Category: Statistics

J Am Heart Assoc. 2026 Jan 30:e046558. doi: 10.1161/JAHA.125.046558. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial intelligence (AI)-enabled electrocardiography has emerged as a tool for detecting cardiac dysfunction. The prognostic relevance of AI-enabled electrocardiography-derived diastolic dysfunction (DD) in patients undergoing transcatheter aortic valve replacement had not been assessed.

METHODS: We analyzed 3197 patients undergoing transcatheter aortic valve replacement for severe aortic stenosis between 2010 and 2023 with baseline 12-lead ECGs processed by a validated AI model to classify diastolic function (grades 0-3). Multivariable Cox models and nested model comparisons assessed associations with all-cause mortality, including a prespecified analysis in patients with indeterminate echocardiographic grading. Trajectories were defined by change in AI-enabled electrocardiography DD grade (<2 versus ≥2) from baseline to 30-day or 1-year follow-up.

RESULTS: At baseline, 21% had grade 3, 57% had grade 2, 8% had grade 1, and 14% had grade 0 AI-enabled electrocardiography DD. Higher grades were associated with adverse cardiac remodeling and comorbidities. Over a median follow-up of 3.4 years, grade 3 AI-enabled electrocardiography DD independently predicted mortality (hazard ratio [HR], 1.80 [95% CI, 1.47-2.20]; P<0.001). AI-enabled electrocardiography DD improved prognostic discrimination beyond clinical and echocardiographic measures (ΔHarrell concordance statistic, 0.016; Δχ²=57; P<0.001). Among 1259 patients with indeterminate echocardiographic grading, AI-enabled electrocardiography added prognostic value (ΔHarrell concordance statistic, 0.02; Δχ²=13; P=0.006). Worsening or persistently high-risk trajectories were associated with increased mortality (HRs, 1.45-1.80; all P<0.05).

CONCLUSIONS: AI-enabled electrocardiography-derived DD independently predicts mortality after transcatheter aortic valve replacement, adds value beyond echocardiographic grading, and enables dynamic risk stratification through longitudinal tracking.

PMID:41614319 | DOI:10.1161/JAHA.125.046558

Prim Health Care Res Dev. 2026 Jan 30;27:e16. doi: 10.1017/S1463423625100753.

ABSTRACT

OBJECTIVES: Smartphones have become essential, making our daily lives more manageable; however, excessive use may cause problems. University students are particularly vulnerable to smartphone addiction. This study examines the relationship between smartphone addiction and health-promoting lifestyles among university students.

METHODS: A cross-sectional study was conducted with 911 students at Dokuz Eylul University, Izmir, Turkey. Data were collected via Smartphone Addiction Scale-Short Version (SAS-SV) and Health Promotion Lifestyle Profile II (HPLP II). The printed forms were used, and the researcher administered the survey in person and recorded the responses.

RESULTS: Prevalence of smartphone addiction was 34.1%. Several factors were significantly associated, including female gender (p = 0.049), being single (p = 0.042), self-perceived smartphone addiction (p < 0.001), daytime sleepiness (p < 0.001), and poor sleep quality (p < 0.001). Students with smartphone addiction had significantly lower HPLP II scores (p = 0.001).Logistic regression analysis showed that gender was no longer a significant factor. Those without a partner (OR: 1.47, 95% CI: 1.07-2.03), those who considered themselves smartphone addicts (OR: 6.86, 95% CI: 4.99-9.42), and those with daytime sleepiness (OR: 1.52, 95% CI: 1.08-2.14) had higher odds of smartphone addiction. Higher HPLP II scores were protective against smartphone addiction (OR: 0.99, 95% CI: 0.98-0.99).

CONCLUSIONS: This study highlights that students with smartphone addiction engage in less health-promoting behaviours and experience poor sleep quality and daytime sleepiness. Self-perceived smartphone addiction was strongly associated with actual addiction, while a healthier lifestyle appeared to have a protective effect. There is a need for strategies to promote healthy habits and reduce smartphone addiction among university students.

PMID:41614313 | DOI:10.1017/S1463423625100753

Ir J Psychol Med. 2026 Jan 30:1-10. doi: 10.1017/ipm.2026.10170. Online ahead of print.

ABSTRACT

OBJECTIVES: Understanding service users’ knowledge of and attitudes towards the rapidly progressing field of mental health technology (MHT) is an important endeavour in clinical psychiatry.

METHODS: To evaluate the current use of and attitudes towards MHT (mobile apps, online therapy and counselling, telehealth, web-based programmes, chatbots, social media), a 5-point Likert-scale survey was designed based on previous studies and distributed to attendees of an adult community mental health service in Ireland. Chi-square tests were used and corrected for multiple comparisons.

RESULTS: 107 mental health service users completed the survey (58% female, aged 18-80). 86% of respondents owned a smartphone. 27.1% reported using a mental health application, while 33.6% expressed interest in using one in the future. 61.7% reported they had not used and were not interested in using AI for their mental health, and 51.4% indicated they would not feel comfortable using it. 46.8% were not comfortable with psychiatrists utilising AI in their care. The majority (86.9%) preferred face-to-face appointments, while 52.6% would consider using MHT while on a waiting list. Younger participants reported significantly greater comfort using mental health apps and higher self-rated knowledge of AI.

CONCLUSION: There were low levels of knowledge about and comfort using MHT, accompanied by concerns about confidentiality and privacy. Younger service users tended to be more comfortable with and knowledgeable about MHT. Despite the growing interest in digital approaches, there remains a clear preference for face-to-face appointments, underscoring the importance of addressing privacy and safety concerns, together with training and education.

PMID:41614310 | DOI:10.1017/ipm.2026.10170

J Am Heart Assoc. 2026 Jan 30:e045631. doi: 10.1161/JAHA.125.045631. Online ahead of print.

ABSTRACT

BACKGROUND: The risk of ischemic stroke is highest during the first year following a new diagnosis of cancer, but no tools exist to identify patients at highest risk.

METHODS: Using linked clinical and administrative databases, we conducted a population-based retrospective cohort study of adults in Ontario, Canada, with newly diagnosed cancer from 2010 to 2021. Patients were randomly selected for prediction model derivation (60%) or validation (40%). The final model predicting ischemic stroke within 1 year following cancer diagnosis was derived using multivariable Fine-Gray regression with candidate predictors selected via backward elimination. Subdistribution-adjusted hazard ratios and 95% CIs were calculated, where all-cause mortality was treated as a competing event. Performance of the prediction model was assessed in the validation cohort based on the C statistic and calibration plots for discrimination and calibration, respectively.

RESULTS: There were 698 566 eligible patients, with 418 911 in the derivation cohort and 279 576 in the validation cohort. The overall rate of stroke per 1000 person-years was 6.7 (95% CI, 6.4-6.9). The final model included 22 predictors, including age, sex, demographic factors, cancer characteristics, and treatment characteristics. Discrimination was good, with a C statistic of 0.73. The model was well calibrated, with points following the desired 45-degree line.

CONCLUSIONS: We derived and validated the PRIME (Predicting Risk of Ischemic Stroke in Malignancy Estimation) tool with good discrimination for ischemic stroke in patients with a new cancer diagnosis. The model was built into an online calculator (https://study.ohri.ca/PRIME/) and has the potential to stratify patients with cancer based on their risk of stroke within a year following their diagnosis.

PMID:41614295 | DOI:10.1161/JAHA.125.045631

Alzheimers Dement. 2026 Feb;22(2):e71160. doi: 10.1002/alz.71160.

ABSTRACT

INTRODUCTION: Recent work has identified unique cognitive profiles for early-onset Alzheimer’s disease (EOAD) relative to late-onset Alzheimer’s disease (LOAD), however, examination has been limited in determining whether the association between age and cognitive severity at presentation also differs across conditions.

METHODS: A series of linear spline regression models was conducted across baseline cognitive data from 325 EOAD and 314 LOAD participants, after accounting for education, sex, and apolipoprotein ε4 status.

RESULTS: Significant differences existed in the relationship between baseline age and cognitive performance between EOAD and LOAD samples for Processing Speed/Attention, Executive Functioning, and Episodic Immediate Memory. Younger participants from both EOAD and LOAD groups performed disproportionately worse on non-amnestic cognitive domains, with this occurring to a greater extent in EOAD than LOAD.

DISCUSSION: In the age of disease-modifying treatments, results highlight the importance of assessing for cognitive declines in individuals starting much earlier than age 65.

HIGHLIGHTS: Early-onset Alzheimer’s disease (EOAD) and late-onset Alzheimer’s disease (LOAD) participants each displayed cognitive impairments relative to same-aged peers across most domains. Both groups displayed positive relationships between impairment among non-amnestic cognitive domains and baseline age. This relationship displayed a significantly greater effect in EOAD than LOAD, with domains of Processing Speed/Attention and Executive Functioning skills being the most pronounced. Of those participants developing AD, age displayed a disproportionate impact on their symptom onset.

PMID:41614286 | DOI:10.1002/alz.71160

Nurs Crit Care. 2026 Mar;31(2):e70282. doi: 10.1111/nicc.70282.

ABSTRACT

BACKGROUND: Tracheostomy is a common procedure in intensive care units (ICUs), with a rising number of patients requiring specialised nursing care. Effective tracheostomy management is critical for preventing complications such as tube blockage, infection and bleeding. Critical care nurses play a pivotal role in ensuring patient safety, highlighting the need for innovative approaches to enhance their knowledge and clinical performance.

AIM: To evaluate the effect of implementing a Tracheal nursing care bundle on critical care nurses’ knowledge and performance in the ICU.

STUDY DESIGN: A quasi-experimental design was conducted involving critically ill adult patients with tracheostomies and ICU nurses. Data were collected using three tools: (i) a self-administered questionnaire to assess nurses’ knowledge, (ii) a pre-post observational checklist to evaluate nurses’ performance in applying the Tracheal nursing care bundle and (iii) a patient outcome sheet documenting demographic characteristics, adverse events and tracheostomy-related complications.

RESULTS: A total of 60 critical care nurses and 60 ICU patients participated in the study. Post-implementation of the Tracheal nursing care bundle, there was a statistically significant improvement in nurses’ knowledge and practice, with 81.7% achieving adequate performance levels. The overall complication rate significantly decreased (pre 28.3% (n=17) vs. post 8.3% (n=5), p=0.006).

CONCLUSIONS: The Tracheal nursing care bundle enhanced ICU nurses’ knowledge and performance, leading to a reduction in tracheostomy-related complications and improved patient outcomes.

RELEVANCE TO CLINICAL PRACTICE: Implementation of structured care bundles, such as the Tracheal nursing care bundle, strengthens evidence-based tracheostomy management in ICUs. By standardising nursing practice, the bundle reduces preventable adverse events, reinforces patient safety and supports high-quality care delivery. Incorporating such interventions into routine ICU practice can optimise patient outcomes and empower nurses with the confidence and competence required for managing tracheostomies effectively.

PMID:41614279 | DOI:10.1111/nicc.70282

Climacteric. 2026 Jan 30:1-6. doi: 10.1080/13697137.2026.2615391. Online ahead of print.

ABSTRACT

OBJECTIVE: Adhesive capsulitis (AC) is considered idiopathic, yet typically affects women aged 40-60 years. The purpose of this study was to determine whether hormone therapy is protective against AC in menopausal women. The study hypothesized that patients prescribed hormone therapy would have lower odds of AC than those not using hormone therapy.

METHOD: Medical record extraction for a single health maintenance organization was used to identify postmenopausal women aged 40- 60 years and assess the utilization of hormone therapy and diagnosis of AC. The distribution of AC and endocrine disorders was compared between treatment groups using chi-squared tests and the odds ratio (OR) was reported.

RESULTS: The cohort included 1952 patients (152 hormone therapy, 1800 without hormone therapy). No statistically significant differences were found between treatment groups for endocrine disorders. A higher percentage of AC was noted in patients without hormone therapy compared to patients with hormone therapy (7.65% vs. 3.95%), although the association was not statistically significant (OR 1.99; 95% confidence interval 0.86-4.58; p = 0.10).

CONCLUSION: This pilot study did not demonstrate a statistically significant difference in odds of AC in menopausal women with and without hormone therapy. Larger prospective studies are needed to further explore potential protective effects of hormone therapy against AC.

PMID:41614260 | DOI:10.1080/13697137.2026.2615391

ANZ J Surg. 2026 Jan 30. doi: 10.1111/ans.70513. Online ahead of print.

ABSTRACT

BACKGROUND: Cosmetic tourism has become increasingly popular, with patients seeking lower cost cosmetic surgery overseas. However, complications often necessitate management in local public hospitals upon their return, placing a burden on healthcare systems. This study examines the demographics, complications, interventions and resource utilisation of patients presenting to an Australian hospital with complications from overseas cosmetic surgery.

METHODS: This study retrospectively reviewed patients who presented to Westmead Hospital, NSW, during two time periods-01/07/2022 to 01/01/2023 and 01/05/2024 to 30/12/2024-with complications following cosmetic surgery performed overseas. Hospital records were analysed to extract data on patient demographics, comorbidities, presenting complications, interventions, diagnostic tests and resource utilisation. Descriptive statistics were used to summarise the findings, and patterns in clinical management were evaluated.

RESULTS: Twenty-four patients met the inclusion criteria, with a mean age of 38.4 ± 12.5 years; 87.5% were female. Comorbidities included smoking (50%), mental health conditions such as anxiety, depression, or self-harm (20.8%) and hypothyroidism (12.5%). Abdominoplasty (54.2%), breast augmentation (20.8%) and liposuction (25%) were the most frequently performed procedures. The mean Charlson Comorbidity Index was 0.2 ± 0.4, and the mean LACE Index was 5.9 ± 1.5. Complications included wound dehiscence (45.8%), infection (41.7%) and seroma (20.8%). The median time from surgery to presentation was 3.8 weeks, with a mean hospital stay of 3.3 ± 2.9 days. Interventions included oral antibiotics (83.3%), IV antibiotics (58.3%), drainage or aspiration (33.3%) and surgery (54.2%).

CONCLUSION: Overseas cosmetic surgery is associated with high complication rates and significant utilisation of public hospital resources. These findings highlight the impact of cosmetic tourism on the Australian healthcare system.

PMID:41614248 | DOI:10.1111/ans.70513

APMIS. 2026 Feb;134(2):e70144. doi: 10.1111/apm.70144.

ABSTRACT

The present investigation was designed to assess the prognostic value of microRNA-648 (miR-648) in osteosarcoma (OS) and elucidate its regulatory mechanisms. Quantitative real-time PCR was employed to measure miR-648 expression levels in 80 paired OS specimens and their matched adjacent non-tumor tissues. Statistical assessments of clinical parameters were conducted using Chi-squared tests, while patient survival data were evaluated through Kaplan-Meier estimation and Cox proportional hazards regression modeling. Functional assays were performed in OS cell lines. Bioinformatic prediction of target genes was followed by experimental validation using dual-luciferase reporter assays. MiR-648 exhibited significant downregulation in OS clinical specimens and cell lines (p < 0.001). Low miR-648 expression correlated with lung metastasis (p = 0.027), advanced Enneking stage (p = 0.031), and poorer progression-free survival (p < 0.001). MiR-648 was identified as a significant independent prognostic indicator (hazard ratio [HR] = 0.235, p < 0.001). Moreover, the overexpression of miR-648 significantly suppressed cellular proliferation, migration capacity, and invasion potential while enhancing apoptotic activity (p < 0.001). High mobility group box 1 (HMGB1) was confirmed as a direct target, with its role in reversing miR-648’s tumor-suppressive effects. MiR-648 exerts tumor-suppressive effects in OS by modulating HMGB1, suggesting its clinical utility as both a prognostic biomarker and a therapeutic intervention point.

PMID:41614245 | DOI:10.1111/apm.70144

Cancer Med. 2026 Feb;15(2):e71549. doi: 10.1002/cam4.71549.

ABSTRACT

PURPOSE: To determine whether adolescent and young adults (AYA) with Hodgkin lymphoma (HL) who are treated by oncologists with “AYA expertise” improve outcomes.

METHODS: All AYA aged 15-21 years diagnosed with HL in Ontario, Canada between 1992 and 2012 were identified, and clinical data abstracted as part of the IMPACT cohort. Linked administrative data were used to identify primary oncologists, defined as “AYA experts” if at diagnosis, ≥ 15% of the oncologist’s previous 2 years of chemotherapy billings were for patients aged 15-29 years. Associations between seeing an AYA expert and outcomes were analysed.

RESULTS: Among 863 AYA with HL, 225 unique primary oncologists were identified. A total of 112 (13.0%) AYA had a primary oncologist with AYA expertise. Older patients [adjusted OR (aOR): 0.8 per year, 95% CI: 0.7-1.0; p = 0.04] and those seen in adult community hospitals [vs. regional cancer centre, aOR: 0.1, 95% CI: 0.02-0.4; p = 0.001] were less likely to see an AYA expert. Only 56 (6.4%) AYA received a fertility consult within 30 days of HL diagnosis; most occurred in the later study period (2006-2012). Seeing an AYA expert was associated with increased odds of fertility consultation (aOR: 2.1, 95% CI: 1.0-4.3; p = 0.04). Among the full cohort, there was no association between AYA expert care and event-free survival (EFS), overall survival (OS), or subsequent live birth.

CONCLUSION: A volume-based definition of AYA expertise was associated with receipt of fertility consults, but not with EFS or OS for AYA with HL. If validated in other populations and settings, seeing a volume-defined AYA expert could serve as a quality metric in AYA cancer care.

PMID:41614232 | DOI:10.1002/cam4.71549