Category: Statistics

Phlebology. 2026 May 11:2683555261451555. doi: 10.1177/02683555261451555. Online ahead of print.

ABSTRACT

BackgroundLipedema is an adipose disorder associated with multiple impairments. Conservative treatments remain the mainstay of management, yet evidence regarding the effects of physical therapies on clinical, imaging, and body composition outcomes is limited. Radial extracorporeal shock wave therapy (rESWT) has been proposed as a non-invasive therapeutic option, although its impact is not fully established.MethodsThis was a prospective, longitudinal, within-patient study conducted in women with clinically diagnosed lipedema. One lower limb was treated with radial extracorporeal shock wave therapy (rESWT), whereas the contralateral limb served as an internal control. A total of 16 patients were initially assessed, of whom 12 completed the full follow-up and were included in the final analysis. rESWT was applied over six sessions (two sessions per week) using standardized parameters. Clinical outcomes (LEFS, EQ-5D, SF-36 Physical Function, and IPAQ) were assessed at baseline, 6 weeks, and 3 months. Ultrasound and elastography were used to evaluate subcutaneous tissue thickness and stiffness at predefined leg and thigh sites, while segmental bioimpedance analysis assessed body composition and fluid distribution. Longitudinal changes were analyzed using mixed-effects models.ResultsSignificant improvements were observed in functional capacity, quality of life, and physical activity levels at both 6 weeks and 3 months compared with baseline (p < .05). In contrast, no statistically significant changes were detected in ultrasound-derived tissue thickness, elastography measurements, or bioimpedance parameters over time, and no significant differences were detected between treated and control limbs within the constraints of the available sample size.ConclusionsrESWT was associated with meaningful clinical and functional improvements in patients with lipedema, despite the absence of detectable changes in tissue thickness, stiffness, or body composition. These findings suggest that the benefits of rESWT may be mediated through symptom modulation and functional adaptation rather than structural tissue modification, supporting its role as part of conservative, symptom-oriented treatment strategies in lipedema.

PMID:42109195 | DOI:10.1177/02683555261451555

Int J Health Plann Manage. 2026 May 11. doi: 10.1002/hpm.70084. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: The performance of healthcare organisations with their considerably complex structures is often on the agenda due to limited resources. Service quality, commonly assessed using the SERVQUAL scale, represents a key performance dimension in healthcare delivery. This paper aims to investigate the extent of meeting the expectations in health service provision in Turkiye and countries in Asia.

METHODS: We searched electronic databases, namely Web of Science, Google Scholar, PubMed, and Turkish Council of Higher Education National Thesis Centre, to find relevant and accessible English and Turkish studies published until 1 January 2023. Eligible studies were empirical research conducted in healthcare settings using the SERVQUAL scale and reporting expectation-perception gaps. Mean differences with 95% confidence intervals were calculated. Heterogeneity was assessed using the I² and τ² statistics, and publication bias was evaluated using funnel plots and Egger’s test.

RESULTS: A total of 47 studies (N = 13,581) were included. The highest quality gap occurred in the responsiveness (0.59) and reliability (0.54) dimensions. Patients had high levels of expectations from healthcare organisations in all five subdomains examined for both Turkiye and other Asian countries.

CONCLUSION: Highly significant quality gaps in the examined domains emphasise the need for improvements in appropriate and quality service delivery and the implementation of compassionate patient-centred approaches. We have concluded that healthcare managers and decision-makers should regularly monitor the quality level of provided healthcare services, find the gaps that need to be improved, and better understand how client expectations in healthcare might be shaped in different settings and countries. Limitations include the restriction to English and Turkish languages, the cross-sectional design of studies, and variability in hospital settings. No protocol was registered.

PMID:42109192 | DOI:10.1002/hpm.70084

Nucleic Acids Res. 2026 May 11:gkag454. doi: 10.1093/nar/gkag454. Online ahead of print.

ABSTRACT

Interpreting genome-wide epigenomic experiments, such as DNA methylation profiling and chromatin accessibility assays, requires tools that can identify which regulatory programs underlie coordinated changes across genomic regions. Without this regulatory context, lists of differential regions remain largely descriptive and difficult to interpret mechanistically. Existing approaches either apply hard significance cutoffs that discard moderate but biologically meaningful signals, or rely on gene-centric annotations that neglect enhancers and intergenic space, introducing bias into the interpretation. RegRegSEA addresses both shortcomings by adapting the Gene Set Enrichment Analysis framework directly to genomic coordinates. The server accepts a standard differential analysis table, ranks all tested intervals by a signed statistic, and computes enrichment scores against curated regulatory databases including transcription factor binding site collections. Results are returned as an interactive, publication-ready report featuring dynamic visualizations of enrichment profiles and regulatory annotations, along with downloadable leading-edge regions for downstream analyses. We demonstrate the utility of this approach through re-analysis of Down syndrome brain methylation data and chromatin accessibility in ageing mouse liver. The server is freely available at https://web.ccb.uni-saarland.de/regregsea/ and open to all users with no login required.

PMID:42109173 | DOI:10.1093/nar/gkag454

BJPsych Open. 2026 May 11;12(3):e133. doi: 10.1192/bjo.2026.11039.

ABSTRACT

BACKGROUND: Depression is common in end-stage kidney disease (ESKD) and is associated with poorer outcomes and higher mortality. However, treatment guidance is inconsistently applied.

AIMS: To investigate screening measures, somatic symptoms, comorbidities and psychosocial and cultural influences on depression diagnosis in ESKD patients.

METHOD: We recruited 300 people with ESKD receiving maintenance hospital haemodialysis in a deprived ethnically diverse area. We assessed depression using validated screening tools (Hamilton Depression Rating Scale and Patient Health Questionnaire 2) and a definitive ICD-10 diagnosis using a structured interview (Clinical Interview Schedule-Revised). We considered the role of adverse life events, co-occurring medical conditions, as well as age, sex and ethnicity, using descriptive statistics and multiple logistic regression.

RESULTS: An ICD-10 diagnosis of moderate or severe depression was made in 8% of the sample, taking care to exclude potentially confounding symptoms associated with chronic kidney disease and depression. Applying validated thresholds on commonly used screening tools yielded substantially higher prevalence estimates. An ICD-10 diagnosis of moderate and severe depression associated with loss events: death of a spouse, child or parent (odds ratio 3.62, 95% CI: 1.09-12, p = 0.04), financial strain (odds ratio 3.51, 95% CI: 1.04-11.87, p = 0.04), type 2 diabetes (odds ratio 5.32, 95% CI: 1.34-20.76, p = 0.02) and education, whereby university graduates were less likely to have depression than school-only attendees (odds ratio 0.18, 95% CI: 0.03-1.02, p = 0.05). Ethnicity and sex were not significantly associated with moderate or severe depression.

CONCLUSIONS: We found a lower prevalence of moderate to severe depression than commonly reported. Future research should consider careful diagnostic assessment, financial strain, loss events and physical co-occurring medical conditions such as diabetes.

PMID:42109130 | DOI:10.1192/bjo.2026.11039

J Atten Disord. 2026 May 11:10870547261448260. doi: 10.1177/10870547261448260. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the effect of attention-deficit hyperactivity disorder (ADHD) on sex differences in the hazard risk of a physical disease (PD) in childhood and adolescence, per ICD-10 criteria.

METHOD: The Danish population born from 1984 to 1995, comprising over 800,000 individuals, was studied for the 13 different ICD-10 PD categories with ADHD as a time-dependent exposure in time-to-event settings. Time from birth to first episode PD, emigration, death, or 31st December 2017, whichever occurred first, was analyzed by use of piecewise Cox models.

RESULTS: Individuals with an ADHD diagnosis had higher or similar hazard risk than undiagnosed individuals throughout follow-up. Across all PD categories, baring malignant neoplasms, ADHD-diagnosed individuals had a higher hazard risk from teen age. In the general population, females had higher hazard risk of most PDs from teen age or early adolescence, while males had higher hazard risk in early childhood. Dispersed modification occurred in the hazard difference between sex post-ADHD diagnosis. For eye and adnexa diseases in childhood, males had about a 15% added hazard that of females in the general population, while females had twice the hazard of males among those diagnosed with ADHD. In the general population of young adulthood, females faced a hazard risk of endocrine, nutritional, and metabolic diseases nine times higher than that of males, with an ADHD diagnosis reducing this ratio by half.

CONCLUSION: The time-dependent ADHD diagnosis alters sex differences in the vulnerability to certain PD categories at various ages, while ADHD considerably increases vulnerability to all PDs except malignant neoplasms.

PMID:42109088 | DOI:10.1177/10870547261448260

ScientificWorldJournal. 2026;2026(1):e1551004. doi: 10.1155/tswj/1551004.

ABSTRACT

Chronic wounds, especially in diabetic patients, are difficult to manage because of delayed healing and high infection risk. Traditional polyherbal formulations, which are composed of multiple medicinal plants with synergistic effects, are widely used in wound care, but their clinical effectiveness has not been comprehensively synthesized. This study aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effectiveness of traditional polyherbal formulations for wound healing. Databases were searched, and RCTs involving adults with wounds, where the intervention was traditional polyherbal formulation rather than a placebo, standard care, or other active treatments, were included. The meta-analysis was conducted via a random-effects model, and the certainty of evidence was evaluated via GRADE. Eight RCTs were included. The pooled mean difference for healing time favored polyherbal formulations (-3.28 days; 95%CI = -8.56 to 2.01) but was not statistically significant. Similarly, HbA1c reduction (-5.97%; 95%CI = -30.86 to 18.93) was not significantly different, with high heterogeneity (I² = 98%), and no publication bias was detected. Although several individual herbs within these formulations possess tissue-regenerative, angiogenic and anti-inflammatory properties, the pooled results indicate only a modest, nonsignificant trend toward faster healing. Variations in formulation composition, treatment duration, and methodological quality limit the certainty of evidence, which ranges from high (age) to very low (HbA1c) on the GRADE assessment. Overall, polyherbal formulations show therapeutic promise as adjuncts to standard wound, whereas larger, well-designed trials using standardized formulations and clinically relevant endpoints are needed to establish their efficacy and optimize their clinical application.

PMID:42109081 | DOI:10.1155/tswj/1551004

Clin Transl Sci. 2026 May;19(5):e70579. doi: 10.1111/cts.70579.

ABSTRACT

Lung cancer continues to be the leading cause of morbidity and mortality associated with malignancies. Identifying prognostic factors is vital for improving survival outcomes. This study assessed the impact of clinical, demographic, and genetic factors on overall survival (OS) and progression-free survival (PFS) in patients with non-small cell lung cancer (NSCLC). A prospective cohort of 70 NSCLC patients was analyzed. Demographic and clinical data, including epidermal growth factor receptor (EGFR) mutation status and clinical response by RECIST 1.1 criteria, were assessed. Survival outcomes were estimated using the Kaplan-Meier method with log-rank test. The median PFS and OS were 15 and 24 months, respectively. EGFR-positive patients showed significantly longer survival than EGFR-negative patients (PFS: 17 vs. 11 months, OS: not reached [NA] vs. 24 months). Brain metastases indicated poor OS (OS: 15 months vs. NA) but did not affect PFS. Patients with a partial response after one year exhibited improved overall survival (24-month OS probability of 77.8%). EGFR mutation status, brain metastases, and clinical response are key predictors of survival in NSCLC patients. Integrating genetic screening, timely management of brain metastases, and early assessment may enhance personalized treatment and improve prognosis.

PMID:42109065 | DOI:10.1111/cts.70579

J Endovasc Ther. 2026 May 11:15266028261439629. doi: 10.1177/15266028261439629. Online ahead of print.

ABSTRACT

BACKGROUND: Drug-coated balloon (DCB) have gained prominence as an innovative drug delivery approach in intravascular interventions. Despite its growing clinical application, the safety and efficacy of DCB, especially in the treatment of below-the-knee arterial occlusive disease, require further investigation and validation.

OBJECTIVE: This study aimed to systematically evaluate the comparative clinical outcomes of DCB versus percutaneous transluminal angioplasty (PTA) in patients with below-the-knee arterial disease.

METHODS: This systematic review and meta-analysis included studies from PubMed, Embase, and Cochrane Library (2009-2024). Two investigators independently screened the studies, extracted the data, and assessed the quality using predefined criteria. The primary outcomes were clinically-driven target lesion revascularization (CD-TLR) and binary restenosis, and the secondary outcomes included primary patency, late lumen loss, and major amputation. Safety outcomes included all-cause mortality and major adverse events (MAEs). Data were analyzed using RevMan version 5.4.

RESULTS: Twelve studies (2165 patients, 2986 lesions) were included, with an overall moderate-to-low quality. DCB demonstrated superior outcomes versus PTA: trend toward reduction CD-TLR (17.2% vs 23.2%; OR 0.69, 95% CI 0.47-1.01), reduced restenosis (40% vs 67.9%; OR 0.43, 95% CI 0.13-1.36), and improved 6-month primary patency (70.1% vs 50.8%; OR 2.41, 95% CI 1.00-5.84). DCB also showed reduced late lumen loss (MD -0.45, 95% CI -0.92 to 0.01), lower major amputation (12.1% vs 23.1%; OR 0.89, 95% CI 0.49-1.60), decreased mortality (16.0% vs 19.6%; OR 0.90, 95% CI 0.71-1.13), and fewer MAEs (44.1% vs 47.9%; OR 0.67, 95% CI 0.48-0.94). Detailed statistical analyses are presented in the main text of this paper.

CONCLUSION: In below-the-knee arterial disease, DCB showed a trend toward reduced repeat revascularization and improved vessel patency compared to PTA, although the reduction in CD-TLR was not statistically significant. DCB demonstrated comparable safety and limb preservation outcomes. These results indicate that DCB represents a viable therapeutic option for this challenging disease.Clinical ImpactThis meta-analysis moderates expectations regarding DCB use in BTK arterial disease. While DCB appears effective in reducing reinterventions and MAEs compared to PTA, these benefits did not clearly translate to improved amputation-free survival or mortality. For clinicians, this suggests a need for cautious patient selection rather than routine escalation. The innovation lies in highlighting the apparent dissociation between surrogate markers and hard outcomes. This warrants a balanced approach: prioritizing wound care and comorbidity control, while reserving DCB for select cases where lesion characteristics may favor drug delivery.

PMID:42109064 | DOI:10.1177/15266028261439629

Pediatr Int. 2026 Jan-Dec;68(1):e70412. doi: 10.1111/ped.70412.

ABSTRACT

BACKGROUND: Dengue remains a major public health burden in Malaysia, with vaccination offering a promising strategy for control. Following conditional approval of the TAK-003 vaccine for individuals aged 4 years and above, understanding acceptance among public and healthcare workers is essential.

METHODS: This cross-sectional study was conducted from November 2024 to April 2025 at a tertiary hospital in Negeri Sembilan, Malaysia. Parents/guardians of pediatric patients and healthcare workers completed a questionnaire on vaccine acceptance, decision-making factors, and perceived promoters and barriers. Data were analyzed using descriptive statistics and univariate logistic regression.

RESULTS: Of 386 participants (57% parents/guardians, 43% healthcare workers), 59.8% expressed willingness to receive the vaccine, while 53.7% of parents/guardians were willing to vaccinate their children. The most important decision-making factors were vaccine efficacy, advice from healthcare professionals, and long-term safety. Promoters included fears of severe dengue and belief in vaccine efficacy, while barriers included potential side effects, long-term safety, and doubts about vaccine efficacy. No sociodemographic factor was significantly associated with vaccine acceptance.

CONCLUSION: This study, conducted within the first year of the dengue vaccine’s approval in Malaysia, found a moderate level of acceptance. These early perceptions may evolve as awareness of the vaccine grows.

PMID:42109061 | DOI:10.1111/ped.70412

J Diabetes Sci Technol. 2026 May 11:19322968261446654. doi: 10.1177/19322968261446654. Online ahead of print.

ABSTRACT

BACKGROUND: Automated insulin delivery (AID) improves glycemia in people with type 1 diabetes (T1D). However, concern remains about early worsening of diabetic retinopathy (EWDR) following rapid and large glycemic improvements. This study evaluated diabetic retinopathy (DR) outcomes in adolescents and young adults with T1D (aged 10-30 years) following AID initiation.

METHODS: This retrospective observational study included adolescents and young adults with T1D and hemoglobin A1c (HbA1c) ≥ 8.5% (69 mmol/mol) prior to AID initiation. Clinical data, continuous glucose monitoring (CGM) metrics, and retinopathy grading were collected from research and clinical databases before and after at least three months of AID initiation. Statistical analyses assessed outcomes.

RESULTS: A total of 95 adolescents/young adults (mean age 17.8 years, diabetes duration 9.7 years, 54.7% female) with a baseline HbA1c of 10.3% (89.5 mmol/mol) were included. Mean HbA1c improved by 2.1 percentage points (22.6 mmol/mol) following AID initiation. Retinopathy remained stable or improved in 72/95 (75.8%), while 23/95 (24.2%) experienced EWDR inclusive of diabetic macular edema (DME). While no one required treatment for DME, proliferative DR requiring treatment developed in three participants (3.2%); all had preexisting retinopathy and ≥1 additional diabetes-related complication/risk factor. Logistic regression identified age >18 years and preexisting retinopathy at AID initiation as the only significant risk factors for EWDR.

CONCLUSIONS: Automated insulin delivery is associated with substantial glycemic improvement in adolescents and young adults with T1D. Despite these large glycemic improvements, diabetic retinal disease remains stable or improves in most cases. Risk factors for deterioration include age >18 years and preexisting DR.

PMID:42109056 | DOI:10.1177/19322968261446654