Category: Statistics

Bol Med Hosp Infant Mex. 2026;83(2):94-101. doi: 10.24875/BMHIM.25000020.

ABSTRACT

INTRODUCCIÓN: El síndrome de Down (SD) se caracteriza por dismorfias, retraso psicomotor y afectaciones sistémicas. Su prevalencia es de 1:700 nacidos vivos. Aproximadamente el 80% de los recién nacidos con SD presentan hipotonía, que es la principal causa de retraso motor grueso. El desarrollo motor se considera atípico, dado que se retrasa en comparación con niños de la población general. El objetivo de este trabajo es describir los factores asociados al desarrollo motor en pacientes con SD.

MÉTODOS: Se realizó un estudio observacional, analítico, transversal y ambispectivo en el Servicio de Genética Médica del Hospital General de Zona No. 20, Puebla. Se analizaron: edad, sexo, mecanismo citogenético, prematurez, lactancia materna, nivel socioeconómico, cardiopatía congénita, función tiroidea y rehabilitación para el desarrollo motor. Se realizó análisis estadístico descriptivo e inferencial (chi cuadrada) para identificar las variables asociadas al desarrollo motor de pacientes con SD.

RESULTADOS: Se analizaron 40 pacientes con SD, 22 (55%) de sexo masculino y 18 (45%) femenino; la mediana de edad fue 32.5 meses; 22 individuos (55%) presentaron trisomía 21 libre y 18 (45%) en mosaico; en 37 individuos (92.5%) se retrasó el desarrollo motor y solo 3 (7.5%) alcanzaron los hitos. Se encontró una diferencia estadísticamente significativa entre el presentar o no hipotiroidismo y el logro de los hitos (p = 0.046).

CONCLUSIONES: En este estudio se comprobó que los pacientes con SD presentan retraso del desarrollo motor y que existe una diferencia estadísticamente significativa entre el hipotiroidismo y los hitos motores, destacando que el hipotiroidismo no limitó el desarrollo motor en los pacientes con SD que alcanzaron sus hitos motores.

BACKGROUND: Down syndrome (DS) is characterized by dysmorphia, psychomotor delay, and systemic conditions, with a prevalence of 1:700 live births. Around 80% of newborns with DS exhibit hypotonia, which is the main cause of gross motor delay. In these children, motor milestones are considered atypical because it is delayed compared to children in the general population. The aim is to describe factors associated to motor development in patients with DS.

METHODS: An observational, analytical, cross-sectional, and ambispective study was conducted at the Medical Genetics Service of the General Hospital of Zone No. 20, Puebla. Age, sex, cytogenetic mechanism, prematurity, breastfeeding, socioeconomic level, congenital heart disease, thyroid function, and rehabilitation for motor development were analyzed. Descriptive and inferential statistical analysis was performed with the chi square test to identify variables associated with the motor development of patients with DS.

RESULTS: Forty patients were analyzed, 22 (55%) male and 18 (45%) female, a median age of 32.5 months; 22 individuals (55%) had regular trisomy 21 and 18 (45%) mosaicism; 37 individuals (92.5%) presented developmental motor delay and 3 (7.5%) reached the milestones. A statistically significant difference was found between having or not having hypothyroidism and milestone achievement (p = 0.046).

CONCLUSIONS: This study found that patients with DS have delayed motor development and that there is a statistically significant difference between hypothyroidism and motor milestones, highlighting that hypothyroidism did not limit motor development in patients with DS who reached their motor milestones.

PMID:42184417 | DOI:10.24875/BMHIM.25000020

Cir Cir. 2026;94(2):149-156. doi: 10.24875/CIRU.24000358.

ABSTRACT

OBJECTIVE: To bear the evidence that laparoscopy is the possible new treatment of choice in the management of retroperitoneal disease in patients with testicular cancer. The surgical management of retroperitoneal lymph nodes is a crucial step in the multidisciplinary treatment of testicular germ cell tumors. Laparoscopic retroperitoneal approach poses technical challenges in urologic oncology. This study reports on the safety, efficacy, and short-term oncological outcomes of laparoscopic retroperitoneal lymph node dissection at a tertiary referral hospital.

METHOD: Prospective, observational, descriptive study conducted from 2021 to 2023, including 83 patients who underwent laparoscopic retroperitoneal lymph node dissection.

RESULTS: Eleven cases of primary laparoscopic retroperitoneal lymph node dissection (13.3%), 36 standard (43.3%), 22 salvage (26.5%), 11 desperation (13.3%), and 3 redo cases (3.6%) were performed. In primary cases, 81.9% of patients had positive nodes (pN1-3). The conversion rate to open surgery was 6%. Bleeding, lymph node volume, pre-lymphadenectomy markers, chemotherapy, initial histology, and lymph node histology were not risk factors for conversion = Mean surgical time was 250 minutes. There were no major complications (organ injury, vascular injury) or need for blood transfusion = Mean blood loss was 60 mL. Recurrence rate was 9.6%, with recurrence-free survival of 36.7 months.

CONCLUSIONS: The reported experience demonstrated the safety and efficacy of primary laparoscopic retroperitoneal lymph node dissection, as well as post-chemotherapy cases. Laparoscopic approach allows for early patient recovery without compromising oncological outcomes. It is advisable to perform this surgery in high-volume centers with experienced surgeons in retroperitoneal surgery.

PMID:42184400 | DOI:10.24875/CIRU.24000358

Cir Cir. 2026;94(2):167-178. doi: 10.24875/CIRU.25000390.

ABSTRACT

OBJECTIVES: To assess the clinical and ultrasonographic effectiveness of transfer energy capacitive and resistive (TECAR) therapy in managing lateral epicondylitis (LE).

METHOD: Forty-seven patients with clinically and sonographically confirmed unilateral LE were randomized into two groups. The control group received exercise and LE banding for 3 weeks. The TECAR group received the same treatment, plus TECAR therapy 3 times weekly (nine sessions). Outcomes were evaluated using the patient-rated tennis elbow evaluation (PRTEE) as the primary measure. Secondary outcomes included Visual Analog Scale (VAS) scores, handgrip strength (HGS), common extensor tendon (CET) thickness, and total ultrasonography scale score (TUSS). Assessments were made at baseline and post-treatment.

RESULTS: Both groups demonstrated significant improvements in elbow VAS-rest, VAS-night, VAS for activities of daily living (VAS-ADL), forearm VAS-night, VAS-ADL, arm VAS-ADL, lateral epicondyle tenderness-VAS, HGS, TUSS, hypoechogenicity, and PRTEE scores after treatment compared to baseline. Treatment did not significantly improve either group’s forearm VAS-rest, CET thickness, neovascularity, heterogeneity, or bone abnormality. Change in elbow VAS-ADL was found to be statistically significantly better in the TECAR group.

CONCLUSIONS: TECAR therapy, when combined with conventional treatment, led to greater improvement in ADL-related pain and may be particularly beneficial for active individuals requiring faster symptom relief.

PMID:42184399 | DOI:10.24875/CIRU.25000390

Cir Cir. 2026;94(2):197-204. doi: 10.24875/CIRU.24000319.

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate the relationship between kinesiophobia and physical activity levels in patients with end-stage kidney disease (ESKD) undergoing hemodialysis.

METHOD: This cross-sectional study involved 227 ESKD patients undergoing HD treatment. Patients were assessed using the Tampa Scale of Kinesiophobia (TSK), the International Physical Activity Questionnaire-short form, and Beck Depression and Anxiety scales.

RESULTS: Our findings revealed a significant association between kinesiophobia and low physical activity levels in HD patients (r = 0.384, p < 0.001). Patients with high TSK scores were more likely to have reduced physical activity levels. In addition, age (odds ratio [OR] = -31.3, p < 0.001), dialysis duration (OR = -57.2, p = 0.003), and TSK score (OR = 49.9, p < 0.001) emerged as independent predictors of physical activity levels. Notably, older age and longer dialysis duration were associated.

CONCLUSIONS: This study highlights the significant impact of kinesiophobia on physical activity levels in HD patients. More research is needed to figure out how these things work and help doctors decide how to treat ESKD patients so they can be more active.

PMID:42184398 | DOI:10.24875/CIRU.24000319

Cir Cir. 2026;94(2):137-148. doi: 10.24875/CIRU.24000222.

ABSTRACT

OBJECTIVE: This study aimed to investigate the application of MIMICS software in measuring femoral neck fracture (FNF) parameters and its clinical significance.

METHOD: Computed tomography data from 72 patients with FNFs were used to reconstruct three-dimensional (3D) models using MIMICS. The FNFs were divided into valgus and bowing groups based on the coronal femoral head-neck angle. A simulated sphere identified the center of the femoral head, and a 3D coordinate system was established. Statistical analyses were performed.

RESULTS: The valgus group showed more lateral x-axis and upward z-axis displacement (both p < 0.01). The medial x-axis and downward z-axis displacement distances were larger in the bowing group (both p < 0.01). Strong positive correlations were found between the horizontal head tilt angle and head spacing, spatial head-neck angle and y-axis displacement distance (all r_s > 0.89, p < 0.01).

CONCLUSIONS: MIMICS-based FNF parameter measurement accurately describes spatial characteristics post-fracture, providing guidance for FNF treatment and evaluation.

PMID:42184394 | DOI:10.24875/CIRU.24000222

Cir Cir. 2026;94(2):214-224. doi: 10.24875/CIRU.24000480.

ABSTRACT

OBJECTIVE: We implemented and evaluated a novel score called the blunt thoracic trauma score (BTTS) for the triage of chest wall injury (CWI) patients to optimize utilization of the intensive care unit (ICU).

METHOD: Patients who sustained rib fractures after a traumatic injury (2014-2020) were identified in our trauma registry. Demographics and clinical characteristics were summarized by cohorts pre- and post-BTTS implementation in 2017 and BTTS > 6 versus BTTS < 6 using median or frequency. Wilcoxon rank-sum test was used to compare continuous variables, and χ² or Fisher’s exact test for categorical variables. Logistic/negative binomial regression models were used to find predictors for ICU admission and length of stay (LOS).

RESULTS: Six hundred thirty-three patients were included; 407 pre-BTTS/226 post-BTTS. Pre-BTTShigher median ISS (p < 0.001), more rib fractures (p < 0.001). Post-BTTS older (p < 0.001), more comorbidities (coronary artery disease [p = 0.028], hyperlipidemia [p = 0.004], pulmonary disease [p = 0.038]). Post-BTTS cohort had lower rates of ICU admission (p = 0.008), shorter ICU-LOS (p < 0.001), and Hospital-LOS (p < 0.001). Post-BTTS cohort was associated with shorter Hospital-LOS after adjusting for other factors (p = 0.004).

CONCLUSIONS: Implementation of a novel BTTS for triage of CWI was associated with decreased ICU admission rates and shorter ICU-LOS and Hospital-LOS. The decreased Hospital-LOS persisted even after controlling for other factors.

PMID:42184391 | DOI:10.24875/CIRU.24000480

JMIR Med Inform. 2026 May 25;14:e85335. doi: 10.2196/85335.

ABSTRACT

BACKGROUND: Early prediction of gestational diabetes mellitus (GDM) is critical for improving maternal health outcomes. However, predictive models are often challenged by limited early-pregnancy samples, severe class imbalance in datasets, and complex interrelationships among clinical features.

OBJECTIVE: This study aimed to develop and evaluate a unified dual-dimensional enhancement framework integrating data augmentation and feature engineering. By addressing data imbalance and leveraging medical prior knowledge, this framework significantly improves early GDM prediction performance.

METHODS: We proposed a framework combining Generative Adversarial Network (GAN)-based data augmentation with large language model-inspired feature engineering. GAN sampling was used to generate clinically plausible synthetic minority class samples to mitigate data imbalance. The large language model was guided to organize features into domains (eg, basic demographics, metabolic syndrome, and core liver biomarkers) and generate higher-order composite features, integrating medical prior knowledge. Machine learning models were subsequently developed, and interpretability analyses were performed using Shapley additive explanations to identify key predictors.

RESULTS: This study used a final analytical cohort of 8214 pregnant women, divided into dataset A comprising 966 out of 5251 (18.4%) participants with GDM, and dataset B comprising 598 out of 2963 (20.2%) participants with GDM. The random forest model enhanced by Tabular Variational Autoencoder-based feature augmentation demonstrated the best performance. On the test dataset, it achieved a recall of 0.7559, an accuracy of 0.8444, and an area under the receiver operating characteristic curve (AUROC) of 0.8873. Statistical evaluation confirmed that the Tabular Variational Autoencoder method significantly outperformed the baseline (Cohen d=2.894; P<.001) and the Conditional Tabular Generative Adversarial Network method (Cohen d=1.637; P=.02) in recall enhancement. Shapley additive explanations analysis identified the following 5 features as the most influential predictors: fasting blood glucose, the composite feature (fasting blood glucose+triglycerides)×prepregnancy BMI, activated partial thromboplastin time, leukocyte count, and neutrophil count.

CONCLUSIONS: The proposed dual-dimensional enhancement framework effectively alleviates data limitations and captures complex feature interactions in early GDM prediction. This strategy not only improves model performance, particularly in recall, but also provides interpretable biological evidence to support rapid clinical screening, stratified management, and early intervention in pregnancy.

PMID:42184375 | DOI:10.2196/85335

JMIR Public Health Surveill. 2026 May 25;12:e87537. doi: 10.2196/87537.

ABSTRACT

BACKGROUND: In South Korea, where plain packaging has not been adopted, tobacco packaging continues to function as a key marketing tool for the tobacco industry, using texts, colors, and imagery to attract consumers. Among these, flavor cues are especially important as they enhance product appeal. Cigarette sticks also serve marketing functions through design features such as colors and capsule indicators.

OBJECTIVE: This study aimed to examine flavor-related cues on cigarettes and heated tobacco products (HTPs) packaging and stick design and to assess the presence of flavor additives in these products.

METHODS: This surveillance study was conducted in November 2024. Tobacco products were purchased from convenience stores located in Seoul, supplemented by cross-referencing with national market monitoring data. Of 353 identified products, 214 products (150 cigarettes and 64 HTPs) were collected. Flavor cues were categorized by pack and stick design features, and additives were identified through sensory analysis of product components.

RESULTS: Among the collected products, 63.1% (54% for cigarettes and 84.4% for HTPs) had both flavor cues and flavor additives, while 20.6% (27.3% for cigarettes and 4.7% for HTPs) had neither. Flavor cues were found in 67.3% of cigarettes and 95.3% of HTPs (P<.001), and flavor additives in 59.3% of cigarettes and 84.4% of HTPs (P<.001). Pack color was the most common cue, and additives were most often delivered through crushable capsules. HTPs used a wider range of flavoring methods, including flavoring in tobacco leaves and inner wrappers.

CONCLUSIONS: Tobacco packaging and stick design in South Korea remain important marketing tools for the tobacco industry. Flavor cues and additives are widely used in tobacco products, particularly in HTPs. These findings highlight the need for plain packaging policies and bans on flavor additives in tobacco products.

PMID:42184364 | DOI:10.2196/87537

West J Nurs Res. 2026 May 25:1939459261442459. doi: 10.1177/01939459261442459. Online ahead of print.

ABSTRACT

BACKGROUND: Family caregivers often struggle to track daily caregiving tasks (eg, managing medications, appointments). To address this, our team developed CareMobi, a mobile app designed to make caregiving more organized, collaborative, and manageable.

OBJECTIVE: We sought to evaluate early user satisfaction, real-world utility, and perceived value of CareMobi among informal caregivers.

METHODS: A cross-sectional survey was administered between October 2023 and January 2024 to CareMobi users. The survey included Likert-scale items assessing satisfaction and usability, and open-ended prompts exploring use cases and improvement suggestions. Descriptive statistics summarized quantitative data, and open-ended responses were analyzed using inductive content analysis.

RESULTS: Among respondents (N = 51), 82% reported being satisfied or very satisfied with the app, and 76% found it easy or very easy to use. Highly valued features included appointment/calendar tracking (32 selections), health progress monitoring (30 selections), and file storage (20 selections). Caregivers use CareMobi across diverse contexts, from elder care to self-management, to coordinate care among multiple individuals and streamline information access. Open-ended responses revealed 3 primary areas of impact: improved communication, centralized information management, and support for symptom and medication tracking. Users requested enhancements to support care team coordination, emphasizing the importance of simple, functional tools for daily caregiving.

CONCLUSION: Preliminary findings, based on a small, self-selected sample, suggest CareMobi is a user-friendly tool that supports informal caregivers and facilitates care coordination. Results highlight the importance of caregiver-centered app design and indicate the need for further evaluation through longitudinal, mixed-methods research to assess long-term outcomes and integration into care routines.

PMID:42184363 | DOI:10.1177/01939459261442459

J Med Internet Res. 2026 May 25;28:e88276. doi: 10.2196/88276.

ABSTRACT

BACKGROUND: Wearable devices are increasingly adopted for personal health monitoring, but evidence on their long-term associations with health-related lifestyle behaviors in real-world population settings remains limited.

OBJECTIVE: This study examined the longitudinal association between wearable device adoption and engagement in health-related lifestyle behaviors using a nationally representative panel dataset from South Korea.

METHODS: We analyzed data from the 2016 and 2022 waves of the Korea Media Panel survey. Health-related lifestyle behaviors in the physical, social, and cultural domains were operationalized as estimated annual activity counts based on self-reported frequency measures. We used a difference-in-differences framework with generalized estimating equations to compare changes in these behaviors between new wearable adopters and nonadopters adjusting for demographic and socioeconomic characteristics. Relative changes were estimated using Poisson models with a log link, and subgroup analyses were conducted to explore variation across sociodemographic groups. As a sensitivity analysis, inverse probability of treatment weighting was additionally applied to assess the robustness of the findings to observed baseline imbalance.

RESULTS: Wearable device adoption was associated with greater increases in total, physical, and cultural health-related lifestyle activities over time. In the difference-in-differences model, adopters showed greater relative increases in total activity (rate ratio [RR] 1.24, 95% CI 1.08-1.35), physical activity (RR 1.36, 95% CI 1.12-1.64), and cultural activity (RR 1.78, 95% CI 1.31-2.42) than nonadopters. Subgroup analyses showed limited evidence of consistent heterogeneity and should be interpreted cautiously. Sensitivity analyses using inverse probability of treatment weighting showed overall patterns broadly similar to those of the primary analyses.

CONCLUSIONS: In this nationally representative panel study, wearable device adoption was associated with greater increases in total, physical, and cultural health-related lifestyle activities over time, whereas no clear association was observed for social activity. These findings should be interpreted as associative rather than causal given the observational design and the inability to directly assess parallel trends.

PMID:42184361 | DOI:10.2196/88276