Category: Statistics

J Pediatr Nurs. 2026 Mar 6;88:327-336. doi: 10.1016/j.pedn.2026.02.037. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to develop and evaluate the feasibility of a theory-driven, web-based discharge education program designed to enhance self-management among caregivers of children with epilepsy.

METHODS: Following the Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model, educational needs were assessed through an integrative literature review and focus group interviews with caregivers and pediatric nurses. The program was structured using the Include, Discuss, Educate, Assess, and Listen (IDEAL) discharge planning framework, and individual and family self-management theory.

RESULTS: The key features included self-assessment tools, pre-discharge questions, multimedia materials, health diaries, and Q&A boards. Content validity was reviewed by experts, usability tested with caregivers and professionals, and clinical feasibility examined using a one-group pretest-posttest design involving 13 caregivers. Participants reported high satisfaction with the clarity and accessibility of the content, with strongest engagement in the self-assessment and pre-discharge sections. Although changes in discharge readiness and self-management scores were not statistically significant, moderate-to-large effect sizes suggested an increasing trend in practical improvement. Caregivers also reported improved confidence, medications awareness, and follow-up adherence. Feedback supported mobile-based delivery and highlighted the need for interactive and personalized features.

CONCLUSIONS: The program is a feasible and accepted intervention that incorporates self-assessment into discharge education and leverages web-based delivery to support family centered care.

PRACTICE IMPLICATIONS: The program addresses existing gaps in pediatric epilepsy education and shows potential for broader implementation. Integrating self-assessment and digital platforms into discharge education may enhance caregivers’ preparedness and support sustainable self-management.

PMID:41795271 | DOI:10.1016/j.pedn.2026.02.037

Environ Toxicol. 2026 Mar 7. doi: 10.1002/tox.70074. Online ahead of print.

ABSTRACT

Anthropogenic activities generate a significant amount of pollutants that are released into the environment, causing physiological and ecological disturbances. Among the xenobiotics present in aquatic ecosystems, numerous chemical and organic compounds have oxidative potential or are metabolized through oxidative processes, which may amplify the damage caused by reactive oxygen species to biological systems. The quantification of cellular damage and antioxidant defenses can be used as biomarkers for early aquatic contamination. The aim of this research was to use the shrimp Macrobrachium amazonicum as a bioindicator species to assess oxidative damage caused by xenobiotics in an Environmental Protection Area in the Brazilian Amazon. The analyses evaluated physicochemical parameters, Iron, Copper, Total Solids, pH, and Temperature, as well as non-enzymatic and enzymatic oxidative stress biomarkers: Thiobarbituric Acid Reactive Substances, glutathione (GSH), and catalase (CAT) in hepatopancreas homogenates. Among the analyzed metals, only copper (Cu) showed a statistically significant influence on GSH and CAT activities, whereas the other parameters did not exhibit significant effects. Oxidative stress parameters can be important tools in biomonitoring work, helping to understand the effects of contamination on aquatic organisms and providing important information on cellular defense modulations.

PMID:41795211 | DOI:10.1002/tox.70074

Clin Exp Allergy. 2026 Mar 7. doi: 10.1111/cea.70272. Online ahead of print.

ABSTRACT

BACKGROUND: Allergy is the most common and earliest onset non-communicable disease in children. The early identification of children who are at risk of allergy would allow early intervention to prevent the onset of the disease or reduce its impact. The origins of allergy are hypothesized to be derived from early developmental events which include prenatal events and early childhood exposures. We have previously identified that many placental glucocorticoid-regulated genes were also associated with child allergy.

OBJECTIVE: We have questioned if it is possible to predict which children are at risk of allergy based on their placental glucocorticoid-regulated mRNA profile.

METHODS: Placentae from two different populations located in South Australia (n = 105) and Victoria, Australia (n = 261) were included in the study. Glucocorticoid regulated genes were measured by qPCR. Statistical modelling was executed in R (version 4.4.1).

RESULTS: Evaluation of the importance of each gene in the model identified AFF1, ARID5B, IER3, ATF4 and SLC19A2 as the top five ranking genes. The best-performing random forest model achieved an AUC of 0.664, indicating moderate ability to distinguish between positive and negative allergic susceptibility. While our models demonstrate both measurable specificity and sensitivity, the glucocorticoid genes particularly excel at identifying children who will not develop an allergy.

CONCLUSION: This study demonstrates that placental glucocorticoid-regulated genes possess significant predictive power, especially in identifying individuals unlikely to develop allergies. It offers further evidence that the placentae of nonallergic children and allergic children are transcriptionally distinct.

PMID:41795204 | DOI:10.1111/cea.70272

Aust J Rural Health. 2026 Apr;34(2):e70158. doi: 10.1111/ajr.70158.

ABSTRACT

OBJECTIVE: Australians living in rural areas have a higher prevalence of dental caries and higher potentially preventable hospital admissions for oral health conditions compared to metropolitan-dwelling Australians. Despite high burdens of dental disease and a lack of systems supporting oral health, including water fluoridation and access to dental services, rural Australians have been given limited opportunities to participate in oral health research, resulting in gaps in our understanding. The objective of this study was to explore rural health consumer experiences of using and accessing oral health care services.

DESIGN: Cross-sectional online survey.

SETTING: Rural and remote Australia (MM2-MM7).

PARTICIPANTS: Members of the Rural Health Consumer Panel aged over 18 years.

RESULTS: One hundred and thirty-nine Rural Health Consumer Panel members responded to the survey. Key sociodemographic characteristics included a median age of 61 years, predominantly female (74.5%) and highly educated (73% holding tertiary qualifications). The majority of those visiting an oral health professional in the past 12 months reported visiting a dentist (47.5%). Over a third (38%) of respondents did not visit any oral health professional in the past 12 months. Private health insurance coverage was associated with more regular dental and oral health check-ups. Key challenges in accessing oral health care included cost, wait times for an appointment, and distance travelled to receive care.

CONCLUSION: Rural people in this study face barriers in accessing oral health care, contributing to low rates of preventative dental and oral health visits. The difficulty in accessing oral health services and lower rates of private health insurance in rural areas further exacerbate these inequities. Further research is required to gain a deeper understanding of the experiences of rural people in relation to accessing oral health services and involving rural people in developing place-based solutions across communities.

PMID:41795184 | DOI:10.1111/ajr.70158

Muscle Nerve. 2026 Mar 7. doi: 10.1002/mus.70207. Online ahead of print.

ABSTRACT

INTRODUCTION/AIMS: Myasthenia gravis (MG) is associated with thymic neoplasms. However, an increased prevalence of extrathymic neoplasms has also been reported. This study aimed to evaluate the rates of malignancy in MG patients while accounting for risk factors such as disease characteristics and immunomodulatory treatments.

METHODS: We conducted a case-control study using the Clalit Health Services database, applying a machine learning (ML) algorithm to minimize diagnosis misclassification. We included MG patients aged 18 years and older, with a sex- and age-matched control group in a 1:3 ratio. We compared the prevalence and hazard ratios of extrathymic neoplasms between the groups.

RESULTS: A total of 1558 patients with a high probability of MG, according to our ML model, were included in the cohort, alongside a control group of 4674 individuals. MG patients had a higher prevalence of malignancy prior to MG diagnosis, with an odds ratio of 1.95 (95% CI, 1.65-2.08), and a higher incidence of malignancy after MG diagnosis, with a hazard ratio of 1.56 (95% CI, 1.38-1.77). The most prevalent extrathymic neoplasms after MG diagnosis were respiratory, intrathoracic, skin (specifically non-melanoma), urinary tract, soft tissue, and myelodysplastic syndrome. Risk factors for malignancy included age, male sex, and thymoma. Immunosuppressive treatment did not increase the risk of malignancy.

DISCUSSION: MG patients have a higher prevalence of both solid and hematologic neoplasms compared to non-myasthenic controls, regardless of immunosuppressive treatment. This supports the notion that malignancy is related to MG disease itself rather than external factors.

PMID:41795172 | DOI:10.1002/mus.70207

Paediatr Anaesth. 2026 Mar 7. doi: 10.1002/pan.70157. Online ahead of print.

ABSTRACT

BACKGROUND: Acute and postoperative pain in children is often undertreated, with effects on patient comfort and postoperative recovery. Extended reality (XR) interventions offer non-pharmacological pain management by distracting patients from discomfort. While effective for procedural pain, its impact on prolonged pain episodes remains underexplored.

OBJECTIVES: To systematically review and meta-analyze findings from previous studies on the efficacy of XR interventions in managing acute and postoperative pain in children, compared to standard care.

ELIGIBILITY CRITERIA: Studies involving children (≤ 18 years) with acute or postoperative pain were included if they compared XR interventions to standard care. Studies focusing on procedural or chronic pain were excluded.

METHODS: A systematic search was conducted on January 23, 2025, in MEDLINE, EMBASE, Web of Science, CINAHL, and PsycINFO for studies evaluating XR interventions for acute and postoperative pain in children, using validated pain measures. Pain outcomes were extracted for an exploratory meta-analysis, with self-report as the primary and observer-report as the secondary outcome. Two reviewers independently extracted data and assessed study quality using CONSORT and TREND.

RESULTS: From 1793 records, nine studies were included, all evaluating virtual reality (VR) interventions. Seven focused on postoperative pain, two on acute pain. The primary meta-analysis (n = 6) showed a moderate but nonsignificant effect in self-reported pain (SMD = -0.61; 95% CI, -1.58 to 0.36). The secondary meta-analysis (n = 6) for observer-reported pain showed a large but nonsignificant effect (SMD = -1.04; 95% CI, -2.18 to 0.11).

CONCLUSION: This meta-analysis found no significant analgesic effect of VR on acute or postoperative pain in children. However, moderate effect sizes were observed, but the lack of statistical significance indicates that XR interventions require further investigation in pediatric pain management. Future research should prioritize pain as a primary endpoint and assess the effects of VR type, timing, and age on acute pain using validated measures.

PMID:41795162 | DOI:10.1002/pan.70157

Paediatr Anaesth. 2026 Mar 7. doi: 10.1002/pan.70167. Online ahead of print.

ABSTRACT

BACKGROUND: Albeit the numerous guidelines on pre-operative fasting in pediatric patients, clinical practice varies. Prolonged fasting can result in several complications, hypoglycemia being one of them. This systematic review and meta-analysis (SRMA) was conducted to assess the effect of prolonged pre-operative fasting on the incidence of hypoglycemia in pediatric patients posted for elective surgery.

MATERIALS AND METHODS: Relevant studies (observational and randomized controlled studies [RCTs]) with fasting duration and incidence of hypoglycemia were identified from data sources (Medline, Scopus, Cochrane Library, Google Scholar) using a systematic search strategy. A pooled relative risk (RR) of hypoglycemia and ketosis due to prolonged fasting was calculated from the RCTs.

RESULTS: This SRMA included 42 studies (15 RCTs and 27 observational studies) involving 5121 patients. There was a wide variation in the definition of hypoglycemia, fasting duration, and incidence of hypoglycemia across the studies. The pooled RR for hypoglycemia was 2.0 (95% CI: 0.57-7.03, I² = 0.00%, p = 0.28) in the prolonged fasting group compared to the non-prolonged fasting group. Although statistical significance was not reached, the direction and magnitude of the pooled effect suggest a clinically meaningful trend toward a lower risk of hypoglycemia with adherence to recommended fasting durations compared with prolonged fasting.

CONCLUSION: The findings of the review revealed the need for standardized outcome definitions and fasting protocols to enable comparisons across future studies. The meta-analysis revealed a variable relationship between fasting duration and hypoglycemia incidence. Structured interventions to facilitate the implementation of guidelines in clinical practice may mitigate the problem.

PMID:41795161 | DOI:10.1002/pan.70167

CPT Pharmacometrics Syst Pharmacol. 2026 Mar;15(3):e70230. doi: 10.1002/psp4.70230.

ABSTRACT

Vixarelimab is a first-in-class fully human monoclonal antibody targeting oncostatin M (OSM) receptor beta (OSMRβ). It has been evaluated in Phase 1 and 2 studies in healthy volunteers and patients with chronic pruritic conditions and demonstrated anti-pruritic efficacy in a Phase 2 study in prurigo nodularis, but detailed pharmacokinetic analysis has not been previously reported. In this study, a population pharmacokinetic analysis was performed to characterize the pharmacokinetics of vixarelimab and identify covariates affecting exposure. The analysis dataset contained 4032 measurements from 274 participants from three Phase 1 and 2 studies. A two-compartment target-mediated drug disposition (TMDD) model with a quasi-steady-state (QSS) approximation satisfactorily described the observed concentration-time data across studies and various dose levels. The model estimated linear clearance (CL), central volume (V_c), and peripheral volume (V_p) at 0.00649 L/h, 3.04 L, and 1.74 L, respectively, in line with values for a typical monoclonal antibody. Subcutaneous bioavailability and the absorption rate constant were estimated to be 56.6% and 0.0126 h^-1, respectively. Body weight was identified as the only statistically significant covariate, positively correlating with CL, V_c, and V_p. Model-based simulations showed that the clinical impact of body weight on vixarelimab exposure was minor, suggesting that dose adjustment based on weight is not warranted. The developed model provides a thorough understanding of vixarelimab pharmacokinetics and the impact of covariates on exposure to support future clinical development.

PMID:41795156 | DOI:10.1002/psp4.70230

Cancer Med. 2026 Mar;15(3):e71706. doi: 10.1002/cam4.71706.

ABSTRACT

BACKGROUND: The incidence of pancreatic cancer (PC) and autoimmune diseases (ADs) has been increasing worldwide. While certain associations between specific ADs, such as pancreatitis, and PC have long been well confirmed, population-focused research investigating the broader spectrum of ADs and their relationship with PC risk remains limited.

METHODS: We implemented a cohort study based on population data to analyze the relationships between ADs and PC susceptibility. Diagnostic information on 43 ADs was obtained from the Swedish Inpatient Register (1964-2018), while cancer incidence and mortality data were sourced from the National Cancer Registry and Cause of Death Register starting in 1997. Relative cancer risks were quantified using standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs).

RESULTS: Within the study’s total population of 16.4 million, 1.1 million cases of ADs were identified, and 3257 patients were later diagnosed with PC accounting for 5.42% of all cancer cases in the cohort. The SIRs for PC in patients with ADs were 1.24 (men) and 1.19 (women); 12 ADs were positively correlated with the incidence of PC. The SMRs for PC in patients with ADs were 1.28 (men) and 1.22 (women); 15 ADs were positively correlated with PC mortality. When the follow-up time was less than 1 year, the overall risk of PC in patients with ADs was 3.88; over 10 years, the risk reached 1.12.

CONCLUSIONS: We have newly discovered the relationship between several ADs and the risk of PC incidence and mortality, including discoid lupus erythematosus, lupoid hepatitis, giant-cell arteritis, and rheumatic fever. The results of this study back the notion that ADs may have a role in promoting the onset of PC.

PMID:41795138 | DOI:10.1002/cam4.71706

Anat Histol Embryol. 2026 Mar;55(2):e70100. doi: 10.1111/ahe.70100.

ABSTRACT

In this study, a comparative assessment of species- and sex-related differentiation was conducted using two morphometric approaches based on mandibles of domestic geese (Anser anser domesticus) and domestic ducks (Anas platyrhynchos domesticus). A relatively traditional approach based on linear measurements was applied alongside a more recent method employing three-dimensional scanning and landmark-based geometric morphometric techniques. The effectiveness of both methods in discriminating morphological differences associated with species and sex was evaluated. For this purpose, a total of 80 mandibles were analysed, comprising 40 domestic geese (20 females and 20 males) and 40 domestic ducks (20 females and 20 males). In species discrimination based on linear measurements, the LS measurement was found to be statistically significant (p < 0.001). Furthermore, discriminant function analysis correctly classified domestic geese at 72.5% and domestic ducks at 87.5%. In the geometric morphometric analyses, PC1 accounted for 50% of the total shape variation, while PC2 explained 16.9%, and a clear separation between species groups was observed. In the assessment of morphological differences between sex groups, all linear measurements were significantly different between sexes in domestic geese (p < 0.001). Regarding shape variation, species groups showed a relatively homogeneous distribution within each group. Overall, this study aims to demonstrate the combined applicability of linear and geometric morphometric methods and to identify mandibular morphological differences across species and sexes, thereby contributing to research on avian morphology.

PMID:41795134 | DOI:10.1111/ahe.70100