026-03304-w. Online ahead of print.

ABSTRACT

BACKGROUND: Early age at diagnosis in Crohn’s disease is linked to aggressive phenotypes, yet evidence regarding its impact on surgical risk remains inconsistent. This study aimed to elucidate the relationship between age at diagnosis, utilizing Vienna and Montreal classifications, and surgical prognosis in patients undergoing ileocecal resection.

METHODS: A retrospective analysis of a prospective database identified 810 patients undergoing ileocecal resection between 2014 and 2022. Patients were stratified by Vienna (< 40 versus > 40 years) and Montreal (A1, A2, A3) classifications. Primary end points included 30-day overall complications, serious complications, reoperation and readmission. Statistical analysis employed multivariable regression, propensity score matching, G-computation and Random Forest models to adjust for confounders.

RESULTS: Baseline characteristics differed significantly: younger patients exhibited more penetrating disease and biologic exposure, while older patients had higher ASA scores and comorbidities. After robust adjustment, the Vienna and Montreal age classification showed no significant association with postoperative complications, serious complications, reoperation or readmission. Random Forest analysis consistently identified ASA score and comorbidities, rather than age at onset, as the dominant predictors of surgical outcomes.

CONCLUSIONS: Age at diagnosis does not independently predict short-term surgical outcomes after ileocecal resection. Postoperative morbidity is driven primarily by general health markers, such as ASA score, rather than disease onset timing. These findings highlight the need for validated disease-specific risk scores.

PMID:42018163 | DOI:10.1007/s10151-026-03304-w

Eur J Pediatr. 2026 Apr 22;185(5):288. doi: 10.1007/s00431-026-06930-6.

ABSTRACT

The rapid rise of short video consumption among children and adolescents has raised concerns regarding its associations with cognitive and emotional functioning. This study aimed to examine whether cognitive emotion regulation strategies predict short video addiction levels in children aged 10-14 and to explore the relationship between specific emotion regulation strategies and short video addiction. A descriptive and correlational research design was employed. The study was conducted between January and June 2025 with 202 middle school students aged 10-14. Participants completed an Information Form, the Short Video Addiction Scale (SVAS), and the Turkish Child Version of the Cognitive Emotion Regulation Questionnaire (CERQ-k). Descriptive statistics, correlation analyses, and multiple linear regression analyses were performed. The mean age of the participants was 12.12 years (SD = 1.24). Most were female (52.97%) and enrolled in the 7th grade (30.20%). SVAS scores were positively correlated with self-blame (r = .21, p < .05), putting into perspective (r = .20, p < .05), and catastrophizing (r = .24, p < .01), indicating that higher levels of short video addiction were associated with greater reliance on maladaptive cognitive emotion regulation strategies. Regression analysis identified catastrophizing as a significant predictor of short video addiction scores (B = 0.59, p < .05), indicating that greater use of catastrophizing was associated with higher levels of short video addiction.

CONCLUSION: The findings indicate that maladaptive cognitive emotion regulation strategies, particularly self-blame and catastrophizing, are associated with higher levels of short video addiction among children. These results highlight the importance of interventions that strengthen adaptive emotion regulation skills as a potential approach to preventing or reducing problematic short video use in childhood.

WHAT IS KNOWN: • Short video use is increasingly common among children and may be associated with cognitive and emotional functioning. • Maladaptive cognitive emotion regulation strategies, such as self-blame and catastrophizing, are linked to poorer emotional and behavioral outcomes in children.

WHAT IS NEW: • Maladaptive cognitive emotion regulation strategies are associated with higher levels of short video addiction in children aged 10-14. • Catastrophizing significantly predicts short video addiction, identifying a potential target for early prevention and intervention efforts.

PMID:42018161 | DOI:10.1007/s00431-026-06930-6

Diabetologia. 2026 Apr 22. doi: 10.1007/s00125-026-06740-3. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: Ethnic disparities in the incidence of type 2 diabetes mellitus are well documented in multiethnic urban populations, but the contributions of migration status and mental health are less well understood. This study used a large dataset from primary care centres in South London that is unique in that it includes migration-related information together with information on mental and physical health comorbidities. We aimed to assess how migration status and mental health contribute to longitudinal associations of ethnicity and type 2 diabetes risk in a multiethnic urban population.

METHODS: We conducted a longitudinal cohort study (2012-2019) of approximately 340,000 adults without baseline type 2 diabetes. Cox proportional hazards models were applied with sequential adjustments: first for age and sex; second, adding migration status (country of birth being UK or not); and third, further adding mental health conditions (depression, anxiety, severe mental illness), physical health factors (BMI, hypertension and other macrovascular diseases) and area-level deprivation. This approach allowed us to examine whether ethnic differences in the incidence of type 2 diabetes persist after accounting for additional factors.

RESULTS: South Asian, Black African and Black Caribbean groups had 2-3-fold higher type 2 diabetes risks compared with White British individuals, which were only partially explained by socioeconomic and clinical factors. Being born outside the UK increased type 2 diabetes risk by 29% across all ethnic groups. Depression/anxiety and severe mental illness were associated with a higher risk of type 2 diabetes. No statistical evidence of strong interactions between these factors was obtained.

CONCLUSIONS/INTERPRETATION: Ethnicity, migration status and mental health conditions were each independently associated with type 2 diabetes risk, and ethnic disparities persisted after adjustment. The lack of evidence for interactions suggests that migration- and mental health-related mechanisms may operate similarly across ethnic groups rather than amplifying or mitigating existing disparities in type 2 diabetes rates. Efforts to reduce diabetes inequalities will require both support for post‑migration challenges and addressing of the broader structural and environmental determinants underlying persistent ethnic disparities.

PMID:42018145 | DOI:10.1007/s00125-026-06740-3

Equine Vet J. 2026 Apr 22. doi: 10.1002/evj.70170. Online ahead of print.

ABSTRACT

BACKGROUND: Misconceptions can be defined as ‘false, persistent beliefs’ or ‘inaccurate, prior knowledge’ and can influence decision-making.

OBJECTIVES: To investigate the impact of evidence-based information on UK horse owners’ decision-making for colic.

STUDY DESIGN: Mixed-methods cross-sectional study.

METHODS: An online survey was distributed to UK horse owners, with four sections: owner demographics; views on decision-making and referral to an equine hospital facility for colic; current knowledge and approach to colic; impact of evidence-based information (including evidence on recognising and responding to colic, and colic surgery survival and outcome data) on decision-making. Statistical analysis was performed using Kendall’s tau for continuous variables and Chi-squared testing for categorical variables. Multivariable analysis was performed using a generalised linear model with binomial distribution (logistic regression), with p < 0.05 for model fit. Content analysis was used for free-text answers.

RESULTS: In total, 1544 participants met inclusion criteria. Owners were more likely to agree to referral if their horse was insured (p < 0.001, 95% confidence interval [CI]: 1.86-2.93), and less likely if their horse was older (p < 0.001, CI: 0.90-0.94) or they felt pressure (p < 0.001, CI: 0.44-0.70). Pressure to refer was mainly from veterinary professionals (66%, 367/549) or peers (20%, 110/549). Many participants were unaware of how quickly irreversible intestinal damage could occur (58%, 903/1544), costs of colic surgery and UK insurance cover limits (63%, 966/1544), post-operative survival rates for geriatric vs. non-geriatric horses (65%; 996/1544), or prognosis for return to work following colic surgery (68%, 1052/1544). Sharing evidence-based information had limited impact on decision-making. Free text response analysis identified previous experience of colic, anecdotal information, finances and peer pressures as barriers to change.

MAIN LIMITATIONS: Potential for response bias, UK participants only.

CONCLUSIONS: Misconceptions around colic were common, with many horse owners reluctant to change their approach after evidence-based information. Intent to pursue referral was less likely with increasing horse age and perceived pressure to refer.

PMID:42018127 | DOI:10.1002/evj.70170

Eur J Health Econ. 2026 Apr 22. doi: 10.1007/s10198-026-01923-6. Online ahead of print.

NO ABSTRACT

PMID:42018119 | DOI:10.1007/s10198-026-01923-6

J Am Heart Assoc. 2026 Apr 22:e042044. doi: 10.1161/JAHA.125.042044. Online ahead of print.

ABSTRACT

BACKGROUND: Although large studies and pooled analyses of individual patient data have demonstrated the safety of deferring coronary revascularization based on a nonischemic intracoronary pressure index result, conflicting findings have emerged in specific patient subsets and with varying follow-up. Thus, we conducted an updated comprehensive systematic review and meta-analysis to investigate the cardiovascular outcomes associated with deferred or performed coronary revascularization based on intracoronary physiology.

METHODS: Available studies were identified through a systematic search of PubMed, EMBASE, and CENTRAL. Efficacy outcomes investigated were major adverse cardiovascular events, all-cause death, cardiovascular death, noncardiovascular death, myocardial infarction, and unplanned revascularization.

RESULTS: A total of 24 studies enrolling 24 285 patients were included in the meta-analysis. After a mean±SD follow-up of 2.6±1.6 years, patients undergoing physiology-guided deferred revascularization show consistently better outcomes than patients who underwent revascularization, including all-cause death (incidence rate ratio [IRR], 1.14 [95% CI, 1.00-1.30]; P=0.05), cardiovascular death (IRR, 1.53 [95% CI, 1.17-2.00]; P=0.002), and unplanned revascularization (IRR, 1.38 [95% CI, 1.06-1.79]; P=0.01). For major adverse cardiovascular events (IRR, 1.15 [95% CI, 0.99-1.34]; P=0.07) and myocardial infarction (IRR, 1.24 [95% CI, 0.95-1.61]; P=0.11), the associations did not reach statistical significance.

CONCLUSIONS: Patients in whom revascularization was deferred based on intracoronary physiology show lower risk of adverse cardiovascular events compared with those who underwent revascularization. These findings suggest that pressure wire assessment has prognostic implications besides the indication for revascularization.

PMID:42017344 | DOI:10.1161/JAHA.125.042044

Stress Health. 2026 Apr;42(2):e70178. doi: 10.1002/smi.70178.

ABSTRACT

Childhood maltreatment has been associated with an increased risk of irritable bowel syndrome (IBS) in adulthood, but the longitudinal relationship and underlying mechanisms remain underexplored. Using data from the UK Biobank, this cohort study investigated the association between childhood maltreatment and the onset of IBS in adulthood and explored potential mediating pathways. A total of 108,365 participants (mean age: 34.57 [SD: 4.81] years; 57.2% were female) were followed up from age 30 onwards (or January 1, 1985, whichever was later) until the first IBS diagnosis, death, or the end of follow-up, whichever occurred first. Childhood maltreatment was assessed through self-reported data, and incident IBS cases were identified using ICD-10 codes, with subtypes classified by Rome III criteria. Cox proportional hazards, sequential mediation analyses, and multinomial logistic regression were performed. Over a mean follow-up of 35.6 years, 5806 incident IBS cases were recorded. A positive association was observed between cumulative childhood maltreatment and incident IBS (HR: 1.10; 95% CI: 1.07-1.12). Among individual maltreatment types, emotional neglect showed the strongest association with IBS (HR: 1.27; 95% CI: 1.20-1.35). Sequential mediation analyses indicated that psychological adversity accounted for the largest proportion of the indirect effect (15.3%-17.0%), followed by socioeconomic status, lifestyle behaviours, and biological alterations. These findings emphasise the need for prevention strategies to reduce childhood maltreatment and mitigate its long-term health impacts. Tailored interventions focussing on psychosocial support, addressing socioeconomic disparities, and promoting healthy lifestyle changes may further reduce IBS risk in affected individuals.

PMID:42017339 | DOI:10.1002/smi.70178

J Am Heart Assoc. 2026 Apr 22:e048080. doi: 10.1161/JAHA.125.048080. Online ahead of print.

ABSTRACT

BACKGROUND: Although public access defibrillation programs have expanded, real-world bystander automated external defibrillator (AED) use remains limited. The concept of functional accessibility, the realistic ability of bystanders to retrieve and use an AED within a time window that affects survival, has not yet been systematically evaluated. This study aimed to evaluate the functional accessibility of publicly installed AEDs by integrating factors influencing their usability in out-of-hospital cardiac arrest events.

METHODS: We conducted a population-based geospatial analysis of 39 563 out-of-hospital cardiac arrests in Gyeonggi-do, Korea (2021-2023). Each incident was matched to the nearest public AED using network-based walking routes. Functional accessibility was measured by walking time and distance, stratified by urbanization, time of day, and location of arrest. Multivariable logistic regression was used to assess the association of AED accessibility with bystander AED use and prehospital return of spontaneous circulation.

RESULTS: The median walking time to the nearest AED was 1.9 minutes; only 25.4% of rural arrests were within 3 minutes. Among 17 285 resuscitation-attempted cases, bystander AED use occurred in 2.9%. Shorter walking time was a statistically significant predictor of AED use and prehospital return of spontaneous circulation. Nighttime and residential arrests showed markedly reduced AED use irrespective of proximity. Moreover, although home arrests accounted for 70% of cases, bystander defibrillation occurred in <2%.

CONCLUSIONS: Functional accessibility determines both device use and survival outcomes. Policies should prioritize 24/7 external AED availability, integration of dispatcher-assisted public access defibrillation programs, and novel delivery systems, such as drones, to bridge the spatial and temporal gaps in access.

PMID:42017328 | DOI:10.1161/JAHA.125.048080

Phlebology. 2026 Apr 22:2683555261446155. doi: 10.1177/02683555261446155. Online ahead of print.

ABSTRACT

BackgroundEffective management of lower extremity lymphedema requires its recognition as a distinct clinical entity. This study aimed to evaluate the validity and reliability of the Turkish version of the Lymphedema Symptom Intensity and Distress Survey-Lower Limb (LSIDS-L), a tool designed to assess both the severity and distress of symptoms in patients with lower limb lymphedema.AimsTo evaluate the validity and reliability of the Turkish version of the Lymphedema Symptom Intensity and Distress Survey-Lower Limb (LSIDS-L) in patients with lower extremity lymphedema.Study designDiagnostic Accuracy Study.MethodsThe LSIDS-L was translated and culturally adapted into Turkish using the forward-backward translation method. The final version was administered to 155 patients alongside the Lymphoedema Quality of Life Questionnaire-Leg (LYMQOL-Leg). Reliability was assessed using a 7-days test-retest approach. Descriptive statistics were used for demographic data. Construct validity was evaluated using Spearman’s rank correlation coefficient, while internal consistency and test-retest reliability were assessed via Cronbach’s alpha and the intraclass correlation coefficient (ICC), respectively.ResultsThe questionnaire demonstrated excellent test-retest reliability with ICC_1k = 0.9989 and r = 0.9970. Internal consistency was also high, with a Cronbach’s alpha of 0.9180 and a standardized alpha of 0.9145, indicating strong coherence among items.ConclusionThe Turkish version of the LSIDS-L (LSIDS-L-TR) is a valid and reliable instrument for assessing symptom intensity and distress in patients with lower extremity lymphedema. It offers a comprehensive tool for use in both clinical practice and research settings.

PMID:42017324 | DOI:10.1177/02683555261446155

J Am Heart Assoc. 2026 Apr 22:e047923. doi: 10.1161/JAHA.125.047923. Online ahead of print.

ABSTRACT

BACKGROUND: Combining PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors with statins significantly lowers low-density lipoprotein cholesterol and reduces cardiovascular events in patients with coronary heart disease versus statins alone. However, it remains unclear which monotherapy offers greater cardiovascular benefit.

METHODS: This prospective non-randomized real-world observational cohort study enrolled coronary heart disease inpatients from July 2020 to March 2024. Patients received either alirocumab (75 mg/2 weeks) or statins (atorvastatin 20 mg/day or rosuvastatin 10 mg/day). The primary outcome was a composite of cardiovascular death, myocardial infarction, stroke, heart failure hospitalization, or coronary revascularization. Cox proportional hazards models and restricted mean survival time analyses were used.

RESULTS: Among 1165 analyzed patients, 215 received PCSK9 inhibitors and 950 received statins. After 1 month, low-density lipoprotein cholesterol reduction was greater in the PCSK9 inhibitor group (from 2.57 to 0.75 mmol/L) than in the statin group (from 2.29 to 1.40 mmol/L; P<0.001). However, this difference was not significant at 12 months (1.44 versus 1.52 mmol/L; P=0.058). Multivariate Cox regression analysis revealed an adjusted hazard ratio of 0.74 (95% confidence interval, 0.49-1.12; P=0.152) for the primary outcome with statins versus PCSK9 inhibitors. The restricted mean survival time was 26.11 months for the PCSK9 inhibitor group and 26.48 months for the statin group. The results were consistent across key subgroups. No serious adverse events occurred during the follow-up.

CONCLUSIONS: PCSK9 inhibitor monotherapy showed no statistically significant difference from statin monotherapy in long-term lipid-lowering efficacy or cardiovascular risk reduction, suggesting it may be an effective alternative for secondary prevention in coronary heart disease.

PMID:42017316 | DOI:10.1161/JAHA.125.047923