Category: Statistics

Patient Prefer Adherence. 2026 Jul 14;20:619080. doi: 10.2147/PPA.S619080. eCollection 2026.

ABSTRACT

PURPOSE: This cross-sectional study aimed to investigate factors influencing healthcare-seeking delays among Chinese residents using the Andersen Model of Total Patient Delay and the Behavioral Model of Health Services Use.

METHODS: A self-designed questionnaire was developed by integrating the two theoretical frameworks. A cross-sectional survey was conducted from July to September 2022 among Chinese residents aged 16 years and older. Stratified sampling was employed across three economic development strata, with trained investigators conducting face-to-face interviews using a standardized electronic questionnaire. Descriptive statistics, one-way ANOVA, and multiple linear regression were used to analyze delay patterns and influencing factors.

RESULTS: The study included 580 participants, with 312 (53.79%) experienced healthcare-seeking delays. The total delay was 5.63 (± 11.95) days. Age, interpersonal manner, and social networks showed significant positive associations with total delay (p < 0.05). Female gender, inadequate communication, and self-medication were associated with longer delays.

CONCLUSION: The findings suggest that targeted interventions-including priority care pathways for at-risk groups, public education on appropriate care-seeking, and patient-centered facility design-may help reduce healthcare-seeking delays.

PMID:42472261 | PMC:PMC13380277 | DOI:10.2147/PPA.S619080

Curr Res Food Sci. 2026 Jul 7;13:101492. doi: 10.1016/j.crfs.2026.101492. eCollection 2026.

ABSTRACT

Human milk (HM) provides essential nutrients for infant growth and development. When own mother’s milk is unavailable, donor human milk (DHM) is used and typically pasteurized, which may alter protein integrity. This study presents the use of external cavity-quantum cascade laser (EC-QCL) mid-infrared spectroscopy, as a rapid, non-destructive technique, to quantify both individual and total proteins in 276 HM and DHM samples. The method showed high accuracy (≥84% explained variance) and strong correlation with reference techniques. Pasteurization significantly reduced α-lactalbumin (24%) and lactoferrin (14%), while casein and total protein declined slightly (3%). Protein levels decreased notably during early lactation, then stabilized. In the cohort of the present study, no statistically significant differences in protein content were observed between preterm and term milk. EC-QCL spectroscopy also differentiated raw and pasteurized DHM. These results support EC-QCL as a reliable tool for clinical use and quality control, with implications for improving processing methods to preserve the nutritional and immunological integrity of DHM.

PMID:42472244 | PMC:PMC13380451 | DOI:10.1016/j.crfs.2026.101492

Brain Behav Immun Health. 2026 Jul 6;56:101299. doi: 10.1016/j.bbih.2026.101299. eCollection 2026 Oct.

ABSTRACT

INTRODUCTION: Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) is a debilitating condition characterized by severe fatigue and post-exertional malaise (PEM). Reported neuropsychophysiological abnormalities suggest ME/CFS is multifactorial, but current knowledge remains fragmented. This study protocol outlines a multimodal investigation designed to (1) compare neuropsychophysiological mechanisms between ME/CFS patients and healthy participants, (2) test an integrative model of ME/CFS, (3) identify neuropsychophysiological subgroups within the patient population, and (4) identify predictors of symptom response during rehabilitation.

METHODS AND ANALYSIS: This study will enroll 115 ME/CFS patients and 55 healthy participants. Groups will be comparable in age, sex, and education level, with a larger patient sample enabling subgroup and longitudinal analyses. A cross-sectional assessment at baseline will be carried out in both groups. Patients will then be evaluated longitudinally throughout a standardized cognitive-behavioral therapy rehabilitation program delivered as routine care. Baseline measures include systemic inflammation and general health biomarkers, measures of autonomic and central nervous system function, neuroinflammation (magnetic resonance spectroscopy, [¹⁸F]DPA714 PET in a subsample), serum short-chain fatty acid levels, gut microbiota composition and function, and neuroendocrine and self-reported responses to psychosocial stress. Fatigue severity (physical and cognitive) and PEM will be assessed through validated questionnaires, ecological momentary assessment, and laboratory tasks. These will be re-evaluated during therapy, and all non-neuroimaging measures will be repeated after the rehabilitation program. Statistical analyses will comprise multivariate analysis of variance, general linear models, classification algorithms, structural equation models, least absolute shrinkage selection operator principal component regression (LASSO-PCR), cluster analysis and latent class growth analysis (LCGA).

PMID:42472232 | PMC:PMC13380062 | DOI:10.1016/j.bbih.2026.101299

Infect Drug Resist. 2026 Jul 14;19:610414. doi: 10.2147/IDR.S610414. eCollection 2026.

ABSTRACT

BACKGROUND: Respiratory tract infections (RTIs) remain a major cause of morbidity and mortality, particularly among hospitalized and critically ill patients. The increasing prevalence of multidrug-resistant organisms (MDROs) complicates treatment and highlights the need for local surveillance to guide antimicrobial stewardship. This study investigated the epidemiology, antimicrobial resistance patterns, and seasonal trends of respiratory bacterial pathogens in a tertiary care hospital in Riyadh, Saudi Arabia.

METHODS: A retrospective observational study was conducted on 5582 respiratory specimens collected between January 2023 and December 2025. Samples included tracheal aspirates, sputum, bronchoalveolar lavage, throat swabs, pleural fluids, ear swabs, and nasal swabs. Bacterial identification and antimicrobial susceptibility testing were performed using the VITEK® 2 Compact system and interpreted according to CLSI M100-S35 guidelines. Statistical analyses included Chi-square tests and logistic regression.

RESULTS: Culture positivity was 38.6% (2154/5582), with tracheal aspirates and sputum accounting for the most positive specimens. The predominant pathogens were Pseudomonas aeruginosa (31.9%), Klebsiella spp. (21.3%), Staphylococcus aureus (10.2%), Serratia marcescens (6.3%), Escherichia coli (5.7%) and Acinetobacter baumannii (5.5%). Culture positivity increased significantly with age (p<0.001), with Gram-negative bacteria predominating in older patients. MDROs were slightly prevalent, including, carbapenem-resistant organisms (22.9%) and ESBL producers (12.3%). The highest MDRO burden occurred in intensive care and other high-acuity wards. Seasonal analysis demonstrated a significant increase in MDRO prevalence during the summer months, with carbapenem-resistant Gram-negative pathogens rising from 18.2% in the winter to 28.7% in the summer (OR 1.82, 95% CI: 1.45-2.28; p<0.001).

CONCLUSIONS: Respiratory pathogens in this Saudi tertiary care hospital exhibited a high prevalence of multidrug resistance, particularly among Gram-negative bacteria and in critical care settings. Seasonal increases in resistance during the summer months suggest the need for intensified infection control measures, strengthened antimicrobial stewardship, and ongoing surveillance to reduce MDRO transmission and optimize patient outcomes.

PMID:42472230 | PMC:PMC13380242 | DOI:10.2147/IDR.S610414

Brain Spine. 2026 Jul 1;6:106157. doi: 10.1016/j.bas.2026.106157. eCollection 2026.

ABSTRACT

INTRODUCTION: Treatment-refractory chronic pain is a prevalent condition affecting a significant portion of the population. Available treatment strategies range from non-invasive to invasive approaches, including several surgical procedures. The most commonly reported intracranial neurosurgical interventions are deep brain stimulation (DBS) and ablative techniques such as cingulotomy, thalamotomy, and mesencephalotomy.

RESEARCH QUESTION: This study aimed to evaluate the efficacy of different intracranial surgical treatments for refractory chronic pain through a systematic review and meta-analysis, focusing on quantitative trends in clinical pain outcomes.

MATERIAL AND METHODS: A systematic literature search was conducted in PubMed according to PRISMA guidelines.

RESULTS: In total, 75 studies including 666 patients that underwent at least one surgical procedure, with nearly half achieving significant pain reduction (>50%). A meta-analysis compared surgical treatments; where mesencephalotomy was excluded due to insufficient data. Pain levels at baseline were compared at four follow-up periods: T1 (≤1 month), T2 (>1-≤6 months), T3 (>6-≤12 months), and T4 (>12 months). Wilcoxon tests demonstrated statistically significant differences between baseline and the latest follow-up for all included methods: DBS: p < 0.001, g = 1.44 85-90%; cingulotomy: p < 0.001, g = 2.6 > 95%; thalamotomy: p < 0.001, g = 0.92 ≈ 74%. Comparisons between follow-up time points were possible only for DBS, which also showed significant differences (p < 0.05).

DISCUSSION AND CONCLUSION: Our findings indicate that intracranial surgical procedures for chronic pain are effective/safe and may maintain their clinical benefit for months following treatment. Furthermore, substantial variability in clinical outcomes was observed, even after stratification according to etiology and target groups.

PMID:42472183 | PMC:PMC13380498 | DOI:10.1016/j.bas.2026.106157

Cureus. 2026 Jun 18;18(6):e111081. doi: 10.7759/cureus.111081. eCollection 2026 Jun.

ABSTRACT

Background Hormone Replacement Therapy (HRT) is a widely used method for endometrial preparation in Frozen Embryo Transfer (FET) cycles. Although multiple estradiol formulations and routes of administration exist, limited data directly compare oral estradiol hemihydrate, vaginal estradiol hemihydrate, and oral estradiol valerate. This study evaluated the efficacy and safety of these three estradiol regimens for endometrial preparation in an assisted reproduction setting. Objectives To compare endometrial outcomes, serum estradiol levels, and pregnancy outcomes among three estradiol treatment protocols, oral estradiol hemihydrate, vaginal estradiol hemihydrate, and oral estradiol valerate, in HRT‑based FET cycles. Methods This prospective, open‑label, three‑arm investigator‑initiated study was conducted at a single center and included 133 women aged 25-42 years undergoing HRT‑FET cycles. Participants received one of the following regimens: oral estradiol hemihydrate, vaginal estradiol hemihydrate, or oral estradiol valerate. Endometrial thickness, endometrial volume, and serum estradiol levels on progesterone‑start day were measured. Clinical outcomes included serum β-human chorionic gonadotropin (β‑hCG) positivity and clinical pregnancy rates. Data were analyzed using descriptive and comparative statistics. Results The mean daily estradiol dose was significantly lower with vaginal estradiol hemihydrate compared to both oral arms (p<0.001). Endometrial thickness and volume showed no significant differences among groups. Mean serum estradiol levels were highest with vaginal estradiol hemihydrate (701.63 pg/mL), significantly exceeding levels with oral estradiol hemihydrate (331.84 pg/mL; p=0.042). Serum β‑hCG positivity rates were 58.33%, 47.62%, and 40.47% (p=0.375) and clinical pregnancy rates were comparable at 44.0%, 28.0%, and 22.7% (p=0.168) in oral estradiol hemihydrate, vaginal estradiol hemihydrate, and oral estradiol valerate groups, respectively. Conclusions Estradiol hemihydrate, whether administered orally or vaginally, demonstrated non‑inferior efficacy to oral estradiol valerate for endometrial preparation in FET cycles. Vaginal estradiol hemihydrate achieved adequate endometrial development at significantly lower doses overcoming the barriers of first pass metabolism and minimizing the safety concerns of thrombo-embolism.

PMID:42472174 | PMC:PMC13380402 | DOI:10.7759/cureus.111081

Cureus. 2026 Jun 18;18(6):e111083. doi: 10.7759/cureus.111083. eCollection 2026 Jun.

ABSTRACT

Background Medicare direct graduate medical education (DGME) payments are essential to sustaining residency training and shaping the physician workforce. While geographic variation in total DGME spending is well described, less is known about inequities in per-resident funding across states and program sizes. Objective The objective of this article was to assess variation in Medicare DGME payments per resident across US states and residency program sizes and identify patterns relevant to equitable graduate medical education (GME) funding. Methods In 2025, we conducted a retrospective cross-sectional analysis of publicly available Medicare DGME payment data from 2014-2024. All US hospitals reporting DGME payments were eligible (N = 447), with 439 hospitals included (98.2%). Hospitals were stratified by state and residency program size: small (0-20 residents), mid-sized (21-200), and large (>200). The primary outcome was DGME payment per resident. Comparisons were performed across states and program sizes. Sensitivity analyses evaluated resident count and hospital bed capacity. Results Per-resident DGME payments varied significantly by state and program size (p<0.001). The national median payment was approximately $22,000 per resident, with the highest payments in Mississippi and the lowest in California. Small programs received higher mean per-resident payments than mid-sized programs (p<0.01). Hospitals in the highest and lowest payment deciles were concentrated within specific states. Resident count was a stronger predictor of per-resident payments than hospital bed capacity (p<0.001). Conclusions Substantial geographic and program-size-related inequities in per-resident DGME funding persist nationwide. This may disadvantage mid-sized and underserved programs and should be considered in promoting equitable training and workforce distribution.

PMID:42472170 | PMC:PMC13380125 | DOI:10.7759/cureus.111083

Cureus. 2026 Jun 18;18(6):e111112. doi: 10.7759/cureus.111112. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Peripheral arterial disease (PAD) is a major global health concern, as critical limb-threatening ischemia leads to higher rates of amputation and mortality. The prognostic impact of prior minor amputation (PMA) is unclear. This study compares major amputation and all-cause mortality rates in patients with PAD with and without PMA and examines key demographic and clinical differences between these groups.

METHODS: This retrospective cohort study included 430 consecutive patients with PAD at a tertiary vascular center. Patients were stratified according to PMA status into a PMA group (n = 72, 16.7%) and a non-PMA group (n = 358, 83.3%). Demographic data, comorbidities, and treatments were analyzed. Primary outcomes were major amputation and all-cause mortality. Statistical analysis included unpaired t-tests, chi-square tests, Cox proportional hazards regression, and Kaplan-Meier analysis.

RESULTS: Among 430 patients, 72 (16.7%) had PMA, whereas 358 (83.3%) did not. The PMA group had higher rates of smoking (n = 45, 62.5%, vs. n = 175, 48.9%; P = 0.039), chronic kidney disease (n = 29, 40.3%, vs. n = 98, 27.4%; P = 0.034), and revascularization (n = 16, 22.2%, vs. n = 14, 3.9%; P < 0.001), but lower utilization of antiplatelet therapy (n = 34, 47.2%, vs. n = 229, 64.0%; P = 0.006) and statin therapy (n = 38, 52.8%, vs. n = 258, 72.1%; P = 0.001). Although unadjusted Kaplan-Meier analysis demonstrated lower survival in the PMA group, multivariable Cox regression showed that PMA was associated with a lower adjusted risk of major amputation (hazard ratio (HR), 0.05; 95% confidence interval (CI), 0.02-0.18; P = 0.001) and all-cause mortality (HR, 0.44; 95% CI, 0.22-0.87; P = 0.017). Statin therapy (HR, 0.21; 95% CI, 0.10-0.43; P < 0.001) and anticoagulation (HR, 0.39; 95% CI, 0.21-0.72; P = 0.003) were associated with reduced mortality risk, whereas revascularization was associated with increased mortality risk (HR, 2.02; 95% CI, 1.05-3.83; P = 0.033).

CONCLUSIONS: PMA was associated with lower adjusted risks of major amputation and mortality in this retrospective cohort of patients with PAD. These results represent observational associations and require prospective validation. Aggressive medical management should be prioritized in all patients with PAD.

PMID:42472145 | PMC:PMC13380416 | DOI:10.7759/cureus.111112

Cureus. 2026 Jun 17;18(6):e111064. doi: 10.7759/cureus.111064. eCollection 2026 Jun.

ABSTRACT

Introduction Breast self-examination (BSE) is promoted as a component of breast self-awareness and a preventive measure, yet its psychosocial impact remains debated. This study aimed to evaluate the effects of BSE education on self-efficacy, health anxiety, and health locus of control among Greek women. Materials and methods A prospective cohort of 298 women (mean age 48.7 ± 10.7 years) participated in a structured BSE educational intervention. Psychosocial parameters were assessed at baseline, 6, and 12 months using validated scales: general self-efficacy, health anxiety, and multidimensional health locus of control. Statistical analyses included repeated-measures ANOVA, post hoc comparisons, and regression modeling to explore temporal changes and predictors. Results BSE practice increased markedly from 44.3% (n = 132) at baseline to 92.2% (n = 271) at six months and 85.0% (n = 250) at 12 months (Cochran’s Q = 188.96, p < 0.001). Self-efficacy and health anxiety scores remained stable over time (p = 0.570 and p = 0.955, respectively). Health locus of control subscales revealed small but statistically significant declines in internal control (baseline: 19.2 ± 4.9; 12 months: 18.1 ± 4.6; p < 0.001) and in attribution to “powerful others” and “chance” (p = 0.040 and p = 0.039). Regression analyses indicated that prior scores were the strongest predictors of 12-month outcomes, with age associated with greater reliance on “powerful others” (β = 0.107, p = 0.040). No increase in health anxiety was observed despite the rise in BSE practice. Conclusions BSE education significantly enhanced preventive behavior without increasing health anxiety or altering general self-efficacy. These findings support BSE education as a complementary strategy for breast health awareness, emphasizing its role in early care-seeking rather than as a substitute for formal screening.

PMID:42472144 | PMC:PMC13379682 | DOI:10.7759/cureus.111064

Cureus. 2026 Jun 18;18(6):e111073. doi: 10.7759/cureus.111073. eCollection 2026 Jun.

ABSTRACT

INTRODUCTION: Cuffed tunneled hemodialysis catheters are an important vascular access option for patients with end-stage renal disease (ESRD) when arteriovenous fistula (AVF) creation is not feasible or when urgent initiation of hemodialysis is required. However, clinical outcomes may vary according to the catheter insertion site.

OBJECTIVE: To compare procedural safety, biochemical outcomes, and six-month clinical outcomes among different tunneled hemodialysis catheter insertion sites.

METHODS: This retrospective observational study included 1,050 consecutive patients who underwent tunneled hemodialysis catheter insertion over four years at a tertiary care center. Patients were categorized according to catheter insertion site into right internal jugular vein (RIJV; n = 535), left internal jugular vein (LIJV; n = 416), subclavian vein (n = 53), and femoral vein (n = 46) groups. Baseline characteristics, procedure-related complications, laboratory outcomes at three months, and clinical outcomes at six months were compared using appropriate statistical analyses.

RESULTS: Baseline demographic and laboratory characteristics were comparable among all groups (all P > 0.05). Procedure-related complications were significantly more frequent in the subclavian and femoral groups, including exit-site bleeding (P = 0.032), catheter malposition (P = 0.028), hematoma formation (P = 0.018), arterial puncture (P = 0.022), hypoxia (P = 0.036), arrhythmia (P = 0.041), and pneumothorax (P = 0.048). At three months, patients with subclavian and femoral access demonstrated significantly poorer biochemical profiles, characterized by lower hemoglobin and serum albumin levels and higher leukocyte counts, serum creatinine, C-reactive protein, phosphorus, and intact parathyroid hormone levels (all p<0.05). At six months, internal jugular vein access was associated with significantly higher rates of successful AVF creation (P = 0.018) and ongoing catheter survival (P = 0.012). Conversely, subclavian and femoral access were associated with significantly higher rates of catheter dysfunction (P = 0.015), catheter-related bloodstream infection (P = 0.013), and mortality (P = 0.020).

CONCLUSIONS: Internal jugular vein access, particularly RIJV access, was associated with superior procedural safety, more favorable biochemical profiles, and better six-month clinical outcomes compared with subclavian and femoral access. These findings support the preferential use of internal jugular vein access for tunneled hemodialysis catheter placement whenever feasible.

PMID:42472140 | PMC:PMC13379867 | DOI:10.7759/cureus.111073