Category: Statistics

J Peripher Nerv Syst. 2026 Sep;31(3):e70154. doi: 10.1111/jns.70154.

ABSTRACT

BACKGROUND AND AIM: Neuropathic pain (NeuP) is widely underdiagnosed, and treatment-related adverse events often drive nonadherence. We investigated the probable NeuP prevalence, symptoms recognition, and treatment preferences among the general population in Malaysia.

METHODS: We utilized a digital ID-Pain questionnaire across nine tertiary hospitals to screen for probable NeuP. We also designed a discrete choice experiment (DCE) to assess participants’ ability to differentiate NeuP from nociceptive symptoms and to evaluate treatment preferences across five attributes (perceived pain reduction, time to effect, proven effectiveness, risk of common side effects, and cost) among the general population.

RESULTS: The screening cohort included 13 592 adults (17.1% with diabetes). The overall prevalence of screen-positive for probable NeuP was 18.3% in the general population, increasing to 40.1% among people with diabetes. In the DCE cohort (n = 3999), 82.1% of participants demonstrated poor-to-moderate NeuP symptom recognition. Regarding treatment preferences, avoiding a high risk of common side effects was the primary driver of choice (coefficient -1.744, 95% CI -1.820, -1.669), followed by the desire for strong scientific evidence (coefficient 1.237, 95% CI 1.182, 1.291). Apart from clinical attributes, participants showed significant cost sensitivity (coefficient -5.565, 95% CI -6.909, -4.221).

INTERPRETATION: Despite a high prevalence of probable NeuP, poor symptom recognition creates a significant diagnostic challenge. Given that aversion to side effects is prioritized over other attributes, clinicians need to focus on tolerable anti-neuropathic agents and employ proactive side-effect management to optimize NeuP treatment adherence.

PMID:42552228 | DOI:10.1111/jns.70154

Eur J Intern Med. 2026 Aug 4:107116. doi: 10.1016/j.ejim.2026.107116. Online ahead of print.

ABSTRACT

BACKGROUND: Orthostatic hypotension (OH), defined as a reduction in systolic/diastolic blood pressure ≥20/10 mmHg upon standing, is common in older adults and may interfere with the optimization of guideline-directed medical therapy (GDMT) for Heart Failure (HF). However, the prevalence of OH in patients with HF has not been systematically quantified.

AIMS: To estimate the prevalence of orthostatic hypotension among patients with heart failure through a systematic review and meta-analysis.

METHODS: This study was conducted according to PRISMA guidelines and registered in PROSPERO (CRD42023420255). MEDLINE and EMBASE databases were systematically searched from inception to 31 December 2025. Studies reporting the prevalence of OH in HF populations with a sample size ≥100 patients were included. Pooled prevalence estimates with 95% confidence intervals (CI) were calculated, and heterogeneity was assessed using the I² statistic. Subgroup analyses were performed according to geographical location, study design, and clinical setting.

RESULTS: Nine studies (10 cohorts) including 2036 patients with HF were analyzed. The pooled prevalence of OH was 26.7% (95% CI 20.4-34.2%), indicating that approximately one in four HF patients presents this condition. Between-study heterogeneity was high (I²=90.2%). Subgroup analyses revealed higher prevalence in Europe and Asia and the Middle East compared with other countries.

CONCLUSIONS: HF is often burdened by OH which is common and found in 1 out 4 patients with HF and may complicate its management. Its impact on GDMT and clinical outcomes needs to be further investigated.

PMID:42552200 | DOI:10.1016/j.ejim.2026.107116

J Prosthet Dent. 2026 Aug 5:S0022-3913(26)00514-7. doi: 10.1016/j.prosdent.2026.07.010. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Although digital prosthodontic workflows have improved anatomic data acquisition for articulator mounting and jaw simulation, virtual articulator systems still commonly rely on average intercondylar distance values and standardized mounting procedures, limiting the simulation of patient-specific mandibular movement.

PURPOSE: The purpose of this in vitro study was to evaluate the feasibility of estimating sagittal condylar inclination (SCI) from facial scan-derived eccentric mandibular positional data in a temporomandibular joint (TMJ) simulation model and to investigate whether intercondylar distance influences measurement behavior.

MATERIAL AND METHODS: This study used a TMJ simulation model with intercondylar distance set at 5 levels (90, 100, 110, 120, and 130 mm) and SCI set at 4 levels (0, 15, 30, and 45 degrees). For each condition, facial scans at maximum intercuspation position (MIP), protrusive, right lateral, and left lateral positions were acquired as a single acquisition cycle, with 15 repeated cycles per condition. Eccentric scans were aligned to the MIP scan, and mandibular anterior transformation matrices were derived and mapped to the hinge axis to calculate SCI and the Bennett angle. Agreement between measured and actual SCI was evaluated using a mixed-effects Bland-Altman approach. Supportive analyses included linear regression, signed and absolute error, root mean square error (RMSE), mixed-effects modeling of SCI absolute error, and intraclass correlation coefficient (ICC) for repeatability.

RESULTS: The mixed-effects Bland-Altman analysis showed a negative overall bias (-1.07 degrees; 95% confidence interval (CI), -1.78 to -0.36), with broad individual-measurement variability. Supportive regression analyses showed slopes not significantly different from 1 and intercept confidence intervals including 0. Pooled mean ±standard deviation absolute error was 4.56 ±4.34 degrees, and RMSE was 6.29 degrees. For SCI absolute error, actual SCI was significant, whereas the side, intercondylar distance, and intercondylar distance×actual SCI interaction were not. Overall ICC was 0.886 (95% CI, 0.819 to 0.919). Descriptively, the Bennett angle showed significant negative correlations with intercondylar distance and positive correlations with actual SCI in most, but not all, distance conditions.

CONCLUSIONS: Based on the findings of this in vitro TMJ simulation study, facial scan- and eccentric position-based SCI estimation showed generally stable measurement performance across the evaluated conditions, with no statistically detectable systematic effect of intercondylar distance on SCI error under the evaluated simulator-based conditions.

PMID:42552176 | DOI:10.1016/j.prosdent.2026.07.010

Womens Health Issues. 2026 Aug 4:S1049-3867(26)00103-9. doi: 10.1016/j.whi.2026.06.008. Online ahead of print.

ABSTRACT

BACKGROUND: Comorbidity is common with migraine. To inform services to support maternal well-being, we identified comorbidity patterns among pregnant individuals with a history of seeking health care for migraine before pregnancy.

METHODS: In a population-based cohort of pregnancies in 2007-2022 in Ontario, Canada, to individuals with migraine-related health care encounters in the 5 years before conception, we used latent class analysis to identify subgroups using 33 comorbidities. Classes were chosen using statistical fit indices, parsimony, and clinical interpretability. We compared the sociodemographic and reproductive health-related characteristics of the classes using standardized differences.

RESULTS: Of 174,164 pregnant individuals with migraine, 67.2% had one or more comorbidities. The most prevalent comorbidities were mood/anxiety disorders (41.4%), low back pain (16.9%), obesity (12.1%), and asthma (10.6%). Three distinct subgroups characterized comorbidity patterns: class 1, the “mood/anxiety disorder comorbidity,” included 81.2% of the cohort; class 2, the “mood/anxiety disorder and low back pain comorbidity” cohort included 8.3%’ and class 3, the “multiple mental health comorbidity” cohort included 10.6%. Compared with class 1, at conception individuals in the “multiple mental health comorbidity” group were more likely to be aged 13 to 24 years (37.9% vs. 18.9%; standardized difference, 0.43), reside in neighborhoods in the lowest income quintile (29.7% vs. 22.1%, 0.17), be Canadian born or a long-term resident (87.0% vs. 74.4%, 0.32), and be nulliparous (53.2% vs. 47.5%, 0.11). Those in the “mood/anxiety disorder and low back pain comorbidity” group were more likely to be 35 to 44 years of age (31.9% vs. 20.6%, 0.26) or 45 to 54 years of age (2.1% vs. 0.6%, 0.14), more likely to reside in neighborhoods in the lowest income quintile (26.6% vs. 22.1%, 0.11), and less likely to be nulliparous (38.6% vs. 47.5%, 0.18). Findings were similar in a sensitivity analysis including only comorbidities with a prevalence of 1% or greater. Using physical conditions as indicators only, we also identified three latent classes: “low back pain comorbidity” (4.3%), “obesity comorbidity” (2.8%), and “no physical comorbidity” (92.9%).

CONCLUSION: Comorbidity affects two-thirds of pregnant individuals with a history of seeking health care for migraine. Identified patterns of comorbidity suggest subgroups who may benefit from tailored perinatal support related to mental health and chronic pain.

PMID:42552172 | DOI:10.1016/j.whi.2026.06.008

Pain Manag Nurs. 2026 Aug 4:S1524-9042(26)00254-7. doi: 10.1016/j.pmn.2026.07.019. Online ahead of print.

ABSTRACT

PURPOSE: To explore the impact of health insurance on the rural-urban disparities in opioid misuse in the United States.

METHODS: A secondary analysis of the National Survey on Drug Use and Health (NSDUH) was conducted using datasets from 2021 to ​2023. Outcomes examined were past-month and past-year opioid misuse. Residence was categorized using the Core Based Statistical Area (CBSA) classifications: large CBSA (>1 million persons); small CBSA (<1 million persons); rural: residing in a non-CBSA. Statistical analysis included univariate analysis, multivariable logistic regression, and a model for each outcome that accounted for moderation between residence and insurance.

RESULTS: The weighted sample comprised 281,769,638 individuals, of whom 3.2% and 1.0% reported past-year and past-month opioid misuse, respectively. The multivariable analysis without moderation showed that, compared with non-Hispanic Whites, non-Hispanic Asians had lower odds of past-year opioid misuse (p < .001). Significant moderation was observed only for past-month opioid misuse. The main effect of residence showed that past-month misuse was lower among individuals living in non-CBSAs than among those in large CBSAs (aOR = 0.58; 95% CI, 0.39,0.85). After adjusting for moderation, individuals in non-CBSAs without health insurance had higher odds of past-month misuse than those in large CBSAs without insurance (aOR = 3.41, 95% CI, 1.37, 8.51). Higher income was protective against opioid misuse, but being male was associated with increased odds of misuse.

CONCLUSIONS: People from rural areas without health insurance had higher odds of past-month opioid misuse than those without health insurance in large CBSAs. These findings can guide focused interventions to address opioid misuse.

PMID:42552148 | DOI:10.1016/j.pmn.2026.07.019

Occup Environ Med. 2026 Aug 4:oemed-2025-110662. doi: 10.1136/oemed-2025-110662. Online ahead of print.

ABSTRACT

OBJECTIVE: To systematically review the evidence on the association between occupational exposure to pesticides and the risk of amyotrophic lateral sclerosis (ALS).

METHODS: A systematic search, conducted in eight bibliographic databases for publications between 1990 and 2025, identified observational studies estimating the risk of ALS after occupational pesticide exposure. Study quality was assessed using the WHO Risk of Bias (RoB) assessment instrument for systematic reviews, with the ROBINS-E (RoB in non-randomised studies of exposure) tool domains of bias. Pooled risk estimates were produced using random-effects models with restricted maximum likelihood, heterogeneity was assessed with I² statistics, and meta-regressions and publication bias explored with funnel plots and Egger’s test.

RESULTS: Eight case-control studies (1734 cases) were retained for meta-analysis from 767 initially screened articles. ‘Ever’ occupational exposure to pesticides was associated with an increased risk of ALS (n=6 studies, pooled OR (pOR)=1.6; 95% CI 1.1, 2.2; I²=57%), for combined sexes. The risk for exposure to herbicides was slightly greater (pOR=1.7, I²=0.0%) than for exposure to insecticides or fungicides (pORs=1.6, I²=0.0%). Based on three studies, ever exposure to high levels of pesticides was associated with a higher risk (pOR=2.7; 95% CI=1.4, 5.0) than exposure to low levels (pOR=1.9; 95% CI=1.0, 3.7). Self-reported exposure assessment methods and older publication dates (<2015) were statistically significant predictors of the effect size.

CONCLUSION: Despite the small number of studies and some heterogeneity, our results add to the evidence suggesting that occupational exposure to pesticides may increase the risk of ALS.

PMID:42552132 | DOI:10.1136/oemed-2025-110662

Mil Psychol. 2026 Aug 4:1-11. doi: 10.1080/08995605.2026.2713799. Online ahead of print.

ABSTRACT

This study examines the psychological mechanisms through which belief in state war propaganda relates to combat motivation among Russian soldiers during the war in Ukraine. Using a cross-sectional survey of 1,060 Russian prisoners of war, we examined the relationship between belief in official propaganda narratives and two key outcomes: voluntary surrender and self-reported intentions to re-enlist. Results revealed that stronger belief in propaganda was associated with a lower likelihood of surrendering voluntarily and higher intentions to re-enlist upon release. Mediation analyses identified perceived legitimacy of the “Special Military Operation” (SMO) as the primary psychological pathway, such that only perceived legitimacy statistically accounted for the association between propaganda beliefs and both outcomes in our models. Contrary to expectations, identity fusion with the “Russian World” ideology and dehumanization of Ukrainians did not exhibit significant relationships in the mediation models once covariates were accounted for. These findings suggest that propaganda’s association with combat motivation may primarily be explained by soldiers’ perceptions of the war’s legitimacy rather than by identity-based or dehumanizing beliefs. The study offers empirical insights on propaganda’s link to combat motivation via legitimacy, informing narrative interventions in deradicalization and conflict psychology.

PMID:42552129 | DOI:10.1080/08995605.2026.2713799

Zhonghua Yan Ke Za Zhi. 2026 Aug 11;62(8):612-620. doi: 10.3760/cma.j.cn112142-20260427-00179.

ABSTRACT

Objective: To evaluate the changes of binocular visual function and patient satisfaction after small-incision lenticule extraction (SMILE) with micro-monovision in myopic patients with presbyopia. Methods: This was a single-arm clinical trial. Myopic patients with presbyopia who underwent micro-monovision SMILE at Beijing Tongren Hospital, Capital Medical University, from January 2019 to March 2021 were enrolled. The surgical design principle was full correction of the dominant eye for distance vision, with the non-dominant eye undercorrected by -1.50 D to -0.50 D for near vision. Best corrected distance visual acuity and best corrected near visual acuity (CNVA) for the dominant eye, non-dominant eye, and both eyes were measured before surgery. Uncorrected distance and near visual acuity (UDVA, UNVA), CDVA, and CNVA for the dominant eye, non-dominant eye, and both eyes were measured at 1, 3, 6 months, 3 years, and 5 years after surgery. Accommodative function parameters were measured preoperatively and at each postoperative follow-up visit, including binocular accommodative amplitude (AMP) measured by the push-up method, accommodative response (BCC) measured by the binocular cross-cylinder method, negative relative accommodation (NRA), and positive relative accommodation (PRA), as well as distance and near stereopsis and Worth 4-dot tests. A visual satisfaction questionnaire was administered after surgery. Results: A total of 51 patients (102 eyes) with myopia and presbyopia were included, comprising 19 males and 32 females, aged (41.68±2.47) years. Sixteen patients (32 eyes) completed the 5-year follow-up. The binocular UDVA and UNVA were (-0.02±0.06) logMAR and (0.01±0.09) logMAR at 5 years after surgery, respectively. The spherical equivalent of the dominant and non-dominant eyes was (-0.24±0.22) D and (-0.80±0.37) D, respectively. The binocular AMP decreased from (5.66±0.28) D before surgery to (4.36±0.19) D at 1 month after surgery, and returned to the preoperative level at 3 months after surgery; The PRA decreased from (-1.93±0.17) D before surgery to (-1.33±0.13) D at 1 month after surgery, and returned to the preoperative level at 6 months after surgery. The BCC increased at 1 month after surgery and returned to the preoperative level at 6 months after surgery (differences across time points were all statistically significant, P<0.05). These indicators slightly decreased at 3 and 5 years postoperatively compared with their respective recovered levels. There were no statistically significant differences in NRA and near stereopsis at any postoperative follow-up time point compared with preoperative values. All patients achieved 60″ distance and near stereopsis at each postoperative follow-up visit point, and the Worth 4-dot tests showed both central and peripheral fusion function in both eyes. The subjective satisfaction score was (9.06±1.18) (out of 10) at 5 years after surgery, with a satisfaction rate of 15/16. Conclusions: SMILE with micro-monovision had an impact on accommodative function in the early postoperative stage. The AMP, PRA, and BCC returned to preoperative levels at 3 and 6 months postoperatively, with a slight decrease at 3 to 5 years. The procedure did not affect binocular visual functions such as fusion and stereopsis. At 5 years after surgery, patients exhibited good distance and near vision, maintained binocular visual functions, and reported high subjective satisfaction.

PMID:42552120 | DOI:10.3760/cma.j.cn112142-20260427-00179

Zhonghua Yan Ke Za Zhi. 2026 Aug 11;62(8):602-611. doi: 10.3760/cma.j.cn112142-20260508-00188.

ABSTRACT

Objective: To explore the safety, efficacy, predictability, binocular visual balance, and postoperative visual quality of a monocular bi-aspheric ablation profile combined with laser corneal refractive surgery in patients with refractive errors associated with presbyopia, and to provide clinical evidence for individualized surgical correction of presbyopia. Methods: This retrospective case series study included 64 patients (128 eyes) with refractive errors and presbyopia treated at Gansu Aier Eye Hospital from April 2022 to April 2026, comprising 25 males and 39 females with a mean age of (46.66±4.87) years. The dominant eye was designated for distance vision and treated with small-incision lenticule extraction (SMILE) or femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) according to the corneal characteristics and refractive status; the non-dominant eye was designated for near vision and treated with a monocular bi-aspheric ablation profile combined with FS-LASIK, in which a certain degree of residual myopia and negative spherical aberration were intentionally induced to increase depth of focus and enhance near vision. Postoperative follow-ups were conducted at 1 day, 1 month, 3 months, and 6 months. Binocular uncorrected distance visual acuity(BUDVA), binocular uncorrected near visual acuity (BUNVA), refractive outcomes, higher-order aberrations, and subjective visual quality were evaluated. Results: Subgroup analysis based on dominant-eye surgical procedure showed no significant differences in postoperative binocular distance or near visual acuity between the SMILE and LASIK groups. Pooled analysis showed that BUDVA remained stable throughout follow-up and was comparable to the preoperative level, while BUNVA was significantly improved postoperatively. At 1 month postoperatively, 94.2%(49/52) of patients achieved binocular uncorrected distance visual acuity of 20/25 or better, and 80.7%(42/52) achieved 20/20 or better; meanwhile, 94.2%(49/52) achieved BUNVA of 0.8 or better, and 80.7% (42/52)achieved 1.0 or better. The median efficacy index was 1.11 (interquartile range, 1.0 to 1.2). Postoperatively, uncorrected distance visual acuity was significantly better in the dominant eye than in the non-dominant eye (P<0.001), whereas uncorrected near visual acuity was significantly better in the non-dominant eye than in the dominant eye (P=0.010), indicating successful establishment of the intended monocular bi-aspheric visual profile. At 6 months, actual spherical equivalent correlated strongly with the predicted values in both dominant and non-dominant eyes (R²=0.924 and 0.922, respectively; all P<0.001). Safety analysis showed that 90.7%(39/43) of patients had postoperative distance visual acuity that remained stable or improved, with only 9.3%(4/43) experiencing a decline; for near visual acuity, 51.2% improved by 2 or more lines and only 2.3% declined. At 6 months, the root mean square of higher-order aberrations in non-dominant eyes increased significantly compared with baseline (P=0.027), whereas spherical aberration showed a decreasing trend without statistical significance. On the subjective visual quality questionnaire, most patients reported no or only occasional visual disturbances. Conclusions: The monocular bi-aspheric ablation profile combined with laser corneal refractive surgery demonstrated favorable safety, efficacy, and predictability in patients with refractive errors and presbyopia. It effectively enhanced near visual acuity while maintaining distance vision, thereby achieving binocular visual balance with good postoperative visual quality, and supporting its role as an individualized surgical approach for presbyopia correction.

PMID:42552119 | DOI:10.3760/cma.j.cn112142-20260508-00188

Tob Control. 2026 Aug 4:tc-2026-060085. doi: 10.1136/tc-2026-060085. Online ahead of print.

ABSTRACT

BACKGROUND: Specialty tobacco retailers, including vape shops, smoke shops and cigar shops, are important sources of tobacco access, yet there is no reproducible national database documenting their locations and consumer engagement.

METHODS: We develop a national database of specialty tobacco retailers in the USA by combining Google Maps business listings as of June 2024 with Advan unique visitor count data, updated to May 2024. We match approximately 20 000 businesses across both databases and observe roughly 50 million monthly visits to these locations. We then perform two cross-sectional analyses examining specialty retailer density and visits at the census tract and county levels.

RESULTS: We find strong clustering of all types of specialty retailers in low-income areas and fewer shops per capita in rural areas. We find that smoke and vape shop density is negatively correlated with both educational attainment and population share of racial and ethnic minorities. Cigar and smoke shops were less common in areas with high shares of young people aged 15-24. Additional businesses are positively associated with total consumer visits, with evidence of spillover effects across shop types.

CONCLUSIONS: This study provides the first reproducible national assessment of specialty tobacco retailer locations linked to consumer visit data, offering a new foundation for monitoring retail access and informing tobacco control policy.

PMID:42552112 | DOI:10.1136/tc-2026-060085