Category: Statistics

Knee. 2026 Jun 18;62:104548. doi: 10.1016/j.knee.2026.104548. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to biomechanically evaluate and compare five different fixation techniques for isolated Letenneur Type I lateral Hoffa fractures using a fresh-frozen cadaveric model under both static and dynamic axial loading conditions.

METHODS: Twenty-five fresh-frozen distal femurs were homogeneously assigned to five groups based on fixation method: (A) two postero-anterior (PA) screws (6.5 mm), (B) two antero-posterior (AP) screws (6.5 mm), (C) two PA screws combined with a posterior 3.5-mm tubular plate, (D) one PA screw combined with a lateral 3.5-mm locking compression plate (LCP), and (E) two AP screws combined with a lateral horizontal 3.5-mm tubular plate. Specimens underwent dynamic loading (2500 cycles, five stages, 2 Hz) followed by static axial loading using a servo-hydraulic testing machine. The parameters evaluated included load at 3-mm displacement, ultimate load, stiffness, and photogrammetric displacement.

RESULTS: Plate-augmented constructs demonstrated significantly superior biomechanical stability. Ultimate load was highest in Group C (1761.8 ± 299.5 N), followed by Group D (1564.4 ± 162.1 N) and Group E (1571.2 ± 420.8 N), all significantly greater than Groups A (902.4 ± 522.8 N) and B (1088.2 ± 323.1 N) (P < 0.01). Photogrammetric displacement was significantly lower in plate-augmented groups (Group C: 0.32 ± 0.24 mm; Group E: 0.59 ± 0.58 mm) (P < 0.05). No statistically significant differences were observed between screw-only constructs.

CONCLUSIONS: Plate-augmented fixation provides superior biomechanical stability for isolated Letenneur Type I lateral Hoffa fractures. Lateral plating achieves comparable stability to posterior plating while avoiding the technical challenges. The comparable performance of screw configurations suggests that screw trajectory can be flexibly selected based on fracture morphology. These findings offer guidance for surgical planning and implant selection in the management of these complex fractures.

PMID:42314239 | DOI:10.1016/j.knee.2026.104548

Asian Pac Isl Nurs J. 2026 Jun 18;10:e85340. doi: 10.2196/85340.

ABSTRACT

BACKGROUND: Breast cancer (BC) symptom awareness through screening measures, such as breast self-examination practice (BSEP), is promoted in low-resource countries. The Muslim culture has a unique impact on family support for women’s health care decisions, especially from the mother. Given the proven effect of educational intervention on breast health through interactive sessions and mobile health, implementation according to Muslim cultural values through family support, especially from the mother, was lacking, and this study was planned.

OBJECTIVE: This study aimed to determine the effects of a culture-based breast health education program (CBBHEP) on BSEP in high-risk women.

METHODS: A single-site randomized controlled trial was conducted in a hospital on 72 high-risk women, aged 20-50 years, from August 19 to November 29, 2024. The trial was registered prospectively (ID: ISRCTN-39194106). The participants were matched in pairs by age and educational level, and randomly assigned to experimental and control groups. The intervention program was based on social cognitive theory and the cultural identity concept of the PEN-3 model. The program consisted of face-to-face interactive sessions and a health app called a Women’s Health app for promoting BSEP. The experimental group received CBBHEP, whereas the control group received the usual care. BSEP was measured at baseline and 12 weeks using a translated, valid, and reliable Toronto BSE frequency and proficiency of practice scale. Data analysis was performed using 1-way analysis of covariance and paired sample 1-tailedt test.

RESULTS: The participants in the experimental group who received CBBHEP for 12 weeks increased their BSEP much better than those in the control group (F1, 69=58.908, η2=0.46; P<.001). The results also revealed a statistically significant effect of a higher BSEP in the experimental group (t35=7.21, Cohen d=0.88; P<.001).

CONCLUSIONS: The findings suggest that health care practitioners can apply this program to increase BSEP among high-risk women through their family support, especially from mothers.

PMID:42314192 | DOI:10.2196/85340

J Occup Environ Hyg. 2026 Jun 18:1-13. doi: 10.1080/15459624.2026.2664464. Online ahead of print.

ABSTRACT

Exposure monitoring data available to industrial hygienists will eventually surpass the ability of a practitioner to effectively interpret without a consolidating computational approach. For large sets of time-series exposure data, the most important question that can be answered to determine if further exposure evaluation is required may be formulated as: Does this exposure data contain any period of time during which the identified occupational exposure limit value could be exceeded? Determining the answer to this question may be computationally intensive using current exposure decision methodology, better suited for small data sets consisting of single time-weighted average exposures. The authors instead proposed an algorithmic method for evaluating large sets of time-series exposure data without clearly defined exposure start and stop times, while also incorporating recommended data cleaning methods and an evaluation of statistical uncertainty. The outcome of this analysis was a binary “thumbs up,” indicating the time-series exposure data did not contain any time period that may have exceeded the limit value when considering confidence intervals, or “thumbs down,” indicating the opposite. Finally, the authors demonstrated the algorithmic heuristic using a proof-of-concept available to the public at no cost at https://athena-heuristic.streamlit.app/.

PMID:42314188 | DOI:10.1080/15459624.2026.2664464

Obstet Gynecol. 2026 Jun 18. doi: 10.1097/AOG.0000000000006354. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess adverse pregnancy and birth outcomes after bivalent prefusion F subunit-based respiratory syncytial virus vaccine (RSVpreF) vaccination during the first season of availability.

METHODS: This was a target trial emulation study including eight health systems across eight states (California, Oregon, Washington, Colorado, Maryland, Virginia, Minnesota, and Wisconsin) and Washington, DC, in the Vaccine Safety Datalink (VSD). We included pregnant patients aged 16-49 years who had enrolled at a VSD site between September 22, 2023, and February 29, 2024. Exposure was defined as receipt of RSVpreF vaccination between 32 and less than 37 weeks of gestation. Outcomes included preterm birth (PTB), stillbirth, small-for-gestational-age (SGA) birth weight, and hypertensive disorders of pregnancy (HDP) assessed with electronic health record data. Stillbirth cases were confirmed through chart review. Pregnant patients exposed to RSVpreF vaccines were matched 1:1 to unexposed pregnant patients at the gestational week of vaccination by propensity to be vaccinated and VSD site. Unexposed pregnant patients were assigned an index date equivalent to the gestational day of vaccination for their vaccinated match. If the unvaccinated match was subsequently vaccinated, the pair was censored. We report adverse event risks and adjusted risk ratios (aRRs) with corresponding 95% CIs adjusted for nulliparity using a log binomial model with robust variance.

RESULTS: We identified 13,966 pregnant patients who received the RSVpreF vaccine. A higher percentage of nulliparous patients were in the vaccinated group (46.4%) compared with the unvaccinated group (38.7%). Comparing RSVpreF vaccinated pregnant patients and their unvaccinated matches, rates of PTB (4.0% vs 4.5%, respectively; aRR 0.90, 95% CI, 0.80-1.00), stillbirth (0.79/1,000 and 0.72/1,000; aRR 0.99, 95% CI, 0.41-2.36), and SGA birth weight (6.8% and 6.5%; aRR 1.02, 95% CI, 0.92-1.12) did not significantly differ. The rate of any HDP among RSVpreF vaccinated patients was 17.3% vs 15.0% among their unvaccinated matches (aRR 1.13, 95% CI, 1.07-1.19).

CONCLUSION: Initial prenatal RSVpreF safety surveillance shows a largely favorable safety profile. Although we identified a small but statistically significant increased risk for HDP after RSVpreF vaccination, there was no increased risk for PTB, SGA birth weight, or stillbirth.

PMID:42314184 | DOI:10.1097/AOG.0000000000006354

J Urol. 2026 Jun 18:101097JU0000000000005151. doi: 10.1097/JU.0000000000005151. Online ahead of print.

NO ABSTRACT

PMID:42314173 | DOI:10.1097/JU.0000000000005151

Brain. 2026 Jun 18:awag213. doi: 10.1093/brain/awag213. Online ahead of print.

ABSTRACT

Despite improved survival in recent years, long-term outcomes in patients surviving progressive multifocal leukoencephalopathy beyond the first year remain poorly defined. This international multicenter retrospective study aimed to characterize the three-year prognosis of patients with progressive multifocal leukoencephalopathy who had survived at least one year, identify factors associated with favorable outcomes and late mortality, and determine recurrence rate. Data were collected through standardized questionnaires across forty-one centers in twelve countries. Patients were eligible if they met the 2013 diagnostic criteria for definite progressive multifocal leukoencephalopathy of the American Academy of Neurology, survived at least one year after diagnosis, and had documented follow-up three years after diagnosis. Demographic, clinical, virological, and radiological data were retrieved at diagnosis, one year, and three years. Functional status was assessed using the modified Rankin Scale, with scores of 0-2 defining a favorable outcome. Generalized linear mixed models identified independent predictors of three-year functional status and late mortality. Among 1877 screened cases, 245 patients met inclusion criteria. The most common underlying causes of immunosuppression were HIV infection (48%), autoimmune/inflammatory diseases (26%), and hematological malignancies (18%). At three years, 220 patients (89.8% of the cohort) were alive and 188 (85.5% of survivors) had neurological sequelae, most frequently motor or cognitive impairment. Overall, 112/245 (45.7%) achieved a favorable functional outcome. HIV-associated progressive multifocal leukoencephalopathy (OR 2.36, 95% CI 1.05-5.28) was associated with a favourable outcome, whereas higher modified Rankin Scale score at diagnosis (OR 0.48, 95% CI 0.35-0.66) and higher number of affected brain regions on baseline MRI (OR 0.78, 95% CI 0.64-0.95) were independently associated with poorer functional outcome. Among variables collected one year after diagnosis, good functional status at that time was significantly associated with long-term favorable outcome (OR 0.01, 95% CI <0.01-0.03). Twenty-five patients (10.2%) died after the first year, with mortality associated with higher lesion burden at diagnosis and primary immunodeficiency as underlying disease. Even beyond the first year, progressive multifocal leukoencephalopathy remained the leading cause of death (11/25). Recurrence occurred in seven patients (2.9%) and was almost always fatal (6/7). This study provides a comprehensive evaluation of long-term outcomes among survivors of progressive multifocal leukoencephalopathy. These findings present a nuanced picture: while most remain neurologically impaired, nearly half achieve functional independence at three years. The results emphasize the prognostic relevance of the initial clinical and radiological burden and early functional trajectory and highlight the need for research into mechanisms driving disease recurrence.

PMID:42314166 | DOI:10.1093/brain/awag213

JMIR Res Protoc. 2026 Jun 18;15:e92511. doi: 10.2196/92511.

ABSTRACT

BACKGROUND: Workplace violence against health care professionals has increased worldwide, leading to negative psychological, professional, and organizational outcomes. Despite existing prevention and reporting programs, underreporting and lack of accessible, confidential support persist. Digital health tools, including chatbots, may offer scalable support, guidance, and follow-up for affected professionals.

OBJECTIVE: This study aims to design, develop, and validate a chatbot (Sanidad Segura) to assist health care professionals who experience workplace aggression and evaluate its usability, readability, and exploratory indicators of perceived usefulness and support in a pilot study.

METHODS: This study will follow a mixed methods design conducted in two main phases: (1) design, development, and content validation of the chatbot based on literature review, institutional protocols, and expert consensus; and (2) pilot-testing, including usability and readability assessment using standardized instruments, as well as feasibility and acceptability evaluation among health care professionals working in emergency and critical care settings in Almería (Spain). The study is aligned with the Medical Research Council framework for complex interventions, incorporating development and feasibility stages. Quantitative data will be collected using the System Usability Scale and Inflesz readability scale. Qualitative data will be collected through semistructured interviews and analyzed using thematic analysis to explore user experience and identify barriers to and facilitators of use.

RESULTS: The study has been funded for a 2-year period starting on December 18, 2024. Quantitative outcomes will include usability scores (System Usability Scale), readability scores (Inflesz), and participants’ sociodemographic characteristics. Qualitative findings will identify themes related to usability, user experience, and suggestions for improvement. Integration of quantitative and qualitative findings will be conducted through triangulation to provide a comprehensive understanding of the usability, acceptability, and readability of the chatbot.

CONCLUSIONS: This study addresses the increasing incidence of workplace violence against health care professionals through the development of a new chatbot (Sanidad Segura). This intervention seeks to facilitate the identification, support, and follow-up of affected individuals while minimizing the adverse effects of such events on their physical and psychological well-being, social interaction, and professional performance. Sanidad Segura will enable confidential case reporting and provide access to tailored medical, psychological, and legal resources, as well as information about institutional support services. This project represents a crucial step toward implementing an integrated digital framework for the detection, management, and prevention of workplace violence in health care settings.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/92511.

PMID:42314161 | DOI:10.2196/92511

Stomatologiia (Mosk). 2026;105(3):54-59. doi: 10.17116/stomat202610503154.

ABSTRACT

OBJECTIVE: Obtaining data from dentists at medical dental organizations in various regions of the Russian Federation on issues related to professional oral hygiene.

MATERIALS AND METHODS: A survey was conducted among 600 dentists at dental organizations of various types in five regions of the Russian Federation (Moscow, Omsk, Ryazan, Samara, and Tambov). The questionnaire included general questions, questions on how to organize patient interactions during professional oral hygiene, and questions specific to performing professional oral hygiene. Over 50% of the respondents were general practitioners and dentists, while the remaining 37.4% specialized in pediatric dentistry, surgical dentistry, and orthopedic dentistry.

RESULTS: Over 69% of specialists reported a high level of availability of visual aids for demonstrating oral hygiene rules at their workplaces. Forty percent of specialists in Moscow are fully equipped with everything necessary for oral hygiene, exceeding the results obtained in a survey of dentists in other regions. A significant number of patients with signs of gingivitis and periodontitis remain, with over 72.7% of respondents indicating that they perform oral hygiene specifically for this category of patients. The most common strategies for removing mineralized plaque by dentists in dental facilities across the Russian Federation include ultrasonic scalers, Air-Flow technology, and circular brushes with pastes of varying abrasiveness. The Vector system is more accessible to dentists in larger cities. Perio tips, glycine/erythritol powders, and hand curettes are used by an average of 8.5% of specialists.

CONCLUSION: The primary approach to improving and maintaining oral hygiene will likely remain individualized recommendations from a dentist tailored to the patient’s needs, as noted by 32.8% of respondents.

PMID:42314130 | DOI:10.17116/stomat202610503154

Stomatologiia (Mosk). 2026;105(3):22-29. doi: 10.17116/stomat202610503122.

ABSTRACT

OBJECTIVE: Increasing the effectiveness of dental implantation after subantral augmentation through postoperative assessment of bone tissue and mucous membrane parameters of the maxillary sinus, taking into account the response to various bone substitutes.

MATERIALS AND METHODS: The study included 62 patients (25-65 years old) with alveolar process atrophy of the maxilla, divided into two groups depending on the stage and method of treatment: control (n=48) – two-stage sinus lifting with mineralized allogeneic spongy powder and bioresorbable membrane “Lioplast”, implantation after 6 months; main (n=76) – one-stage augmentation with allogeneic bone rings “Maxgraft Bonering”, filling with platelet-rich plasma (OPP gel, PRP gel – platelet-rich plasma-gel) and a bioresorbable membrane. The assessment was carried out using cone beam computed tomography (CBCT): thickness of the mucous membrane of the maxillary sinus (SM MMP), height of the bone tissue of the maxillary sinus (CT MMP); Implant stability was determined using the dental implant stability coefficient (DISC) using resonance frequency analysis (Osstell ISQ). Measurements were taken immediately after surgery and after 12, 24, and 36 months.

RESULTS: In the study group, by 36 months, a more stable maxillary sinus thickness was observed (2.83±0.14 mm in the study group and 4.84±0.72 mm in the control group, p<0.01), along with a higher maxillary sinus height (10.83±0.43 mm in the study group and 9.23±0.46 mm in the control group, p<0.05) and DIC (80.44±0.27 units in the study group and 78.51±0.62 units in the control group, p<0.05). Statistically significant time and between-group differences (p<0.001) confirm progressive osseointegration and reduced postoperative swelling without complications.

CONCLUSION: One-stage subantral augmentation with allogeneic bone rings and PRP is superior to the two-stage method in terms of peri-implant tissue stability, minimizing the risk of Schneiderian membrane perforation and mucosal hypertrophy. Preoperative CBCT analysis and the use of bioresorbable materials are recommended to optimize dental implant placement.

PMID:42314126 | DOI:10.17116/stomat202610503122

J Med Internet Res. 2026 Jun 18;28:e86249. doi: 10.2196/86249.

ABSTRACT

BACKGROUND: Case definitions are essential for effectively communicating public health threats. However, the absence of a standardized, machine-readable format poses significant challenges to interoperability, epidemiological research, data sharing, and the application of computational methods, including artificial intelligence. These barriers complicate collaboration across regions and organizations and hinder technological progress in public health.

OBJECTIVE: This study aims to propose and release the first open, machine-readable format for representing case and syndrome definitions, together with tools and resources that enable their standardized and scalable use.

METHODS: We developed the Open Syndrome Definition, a structured, machine-readable schema for representing case and syndrome definitions. We compiled official public health case definitions from multiple institutions and converted them into standardized, machine-readable representations using open-source tools. These tools, available through GitHub under the Massachusetts Institute of Technology license, automate the translation of narrative definitions into structured data. We also created a platform for browsing, analyzing, and contributing new definitions on our initiative website.

RESULTS: The Open Syndrome Definition format enabled consistent, automated representation of case definitions across different diseases and jurisdictions. The conversion tools achieved high semantic fidelity, as assessed by qualitative expert review, between narrative and structured representations, supporting human verification and automated analysis. The dataset and accompanying tools demonstrated structural and semantic interoperability by standardizing definitions from various health systems into a unified format and integrating existing medical ontologies through JSON for Linked Data. To further illustrate practical applicability and downstream usage, we introduced a data filtering prototype that allows users to upload their own datasets and verify the results against the standardized definitions.

CONCLUSIONS: The Open Syndrome Definition establishes a foundation for consistent and machine-readable public health definitions, facilitating reproducible research and interoperability at scale. By enabling systematic data exchange and artificial intelligence-driven analysis, it strengthens public health preparedness and supports more rapid, coordinated responses to emerging health threats.

PMID:42314117 | DOI:10.2196/86249