Category: Statistics

JMIR Form Res. 2026 May 25;10:e83018. doi: 10.2196/83018.

ABSTRACT

BACKGROUND: Suicide is a leading cause of death in the United States, and state policies can be effective tools to prevent suicide. State legislators are increasingly active on social media, communicating about their legislative priorities and signaling information about their knowledge and attitudes about issues.

OBJECTIVE: This study aimed to characterize US state legislators’ social media posts mentioning suicide on X (formerly Twitter) and explore differences in how Democrat and Republican legislators communicate about suicide.

METHODS: We used Quorum, a public affairs database, to identify all state legislator X posts mentioning suicide (N=1049) between December 1, 2023, and November 30, 2024. We developed a codebook and used content analysis to characterize posts and document the frequency of communication about suicide and themes related to causes, solutions, and consequences of suicide. We assessed concordance between the social media post language used and guidelines for reporting about suicide. We conducted univariate analysis and chi-square tests to assess differences in the content of posts between Democrat and Republican legislators. Differences in the frequency of posts about suicide were analyzed using 2-tailed t tests.

RESULTS: Of 1049 posts identified, 849 (80.9%) were included in the final sample. The annual suicide post rate per 10,000 posts was 13.2 (0.1% of all posts) among Democrats and 7.4 (0.1% of all posts) among Republicans (P=.09). Suicide related to a specific population was identified in 52.2% (443/849) of posts, with youth, veterans, firearm owners, and the LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and more) population being identified most frequently. Causes of suicide were identified in 37.1% (315/849) of posts, with no significant difference between Democrats and Republicans. However, the types of causes identified varied, with Democrats more likely to identify lethal means (eg, firearms) as a cause of suicide than Republicans (115/573, 20.1% vs 20/172, 7.5%; P<.001). About two-thirds (558/849, 65.7%) of posts identified at least one solution to prevent suicide, with Democrats more likely to identify a solution than Republicans (443/573, 77.3% vs 114/268, 42.5%; P<.001). General awareness was the most frequent solution, while policy-specific solutions were present in only 23.3% (198/849) of posts. Collateral consequences of suicide were infrequently mentioned.

CONCLUSIONS: This study found differences between Democrats and Republicans in their X posts about suicide and areas of misalignment with research evidence. When considered within the context of research on the epidemiology of suicide and evidence supporting suicide prevention policies, the study highlights the need to improve communication about suicide with state legislators and to encourage further collaboration with suicide prevention organizations and experts. Furthermore, given the differences observed, study findings suggest potential value in tailoring messages about suicide for legislators based on their political party.

PMID:42184359 | DOI:10.2196/83018

SICOT J. 2026;12:33. doi: 10.1051/sicotj/2026030. Epub 2026 May 26.

ABSTRACT

BACKGROUND: Distal femur fractures represent a small but clinically significant proportion of femoral injuries and are associated with high rates of complications, including non-union and revision surgery. Intramedullary nailing is a commonly employed fixation strategy, with both antegrade and retrograde approaches widely used in current practice. However, controversy persists regarding the optimal nail entry technique, particularly with respect to fracture healing, revision rates, and complications. This systematic review and meta-analysis aimed to compare clinical and radiological outcomes of antegrade versus retrograde intramedullary nailing for femoral shaft and distal femur fractures.

METHODS: This review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251274011). MEDLINE, EMBASE, and Cochrane databases were systematically searched for comparative studies evaluating antegrade and retrograde intramedullary nailing. Retrospective and prospective human studies reporting outcomes of union, revision, refracture, malunion, delayed union, operative time, and complications were included. Data extraction and quality assessment were independently performed, with risk of bias evaluated using the ROBINS-I tool. Meta-analysis was conducted using odds ratios (ORs) and weighted mean differences with 95% confidence intervals.

RESULTS: Five studies encompassing 1,479 patients were included, of whom 894 underwent antegrade nailing, and 585 underwent retrograde nailing. Antegrade nailing demonstrated a significantly lower rate of refracture following primary fixation compared with retrograde nailing (OR 31.41; 95% CI 4.45-221.80; p < 0.001). Revision rates were also significantly lower in the antegrade group (OR 1.76; 95% CI 1.21-2.58; p = 0.003). Retrograde nailing showed a higher overall union rate, although this did not reach statistical significance (p = 0.10). Rates of malunion, delayed union, non-union, operative time, and overall complications were comparable between groups, with moderate to substantial heterogeneity observed for several outcomes.

CONCLUSION: Both antegrade and retrograde intramedullary nailing provide effective fixation for femoral shaft and distal femur fractures. Antegrade nailing is associated with significantly lower rates of refracture and revision, while retrograde nailing demonstrates comparable union outcomes. These findings suggest that antegrade nailing may offer advantages in selected patient populations, particularly elderly individuals, although the surgical approach should ultimately be guided by fracture pattern, patient factors, and surgeon expertise.

PMID:42184353 | DOI:10.1051/sicotj/2026030

J Med Internet Res. 2026 May 25;28:e84228. doi: 10.2196/84228.

ABSTRACT

BACKGROUND: The number of cancer survivors in Switzerland is increasing. Many individuals face challenges in dealing with health-related information and navigating the health care system. Digitalization offers new care and support opportunities, but its effective use requires digital and navigational health literacy (HL) and self-management skills.

OBJECTIVE: This study aimed to assess the competencies of cancer survivors in Switzerland, compare them with those of the general population, and identify vulnerable subgroups.

METHODS: A cross-sectional online survey was conducted using validated scales from the Health Literacy Survey 2019-2021 (HLS19), measuring digital HL, interaction with digital devices, frequency of use of digital resources, and navigational HL. Self-management skills were assessed with the Health Education Impact Questionnaire (heiQ). HLS19 scores were compared to data from the general Swiss population and a subpopulation with chronic diseases provided by the Federal Office of Public Health, using Mann-Whitney U tests, chi-square tests, and independent t tests. Regression analyses identified associations of sociodemographic and clinical factors with digital and navigational HL and self-management skills.

RESULTS: A total of 131 cancer survivors (74.8% female, 41% with breast cancer) completed the survey. Only 30% reported high digital HL, while self-management skills were generally high, particularly in “health service navigation” (median 3.6, IQR 0.8 on a 4-point Likert scale) and “constructive attitudes” (median 3.6, IQR 1). Compared to the general population, cancer survivors had significantly higher scores in digital interaction and digital resource use (P≤.002), while no differences were observed in digital or navigational HL. Digital and navigational HL, as well as self-management, were consistently associated with education level, social support, and financial deprivation.

CONCLUSIONS: Cancer survivors in Switzerland report low digital and navigational HL, comparable to the general population, while self-management skills were strong overall. Support strategies should simultaneously target individual and systemic factors to improve cancer survivors’ ability to access and use digital health resources. Future research should include a more representative sample to validate these findings.

PMID:42184350 | DOI:10.2196/84228

JMIR Res Protoc. 2026 May 25;15:e87020. doi: 10.2196/87020.

ABSTRACT

BACKGROUND: Postoperative delirium (POD) is a frequent and serious complication in older surgical patients, characterized by acute cognitive dysfunction and fluctuating levels of consciousness. POD is associated with prolonged hospitalization, long-term cognitive decline, reduced quality of life, and increased mortality. Despite its clinical relevance, the underlying pathophysiological mechanisms remain poorly understood, and reliable biomarkers for early prediction and prevention are lacking.

OBJECTIVE: The CONFUSED study aims to identify molecular and clinical predictors of POD by integrating clinical data with proteomic, transcriptomic, and epigenetic analyses. The primary objective is to develop predictive models for POD using multimodal data. Secondary objectives include the identification of delirium-associated genes, proteins, and epigenetic signatures, as well as the exploration of patient subgroups at increased risk for POD.

METHODS: CONFUSED is a prospective observational cohort study conducted at a German university hospital. Adult patients undergoing major surgery under general anesthesia will be enrolled until 100 cases of POD have been observed, which is expected to require a total sample size of approximately 200 to 300 patients. Blood samples are collected at 4 predefined time points: before premedication, immediately after surgery, and on postoperative days 2 and 5. Samples undergo comprehensive proteomic profiling, transcriptomic analysis using RNA microarrays, DNA methylation analysis, and genotyping of selected polymorphisms. Clinical data, including demographics, comorbidities, perioperative variables, medications, and delirium assessments using the Confusion Assessment Method (CAM) and CAM for the intensive care unit, are systematically recorded. Statistical analyses include univariate and multivariate methods, as well as machine learning approaches such as random forests and support vector machines, to identify relevant biomarkers and develop predictive models. The study protocol follows STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) guidelines and was approved by the responsible ethics committees.

RESULTS: The study was registered in the German Clinical Trials Register (DRKS00033854) on March 18, 2024. Recruitment started in January 2024 and is ongoing at the time of manuscript submission. As of now, 135 patients have been enrolled. Sample collection and laboratory analyses are ongoing. Data analysis began in January 2026, with first results anticipated in July 2026. Final data lock is anticipated after the completion of recruitment.

CONCLUSIONS: By integrating multimodal molecular data with clinical parameters and applying advanced machine learning techniques, the CONFUSED study aims to improve the prediction and understanding of POD. The results are expected to support the development of personalized preventive strategies and contribute to improved perioperative care for patients at risk of POD.

PMID:42184339 | DOI:10.2196/87020

JMIR Nurs. 2026 May 25;9:e84436. doi: 10.2196/84436.

ABSTRACT

BACKGROUND: The growing aging population and staff shortages are placing pressure on Dutch nursing homes (NHs). These challenges have led to an increased interest in digital health technologies. Among these are wearable devices that allow for remote continuous monitoring of vital signs. An example is the Healthdot (smartQare), a wearable electronic device that continuously monitors heart rate, respiratory rate, and physical activity. In the context of acute respiratory infections (ARIs) in NHs, where initial symptoms can go unnoticed, continuous monitoring may aid in early recognition, timely intervention, and reduce staff workloads. However, little is known about how health care professionals perceive the use of continuous vital signs monitoring devices, such as the Healthdot, for this cause in NHs.

OBJECTIVE: This study aims to explore the perspectives of healthcare professionals on the use of the Healthdot for early detection and monitoring of ARIs in NHs, to inform potential future implementation.

METHODS: Semistructured interviews were conducted with 20 physicians, nurses, and certified nursing assistants from 4 NHs and 1 acute geriatric community hospital located in a NH. Interview transcripts were thematically analyzed to identify themes regarding their perspectives on the use of the Healthdot for monitoring ARIs in this setting.

RESULTS: Five main themes were identified that related to the appropriate use of the Healthdot for NH clients and health care professionals: alignment of Healthdot use and NH clients’ treatment policies, balancing safety and freedom, impact of the Healthdot on work processes, supporting rather than replacing care, and possible use during pandemics and in the future. Additionally, several preconditions for the use of the Healthdot were identified, including its usability, a support base among care staff, adequate training and guidance, communication with NH clients and their relatives, and a clear policy regarding its use.

CONCLUSIONS: Given the complexity of care in NHs, where clinical care is typically balanced against quality of life and a homelike environment, physicians generally expressed reserved attitudes toward the Healthdot, highlighting the need to consider multiple factors in its implementation. Care staff were generally positive about the device. Nevertheless, tailored assessment for each individual NH client remains essential, balancing treatment goals, safety, autonomy, and person-centered care. Additionally, clear communication and alignment between health care professionals in this setting are crucial, specifically regarding their expectations of the Healthdot’s role in care processes. This study offers practical guidance that may inform future implementation efforts of continuous vital sign monitoring devices in NHs.

PMID:42184338 | DOI:10.2196/84436

JMIR Dermatol. 2026 May 25;9:e93639. doi: 10.2196/93639.

ABSTRACT

BACKGROUND: Climate and weather factors of temperature and humidity are widely reported to be associated with xerosis (dry skin), a common inflammatory skin condition and frequent driver of pruritus (itchy skin) and reduced quality of life. Growing evidence supports links between environmental conditions and skin barrier function, with extreme climates associated with increased atopic dermatitis-related clinical visits. Mechanistically, temperature and humidity affect the stratum corneum, the skin’s primary permeability barrier, with low humidity and high temperature increasing transepidermal water loss and promoting cutaneous inflammation.

OBJECTIVE: This study examines the relationship between climate, namely temperature and humidity, and the general public’s experience in dry skin and moisturizing products, throughout the United States. This study sought to address gaps in traditional epidemiologic approaches by linking climate conditions with population-level online search behavior related to dry skin and moisturizer use across the United States.

METHODS: Publicly available climate data were obtained from the National Oceanic and Atmospheric Administration (NOAA), including average temperature and dew point by state over a recent nine-year period (2016-2025). Dew point served as a proxy for ambient humidity. Google Trends was used to assess relative search interest for five dry skin- and moisturizer-related terms by state during the same period. Search interest was normalized per million residents, and associations between climate variables and search interest were evaluated using linear regression analyses. Statistical analyses were conducted using R.

RESULTS: Lower average temperatures and lower dew points were associated with higher dry skin-related search interest, while warmer, more humid states showed lower interest. Both temperature and dew point demonstrated significant negative associations with Google search interest. This work was not funded and data collection was performed using publicly available, free databases.

CONCLUSIONS: Population-level search behavior related to xerosis reflects national patterns of climate-associated dermatologic burden.

PMID:42184334 | DOI:10.2196/93639

Ann Plast Surg. 2026 May 25. doi: 10.1097/SAP.0000000000004775. Online ahead of print.

ABSTRACT

BACKGROUND: The pathophysiology of keloid formation remains poorly understood, and treatment typically involves multimodal approaches. Previous studies suggest that keloids on the earlobes, head, and neck may be more responsive to radiation than those on other anatomic sites due to putative differences in skin tension and biomechanical properties. However, limited comparative data exist to substantiate these anatomic distinctions in clinical outcomes.

AIM: To compare recurrence rates, treatment outcomes, and radiation-related side effects between auricular and nonauricular keloids following surgical excision with adjuvant radiation therapy or surgical excision alone.

METHODS: This retrospective cohort study analysed 168 cases with keloids (60 auricular and 108 nonauricular) treated by a single surgeon between January 2020 and May 2024. Of these, 122 patients underwent surgical excision followed by adjuvant radiation therapy, while 46 patients received surgical excision only. Intralesional 5-Fluorouracil and Kenalog was injected across both groups during surgical excision. Demographic and clinical data, including age, sex, race, BMI, keloid site and size, and treatment modality, were collected. Patients were followed up post-treatment to assess recurrence, radiation-related side effects, and treatment response patterns.

RESULTS: Auricular keloids were more common in younger patients and significantly smaller in size (median 12 vs. 19.5 mm for nonauricular, P<0.001). The majority of patients received 2100 cGy of radiation. Among those receiving surgery plus radiation, 17.07% of auricular and 16.22% of nonauricular keloids recurred (P=0.91). In the surgery-only group, recurrence was 47.37% and 44.12%, respectively (P=0.82). Notably, radiation-related side effects were significantly more frequent in nonauricular sites (37%) compared with auricular (20%) (P=0.022). Age, sex, race, BMI, and radiation dose did not independently predict recurrence in the final model.

CONCLUSION: Anatomic site did not significantly influence keloid recurrence rates, challenging previous assumptions about site-specific treatment responses, while adjuvant radiotherapy significantly reduced recurrence irrespective of site. Radiation-related side effects were more common in nonauricular locations. Age, sex, race and BMI did not emerge as statistically significant demographic predictors of recurrence in this study. These findings support the routine inclusion of radiotherapy in keloid management and suggest that demographic and treatment factors may outweigh anatomic considerations in predicting outcomes.

PMID:42184131 | DOI:10.1097/SAP.0000000000004775

Arch Clin Neuropsychol. 2026 May 6;41(4):acag039. doi: 10.1093/arclin/acag039.

ABSTRACT

OBJECTIVE: Confrontational naming is an important part of many neuropsychological evaluations. Yet, data on the feasibility and psychometric properties of telephone-based confrontational verbal naming tests (VNTs) are quite limited. The current study conducted a preliminary, exploratory examination of the psychometrics and correlates of an abbreviated version of the 50-item VNT administered via telephone.

METHOD: Participants were 220 healthy adults, including 110 younger adults (ages 18-35) and 110 middle-aged to older adults (ages 50-85). Participants completed a 15-item version of the VNT as part of a broader telephone-based cognitive battery.

RESULTS: Confirmatory factor analysis suggested support for a 12-item model of the VNT (VNT-T12) with acceptable fit. VNT-T12 scores were negatively skewed and demonstrated good internal consistency. A quantile regression predicting VNT-T12 from domain-level cognitive variables showed that executive functions (e.g., verbal fluency) and fund of verbal knowledge were significantly and positively associated with VNT-T12 scores at most percentile ranges. The VNT-T12 scores were also significantly associated with race/ethnicity and English as a second language at higher quantiles of performance. Demographically-adjusted coefficients and an associated calculator are provided as a normative resource.

CONCLUSIONS: Findings provide mixed and preliminary support for the feasibility, psychometrics, and validity of a 12-item VNT administered via telephone. Future research on the psychometrics and validity of the VNT-T12 is warranted in samples with lower levels of education and in clinical populations.

PMID:42184122 | DOI:10.1093/arclin/acag039

Brief Bioinform. 2026 May 4;27(3):bbag243. doi: 10.1093/bib/bbag243.

ABSTRACT

Understanding protein functions in biological processes is pivotal for disease elucidation and drug discovery. Despite notable progress, existing approaches primarily focus on function transfer under in-distribution (ID) settings, where training and test proteins exhibit high sequence similarity. As a result, their performance often degrades when applied to novel, diverse, and low-homology protein sequences, posing a major challenge for out-of-distribution (OOD) generalization encountered in practice. Towards this end, we develop ProteinScore, a graph transformer approach tailored to improve protein function prediction in OOD settings. ProteinScore integrates a label-invariant variational subgraph generator with self-supervised contrastive learning, thereby identifying meaning substructures within proteins. By highlighting informative features while filtering out redundant ones, ProteinScore improves generalization to diverse and low-homology sequences. Experiments on datasets with both experimentally resolved and AlphaFold2-predicted structures demonstrate that ProteinScore consistently outperforms strong baselines and provides biologically meaningful interpretability through accurately identifying binding sites. In addition, ProteinScore generalizes effectively to two additional downstream tasks, drug-target interaction classification and subcellular localization prediction, achieving superior predictive performance and reliable interpretability.

PMID:42184116 | DOI:10.1093/bib/bbag243

Brief Bioinform. 2026 May 4;27(3):bbag251. doi: 10.1093/bib/bbag251.

ABSTRACT

N 6-methyladenosine (m6A), the most prevalent internal RNA modification, is an emerging key regulator of gene expression in the central nervous system, and its dysregulation is connected to psychiatric disorders. However, disentangling the causal links between specific m6A sites and diseases phenotypes remain challenging. This review presents a comprehensive survey of practical bioinformatics strategies to address it. Our review outlines four analytical themes: (i) the reliable calibration of false-positive signals, (ii) causal inference via statistical genetics, (iii) the acquisition of cell-type-specific functional insights, and (iv) the application of machine learning to predict clinical biomarkers. We validate these analytical strategies through a case study in major depressive disorder, specifically by intersecting m6A effects with psychiatric genetic risk. By streamlining these workflows, we provide a roadmap for formulating testable hypotheses regarding epitranscriptome-targeted therapeutic interventions in psychiatric disorders.

PMID:42184108 | DOI:10.1093/bib/bbag251