Category: Statistics

J Am Med Dir Assoc. 2026 Jul 7;27(8):106342. doi: 10.1016/j.jamda.2026.106342. Online ahead of print.

ABSTRACT

OBJECTIVES: To examine the short-term within-individual changes in residents’ depressive and behavioral symptoms following the March 2020 lockdown in US nursing homes.

DESIGN: Retrospective cohort study.

SETTING AND PARTICIPANTS: Nursing home residents in US nursing homes operating from 2019 to 2020.

METHODS: Residents in 2020 were considered exposed to the lockdown, and residents in 2019 were considered not exposed to the lockdown. Using the national Minimum Data Set 3.0, outcomes included changes in depressive symptoms (Patient Health Questionnaire [PHQ]-9 or PHQ-10-OV) and behavioral symptoms (Agitated and Reactive Behavior Scale), examined as continuous score changes and binary adverse severity changes between baseline and follow-up (PHQ-9: n₂₀₂₀ = 499,984, n₂₀₁₉ = 514,378; PHQ-10-OV: n₂₀₂₀ = 47,371, n₂₀₁₉ = 51,398; Agitated and Reactive Behavior Scale: n₂₀₂₀ = 628,332, n₂₀₁₉ = 641,403). Mixed-effects models with facility random intercepts estimated changes in symptom scores and generalized estimating equations with a log link to estimate the risk ratios of adverse severity changes. Statistical interactions between the lockdown and resident cognitive impairment, facility ownership, size, overall ratings, and staffing levels were examined. Sensitivity analyses were conducted among residents in states with state-level visitation bans.

RESULTS: No clinically meaningful within-individual, short-term changes in depressive or behavioral symptom scores were observed. Associations did not meaningfully differ across resident cognitive impairment levels, facility characteristics, or states with visitation bans. For residents with minimal or mild depressive symptoms at baseline, those exposed to the lockdown were 22% and 39% more likely to experience worsening symptoms than those unexposed, whereas those with very severe behavioral symptoms at baseline were 7% less likely to show no improvement. These associations were slightly stronger in states with visitation bans.

CONCLUSIONS AND IMPLICATIONS: Findings should be interpreted with measurement sensitivity, residents’ lived experiences, and nursing home efforts to address social isolation in mind, underscoring the need for more responsive and timely assessments and for balanced approaches that consider both infection control and residents’ psychosocial well-being.

PMID:42413137 | DOI:10.1016/j.jamda.2026.106342

Biomedica. 2026 Apr 28;46(Sp. 1):118-128. doi: 10.7705/biomedica.8220.

ABSTRACT

Introducción. Las infecciones virales, bacterianas y fúngicas constituyen un importante problema de salud, asociado a un incremento significativo de la morbimortalidad de las enfermedades respiratorias. Objetivo. Caracterizar las infecciones respiratorias y sus agentes etiológicos en pacientes de los dos hospitales de tercer nivel de Guayaquil (Ecuador) durante los primeros seis meses del 2024. Materiales y métodos. Estudio observacional, transversal y prospectivo de dos hospitales, entre el 1° de enero y el 30 de junio del 2024. Se recopilaron los datos demográficos, clínicos y microbiológicos (fechas, edad, sexo, tipo de muestra, resultados y diagnósticos), los cuales fueron analizados mediante el programa estadístico IBM SPSS™ Statistics 27.0. Resultados. De los 56 pacientes incluidos, 35 presentaron infecciones respiratorias, con predominio del sexo femenino y con una edad promedio de 49 años. Se identificaron los siguientes agentes: rinovirus-enterovirus, virus de la influenza A, coronavirus, virus de la parainfluenza y virus respiratorio sincitial. Entre las bacterias más frecuentes se encontraron: Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, Haemophilus influenzae, Enterobacter cloacae, Escherichia coli, Proteus spp., Stenotrophomonas maltophilia, Serratia marcescens, Streptococcus agalactiae y Streptococcus pneumoniae. Asimismo, se detectaron genes de resistencia de las bacterias como CTX-M, KPC, mecA/mecC y MREJ, NDM, Oxa48-like y VIM. En el caso de infecciones fúngicas, se aislaron Candida albicans y C. glabrata. La mayoría de los pacientes con enfermedad respiratoria evolucionaron a neumonía intrahospitalaria. Conclusión. Durante el período estudiado, las infecciones respiratorias en las unidades de cuidados intensivos se asociaron principalmente con bacterias patógenas, destacándose la gran frecuencia de neumonías intrahospitalarias y la detección de genes de resistencia antimicrobiana.

PMID:42413100 | DOI:10.7705/biomedica.8220

Psychol Sci. 2026 Jul 7:9567976261459011. doi: 10.1177/09567976261459011. Online ahead of print.

ABSTRACT

Researchers have long debated whether self-esteem is associated with aggression. In this preregistered research, we tested the effects of self-esteem on aggression by using statistical models that control for unmeasured time-invariant confounders. Data came from a multi-wave longitudinal study of 674 Mexican-origin families, including multi-informant assessments of children, mothers, and fathers at 1- or 2-year intervals. There was no evidence of systematic self-esteem effects on aggression, and the results held when we controlled for narcissism and when the influence of shared-method variance could be ruled out. Also, there was little evidence for effects in the reverse direction, that is, from engaging in aggression on self-esteem. One limitation was that in most cases it was not possible to test whether the self-esteem effects were curvilinear because of the nonconvergence of these models. Overall, the findings do not support either low or high self-esteem as a risk factor for aggression.

PMID:42413080 | DOI:10.1177/09567976261459011

J Clin Oncol. 2026 Jul 7:JCO2601147. doi: 10.1200/JCO-26-01147. Online ahead of print.

NO ABSTRACT

PMID:42413068 | DOI:10.1200/JCO-26-01147

JCO Oncol Pract. 2026 Jul 7:OP2501376. doi: 10.1200/OP-25-01376. Online ahead of print.

ABSTRACT

PURPOSE: Social determinants of health (SDOH) shape cancer treatment access, adherence, and outcomes, yet their collection and use within National Clinical Trials Network (NCTN) studies remain poorly defined. This study examined how demographic and SDOH-related variables were historically collected and published to identify gaps that constrain the study of social context within NCTN trials.

METHODS: Participant-level data from completed phase III trials for gastrointestinal (GI) cancers conducted by the Alliance for Clinical Trials in Oncology (Alliance) or its legacy groups from 1999 to 2018 were pooled. Thirteen measures were assessed: four demographic and nine SDOH-related. The proportion of individual participants with data collected for each measure was evaluated. Data utilization was evaluated for all primary articles and via targeted review of related publications using the number either reporting subgroups or publishing analyses for each measure.

RESULTS: A total of 12,701 participants across 11 trials were included. All trials collected demographic measures (<2% of patients missing), insurance status (1% missing), and ZIP code (3% missing). Education level was collected in two trials (28% missing) with marital and employment status collected in one trial (41% missing for both). No trials collected data on other SDOH-related measures. Education level was the only SDOH-related measure reported in primary articles, and none reported analysis of SDOH-related measures. Of the 149 related publications, <2% reported or analyzed any SDOH-related measure.

CONCLUSION: Across Alliance and NCTN legacy group phase III trials for GI cancers, demographic variables have been consistently collected and frequently reported or analyzed, whereas SDOH-related measures are inconsistently collected and rarely published in the literature. These findings demonstrate a historical absence of routine SDOH data capture and utilization within NCTN trials.

PMID:42413064 | DOI:10.1200/OP-25-01376

Ann Work Expo Health. 2026 Jun 3;70(5):wxag054. doi: 10.1093/annweh/wxag054.

ABSTRACT

With an aging workforce and longer working lives, staying in physically demanding occupations is increasingly challenging, and the factors influencing perceived exertion are still poorly understood. Also, self-rated exertion may not correlate strongly with physiological measurements of physical strain at work, such as heart rate. Our study aimed to describe the physical strain experienced by senior workers in manual occupations using Borg’s Rating of Perceived Exertion (RPE) scale and to explore associations between personal variables such as heart rate during work, age, physical fitness, and RPE ratings. We recruited workers aged 50 yr or older in manual occupations and collected data using questionnaires, physical examinations, field heart rate monitoring, and RPE ratings during work. Field heart rate monitoring was conducted using a chest band with a pulse sensor that transmitted data to a mobile application, and the first 6 h of recordings were used in subsequent analyses. Subjects were asked to simultaneously complete a diary at the end of each shift, rating the overall physical exertion for that day using the RPE scale, ranging from 6 (rest) to 20 (maximal physical exertion). Correlation between variables was determined using Spearman’s rank correlation coefficient (r). A linear mixed model was used to investigate associations between personal variables and RPE ratings. The sample consisted of 126 subjects, aged 50 to 67 yr, of whom 76 (60.3%) were females. The participants were employed as construction workers, kitchen workers, cleaners, or assistant nurses. They rated perceived physical exertion on the RPE scale once daily in one to three workdays, resulting in a total of 250 workdays. The mean (SD) RPE rating was 12.1 (2.1). When stratified by sex, the mean (SD) RPE rating was 12.1 (2.2) among females and 12.0 (1.8) among males (P = 0.669). When stratified by occupational group, the mean (SD) was 11.9 (1.9) for construction workers, 12.1 (2.0) for kitchen workers, 12.4 (1.6) for cleaners, and 11.8 (2.8) for assistant nurses (P = 0.139 to 0.815). In total, 298 heart rate (HR) recordings were obtained during work with a mean (SD) HR of 89.4 (11.4) beats/min (range 54 to 125). There was a significant bivariate correlation between the RPE ratings and mean HR for the entire study population (r = 0.14; P = 0.025) as well as in the group of construction workers (r = 0.23; P = 0.042), but not for any other occupational groups (r = 0.04 to 0.25; P = 0.096 to 0.752). In the linear mixed model, using the RPE ratings as the dependent variable, the statistically significant (P < 0.05) estimated coefficients (SE) were as follows: mean heart rate (beats/min), 0.03 (0.01); very poor sleep quality, 3.38 (0.93); and high psychological stress, 2.62 (0.71). Age, body mass index, theoretical maximum oxygen consumption, and chronic pain ratings were not significantly associated with the RPE ratings. We conclude that senior workers in manual occupations reported that their work was somewhat hard in terms of physical exertion. Our study also indicates associations between mean heart rate, sleep quality, psychological stress, and RPE ratings.

PMID:42413062 | DOI:10.1093/annweh/wxag054

Health Aff (Millwood). 2026 Jul;45(7):775-781. doi: 10.1377/hlthaff.2025.00179.

ABSTRACT

Long COVID has debilitating effects but is inconsistently diagnosed because of subjective criteria, limited treatments, and variations in health care access. We analyzed electronic health records from the National Clinical Cohort Collaborative for patients diagnosed with acute COVID-19 in the US between January 2022 and March 2023. Using six race and ethnicity categories, we evaluated 222 symptoms and long COVID diagnoses (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, code U09.9) within twelve months after infection. We assessed the relationship between race and ethnicity and long COVID diagnosis, adjusting for patient covariates and long COVID symptomatology set to the presence of at least one documented long COVID-associated symptom. Among 2.4 million patients, Black patients were less likely to be diagnosed with long COVID than White patients under a scenario in which a symptom was present and health care monitoring was at least bimonthly. For the remaining racial and ethnic groups, we found no statistically significant differences in long COVID diagnoses compared with White patients. Although the magnitude was small, the difference in diagnosis likelihood suggests the presence of potential diagnostic bias.

PMID:42413051 | DOI:10.1377/hlthaff.2025.00179

Prehosp Emerg Care. 2026 Jul 7:1-11. doi: 10.1080/10903127.2026.2697436. Online ahead of print.

ABSTRACT

OBJECTIVES: Sudden cardiac death is a leading cause of death globally. Recent guidelines recommend considering extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest, but evidence regarding favourable outcomes remains scarce.

METHODS: This nationwide retrospective observational study analyses ECPR for out-of-hospital cardiac arrest (OHCA) in Germany. The Federal Statistical Office of Germany provided data for all refractory OHCA patients in German hospitals between 2018 and 2023, including identification of those who received ECPR. All patients aged 18 years and older were included. The primary endpoint was hospital mortality. Secondary endpoints were centre caseload and location.

RESULTS: Between 2018 and 2023 27,056 patients were admitted with OHCA refractory to conventional CPR and 785 (2.9%) received ECPR. Survival without ECPR was 11.3% and 11.8% with ECPR, with no significant difference between the groups. ECPR utilization increased from 1.8% (n = 62) in 2018 to 4.1% (n = 168) in 2023, but survival rates remained unchanged. Among hospitals treating patients with OHCA, 11.6% (n = 102) provided ECPR. The median number of annual cases per ECPR centre was three. Urban centres had higher prior VA ECMO experience and ECPR caseload. Survival was higher for urban centres, though not statistically significant.

CONCLUSIONS: Between 2018 and 2023, ECPR was used for 2.9% of refractory OHCA cases admitted to hospitals in Germany. ECPR utilization increased while survival remained unchanged at approximately 12%. The widespread provision of ECPR by institutions with low case volume, within the specific regulatory and organisational context of the German health care system, underscores the need for national quality standards and registries to improve consistency of ECPR care.

PMID:42413030 | DOI:10.1080/10903127.2026.2697436

J Cardiovasc Pharmacol. 2026 Jul 7. doi: 10.1097/FJC.0000000000001832. Online ahead of print.

ABSTRACT

Anthracyclines remain a cornerstone of cancer therapy but are associated with a spectrum of cardiovascular toxicity, ranging from subclinical myocardial injury to overt heart failure (HF). Despite strong biological rationale, the role of universal pharmacologic prophylaxis remains uncertain. In this context, the recent meta-analysis by Pizzi et al. provides a timely synthesis of randomized evidence evaluating angiotensin-converting enzyme inhibitors (ACEi) for the prevention of anthracycline-related cardiotoxicity. The analysis demonstrates a statistically significant attenuation of left ventricular ejection fraction decline with ACEi prophylaxis, although the absolute effect size is modest and accompanied by substantial heterogeneity. Importantly, the magnitude of benefit appears to be context-dependent, with more consistent effects observed in higher-risk settings, such as combined anthracycline and trastuzumab exposure or in patients with early markers of myocardial injury. Contemporary data suggest that declining event rates and improved supportive care may limit the ability of prophylaxis trials to detect clinically meaningful differences in low-risk populations. Furthermore, the absence of significant effects on clinical endpoints underscores the limitations of current surrogate markers and trial design. Emerging evidence supports a more nuanced, risk-adapted approach, integrating early detection strategies such as global longitudinal strain and biomarker-guided intervention. Within this framework, ACEi prophylaxis may be most appropriately targeted to patients with higher baseline risk or early evidence of myocardial injury, rather than applied universally. Future studies should prioritize risk enrichment, standardized imaging protocols, and clinically meaningful outcomes to better define the role of cardioprotective strategies in cardio-oncology.

PMID:42413029 | DOI:10.1097/FJC.0000000000001832

G3 (Bethesda). 2026 Jul 7:jkag165. doi: 10.1093/g3journal/jkag165. Online ahead of print.

ABSTRACT

Polyploidy has repeatedly shaped grass evolution, yet direct observations of how polyploid-derived chromosomes behave when returned to diploidy remain rare. Interspecific crosses between diploid Sorghum bicolor and tetraploid hybrids derived from S. halepense generate mixed-ploidy progeny, providing an opportunity to examine chromosome transmission during the early stages of diploidization. Using genome-wide SNP markers, we characterized chromosomal inheritance patterns in two diploid and two tetraploid families derived from these crosses. Genotype-dosage profiles alone distinguished diploids from tetraploids with complete accuracy, reflecting strong ploidy-dependent differences in dosage-class distributions. Although diploid progeny retained much of the halepense-derived genomic background, several genomic intervals exhibited extended, non-random runs of S. bicolor homozygosity that remained polymorphic in corresponding tetraploid populations. These patterns, together with recurrent segregation distortion across independent families, suggest that the transition from tetraploidy to diploidy can expose allelic combinations that differ in transmission or viability. Analyses of flowering time further indicated that diploid and tetraploid derivatives possess distinct genomic architectures, with major association peaks occurring in different chromosomal regions across ploidy levels. Collectively, these results indicate that early diploidization involves non-random retention and loss of parental haplotypes shaped by both selective and structural constraints. The diploid extractions characterized here provide a rare empirical system for investigating the early stages of diploidization and a practical framework for studying and eventually mobilizing polyploid-derived variation into sorghum germplasm development. However, broader integration into elite breeding programs will require additional evaluation of cross-fertility, meiotic behavior, and chromosomal stability across diverse breeding backgrounds.

PMID:42413025 | DOI:10.1093/g3journal/jkag165