Category: Statistics

JMIR Dermatol. 2026 Jun 23;9:e91126. doi: 10.2196/91126.

ABSTRACT

BACKGROUND: Acne is a chronic skin condition that primarily affects adolescents and young adults but can persist into adulthood. It can have repercussions on physical and mental health, self-esteem, and body image. The increasing use of social media for health information and peer support offers an opportunity to explore real-life experiences with acne.

OBJECTIVE: This study aims to analyze social media messages from users in the United States and the United Kingdom using artificial intelligence to assess the impact of acne on quality of life (QoL), identify discussion topics, and explore unmet needs.

METHODS: The data were extracted from public platforms using a query containing the word “acne” between January 1 and December 31, 2024. Data cleaning and filtering were performed using natural language processing, machine learning methods, and algorithms. Biterm topic modeling was used to identify the main discussion topics, and QoL impact was assessed using a deep learning algorithm adapted from the EuroQol 5-Dimension Questionnaire or the 36-Item Short Form Health Survey. Unmet needs were identified through manual annotation using the saturation method.

RESULTS: A total of 646,809 messages posted by 432,234 users were identified. The main topics included skincare routines and product recommendations (n=154,907, 23.9%), acne scars (n=135,643, 21%), and general treatment information (n=97,177, 15%). Engagement varied across topics and platforms. On Instagram, dietary and nutritional strategies (0.16%, SD 6.36%) showed the highest mean engagement, followed by skincare routines and product recommendations (0.11%, SD 4.81%). In general, engagement scores were higher in the United Kingdom compared to the United States across all topics. On TikTok, content about makeup and acne had the highest mean engagement score (3.03%, SD 92.65%). Overall, 52.9% (228,613/432,234) of the users expressed at least 1 QoL impact, most frequently related to signs and symptoms (175,604/228,613, 76.8%), social functioning (n=149,234, 65.3%), mental health (n=107,155, 46.9%), and cost (n=62,008, 27.1%). Of 3200 annotated messages, 582 contained unmet needs, including effective solutions for hormonal acne (111/582, 19.1%), clarity in identifying acne triggers (n=84, 14.4%), treatment guidance (n=68, 11.7%), and psychological support (n=68, 11.7%).

CONCLUSIONS: This study revealed the significant physical, psychological, social, and financial impact of acne on QoL and identified several unmet needs. Given the growing role of social media, these findings highlight opportunities for dermatologists and health professionals to educate and engage with the acne community through digital platforms.

PMID:42335467 | DOI:10.2196/91126

JMIR Form Res. 2026 Jun 23;10:e90020. doi: 10.2196/90020.

ABSTRACT

BACKGROUND: Leisure-time physical activity (LTPA) participation among Chinese college students remains insufficient despite growing public health concerns regarding sedentary lifestyles and obesity. Social media platforms have increasingly become important channels for delivering social support related to physical activity (PA); however, different dimensions of social support on social media may exert distinct psychological influences on exercise intentions.

OBJECTIVE: Guided by the theory of planned behavior, this study aimed to examine the direct and indirect relationships between different dimensions of social support on social media and Chinese college students’ intentions to engage in LTPA.

METHODS: A cross-sectional online survey was conducted among undergraduate and graduate students from a comprehensive university in East China between February and June 2022. A total of 310 valid responses were analyzed using structural equation modeling in R. Three dimensions of social support on social media, including companionship support, informational support, and self-esteem support, were examined as predictors of LTPA intention, with the theory of planned behavior constructs (attitude, subjective norms, and perceived behavioral control) modeled as mediators. Demographic characteristics, BMI, social media use, and prior PA behaviors were included as covariates.

RESULTS: Companionship support demonstrated the strongest positive association with LTPA intention, including both a direct effect (β=.348; P=.005) and an indirect effect through attitudes toward PA (β=.286; P=.002). Self-esteem support also showed a significant positive indirect association with LTPA intention via attitude (β=.138; P=.02). In contrast, informational support demonstrated a significant negative indirect effect on LTPA intention through attitude (β=-.291; P<.001). Subjective norms and perceived behavioral control did not significantly mediate the relationships between social support dimensions and LTPA intention. The findings suggest that companionship-oriented interactions on social media may strengthen positive exercise attitudes, whereas excessive or low-credibility informational content may undermine exercise motivation.

CONCLUSIONS: Different dimensions of social support on social media play distinct roles in shaping Chinese college students’ intentions to engage in LTPA. Social media-based PA interventions should prioritize companionship and esteem support while improving the credibility, personalization, and quality of informational support to reduce potential negative effects associated with misinformation and information overload.

PMID:42335465 | DOI:10.2196/90020

JMIR Nurs. 2026 Jun 23;9:e94722. doi: 10.2196/94722.

ABSTRACT

BACKGROUND: Nursing students are the future workforce, and their readiness to use digital health tools is important. Previous studies have focused on knowledge and attitudes; however, they have not examined the wide range of digital health literacy levels that may influence nursing students’ attitudes toward using telehealth in clinical settings.

OBJECTIVE: This study aimed to determine the relationship between nursing students’ digital health literacy and their attitudes toward telehealth use in practice.

METHODS: A cross-sectional design was used. The sample consisted of undergraduate nursing students enrolled in a Bachelor of Nursing program at a selected Saudi Arabian university. The online survey used 2 scales: the Digital Health Care Literacy Scale and the Nurses’ Attitudes Toward Use of a Telehealth Scale.

RESULTS: A total of 273 students participated (mean age 21.3, SD 1.9 years). Most of the nursing students demonstrated a high digital health literacy level (n=184, 67.4%; mean Digital Health Care Literacy Scale score 11.9 out of 15, SD 3.1). Digital health literacy was a significant predictor of positive attitudes toward telehealth use in practice (adjusted odds ratio 1.48, 95% CI 1.28-1.71; P<.001). Male students were significantly less likely to report positive attitudes than female students (adjusted odds ratio 0.62, 95% CI 0.39-0.97; P=.03). However, academic year, telehealth workshops, and informatics courses were not significantly associated with positive attitudes toward telehealth use in practice.

CONCLUSIONS: Higher levels of literacy appear to correlate with more positive attitudes toward telehealth use in practice. However, current formal education and workshops had no apparent influence on digital health literacy. This suggests a potential need for strengthening digital training and development in nursing education. This may enhance telehealth readiness and support future digital health care delivery.

PMID:42335464 | DOI:10.2196/94722

JMIR Med Educ. 2026 Jun 23;12:e81570. doi: 10.2196/81570.

ABSTRACT

BACKGROUND: The number of 1-year Accreditation Council for Graduate Medical Education (ACGME) fellowships continues to grow. The ACGME recommends a holistic curriculum with nonclinical areas, inclusive of educational sessions. Given the competing demands between clinical skill development, educational pursuits, and work-hour restrictions, we propose an andragogic curriculum using pediatric anesthesiology as the model fellowship.

OBJECTIVE: The primary objective was to improve fellows’ perceptions of their educational experience during their fellowship year after implementing an andragogic holistic curriculum. Secondary objectives assessed improvements in diversity, equity, and inclusion (DEI) training and resources.

METHODS: This was a single-center educational improvement project completed at Lucile Packard Children’s Hospital Stanford. Data were collected between 2014 and 2024. The new curriculum was introduced in 2021-2022 and involved 12 different teaching modalities rooted in andragogic principles. A statistical process control p-chart was used to analyze the primary outcome based on the ACGME annual program evaluation. Outcomes were analyzed using censored regression modeling or a t test, depending on the presence of ceiling effects.

RESULTS: From 2014 to 2024, 58 of 60 pediatric anesthesiology fellows completed the ACGME survey. A break in the statistical process control p-chart for educational content scores occurred during 2021-2022, when the new curriculum was introduced. The mean difference was 0.89 (P<.001). Scores in DEI improved (mean difference 0.52; P=.03), and no difference was noted in resources (mean difference -0.13; P=.98).

CONCLUSIONS: Introduction of an andragogic curriculum into a pediatric anesthesiology fellowship program was associated with more favorable perceptions of educational content and DEI training.

PMID:42335453 | DOI:10.2196/81570

JCO Oncol Pract. 2026 Jun 23:OP2501413. doi: 10.1200/OP-25-01413. Online ahead of print.

ABSTRACT

PURPOSE: Multiple reports have suggested that receiving immunotherapy infusions earlier in the day is associated with improved outcomes, including longer overall survival (OS) and lower toxicity rates. However, the definition of early varies between publications. Reports also fail to account for confounding factors (including distance to infusion center), are subject to survivor bias (analyzing postbaseline factors at baseline), and do not adjust P values for multiple comparisons when evaluating multiple potential thresholds for early versus late time of day of infusion.

METHODS: We analyzed a previously reported multicenter clinical trial evaluating pembrolizumab as adjuvant therapy for participants with resectable high-risk melanoma. Standard statistical methodologies that account for potential biasses were used to evaluate the association between time of day of infusion and clinical outcomes.

RESULTS: A total of 628 participants received pembrolizumab and had time of first infusion recorded. The median age was 55 years, range, 20-82. Odds of infusion before 11:00 hours increased by 32% over 12 months of therapy (P = .013). Participants living further from their treating institution had later infusion times on average: odds of infusion before 11:00 decreased by 9% for each additional 50 miles (P = .017). The optimal cut point for first infusion time for OS was 15:48 with hazard ratio (HR) = 1.40; changing the cut point by 30 minutes earlier to 15:18 decreased HR to 0.98, indicating lack of robustness of the threshold. No significant association was identified between proportion of early infusions and outcomes in multivariable time-dependent Cox regression models.

CONCLUSION: In this multicenter trial of adjuvant pembrolizumab for participants with high-risk melanoma, analyses that account for common sources of bias found no significant association between recurrence-free or OS and time of day of infusion.

PMID:42335437 | DOI:10.1200/OP-25-01413

Eur J Gastroenterol Hepatol. 2026 Aug 1;38(8):971-976. doi: 10.1097/MEG.0000000000003223. Epub 2026 Jun 25.

ABSTRACT

BACKGROUND: Alcohol consumption is associated with increased risk for development of atrial fibrillation. Outcomes of patients with atrial fibrillation in the context of acute alcohol-associated hepatitis have yet to be investigated.

METHODS: We performed a retrospective study of patients with alcohol-associated hepatitis from the National Inpatient Sample (2016-2019), comparing those with and without concurrent atrial fibrillation. Subgroup analysis with and without cirrhosis was alone performed. Statistical analysis performed using STATA 16.1 and multivariate logistic and linear regression.

RESULTS: Among 475 600 patients with alcohol-associated hepatitis, 27 675 (5.8%) had atrial fibrillation. Patients with atrial fibrillation had a nearly two-fold increased in-hospital mortality (6.9%) compared with those without atrial fibrillation (3.9%) [adjusted odds ratio (OR) = 1.35, 95% confidence interval (CI) = 1.20-1.53] and higher odds of developing acute kidney injury (OR = 1.23, 95% CI = 1.15-1.32). They also had longer hospital stays and higher total hospital charges (7.5 vs. 6.0 days and $20 005 vs. $14 714, respectively). Among patients with alcohol-associated hepatitis and atrial fibrillation, 33% also had cirrhosis (n = 9190), and these patients had an even higher mortality rate (11.3%) than those with alcohol-associated hepatitis and atrial fibrillation alone (4.7%). Acute coronary syndrome, chronic kidney disease, and obesity were independently associated with increased mortality.

CONCLUSION: Patients with alcohol-associated hepatitis who have atrial fibrillation have an increased risk of in-hospital mortality and underlying cirrhosis compounds this risk. Early recognition of the effect of concomitant atrial fibrillation and alcohol-associated hepatitis could provide an opportunity for intervention.

PMID:42335427 | DOI:10.1097/MEG.0000000000003223

J Trauma Nurs. 2026 Jun 24. doi: 10.1097/JTN.0000000000000929. Online ahead of print.

ABSTRACT

BACKGROUND: Timely transition from the emergency department (ED) to definitive care is critical in severely injured patients. Deploying surgical trauma intensive care nurses (ICU) as trauma response nurses (TRNs) during highest (alpha-level) trauma activations may improve care coordination and expedite transitions; however, evidence supporting this practice remains limited.

OBJECTIVE: To evaluate the effect of the TRN on ED length of stay (LOS) and time to definitive care for alpha trauma activation patients.

METHODS: This single-center, retrospective cohort study analyzed all alpha trauma activations involving patients aged 16 years and older admitted to a Level I trauma center in the southeastern US between July 1, 2022, and June 30, 2024. Clinical outcomes were compared between patients managed with and without a TRN during trauma bay resuscitation.

RESULTS: Among 353 patients, 193 (55%) were in the TRN group and 160 (45%) in the non-TRN group. The median ED LOS was 77 minutes (IQR, 59-105.5) for the TRN group versus 81.5 minutes (IQR, 61.5-127.3) for the non-TRN group (p = .20, r = 0.07). The median time to the operating room (OR) was 63 (IQR, 32-94.5) minutes versus 80 (IQR, 24.8-120.5) minutes (p = .88, r = 0.03). The median time to ICU was 77 (IQR, 62.5-105) minutes with a TRN, compared to 81 (IQR, 65-129.3) minutes (p = .21, r = 0.07). We did not observe statistically significant differences between groups.

CONCLUSION: ED LOS, time to OR, and time to ICU were similar between groups, with slightly lower values in patients with TRN involvement. Further evaluation is needed to determine clinical relevance and impact on trauma protocol adherence.

PMID:42335398 | DOI:10.1097/JTN.0000000000000929

Adv Clin Exp Med. 2026 Jun 23. doi: 10.17219/acem/210555. Online ahead of print.

ABSTRACT

The specific conditions prevailing in prisons increase the risk of disease transmission among inmates. Several factors influence the risk of infectious disease transmission in prisons, including overcrowding, limited access to water, delayed diagnosis, and poor ventilation. The aim of this study was to assess the burden of selected infectious diseases among Polish prisoners between 2002 and 2023 and to analyze the literature addressing these diseases published between 2015 and 2025. In the 1st part, a systematic review was conducted. In the 2nd part, the results of the authors’ own research were presented. The source material was obtained from Statistics Poland. An increase in tuberculosis (TB) cases was observed from the early to mid-2010s, peaking in 2012. Subsequently, a decrease in TB cases was noted after 2012, reaching a nadir in 2021, followed by a resurgence in 2023. A decrease in scabies cases was also observed. However, from 2009 onward, this trend reversed, with cases increasing and peaking in 2014. Subsequently, the number of cases reached a new low in 2022, before increasing again in 2023. For Salmonella/Shigella, the number of tests remained around 5,000 in the early years, reaching a peak of 8,876 in 2020. This was followed by a decline, with 5,204 tests recorded in 2023. To minimize the risk of infectious disease transmission in prisons, several preventive measures should be implemented, including screening of newly admitted prisoners, introduction of prophylactic programs, and development of standardized procedures to follow in cases of infection.

PMID:42335388 | DOI:10.17219/acem/210555

Adv Clin Exp Med. 2026 Jun 23. doi: 10.17219/acem/209761. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative urinary tract infection (UTI) following pyeloplasty remains a significant complication and continues to pose challenges in pediatric urological care.

OBJECTIVES: This study aimed to develop a simplified predictive model to identify risk factors for postoperative UTI after unilateral pyeloplasty and to support clinicians in implementing preventive strategies targeting modifiable risk factors.

MATERIAL AND METHODS: Clinical data from children who underwent unilateral pyeloplasty at the Children’s Hospital of Capital Institute of Pediatrics (Beijing, China) between January 2012 and January 2022 were retrospectively analyzed. Variables including sex, age, body mass index (BMI), surgical modality, drainage tube type, and parameters from blood and urine tests were evaluated. Statistical analyses, including least absolute shrinkage and selection operator (LASSO) regression, logistic regression, and random forest modeling, were performed to identify significant predictive factors. Variables with the greatest predictive importance were used to develop a nomogram, and its clinical utility was evaluated using decision curve analysis (DCA).

RESULTS: Among 764 patients, 265 (35%) developed postoperative UTI. Key risk factors included surgical modality, laterality of ureteropelvic junction obstruction (UPJO), drainage tube type, blood urea nitrogen (BUN) level, and patient height. LASSO regression identified 14 predictive variables, while logistic regression determined independent risk and protective factors. Ultimately, 8 variables (e.g., sex, operative time, drainage tube type, history of infection, history of fistula, age, BUN level, and renal cortical thickness) were selected for development of the nomogram predicting postoperative UTI risk after unilateral pyeloplasty.

CONCLUSIONS: This study identified 8 factors associated with postoperative UTI following unilateral pyeloplasty in children. The developed predictive model may assist clinicians in identifying high-risk patients, thereby supporting improved perioperative planning and postoperative management.

PMID:42335386 | DOI:10.17219/acem/209761

JMIR Form Res. 2026 Jun 22. doi: 10.2196/86999. Online ahead of print.

ABSTRACT

BACKGROUND: Large language models (LLMs) have demonstrated expert-level performance on medical licensing examinations, but most benchmarks focus on final accuracy, obscuring model-specific behaviors. Critical gaps remain in understanding model efficiency (latency), the efficacy of tiered “rescue” protocols for error correction, and the systematic correlation between performance and human-rated question difficulty. The German M2 exam, paired with the AMBOSS platform’s user-data-driven difficulty ratings, provides a unique opportunity to map AI performance directly against human cognitive load.

OBJECTIVE: This study aimed to move beyond singular accuracy scores by (1) evaluating and comparing the baseline (Tier 1) accuracy and response latency of next-generation rapid-response LLMs; (2) analyzing the efficacy of a two-tiered rescue (Tier 2) protocol in correcting initial errors; and (3) correlating model performance with the user-data-driven Amboss difficulty rating.

METHODS: We evaluated four LLMs (Gemini 2.5 Flash/Pro and ChatGPT 5 Instant/Thinking) on the complete 316-item German M2 (Fall 2024) medical exam, including all multimodal (image-based) questions. A zero-shot copy-paste prompting strategy was utilized, and outputs were evaluated against ground-truth answers using a strict exact-match criterion. A two-tiered protocol was used: Tier 1 (Flash/Instant) provided baseline responses. If incorrect, a Tier 2 (Pro/Thinking) model was deployed as a “rescue.” Performance was analyzed using McNemar’s test, Wilcoxon signed-rank test, Fisher’s exact test, and logistic regression.

RESULTS: Baseline (Tier 1) accuracy was identical at 91.46% (95% CI 87.85-94.06; n = 289/316) for both Gemini 2.5 Flash and ChatGPT 5 Instant, with 27 errors each. However, Gemini Flash (Mean=1.57s) was significantly faster than ChatGPT Instant (Mean = 2.07s; P < .001). Additionally, ChatGPT Instant expended significantly more time on incorrect answers compared to correct ones (P = .002), whereas Gemini Flash showed no such hesitation (P = .814). The Tier 2 rescue rate for ChatGPT 5 Thinking (48.15%, 13/27; 95% CI 30.74-66.01) was higher, though not statistically significant (P = .406), than for Gemini 2.5 Pro (33.33%, 9/27; 95% CI 18.64-52.18). This rescue protocol elevated final accuracy to 94.30% (95% CI 91.18-96.37) for the Gemini system and 95.57% (95% CI 92.70-97.34) for the ChatGPT system (P = .481). A strong, inverse relationship with difficulty was found: for every one-point difficulty increase, the odds of a correct Tier 1 response decreased by 42.1% (OR 0.579, 95% CI 0.425-0.788; P < .001) for Gemini Flash and 47.7% (OR 0.523, 95% CI 0.379-0.720; P < .001) for ChatGPT Instant. This negative correlation persisted even after the rescue (P = .013 and P = .006, respectively).

CONCLUSIONS: Expert-level LLM performance on the German M2 exam masks a critical, systematic vulnerability: a significant decrease in accuracy directly correlated with increased question difficulty. A two-tiered “rescue” system is an effective strategy to mitigate these difficulty-based failures and achieve >95% accuracy, rivaling the best-performing, full-capacity models. We conclude that a simple reliance on a single model is insufficient; hierarchical systems that manage query difficulty are essential for safe and effective integration into medical education.

PMID:42334858 | DOI:10.2196/86999