Category: Statistics

Clin Nutr. 2026 Apr 9;62:106661. doi: 10.1016/j.clnu.2026.106661. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Although whole-body phase angle (PhA) is a recognized prognostic marker in cardiovascular surgery, the clinical significance of segmental PhA and the impact of fluid overload on its interpretation remain insufficiently elucidated. This study investigated the associations between segmental PhA, physical function, and long-term prognosis in patients undergoing cardiovascular surgery.

METHODS: This retrospective cohort study included consecutive patients who underwent elective cardiovascular surgery between October 2016 and March 2021 at Nagoya Heart Center, Japan. Preoperative whole-body, upper extremity, and lower extremity PhA were measured using bioelectrical impedance analysis. We analyzed correlations between PhA and physical functions. Additionally, the impact of fluid overload was assessed by stratifying patients based on an extracellular-to-total body water ratio (ECW/TBW) cut-off of 0.400. Long-term all-cause mortality was evaluated using multivariate Cox regression analyses adjusting for confounders including age, sex, cardiac and renal function.

RESULTS: A total of 859 patients were included in the present analysis (mean age = 68.4 ± 11.9 years, 67.6% male). Segmental PhA significantly correlated with muscle mass, grip strength, and knee extension strength. However, in patients with fluid overload (ECW/TBW ≥0.400), the associations between PhA and physical function were attenuated, and the correlation with age lost statistical significance. Regarding prognosis, low PhA values across all segments were independent predictors of long-term all-cause mortality, even after adjusting for confounders.

CONCLUSIONS: Segmental PhA is a robust predictor of long-term mortality in cardiovascular surgery patients. However, because fluid overload confounds the relationship between PhA and physical function, clinicians must account for fluid status when interpreting PhA as a marker of muscle quality..

PMID:42127431 | DOI:10.1016/j.clnu.2026.106661

Sleep. 2026 May 13:zsag130. doi: 10.1093/sleep/zsag130. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Sleep duration is a key component of overall sleep health, but prior population-level studies characterizing this have relied on brief self-report questions (often one item) or used different objective devices within the same study. We examined the normal variation of sleep duration in an adult population using a single consumer-grade wearable device with a unified algorithm.

METHODS: Retrospective cohort study conducted in the United States. Data were analyzed from 274,128 U.S.-based adults aged 20 to 69 who used a Samsung Galaxy Watch between February 2023 and April 2023; participants were included if they had ≥20 valid weekdays and ≥8 valid weekend days of data. Sleep duration was the primary outcome, defined as the longest continuous nighttime sleep period between 6:00 p.m. and 6:00 a.m. averaged over a three-month period. Sleep duration and weekday-weekend variability were examined across age groups and by sex using descriptive statistics and independent t-tests.

RESULTS: Overall, average sleep duration was 7.57 hours, with a 10th-90th percentile range of 6.5 to 8.9 hours. Sleep duration was shortest in the 40-49 year old group (7.54 hours) and longest in the 60-69 year old group (7.75 hours; p < .001). Overall, 23.0% of adults slept less than 7 hours, more commonly among those aged 40-49 (25.1%) and 50-59 (24.7%). Across all age groups, weekend sleep was longer than weekday sleep by an average of 28 minutes, with the largest gap in the 40-49 year old group (34 minutes), and the smallest in the 60-69 year old group (20 minutes). Women consistently slept longer than men (+18 minutes on average), and exhibited greater between-subject variability in total sleep duration (SD = 1.61 hours for women vs. 1.54 hours for men).

CONCLUSIONS: This study demonstrates considerable variability in objectively measured sleep duration across adulthood, spanning a broad range and differing by age groups and sex. These findings provide reference distributions that may inform clinical expectations and public health messaging regarding sleep duration.

PMID:42127423 | DOI:10.1093/sleep/zsag130

JMIR Form Res. 2026 May 13;10:e89681. doi: 10.2196/89681.

ABSTRACT

BACKGROUND: Due to demographic changes, the number of older people is increasing, often accompanied by limitations in mobility, nutrition, and independence. Preventive monitoring is rare, as care systems struggle with staff shortages and limited resources. Technical assistance systems can support older people in self-assessing their health and maintaining independence. We developed the AS-Tra system, which combines an application with a measurement and training station (MuTS), to enable early detection of nutrition and mobility-related deficits and risks.

OBJECTIVE: This paper presents the pilot study of the AS-Tra system with the aim of evaluating its usability and testing the feasibility of collecting health-related data from older adults (≥70 y) with early/mild deficiencies in nutritional state and mobility in preparation for a future randomized controlled trial.

METHODS: The system used in this 4-week pilot study was developed as a complex intervention in accordance with the Medical Research Council framework. Participants (target n=10) were recruited through a participant registry. They completed standardized mobility assessments (grip strength, Timed “Up and Go,” and 5-Time Chair Rise) at baseline and after 1, 2, and 4 weeks (T0, T1, and T2, respectively). Mini Nutritional Assessment-Short Form and short physical performance battery were recorded at baseline and at T2. Participants received a tablet app for regularly documenting nutrition and an activity sensor for 7 days of physical activity monitoring and performed weekly training starting at T0. At T2, the System Usability Scale (SUS) and feedback questionnaires (Evaluation Overall System [EOS] questionnaire-the evaluation of all subcomponents on a scale of 1-5, weekly Experience Report) were additionally collected. Data were analyzed descriptively using IBM SPSS Statistics, in which data were shown as total numbers, percentages, and means with SDs, and data from the activity sensor were displayed and analyzed using Python.

RESULTS: A total of 9 older adults, with 1 dropout (mean 80, SD 5 y, 50% female), participated in this study. The SUS score was good (mean 79, SD 13.4 points). The MuTS devices had minor technical problems (in <17% of MuTS sessions), while 57% (17/30) of the users experienced instability issues with the food diary in the tablet app. The average overall system ratings were positive, with an EOS score of 2.01 (SD 0.99).

CONCLUSIONS: The usability of the technical assistance system used in this study was rated as good. The data collection using questionnaires, sensors, and automated assessments proved feasible. The biggest challenge was the tablet-based food diary, which still needs improvement before the effectiveness of the AS-Tra system regarding mobility and nutritional status can be evaluated in a randomized controlled trial.

PMID:42127422 | DOI:10.2196/89681

Int Clin Psychopharmacol. 2026 May 13. doi: 10.1097/YIC.0000000000000630. Online ahead of print.

ABSTRACT

Attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) frequently co-occur. However, evidence on the clinical effects of stimulant treatment in ADHD-BPD comorbidity remains limited. This prospective study aimed to investigate the longitudinal effects of methylphenidate (MPH) on borderline personality features in adults with ADHD-BPD. Thirty-six adults diagnosed with ADHD who also met the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria for BPD were treated with MPH and followed for at least 16 weeks. Clinical ratings of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition BPD criteria and psychometric measures assessing symptom severity and personality functioning were obtained at baseline and follow-up. Twenty-four participants (66.7%) completed the follow-up. Follow-up duration ranged from 3.9 to 12.3 months, with a mean duration of 7.8 ± 2.48 months. The number of BPD criteria significantly decreased after treatment (r = 0.82, P < 0.001). Nineteen participants no longer met the diagnostic threshold for BPD, and 10 achieved remission (≤2 BPD criteria). Baseline anger dysregulation (P = 0.009) and mood stabilizer use (P = 0.029) were associated with continued MPH treatment. Our findings preliminarily suggest that MPH, especially combined with mood stabilizers, may be associated with clinical benefits and acceptable tolerability in patients with comorbid ADHD-BPD. While causal conclusions cannot be drawn, replication in randomized controlled trials is warranted.

PMID:42127382 | DOI:10.1097/YIC.0000000000000630

J Strength Cond Res. 2026 May 13. doi: 10.1519/JSC.0000000000005531. Online ahead of print.

ABSTRACT

Carminatti, LJ, de Souza, PV, Cetolin, T, Mohr, PA, Netto, AS, Ortiz, JG, da Silva, JF, and Teixeira, AS. A cross-sectional analysis of Carminatti’s test versions: Age- and position-specific variations and normative reference values in male soccer players. J Strength Cond Res XX(X): 000-000, 2026-The primary aims were: (a) to compare the peak speed (PST-CAR) and peak heart rate (HRpeak) between the 2 Carminatti’s test (T-CAR) protocols, and (b) to compare T-CAR performance across age groups and playing positions. Part I used a randomized crossover design where 26 elite U-20 players completed the original T-CAR (starting at 9 km·h-1) and a modified, shorter version (starting at 12 km·h-1) to assess their interchangeability. Part II involved a cross-sectional analysis of a large data set (n = 3,161) to establish normative values and assess T-CAR performance from Under-11 to professional levels. Statistical significance was set at 5%. Part I revealed no significant differences in PST-CAR or HRpeak between the 2 T-CAR versions, with a nearly perfect correlation for PST-CAR (r = 0.93) and a very large correlation for HRpeak (r = 0.89). The intraclass correlation coefficient results indicated excellent consistency, with values of 0.96 (95% CI = 0.92 to 0.98) and 0.94 (95% CI = 0.87 to 0.97) for PST-CAR and HRpeak, respectively. Part II demonstrated that T-CAR performance improved with age, with the most substantial gains occurring between the U-13 and U-15 age groups. Furthermore, position-specific differences emerged from the U-15 level onward, with wide defenders and midfielders generally outperforming central defenders. In conclusion, the modified T-CAR is a valid and time-efficient alternative to the original protocol for assessing intermittent endurance performance in highly trained soccer players. The normative data established in this study provide valuable benchmarks for practitioners to monitor long-term athletic development according to age and playing position.

PMID:42127380 | DOI:10.1519/JSC.0000000000005531

Am J Public Health. 2026 Jun;116(6):798-805. doi: 10.2105/AJPH.2026.308513.

ABSTRACT

Objectives. To examine the magnitude of heat-related emergency medical services (EMS) activations across the United States and identify factors that increase the risk of heat exposure illness. Methods. We extracted heat-related EMS activations from April through September for 2020 through 2024 from the National Emergency Medical Services Information System (NEMSIS) database. We linked information from the 2022 Centers for Disease Control and Prevention (CDC) Social Vulnerability Index with heat-related EMS activations using county of residence. Our analysis focused on heat-related illness by patient demographic, geographic, and EMS system factors. Results. Among the 79 077 804 EMS activations meeting study inclusion criteria, 261 687 (0.3%) were heat related. The rate of heat-related EMS activations was 16.46 per 100 000 population, with higher rates among older adults, males, African Americans, and Native Hawaiians/Pacific Islanders. Rates were higher in rural counties and in counties characterized by the CDC Social Vulnerability Index as having relatively worse socioeconomic or environmental conditions. Heat-related EMS activations were commonly reported in the afternoon and in indoor locations. Conclusions. The NEMSIS database provides novel information that improves our ability to monitor heat-related adverse health outcomes. Public Health Implications. The timely collection and sharing of data provide critical situational awareness to inform public health response efforts during a heat wave. (Am J Public Health. 2026;116(6):798-805. https://doi.org/10.2105/AJPH.2026.308513).

PMID:42127377 | DOI:10.2105/AJPH.2026.308513

Am J Public Health. 2026 Jun;116(6):851-854. doi: 10.2105/AJPH.2026.308459.

ABSTRACT

Objectives. To examine trends in meningococcal B (MenB) vaccination coverage among US adolescents aged 16 and 17 years. Methods. We conducted cross-sectional and longitudinal analyses of 2018 to 2023 National Immunization Survey-Teen data to calculate the annual percentage of eligible adolescents who received the MenB vaccine and to assess changes over time. Results. Only 19.8% of the 41 505 eligible adolescents initiated MenB vaccination between 2018 and 2023. A total of 24.5% (95% confidence interval [CI] = 22.5, 26.6) of adolescents received 1 or more MenB vaccinations in 2023, as compared with 13.2% (95% CI = 11.7, 14.6) in 2018. Among initiators, most received only 1 dose. Conclusions. MenB vaccination coverage among 16- and 17-year-old adolescents increased modestly between 2018 and 2023. As of 2023, approximately 3 out of 4 adolescents in this age group had not received the MenB vaccine. Public Health Implications. As of 2023, less than one quarter of 16- and 17-year-old adolescents had initiated MenB vaccination. Given that MenB has accounted for most meningococcal disease among adolescents and young adults since 2013, efforts to improve uptake are warranted. (Am J Public Health. 2026;116(6):851-854. https://doi.org/10.2105/AJPH.2026.308459).

PMID:42127373 | DOI:10.2105/AJPH.2026.308459

Am J Public Health. 2026 Jun;116(6):841-850. doi: 10.2105/AJPH.2026.308508.

ABSTRACT

Objectives. To expand the understanding of food security among a racially and ethnically diverse sample of US adults living below 200% of the federal poverty line (FPL). Methods. I performed a cross-sectional analysis of the National Health Interview Survey (2019-2023) that included 37 748 respondents. I estimated unadjusted proportions and adjusted probabilities of food security for non-Hispanic White, Black, American Indian/Alaska Native (AIAN), Asian, and Hispanic adults living in severe (< 50% FPL), moderate (50% to < 100% FPL), and near poverty (100% to < 200% FPL). Results. The study reveals important nuances in food security by race and ethnicity. Non-Hispanic Asian adults in severe poverty experienced higher food security than their counterparts in less dire economic situations, non-Hispanic Whites and Hispanics were more similar than previously reported, and non-Hispanic AIAN adults reported extremely low probabilities of food security. Conclusions. Thoroughly documenting and expanding on these patterns of food security for lower-income adults could lead to better understanding of policy mechanisms that could alleviate food insecurity and reduce health disparities by racial and ethnic identity in the United States. (Am J Public Health. 2026;116(6):841-850. https://doi.org/10.2105/AJPH.2026.308508).

PMID:42127364 | DOI:10.2105/AJPH.2026.308508

JMIR Med Inform. 2026 May 13;14:e79929. doi: 10.2196/79929.

ABSTRACT

BACKGROUND: Antibiotic therapies are the main treatment for bacterial infections, but growing antibiotic resistance is a major global health threat, severely impacting patients with sepsis. Rapid selection of the most effective antibiotic therapy is critical for survival and for preventing further resistance. Physicians must consider numerous factors for proper empiric treatment selection. A clinical decision support system (CDSS) aims to support physicians in this process, facilitating rapid and targeted therapy.

OBJECTIVE: The purpose of this work is to explore the extent to which the realization of a CDSS is possible based on the data available to us and to document insights gained during the development of a foundational model designed to assist physicians in determining empiric treatment options for patients with sepsis. In this regard, rather than aiming to develop a CDSS for clinical application, we highlight the importance of close interprofessional collaboration between scientists from various disciplines and analyze the effects of data quality and quantity on the performance of our statistical models.

METHODS: Empirical scientists conducted interviews with medical practitioners to acquire the medical knowledge required to develop sound statistical models. We developed and applied 2-step cross-sectional, as well as time-series classification models, to carefully preprocessed data of patients with sepsis admitted to the intensive care unit of a German hospital.

RESULTS: We identified several factors as crucial information for valid decisions on empiric therapy for treating patients with sepsis. These include the patients’ core data, especially the infection focus. To prevent further resistance, individual risk factors such as travel history and professional background should be considered. The evaluation of a therapy’s effectiveness is mainly based on the patient’s general condition and blood values such as procalcitonin and interleukin 6. One key factor in the acceptance of a CDSS is the explainability of the results produced by the applied methods. Our models demonstrated mainly weak predictive ability for all considered empiric antibiotic therapies. However, they are not yet suitable for use in clinical practice, especially as they are based on prescribing habits rather than on optimal treatment decisions.

CONCLUSIONS: This work highlights the importance of interprofessional collaboration between medical experts and model developers, ensuring that data quality and clinical relevance are central to the process. It emphasizes the urgent need for high-quality, comprehensive data to overcome challenges such as data discontinuity and improve model performance, particularly through enhanced digitization in health care. This feasibility study will facilitate future efforts to develop a CDSS for treating patients with sepsis and to translate it into clinical use.

PMID:42127362 | DOI:10.2196/79929

Acute Med. 2025;24(3):139-146. doi: 10.52964/AMJA.1019.

ABSTRACT

INTRODUCTION: Use of procalcitonin (PCT) across Acute Medical Units (AMUs) in the United Kingdom (UK) post-COVID-19 is not well understood. We aim to explore clinician knowledge and behaviours relating to PCT-guided antimicrobial decision making for patients managed in NHS AMUs across the UK.

METHODS: A web-based survey was sent via email to members of the Society for Acute Medicine Results: There were 342 individual responses from 133 organisations, of which half (52.6%) had access to PCT. Self-reported knowledge of PCT was rated adequate or good for most respondents (84.3%), despite the majority of respondents reporting non-availability or unawareness of local PCT guidance (66.2% organisations). The greatest influences of PCT use were previous experience, personal review of evidence, and local culture. A majority of respondents (115/211;54.5%) felt PCT often (≥40% of the time) had a role in guiding antimicrobial decision making in the AMU.

CONCLUSIONS: There is widespread variation in practice, driven in part by inconsistency around local guidelines and a lack of national guidance to inform the use of this biomarker. We recommend the development of national, evidence-based guidance around the use of PCT to ensure consistency of approach and high-quality care for patients with suspected infection.

PMID:42127353 | DOI:10.52964/AMJA.1019