Category: Statistics

Asian Pac J Cancer Prev. 2026 Apr 1;27(4):1211-1217. doi: 10.31557/APJCP.2026.27.4.1211.

ABSTRACT

BACKGROUND: Cervical cancer is a leading cause of cancer-related morbidity and mortality among women in Thailand. Despite the availability of national cervical cancer screening programs, participation rates remain low in Northern Thailand due to barriers such as limited accessibility and discomfort with clinical sample collection. Self-collected HPV DNA testing offers a promising alternative to traditional screening methods by addressing these barriers and improving access to care.

OBJECTIVE: Cervical cancer is a major health burden in Thailand, yet participation in national screening programs remains low, particularly in Northern Thailand. This study evaluated satisfaction with self-collected HPV DNA testing and examined factors influencing screening acceptance to inform strategies for increasing uptake.

METHODS: A cross-sectional study was conducted among 299 women aged 30-60 years attending the national cervical cancer screening program at Maharaj Nakorn Chiang Mai Hospital. Participants performed self-collection following a demonstration and completed a five-point Likert scale satisfaction survey. Descriptive statistics and logistic regression were used to assess satisfaction and identify predictors of screening intention.

RESULTS: Most participants (85.95%) strongly agreed that self-collected HPV DNA testing improved screening accessibility, and 100% found the process easy to follow. Mean satisfaction scores were high for accessibility (4.85/5), effectiveness (4.82/5), and reliability (4.81/5). No invalid samples were reported, and beta-globin Ct values confirmed high-quality sample collection (mean Ct = 29.00 ± 1.70). Education level significantly influenced screening intention (OR = 17.61, p = 0.039).

CONCLUSION: Self-collected HPV DNA testing was highly satisfactory and could enhance national screening programs, especially in underserved populations.

PMID:41945938 | DOI:10.31557/APJCP.2026.27.4.1211

Asian Pac J Cancer Prev. 2026 Apr 1;27(4):1161-1170. doi: 10.31557/APJCP.2026.27.4.1161.

ABSTRACT

OBJECTIVE: This meta-analysis aims to evaluate the diagnostic efficacy of [68Ga]Ga-FAPI PET imaging in breast, ovarian, and cervical cancers by conducting a systematic review of the existing literature.

METHODS: A systematic review of PubMed, Web of Science, Scopus, and Google Scholar databases, following by a meta-analysis of the included studies, was performed using a random-effects statistical model.

RESULT: Ten eligible studies that described the effectiveness of [⁶⁸Ga]Ga-FAPI PET imaging in breast, ovarian, and cervical cancers were included in this review. The total number of participants was 253 females. Aggregated data from nine studies indicate a remarkably high diagnostic odds ratio (DOR) of 48.69 (95% CI: [16.94-139.96]) for detecting primary tumors, and a DOR of 207.50 (95% CI: [46.18-932.34]) from seven studies for detecting lymph node metastasis. [⁶⁸Ga]Ga-FAPI PET demonstrated high diagnostic accuracy in identifying both primary lesions and metastatic lymph nodes in breast, ovarian, and cervical cancers.

CONCLUSION: [68Ga]Ga-FAPI PET imaging could function as a supplementary technique to [18F]F-FDG PET imaging modalities, offering a more comprehensive evaluation for cancer staging, assessment of treatment response, and guidance in radiation therapy planning.

PMID:41945933 | DOI:10.31557/APJCP.2026.27.4.1161

Arch Cardiol Mex. 2026 Apr 7. doi: 10.24875/ACM.25000234. Online ahead of print.

ABSTRACT

BACKGROUND: Venovenous extracorporeal membrane oxygenation (VV ECMO) is a fundamental strategy in the management of refractory respiratory failure. In this context, the National Institute of Cardiology Ignacio Chávez (INCICh) has implemented VV ECMO within its cardiovascular intensive care unit (CICU).

OBJECTIVE: To describe the experience and clinical outcomes of VV ECMO use in patients with severe respiratory failure in a Latin American cardiovascular center.

METHOD: A retrospective observational study was conducted including patients who received VV-ECMO support at INCICh. Demographic, clinical, and hemodynamic variables, cannulation type, duration of support, complications, and hospital outcomes were analyzed. The primary outcome was in-hospital mortality. Data were analyzed using nonparametric tests and Kaplan-Meier survival curves.

RESULTS: Twenty patients were included, with a median age of 41.5 years (IQR: 23-59) and a predominance of males (80%). The main indication was respiratory failure due to SARS-CoV-2 infection (55%). In-hospital survival was 70%, higher than that reported in international series. Comorbidities and anthropometric variables were not associated with mortality. Non-survivors had longer stays in the CICU, mechanical ventilation, and ECMO support, though without statistical significance. Acute kidney injury was the most frequent complication, with no direct impact on mortality.

CONCLUSIONS: VV-ECMO therapy at INCICh demonstrated lower mortality compared with other series, underscoring the importance of specialized teams and established protocols to optimize outcomes in patients with refractory respiratory failure.

PMID:41945927 | DOI:10.24875/ACM.25000234

J Med Internet Res. 2026 Apr 7;28:e82564. doi: 10.2196/82564.

ABSTRACT

BACKGROUND: Autism spectrum disorder (ASD) is often underdiagnosed in low- and middle-income countries due to limited specialist access, sociocultural stigma, and fragmented screening systems. Artificial intelligence (AI)-powered screening tools may improve early detection by enabling low-cost, accessible assessments. However, adoption depends on stakeholder trust, ethical safeguards, and alignment with local health system capacities.

OBJECTIVE: This study explored the feasibility, acceptability, and perceived ethical and practical enablers and barriers to implementing AI-powered tools for early ASD screening in Egypt, with attention to urban-rural disparities and integration into existing care pathways.

METHODS: We used a qualitative design with semistructured focus group discussions with 49 participants (21 parents of children with ASD and 28 health care professionals) recruited from urban and rural governorates. Discussions were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke’s reflexive thematic analysis, supported by NVivo software (Lumivero). Methodological integrity was ensured through reflexivity, triangulation, and peer debriefing. Thematic saturation was monitored across groups, and participant diversity was prioritized across contexts.

RESULTS: Five themes emerged: (1) AI as a supportive tool rather than a replacement for clinicians, emphasizing scalability and assistance for nonspecialists; (2) the need for cultural and contextual adaptation to ensure local relevance; (3) privacy, trust, and transparency concerns, including data security, consent, and algorithmic opacity; (4) reducing diagnostic inequities by addressing urban-rural disparities and strengthening community-based deployment; and (5) the preference for hybrid AI-human models, with conditions for adoption including cultural sensitivity, human oversight, and digital literacy support. Counts (n/N) of parents and health care professionals contributing to each theme were used descriptively as indicators of pattern salience rather than as statistical estimates of prevalence. Participants expressed cautious optimism, with parents emphasizing accessibility and speed, while health care professionals highlighted concerns about reliability, cultural adaptation, and data governance.

CONCLUSIONS: AI-powered ASD screening has potential to advance equitable early detection in underserved areas. Adoption requires transparent data governance, integration into hybrid human-AI models, culturally adaptive design, and targeted digital literacy initiatives. These findings provide an evidence-based roadmap for policymakers, technologists, and health system leaders to implement AI screening tools that are ethically sound, contextually relevant, and equity-focused.

PMID:41945920 | DOI:10.2196/82564

Acta Med Port. 2026 Feb 27;39(4):287-290. doi: 10.20344/amp.23956. Epub 2026 Apr 1.

ABSTRACT

Adolescents with severe suicide attempts requiring intensive care represent a major public health challenge, with high morbidity and resource utilization. This retrospective study reviewed all cases of young people aged 10 to 18 years admitted to a pediatric intensive care unit between 2014 and 2024 following a suicide attempt. Eighteen cases were identified, predominantly female patients (72%) with a median age of 15.5 years. The most common methods were drug overdose (56%) and major trauma due to jumping from heights (39%). Most patients required invasive mechanical ventilation (89%), with a mean pediatric intensive care unit stay of 5.6 days and a total hospital stay of 29 days, markedly longer in trauma cases. No deaths occurred, but three patients developed severe sequelae. Family conflict, gender/sexuality concerns and school-related problems were frequent precipitating factors; only one patient had a previously recorded suicide attempt. Following discharge, 89% were referred for psychiatric follow-up, with post-discharge diagnoses of depression, anxiety, personality disorder and substance abuse. These findings highlight the need for systematic suicide risk screening in primary care and emergency settings, community- and family-based interventions, and structured post-discharge protocols to prevent recurrence and reduce long-term complications.

PMID:41945913 | DOI:10.20344/amp.23956

Int J Speech Lang Pathol. 2026 Apr 7:1-20. doi: 10.1080/17549507.2026.2645784. Online ahead of print.

ABSTRACT

PURPOSE: Youth offenders disproportionately come from low socioeconomic status backgrounds and are more likely to present with a language disorder than their non-offending peers. Literature on the presence of socioeconomic status-related risk factors among youth offenders with language disorders is limited, despite its important role in both language development and youth offending behaviour.

METHOD: A scoping review protocol was developed using the PRISMA-ScR protocol and executed across five electronic databases. Data sources were deduplicated, screened, charted, and appraised. Synthesis was conducted using descriptive statistics and qualitative content analysis. Initially, 787 sources were identified, of which 16 (1993-2024) were analysed.

RESULT: Thirteen sources (81.3%) that investigated language disorders among incarcerated youth offenders and discussed result related to socioeconomic status factors were identified. Eleven risk factors were identified, with the most frequent being illicit substance use (n = 6, 46.2%), dropping out of school (n = 4, 30.8%), and coming from low-income communities (n = 3, 23.1%).

CONCLUSION: Despite significant variability and inconsistency in measurement, a number of socioeconomic status-related risk factors were identified. A dearth in literature on diverse contexts and demographics were observed. The need for further research on socioeconomic status risk factors among youth offenders with language disorders is evident.

PMID:41945387 | DOI:10.1080/17549507.2026.2645784

J Patient Saf. 2026 Apr 7. doi: 10.1097/PTS.0000000000001505. Online ahead of print.

ABSTRACT

OBJECTIVES: Medically ill patients, especially those with psychiatric comorbidities, may exhibit behavioral disturbance while hospitalized. Restlessness, removing medical devices, or wandering may lead to sentinel events such as falls, elopements, or violence. An interdisciplinary behavioral intervention team (BIT) was implemented to address and anticipate the need for behavioral health support on medical units. A retrospective review was conducted to evaluate the effects of BIT interventions on patient safety events.

METHODS: Two psychiatric nurses were embedded on medical/surgical units as part of medical and psychiatric interdisciplinary teams. A retrospective review was conducted to evaluate outcomes. Two time periods were examined: 6 months with early-BIT efforts and 6 months with expanded-BIT efforts. Medical records and safety reports were reviewed, and statistical analysis was conducted in SAS Enterprise Guide 8.3. Statistical significance was based on associated P-values (P<0.05).

RESULTS: Of admitted patients during the study period (N=1413), pre-existing psychiatric diagnoses were present in 58% of cases, with mood, anxiety, and neurocognitive disorders being most common. A majority of patients were on psychotropic medications during both study periods; however, there was a significant decrease in the use of psychotropic medications with expanded-BIT efforts (71.2% versus 61.3%, P<0.001). In comparing early-BIT efforts to expanded-BIT efforts, significant reductions in workplace aggression (6.7% versus 2.3%, P<0.001), use of restraints (5.8% versus 3.4%, P=0.034), and need for security officers (4.2% versus 0.8%, P<0.001) were observed.

CONCLUSIONS: Engaging BIT significantly reduced aggression, restraint use, and security officer interventions. An interdisciplinary BIT is feasible and effective in reducing negative outcomes.

PMID:41945363 | DOI:10.1097/PTS.0000000000001505

JAMA Netw Open. 2026 Apr 1;9(4):e265439. doi: 10.1001/jamanetworkopen.2026.5439.

ABSTRACT

IMPORTANCE: Financial and geographic barriers are associated with worse cardiovascular outcomes, underscoring the need to improve access to cardiovascular care. Medicare Advantage (MA) plans offer reduced cost-sharing for cardiologists, potentially mitigating financial barriers to cardiovascular care through minimizing out-of-pocket costs.

OBJECTIVES: To determine how availability of Medicare Advantage plans with reduced cost-sharing for cardiologists has changed over time, whether plans offer reduced cost-sharing to beneficiaries in communities with more or less cardiologist supply or cardiovascular care infrastructure, and whether such benefits are offered by high-quality plans.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of MA benefit design related to cardiovascular care used plan benefits package and MA enrollment data from December 31, 2022, to December 31, 2024. Participants were MA beneficiaries. Data were analyzed from March 1 to May 23, 2025.

EXPOSURES: MA plans with reduced cost-sharing for cardiologists.

MAIN OUTCOMES AND MEASURES: The primary outcomes were (1) enrollment patterns in MA plans offering reduced-cost sharing for cardiologists (measured as quarterly enrollment in such plans from 2022 to 2024), (2) number of MA plans with reduced cost-sharing for cardiologists mapped to county-level cardiologist supply (measured as the number of cardiologists per 1000 MA beneficiaries) and cardiovascular care infrastructure (measured via individual measures and a composite index of 3 county-level measures), and (3) quality of these plans vs other MA plans (measured via 3 metrics of cardiovascular care-related quality from the Healthcare Effectiveness Data and Information Set).

RESULTS: Among 2993 plans with reduced cost-sharing for cardiologists and 3143 counties, the number of plans offering reduced cost-sharing for cardiologists (from 134 of 6448 [2.1%] in 2022 to 158 of 6808 [2.3%] in 2024) and enrollment in such plans (1.4 million in 2022 to 1.5 million in 2024) increased during the study period. Across counties, the number of MA plans with reduced cost-sharing for cardiologists varied considerably compared with cardiologist supply and cardiovascular care infrastructure. Reduced cost-sharing plans had greater care quality compared with other MA plans (116 of 158 [73.4%] with reduced cost-sharing for cardiologists being high quality vs 2508 of 6650 [37.7%]; P < .001).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of plans with reduced cost-sharing for cardiologists, the number of plans increased over time and tended to be higher quality compared with other MA plans. However, persistent geographic variability in number of plans offered, cardiologist supply, and cardiovascular care infrastructure underscore the need for additional strategies to minimize financial and geographic barriers for cardiovascular care.

PMID:41945346 | DOI:10.1001/jamanetworkopen.2026.5439

JAMA Netw Open. 2026 Apr 1;9(4):e265528. doi: 10.1001/jamanetworkopen.2026.5528.

ABSTRACT

IMPORTANCE: The prevalence of childhood obesity has tripled between 1999 and 2021, and the greatest increases have been observed in Asia. Ultraprocessed foods are considered a major risk factor for obesity; however, trends in ultraprocessed food consumption among Korean youths remain understudied.

OBJECTIVE: To examine 18-year trends in ultraprocessed food consumption stratified by obesity and demographic characteristics among Korean youths.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study used 24-hour dietary recall data from 6 cycles of the Korea National Health and Nutrition Examination Survey from 2007 to 2024. Participants included Korean youths aged 1 to 18 years.

EXPOSURE: Survey cycles.

MAIN OUTCOMES AND MEASURES: The percentage of energy intake from ultraprocessed foods based on the Nova food classification system was estimated across survey cycles.

RESULTS: Among the 24 518 youths included, the weighted mean (SD) age of participants was 10.2 (5.1) years, of whom 12 797 (52.2%) were boys. From the 2007-2009 to 2022-2024 cycles, the percentage of energy from ultraprocessed foods increased from 24.6% (SE, 0.5%) to 33.0% (SE, 0.5%) (P < .001 for trend), while the percentage of energy from unprocessed or minimally processed foods decreased from 64.8% (SE, 0.5%) to 51.8% (SE, 0.4%) (P < .001 for trend). There was a greater increase in ultraprocessed food consumption among school-aged children (from 22.9% [SE, 0.6%] to 34.0% [SE, 0.6%]) and adolescents (from 28.7% [SE, 0.8%] to 36.9% [SE, 0.7%]) than among preschool-aged children (from 23.5% [SE, 0.6%] to 26.4% [SE, 0.9%]) and among youths without obesity (from 24.7% [SE, 0.5%] to 33.5% [SE, 0.5%]) than those with obesity (from 24.9% [SE, 0.8%] to 30.9% [SE, 1.1%]) (P ≤ .001 for interaction).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of Korean youths, the estimated proportion of energy intake from ultraprocessed foods increased from 2007 to 2024, indicating that ultraprocessed foods became a more dominant part of Korean youths’ diets, especially among older youths and those without obesity. These findings suggest the need for monitoring and preventive strategies to reduce intake.

PMID:41945345 | DOI:10.1001/jamanetworkopen.2026.5528

JAMA Netw Open. 2026 Apr 1;9(4):e265585. doi: 10.1001/jamanetworkopen.2026.5585.

ABSTRACT

IMPORTANCE: Life-prolonging targeted therapies are available based on alterations detected on next-generation sequencing (NGS); however, clinical data on NGS adoption are limited.

OBJECTIVE: To assess trends and disparities in NGS among patients with common advanced or metastatic cancers.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 280 US-based cancer clinics (approximately 800 sites of care) using electronic health record-derived deidentified information from Flatiron Health Research Database. Participants were patients diagnosed with metastatic breast (mBC), metastatic prostate (mPC), advanced non-small cell lung (aNSCLC), metastatic colorectal (mCRC), and metastatic pancreatic (mPanC) cancers between January 1, 2018, and December 30, 2022. Data were analyzed from April 2024 to December 2025.

MAIN OUTCOMES AND MEASURES: Time to NGS from diagnosis, considering death as competing risk. Multivariable cause-specific Weibull accelerated failure time models evaluated association of socioeconomic status (SES), race and ethnicity, insurance type, practice setting, and sex with time to NGS.

RESULTS: Overall, 63 294 patients with advanced or metastatic cancer who underwent NGS were eligible and included: 12 085 with mBC (19.1%), 4341 with mPC (6.9%), 27 050 with aNSCLC (42.7%), 13 648 with mCRC (21.6%), and 6170 with mPanC (9.7%). The median (IQR) age was 68 (60-76) years and 33 975 patients (53.7%) were female; 1703 (2.7%) were Asian, 6551 (10.0%) were Black, 3772 (6.0%) were Hispanic, 38 318 (61.0%) were White, and 12 950 (20.3%) were other races and ethnicities. One-year cumulative incidence of NGS increased in patients diagnosed in 2022 compared with 2018 across all cancer types. Significantly longer time to NGS (time ratio [TR]) was observed in those with mBC with low SES (1, lowest: TR, 1.3; 95% CI, 1.1-1.6; 2: TR, 1.3; 95% CI, 1.1-1.5), those who were Hispanic (TR, 1.4; 95% CI, 1.2-1.7), or those on Medicare (TR, 1.5; 95% CI, 1.3-1.8). Longer TRs were also observed in those with mPC and Hispanic ethnicity (TR, 1.6; 95% CI, 1.3-2.1), those on Medicaid (TR, 2.0; 95% CI, 1.2-3.5), those with aNSCLC with low SES (1, lowest: TR, 1.6; 95% CI, 1.5-1.8; 2: TR, 1.4; 95% CI, 1.3-1.6; 3: TR, 1.2; 95% CI, 1.1-1.3), Black patients (TR, 1.4; 95% CI, 1.2-1.5), and those on Medicare (TR, 1.4; 95% CI, 1.3-1.5). For mCRC, TRs were elevated for those with low SES (1, lowest: TR, 1.3; 95% CI, 1.1-1.5; 2: TR, 1.1; 95% CI, 1.0-1.3), Black patients (TR, 1.4; 95% CI, 1.2-1.6), Hispanic patients (TR, 1.4; 95% CI, 1.2-1.6), and those on Medicare (TR, 1.4; 95% CI, 1.3-1.6). Elevated TRs were also observed for mPanC in Black patients (TR, 1.5; 95% CI, 1.2-1.8) and those on Medicare (TR, 1.3; 95% CI, 1.1-1.5).

CONCLUSIONS AND RELEVANCE: In this cohort study, most patients with advanced or metastatic cancers did not undergo tumor genomic testing. Low SES, Black race or Hispanic ethnicity, and Medicaid or Medicare coverage were associated with significantly longer time to NGS, highlighting the need for awareness and health care policies aimed at bridging these gaps.

PMID:41945343 | DOI:10.1001/jamanetworkopen.2026.5585