Category: Statistics

Am J Trop Med Hyg. 2025 Dec 4;114(2):338-347. doi: 10.4269/ajtmh.24-0837. Print 2026 Feb 4.

ABSTRACT

The alarming growth of dengue worldwide, as well as its social and economic impact, has necessitated effective responses for its control. Brazil, the second country to use Dengvaxia® (Sanofi Pasteur, Paris, France) after the Philippines, has offered the vaccine to ∼500,000 residents in 30 municipalities, with ∼300,000 being vaccinated. In this population-based cohort study, the vaccine’s effectiveness (VE) is reported after a 6-year follow-up for a vaccination campaign. The primary outcome was probable dengue case (PDC). Laboratory-confirmed dengue, serotype, warning signs, and hospitalization were considered secondary endpoints. Approximately 60% of participants received at least one vaccine dose. A total of 50,658 PDCs were identified, of which 15,131 were laboratory-confirmed dengue cases. Overall, the VE was 34% (95% CI: 33% to 35%) for PDCs and 20% (95% CI: 17% to 23%) for laboratory-confirmed cases. Greater VE was observed in older individuals. Vaccination was effective in reducing dengue virus (DENV)-1 and DENV-4 cases but not DENV-2 cases. No DENV-3 cases were registered. Among the 1,129 hospitalizations, 619 (54.8%) occurred within the vaccinated population, including 16 severe cases, whereas 510 (45.2%) hospitalizations occurred within the non-vaccinated population, with 18 severe cases. The VE for PDC hospitalizations was 16.5% (95% CI: 5.5% to 26.3%). Five and nine dengue-related deaths occurred within the vaccinated and non-vaccinated populations, respectively. The low incidence of severe cases and warning signs compromised accuracy. Vaccination with at least one dose was associated with approximately a one-third reduction in PDC incidence and a significant reduction in DENV-1 and DENV-4 cases. Despite the VE falling below 50%, vaccination may be justifiable in regions with high disease burden.

PMID:41662753 | DOI:10.4269/ajtmh.24-0837

Am J Trop Med Hyg. 2025 Dec 2;114(2):216-223. doi: 10.4269/ajtmh.25-0440. Print 2026 Feb 4.

ABSTRACT

Antimicrobial resistance poses a growing threat to pediatric care, yet data on its clinical and economic burden in low-resource settings remain limited. The impact of antibiotic-resistant infections on mortality, hospital stay, and treatment costs was assessed among children admitted to a national referral hospital in Kenya in the present study. A retrospective review of medical records for pediatric patients (0-12 years) hospitalized with bacterial infections between January 2017 and December 2021 was conducted. Diagnoses included gastroenteritis, pneumonia, sepsis, urinary tract infections, meningitis, and others. Data on treatment, laboratory testing, outcomes, hospital stays, and costs were abstracted. Statistical analyses included Kaplan-Meier survival curves, Cox regression, and mixed-effects negative binomial and generalized linear models. Among 1,608 patients, 63% were infants, and 38% were referrals. Gastroenteritis (46%) and pneumonia (28%) were the most common diagnoses. Antibiotic-resistant infections occurred in 27% of participants and were associated with higher mortality (26% versus 9% in susceptible participants) and an attributable risk of 17%; the population attributable fraction was 65%. After adjustment, resistance was associated with increased mortality (HR 1.44), longer hospital stays (60% increase), and higher treatment costs (33% increase). Antimicrobial resistance significantly increases mortality, hospital stays, and healthcare costs in pediatric patients. Strengthening diagnostics, antimicrobial stewardship, and policy interventions is critical to address this threat.

PMID:41662743 | DOI:10.4269/ajtmh.25-0440

JMIR Hum Factors. 2026 Feb 9;13:e54431. doi: 10.2196/54431.

ABSTRACT

BACKGROUND: Over 1 million Dutch people have diabetes, of whom 90% have type 2 diabetes. Studies show that lifestyle plays an important role in the course of type 2 diabetes. MiGuide (MiGuide Ltd) is an online platform that helps people adopt and sustain lifestyle changes. The platform is integrated into existing diabetes care within primary care. Previous research has shown that implementing new (eHealth) interventions is challenging and may reduce effectiveness. Mapping out the barriers and success factors in the implementation process is essential so that eHealth interventions such as MiGuide can be used effectively in regular health care.

OBJECTIVE: This study aimed to evaluate the implementation of MiGuide within Dutch primary care.

METHODS: A qualitative study design was used, supplemented by quantitative data from patients. Five general practices participated. Three focus groups (FGs; at baseline, after 6 months, and after 12 months) were conducted with 3 general practitioners, 3 FGs with 8 specialized practice nurses (divided into 2 separate groups with 4 participants per group), 2 FGs (at 6 months and after 12 months) with 5 patients, and 2 FGs (at baseline and after 12 months) with 4 stakeholders from the management of the care group. The implementation process was discussed with health care professionals and management, and usage and user-friendliness were discussed with patients. The framework method was used to analyze the data. The following quantitative data were collected: patient characteristics, user data, and questionnaires at baseline and 6 months, assessing quality of life, usability, and diabetes self-care. The quantitative data were examined using exploratory analyses.

RESULTS: Four themes were found in the qualitative data: “innovation,” “capability, motivation, and opportunity,” “processes,” and “setting.” Different factors within these themes played an essential role throughout the implementation process, such as facilities, technical difficulties, motivation, COVID-19, and the work processes. Areas for improvement were also identified. The supplemented quantitative data showed that usability scored below average at 6 months (mean 53.8; SD 9.3; n=8). Participants had a mean score of 0.84 (SD 0.13) on the EuroQoL-5 dimension and 81.9 (SD 13.4) on the EuroQoL visual analogue scale at baseline. Moreover, the average number of days someone exercised was 4.2 (SD 1.7), and the number of days someone ate a generally healthy diet was 5.1 (SD 1.3). Insufficient data on quality of life and diabetes self-care were collected at 6 months and therefore not presented in this study.

CONCLUSIONS: Implementation is a complex process with multiple barriers and facilitators. It is essential to explore the use of context-specific strategies that are aligned with the implementation process phase. Further research is needed to evaluate the next version of the MiGuide platform, which is being implemented in another setting with lifestyle coaches.

PMID:41662702 | DOI:10.2196/54431

JMIR Hum Factors. 2026 Feb 9;13:e78483. doi: 10.2196/78483.

ABSTRACT

BACKGROUND: Patient autonomy through informed consent is a foundational ethical principle for health care practitioners. Online consent processes risk producing “consent in name only,” using manipulative or confusing user interfaces to extract consent artificially. This presents a significant danger for safe and ethical remote consultations for primary care providers, which often extract significant amounts of sensitive personal data.

OBJECTIVE: This study aims to examine the quality of consent obtained through both currently used and novel consent acquisition interfaces for remote e-consultations between a patient and a primary care provider.

METHODS: A total of 55 adult participants in the United Kingdom completed an interaction with a mock-up e-consultation system’s consent interface for data processing, with 54 completing the full study protocol. The participants were then asked questions regarding what they had provided consent for and the usability of the interface. These responses led to the calculation of an industry-standard System Usability Scale (SUS) score and a novel Quality of Informed Consent Collected Digitally (QuICCDig) score.

RESULTS: Users perceiving interfaces to be more usable (with a greater SUS score) were statistically significantly (n=54; P=.004) correlated with an increase in the quality of consent collected from those users (with a higher QuICCDig score). Nonetheless, both existing and novel user interfaces for collecting e-consultation consent were rated poorly, achieving a maximum SUS letter grade of “F.” In total, 45% (25/55) of all the participants reported not recalling making a privacy-related decision at all during their consultation, and 87% (48/55) did not recall being offered any alternatives to e-consultation.

CONCLUSIONS: The findings demonstrate that current methods for collecting consent in telemedical applications may not be fit for purpose and potentially fail to collect valid informed consent. However, increased usability scores from users do appear to drive improvements in the quality of consent collected. Therefore, decision-makers should place importance on high-quality interface design when building or procuring these systems. We have also provided the QuICCDig score for further use.

PMID:41662699 | DOI:10.2196/78483

JMIR AI. 2026 Jan 30. doi: 10.2196/76928. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) models are increasingly being used in medical education. Although models like ChatGPT have previously demonstrated strong performance on USMLE-style questions, newer AI tools with enhanced capabilities are now available, necessitating comparative evaluations of their accuracy and reliability across different medical domains and question formats.

OBJECTIVE: To evaluate and compare the performance of five publicly available AI models: Grok, ChatGPT-4, Copilot, Gemini, and DeepSeek, on the USMLE Step 1 Free 120-question set, checking their accuracy and consistency across question types and medical subjects.

METHODS: This cross-sectional observational study was conducted between February 10 and March 5, 2025. Each of the 119 USMLE-style questions (excluding one audio-based item) was presented to each AI model using a standardized prompt cycle. Models answered each question three times to assess confidence and consistency. Questions were categorized as text-based or image-based, and as case-based or information-based. Statistical analysis was done using Chi-square and Fisher’s exact tests, with Bonferroni adjustment for pairwise comparisons.

RESULTS: Grok got the highest score (91.6%), followed by Copilot (84.9%), Gemini (84.0%), ChatGPT-4 (79.8%), and DeepSeek (72.3%). DeepSeek’s lower grade was due to an inability to process visual media, resulting in 0% accuracy on image-based items. When limited to text-only questions (n = 96), DeepSeek’s accuracy increased to 89.6%, matching Copilot. Grok showed the highest accuracy on image-based (91.3%) and case-based questions (89.7%), with statistically significant differences observed between Grok and DeepSeek on case-based items (p = .011). The models performed best in Biostatistics & Epidemiology (96.7%) and worst in Musculoskeletal, Skin, & Connective Tissue (62.9%). Grok maintained 100% consistency in responses, while Copilot demonstrated the most self-correction (94.1% consistency), improving its accuracy to 89.9% on the third attempt.

CONCLUSIONS: AI models showed varying strengths across domains, with Grok demonstrating the highest accuracy and consistency in this dataset, particularly for image-based and reasoning-heavy questions. Although ChatGPT-4 remains widely used, newer models like Grok and Copilot also performed competitively. Continuous evaluation is essential as AI tools rapidly evolve.

PMID:41662695 | DOI:10.2196/76928

Ann Plast Surg. 2026 Feb 9. doi: 10.1097/SAP.0000000000004663. Online ahead of print.

ABSTRACT

BACKGROUND: Free tissue transfer (FTT) can be used to achieve functional limb salvage in patients undergoing transmetatarsal amputation (TMA). However, the added bulk of the FTT can limit footwear options and hinder ambulation. Dysfunctional gait mechanics may lead to uneven pressure distribution and an increased risk of ulceration. In this proof-of-concept study, wearable sensor data were utilized to compare gait patterns between TMA patients closed with free tissue transfer (FTT) versus those closed with native plantar flaps to assess the biomechanical impact of FTT closure in patients undergoing TMA.

METHODS: Nineteen patients who underwent TMA (n = 14 [73.7% with native plantar flap] and n = 5 [26.3% with FTT]) completed a 120-second gait test with wearable sensors. Gait parameters included cadence (steps per minute), speed (meters per second), stride length (meters), stride duration (seconds), single- and double-limb support (%), elevation at midswing (centimeters), and root mean square (RMS) sway (centimeters), a marker of postural instability. Demographics, comorbidities, and operative details were collected. Groups were compared using univariate and multivariate analyses.

RESULTS: There were no significant differences observed between cohorts with respect to gait speed (0.85 vs 0.85 m/s, P = 0.997), cadence (97.8 vs 98.5 steps/min, P = 0.883), stride duration (P = 0.797), or elevation at midswing (1.64 vs 2.73 cm, P = 0.131). RMS sway was statistically significantly higher in the FTT group (0.35 vs 0.20 cm, P = 0.041), suggesting greater postural instability. On multivariate analysis, flap type was not independently associated with RMS sway (P = 0.839), although higher BMI trended toward significance (P = 0.116). The FTT group had significantly higher BMI (35.5 vs 28.1 kg/m2, P = 0.018) and greater prevalence of peripheral vascular disease (PVD) (80.0% vs 21.4%, P = 0.038).

CONCLUSION: Most spatiotemporal gait parameters were similar between TMA patients reconstructed with FTT and those with a native plantar flap. Although FTT patients had significantly higher RMS sway on univariate analysis, this was not independently associated with flap type after adjusting for confounders. This proof-of-concept analysis suggests that FTT, despite its bulk, may not significantly impair postamputation ambulation and remains a valuable limb salvage option when native plantar flap coverage may not be feasible.

PMID:41662694 | DOI:10.1097/SAP.0000000000004663

Ann Plast Surg. 2026 Feb 9. doi: 10.1097/SAP.0000000000004645. Online ahead of print.

ABSTRACT

BACKGROUND: Social media influences adolescent self-image and confidence, yet its impact on psychosocial outcomes in adolescents with cleft lip and/or palate remains poorly defined. This population may be particularly vulnerable given the importance of craniofacial features to self-perception during adolescence. Negative self-perceptions have been linked to psychosocial distress and interest in revisional surgery, whereas social media may also provide peer support and cleft-related information. This study examined social media use patterns and their association with psychosocial functioning in adolescents with cleft lip and/or palate.

METHODS: A cross-sectional online survey adapted from the CLEFT-Q and Pediatric Quality of Life Inventory (PedsQL) was distributed via REDCap to adolescents aged 10-18 years with cleft lip and/or palate. A parallel survey assessed parental perceptions of their child’s psychosocial functioning. Recruitment occurred at the Lancaster Cleft Palate Clinic between 2023 and 2025. The approximately 10-minute survey assessed demographics, social media use, and psychosocial outcomes across well-being, social functioning, school functioning, and self-perception domains using 5-point Likert scales.

RESULTS: Thirty-one adolescents completed the teen survey (mean [SD] age, 15.2 [2.1] years). Daily social media use was reported as <1 hour by 5/31 (16.1%), 1-3 hours by 14/31 (45.2%), 3-5 hours by 9/31 (29.0%), and ≥5 hours by 3/31 (9.7%). The most commonly used platforms were YouTube 24/31 (77.4%), TikTok 21/31 (67.7%), Snapchat 21/31 (67.7%), and Instagram 16/31 (51.6%). Palate surgery was reported by 29/31 (93.5%), and 17/31 (54.8%) had undergone combined lip, palate, and nasal surgery. Adolescents reporting ≥5 h/d of use demonstrated lower psychosocial functioning scores across domains, including teasing, appearance concerns, and happiness, although differences were not statistically significant. No significant differences were observed between adolescents reporting 1-3 versus 3-5 h/d of use. Surgical history and platform choice were not associated with psychosocial outcomes.

CONCLUSIONS: This pilot study provides preliminary descriptive insight into social media use and psychosocial functioning among adolescents with cleft lip and/or palate. Although no statistically significant associations were identified, consistent directional trends suggested lower psychosocial scores among adolescents reporting heavy social media use. These findings support cautious consideration of social media-based interventions and highlight the need for larger, adequately powered studies.

PMID:41662684 | DOI:10.1097/SAP.0000000000004645

JMIR Cancer. 2026 Feb 9;12:e73058. doi: 10.2196/73058.

ABSTRACT

BACKGROUND: Reliance on telehealth increased dramatically during the COVID-19 pandemic, introducing new opportunities to consider the use of telehealth across the cancer control continuum. However, patient, clinician, and staff perspectives about the types of cancer care appointments that are considered appropriate and the clinical care needs to support expanded remote care services are limited. Understanding older adults’ diverse technology needs and perspectives is especially important given that they comprise a large and growing proportion of patients with cancer.

OBJECTIVE: This study aimed to describe the perceptions and experiences of older patients with cancer and their clinical care team members regarding the expansion of telehealth use across the cancer control continuum and to solicit suggestions about how to support telehealth use for cancer care delivery.

METHODS: Using a convergent mixed methods design, we surveyed and interviewed patients aged ≥60 years, clinicians, and staff at a comprehensive cancer center in the southern United States between December 2020 and November 2021. Interview questions were rooted in the sociotechnical model, which proposes 8 interrelated dimensions representing factors influencing the design, use, and outcomes associated with health information technologies. Patient survey domains included telehealth experience and satisfaction and factors affecting telehealth perceptions and use; clinician survey domains included contexts of telehealth appropriateness, training, and barriers and facilitators to telehealth service provision. Survey data were analyzed using descriptive statistics. Qualitative data were thematically analyzed using a combined deductive and inductive approach.

RESULTS: We received completed surveys from 128 patients (567 invited) and 106 clinicians and staff (146 invited). We completed 14 patient (29 invited) and 20 clinician and staff (22 invited) interviews. Across all participants, most agreed or strongly agreed that multiple cancer care appointment types should be offered via telehealth, including discussing treatment side effects (75/102, 73.5% of patients and 66/94, 70.2% of clinicians and staff), results communication (71/102, 69.6% of patients and 65/94, 69.1% of clinicians and staff), and treatment follow-up (67/102, 65.7% of patients and 52/93, 55.9% of clinicians and staff). In interviews, participants elaborated on factors influencing the appropriateness of telehealth versus in-person appointments, including symptom severity, type of cancer, and purpose of the appointment. Many patient and staff suggestions focused on ways to address digital literacy gaps, while clinicians recommended improving clinic workflows, infrastructure, and training.

CONCLUSIONS: Overall, clinicians, staff, and older patients with cancer all responded positively toward expanding telehealth use across multiple cancer and appointment types across the cancer control continuum. Older adults with cancer are generally interested in telehealth for cancer care, especially if strategies to address digital literacy gaps are incorporated. Clinicians and staff members expressed specialized training and infrastructure needs to optimize telehealth uptake and service delivery.

PMID:41662673 | DOI:10.2196/73058

Int J Group Psychother. 2026 Feb 9:1-38. doi: 10.1080/00207284.2025.2600103. Online ahead of print.

ABSTRACT

Experienced and internalized weight stigma (IWS) are associated with a plethora of health and psychosocial consequences. In this study, we tested the outcomes of a 10-12 week, online, counselor-facilitated support group (We Deserve Space; WDS) for individuals who had experienced weight stigma. Twenty-five large-bodied individuals participated in three iterations of the WDS group. Participants average age was 43.68 years (SD = 13.84, range = 28-78). Revisions to WDS curricula were made iteratively in response to feedback. Paired samples t-tests yielded statistically significant improvements on all variables (IWS, antifat attitudes, depressive symptoms, loneliness, eating-disorder functional impairment, belongingness) from baseline to end-of-group, with effect sizes in the medium to large range. This study provides preliminary evidence that WDS may improve IWS, disordered-eating functional impairment, and psychosocial well-being in large-bodied individuals.

PMID:41662670 | DOI:10.1080/00207284.2025.2600103

Ann Plast Surg. 2026 Feb 9. doi: 10.1097/SAP.0000000000004661. Online ahead of print.

ABSTRACT

BACKGROUND: Nipple-sparing mastectomy (NSM) improves aesthetic outcomes but carries a higher risk of ischemic complications, particularly in patients with large, ptotic breasts. This study evaluates whether reduction mammaplasty prior to NSM with deep inferior epigastric perforator (DIEP) flap reconstruction can help mitigate these risks.

METHODS: All patients who underwent NSM with immediate DIEP flap reconstruction between 2016 and 2024 were identified. Only those with native breast cup size D or larger were included. Patients were divided into 2 cohorts: those who underwent reduction mammaplasty prior to NSM (reduction cohort) and those without prior breast surgery (control cohort).

RESULTS: The reduction group included 21 patients (39 breasts), and the control group included 29 patients (51 breasts). Both groups had an average preoperative breast cup size of DD. Within the reduction group, 41.0% underwent planned staged reductions (average interval, 4.63 months), whereas 59.0% had prior elective reductions (average interval, 13.35 years). Postoperatively, the reduction group experienced significantly lower rates of skin necrosis (5.1% vs 37.3%, P < 0.001) and nipple-areolar complex (NAC) necrosis (2.6% vs 21.6%, P = 0.011). Infection rates were also lower, approaching statistical significance (5.1% vs 19.6%, P = 0.061). On multivariate regression, reduction mammaplasty was a significant protective factor against both skin (β = -2.774, P = 0.002) and NAC necrosis (β = -2.385, P = 0.030), reducing the odds by 93.8% and 90.8%, respectively.

CONCLUSION: Our findings suggest that prior reduction mammaplasty is associated with decreased ischemic complications in large-breasted patients undergoing NSM and DIEP flap reconstruction.

PMID:41662666 | DOI:10.1097/SAP.0000000000004661