Category: Statistics

BJS Open. 2026 Jul 3;10(4):zrag115. doi: 10.1093/bjsopen/zrag115.

ABSTRACT

BACKGROUND: Ampullary tumours are rare but present important clinical challenges. This meta-analysis aims to evaluate the outcomes of endoscopic resection (ER), transduodenal ampullectomy (TDA) and pancreatoduodenectomy (PD) for both benign and malignant ampullary tumours.

METHODS: A comprehensive search was performed up to 15 December 2025. Studies were included if they reported short-term outcomes including complete resection rate, recurrence, or complications of ampullary tumours after ER, TDA, or PD. Statistical analyses were performed using both random-effects and fixed-effects models to calculate pooled means. Publication bias was evaluated using funnel plots and Egger’s test, and risk of bias was assessed using ROBINS-I V2.

RESULTS: A total of 80 studies were included. For complete resection rate, ER showed high heterogeneity (29%-100%), TDA showed a pooled rate of 90% for benign and early-stage tumours and 66% for malignant tumours, whereas PD showed 99% and 97%, respectively. ER and TDA showed both a pooled recurrence rate of 12% for benign and early-stage tumours, whereas PD showed 6%. For recurrence of malignant tumours, TDA showed high heterogeneity (48%-90%) whereas PD had a pooled rate of 16%. For complications, ER and PD exhibited high heterogeneity (9%-95% and 27%-98%, respectively), whereas TDA had a pooled rate of 32%.

CONCLUSION: PD provides the best outcomes in terms of complete resection and recurrence, despite higher morbidity. ER is a viable option for benign tumours, offering lower morbidity and manageable recurrence rates. Further prospective research is needed to optimize preoperative diagnostics to distinguish benign tumours from malignant tumours accurately to select the appropriate treatment.

PMID:42647826 | DOI:10.1093/bjsopen/zrag115

Am J Public Health. 2026 Sep;116(S4):S276-S284. doi: 10.2105/AJPH.2026.308641.

ABSTRACT

Objectives. To evaluate workplace conditions in the Community Health Workers (CHWs) for COVID Response and Resilient Communities initiative using the workplace-related CHW Common Indicators and to conduct a preliminary validation of those indicators. Methods. A CHW survey conducted between February 12, 2024, and March 29, 2024, incorporated all or part of the workplace-related Common Indicators. We produced descriptive statistics to answer evaluation questions and conducted exploratory factor analyses to initially validate scalar portions of the indicators. Results. Our analyses revealed generally positive ratings of workplace conditions for CHWs in diverse sites around the United States. Scalar components of the Common Indicators achieved Cronbach alpha values above 0.8 and loaded on 1 principal factor per scale. Conclusions. Our findings from a definable large-scale sample confirm that the Common Indicators provide a practical, reliable, and valid way to measure workplace conditions that allow CHWs to be optimally effective across settings and jurisdictions. The positive results indicate that a federal CHW program can help to create beneficial workplace conditions for CHWs while making it possible to compare consistent data about the CHW workforce. (Am J Public Health. 2026;116(S4):S276-S284. https://doi.org/10.2105/AJPH.2026.308641).

PMID:42647812 | DOI:10.2105/AJPH.2026.308641

Am J Public Health. 2026 Sep;116(S4):S295-S304. doi: 10.2105/AJPH.2026.308660.

ABSTRACT

Objectives. To examine the roles and activities performed by community health workers (CHWs) involved in the national Community Health Workers for COVID Response and Resilient Communities (CCR) program and examine differences based on setting characteristics. Methods. We used data from a CHW self-report survey (n = 689) conducted February through March 2024 in the United States. We ran a series of ordered logistic regression models to examine the association between setting characteristics (i.e., type of organizational setting, organizational experience with CHWs, and populations of focus) and CHW core roles and COVID-19‒specific activities. Results. A total of 69.2% of CHWs in the analytic sample reported performing all 10 core roles. Organizational experience with CHWs and populations of focus emerged as the most salient predictors of CHW core roles and activities. Conclusions. A substantial proportion of CHWs performed the full range of core roles. Results suggest that CHWs in the CCR program tailored their roles and activities according to the unique factors of the communities in which they worked. Public Health Implications. Programs such as CCR may result in CHWs using a wide range of core roles across multiple settings. (Am J Public Health. 2026;116(S4):S295-S304. https://doi.org/10.2105/AJPH.2026.308660).

PMID:42647810 | DOI:10.2105/AJPH.2026.308660

Am J Public Health. 2026 Sep;116(S4):S305-S313. doi: 10.2105/AJPH.2026.308655.

ABSTRACT

Objectives. To examine patterns of community health worker (CHW) core roles within the Community Health Workers for COVID Response and Resilient Communities (CCR) program through a latent class analysis (LCA). Methods. We used data from a CHW self-report survey (n = 689) conducted in the United States during February and March 2024. LCA was used to examine whether distinct classes existed according to patterns of reported engagement in CHW core roles in the CCR program. Results. The study findings supported a 2-class model: (1) “low assessment and evaluation CHWs,” which represented 52.6% of CHWs, and (2) “full range of core roles CHWs,” which represented 47.4% of CHWs. Conclusions. This study is the first to use LCA to identify patterns of CHW core roles. The fairly even split between the 2 classes suggests that a substantial proportion of CCR CHWs performed the full range of core roles and indicates assessment and evaluation as key areas to target for increased CHW involvement. Public Health Implications. Our findings can inform organizational policy to ensure that CHWs are supported in performing the full range of core roles. (Am J Public Health. 2026;116(S4):S305-S313. https://doi.org/10.2105/AJPH.2026.308655).

PMID:42647807 | DOI:10.2105/AJPH.2026.308655

Am J Public Health. 2026 Sep;116(S4):S331-S340. doi: 10.2105/AJPH.2026.308642.

ABSTRACT

Objectives. To describe the health care and social services needs addressed by community health workers (CHWs) through referrals in the Community Health Workers for COVID-19 Response and Resilient Communities (CCR) program. Methods. We performed a descriptive analysis of national performance measure data from 67 CCR recipients from 2021 to 2024 documenting referrals, alongside 2 web-based surveys of 63 program administrators and 689 CHWs in the United States in early 2024. Results. CHWs made 464 158 social and 323 769 health referrals, with 282 596 referrals completed. Referrals included services for food, housing, legal assistance, health insurance, lifestyle interventions, chronic disease management, COVID-19‒related care, and maternal and child health care. Referral success was aided by community resources, CHW knowledge, and networking, and limited by costs, mistrust, language barriers, transportation, and child care challenges. Conclusions. CHWs connect individuals to health care and provide follow-up care and social support. Comprehensive and coordinated health and social services are essential to optimize the referral and service delivery. Public Health Implications. Findings support policies promoting the integration, expansion, and sustainability of the CHW workforce. (Am J Public Health. 2026;116(S4):S331-S340. https://doi.org/10.2105/AJPH.2026.308642).

PMID:42647805 | DOI:10.2105/AJPH.2026.308642

Am J Public Health. 2026 Sep;116(S4):S285-S294. doi: 10.2105/AJPH.2026.308734.

ABSTRACT

Objectives. To examine characteristics of CHWs engaged in a nationwide program in the United States and the extent to which they were culturally congruent with program participants. Methods. In 2024, CHWs participating in a nationwide federal program completed a cross-sectional census survey (n = 689). Results. High CHW-centered congruence and varying levels of community-centered congruence were observed across racial/ethnic and other communities of identity. Among CHWs who self-identified with specific communities, proportions also serving those communities ranged from 86.4% to 100%; among communities defined in other ways, congruence ranged from 76.5% to 96.7%. Congruence was higher in community-based settings than in clinical or public health settings. Conclusions. As one of few studies examining CHW congruence in a large-scale national program, our findings demonstrate that substantial cultural congruence was achieved across diverse communities. Public Health Implications. Findings demonstrate that (1) CHWs are embedded within communities most affected by structural inequities, optimally positioned to address health disparities and (2) even in federally funded, multisite CHW programs, cultural congruence can be achieved at scale. (Am J Public Health. 2026;116(S4):S285-S294. https://doi.org/10.2105/AJPH.2026.308734).

PMID:42647797 | DOI:10.2105/AJPH.2026.308734

Age Ageing. 2026 Aug 3;55(8):afag254. doi: 10.1093/ageing/afag254.

ABSTRACT

BACKGROUND: Prescribing cascades occur when an adverse drug event is misinterpreted as a new medical condition, leading to the prescription of additional medications. They represent an important and preventable source of potentially inappropriate prescribing in older adults, yet their population-level incidence remains poorly documented in France.

METHODS: We conducted a nationwide retrospective cohort study in 2022 using the French National Health Data System, including all individuals aged ≥65 years in 2022. Clinically important prescribing cascades were identified using a consensus-based list (ThinkCascades). Two complementary approaches were applied: a conservative longitudinal analysis and prescription sequence symmetry analysis. Incidence ranges were estimated, and subgroup analyses were performed to identify factors associated with cascade initiation.

RESULTS: Among 16.6 million older adults, four of seven predefined potential prescribing cascades showed significant positive signals. The strongest associations were observed for benzodiazepine-antipsychotic (adjusted sequence ratio [aSR] 2.48, 99% CI 2.44-2.51) and antipsychotic-antiparkinsonian cascades (aSR 2.01, 99% CI 1.91-2.11). Incidence estimates ranged from 0.69% to 3.29%. Female sex, advanced age (≥85 years), hospital initiation of the index drug and lack of prescriber continuity were associated with higher risks for specific cascades.

CONCLUSIONS: Clinically important potential prescribing cascades are common among older adults in France. These findings suggest potential prescribing cascades as a persistent and preventable contributor to medication-related harm and underscore the importance of systematic medication review, particularly during transitions of care and when new prescriptions shortly follow treatment initiation, as potential signals of prescribing cascades.

PMID:42647768 | DOI:10.1093/ageing/afag254

J Occup Environ Med. 2026 Aug 26. doi: 10.1097/JOM.0000000000003869. Online ahead of print.

ABSTRACT

OBJECTIVES: To develop an instrument for assessing organizational well-being and examine its construct validity and cross-sample stability among Thai workers.

METHODS: This sequential validation study generated a 45-item pool across five domains. Survey 1 (telecommunications; n = 655) refined the scale using first- and second-order confirmatory factor analyses (CFA). Survey 2 (multi-sector; n = 511) evaluated cross-sample validation, model fit, and structural stability.

RESULTS: CFA condensed the instrument into a 26-item, five-domain structure with acceptable fit (RMSEA = 0.060, SRMR = 0.048, CFI = 0.934, TLI = 0.924). Cross-sample validation confirmed that model fit and factor loadings remained stable. Convergent and discriminant validity were largely supported across both samples.

CONCLUSIONS: The 26-item Organizational Well-being Scale (OWS) is a reliable, valid, and structurally stable tool for assessing organizational well-being across diverse industries.

PMID:42647738 | DOI:10.1097/JOM.0000000000003869

Eur J Heart Fail. 2026 Aug 26:xuag274. doi: 10.1093/ejhf/xuag274. Online ahead of print.

ABSTRACT

BACKGROUND: The C-MIC II trial demonstrated benefits of 6 months of cardiac microcurrent (C-MIC) therapy in patients with non-ischemic heart failure with reduced ejection fraction (HFrEF). The prospective C-MIC II Follow-Up Study evaluates safety and efficacy outcomes post-device deactivation.

METHODS: Primary safety-related endpoints included all-cause, cardiovascular and device-related mortality and hospitalizations and adverse events (AEs). Secondary efficacy-related endpoints included changes in left ventricular ejection fraction (LVEF), Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS), 6-minute walk distance (6MWD), New York Heart Association (NYHA) class and device reactivation rate. Here, we report 12-month results comparing the 6-month time-point (at the end of active therapy) with the 18-month time-point (12 months post-deactivation).

RESULTS: Of 32 eligible patients, 31 (97%) were enrolled. At 12 months post-device deactivation, 3 patients (10%) were hospitalized and 1 died (3%); none were device-related. One device-related AE occurred and resolved completely. Improvements in LVEF (vs pre-implantation: +6%; 95% CI 5-8; p<0.0001) and KCCQ-OSS (vs pre-implantation: +43 points; 95% CI 36-49; p<0.0001) were sustained and unchanged from 6 months (LVEF: -0.1%; 95% CI -2-2; p=0.87; KCCQ-OSS:-2; 95% CI -8-4; p=0.49). The 6MWD remained improved (vs pre-implantation: +150 m; 95% CI 109-191; p<0.0001), with a modest decrease (-31 m; 95% CI -56- -7; p=0.013) from 6 months. Improvements in NYHA class (≥1-class improvement in 77% patients) were sustained. Three (10%) patients required device reactivation.

CONCLUSION: Among patients previously treated with C-MIC device, improvements in LVEF, 6MWD, NYHA class and KCCQ-OSS were sustained, with a favorable safety profile 12 months post-deactivation.

PMID:42647736 | DOI:10.1093/ejhf/xuag274

IEEE J Biomed Health Inform. 2026 Aug 26;PP. doi: 10.1109/JBHI.2026.3727632. Online ahead of print.

ABSTRACT

Human Activity Recognition (HAR) with wear able multi-Inertial Measurement Unit (IMU) systems is challenged by limited labeled data, sensor instability, and real-time constraints. This paper proposes an adaptive TimeGAN-augmented fully convolutional framework for robust and efficient multi-IMU HAR. TimeGAN is used to generate high-fidelity synthetic data, alleviating data scarcity while preserving temporal and statistical characteristics. Based on augmented data, the Hybrid Activity Recognition Topology (HART) is developed, combining1Dconvolutional layers and Squeeze-and-Excitation (SE) channel attention to achieve robust feature representation under sensor variability. An adaptive online updating mechanism is further introduced to enable continuous model refinement during inference, supporting fast and accurate recognition in dynamic environments. Experimental results on multiple datasets demonstrate that the proposed framework achieves superior accuracy with reduced computational cost and strong robustness under varying conditions.

PMID:42647703 | DOI:10.1109/JBHI.2026.3727632