Category: Statistics

JCO Glob Oncol. 2026 Apr;12(4):e2500512. doi: 10.1200/GO-25-00512. Epub 2026 Apr 15.

ABSTRACT

PURPOSE: Early integration of palliative care (PC) for children with cancer is vital to improved patient outcomes. Despite this, access to PC services for children in Asia Pacific (AP) is sparce. We aimed to explore potential barriers to PC provision in childhood cancer care across AP.

METHODS: The Assessing Doctors’ Attitudes on Palliative Treatment survey was revised for cultural context, translated into six languages, and distributed electronically to physicians who care for children with cancer. Descriptive statistics were used to summarize data. Secondary analyses used the Pearson chi-square test or Fisher exact test to examine associations between prior PC training and physician subspecialty with reported barriers. The McNemar test was applied to evaluate differences between actual versus ideal timing of PC consultations. Analysis of variance was conducted to compare mean values for perceived barriers across country income levels.

RESULTS: Six hundred twenty-one physicians from 18 countries participated, with an overall response rate of 27% (621/2,305) and a median country response rate of 30% (range, 11%-85%). Most respondents (n = 366; 59%) believed PC should be consulted at diagnosis, but only 18% (n = 117) stated that this occurred in their clinical setting (P < .001). The most highly ranked barriers to PC provision included limited physician knowledge (n = 511; 82%), lack of national health policy/advocacy (n = 494; 79%), lack of PC-trained clinicians (n = 492; 79%), lack of home-based services (n = 487; 78%), and physician discomfort in discussing PC (n = 483; 78%). Physicians practicing in lower-middle-income countries rated these barriers more significantly.

CONCLUSION: Physicians report a discrepancy between ideal and actual timing of PC integration and identify several barriers to PC provision. Study findings will inform capacity building, education, and advocacy initiatives to improve the timing and quality of PC delivery in the region.

PMID:41985116 | DOI:10.1200/GO-25-00512

JMIR Ment Health. 2026 Apr 15;13:e88700. doi: 10.2196/88700.

ABSTRACT

BACKGROUND: Individuals with serious mental illness increasingly use digital devices and the internet to access health information and services but often face challenges when navigating digital tools, which may limit the benefits they receive from online health resources and digital health care services.

OBJECTIVE: The objective of our study was to assess digital health literacy among individuals with serious mental illness and identify factors influencing this literacy.

METHODS: Participants were recruited, using convenience sampling, from 2 psychiatric clinics, 1 day-care center, and 4 halfway houses in Taipei, Taiwan, between May 2024 and February 2025. Self-reported data were collected using a survey that incorporated the eHealth Literacy Scale, the Attitudes Toward Computer/Internet Questionnaire, and the Mobile Device Proficiency Questionnaire. Generalized linear modeling was applied to identify factors associated with digital health literacy.

RESULTS: Among 255 participants included in the analysis, 83.5% (n=213) reported owning at least 1 digital device. Digital health literacy was significantly lower among individuals who reported greater perceived difficulty in using digital tools (B=-1.533, 95% CI -2.350 to -0.717; P<.001) and higher distrust in online information (B=-0.986, 95% CI -1.916 to -0.056; P=.04). By contrast, greater mobile device proficiency (B=0.144, 95% CI 0.008-0.281; P=.04) and self-efficacy (B=1.777, 95% CI 0.376-3.177; P=.01) were positively associated with digital health literacy.

CONCLUSIONS: Despite widespread device ownership, digital health literacy was varied and generally suboptimal among patients with serious mental illness. Perceived difficulty and distrust emerged as major barriers; proficiency and self-efficacy facilitated higher literacy. These findings highlight the need for mental health professionals to integrate tailored digital skills training, confidence-building strategies, and ongoing support into digital health interventions for individuals with serious mental illnesses.

PMID:41985096 | DOI:10.2196/88700

JMIR Rehabil Assist Technol. 2026 Apr 15;13:e80971. doi: 10.2196/80971.

ABSTRACT

BACKGROUND: Mobile apps and biofeedback using motion analysis have both been used separately to increase compliance with exercise programs. We developed a mobile app, Osteoarthritis-Rehabilitation Assistant (O-RA), that uses motion analysis technology in the mobile app to assist older adults with performing a knee exercise program.

OBJECTIVE: This study aimed to evaluate the effects of the O-RA app on the compliance and correctness of the exercise program by older adults.

METHODS: We conducted an assessor-blind, parallel-design, randomized controlled trial with 40 older adults (aged 60 years or older) who had no symptoms and no diagnosis of knee osteoarthritis. Participants were divided into 2 groups: O-RA app (intervention) group and standard treatment (control) group. Both groups were taught 4 types of exercise programs by a physical therapist for 15 minutes and were instructed to do exercises at home every day for 1 week. The number of exercises, the percentage between observed and prescribed exercises, the correctness of exercises, and overall pain during the program were assessed in both groups.

RESULTS: The control group had significantly higher compliance with the exercise program than the intervention group (t38=3.5044, P=.001). There was no statistically significant difference in the correctness of the exercise program between the intervention and control groups. The difficulty of use and satisfaction were 47 and 59, respectively, out of the full score of 100. The main problems were the instability and the difficulty using the app.

CONCLUSIONS: In older adults without knee osteoarthritis symptoms or diagnosis, the O-RA app was not a facilitator but a barrier to the lower extremity exercise program. An updated version, aiming to increase the stability and make it more user-friendly, should be developed; however, more comprehensive data, including qualitative user feedback and standardized usability metrics, will be needed to effectively guide its design.

PMID:41985075 | DOI:10.2196/80971

Clin Exp Dent Res. 2026 Apr;12(2):e70357. doi: 10.1002/cre2.70357.

ABSTRACT

OBJECTIVES: Hormonal changes during pregnancy can increase susceptibility to plaque-induced gingivitis, and at the same time, dental care visits during pregnancy have been reported to be low. This study evaluated the effect of an oral health education program on knowledge, attitude, and clinical indices of oral health in pregnant women.

METHODS: This nonrandomized controlled intervention study was conducted at Kowsar Hospital, Urmia. Allocation to groups was based on the day of visit (even/odd days). In addition to routine prenatal care, the intervention group received an individual education session of approximately 60 min with a brochure, and the control group received routine care only. Knowledge, attitude, plaque index (PI), gingival index (GI), and decayed, missing, and filled teeth (DMFT) indices were measured at baseline and 3 months later. Statistical analysis was performed in Statistical Package for the Social Sciences.

RESULTS: Of 240 enrolled participants, 200 (100 per group) provided complete follow-up data. Baseline characteristics and oral health indices were comparable between groups. At 3 months, the intervention group demonstrated improved knowledge and attitude, lower PI, and modest improvement in GI. In the control group, knowledge and attitude changed little, GI worsened, and PI remained largely unchanged. DMFT increased in both groups over the 3-month period.

CONCLUSIONS: Short-term, structured oral health education with a brochure can improve knowledge and attitude of pregnant women in the short term and improve plaque and gingivitis.

PMID:41985064 | DOI:10.1002/cre2.70357

Hepatol Commun. 2025 Dec 1;9(12):e0832. doi: 10.1097/HC9.0000000000000832. eCollection 2025 Dec 1.

ABSTRACT

BACKGROUND: The impact of acute-on-chronic liver failure (ACLF), a deadly form of decompensated cirrhosis characterized by the presence of organ failures, has not been well characterized, largely due to the lack of a code for ACLF in the International Classification of Diseases (ICD). We used ICD codes for extrahepatic organ failure to assess the burden of cirrhosis with extrahepatic organ failures (EHOFs) on European health care systems.

METHODS: The authors have searched national healthcare system databases from Germany for the period 2005-2020 and matched the data with that from France, Italy, and Denmark for admissions between 2017 and 2020, specifically for cases with an ICD diagnosis of cirrhosis combined with kidney, brain, respiratory, or circulatory failure.

RESULTS: During the 4-year period, 1,599,680 hospital admissions for cirrhosis, which included 329,093 (20.6%) admissions with at least 1 EHOF, were recorded across the 4 countries. The most frequent failing organs were kidneys (52.9%) and respiration (41.2%). The annual number of admissions for cirrhosis decreased over time (from 414,093 to 375,112), whereas the percentage of admissions with EHOF rose from 19.9% to 21.5%. Overall, the in-hospital mortality rate of patients with a diagnosis of EHOF was high (29.2%), markedly exceeding the mortality of those with a diagnosis of cirrhosis (7.9%). The proportion of estimated total healthcare claims of all hospital admissions of EHOF from cirrhosis was 44.9%.

CONCLUSIONS: This study reveals that the burden of cirrhosis with EHOF was high in the 4 European countries, with a substantial impact on patient mortality. Crucially, these findings underscore the significant economic strain placed on healthcare systems by EHOF in cirrhosis patients. This should motivate all stakeholders to take action aiming at reducing this burden.

PMID:41985063 | DOI:10.1097/HC9.0000000000000832

Brief Bioinform. 2026 Mar 1;27(2):bbag175. doi: 10.1093/bib/bbag175.

ABSTRACT

Advances in single-cell sequencing and Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) technologies have enabled detailed case-control comparisons and experimental perturbations at single-cell resolution. However, uncovering causal relationships in observational genomic data remains challenging due to selection bias and inadequate adjustment for unmeasured confounders, particularly in heterogeneous datasets. To address these challenges, we introduce causarray, a robust causal inference framework for analyzing array-based genomic data at both pseudo-bulk and single-cell levels under unmeasured confounding. causarray integrates a generalized confounder adjustment method to account for unmeasured confounders and employs semiparametric inference with flexible machine learning techniques to ensure robust statistical estimation of treatment effects. Benchmarking results show that causarray robustly separates treatment effects from confounders while preserving biological signals across diverse settings. We also apply causarray to two single-cell genomic studies: (i) an in vivo Perturb-seq study of autism risk genes in developing mouse brains and (ii) a case-control study of Alzheimer’s disease (AD) using three human brain transcriptomic datasets. In these applications, causarray identifies clustered causal effects of multiple autism risk genes and consistent causally affected genes across AD datasets, uncovering biologically relevant pathways directly linked to neuronal development and synaptic functions that are critical for understanding disease pathology.

PMID:41985059 | DOI:10.1093/bib/bbag175

JMIR Diabetes. 2026 Apr 15;11:e85083. doi: 10.2196/85083.

ABSTRACT

BACKGROUND: Patients with type 2 diabetes mellitus (T2D) have a higher risk of cardiovascular disease, including heart failure (HF), leading to health care burden including hospitalization and mortality. Among multiple T2D therapies, there are inadequate head-to-head comparisons of their effects on HF in the real-world patient population.

OBJECTIVE: This study aims to compare the time-to-HF among patients treated with different T2D drugs following metformin.

METHODS: We conducted a retrospective data analysis on electronic health records of 5000 patients with T2D. The inclusion criteria were previous treatment with metformin and initiation of glucagon-like peptide-1 receptor agonists (GLP1 RAs), dipeptidyl peptidase-4 inhibitors (DPP4i), sulfonylureas, or insulin. We grouped patients by the mechanism of their subsequent therapies and focused on 2 pairs of comparisons classified by insulin resistance: sulfonylureas versus insulin (increased resistance) and GLP1 RA versus DPP4i (decreased resistance). The outcomes were 5-year HF status and the HF-free survival time, which was verified manually by examining clinical notes. We applied doubly robust causal estimation and accounted for confounding by adjusting for coded and natural language processing electronic health record features identified through medical knowledge networks.

RESULTS: The study included 939 patients, of whom 204 (21.7%) received insulin, 482 (51.3%) received sulfonylureas, 90 (9.6%) received GLP1 RA, and 163 (17.4%) received DPP4i. Patients in the sulfonylureas group had a significantly higher 5-year HF-free survival compared to the insulin group (survival ratio of insulin/sulfonylureas 0.902, 95% CI 0.840-0.976; P=.01). There was no significant difference between the DPP4i versus GLP1 RA group in 5-year HF-free survival (survival ratio of GLP1 RA/DPP4i was 0.953, 95% CI 0.849-1.067; P=.40). For the occurrence of a HF-related hospitalization within 5 years, there were no significant differences between the sulfonylureas and insulin groups (risk difference 0.057, 95% CI -0.011 to 0.132; P=.11), and between the GLP1 RA and DPP4i groups (risk difference 0.010, 95% CI -0.096 to 0.129).

CONCLUSIONS: We evaluated real-world evidence on 2 head-to-head comparisons of second-line T2D therapies on 5-year HF outcomes. Patients on sulfonylureas were associated with lower 5-year HF risks than those treated with insulin when measured by risk ratio, but no significant difference was detected when measured by the risk difference. Limitations of this study included potentially inadequate adjustment of confounding in the observational study and a limited sample size with validated HF outcomes.

PMID:41985055 | DOI:10.2196/85083

J Sex Med. 2026 Apr 9;23(5):qdag100. doi: 10.1093/jsxmed/qdag100.

ABSTRACT

BACKGROUND: Prostate cancer remains one of the most common cancers in men, and while active surveillance using serial prostate-specific antigen (PSA), imaging, and biopsies is the preferred management for low-risk cases, concerns remain about the impact of biopsy-related sexual dysfunction due to proximity to neurovascular bundles.

AIM: To evaluate the association in biopsy frequency and sexual function in men on active surveillance (AS) for low-grade prostate cancer.

METHODS: We analyzed data from the Miami Active Surveillance Trial (MAST, a prospective, single-arm study of men with Gleason grade ≤2 prostate cancer under AS, managed with annual magnetic resonance imaging-ultrasound fusion-guided transrectal ultrasound (TRUS) biopsies. Sexual and hormonal function was assessed using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire at baseline and 12-, 24-, and 36-month follow-ups. Minimally important differences (MID) were defined as 10-12 points for the sexual domain, and 4-6 points for the hormonal domain. Statistical analysis involved repeated measures analysis of variance (ANOVA) and paired t-tests using distribution of EPIC scores.

OUTCOMES: Annual transrectal biopsies were associated with small, statistically, but not clinically significant declines in sexual function, with no meaningful impact on overall quality of life observed.

RESULTS: Among 200 men enrolled, the median age was 62 years old, 89.5% were white, and 43% were Hispanic. A total of 52 men completed all follow-up biopsies. The mean baseline sexual function score was 43.7 (SD 13.1). Repeated measures ANOVA indicated a statistically significant decline in sexual function over time (P = .0105). Though statistically significant, this decline did not exceed the MID threshold for the sexual domain and therefore not clinically significant. Hormonal scores remained stable and showed no significant difference across time points (P = .5767).

CLINICAL IMPLICATIONS: These findings support annual biopsy usage in AS protocols for clinicians without compromising sexual function.

STRENGTHS & LIMITATIONS: The strengths of this study include rigorous annual biopsy protocols and validated EPIC measures to identify clear clinically significant thresholds. Limitations include sample attrition over time due to longer follow-up and single-institution design.

CONCLUSION: Increased frequency of TRUS biopsies was associated with a statistically, but not clinically significant decline in sexual function, indicating that annual TRUS fusion biopsies are not likely to significantly impact sexual health and may be confidently recommended for patients on active surveillance.

PMID:41985042 | DOI:10.1093/jsxmed/qdag100

A A Pract. 2026 Apr 15;20(4):e02183. doi: 10.1213/XAA.0000000000002183. eCollection 2026 Apr 1.

ABSTRACT

BACKGROUND: Preoperative chart review is time-consuming and prone to errors, particularly for cardiopulmonary conditions that impact anesthetic planning. We developed a guideline-aligned “clinical insight bot” that mines free-text documentation to surface perioperative cardiovascular risk signals relevant to the 2024 Mult Society perioperative guideline for noncardiac surgery.

METHODS: We analyzed 1000 de-identified medical cases from the PhysioNet MIMIC database. Medical terminology was extracted using regex-based NLP and categorized into 13 clinical specialties. Text features were encoded using TF-IDF vectorization and 1536-dimensional semantic embeddings stored in a PostgreSQL vector database (pgvector). Four machine learning models-Logistic Regression, Random Forest, Support Vector Machine (SVM), and Naive Bayes-were trained with stratified fivefold cross-validation to classify cases as “cardiopulmonary-only” versus “mixed/other.” Performance was evaluated using accuracy, precision, recall, and F1 score, with statistical comparison via McNemar’s test and bootstrap confidence intervals.

RESULTS: In a held-out test set of 200 notes (28 positive; 172 negatives; ~14% prevalence), a linear support vector machine achieved the best overall balance (F1 ≈ 0.71), with high precision (positive predictive value 0.94) and very low false positive rate (FPR) (1/172 ≈ 0.6%). False negatives were the dominant residual error class. The pipeline processed documents near-instantaneously and, when scaled to 1000 notes, replaced on the order of tens of clinician review hours (≈100× efficiency gain) while maintaining performance across common preoperative document types.

CONCLUSIONS: A lightweight, guideline-aligned insight bot can transform unstructured preoperative notes into concise, stepwise prompts that flag cardiovascular risk signals before the day of surgery. High precision with a very low FPR supports safe integration with anesthesiology workflows by minimizing paging noise, whereas time savings create operational and financial value. Future work should emphasize multicenter validation, structured data fusion (including labs, imaging, and vitals) to improve sensitivity, and prospective evaluation of downstream clinical and operational outcomes.

PMID:41985030 | DOI:10.1213/XAA.0000000000002183

Adv Sci (Weinh). 2026 Apr 15:e22070. doi: 10.1002/advs.202522070. Online ahead of print.

ABSTRACT

Ecosystem services (ES) link ecosystems and human societies, yet approaches to ecosystem service flow (ESF) are constrained by ambiguous definitions and limited process-oriented and scale-sensitive classifications. Here, we developed a “supply-demand-flow” framework distinguishing potential and actual supply and demand, and classifying ESF into in situ, interior, and exterior flows. Integrating multi-source datasets, biophysical models (InVEST, RUSLE, i-Tree), and socio-economic accounting based on population-consumption dynamics and sectoral statistics, we mapped nine ES across China from 2000 to 2020 at 1 km resolution. Results revealed pronounced ES supply and demand spatio-temporal heterogeneity. While the national ESF pattern remained stable, most services showed increasing exterior reliance, whereas water yield and tourism recreation became more locally sustained. Using flow balance and demand fulfillment as policy-proximal indicators, five management zones were delineated: local-sustained counties dominated southern China (∼30%); local-pressured types occurred in the Northeast, Qinghai-Tibet, and southwestern areas (∼15%); external-pressured types occurred in arid northwestern regions (1%-3%); southeastern coasts shifted toward external-sustained types (∼30%); and dynamic-transitional counties (∼20%) were scattered nationwide. By decomposing supply-demand relations into supply realization, spatial reallocation, and demand fulfillment, our framework helps align ecological functions with management priorities and offers insights for reconciling development and conservation in comparable socio-ecological contexts.

PMID:41984530 | DOI:10.1002/advs.202522070