Category: Statistics

Addiction. 2026 May 26. doi: 10.1111/add.70474. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: With expanding cannabis legalization, normalization, and diversifying products and delivery methods in the United States (US), cannabis use disorder (CUD) prevalence is rising. Various modes of cannabis use may influence pharmacokinetics, usage patterns, and harm, affecting CUD risk. We measured associations between modes of cannabis use, including multi-modal patterns, and CUD prevalence and severity.

DESIGN AND SETTING: This cross-sectional study analyzed data from a nationally representative sample of US adults using the 2022-2023 National Survey on Drug Use and Health (NSDUH) data. Multivariable logistic regression analyses were employed to estimate the association between modes of cannabis use and past-year CUD, adjusting for potential confounders and covariates. Analyses were stratified by sex, age, and cannabis use frequency. Among multi-modal users, common combinations and their associations with CUD were further examined.

PARTICIPANTS/CASES: Respondents 18 years or older who reported past-year cannabis use (unweighted n = 25 549; weighted N = 58 850 309).

MEASUREMENTS: Exposure of interest was the mode of cannabis use, primarily categorized as smoke-only, vape-only, oral/mucosal-only, dab-only, topicals-only, and multi-modal (≥ two modes). The outcome variable was CUD in the past year, and CUD severity, based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Covariates included age, sex, race/ethnicity, income, education, state cannabis law status, age of cannabis initiation, cannabis use motive, frequency of use, perceived risk of smoking cannabis, illicit drug use, past year mental illness, nicotine dependence, and alcohol use disorder.

FINDINGS: Of the total past-year cannabis users, 53.9% reported multi-modal cannabis use. Overall, CUD prevalence was 30.3%, ranging from 4.4% among oral/mucosal-only to 40.5% among multi-modal, and 28.9% among dab-only users (p < 0.0001). Moderate-to-severe CUD affected 13.2% of all users and was concentrated among multi-modal and dab-only users. In multivariable regression, multi-modal users had fourfold higher odds of CUD (adjusted odds ratio [AOR] = 4.14; 95% confidence interval [CI]: 2.91-5.90). Elevated odds were also observed among smoke-only (AOR = 2.98; 95% CI: 2.02-4.39) and vape/dab-only users (AOR = 1.89; 95% CI: 1.09-3.29), compared with oral/mucosal-only users. Analyses of multi-modal combinations showed the highest CUD odds among those using smoke + vape + oral/mucosal + dab (AOR = 19.74; 95% CI: 9.11-42.75), compared with oral/mucosal + topicals users.

CONCLUSIONS: In the United States, modes of cannabis use appear to be statistically significantly associated with prevalence and severity of cannabis use disorder, with multi-modal and inhaled routes conferring the greatest risk. Findings underscore the importance of considering mode of use alongside frequency and potency in clinical assessment, prevention, and policy strategies aimed at reducing cannabis-related harms.

PMID:42186749 | DOI:10.1111/add.70474

J Sleep Res. 2026 May 26:e70368. doi: 10.1111/jsr.70368. Online ahead of print.

ABSTRACT

Chronic spinal pain is associated with fragmented sleep, yet the neurophysiological mechanisms linking the two remain unclear. Given their role in sensory gating and sleep stability, sleep spindles may represent a key mechanism connecting chronic spinal pain and sleep fragmentation. This study examined whether pain intensity over the past 4 weeks was associated with sleep spindle density and related characteristics in individuals with chronic low back or neck pain and chronic insomnia disorder. Data from 120 participants, classified by self-reported pain severity (mild, moderate, severe), were compared on spindle density derived from C4-A1A2 and F4-A1A2 EEG channels. No significant group differences were found in spindle density (respectively, C4: p = 0.372 and F4: p = 0.744). Regression analyses adjusted for age, sex and medication use showed that pain intensity did not significantly predict spindle density (p > 0.05). However, exploratory regression models revealed small but statistically significant associations between pain intensity and both spindle power (p = 0.047) and amplitude (p = 0.038) on the C4 channel. These findings suggest that while spindle density does not vary meaningfully with pain intensity in this clinical population, alterations in spindle power and amplitude may reflect pain-related modulation of thalamocortical activity. This highlights the complexity of pain-sleep interactions in the presence of chronic spinal pain and insomnia. More nuanced, temporally resolved assessments of pain are needed to clarify the dynamic interactions between chronic pain, insomnia, and sleep microarchitecture.

PMID:42186730 | DOI:10.1111/jsr.70368

Chem Res Toxicol. 2026 May 26. doi: 10.1021/acs.chemrestox.6c00057. Online ahead of print.

ABSTRACT

Early warning systems (EWSs) are currently being developed by various authorities aiming at identifying potentially hazardous chemicals before they become a threat to the environment and human health. In this context, patents provide an excellent data source for exploring novel chemistry or the use of chemicals in materials and products. However, analysis of patents is challenging, including unraveling molecular structures presented as graphics depicting various elements, functional groups, and molecular bonds. Our study aims to improve EWS using automated artificial intelligence-based molecular structure recognition methods for encoding these for further hazard analysis. Current structure extraction tools are primarily trained on chemical structures collected from publicly available data sets, and the application of these tools to patent-specific chemical data has received little attention. This paper presents a field study utilizing the three tools Decimer, Molscribe, and Mathpix and assesses their performance in recognizing chemical structures in patents. Two data sets were compiled and curated including (1) diverse organic chemicals and (2) per- and polyfluoroalkyl substances (PFAS). It was revealed that these tools perform well on simpler molecular structures, whereas they struggle with more complex structural features, including repetitive units, cross-bonding, and Markush structures. Furthermore, it was discovered that these tools are extremely sensitive to image artifacts such as noise from lines and dots or distortions. Overcoming these challenges will be critical before implementation in automated EWS and thereby enable screening of patents for rapid and effective identification of potentially hazardous emerging chemicals.

PMID:42186716 | DOI:10.1021/acs.chemrestox.6c00057

Pulmonology. 2026 Dec;32(1):2671584. doi: 10.1080/25310429.2026.2671584. Epub 2026 May 26.

ABSTRACT

BACKGROUND: Respiratory syncytial virus (RSV) is an important cause of acute respiratory infection (ARI), but its burden in Portuguese adults remains under-investigated.

METHODS: This single-centre retrospective database cohort study examined RSV-ARI hospitalisations in adults aged ≥18 years over six consecutive seasons (2018/19 to 2023/24), a period which includes years impacted by COVID-19 disruptions. Outcomes included the prevalence of RT-PCR-confirmed RSV-ARI among tested ARI admissions, clinical features and adverse outcomes, healthcare resource use and direct costs; outcomes were also described for influenza-ARI to provide context. Analyses were descriptive without any comparison between the groups.

RESULTS: Of 7,125 ARI-hospitalisations 3,011 underwent RSV/influenza testing. The overall prevalence of RT-PCR-confirmed RSV-ARI and influenza-ARI in tested admissions was 8.1% and 20.3%, respectively. The study included 244 RSV-ARI and 612 influenza-ARI admissions, most ≥60 years old; 77.1% of RSV-ARI admissions and 61.4% of influenza-ARI admissions involved high-risk patients with comorbidities. Complications within 90 days were frequent, including acute cardiac events (RSV-ARI, 47.1%; influenza-ARI, 38.2%), respiratory failure (46.3% and 31.5%), pneumonia (34.0% and 22.4%) and acute renal disease (34.0% and 29.3%). All-cause in-hospital mortality was 19.7% for RSV-ARI (influenza-ARI, 12.8%). Mean length of stay for RSV-ARI was 8.5 days (interquartile range ([IQR], 9.7) with a mean cost of €4 757; for influenza-ARI, 7.4 days (IQR 8.9) and €3 537, respectively.

CONCLUSIONS: RSV represents an important cause of ARI-hospitalisation in older adults, especially in those with comorbidities, with a substantial clinical and economic burden, which was similar or higher than influenza (GSK study identifier: VEO-000773).

PMID:42186711 | DOI:10.1080/25310429.2026.2671584

JPEN J Parenter Enteral Nutr. 2026 May 26. doi: 10.1002/jpen.70106. Online ahead of print.

NO ABSTRACT

PMID:42186708 | DOI:10.1002/jpen.70106

J Periodontol. 2026 May 26. doi: 10.1002/jper.70145. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to evaluate the impact of smoking on root coverage outcomes, comparing healing responses at 3-12 months following coronally advanced flap with a connective tissue graft (CAF+CTG).

METHODS: This prospective cohort study included 27 participants (13 smokers, 14 non-smokers) who required root coverage for a single Cairo Type 1 defect. Smoking status was biochemically verified (salivary cotinine). Clinical parameters, including recession depth and width, keratinized tissue width, and percentage of root coverage, were assessed at baseline, 3 months, and 12 months postoperatively. Statistical analysis employed both parametric and non-parametric tests to assess intra- and inter-group differences.

RESULTS: Compared with 3 months, both groups demonstrated increases in recession depth and decreases in percentage root coverage at 12 months. Median (interquartile range) recession depth increased from 1.0 (0.0-1.0) mm at 3 months to 1.0 (1.0-2.0) mm at 12 months in smokers, and from 0.0 (0.0-0.8) mm to 0.5 (0.0-1.0) mm in non-smokers. Root coverage percentage was significantly higher in non-smokers at 12 months, with 87.5% achieving root coverage compared with 66.6% in smokers (p = 0.024). Keratinized tissue width increased at 12 months, compared with 3 months, in both groups, from 5.08 ± 1.21 (mean ± SD) to 5.36 ± 1.80 mm and from 5.64 ± 1.59 to 5.77 ± 1.25 mm in smokers and non-smokers, respectively.

CONCLUSIONS: The negative impact of smoking on CAF+CTG outcomes became statistically detectable at 12 months postoperatively, a finding underscoring the need to consider smoking status when treatment planning and discussing expectations with patients.

PLAIN LANGUAGE SUMMARY: This study explored how smoking affects healing after a common gum surgery used to cover exposed tooth roots. We followed two groups of patients, smokers and non-smokers, for 1 year after they received the same treatment, which involved repositioning the gum and adding a tissue graft from the palate. At first, both groups showed good early healing, but differences emerged over time. By 12 months, smokers showed more return of gum recession and achieved less complete root coverage than non-smokers. Although most non-smokers maintained full coverage of the treated tooth, this was true for far fewer smokers. Both groups did show some healthy growth of the firm gum tissue around the tooth, but this did not offset the long-term disadvantage seen in smokers. These findings suggest that the harmful effects of smoking may not be obvious in the early months after surgery but become clearer as healing continues. Understanding this gradual difference can help dentists to guide patients more effectively, especially those who smoke, by setting realistic expectations and highlighting how smoking may limit the long-term success of treatment.

PMID:42186701 | DOI:10.1002/jper.70145

BMC Sports Sci Med Rehabil. 2026 May 26. doi: 10.1186/s13102-026-01767-w. Online ahead of print.

ABSTRACT

BACKGROUND: The present study aims to examine the impact of badminton training programs on the attention and motor skills performance of students with specific learning disabilities (SLDs).

METHODS: The study was carried out with students at a public middle school. The study group consisted of a total of 44 volunteer students with SLD, with 22 participants in the experimental group (mean age 12.41 ± 0.90) and 22 participants in the control group (mean age 11.64 ± 0.49). Over a 12-week period, the experimental group regularly participated in two hours of badminton training per week in addition to their daily activities. Meanwhile, the control group was not included in any additional physical activity program and maintained their daily routines. Prior to the start of the study, information regarding the participants was recorded using a personal information form. The Bourdon Attention Test, Togu Balance Test, and Sit-and-Reach Flexibility Test were administered to the participants prior to the study and following the badminton training. To isolate the impact of differences in pre-test scores between the groups on the post-test, an Analysis of Covariance (ANCOVA) for Repeated Measures was conducted.

RESULTS: Following the 12-week badminton training program, a statistically significant difference was observed in terms of the pre- and post-test results for balance and attention performance in the experimental group (p < 0.05), while no statistically significant difference was found in terms of the pre- and post-test results for flexibility performance (p > 0.05). In the control group, no statistically significant differences were identified in the pre- and post-test results for any of the parameters (p > 0.05).

CONCLUSIONS: It can be concluded that the 12-week badminton training program is an effective method for improving static balance and selective attention skills in students with SLD. However, it is thought that more long-term or specific exercise content may be needed to achieve changes in flexibility.

PMID:42185927 | DOI:10.1186/s13102-026-01767-w

BMC Endocr Disord. 2026 May 25. doi: 10.1186/s12902-026-02332-9. Online ahead of print.

ABSTRACT

BACKGROUND: Metformin is the preferred initial therapy for type 2 diabetes mellitus (T2DM) and gradual upward dose titration is recommended to reach target blood glucose levels. The aim of this study was to assess the pattern of metformin dose up-titration and its effect on glycemic control among T2DM patients.

METHODS: A retrospective cohort study of people with T2DM was conducted at Ayder Comprehensive Specialized Hospital from January to March 2020. Participants with fasting plasma glucose above 140 mg/dl after one month of initiating metformin were followed over the course of treatment. Multivariable binary logistic regression models were used to evaluate independent variables associated with metformin dose up-titration and glycemic control. The output of the logistic regression was expressed as adjusted odds ratios at 95% confidence intervals. Test results were considered statistically significant when p < 0.05. A total of 284 T2DM patients on metformin were included in the study.

RESULTS: The mean age and SD of the study participants was 54.0 ± 10.5. Metformin dose was up-titrated at least once in 61.6% of the study participants. Almost half of the study participants had achieved glycemic control (HbA1c ≤ 7). Having a duration of treatment less than five years, initiating metformin at a daily dose of 500 mg and the addition of hypoglycemic medications were independent predictors of metformin dose up-titration. T2DM patients whose metformin dose was up-titrated had two times higher odds of having controlled blood glucose levels compared to those not up-titrated (P-value: 0.015; OR: 1.823; 95% CI: 1.121-2.963). A gradual metformin dose titration at later than the 4th month was associated with better glycemic control. T2DM patients whose metformin dose was titrated only once were less likely to achieve glycemic control (P-value: 0.038; OR: 0.482; 95% CI: 0.242-0.962).

CONCLUSIONS: In this resource-constrained setting, metformin dose up-titration was less commonly practiced than adding another hypoglycemic agent in the management of T2DM. However, dose up-titration was associated with a higher likelihood of achieving glycemic control. These findings suggest that optimizing metformin dosing may improve glycemic outcomes before intensifying therapy with additional agents, although prospective studies are needed to confirm this association.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42185896 | DOI:10.1186/s12902-026-02332-9

BMC Oral Health. 2026 May 26. doi: 10.1186/s12903-026-08626-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Immediate implant placement with flap elevation and guided bone regeneration in Type II sockets often leads to midfacial gingival recession and compromised esthetics. To address these limitations, vestibular socket therapy (VST) has been proposed as an alternative technique. Our objective is to compare vestibular socket therapy using pericardium membrane versus conventional flap and guided bone regeneration (GBR) for immediate implant placement in type II sockets regarding bone and soft-tissue outcomes.

MATERIALS AND METHODS: Twenty patients with Type II sockets were divided into two equal groups. Group-I: received immediate implant placement through a vestibular incision with pericardium membrane placement; the defect was grafted with a mixture of allograft and xenograft. Group-II: received immediate implant placement with conventional open-flap surgery using the same membrane and grafting materials. Radiographic evaluation of labial bone was performed at 3 and 6 months using CBCT assessments. Volumetric analyses of buccal soft-tissue contours were recorded preoperatively and at 6 months. Clinical assessment of pink esthetic score (PES) and modified sulcus bleeding index (mSBI) also were performed at 6 months.

RESULTS: Both groups showed statistically significant increases in buccal bone thickness and height from baseline to 3 and 6 months. Volumetric change and mSBI values demonstrated no statistically significant differences between groups (p > 0.05). Mean PES was significantly higher in the study group (12.78 ± 0.83) compared to controls (11.56 ± 1.24) (p = 0.03).

CONCLUSIONS: Pericardium membrane with VST offers a promising approach for immediate implant placement in type-II sockets, achieving predictable bone regeneration and better esthetic outcomes, as reflected by higher PES.

TRIAL REGISTRATION: Retrospectively registered at ClinicalTrials.gov (NCT07337837) (13/1/2026).

PMID:42185891 | DOI:10.1186/s12903-026-08626-7

BMC Med Educ. 2026 May 26. doi: 10.1186/s12909-026-09524-w. Online ahead of print.

ABSTRACT

BACKGROUND: Flexible bronchoscopic intubation (FBI) is a vital skill for anaesthesiologists managing difficult airways. Traditional training models often fail to replicate real difficult airway scenarios, limiting their educational value. This study aimed to assess the effectiveness of three-dimensional (3D) printed difficult airway models, developed from patient CT/MRI images, in improving FBI skills among anaesthesia residents compared to conventional manikin models.

METHODS: Twenty-eight anaesthesia residents were randomised equally into the 3D-printed model group and the AirSim manikin group. Each resident received a standardised lecture, followed by FBI training using their assigned model and then a crossover with the alternate model. Educational effectiveness was assessed using a global rating scale, performance on the ORSIM simulator scenarios, and a trainee-reported questionnaire measuring suitability, realism, and educational effectiveness.

RESULTS: The global rating scales of operative performance and FBI time improved significantly after training in both groups. The post-training performance on the ORSIM simulator did not differ significantly between both groups. Compared with the AirSim manikin model, the 3D-printed model had a higher trainee-reported educational effectiveness (8.6 ± 1.0 vs. 7.9 ± 1.0; p = 0.050). Exploratory post-hoc analyses suggested that prior FBI experience modified the training response.

CONCLUSIONS: Both 3D-printed difficult airway models and conventional manikins were associated with improvement in FBI performance, with no statistically significant between-group differences in objective skill-acquisition outcomes. Trainees perceived the 3D-printed model as more educationally effective.

TRIAL REGISTRATION: Not applicable. The study was launched based on simulation models and without enrollment of patients nor animals; hence the protocol registration number was not attributed.

PMID:42185890 | DOI:10.1186/s12909-026-09524-w