Category: Statistics

J Neurosurg Pediatr. 2026 Jun 12:1-10. doi: 10.3171/2025.12.PEDS2553. Online ahead of print.

ABSTRACT

OBJECTIVE: Approximately one-third of patients with epilepsy develop drug-resistant epilepsy (DRE). Extratemporal lobe epilepsy (ETLE) represents 30%-40% of focal epilepsy cases. ETLE poses significant challenges in localization and treatment because these patients often have diffuse and complex epileptogenic networks. Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive alternative for localizable DRE, yet data for its use in the pediatric ETLE population remain limited. This study aimed to evaluate the safety and efficacy of LITT in pediatric ETLE and identify predictive factors for favorable seizure outcomes.

METHODS: This retrospective study reviewed pediatric patients who underwent LITT for ETLE at a single National Association of Epilepsy Centers level 4 epilepsy center from 2015 to 2023. Patients with prior LITT for temporal lobe epilepsy, hypothalamic hamartomas, or corpus callosotomies were excluded. Preoperative evaluations included noninvasive testing (e.g., video-EEG, MRI, PET, magnetoencephalography) and invasive monitoring with stereo-EEG. The primary study endpoints were 1) International League Against Epilepsy (ILAE) classification at 12 months after the index LITT or additional surgical intervention for the treatment of seizures, and 2) procedure-related complications. Secondary analyses examined imaging concordance with the final ablation location, total ablation volume, and perioperative metrics.

RESULTS: Twenty-nine patients underwent an index LITT procedure for ETLE. At 12 months, 14 patients (48.3%) achieved a good outcome (ILAE class 1-3), and 12 (41.4%) were seizure free (ILAE class 1). There were 6 patients (20.7%) who required additional surgery within 12 months. Concordant PET with the final LITT ablation volume independently predicted seizure outcome (p = 0.04). The total ablation volume ranged from 0.66 to 8.45 cm3, and was not statistically different between groups. In the perioperative period, 3 patients developed transient steroid-responsive LITT-related edema, while no permanent neurological deficits, hematomas, surgical site infections, or deaths occurred.

CONCLUSIONS: This study demonstrated that LITT is a safe and effective treatment option for pediatric ETLE and may achieve acceptable rates of seizure freedom with a minimally invasive approach. Concordance between noninvasive imaging (particularly PET) with LITT targets was associated with favorable outcomes, underscoring the importance of thorough preoperative evaluations to determine appropriate ablation candidates. Future multicenter prospective studies are warranted to further refine patient selection criteria and optimize treatment paradigms.

PMID:42284607 | DOI:10.3171/2025.12.PEDS2553

JMIR Mhealth Uhealth. 2026 Jun 12;14:e71241. doi: 10.2196/71241.

ABSTRACT

BACKGROUND: Digital health interventions show promise for promoting behavior change, but how they incorporate action planning strategies is underreported. This oversight limits understanding of how to implement behavior change techniques. iSIPsmarter is a digital health intervention aimed at reducing sugar-sweetened beverage (SSB) consumption among Appalachian adults.

OBJECTIVE: This study aimed to examine the digital action planning process in the iSIPsmarter intervention, specifically by (1) assessing the frequency of action plan engagement, (2) evaluating participants’ perceived difficulty implementing their action plans and examining progress toward achieving SSB reduction and weight goals, and (3) exploring the selection of barriers and strategies.

METHODS: The digital action planning process is embedded within 5 of iSIPsmarter’s 6 behavioral content modules (Cores) and paired with self-monitoring of SSB intake via SMS text messaging and weight via a cellular-enabled scale. Participants first self-select program goals for SSB intake (in ounces) and weight (loss or maintenance). Then, in Cores 2-6, they complete action plans using personalized tracking feedback, recommendations, and goal progress updates. Participants identify barriers and strategies using preprogrammed or write-in responses. Summary statistics described the aims.

RESULTS: Participants (n=119) were predominately White (Caucasian), female, aged between 18 and 44 years, college-educated, and from rural counties. On average, participants completed 4.5 (SD 1.1) of 5 possible SSB action plans, with 80% (95/119) completing all 5. Across all Cores, perceived difficulty implementing action plans and achieving goals remained relatively stable, with an average of 48% rating the tasks as impossible or hard, 29% as neither hard nor easy, and 24% as easy or very easy. Nearly half achieved their self-selected weekly SSB goals, and one-third made progress toward them. At Core 6, 57% (54/95) of participants met their self-selected SSB program goal, while 46% (44/95) met the recommended SSB intake of less than 8 ounces per day. Of 119 participants, 53 (45%) modified their SSB barriers, and 63 (53%) selected new strategies during action planning. Top reported SSB barriers included (1) caffeine, (2) taste, and (3) habit. Among those with a program weight loss goal (n=94), the average weight loss was -1.3% (SD 2.6) at the 9-week follow-up, with 61% (57/94) achieving their goal. By 6 months, weight loss increased to -2.1% (SD 5.6), with 54% (49/90) achieving their goal. Of those completing weight action plans, 62% (69/112) modified their barriers. Top weight barriers included (1) sweets, (2) portion sizes, and (3) eating healthy foods.

CONCLUSIONS: Findings underscore the value of digital action planning as a central behavior change technique within a nutrition-focused digital intervention. High action plan completion and consistent strategy adaptation suggest that structured, digitally personalized goal setting and action planning processes can effectively support behavior change, particularly among underserved populations with limited access to preventative care.

PMID:42284600 | DOI:10.2196/71241

Surg Laparosc Endosc Percutan Tech. 2026 Jun 5. doi: 10.1097/SLE.0000000000001479. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the clinical application value of the combined use of 3 endoscopes (laparoscope, choledochoscope, gastroscope) with antegrade nasobiliary drainage in the treatment of common bile duct stones.

MATERIALS AND METHODS: A retrospective analysis was conducted on 80 patients diagnosed with cholecystolithiasis and choledocholithiasis admitted to Dongshan Hospital from January 2024 to August 2025. According to the bile drainage method, patients were divided into the endoscopic nasobiliary drainage tube group (ENBD group, n = 40), who underwent concurrent 3-endoscope combination with antegrade nasobiliary tube placement, and the T-tube group (n = 40), who underwent 2-endoscope (laparoscope, choledochoscope) combination with T-tube placement. Intraoperative, postoperative, and complication conditions were compared between the two groups.

RESULTS: All patients in both groups underwent surgery and had drainage tubes successfully placed, with no fatalities reported. There were no statistically significant differences between the two groups in intraoperative blood loss or postoperative complications (bile leakage, pancreatitis) (P > 0.05). The operation time in the ENBD group was longer than that in the T-tube group (P < 0.05). However, the duration of tube retention in the ENBD group was significantly shorter than that in the T-tube group, with a statistically significant difference (Z = -7.698, P < 0.05). The postoperative hospital stay in the ENBD group was significantly shorter than that in the T-tube group, with statistically significant differences (P < 0.05).

CONCLUSION: The concurrent combined use of 3 endoscopes with antegrade nasobiliary drainage is a safe and effective surgical option for the treatment of selected cases of common bile duct stones.

PMID:42284571 | DOI:10.1097/SLE.0000000000001479

JMIR Med Educ. 2026 Jun 12;12:e79027. doi: 10.2196/79027.

ABSTRACT

BACKGROUND: According to the World Health Organization, education and awareness are essential components of public health promotion strategies. In the context of rare diseases (RDs), these actions are particularly critical because of persistent stigma, fragmented knowledge, and the frequent absence of consolidated clinical and organizational protocols. These gaps often result in inappropriate referrals, inefficient care pathways, unnecessary procedures, and delays in diagnosis, negatively affecting health outcomes and quality of life.

OBJECTIVE: This study aimed to identify and systematize the main recommendations for health education and awareness in the field of RDs, supporting the development of health care programs, public policies, and strategic initiatives.

METHODS: We formulated the research question using the Population, Concept, and Context framework. This scoping review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines to ensure methodological transparency. Eligible records included peer-reviewed research articles of any design and official documents published in Portuguese, English, or Spanish, with no time restrictions. Records that did not address the research question, lacked sufficient rigor, or focused exclusively on specific subgroups of RDs were excluded. Searches were performed in PubMed/MEDLINE, Scopus, Embase, Web of Science, as well as gray literature. Study selection and data extraction were conducted by the research team, with disagreements resolved and the included sources reviewed by an RDs expert. Data were thematically categorized by consensus, and descriptive statistics were used to summarize findings.

RESULTS: A total of 58 sources of evidence were included. Among the identified recommendations related to education and awareness, most sources focused on professional education and training (49/58, 84.4%), followed by public policies and intersectoral integration (36/58, 62%), education and awareness for the general population (28/58, 48.2%), digital technologies (27/58, 46.5%), emotional support and experience sharing (20/58, 34.4%), and awareness events and dates (8/58, 13.7%). Percentages exceed 100% because individual sources could report multiple recommendations. Overall, the literature emphasizes integrating RDs content into educational initiatives and strengthening professional competencies, intersectoral collaboration, digital technologies, and broader awareness strategies.

CONCLUSIONS: This scoping review systematically mapped and organized recommendations from diverse sources of evidence on strategies for health education and awareness related to RDs. It synthesizes heterogeneous evidence using a structured approach to provide a comprehensive overview of strategies in this field, consolidating dispersed knowledge into a coherent body of evidence. The findings may inform improvements in health services, as well as professional and managerial practices, and initiatives aimed at supporting patients, families, and advocacy groups involved in RDs, with potential implications for strengthening diagnostic processes, referral coordination, and more equitable access to information and care.

PMID:42284567 | DOI:10.2196/79027

Prim Care Companion CNS Disord. 2026 Jun 9;28(3):25m04168. doi: 10.4088/PCC.25m04168.

ABSTRACT

Objective: To determine the prevalence of generalized anxiety disorder (GAD) in patients (aged 18-86 years, not under treatment, and with no prior diagnosis of GAD) attending an underserved primary care outpatient clinic in Higuerote, Venezuela, between October and December 2023.

Methods: A descriptive, cross-sectional, quantitative, population-based study was conducted. Data were collected via a 49-item closed-question survey that included the Hamilton Anxiety Rating Scale, Perceived Stress Scale, and 16 author-designed yes/no questions on GAD-related risk factors. Statistical analysis was performed using SPSS V26; P < .01 was considered statistically significant.

Results: The study included 440 patients (mean age of 33.8± 15.3 years; 70.2% female); 50.0% of participants presented with mild anxiety, 6.0% with mild-to-moderate anxiety, and 44.0% with moderate-to-severe anxiety. Psychosocial stress, reported by 299 patients (67.9%), was strongly associated with anxiety severity (odds ratio [OR] =124.6; 99% CI, 29.3-529.6; P<.001). Among those with moderate-to-severe anxiety, 85.7% (n=192; OR= 641.0; 99% CI, 138.5-2,966.8; P<.001) reported anxiety episodes, and 90.0% (n= 180; OR= 74.9; 99% CI, 30.2-185.7; P<.001) reported panic attacks. Alcohol consumption (71.8%, n=316) was significantly associated with anxiety severity (P<.001). Family history of anxiety (60.0%, n=264) and depression (51.8%, n=228) were also significantly associated with anxiety severity (P<.01). While SARS-CoV-2 was infection was significantly associated with anxiety severity (OR=1.9; 99% CI, 1.2-3.1; P<.001), history of traumatic brain injury was not (P = .12).

Conclusions: This study revealed a statistically significant high prevalence of GAD in the underserved population of Higuerote, Venezuela. These results show the need for updated mental health epidemiologic data, surveillance, and individualized community-based strategies in disadvantaged/marginalized populations, by empowering local psychiatric workforces through data-driven, context-specific care initiatives.

Prim Care Companion CNS Disord 2026;28(3):25m04168.

Author affiliations are listed at the end of this article.

PMID:42284562 | DOI:10.4088/PCC.25m04168

Ig Sanita Pubbl. 2026 Mar-Apr;99(2):94-109.

ABSTRACT

BACKGROUND: The increasing clinical complexity of pediatric patients, combined with global nursing workforce shortages, requires reliable tools to measure nursing care complexity and support evidence-based staffing decisions. In highly specialized settings such as pediatric cardiovascular units, patient acuity and cognitive nursing workload are particularly demanding. However, data on validated tools for assessing care complexity in pediatric contexts remain limited.

OBJECTIVE: To measure nursing care complexity in pediatric cardiovascular patients and to identify clinical and organizational factors associated with higher complexity levels using validated pediatric acuity tools.

MATERIAL AND METHODS: A retrospective cross-sectional observational study was conducted on 313 patient records from the Pediatric and Congenital Cardiac Surgery and Cardiology Unit and the Pediatric Intensive Care Unit of a tertiary university hospital in Italy (January-December 2022). Nursing care complexity was assessed using the CAMEO II tool for intensive care and the Inpatient CAMEO tool for ward settings. Descriptive statistics were performed. Associations between complexity and categorical variables were analyzed using chi-square tests. Simple and multiple linear regression analyses were conducted to identify predictors of baseline complexity (T0). Statistical significance was set at p 0.05.

RESULTS: All patients admitted to the intensive care unit showed medium nursing care complexity. In the inpatient cardiac unit, 27% of patients had low complexity and 73% had medium complexity; no high-complexity cases were observed. Younger age was significantly associated with higher complexity (B = -0.29, p 0.001). Urgent admission (B = 6.73, p 0.001) and longer hospital stay (B = 0.37, p 0.001) were also significant predictors. Organizational variables, including day of the week and work shift, were not significantly associated with complexity. The regression model explained 46% of the variance in baseline complexity scores (adjusted R² = 0.451).

DISCUSSION AND CONCLUSIONS: In pediatric cardiovascular settings, nursing care complexity is primarily driven by patient-related clinical factors rather than organizational variables. Younger and urgently admitted patients with longer hospital stays require higher cognitive nursing workload. The systematic implementation of validated acuity tools such as CAMEO II and Inpatient CAMEO may support evidence-based workforce planning, optimize nurse-to-patient ratios according to patient acuity, and enhance quality and safety of care. These findings are particularly relevant in the context of healthcare resource constraints and contribute to improving organizational decision-making in specialized pediatric settings.

PMID:42284558

JCO Precis Oncol. 2026 Jun;10(6):e2501230. doi: 10.1200/PO-25-01230. Epub 2026 Jun 12.

ABSTRACT

PURPOSE: Constitutional epimutations arise early in development and are present across normal tissues, including peripheral blood. Constitutional BRCA1 promoter methylation has emerged as a risk factor for BRCA1-associated cancers, such as ovarian cancer (OC), and may serve as a biomarker for OC risk. This study retrospectively evaluated the clinical relevance of constitutional BRCA1 promoter methylation in 473 patients with OC enrolled in the observational AGO-TR1 study (ClinicalTrials.gov identifier: NCT02222883).

MATERIALS AND METHODS: BRCA1 promoter methylation was quantified by the methylation-specific real-time polymerase chain reaction using whole blood-derived DNA from 476 female controls and 473 patients with OC along with 473 corresponding tumor-derived DNA samples. Methylation levels ≥1.0% were considered methylation-positive.

RESULTS: BRCA1 promoter methylation in blood-derived DNA was detected in 42 of 473 patients with OC and in 26 of 476 controls (8.9% v 5.5%; odds ratio [OR], 1.69 [95% CI, 1.02 to 2.80], P = .0432), with the strongest association observed with methylation levels ≥10% (OR, 6.17 [95% CI, 1.37 to 27.72], P = .018). Patients with BRCA1 promoter methylation in blood-derived DNA were diagnosed at a younger median age than those without (54.0 v 60.0 years, P = .018). Constitutional BRCA1 promoter methylation was less frequent in patients carrying pathogenic germline variants in OC predisposition genes than in noncarriers (4.1% v 10.5%; OR, 0.37 [95% CI, 0.14 to 0.96], P = .04) and showed no association with a family history of cancer or platinum-based chemotherapy before blood draw. BRCA1 promoter methylation in blood-derived DNA was correlated with tumor BRCA1 promoter methylation (P < .001). Tumor BRCA1 promoter methylation was observed in 64 of 473 samples (13.5%), half (32 of 64) of which were attributable to constitutional BRCA1 promoter methylation also detectable in the blood.

CONCLUSION: Constitutional BRCA1 promoter methylation accounts for a substantial proportion of OCs and represents a robust biomarker for individual OC risk.

PMID:42284542 | DOI:10.1200/PO-25-01230

Neurology. 2026 Jul 14;107(1):e218183. doi: 10.1212/WNL.0000000000218183. Epub 2026 Jun 12.

ABSTRACT

BACKGROUND AND OBJECTIVES: The 2024 McDonald criteria allow diagnosis of multiple sclerosis (MS) in individuals presenting with symptoms not specific for MS or incidental imaging findings suggestive of demyelination when supported by biomarker evidence, reflecting a shift toward diagnostic definitions increasingly grounded in biological mechanisms of disease. The diagnostic yield of these criteria in such populations has not been evaluated in multicenter cohorts. We aimed to determine the proportion of individuals with nonspecific or incidental imaging presentations who meet the 2024 McDonald criteria and describe the contribution of central vein sign and CSF oligoclonal bands (OCBs) to diagnostic classification.

METHODS: This cross-sectional post hoc analysis used data from the Central Vein Sign in Multiple Sclerosis study, a multicenter observational cohort. Adults aged 18-65 years referred for diagnostic evaluation of possible MS were adjudicated by an expert panel. This analysis focused on participants with symptoms not specific for MS or incidental imaging findings suggestive of demyelination. Dissemination in space (DIS) and dissemination in time (DIT) were assessed using 2017 MRI criteria. Fulfillment of the 2024 McDonald criteria at baseline-the primary outcome-was determined using the Select-6 CVS and CSF OCBs. Select-6 assessment was available for all participants, whereas OCB data were available for a subset based on prior clinical evaluation.

RESULTS: Of 420 participants enrolled, 191 (45%) presented with either nonspecific symptoms (n = 166) or incidental imaging findings (n = 25). The mean age was 42 years, and 78% were female. Thirty-six (19%) met the 2024 McDonald criteria at baseline, including 28 (17%) in the nonspecific symptom cohort and 8 (32%) in the incidental imaging cohort. Among 51 participants meeting 2017 DIS, 22 (43%) were Select-6 positive, 17 (33%) had positive OCBs, and 4 (8%) met 2017 DIT. Nonspecific sensory symptoms, visual disturbances, and subacute cognitive decline were most associated with a diagnosis of MS.

DISCUSSION: Application of the 2024 McDonald criteria identified nearly one-fifth of individuals without typical presentations as meeting diagnostic criteria for MS at baseline. Biomarker incorporation-particularly the CVS-accounted for a substantial proportion of diagnostic yield. Interpretation is limited by availability of CSF data and absence of longitudinal follow-up.

PMID:42284534 | DOI:10.1212/WNL.0000000000218183

Rev Esc Enferm USP. 2026 Jun 12;60:e20250565. doi: 10.1590/1980-220X-REEUSP-2025-0565en. eCollection 2026.

ABSTRACT

OBJECTIVE: To verify the association between the social determinants of health and quality of life domains in people in a post-COVID-19 condition.

METHODS: A longitudinal study was conducted with 179 people from the states of Ceará and Maranhão, followed for six months after a confirmed diagnosis of COVID-19. Data collection was performed using a link for COVID-19 patients monitoring software, sent monthly via phone messaging app. Variables related to the social determinants of health and the domains of the SF-36 questionnaire for assessing quality of life are considered. Data analyzed using descriptive and inferential statistics.

RESULTS: Women showed improvements in the pain domain between the 2nd and 4th month (p = 0.038), vitality between the 4th and 6th month (p = 0.035), and mental health between the 2nd and 6th month (p = 0.005). Men showed better recovery in overall health status at 2 and 4 months (p = 0.029) and in social aspects at 2 and 6 months (p = 0.040).

CONCLUSION: Progressive improvement in quality of life was observed throughout the follow-up period, with differences between men and women in the areas of pain, vitality, mental health, general health status, and social aspects.

PMID:42284487 | DOI:10.1590/1980-220X-REEUSP-2025-0565en

Rev Esc Enferm USP. 2026 Jun 12;60:e20250336. doi: 10.1590/1980-220X-REEUSP-2025-0336en. eCollection 2026.

ABSTRACT

OBJECTIVE: To identify the main fears related to childbirth in pregnant women in a University Hospital in Southern Brazil, from 2021 to 2023, according to the motivations for fear.

METHOD: A cross-sectional study was conducted with pregnant individuals between 28 and 37 weeks of gestation who answered two self-administered questionnaires: the Wijma Delivery Expectancy Questionnaire (Version A) and a researcher-designed instrument on specific childbirth fears. Based on scores, participants were classified into four levels of fear (low to very high). Descriptive statistics were applied, and differences in the distribution of specific childbirth-related fears across levels of fear were analyzed using the chi-square or Fisher’s exact tests (p ≤ 0.05).

RESULTS: The sample included 334 participants. Moderate fear was most prevalent (44.9%), with tokophobia occurring in 4.8%. High fear levels were significantly associated with fear of panicking, losing control, not knowing labor duration, and intense pain (p < 0.001).

CONCLUSION: These findings demonstrate that the unpredictability of childbirth and the perception of lack of control over the situation are key factors in intensifying childbirth fear, emphasizing that incorporating psychological support and a structured health education program into prenatal care may help reduce fear and improve maternal and neonatal outcomes.

PMID:42284485 | DOI:10.1590/1980-220X-REEUSP-2025-0336en