Category: Statistics

Burns. 2026 May 27;52(8):108084. doi: 10.1016/j.burns.2026.108084. Online ahead of print.

ABSTRACT

AIM: To study the validity, reliability, standard error of the mean (SEM), minimum detectable change (MDC₉₅), and learning effect of three functional capacity tests in hospitalized burn victims: 5-repetition Sit-to-Stand (STS_5r), 1-minute Sit-to-Stand (STS_1min) and Timed up-and-go (TUG).

METHODS: In a cross-sectional study, 64 subjects were evaluated. The tests were randomly applied by two evaluators in three assessment moments: twice by the same evaluator (intra-rater) with a 1-day interval; and once by a second evaluator after the first assessment (inter-rater). 6-minute walk test (6MWT) and assessment of quadriceps femoris (QF) muscle strength were also performed. For analysis of the learning effect, all tests were repeated two times at each assessment moment.

RESULTS: The TUG showed very strong correlation with the 6MWT (r = -0.90, p < 0.0001), whereas for the STS_5r and STS_1min the correlation was moderate (r = -0.55 and 0.60, respectively; p < 0.0001). As for the QF muscle strength test, there was moderate correlation with the TUG (r = -0.41, p = 0.0008) and rather modest correlations with the STS_5r (r = -0.30, p = 0.013) and the STS_1min (r = 0.21, p = 0.091). Intraclass correlation coefficient values were good to excellent in all intra- and inter-rater tests (0.88-0.97). MDC₉₅ values ranged from 19% to 23%. Moreover, a small but statistically significant learning effect was observed in all tests.

CONCLUSIONS: The STS_5r, STS_1min and TUG tests are valid and reliable to assess functional capacity of hospitalized burn victims, despite a small learning effect indicating the need to perform two tests. SEM and MDC values here described can be used in clinical practice to improve interpretability of the tests’ results.

PMID:42296604 | DOI:10.1016/j.burns.2026.108084

Burns. 2026 May 22;52(8):108076. doi: 10.1016/j.burns.2026.108076. Online ahead of print.

ABSTRACT

PURPOSE: This study evaluated the clinical efficacy and safety of amniotic membrane transplantation (AMT) enhanced with a fornix support ring for the treatment of severe acute ocular burns.

METHODS: Eighteen eyes of 15 patients with severe ocular burns (Grades III and IV) were included. Twelve eyes received AMT alone, while six eyes received AMT combined with a fornix support ring. Clinical outcomes, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), and postoperative complications, were monitored over a follow-up period of 3-28 months.

RESULTS: In the Grade III burn group, the addition of a fornix support ring to AMT significantly reduced the incidence of entropion and trichiasis compared to AMT alone (p = 0.018 for both). While the differences in symblepharon, keratitis, BCVA, and IOP changes did not reach statistical significance, clinical improvements were noted. Although statistical significance was not achieved in the Grade IV burn group, the group with the fornix support ring showed a reduced incidence of keratitis and other clinical differences.

CONCLUSIONS: This study demonstrated that the fornix support ring is a reliable and effective option for enhancing surgical outcomes in acute ocular burns. By deepening the fornices, improving amniotic membrane adhesion, and reducing the need for extensive suturing, the ring significantly decreases the occurrence of complications, such as symblepharon, entropion, and trichiasis.

PMID:42296600 | DOI:10.1016/j.burns.2026.108076

Burns. 2026 Jun 1;52(8):108098. doi: 10.1016/j.burns.2026.108098. Online ahead of print.

ABSTRACT

BACKGROUND: Hypothermia is common after major burn injury and may influence both systemic and wound-related outcomes. Although hypothermia has been associated with coagulopathy and higher rates of mortality in the trauma patient cohort, limited literature has examined its effects on the outcomes for patients with burns. The aim of this study was to identify the rate of hypothermia in patients transferred to a specialised burn unit, and to assess the impact on morbidity and mortality.

METHODS: This retrospective, single-centre study examined all burns presentations between 2009-2013. Hypothermia was defined as a core body temperature ≤ 35 °C on arrival. Statistical analysis used logistic regression for binary outcomes and negative binomial models for continuous outcomes. Multivariable logistic regression assessed hypothermia using continuous age, total body surface area burned (TBSA), and their interactions.

RESULTS: Of 268 patients with recorded temperature, 41 (15%) were hypothermic. Hypothermia increased with burn size (11.6% in <20% TBSA vs 35.7% in >50% TBSA; p < 0.01). Hypothermic patients had higher mean age (46.6 vs 41.0 years; p < 0.05) and larger burns (22.8% vs 14.7% TBSA; p < 0.01). Adequate first aid and use of the modified Parkland Formula were less frequently documented in hypothermic patients (75.7% vs 92.3% and 60.7% vs 79.5%, respectively; both p < 0.01). There was no significant difference in burn size across age groups (p = 0.918). On multivariable analysis, increasing TBSA was independently associated with hypothermia, whereas age was not, and no significant age-TBSA interaction was identified (p = 0.647). Hypothermia was associated with higher in-hospital mortality (14.6% vs 3.5%), longer ICU LOS (4.39 vs 2.33 days), and higher sepsis rates (9.8% vs 2.6%); but lower rates of skin grafting (36.6% vs 51.1%) and shorter hospital LOS (17.3 vs 19.7 days). On multivariable analysis, hypothermia independently predicted mortality, LOS, grafting, wound infection and sepsis.

CONCLUSIONS: Hypothermia remains common in burn patients transferred to a tertiary centre in NSW and is associated with larger burns, a higher average age, reduced adherence to early management protocols and poorer systemic outcomes despite reduced grafting rates and shorter hospital admissions.

PMID:42296598 | DOI:10.1016/j.burns.2026.108098

Cancer Radiother. 2026 Jun 15;30(2):104828. doi: 10.1016/j.canrad.2026.104828. Online ahead of print.

ABSTRACT

PURPOSE: Modern adjuvant therapies, including systemic treatments and radiotherapy, have significantly improved outcomes for patients with breast cancer. However, isolated nodal recurrences remain rare, comprising less than 1 % of cases, and pose a therapeutic challenge, with historical 5-year overall survival rates below 50 %. This study evaluated the clinical outcomes of patients with isolated nodal recurrences in the modern era using the Surveillance, Epidemiology, and End Results (SEER) database and examined factors associated with survival.

MATERIALS AND METHODS: We analysed data from 1479 female patients with cT0N+M0 breast cancer diagnosed between 2000 and 2021 in the SEER database. Patients were categorized as having isolated nodal recurrences if they had prior ipsilateral breast cancer or occult primary breast cancer if presenting with a first cancer diagnosis. Demographics, tumour characteristics, and treatments were recorded. Survival outcomes were assessed using Kaplan-Meier and Cox regression models.

RESULTS: Of 1479 patients, 42 (2.8 %) had isolated nodal recurrences, and 1437 (97.2 %) had occult primary breast cancer. Median time to isolated nodal recurrences was 105 months. Most initial tumours were early-stage (T1-T2, 75 %) and node-negative (78.6 %). Five-year overall- and cancer-specific survival rates of patients with isolated nodal recurrences were 72.4 % (95 % confidence interval [CI]: 57.6-91.0 %) and 81.5 % (95 % CI: 67.8-97.9 %), respectively, compared to 80.4 and 86.6 % for patients with occult primary breast cancer. Trends toward improved survival with adjuvant chemotherapy (5-year overall survival rates: 78.0 versus 68.0 %) and radiotherapy (5-year overall survival rates: 83.6 versus 63.2 %) were observed but not statistically significant. No survival benefit was found for total mastectomy in cases of isolated nodal recurrences following breast-conserving surgery.

CONCLUSION: This study showed encouraging survival outcomes for patients with isolated nodal recurrences in the modern era, with 5-year overall survival exceeding historical benchmarks. Comparable survival between patients with isolated nodal recurrences and occult primary breast cancer highlights the potential for curative approaches. Further research is required to refine treatment strategies and identify patient subgroups that may benefit from tailored therapies.

PMID:42296574 | DOI:10.1016/j.canrad.2026.104828

Eur J Surg Oncol. 2026 Jun 12;52(8):111946. doi: 10.1016/j.ejso.2026.111946. Online ahead of print.

ABSTRACT

OBJECTIVE AND BACKGROUND: The optimal surgical strategy for patients with hepatocellular carcinoma (HCC) and liver fibrosis/cirrhosis presenting with a future liver remnant to standard liver volume (FLR/SLV) ratio of 30%-40% remains a subject of clinical controversy. This study aimed to evaluate the safety and efficacy of one-stage hepatectomy (OSH) versus Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) and to validate the feasibility of OSH by benchmarking it against the standard safety criterion (FLR/SLV ≥40%).

METHODS: We conducted a retrospective analysis of 219 patients with HBV-related HCC and liver fibrosis/cirrhosis who underwent right hemihepatectomy. Patients were stratified into three groups: the OSH group (FLR/SLV 30%-40%, n = 62), the ALPPS group (FLR/SLV 30%-40%, n = 20), and the standard control group (FLR/SLV ≥40% undergoing OSH, n = 137). Perioperative outcomes, including post-hepatectomy liver failure (PHLF) and complications, as well as long-term overall survival (OS) and disease-free survival (DFS), were compared.

RESULTS: In the 30%-40% cohort, the incidence of severe PHLF (ISGLS Grade B or C) in the ALPPS group was comparable to that of the one-stage hepatectomy group (P = 0.128), and no 90-day mortality was observed in either group. However, in terms of severe postoperative complications (Clavien-Dindo grade ≥ IIIa), the ALPPS group demonstrated a higher incidence rate compared to the one-stage hepatectomy group, although the difference did not reach statistical significance (P = 0.082). Long-term oncological outcomes, including OS and DFS, were comparable between the OSH and ALPPS groups (p > 0.05). Furthermore, benchmarking analysis revealed preliminary observations that patients in the OSH group (30%-40%) achieved perioperative and long-term outcomes comparable to those in the standard control group (≥40%) (p > 0.05).

CONCLUSIONS: For selected HCC patients with liver fibrosis/cirrhosis and FLR/SLV ratio of 30%-40% undergoing standardized right hemihepatectomy, one-stage hepatectomy might serve as a safe and feasible alternative to ALPPS, though large-scale prospective validation is warranted.

PMID:42296572 | DOI:10.1016/j.ejso.2026.111946

JMIR Mhealth Uhealth. 2026 Jun 15;14:e83162. doi: 10.2196/83162.

ABSTRACT

BACKGROUND: The first 2000 days can profoundly influence long-term health. Healthy Beginnings for Hunter New England Kids (HB4HNEKids) is an SMS text messaging program delivered alongside routine Child and Family Health Nursing (CFHN) care, which provides families with evidence-based, age- and stage-related preventive health information across the first 2000 days.

OBJECTIVE: This pilot study aimed to explore the feasibility, engagement, and acceptability of the HB4HNEKids program. It also aimed to explore the potential effectiveness of the program at 6 and/or 12 months post partum on outcomes including breastfeeding, child diet, child movement, and parental mental well-being.

METHODS: During the pilot phase (October 2021 to July 2024), project records were used to assess the number of families enrolled, number of SMS text messages sent (feasibility), and the number of opt outs (engagement). Repeat cross-sectional surveys were conducted at 5-7 months post partum and again at 12-14 months post partum using validated survey instruments. Using convenience sampling methods, survey participants consisted of birthing parents who had received HB4HNEKids and a concurrent nonrandomized comparison group that did not receive the program. Surveys assessed parental self-reported engagement with the messages, program acceptability, breastfeeding status, child diet, child movement, and parental mental well-being. Mixed linear regression analyses were conducted to calculate mean differences and odds ratios.

RESULTS: During the pilot phase, HB4HNEKids was delivered to 6243 families (73.4% of families contacted by CFHN). A total of 383 birthing parents completed the survey at 6 months (99/383, 26% receiving HB4HNEKids), and 283 completed the survey at 12 months (104/283, 37% receiving HB4HNEKids). Of the survey participants who received HB4HNEKids (n=200), between 76% and 83% reported that they always or very often read the SMS text messages, spending on average 5-7 minutes engaged with the content. At both survey time points, more than 90% of participants receiving HB4HNEKids agreed that the program was acceptable. Child daily intake of vegetables was significantly higher in the HB4HNEKids group (adjusted mean difference 0.23, 95% CI 0.07-0.40; P=.006) than in the comparison group at 12 months. Parents receiving HB4HNEKids also reported significantly better mental well-being scores (P=.005). While HB4HNEKids participants reported breastfeeding rates 5 percentage points greater than comparison participants at 6 and 12 months, this result was not statistically significant. There were no statistically significant differences between HB4HNEKids, and comparison participant responses related to child movement behaviors.

CONCLUSIONS: The HB4HNEKids SMS text messaging program is feasible to deliver at scale alongside routine CFHN care and is highly acceptable and engaging to parents. This pragmatic evaluation of the pilot, embedded into usual care, indicates potential effectiveness of the program for improving child vegetable intakes and parental mental well-being. Further evaluation of this program using robust methodology is needed to determine the effectiveness of this innovative mHealth program across the first 2000 days.

PMID:42296558 | DOI:10.2196/83162

JMIR Mhealth Uhealth. 2026 Jun 15;14:e77736. doi: 10.2196/77736.

ABSTRACT

BACKGROUND: The benefits of multidisciplinary rehabilitation programs on pain and function in people with chronic low back pain (CLBP) are fairly well documented in the literature. However, these positive effects tend to fade over time due to low long-term patient adherence.

OBJECTIVE: The study aimed to evaluate the impact of a smartphone app on adherence to an exercise program for people with CLBP at 6 months. The secondary aims were to assess the effectiveness of the app on pain, disability, fears, and beliefs related to physical activity, physical capacity, and qualitative adherence (correctness of exercise execution) at 6 months.

METHODS: A total of 110 people with CLBP were included and randomized into 2 groups: 54 in the intervention group (IG) who received education on the use of the app in addition to usual care (a 3-week multidisciplinary rehabilitation program with self-management education) and 56 in the control group (CG) who received only usual care. Part B of the Exercise Adherence Rating Scale was used as the primary outcome to assess adherence to the 6-month exercise program. Secondary outcomes were pain (Numeric Rating Scale), disability (Oswestry Disability Index), barriers and facilitators to performing physical activity (Evaluation of Physical Activity Perception), physical capacity (battery of tests), and qualitative adherence (correctness of exercise execution). Statistical analyses were performed according to the intention-to-treat principle. A linear mixed model compared the primary end point between the groups at 6 months.

RESULTS: A total of 71 of 110 participants (n=35 in the CG vs n=36 in the IG) were evaluated at 6 months. We did not observe any significant difference in the Exercise Adherence Rating Scale score between the CG and the IG (group difference 0.01, 95% CI -2.4 to 2.4; P=.97). The same findings were found for pain, disability, and barriers and facilitators to physical activity, except for the motivation criterion. The 6-Minute Walk Test (group difference [log] 0.06, 95% CI 0.01-0.12; P=.06), cycle ergometer (group difference 9.30, 95% CI 0.48-18.13; P=.04), Ito (group difference [log] 0.31, 95% CI 0.01-0.62; P=.04), plank (group difference [log] 0.29, 95% CI 0.03-0.54; P=.03), and qualitative adherence (IG mean 12.6, SD 1.3 vs CG mean 11.4, SD 1.4; P=.02) differed between the groups in favor of the IG. All outcomes improved from baseline to 6 months in the IG but not in the CG.

CONCLUSIONS: The smartphone app did not impact adherence to an exercise program at 6 months in individuals with CLBP. Similar results were found for pain and function. Nevertheless, the app could be a useful self-management tool in view of the positive effects on physical capacity and qualitative adherence.

PMID:42296544 | DOI:10.2196/77736

JMIR Form Res. 2026 Jun 15;10:e91608. doi: 10.2196/91608.

ABSTRACT

BACKGROUND: The mortality rate from liver disease among people with type 2 diabetes mellitus (T2DM) increased by 20% between 2001 and 2018. There are marked racial and ethnic differences among people with T2DM at risk of metabolic dysfunction-associated steatotic liver disease (MASLD) and related complications.

OBJECTIVE: We aimed to investigate the distribution of individual-level social determinants of health (SDOH) in people living with both T2DM and MASLD.

METHODS: In this small cross-sectional study, patients (N=50) were recruited from a tertiary care general hepatology clinic to complete a survey that assessed potential determinants of health. We sought to oversample Black and Hispanic patients to better understand the prevalence of SDOH. Electronic health records were reviewed to determine stage of liver disease, and these data were linked to survey results to identify the distribution of individual-level determinants of health in patients with cirrhosis.

RESULTS: Black and Hispanic respondents were more likely to report more experiences of racial discrimination, worries about being discriminated against, and group-based medical mistrust, especially regarding unsupportive health care providers. Cirrhosis groups tended to have lower incomes and less coverage from private health insurance. However, no substantial trends were observed in the distribution of health literacy, discrimination, and diabetes stigma among patients with and without cirrhosis.

CONCLUSIONS: These findings will inform a future study aimed at assessing and developing interventions to address the combined impact of individual- and neighborhood-level SDOH on health-related outcomes in patients with T2DM and MASLD.

PMID:42296541 | DOI:10.2196/91608

J Med Internet Res. 2026 Jun 15;28:e95562. doi: 10.2196/95562.

ABSTRACT

BACKGROUND: Refugees frequently face language and access barriers to preventive oral health information. Brief multilingual digital interventions may help reduce such barriers in shelter settings.

OBJECTIVE: This randomized controlled trial evaluated whether a multilingual digital microlearning video improved plaque control and selected self-reported oral health-related behaviors among adults living in refugee shelters.

METHODS: A 2-arm, parallel-group randomized controlled trial was conducted among 86 adults living in 2 municipal refugee shelters in Germany. Participants were randomized (1:1) to receive either a multilingual 4-minute oral hygiene microlearning video or delayed access (control group). Plaque index and gingival index were assessed clinically at baseline and at 2-month follow-up. Secondary outcomes included questionnaire-based measures of oral health literacy-related cognitions and self-reported oral health behaviors. Between-group differences in change scores were analyzed using 2-sided tests; exploratory multivariable regression analyses were conducted to assess potential effect modifiers.

RESULTS: Follow-up was completed by 83 (97%) of 86 participants. Plaque index decreased more in the intervention group than in the control group (mean change -0.21, SD 0.27 vs mean change -0.04, SD 0.17; P=.002). Gingival index decreased in both groups, but the between-group difference was not significant. Among questionnaire-based outcomes, toothbrushing frequency increased substantially, whereas the remaining oral health literacy-related items showed small numerical changes that did not reach statistical significance or remained stable. Approximately three-quarters of participants in the intervention group (32/42, 76%) reported reviewing the video at least once.

CONCLUSIONS: Brief multilingual digital microlearning improved plaque control and self-reported toothbrushing frequency in refugee shelters. Effects on broader oral health literacy-related outcomes were limited and should be interpreted cautiously. Larger, prospectively powered trials with longer follow-up periods and blinded outcome assessment are warranted.

PMID:42296536 | DOI:10.2196/95562

JMIR Res Protoc. 2026 Jun 15;15:e88001. doi: 10.2196/88001.

ABSTRACT

BACKGROUND: As the first peoples of Australia, Aboriginal and Torres Strait Islander peoples have continuing cultures that are essential to wellbeing. Complex sociocultural, health, and wellbeing inequities stemming from colonization, settler-colonialism, and mental health system challenges have led to high rates of negative mental health and wellbeing for Aboriginal and Torres Strait Islander peoples. Improving Aboriginal and Torres Strait Islander mental health and wellbeing outcomes is a national public health priority. Social and emotional wellbeing (SEWB) and the cultural determinants of health (CDH) provide evidence-based approaches for providing culturally centered wellbeing support. There is a need to increase the availability, accessibility, and effectiveness of culturally relevant, holistic, and strengths-based wellbeing supports. It is essential that Aboriginal communities have self-determined opportunities to develop and implement culturally centered wellbeing supports informed by SEWB and the CDH. Aboriginal digital health and wellbeing support research is an emerging field offering potential to help improve wellbeing outcomes. This study aims to explore how virtual reality (VR) could be used to provide SEWB and CDH support for Aboriginal and Torres Strait Islander peoples.

OBJECTIVE: This study protocol outlines a 3-phase mixed-methods approach that will inform the co-design and codevelopment of a VR application that aims to provide SEWB and CDH support. In partnership with Tribal Warrior, an Aboriginal Community Controlled Organization, Studio Gilay, an Aboriginal-led animation and storytelling studio, and Phoria, an Australian immersive storytelling technology company, this study will assess cultural relevance, acceptability, and feasibility of the VR application.

METHODS: Using Indigenist and Participatory Action Research methodologies, purposive sampling will be used to recruit 35 Tribal Warrior staff and Aboriginal community members to participate in each phase of research. Qualitative data collection will occur in each phase through yarning circles. Reflexive thematic analysis will guide qualitative analysis. Phase 3 will involve a quantitative survey, generating cultural relevance, acceptability, and feasibility evidence. Descriptive statistics analysis will be used to report results.

RESULTS: As of April 2026, data collection and analysis for phases 1 and 2 are complete. This study will culminate in the development and assessment of a co-designed and codeveloped VR application that aims to provide SEWB and CDH support for Aboriginal peoples. Findings from each phase will be published in academic papers and nonacademic outputs. The VR application will be implemented by Tribal Warrior into existing community programs and supports.

CONCLUSIONS: Findings from this study have potential implications for improving availability and accessibility to culturally centered wellbeing supports for Aboriginal and Torres Strait Islander peoples. Assessing the cultural relevance, acceptability, and feasibility of using VR technology to provide culturally centered wellbeing support will contribute novel evidence to the fields of public health, digital health, and design-based research.

PMID:42296535 | DOI:10.2196/88001