Category: Statistics

EJNMMI Res. 2026 Jun 6. doi: 10.1186/s13550-026-01446-4. Online ahead of print.

ABSTRACT

BACKGROUND: To systematically review and meta-analyse the prognostic value of quantitative mid-treatment imaging biomarkers for predicting locoregional tumour control in patients undergoing definitive radiotherapy for mucosal head and neck squamous cell carcinoma.

MAIN BODY: A systematic literature search (2005-2023) was conducted in PubMed, EMBASE, Scopus, and Cochrane databases according to a pre-registered PROSPERO protocol. Studies evaluating quantitative imaging features derived from CT, MRI, or PET during radiotherapy were included. Imaging features were grouped as baseline, absolute mid-treatment, or relative mid-treatment (delta) parameters. A random-effects meta-analysis was performed on studies reporting receiver operating characteristic (ROC)-based area under the curve (AUC) values. Forty-one studies encompassing 1654 patients were included. Seventeen studies (n = 612 patients) reported sufficient data for meta-analysis. The pooled AUC for relative mid-treatment parameters was 0.796 (95% CI: 0.762-0.831), demonstrating higher predictive performance than absolute mid-treatment parameters (AUC 0.686; 95% CI: 0.628-0.745). Baseline parameters showed moderate predictive ability (AUC 0.736; 95% CI: 0.688-0.785), and while numerically lower than relative mid-treatment parameters, this difference did not reach statistical significance. Diffusion-weighted MRI (ΔADCmean) and FDG-PET (ΔMTV, ΔTLG) emerged as the most consistently predictive modalities. Relative measures offer practical advantages, including internal self-normalisation and improved reproducibility across imaging platforms.

CONCLUSIONS: Relative mid-treatment imaging biomarkers demonstrate superior predictive performance compared to baseline and absolute measures, supporting their potential role in adaptive radiotherapy strategies. Further prospective multi-centre studies with standardised imaging protocols and external validation are essential for clinical translation.

PMID:42250069 | DOI:10.1186/s13550-026-01446-4

MAGMA. 2026 Jun 6. doi: 10.1007/s10334-026-01374-3. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for preoperative diagnosis of perineural invasion (PNI) in rectal cancer (RC).

MATERIALS AND METHODS: A total of 148 patients with pathology-confirmed RC (PNI+, n = 72; PNI-, n = 76) were enrolled. Parameters from mono-exponential (ADC), bi-exponential (D, D*, f), and stretched-exponential (DDC, α) IVIM models were analyzed. Univariate and multivariate logistic regression analyses were used to construct diagnostic models. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. The DeLong test was used to compare the AUC of the models. Internal validation was employed to assess model performance. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI), along with calibration metrics and decision curve analysis, were used to further evaluate model performance. P-value < 0.05 was considered statistically significant.

RESULTS: ADC, D, f, and DDC differed significantly between groups. Multivariate analysis identified ADC and D as independent PNI predictors. The D value yielded the highest AUC (0.84), while ADC showed the highest sensitivity (81.94%). A combined model (ADC + D) achieved an AUC of 0.85, sensitivity of 86.10%, specificity of 73.70%, and accuracy of 77.00%. The fivefold internal validation mean AUC was 0.84 ± 0.04. No significant AUC differences were found among parameters or models (DeLong test, P > 0.05). Further analyses revealed that the combined model provided significant improvements over the ADC model in individual risk reclassification (continuous NRI = 0.65, 95% CI 0.33-0.95), overall predictive accuracy (IDI = 0.07, 95% CI excluding 0), and calibration (Brier score: 0.16 vs. 0.17; MAE: 0.01 vs. 0.04; MSE: 2.3×10⁻⁴ vs. 1.91×10⁻³). Decision curve analysis demonstrated consistently higher net benefit for the combined model across threshold probabilities of 0-0.50.

CONCLUSION: IVIM-DWI demonstrates potential value for the preoperative assessment of PNI status in rectal cancer and may facilitate individualized treatment planning.

PMID:42250045 | DOI:10.1007/s10334-026-01374-3

Ir J Med Sci. 2026 Jun 6. doi: 10.1007/s11845-026-04420-0. Online ahead of print.

ABSTRACT

BACKGROUND: The association between alcohol use and poor mental health is well known. Although psychiatric services and supports are typically delivered in community settings, some individuals require specialist inpatient care for alcohol-related disorders. For many, multiple admissions may be required, referred to as the ‘Revolving Door’ (RD) phenomenon.

AIMS: This study examines alcohol-related admissions to inpatient psychiatric units during a 10-year period (2015 – 2024) using data from the Irish National Psychiatric Inpatient Reporting System (NPIRS). The study aims to compare characteristics of first admissions and re-admissions to examine factors associated with RD admissions.

METHODS: This study used retrospective, anonymised NPIRS data. Descriptive statistics were conducted, and statistical significance was assessed using Pearson X² tests.

RESULTS: During the study period, 5.9% of all inpatient admissions into psychiatric units were alcohol related and almost two-thirds were readmissions (63.8%). Both first and readmissions were predominantly single, male, employed and aged between 45 – 64 years with a diagnosis of alcohol dependency. Readmissions were significantly more likely to have a longer length of stay. Key sex differences in alcohol-related admissions were noted. Male admissions were significantly more likely to be single and younger. Females were more likely to be older, private patients and have longer inpatient stays. Rural areas accounted for a larger share of alcohol-related admissions.

CONCLUSIONS: Despite accounting for less than 6% of all psychiatric admissions, alcohol-related psychiatric hospitalisations represent substantial healthcare costs. The findings from this study highlight the need for more targeted, sex-sensitive interventions to reduce the high level of readmissions.

PMID:42250038 | DOI:10.1007/s11845-026-04420-0

Environ Monit Assess. 2026 Jun 6;198(7):694. doi: 10.1007/s10661-026-15545-1.

ABSTRACT

Anthropogenic activities and fast industrial growth influence the level of PTEs in the soil and the food chain. The contents of PTEs were examined in two wild Cosmos species (C. bipinnatus and D. cosmos) from Jiangsu City, using chemical and AAS methods to determine the risk to human health. The highest mean concentrations of PTEs in plants showed statistically significant (p < 0.05) differences between diverse plant parts and followed the decreasing order Mn (85.0 mg kg^-1 in flower) > Zn (62.0 mg kg^-1 in flower) > Cu (12.0 mg kg^-1 in flower) > Cr (4.3 mg kg^-1 in root) > Ni (0.97 mg kg^-1 in root) > Cd (0.38 mg kg^-1 in root) > Pb (0.03 mg kg^-1 in shoot) > As (0.025 mg kg^-1 in root). The highest values of Cr, Mn, Zn, and Cd in plant samples exceeded the permitted limit. While the quantity of Cr in the soil sample was high, the transfer coefficients (K) were high for Zn and Mn. The high percentage of Mn in roots was 68% and 61%, respectively, for C. bipinnatus and D. cosmos. The THQ values for Mn and HI exceeded 1 in all plant parts, except for the D. cosmos shoot (S2) and flower (F2). The assessment revealed that they are indicating a potential non-carcinogenic risk in human health. The TCR values for Cd and Ni showed a potential carcinogenic risk in adult and child health. This study reveals, for the first time, that wild Cosmos plants in an urban environment accumulate PTEs at levels posing a potential human health risk. The key risk metrics (HI > 1, TCR for Cd/Ni > 10^-4) are highlighting significant health concerns. It is recommended to limit the use of urban-grown wild Cosmos plants for food purposes until further safety assessments are conducted.

PMID:42250037 | DOI:10.1007/s10661-026-15545-1

Qual Life Res. 2026 Jun 6;35(7):186. doi: 10.1007/s11136-026-04200-4.

ABSTRACT

PURPOSE: The Pediatric Quality of Life Inventory™ (PedsQL™ 4.0) is widely used to assess quality of life (QoL) in children, yet evidence on the reliability and validity of young children’s self-reports is inconsistent. We evaluated whether self-reported QoL in young children varies by parental presence during administration and whether parent-child agreement differed between mothers and fathers.

METHODS: Secondary analyses were conducted using data from primary schools (n = 303, children aged 5-7 years) including at least one participating parent. Children completed the PedsQL self-report either at school with a trained research assistant (parent-absent) or at home with a parent who read items aloud and recorded answers (parent-present). Mothers and fathers completed parallel proxy-reports. Multilevel modeling was used to estimate mean differences and correlations between reporters and conditions, with age and sex as covariates.

RESULTS: Internal consistency of child self-reports was limited across the four subdomains, with somewhat lower values in the parent-absent condition. Parent ratings showed no systematic differences between conditions, whereas children scored higher when a parent was present, yielding smaller parent-child gaps and higher correlations. These patterns were similar for mothers and fathers.

CONCLUSIONS: In this school-based community sample, improved agreement with a parent present was driven by higher child scores, consistent with brief, non-leading parental assistance (clarification/recall). Self-reports of young children obtained without a parent present warrant caution. Clear, age-appropriate guidance on administration and structured parental support is needed.

PMID:42250032 | DOI:10.1007/s11136-026-04200-4

Qual Life Res. 2026 Jun 6;35(7):182. doi: 10.1007/s11136-026-04301-0.

ABSTRACT

BACKGROUND: Indigenous Australians in rural and remote areas experience substantial health-related quality of life (HRQoL) impacts alongside persistent healthcare access barriers. Community-led virtual primary care services offer an innovative approach to improving access to health care services for Indigenous Australians in rural and remote areas.

OBJECTIVE: To examine age-stratified HRQoL patterns and estimate the lifetime quality-adjusted life year (QALY) loss among Indigenous Australians with chronic conditions enrolled in a rural virtual primary care service.

METHODS: We conducted a cross-sectional analysis of 75 Indigenous adults residing in rural Queensland. HRQoL was measured using the EQ-5D-5L instrument. Lifetime QALY loss was calculated using Queensland Indigenous life tables and population norms, with sensitivity analyses using Australian norms and varying discount rates.

RESULTS: Overall mean utility was 0.775 (SD = 0.246). Age-stratified analysis revealed significant heterogeneity, with three age groups (18-54, 55-64, 65-74 years) demonstrating lower HRQoL than Queensland norms. The 55-64 age group experienced poorest HRQoL (utility = 0.701, SD = 0.287) and highest projected lifetime QALY loss (4.44 QALYs undiscounted; 2.63 with 5% discount). In contrast, participants aged 75 years and above exceeded population norms (utility = 0.872 vs. 0.863). Chronic disease burden was associated with HRQoL decline in adults aged 18-64 years, while physical activity was associated with higher HRQoL in those aged 65 years and over.

CONCLUSIONS: Indigenous Australians aged 55-64 years represent a critical priority for virtual primary care interventions. Targeted support strategies for this ‘at-risk’ age group are essential to address substantial lifetime health burdens and improve long-term outcomes within remote delivery models.

PMID:42250030 | DOI:10.1007/s11136-026-04301-0

Int J Occup Saf Ergon. 2026 Jun 6:1-10. doi: 10.1080/10803548.2026.2677388. Online ahead of print.

ABSTRACT

Objectives. Proper use of personal protective equipment (PPE) is essential for worker safety, but many employees fail to use it correctly due to limited knowledge, negative attitudes and low perceived control. This study assessed the effectiveness of a health belief model (HBM)-based educational intervention on PPE use among factory workers in Yasuj. Methods. This quasi-experimental study (2022-2023) randomly assigned 109 workers were to experimental (n = 56) and control (n = 53) groups. The intervention included six 60-min in-person sessions delivered by a researcher and an occupational health expert. Data were collected via an HBM-based questionnaire before and 2 months after the intervention. Statistical analyses included paired t tests, independent t tests and χ² tests using SPSS version 27. Results. Pre-intervention assessments showed no significant differences between groups (p > 0.05). Post intervention, the experimental group demonstrated significant improvements in all HBM constructs – knowledge, attitudes, perceived susceptibility and severity, perceived benefits and barriers, self-efficacy, guidance for action – as well as PPE-related behavior (p = 0.001). Conclusion. HBM-based educational interventions effectively enhance PPE usage by improving knowledge, shaping positive attitudes and addressing perceived barriers and benefits. These findings support structured educational programs as a key strategy for promoting workplace health and safety.

PMID:42249752 | DOI:10.1080/10803548.2026.2677388

Physiother Res Int. 2026 Jul;31(3):e70246. doi: 10.1002/pri.70246.

ABSTRACT

BACKGROUND AND PURPOSE: The massage gun is widely used to alleviate delayed-onset muscle soreness (DOMS); however, empirical evidence regarding its physiological effects remains limited.

OBJECTIVES: This study aimed to evaluate the acute effects of percussive massage on the quadriceps muscle’s cross-sectional area (CSA), strength performance, and pain perception following a fatigue protocol.

METHODS: A randomized clinical trial was conducted including 37 physically active men. Participants performed a fatigue protocol on a 45° leg press, at 70% of their one-repetition maximum (1RM). The volunteers were allocated to an intervention group (G0 n = 19, mean ± SD; 25.7 ± 4.5 years, 83.7 ± 10.6 kg, 176.8 ± 6.3 cm) and control group (G1 n = 18, mean ± SD; 27.6 ± 5.0 years, 76.8 ± 15.7 kg, 174 ± 7.3 cm). Assessments were performed at baseline, 24 and 48 h, using ultrasound imaging, isometric dynamometer and VAS questionnaire (visual analog pain scale).

RESULTS: Regarding the muscle area, significant increases were observed in the control group p < 0,05 for the rectus femoris at both measurement points compared with the baseline, which suggests that percussive massage may mitigate exercise-induced edema. While no statistically significant differences were observed between groups or across time points for muscle strength, G0 demonstrated a large effect size (d > 2.0) in strength maintenance at 24 and 48 h compared to G1. Both groups showed reduction in pain over time, while G0 demonstrated a significant decrease at 48 h compared to 24 h (53%, p < 0.001).

CONCLUSION: Within-group assessments revealed significant reductions in pain perception over time for the intervention group. Regarding muscle strength, despite a large exploratory effect size observed during recovery, no statistically significant between-group superiority over passive rest was established. The findings suggest potential preliminary benefits for symptom relief without acute performance deficits.

PMID:42249745 | DOI:10.1002/pri.70246

Eur J Dent Educ. 2026 Jun 6. doi: 10.1111/eje.70199. Online ahead of print.

ABSTRACT

INTRODUCTION: Many dentistry students suffer from intense stress, insomnia, and anxiety throughout their education, especially when they start clinical practice. This study aims to evaluate the effects of sleep quality on complication rates among 5th-grade dentistry students undergoing oral and maxillofacial surgery internships.

METHODS: This cross-sectional observational study evaluated the association between sleep quality, anxiety levels, and clinical complication rates among senior dental interns during an oral and maxillofacial surgery internship. Sleep quality and anxiety were assessed using the Richard-Campbell Sleep Quality Scale and Beck Anxiety Inventory over a 4-week period. Clinical performance was evaluated by recording the number and types of complications occurring during routine tooth extractions. Generalized linear mixed modelling (GLMM) with Poisson distribution and log link function was used to evaluate complication incidence rates while accounting for repeated observations within students. Pearson correlation, independent samples t-test, and Mann-Whitney U test were additionally used for statistical analysis.

RESULTS: Ninety-two dental interns (61 female, 31 male) performed a total of 1320 tooth extractions during the study period, with 211 recorded complications. Generalized linear mixed modelling demonstrated that sleep quality was significantly associated with complication incidence rates (IRR = 0.997, p = 0.023). Anxiety scores were negatively correlated with sleep quality (r = -0.316, p = 0.002) but were not independently associated with complication incidence rates. No significant differences in sleep quality, anxiety scores, or complication rates were observed between genders.

CONCLUSION: Poor sleep quality was associated with higher clinical complication rates among dental interns during OMFS training. Anxiety levels were negatively correlated with sleep quality but did not independently predict complication rates. Due to the cross-sectional design and the presence of multiple uncontrolled clinical factors, these findings should be interpreted cautiously.

PMID:42249732 | DOI:10.1111/eje.70199

Nurs Open. 2026 Jun;13(6):e70622. doi: 10.1002/nop2.70622.

ABSTRACT

AIMS: This study aimed to identify the discharge readiness level of ambulatory surgery patients and examine the effects of these variables on the discharge readiness of ambulatory surgery patients.

DESIGN: A cross-sectional quantitative design was used.

METHODS: A convenience sample of 212 patients undergoing ambulatory surgery between January 2022 and June 2023 was enrolled. Discharge readiness, quality of discharge teaching, health literacy and family support were measured. Pearson correlation and multiple linear regression were used to examine associations and explanatory factors.

RESULTS: It was determined that the discharge readiness of patients with ambulatory surgery was at a medium level (91.10 ± 8.53). Discharge readiness was positively associated with quality of discharge teaching (r = 0.703, p < 0.01), health literacy (r = 0.503, p < 0.01) and family support (r = 0.305, p < 0.01). Stepwise multiple linear regression showed that quality of discharge teaching (β = 0.613, p < 0.001), health literacy (β = 0.205, p < 0.001), surgical specialty (ophthalmology: β = 0.370, p < 0.001; otorhinolaryngology: β = 0.138, p = 0.002), age groups (45-59 years: β = -0.106, p = 0.012; 75-89 years: β = -0.175, p < 0.001), family support (β = 0.112, p = 0.007), living arrangement (β = 0.101, p = 0.011) and occupation (retirement: β = -0.095, p = 0.041) were significantly associated with discharge readiness. The final model was statistically significant (adjusted R² = 0.682), explaining 68.2% of the variance in discharge readiness.

CONCLUSION: Discharge readiness of ambulatory surgery patients was moderate. The quality of discharge teaching, health literacy, surgical specialty (ophthalmology, otorhinolaryngology), age groups (45-59 and 75-89 years), family support, living arrangement and occupation (retirement), which cover multiple dimensions such as spanning personal, environmental, family and therapeutic factors, were associated with discharge readiness.

PATIENT OR PUBLIC CONTRIBUTION: Data were collected via questionnaire from participants. Findings can inform personalised discharge preparation programs to improve the discharge readiness of day surgery patients.

REPORTING METHOD: This study was reported in accordance with the STROBE guidelines.

PMID:42249730 | DOI:10.1002/nop2.70622