Category: Statistics

Water Sci Technol. 2026 Jun;93(11):1550-1562. doi: 10.2166/wst.2026.279. Epub 2026 May 11.

ABSTRACT

The development of microbial communities within granular-activated carbon (GAC) transforms it into a highly effective biofilter, integrating adsorption and biodegradation processes for contaminant removal. This study evaluated the performance of an O₃-biological-activated carbon (BAC)-O₃ system for removal of inorganic contaminants and secondary effluents disinfection. The BAC column was packed with 50 cm of commercial GAC, reaching biological stability after approximately 45 days of operation. System efficiency was assessed based on the removal of sodium (Na), calcium (Ca), magnesium (Mg), chloride (Cl^–), and boron (B). A central composite design (CCD) was employed to the treatment process, generating mathematical models, statistically validated, to determine optimal treatment conditions, leading to the selection of an O₃ dosage of 4 mg L^-1 before and after the BAC stage. The system effectiveness was further tested through the removal of nine metals and microbial disinfection. Results confirmed that the O₃-BAC process efficiently removed inorganic contaminants, while the additional post-BAC ozonation step was essential for achieving effluent disinfection. The final treated effluent achieved quality standards suitable for non-potable restricted reuse, and its successful application in hydroponic lettuce cultivation demonstrates a promising avenue for sustainable water reuse in controlled agricultural environments.

PMID:42301638 | DOI:10.2166/wst.2026.279

Recenti Prog Med. 2026 Jun;117(6):288-294. doi: 10.1701/4716.47323.

ABSTRACT

BACKGROUND: In the Italian Region Friuli-Venezia Giulia, Herpes Zoster (HZ) vaccination of actively offered free of charge to the population at age 65. Vaccination uptake is below the goal of coverage ≥50% set in the national vaccination plan.

OBJECTIVE: We set up a pilot project with a small number of General Practitioners (GPs) of the Health Authority of Udine, to assess whether GPs can catch-up patients invited for vaccination the previous year but not attending the appointment.

METHODS: Twelve GPs voluntarily adhering to the project were provided from the Vaccination Center with 10 doses of vaccine each, corresponding to the immunization of 5 individuals. They contacted patients born in 1959 not adhering to the previous invitation and proposed to immunize them. We assessed whether vaccination coverages increased among patients followed by those GPs and the feasibility of contacting the patient and handling the vaccine.

RESULTS: Among participating GPs, from July to December 2025, coverage of patients in the cohort of interest increased from 42.9% to 63.4%. Although some physicians had difficulties in managing the vaccine and some reported that contacting patients is extremely time-consuming, the overall judgment of feasibility of both the contact and information of patients and of the actual vaccine administration was excellent.

CONCLUSION: This pilot project suggests that the collaboration with GPs can strongly contribute to improve HZ vaccine uptake. Since such collaboration was considered feasible, more GPs from the same Health Authority may be involved.

PMID:42301627 | DOI:10.1701/4716.47323

Recenti Prog Med. 2026 Jun;117(6):279-287. doi: 10.1701/4716.47322.

ABSTRACT

INTRODUCTION: Heart Failure (HF) represents a critical challenge for the National Health Service (SSN) in terms of mortality and costs, often fueled by fragmented management between hospital and community care. The objective of this study is to analyze the current care pathway and related direct costs (hospitalizations, medications, outpatient services) to identify inefficiencies and propose an improvement model based on Lean and Value-Based Healthcare (VBHC) methodologies.

MATERIALS AND METHODS: A retrospective analysis was conducted from January 2022 to December 2023 on a sample of 689 patients with heart failure, utilizing administrative data flows (SDO, SPA, SPF, and SIAD). Lean tools, specifically “As-Is” and “To-Be” Swim Lane maps, were applied to map processes and evaluate hospital-community integration.

RESULTS: The total costs generated by the 689 monitored patients amounted to €2,451,475.60. This is broken down as follows: €1,312,227.66 from hospital discharge records (SDO), €169,716.38 from Emergency Department (PS) services, €82,908.64 from outpatient services (SPA), €114,472.92 from pharmaceutical records (SPF), and €772,150 from home care services (SIAD). Significant critical issues emerged in the “As-Is” pathway, revealing analysis biases such as 32.5% of patients not undergoing outpatient visits and 4.7% not receiving specific medications. The “To-Be” model proposes value-centered management through the activation of the Territorial Operations Center (COT), the assignment of a lead physician (tutor), the use of telemedicine, and the integration of the Electronic Health Record (FSE) to overcome the observed biases.

CONCLUSIONS: Shifting to an integrated and digitalized model is essential to ensure continuity of care and therapeutic adherence, thereby reducing exacerbations and optimizing the use of public resources.

PMID:42301626 | DOI:10.1701/4716.47322

Expert Rev Pharmacoecon Outcomes Res. 2026 Jun 16. doi: 10.1080/14737167.2026.2691188. Online ahead of print.

ABSTRACT

BACKGROUND: Minimal important difference (MID) thresholds distinguish noticeable from meaningful health gains, yet reimbursement decisions often fund high-cost therapies with marginal benefit. Clarifying meaningful patient-reported improvement is important for interpreting evidence and allocating resources.

RESEARCH DESIGN AND METHODS: We reviewed how MID concepts are defined and used across outcomes research, clinical trials and health technology assessment (HTA), and estimated Croatia’s first EuroQol Visual Analogue Scale (EQ-VAS) MID in a representative sample (n = 401), examining whether thresholds vary by baseline health and a €100/month co-payment. Respondents stated the smallest noticeable and meaningful EQ-VAS improvement for a free intervention and the same intervention requiring a co-payment for one year. Analyses combined descriptive statistics, rank-based tests and multivariable regression.

RESULTS: Mean MID was 7.9 EQ-VAS points when treatment was free and increased to 8.7 with co-payment, with higher thresholds among those with poorer baseline health. The co-payment scenario is interpreted cautiously as reflecting a worthwhile-improvement threshold rather than a pure intrinsic MID.

CONCLUSIONS: Elicited thresholds were context-sensitive; however, the co-payment scenario captures what respondents considered worth paying for, arguing against universal MID cutoffs. In HTA, MIDs should serve as patient-centered interpretive benchmarks complementing cost-effectiveness evidence and considerations such as equity and societal preferences.

PMID:42299727 | DOI:10.1080/14737167.2026.2691188

Monaldi Arch Chest Dis. 2026 Jun 15. doi: 10.4081/monaldi.2026.3852. Online ahead of print.

ABSTRACT

Coronary artery disease (CAD) continues to be a major global health burden, and its effective management depends on optimal treatment adherence, realistic illness perception, and adequate acceptance of illness. However, evidence examining these psychosocial and behavioral factors remains limited. This study assessed treatment adherence, illness perception, and acceptance of the illness and explored their associations among CAD patients. A descriptive correlational cross-sectional study was conducted among 250 CAD patients selected through convenience sampling. Data were collected using standardized tools: the Morisky Medication Adherence Scale (MMAS-8), the Brief Illness Perception Questionnaire (IPQ-B), and the Acceptance of Illness Scale (AIS) with the relative ranges (MMAS-8: 0-8, IPQ-B: 0-80, AIS: 8-40). Descriptive statistics (mean, standard deviation, frequency, and percentage) were used to summarize the data, Pearson’s correlation was applied to examine relationships among variables, and the chi-square test was used to assess associations between outcome variables and selected sociodemographic factors. Treatment adherence was predominantly low (59%), with a mean score of 5.69±1.58. Illness perception scores indicated that most participants (82%) experienced a high perceived illness threat (mean = 54.93±8.78). Acceptance of illness was moderate in 57.6% of participants, with a mean score of 25.09±6.07. A weak but statistically significant positive correlation was observed between acceptance of illness and treatment adherence (r=0.245, p<0.001). Illness perception showed no significant relationship with other variables. Significant associations were identified between treatment adherence and socioeconomic status (χ²=19.97, p=0.003); acceptance of illness and educational status (p<0.001), physical activity (χ²=12.98, p=0.011), and past medical history (χ² =29.51, p=0.003); and illness perception with socioeconomic status (χ²=16.18, p=0.013) and area of residence (χ²=16.88, p=0.002). CAD patients showed low treatment adherence, high perceived illness threat, and moderate illness acceptance. Strengthening patient education, addressing illness perceptions, and enhancing psychological support may improve adherence and long-term disease management.

PMID:42299708 | DOI:10.4081/monaldi.2026.3852

Prim Health Care Res Dev. 2026 Jun 16;27:e64. doi: 10.1017/S1463423626101297.

ABSTRACT

AIM: To determine the frequency and nature of referrals for children with acute or chronic otorrhoea from primary care to secondary care ENT services in the UK.

BACKGROUND: Middle ear infections in children are common; if the ear drum bursts discharge leaks out (otorrhoea). This causes hearing loss during a critical developmental period. Managing these children in an appropriate time frame to prevent disease repercussions is vital. There is currently no evidence demonstrating referral patterns and management strategies across primary and secondary care services.

METHOD: Children with otorrhoea were identified amongst a cohort of 2,100 paediatric ENT (age 0-16 years) referrals from primary care at two secondary care hospital trusts in England in 2023. Chi-squared statistical analysis was performed to compare referral urgency for those with or without hearing loss.

FINDINGS: Of the paediatric ENT referrals, 228 (10.9%) had otorrhoea (mean age: 6.4 years, female: n = 110). The most frequent symptom duration at time of referral was >3-6 months (21.1%). Children with hearing loss were not referred more urgently compared to those without reported hearing loss (28.1% vs. 29.4%, p = 0.832). Antibiotic use in primary care was predominantly using oral antibiotics compared to topical antibiotics in secondary care. This study has shown that children with otorrhoea make up a significant proportion of paediatric referrals to the ENT secondary care services in the UK. Current management is heterogenous and could contribute to treatment failure. Standardized management pathways for these patients should be formulated.

PMID:42299707 | DOI:10.1017/S1463423626101297

Dermatol Reports. 2026 Jun 16. doi: 10.4081/dr.2026.10853. Online ahead of print.

ABSTRACT

This systematic review and meta-analysis aimed to comprehensively evaluate the efficacy and safety of topical sofpironium bromide in patients with primary axillary hyperhidrosis (PAH) in various published randomized controlled trials (RCTs). The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched PubMed, Scopus, Web of Science, Embase, and Medline databases through April 30, 2025, using keywords related to sofpironium and PAH. The odds ratio (OR) or mean difference (MD) was calculated using a random effects model with 95% confidence interval (CI). Three RCTs of sofpironium were included in the meta-analysis, with 1,209 patients with PAH. Sofpironium, compared to the vehicle, showed statistically significant improvement in the Hyperhidrosis Disease Severity Measure-Axillary (HDSM-Ax) score (OR=2.35, 95% CI [1.82 to 3.04]), Hyperhidrosis Disease Severity Scale (HDSS) score (OR=2.02, [1.46 to 2.79]), Dermatology Life Quality Index (DLQI) score (MD=-2.75, [-3.58 to -1.92]), and gravimetric sweat production (MD=-26.39, [-44.65 to -8.12]). The incidences of anticholinergic adverse events (AEs) and application site AEs were statistically higher in patients treated with sofpironium. Sofpironium is an effective treatment for PAH associated with significant improvements in sweat reduction and QOL for patients, although the drug also has risks of anticholinergic or application-site AEs.

PMID:42299704 | DOI:10.4081/dr.2026.10853

Prim Health Care Res Dev. 2026 Jun 16;27:e67. doi: 10.1017/S1463423626101327.

ABSTRACT

AIM: We aimed to examine advice interactions among family physicians using social network analysis (SNA) by categorizing advice interaction according to the five advice dimensions.

BACKGROUND: Inter-individual interactions for information exchange is a powerful tool for the pursuit of solutions to issues. These interactions may involve advice-seeking.

METHODS: The whole network approach was adopted and face-to-face research was conducted with 139 family physicians. Data were analysed using social network software, UCINET and visualized using the NETDRAW software. To examine the multidimensional advice networks, the frequency, density, reciprocity (dyad) measures were used. The Quadratic Assignment Procedure was used in UCINET to measure the correlations between the dimensions of advice. The Girvan-Newman algorithm was used to examine clustering in the advice network.

FINDINGS: Density values in the advice dimensions were very low. This indicates that the network was sparse, with limited interactions among family physicians in terms of giving and receiving advice. The strength of the ties in the dimensions was realized through validation, solutions, problem reformulation, meta-information, and legitimization, respectively. The results showed that the relationships between the dimensions were moderately, positively and significantly correlated. The advice network exhibited high modularity. Family physicians tended to seek advice from colleagues at the family health centers where they worked. We presented a visual representation of advice networks in primary healthcare settings. Identifying multidimensional advice networks through social network analysis can provide insight into how information is disseminated among family physicians. Our findings could contribute to decision makers in developing solution-oriented processes.

PMID:42299703 | DOI:10.1017/S1463423626101327

Geospat Health. 2026 Feb 2;21(1). doi: 10.4081/gh.2026.1451. Epub 2026 Jun 16.

ABSTRACT

This study presents the first Knowledge Attitudes, and Practices (KAP) survey on malaria in Djibouti City. It was conducted among 1,344 household heads across nine neighbourhoods in Djibouti City. Composite scores were calculated for each KAP dimension. Analysis of variance and multinomial logistic regression identified socio-demographic predictors and Local Indicators of Spatial Association (LISA) characterised the spatial clustering of the KAP scores. No significant association was found between sociodemographic or economic factors and malaria knowledge. Prevention practices varied notably across neighbourhoods, driven by place of residence, mother tongue, and education-underlining the primacy of spatial determinants. Attitudes were found to be linked to gender and income. Despite high disease awareness, 60% of respondents misidentified transmission routes, nearly two-thirds of respondents failed to adopt effective preventive behaviours, while Long-Lasting Insecticidal Net (LLIN) ownership far exceeded correct use. The gap between awareness and practice suggests that information-deficit approaches have reached their limits; future interventions should target motivational norm-based determinants of behaviour, spatially concentrated in the highest-risk neighbourhoods. Language and cultural barriers require tailored communication strategies beyond standard broadcast campaigns. Strengthened vector control and active surveillance remain essential complements to any behavioural intervention.

PMID:42299701 | DOI:10.4081/gh.2026.1451

J Adolesc. 2026 Jun 16. doi: 10.1002/jad.70206. Online ahead of print.

ABSTRACT

INTRODUCTION: The relationship between psychological distress and problematic mobile phone use (PMPU) is a significant concern for adolescent mental health. However, the longitudinal dynamics of this relationship and the specific cognitive mechanisms driving it remain insufficiently understood. This study aimed to examine the bidirectional relationship between psychological distress and PMPU, and to test the parallel mediating roles of positive and negative metacognitive beliefs.

METHODS: A two-wave longitudinal study was conducted over a 6-month interval in 2023 with 830 Chinese adolescents (48.6% boys; M_age = 15.18, SD = 1.92) in Zhejiang Province, China. Participants completed self-report measures of psychological distress, PMPU, and metacognitive beliefs. A latent cross-lagged panel model (L-CLPM) was used to test for bidirectional effects. The mediating pathways were tested using a longitudinal path model with bootstrapping.

RESULTS: The L-CLPM confirmed a significant bidirectional relationship between psychological distress and PMPU. The mediation analysis revealed that the pathway from T1 psychological distress to T2 PMPU was significantly and simultaneously mediated by both T2 positive and negative metacognitive beliefs. The direct effect was nonsignificant in the presence of the mediators, and the strengths of the two mediation pathways did not statistically differ.

CONCLUSION: Psychological distress and PMPU showed reciprocal prospective associations in adolescents. The pathway from distress to PMPU was accounted for by parallel positive and negative metacognitive beliefs, which may promote engagement and hinder disengagement. Interventions may therefore need to address both emotional distress and these metacognitive beliefs to disrupt this cycle.

PMID:42299685 | DOI:10.1002/jad.70206