Category: Statistics

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

CPT Pharmacometrics Syst Pharmacol. 2026 Jun;15(6):e70281. doi: 10.1002/psp4.70281.

ABSTRACT

Clinical trials in asthma and chronic obstructive pulmonary disease often use exacerbation risk as the primary endpoint. However, exacerbations occur with low frequency, leading to long and costly clinical trials. Home-measured spirometry, which is becoming more common, provides an alternative and has previously been used to shorten the necessary trial duration. In this work, we develop a mixed-effects hidden Markov model (MEHMM) for analyzing home-measured peak expiratory flow (PEF), combining an observation model with a latent two-state disease process representing sustained periods of high and low PEF, respectively. An inference framework is implemented to estimate fixed and random effects together with measures of uncertainty. Data from a phase 2b dose-finding study of velsecorat in asthma are used to investigate dose-response relationships, complemented by an extensive simulation study. The results demonstrate reliable estimation of parameters and identify statistically significant treatment effects on multiple model components. These findings support the use of latent disease-state models for extracting meaningful information from home-measured spirometry.

PMID:42249718 | DOI:10.1002/psp4.70281

J Adv Nurs. 2026 Jun 6. doi: 10.1111/jan.70645. Online ahead of print.

ABSTRACT

AIMS: The Parent Support Team (PST) is an intensive early intervention home visiting programme delivered by child and family health nurses to families with infants aged 0-6 months experiencing psychosocial and health vulnerabilities. In contrast, mainstream services provide universal clinic-based care and scheduled developmental checks. This mixed-methods study aimed to: (1) describe demographic and psychosocial characteristics, service activity and well-baby check attendance among PST clients compared with mainstream service clients; (2) evaluate changes in maternal depressive symptoms following PST engagement; and (3) explore client experiences, including perceived outcomes and facilitators and barriers to change.

DESIGN: Convergent parallel mixed-methods study.

METHODS: Retrospective data were extracted from electronic medical records for PST clients (909 mothers; 1038 children) and mainstream service clients (17,707 mothers; 21,764 children) between August 2019 and December 2022. Quantitative analyses described demographics, psychosocial characteristics, service use and maternal depressive symptoms. PST client experience surveys (166 mothers) were analysed using descriptive statistics and thematic analysis.

RESULTS: PST clients demonstrated greater psychosocial complexity and higher maternal depressive symptoms at entry than mainstream clients. PST mothers had more frequent service contacts and maintained stronger engagement with services after discharge. The proportion of mothers with clinically significant depressive symptoms decreased following programme participation. Survey findings indicated improved parenting confidence and practical skills. Positive outcomes were attributed to nurse qualities, opportunities to discuss concerns, a holistic care approach and the service model. Reported barriers included accessibility, scope of education topics and communication challenges.

CONCLUSION: The PST programme effectively engages vulnerable families, supports maternal mental health and promotes sustained connection with child and family health services.

IMPACT: Intensive early intervention home visiting programmes may improve outcomes for families with complex needs and warrant broader implementation.

REPORTING METHOD: SRQR guidelines were followed.

PATIENT OR PUBLIC CONTRIBUTION: None.

PMID:42249697 | DOI:10.1111/jan.70645

Cancer Med. 2026 Jun;15(6):e71998. doi: 10.1002/cam4.71998.

ABSTRACT

BACKGROUND: Early diagnosis of colorectal cancer (CRC) can significantly improve prognosis, but currently there is a lack of simple and effective screening methods in clinical practice.

METHODS: This single-center retrospective study included patients with CRC and benign colorectal polyps (BCP) diagnosed at our hospital between December 2020 and December 2023, as well as healthy controls (HCs). Eligible participants were randomly assigned to a training cohort and an internal validation cohort in a 7:3 ratio. Univariable and multivariable logistic regression analyses were performed in the training cohort to identify independent diagnostic predictors of CRC. A diagnostic nomogram was then constructed based on these predictors and internally validated.

RESULTS: Six hundred forty seven CRC, 365 BCP, and 400 HC were ultimately included in the study. Univariate and multivariate analysis showed that sex, HB, CEA, CA19-9, CONUT score, and HALP score were independent diagnostic predictors associated with CRC. The internal validation results indicated that the predictive ability of the nomogram (AUC_nomogram = 0.896) is significantly stronger than that of each individual indicator (AUC_HB = 0.78, AUC_CEA = 0.73, AUC_CA19-9 = 0.72, AUC_CONUT = 0.64, AUC_HALP = 0.72) (p < 0.05). The calibration curves confirmed the high consistency between the predicted probability and observed probability of the nomogram, and the decision curve analysis demonstrated its good clinical utility.

CONCLUSION: This study integrated multiple independent diagnostic predictors of CRC and developed an internally validated diagnostic nomogram with good discrimination and calibration in this single-center retrospective cohort.

PMID:42249647 | DOI:10.1002/cam4.71998

Urol J. 2026 May 29;23(1):35-36. doi: 10.22037/uj.v22i.8797.

ABSTRACT

We conducted a retrospective cross-sectional analysis of 288 complaints filed against urologists between 2017 and 2023 at the Forensic Medicine Organization in Shemiranat, Tehran. The number of complaints increased steadily, peaking in 2023 (n = 66) and reaching a nadir in 2020 (n = 13), likely reflecting the impact of the COVID-19 pandemic. Most complainants were male (89.6%), and patients aged >60 years comprised the largest group (31.3%). Complaints were overwhelmingly directed at specialist urologists (97.6%), with subspecialists accounting for only 2.4%. Cases more frequently originated from public hospitals (66.3%) than from private institutions (33.7%).

PMID:42249634 | DOI:10.22037/uj.v22i.8797

Oral Dis. 2026 Jun 5. doi: 10.1111/odi.70380. Online ahead of print.

ABSTRACT

BACKGROUND: This research was designed to establish an innovative diagnostic strategy employing whole-slide imaging (WSI) technology to address the diagnostic difficulties arising from the intricate histological architecture and morphological diversity observed in oral squamous cell carcinoma (OSCC).

METHODS: We proposed a cutting-edge multi-task learning architecture (MILGDF) that combines local-global attention mechanisms with dynamic weighted fusion. This model utilizes instance-level category-specific attention to enhance feature extraction efficacy while overcoming the limitations inherent in traditional bag-level attention methods. An adaptive weighting system was incorporated to dynamically adjust the contribution of local and global features, ensuring optimal performance in diverse prediction tasks.

RESULTS: Rigorous validation on the HIDOC and TCGA-OSCC datasets revealed the exceptional predictive performance of our model. The MILGDF framework attained an AUC of 0.952 (accuracy: 0.909) on HIDOC and 0.745 (accuracy: 0.725) on TCGA-OSCC, demonstrating statistically significant superiority over existing comparative models in both staging classification and diagnostic prediction.

CONCLUSIONS: The MILGDF model is capable of effectively utilizing information from wide-field images (WSI) for the accurate diagnosis and staging of oral squamous cell carcinoma (OSCC); its performance surpasses that of existing methods, demonstrating significant potential for clinical application.

PMID:42249621 | DOI:10.1111/odi.70380

Womens Health (Lond). 2026 Jan-Dec;22:17455057261456875. doi: 10.1177/17455057261456875. Epub 2026 Jun 5.

ABSTRACT

BackgroundPrenatal stress is linked to adverse perinatal outcomes. Indigenous women in Canada face high risks for adverse maternal and perinatal health.ObjectivesThis project aimed to understand levels and sources of stress experienced by Indigenous women during pregnancy and utilization of and experiences with available support.DesignThe project employed a mixed-methods cross-sectional design.MethodsThe project was conducted in three communities in Northwest Territories, Canada with varying road and healthcare accessibility. Indigenous women who were pregnant or had given birth within three years were invited to participate in a semi-structured interviewer-administered questionnaire, which included open and close-ended questions on pregnancy history, stress levels, healthcare access, available support, and experiences during and after giving birth. Descriptive statistics, regression modelling, and deductive thematic analysis were used.ResultsOf 156 participants between the ages of 17 and 47 years (mean age: 29.7 years; SD=6.0), 93.0% had given birth in the past three years, 18.0% were pregnant, and 85.3% were multiparous. Most participants reported pregnancy as somewhat stressful (49.7%) or very stressful (27.5%). Multiparity was associated with greater odds of reporting stressful pregnancy compared to first-time pregnancies (OR = 3.31, 95% CI: 1.22-8.97, p = 0.0186). Qualitative themes included reaction to pregnancy, stress during pregnancy, community support, and professional support. Factors contributing to prenatal stress included personal responsibilities, financial insecurity, housing concerns, and family issues. Support varied, with some feeling inadequately supported.ConclusionWhile various social supports exist, some participants reported inadequate support. The findings suggest the urgent need to expand community support programs in remote areas, both in numbers and access, is crucial for addressing maternal health concerns. Including kin and community supports and supporting community-driven initiatives would be effective strategies and require future exploration as to the impacts on addressing prenatal stress in Indigenous women in remote communities.

PMID:42249615 | DOI:10.1177/17455057261456875

Clin Oral Implants Res. 2026 Jun 5. doi: 10.1111/clr.70140. Online ahead of print.

ABSTRACT

INTRODUCTION: Accurate implant placement with Computer-Assisted Implant Surgery (CAIS) is critical to ensure long-term success. Dynamic-CAIS systems enhance surgical precision through real-time feedback, though comparative data on their accuracy and efficiency remain limited. This study evaluated how different registration methods in d-CAIS systems influence implant placement accuracy and procedural time.

MATERIALS AND METHODS: In this laboratory study, three registration methods were assessed: ND group, XC group, and XM group. Five experienced operators placed 25 implants per group (75 total) in partially edentulous maxillary models. Postoperative CBCT scans were used to measure deviations at the implant entry point, apex, vertical depth, and angle. One-way ANOVA and Tukey’s HSD test were used for statistical analysis.

RESULTS: Mean 3D deviations at the implant entry point were 1.06 mm (ND), 0.71 mm (XC), and 0.90 mm (XM); at the apex 1.23 mm, 0.83 mm, and 1.07 mm, respectively. Vertical depth deviations at the apex were similar across groups: 0.61 mm (ND), 0.59 mm (XC), and 0.64 mm (XM). Angular deviation was highest in the ND group (2.96°) compared to XC (1.17°) and XM (1.02°), with a significant difference between ND and XM (p = 0.028). The average procedural time was shortest in the XM group (7.20 ± 2.48 min), though differences were not statistically significant.

CONCLUSIONS: Although registration methods minimally affect overall accuracy, system-specific factors may influence angular deviation. Future studies should prioritize clinical trials with larger sample sizes and explore the influence of operator experience and learning curves.

PMID:42249609 | DOI:10.1111/clr.70140

Int Wound J. 2026 Jun;23(6):e70969. doi: 10.1111/iwj.70969.

ABSTRACT

Diabetic foot ulceration (DFU) contributes significantly to diabetes-related morbidity and amputation. In Barbados, where amputation rates are among the highest globally, the influence of socioeconomic factors on ulceration outcomes remains underexplored. Educational attainment, a social determinant of health, may influence health behaviours, engagement with healthcare services, and ultimately clinical outcomes. This study examines whether educational attainment is associated with diabetic foot ulcer severity, as measured by the SINBAD scoring system, and six-week healing outcomes among inpatients with DFU. A prospective observational study was conducted over 6 months at Barbados’ sole public hospital. A total of 176 participants admitted with a diagnosis of DFU were recruited. Baseline demographics, comorbidities, and ulcer characteristics were collected, and SINBAD scores were determined. Random forest modelling was employed to evaluate predictors of complete healing at 6 weeks and to assess ulcer severity stratified by educational attainment. Of the cohort, 17.5% reported primary education as their highest attainment level, compared with 2.9% of the general adult population. The mean SINBAD score was 2.45 among those with primary education and 2.51 among those with secondary education (p > 0.05). No statistically significant association was found between educational attainment and healing outcomes at 6 weeks. Educational attainment in this inpatient DFU cohort was lower than that of the general Barbadian population; however, it was not significantly associated with ulcer severity or six-week healing outcomes. In a universal healthcare setting, equitable access to care may attenuate the effect of educational attainment on clinical outcomes. These null findings highlight the need for future adequately powered studies incorporating health literacy assessment and key clinical confounders. Nonetheless, the observed disparity in educational attainment among DFU inpatients suggests that foot health education initiatives should be designed to be accessible to individuals across all educational levels.

PMID:42249595 | DOI:10.1111/iwj.70969