Category: Statistics

JMIR Mhealth Uhealth. 2026 May 15;14:e71251. doi: 10.2196/71251.

ABSTRACT

BACKGROUND: Access to oral health promotion for older adults is globally limited, especially in rural, low- and middle-income settings. Digital research often lacks theoretical foundation and focuses primarily on younger cohorts, yielding few randomized trials evaluating accessible tools for oral health education in older adults.

OBJECTIVE: This study aimed to develop a telehealth reinforcement strategy for oral health promotion to improve knowledge, attitudes, and self-efficacy in community-dwelling older adults.

METHODS: A single-center, parallel-group randomized controlled trial was conducted in 4 municipalities (2 urban and 2 rural) in La Araucanía, Chile. Eligible participants were functionally independent adults aged ≥60 years with smartphone and internet access; those with cognitive impairment, complete edentulism, or inability to use WhatsApp were excluded. Participants were recruited from regional databases and assessed using the Geriatric Dental Specialties Tele-platform, a teledentistry tool for older adults. Participants were randomized (1:1) to face-to-face instruction (comparator) or the same instruction plus 2 weeks of social cognitive theory-informed telehealth reinforcement (4 validated videos via WhatsApp). Clinicians and statistical advisors were blinded. Primary outcomes (oral health knowledge, attitudes, and self-efficacy) were measured via telephone-administered questionnaires at baseline and 6 weeks post intervention. Secondary outcomes included acceptability and self-reported behaviors. Analyses included hypothesis testing, multiple correspondence analysis, and k-means clustering.

RESULTS: A total of 120 older adults were randomized (comparator: n=59; telehealth: n=61), with 103 analyzed (comparator: n=51; telehealth: n=52). Both groups showed substantial within-group improvements in oral health knowledge (comparator: Cohen d=0.93, 95% CI 0.52-1.34; P<.001; telehealth: Cohen d=1.07, 95% CI 0.66-1.48; P<.001) and self-efficacy (comparator: r=0.59, 95% CI 0.38-0.74; P<.001; telehealth: r=0.62, 95% CI 0.43-0.77; P<.001). In per-protocol analysis, telehealth improved dental caries knowledge (P=.03) and attitudes (P=.004), with no between-group differences in other domains (P>.05). In intention-to-treat analysis, telehealth showed a significant between-group difference for attitudes only (adjusted mean difference=0.91, 95% CI 0.34-1.48; P=.002), with no differences for overall oral health knowledge (P=.11) or self-efficacy (P=.59). Exploratory analyses indicated only the rural telehealth subgroup showed significant gains in attitudes (P=.003) and flossing (P<.001). Clustering suggested greater improvements among participants with higher baseline needs, predominantly rural, with fewer teeth. Telehealth demonstrated acceptability across multiple indicators (>80% for most measures) with no clinical adverse events; minor video-access issues occurred.

CONCLUSIONS: Telehealth reinforcement provided significant advantages in oral health attitudes compared with face-to-face instruction. The intervention was acceptable and showed benefits among older adults with higher preventive needs, commonly seen in rural settings. By integrating theory-informed strategies into a familiar digital platform, this study adds evidence from rural and urban contexts, extending prior work on mobile oral health. It offers insights to address service gaps in underserved areas and highlights potential for feasible, context-aligned implementation. Future research should evaluate long-term effects, adaptability, and cost-effectiveness.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05917548; https://clinicaltrials.gov/study/NCT05917548.

PMID:42139689 | DOI:10.2196/71251

Prosthet Orthot Int. 2026 May 14. doi: 10.1097/PXR.0000000000000550. Online ahead of print.

ABSTRACT

INTRODUCTION: There is a paucity of knowledge about personality traits of children and adolescents with lower limb differences. This study investigated the following: (1) comparison of personality traits of patients with limb differences to the general population; (2) comparison of male and female personality traits; and (3) comparison of personality traits, based on the five-factor model, between persons who had lower limb amputation at a young age vs. an older age.

METHODS: Thirty participants with unilateral lower limb differences completed Inventory of Children’s Individual Differences (short version) during a routine clinical visit.

RESULTS: Mean raw scores for openness to experience and agreeableness personality traits were statistically higher for participants with amputations compared with published general population. However, only the frequency distributions of T scores of the Inventory of Children’s Individual Differences-Short Version were statistically different for agreeableness personality trait between the 2 groups. There were no significant differences for all personality traits between participants grouped by age at amputation. Male participants scored lower than female participants on all 5 personality traits, but these differences were not statistically significant.

CONCLUSION: The personality traits of children and adolescents with unilateral lower limb differences demonstrate small differences compared with the general population’s personality traits. Although treatment decisions for prosthetic care cannot be made based only on the patient’s personality traits, an appraisal of the patient’s personality may assist the patient’s and clinician’s decisions in developing a personalized rehabilitation treatment plan.

PMID:42139686 | DOI:10.1097/PXR.0000000000000550

Prosthet Orthot Int. 2026 May 14. doi: 10.1097/PXR.0000000000000533. Online ahead of print.

ABSTRACT

BACKGROUND: Adjustable-volume prosthetic sockets are designed to address residual limb volume fluctuations that temporarily alter socket fit. These systems are relatively new to the market and their global use, and the type of patient they work best for, remains unclear.

OBJECTIVE: This study explored global experiences and perspectives on fitting different styles of commercially available adjustable-volume prosthetic sockets.

METHODS: An online survey was distributed globally to prosthetists. The survey asked about experiences with adjustable sockets, including successes, challenges, and barriers faced when fitting, and the impact of amputation level on success. Responses were statistically compared between United States (US) and non-US respondents.

RESULTS: Of 195 valid responses, 66.7% were from the US. Eighty-five percent of respondents had fit an adjustable socket, with those in the US more likely to fit them than those outside of the US (p = 0.001). Reported success rates ranged from 40.0% to 75.1% depending on the socket style, with no significant differences between US and non-US respondents or between amputation levels. Open-ended feedback highlighted the importance of patient selection, the timing of use, and differing views on the implications of prefabricated designs for clinical practice and access to care.

CONCLUSIONS: Globally, prosthetists report moderate success in fitting a variety of lower limb adjustable-volume sockets at different levels of amputation. As the market for adjustable-volume sockets continues to expand, further research is warranted to evaluate long-term outcomes across styles and amputation levels to better inform global prescription practices.

PMID:42139685 | DOI:10.1097/PXR.0000000000000533

Knee Surg Sports Traumatol Arthrosc. 2026 May 15. doi: 10.1002/ksa.70425. Online ahead of print.

ABSTRACT

PURPOSE: A growing emphasis on patient-centered care, paired with a steady rise in anterior cruciate ligament reconstructions (ACLRs), has led to greater interest in identifying predictors of patient-reported outcomes (PROs) after ACLR. Patient expectations are one factor previously identified as potentially impacting post-operative PROs in orthopaedic surgery; however, the association between preoperative expectations and PROs after ACLR has not been thoroughly investigated. Therefore, the present study aimed to examine the association between preoperative expectations and PROs 2 years after primary ACLR.

METHODS: Patients who underwent primary ACLR at an academic institution from July 2015 to May 2018 were retrospectively identified from a prospectively enroled registry. Surveys were administered at baseline and 2 years post-operatively. Outcomes included six Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT) domains, International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner Activity Scale (TAS), Marx Activity Rating Scale of the lower extremity (MARS LE) and numeric pain scale (NPS) of the operative knee and body. Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) preoperative expectations domain assessed patient expectations.

RESULTS: Out of 184 patients, 129 patients (70.1%) with complete preoperative expectations completed 2-year PROs and were included for statistical analysis. The mean preoperative expectations score for our patient population was 88.1. On bivariate analysis, preoperative expectations were not associated with patient sociodemographics. Higher preoperative expectations correlated with improved 2-year surgical satisfaction (p = 0.005), greater 2-year improvement in PROMIS Social Satisfaction (p = 0.023) and improved PROMIS Pain Interference (p = 0.005). On regression analysis, preoperative expectations predicted 2-year PROMIS Pain Interference (p = 0.030) and Met Expectations (p = 0.038). Preoperative expectations were also a predictor of greater improvement in PROMIS Pain Interference (p = 0.014).

CONCLUSION: The current study found that preoperative expectations are predictive of improved 2-year pain-related outcomes and a greater sense that expectations were met after ACLR.

LEVEL OF EVIDENCE: Level IV, a retrospective cohort study.

PMID:42139673 | DOI:10.1002/ksa.70425

Knee Surg Sports Traumatol Arthrosc. 2026 May 15. doi: 10.1002/ksa.70434. Online ahead of print.

ABSTRACT

PURPOSE: Although bone-patellar tendon-bone autograft is widely used for anterior cruciate ligament reconstruction, it is often associated with anterior knee pain resulting from the residual patellar bone defect. Various materials have been proposed to fill this void, yet no consensus exists regarding the optimal choice. This study compared three commonly used patellar harvest site bone void fillers and assessed their impact on the frequency and severity of anterior knee pain. We hypothesised that calcium phosphate cement would result in lower postoperative anterior knee pain compared with autologous bone graft and demineralised bone matrix (DBM) due to its compressive modulus approximating cancellous bone.

METHODS: Skeletally mature patients undergoing primary anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft were enrolled. Exclusion criteria included age under 18, prior anterior cruciate ligament reconstruction, multiligament knee injury, coronal malalignment exceeding three degrees of varus or valgus, or less than 1 year of follow-up. Participants were randomly assigned to one of three groups: (1) autologous bone graft, (2) calcium phosphate cement or (3) DBM. Patient-reported outcomes were collected preoperatively and at 1 week, 6 weeks, 3 months, 6 months, 9 months and 12 months postoperatively. Analysis of variance and chi-square tests were used for statistical analysis.

RESULTS: After applying exclusion criteria, 148 patients were included in the final analysis. No significant differences in visual analog scale pain scores were observed between cohorts at any postoperative interval (12-month, p = 0.598). Similarly, Kujala and Knee injury and Osteoarthritis Outcome scores did not differ significantly among the three cohorts at any time point (12-month, p = 0.878, p = 0.366).

CONCLUSIONS: Filling the patellar harvest site defect with autologous bone graft, calcium phosphate cement, or DBM resulted in similar postoperative anterior knee pain following anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft.

LEVEL OF EVIDENCE: Level I.

PMID:42139669 | DOI:10.1002/ksa.70434

Wiad Lek. 2026;79(4):892-898. doi: 10.36740/WLek/219914.

ABSTRACT

OBJECTIVE: Aim: The aim of the work is to comprehensively assess the impact of indicators of current success of foreign students on the results of passing the licensing exam KROK-2 and its component – the subtest “Hygiene, Public Health”.

PATIENTS AND METHODS: Materials and Methods: A single-center retrospective quantitative study was conducted, during which a dataset of foreign students (n=70) with depersonalized records of current performance for the 3rd and 6th years, ECTS scales, traditional grades, the final result of KROK-2 and the subtest “Hygiene, Public Health” (2025) was analyzed. Data processing and modeling were carried out in the Python.

RESULTS: Results: Current success in the 6th year is statistically related to the result of KROK-2, but explains a limited proportion of the variation in the result (R2≈0.13-0.21). Indicators of the 3rd year provide moderate incremental value; the most informative is PC_3% (independent association in the extended model). ECTS (6th year) acts as a suitable risk stratifier: categories D/E are associated with a decrease in the expected result from STEP-2 by approximately 11 percentage points compared to the reference C. Traditional assessments have a clear linear gradient: in the 6th year ≈+8.9 p.p./point, in the 3rd year – ≈+7.3 p.p./point.

CONCLUSION: Conclusions: The Hygiene, Public health subtest is poorly predicted by overall grades in the 6th year of study, highlighting the need for subject-specific interventions. Multicollinearity between components of the 6th year current control is high; the use of robust and regularized approaches (HC3, PCA/PC1, Ridge, residualization) confirmed the robustness of key findings under alternative specifications.

PMID:42139629 | DOI:10.36740/WLek/219914

Wiad Lek. 2026;79(4):803-810. doi: 10.36740/WLek/220666.

ABSTRACT

OBJECTIVE: Aim: The aim of the study was to identify the clinical course and endoscopic activity features in patients with uncomplicated diverticular disease (UDD) associated with diabetes mellitus (DM), overweight, and obesity and perform an analysis of the gut microbiome and morphological characteristics of the colonic mucosa in such patients.

PATIENTS AND METHODS: Materials and Methods: 259 patients with UDD, hospitalized in the Department of Gastroenterology of Feofaniya Clinical Hospital of the State Administration of Affairs during the period of 2020-2024, were included in the study. Among all patients with DD included in the study, 43 had no metabolic disorders (MD) (DM, overweight, obesity), while 216 presented with varying degrees of MD. All patients underwent total colonoscopy with assessment of endoscopic activity of diverticular inflammation using the Diverticular Inflammation and Complication Assessment (DICA) score. The clinical course of DD was evaluated according to the classification proposed by the German Society of Gastroenterology, Digestive and Metabolic Diseases and the German Society of General and Visceral Surgery in 2021. The microbiome analysis was conducted only in 172 patients who had the financial means to undergo this test. During endoscopic examination of the colon in all patients, mucosal biopsies were obtained from the diverticular orifice. Histological, histochemical, and immunohistochemical methods were used. The obtained digital indicators in the groups were analyzed using statistical methods.

RESULTS: Results: This study evaluated clinical, endoscopic, morphological, and microbiological characteristics of DD in patients with metabolic disorders. A recurrent course of diverticular inflammation was observed more frequently in patients with metabolic dysfunctions. Endoscopic assessment of inflammatory activity correlated with histological changes of colon mucosa and alterations in mucin expression (MUC2 and MUC4). Microbiological analysis revealed a reduction in butyrate-producing flora (Akkermansia muciniphila, Faecalibacterium prausnitzii) with predominance of Bacteroidetes in metabolic disorder patients.

CONCLUSION: Conclusions: The clinical, morphological, microbiological and endoscopic features of DD identified by the authors highlight pathophysiological links between metabolic dysfunction (DM, overweight, obesity) and DD progression.

PMID:42139619 | DOI:10.36740/WLek/220666

Wiad Lek. 2026;79(4):794-802. doi: 10.36740/WLek/219917.

ABSTRACT

OBJECTIVE: Aim: Identifying key psychosocial factors that contribute to the development of inclusivity and accessibility among students in contemporary crisis conditions, as well as assessing their impact on readiness for social and professional interaction in an inclusive environment.

PATIENTS AND METHODS: Materials and Methods: The materials of the research were based on the results of an anonymous online survey of students from Ukrainian higher education institutions, conducted in the summer semester of 2025 using Google Forms. The questionnaire included blocks of questions aimed at identifying the psychosocial factors influencing the development of inclusivity and accessibility. Descriptive statistics, elements of comparative and correlational analysis, as well as qualitative processing of open-ended responses were used for data analysis, which allowed for a comprehensive assessment of the relationship between students> psychosocial resources and their readiness for inclusive and barrier-free interaction.

RESULTS: Results: The development of inclusivity and accessibility among students is formed through a complex interaction of psychosocial factors: personality traits, social environment, interaction experience, and value orientations. Effective development of readiness for inclusive behavior requires a systematic approach that combines theoretical training, practical tasks, and socio-psychological support.

CONCLUSION: Conclusions: The research findings indicate that the development of inclusivity and accessibility in the student environment is determined by the interaction of personal resources (empathy, tolerance, communication skills), the social environment, participation in communities, family values, the educational context, and experience of living in crisis conditions. Crises can create barriers but at the same time stimulate social empathy, solidarity, and collective support. Effective formation of an inclusive culture requires a comprehensive approach that combines personal development, social integration, and structural changes in the educational environment.

PMID:42139618 | DOI:10.36740/WLek/219917

Wiad Lek. 2026;79(4):779-787. doi: 10.36740/WLek/216926.

ABSTRACT

OBJECTIVE: Aim: The aim of our study was to perform morphological and morphometric analysis of biopsy specimens of the common and biliopancreatic loops after gastric bypass with a single anastomosis 3, 12, 24 months after surgery, which included measurement of villi length, ratio of villi length to the thickness of the lamina propria layer containing crypts, estimation of the number and distribution of goblet cells, quantification of number crypts and Paneth cells and comparing the changes in the biliopancreatic and common loops.

PATIENTS AND METHODS: Materials and Methods: This study included 36 patients who underwent bariatric surgery due to morbid obesity. Patients underwent one of the following procedures: long-loop gastric bypass with one anastomosis, distal gastric bypass with one anastomosis, or mini-gastric bypass. Patients underwent EGDS with mucosal biopsy from the common and biliopancreatic loop at 3, 12, 24 months after gastric bypass with one anastomosis, followed by morphologic and morphometric study of biopsy specimens, which was part of our study.

RESULTS: Results: 2 years follow up show statistically significant differences in villus length were observed between the common and biliopancreatic limbs, with the length being greater in the common limb (0.390 ± 0.199 mm) than in the biliopancreatic limb (0.377 ± 0.184 mm) (p < 0.05). These changes may indicate hypertrophy of the villi in the efferent limb to increase the absorptive surface area. The thickness of the basal layer was greater in the biliopancreatic limb than in the common limb, measuring 0.196 ± 0.068 mm versus 0.167 ± 0.043 mm, respectively (p< 0.05). Regulatory functions of Paneth cells were preserved in both groups.

CONCLUSION: Conclusions: Adaptation of the small intestinal mucosa occurs after gastric bypass with one anastomosis, and these changes are more pronounced in the common loop of the small intestine. The regulatory functions of Paneth cells and their number involve both the common loop and the biliopancreatic region.

PMID:42139616 | DOI:10.36740/WLek/216926

Wiad Lek. 2026;79(4):771-778. doi: 10.36740/WLek/218761.

ABSTRACT

OBJECTIVE: Aim: Colon cancer and rectal cancer are collectively called colorectal cancer (CRC), owing to their distinct anatomical, embryological, and functional features. The study aimed to assess the diagnostic performance of various biomarkers, including liver enzymes, lipid levels, and carcinoembryonic antigen (CEA), in differentiating between colon and rectal cancers.

PATIENTS AND METHODS: Materials and Methods: The study included 70 patients with confirmed histopathology of CRC (46 patients with colon cancer (CC) and 24 patients with rectal cancer (RC), and 40 healthy control individuals. Fasting blood samples were collected to measure liver enzymes, lipid levels, and CEA levels via using enzyme-linked immunosorbent assay (ELISA) method.

CONCLUSION: Results: No statistically significant age difference (p = 0. 417) was seen in all groups. A statistically significant differences were revealed in the distribution of body mass index (BMI) (p = 0.006): 31.4% of colon cancer patients were overweight, compared to 14.3% of rectal cancer patients and 11.4% categorized as obese. A statistically significant difference was also observed in the distribution of sex (p = 0.0269): 41.4% of colon cancer patients were male, and 24.3% were female, 24.3% of rectal cancer patients were male, and 10% were female. The findings showed that the CEA, liver enzymes, and lipid levels exhibited excellent diagnostic performance for both CC and RC. Conclusions: These results highlight the clinical significance of these biomarkers in routine evaluations which can enhance therapeutic management and early diagnosis ultimately increasing survival and cure rates. KEY WORDS: colon cancer (CC), rectal cancer (RC), liver enzymes, lipid profiles, CEA biomarkers.

PMID:42139615 | DOI:10.36740/WLek/218761