Category: Statistics

Indian J Pathol Microbiol. 2026 Jun 2. doi: 10.4103/ijpm.ijpm_366_25. Online ahead of print.

ABSTRACT

AIMS: Despite its importance in patient care, public awareness of histopathology and the role of histopathologists remain overshadowed. This study aimed to assess Jordanians’ public awareness of histopathology and identify areas of misconception or lack of understanding.

METHODS: A cross-sectional survey was conducted among adults (>18 years) in Jordan through a web-based questionnaire. The survey evaluated participants’ knowledge and perceptions of histopathology, including the nature of histopathologists’ work, their educational requirements, and their role in patient care. Descriptive statistics, Chi-square tests, and multivariate linear regression were used to analyze the data.

RESULTS: A total of 614 participants completed the survey, of which 41% did not recognize histopathology as a medical specialty. The majority identified pathologists as medical doctors whose main job is diagnosis of diseases among living patients, while some participants have misconceptions about associating histopathologists’ work with performing autopsies or laboratory tests. Underestimation of the duration of training required to become a certified histopathologist and misconceptions regarding the diagnostic decision-making on selected sample procedures were noticed. Female gender, educational level, and medical background were associated with higher knowledge scores.

CONCLUSION: Despite acceptable general knowledge, the observed misconceptions and lack of understanding regarding histopathology among the public necessitate interdisciplinary collaboration between pathologists and other healthcare professionals to increase the public awareness.

PMID:42262808 | DOI:10.4103/ijpm.ijpm_366_25

Saudi J Kidney Dis Transpl. 2026 Jun 3. doi: 10.4103/sjkdt.sjkdt_165_26. Online ahead of print.

ABSTRACT

CONTEXT: Tunneled cuffed catheters (TCCs) are vital haemodialysis access devices in chronic kidney disease (CKD), yet prone to significant dysfunction-related morbidity.

AIMS: To identify bedside patient-related predictors of TCC dysfunction and reduced patency in adult CKD patients undergoing haemodialysis at a single Indonesian center.

SETTINGS AND DESIGN: Single-center retrospective cohort study at Rasyida Kidney Hospital, Medan, Indonesia, covering TCC insertions from 2021 to 2024.

METHODS AND MATERIAL: Primary outcomes were catheter dysfunction and patency. Variables were extracted from medical records.

STATISTICAL ANALYSIS USED: Multivariable logistic regression identified predictors of dysfunction; Cox proportional hazards regression assessed reduced patency.

RESULTS: A total of 102 TCCs in 96 adult patients were included. Mean age was 62.7 ± 14.9 years and 62.7% were female. Dysfunction occurred in 30 catheters (29.4%) over a mean dwell time of 20.1 ± 13.1 months. Independent predictors of dysfunction were femoral insertion site (aOR 3.56, 95% CI 1.08-11.7, p = 0.036) and hypertension (aOR 3.34, 95% CI 1.01-11.1, p = 0.049). Cox regression confirmed femoral site (aHR 3.10, 95% CI 1.29-7.44, p = 0.011), hypertension (aHR 4.45, 95% CI 1.40-14.15, p = 0.011), and age ≥ 60 years (aHR 3.96, 95% CI 1.48-10.64, p = 0.006) as predictors of reduced patency.

CONCLUSIONS: Femoral insertion site and hypertension were strong independent predictors of TCC dysfunction and shortened patency. Age ≥ 60 years additionally predicted reduced patency. These simple bedside factors support practical risk stratification in low-resource haemodialysis settings.

PMID:42262802 | DOI:10.4103/sjkdt.sjkdt_165_26

J Minim Access Surg. 2026 Jun 2. doi: 10.4103/jmas.jmas_498_25. Online ahead of print.

ABSTRACT

INTRODUCTION: While minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS) are applied, the relative impact of surgical approach versus procedure type on outcomes remains controversial in pulmonary hydatid cyst treatment.

PATIENTS AND METHODS: This retrospective study analysed 192 operations performed in 157 patients with pulmonary hydatid cysts between 2010 and 2023. Patients were stratified by surgical approach (VATS, video-assisted mini-thoracotomy and thoracotomy) and by procedure type (cystotomy, cystotomy + capitonnage, cystotomy + wedge and wedge). Demographic data, cyst characteristics, rupture status, concomitant hepatic hydatidosis, post-operative complications, length of stay and recurrence were evaluated. Statistical comparisons were made as appropriate.

RESULTS: The mean patient age was 38.9 ± 20.2 years; 94 were female (59.5%) and 63 were male (40.5%). Cysts treated with VATS were significantly smaller, likely reflecting selection bias towards thoracoscopic suitability, whereas larger cysts were more often managed with cystotomy + capitonnage. Surgical approach did not significantly affect post-operative complication rates or hospital stay ( P > 0.05). In contrast, procedure type strongly influenced outcomes: cystotomy was associated with prolonged air leak and longer hospitalisation, capitonnage reduced complications but slightly extended recovery, and wedge resections achieved the shortest stays with low morbidity. Overall morbidity, recurrence and hospitalisation duration were comparable between paediatric and adult groups.

CONCLUSIONS: In pulmonary hydatid cyst surgery, prognosis depends primarily on the procedure performed rather than the surgical approach. Parenchyma-preserving techniques – particularly capitonnage and appropriately selected wedge resections – reduce morbidity and accelerate recovery. Surgical planning should therefore prioritise the choice of procedure over the approach to optimise outcomes in pulmonary hydatid disease.

PMID:42262782 | DOI:10.4103/jmas.jmas_498_25

JAMA. 2025 Oct 13. doi: 10.1001/jama.2025.16876. Online ahead of print.

ABSTRACT

IMPORTANCE: Functional outcomes in patients with acute ischemic stroke due to large-vessel occlusion who undergo thrombectomy remain suboptimal, and the benefits of intra-arterial alteplase after thrombectomy remain uncertain.

OBJECTIVE: To investigate whether treatment with intra-arterial alteplase after successful endovascular reperfusion improves functional outcomes among patients with acute, anterior-circulation, large-vessel occlusion stroke.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, randomized clinical trial recruited patients with anterior-circulation, large-vessel occlusion stroke within 24 hours of symptom onset who achieved successful reperfusion (expanded Thrombolysis in Cerebral Infarction scale score of ≥2b50) after thrombectomy. Guideline-based intravenous thrombolysis was allowed. Patients were randomized between August 1, 2023, and October 16, 2024, and the trial was conducted at 28 hospitals in China. Final follow-up occurred on January 7, 2025.

INTERVENTIONS: Intra-arterial alteplase treatment (n = 164) with 0.225 mg/kg (maximum dose of 20 mg) vs standard treatment (n = 160).

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of patients with a modified Rankin Scale score of 0 or 1 at 90 days (score range, 0 [no symptoms] to 6 [death]; a score of 0 or 1 indicates an excellent outcome). The safety outcomes included symptomatic intracranial hemorrhage within 36 hours of randomization, all-cause mortality within 90 days, and any intracranial hemorrhage within 36 hours.

RESULTS: Of the 324 patients randomized (median age, 68 years [IQR, 58-75 years]; 99 were female [30.6%]), 1 patient in each group was lost to follow-up. The proportion of patients with a modified Rankin Scale score of 0 or 1 at 90 days was 44.8% (73/163) in the intra-arterial alteplase group vs 30.2% (48/159) in the standard treatment group (adjusted risk ratio [RR], 1.45 [95% CI, 1.08-1.96]; P = .01). The proportion of patients with symptomatic intracranial hemorrhage within 36 hours was 4.3% (7/164) in the intra-arterial alteplase group vs 5.0% (8/160) in the standard treatment group (adjusted RR, 0.85 [95% CI, 0.43-1.69]; P = .67). The proportion of patients with all-cause mortality within 90 days was 17.1% (28/164) in the intra-arterial alteplase group vs 11.3% (18/160) in the standard treatment group (adjusted hazard ratio, 1.60 [95% CI, 0.88-2.89]; P = .12). The proportion of patients with any intracranial hemorrhage within 36 hours was 32.9% (54/164) in the intra-arterial alteplase group vs 26.9% (43/160) in the standard treatment group (adjusted RR, 1.22 [95% CI, 0.92-1.63]; P = .17).

CONCLUSIONS AND RELEVANCE: Among patients with acute, anterior-circulation, large-vessel occlusion stroke who achieved successful endovascular reperfusion by mechanical thrombectomy, intra-arterial alteplase resulted in a higher likelihood of excellent outcomes at 90 days. The incidence of all-cause mortality and any intracranial hemorrhage was higher in patients who received intra-arterial alteplase, although these differences were not statistically significant.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05856851.

PMID:42262770 | DOI:10.1001/jama.2025.16876

JAMA Netw Open. 2026 Jun 1;9(6):e2617459. doi: 10.1001/jamanetworkopen.2026.17459.

ABSTRACT

IMPORTANCE: Endogenous venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism (PE), is considered a rare event in pediatric patients, and its health care implications are largely unstudied. However, its burden on the health care system may be disproportionately higher owing to age-specific risk factors.

OBJECTIVE: To evaluate and characterize the inpatient cohort of children and adolescents with VTE and PE.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide cohort study used data on inpatient cases of VTE in Germany (data source: Federal Bureau of Statistics DESTATIS) from 2020 to 2024. Cases younger than 20 years with VTE as the main or secondary diagnosis, as well as a subcohort with PE as the main diagnosis, were analyzed regarding risk profiles, inpatient care, and outcomes stratified by sex and age.

MAIN OUTCOMES AND MEASURES: Hospital-based incidence of VTE (VTE cases per 10 000 inpatient cases per year) and in-hospital mortality.

RESULTS: This study identified 14 108 pediatric inpatient cases of VTE (mean [SD] age, 9.0 [7.3] years; 7201 male [51.0%]), corresponding to a hospital-based incidence of 15.3 per 10 000 pediatric cases per year. A total of 3311 patients with VTE (23.5%), comprising 1361 of 6907 female patients (19.7%) and 1950 of 7201 male patients (27.1%), were infants younger than 1 year. Risk factors for VTE varied, as rates of infection, chronic organ failure, and congenital diseases decreased with increasing patient age, while cancer was most commonly diagnosed among cases aged 5 to 14 years, and thrombophilia remained a relatively constant risk factor across all age groups. PE occurred in 1564 VTE cases (11.1%); among cases whose main diagnosis was PE, 624 of 888 (70.3%) were female. The in-hospital mortality rate in the VTE cohort was 3.7% (522 of 14 108); mortality risk was significantly increased among infants aged 4 years or younger (OR, 3.52 [95% CI, 2.73-4.57]; P < .001).

CONCLUSIONS AND RELEVANCE: This cohort study found a marked inpatient health care and economic burden for VTE among children and adolescents. Mortality risk was significantly increased among infants younger than 1 year. Studies are needed to provide evidence-based support for the safety and effectiveness of medical interventions for children and adolescents with VTE.

PMID:42262755 | DOI:10.1001/jamanetworkopen.2026.17459

JAMA Netw Open. 2026 Jun 1;9(6):e2617575. doi: 10.1001/jamanetworkopen.2026.17575.

ABSTRACT

IMPORTANCE: The epidemiology of viral respiratory tract infections (RTIs) in children is constantly changing on the basis of transmission, seasonality, immunity, and disruptive events, such as pandemics.

OBJECTIVE: To describe the clinical characteristics and outcomes of children hospitalized with acute RTIs and to examine factors associated with risk of severe disease.

DESIGN, SETTING, AND PARTICIPANTS: This multisite, retrospective cohort study was conducted at 2 Canadian children’s hospitals. Participants included children aged 0 to 18 years who were hospitalized with acute RTIs from July 1, 2022, to June 30, 2023. Follow-up for readmission was performed at 30 days after discharge. Analysis was conducted in June to November 2025.

EXPOSURE: Clinical and demographic factors, signs and symptoms, diagnostic testing, viral testing, management, and interventions.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of patients who developed severe disease, defined as the need for noninvasive or invasive mechanical ventilation, extracorporeal membrane oxygenation therapy, or kidney replacement therapy; cardiac arrest; or death. Demographics and clinical characteristics were also described. Multivariable robust Poisson regression was used to evaluate factors associated with risk of severe outcomes and was reported as adjusted risk ratios (aRRs) with 95% CIs.

RESULTS: There were 2585 children hospitalized with acute RTIs, with a median (IQR) age of 2.5 (0.9-5.0) years. There were 1542 male children (59.7%), and 1307 patients (50.6%) had at least 1 chronic condition, with neurologic, developmental, or genetic conditions being the most common. More than one-third (879 children [34.0%]) were transferred from a referring institution. Viral testing was performed for 2332 patients (90.2%), with a viral pathogen identified in 1828 (70.7%) of those tested. Viral coinfections were detected in 338 children. The most common viruses were respiratory syncytial virus (709 children) and enterovirus-rhinovirus (598 children). The median (IQR) length of hospital stay was 3 (2-6) days. Nearly one-quarter of children (551 children [21.3%]) developed severe disease. Those with 2 or more comorbidities (aRR, 1.62; 95% CI, 1.36-1.93) or who were transferred from a referring hospital (aRR, 4.73; 95% CI, 4.01-5.59) were at increased risk of severe disease.

CONCLUSIONS AND RELEVANCE: This cohort study found that hospitalized children with acute RTIs frequently have underlying chronic conditions and often require intensive intervention. Understanding the epidemiologic profile and factors associated with risk of severe disease in this population can inform resource allocation to optimize outcomes for pediatric patients.

PMID:42262751 | DOI:10.1001/jamanetworkopen.2026.17575

Womens Health (Lond). 2026 Jan-Dec;22:17455057261455275. doi: 10.1177/17455057261455275. Epub 2026 Jun 9.

ABSTRACT

BackgroundWomen’s futsal has experienced significant growth, highlighting the importance of understanding psychological need satisfaction and burnout as key determinants of athlete well-being. Basic psychological needs satisfaction, according to Self-Determination Theory, and athlete burnout are key constructs in promoting healthy and sustainable sports environments. Foot injuries are also prevalent in high-intensity sports such as Futsal and may be related to psychological outcomes in athletes.ObjectivesThis study aimed to examine the relationship between psychological need satisfaction and burnout in female futsal players, and to explore associations between foot and ankle injuries (podiatric pathology), age, and sport experience with these psychological variables.DesignObservational, cross-sectional, descriptive study.MethodsNinety-four adult female futsal players from first and second national divisions participated. Participants completed a sociodemographic and injury questionnaire, the Athlete Burnout Questionnaire (ABQ), and the Psychological Needs in Sport Questionnaire (PNSQ-15). Injury history included ankle sprains, plantar fasciitis, Achilles tendinopathy, fifth metatarsal fractures, and anterior cruciate ligament ruptures. Data were analyzed using descriptive and correlational statistics.ResultsThe majority of players (85%) reported previous injuries, with ankle sprains (73.4%) and plantar fasciitis (35.1%) being most common. PNSQ-15 scores indicated high activation and concentration, with moderate confidence and motivation. Greater age and sport experience were associated with higher concentration and motivation. ABQ scores were moderate overall; more weekly training hours were associated with lower burnout in the dimensions of reduced sense of accomplishment and sport devaluation. Players with plantar fasciitis showed higher burnout scores, particularly in reduced sense of accomplishment (p=0.036).ConclusionFemale futsal players showed favorable psychological skills and moderate levels of burnout. Age, sport experience, and training load were associated with some psychological dimensions, while the presence of certain foot injuries was related to higher burnout scores. These findings suggest that psychological need satisfaction, training load, and injury history are interrelated factors influencing burnout and psychological well-being in female futsal players.

PMID:42262746 | DOI:10.1177/17455057261455275

Eur J Phys Rehabil Med. 2026 Jun 9. doi: 10.23736/S1973-9087.26.09631-0. Online ahead of print.

ABSTRACT

Chronic primary pain is a leading cause of disability worldwide and requires a multimodal management approach. Instrumental physical therapies are widely used in rehabilitation, although their effectiveness remains heterogeneous across conditions and modalities. The objective of this paper is to synthesize the evidence and recommendations from the 2026 Clinical Practice Guideline developed by the Italian Society of Physical and Rehabilitation Medicine (SIMFER) on the use of instrumental physical therapies in chronic primary pain (i.e., complex regional pain syndrome, fibromyalgia, and primary bone marrow edema syndromes). The guideline was developed following the GRADE methodology. Systematic searches of Medline, Embase, and Cochrane Library were performed to identify systematic reviews and randomized controlled trials. Evidence was appraised in terms of risk of bias, inconsistency, indirectness, imprecision, and publication bias. Recommendations were formulated using the Evidence-to-Decision framework. The panel issued a conditional recommendation in favor of adding instrumental physical therapies to conventional treatment in patients with fibromyalgia, complex regional pain syndrome, and primary bone marrow edema syndromes. Evidence suggests modest to large improvements in pain and disability for specific modalities such as TENS, low-level laser therapy, and electromagnetic field therapy. However, overall certainty of evidence ranged from moderate to very low due to methodological limitations and heterogeneity. Adverse events were generally mild and transient, and patient acceptability was high. Instrumental physical therapies may be considered as adjunctive interventions within a multimodal rehabilitation approach for chronic primary pain. Despite encouraging findings, the low certainty of evidence highlights the need for high-quality trials with standardized protocols and long-term follow-up to strengthen future recommendations.

PMID:42262745 | DOI:10.23736/S1973-9087.26.09631-0

Echocardiography. 2026 Jun;43(6):e70529. doi: 10.1111/echo.70529.

ABSTRACT

OBJECTIVE: To evaluate the corrected index of cardio-electrophysiological balance (ICEBc) and left ventricular mechanical dispersion (LVMD), in obese individuals and to examine their associations with obesity severity and electromechanical myocardial heterogeneity.

METHODS: This prospective case-control study included obese individuals (BMI ≥30 kg/m²) and normal-weight healthy controls. All participants underwent standard 12-lead electrocardiography and transthoracic echocardiography. The ICEB and corrected ICEB (ICEBc) were calculated from ECG recordings. LVMD was assessed using two-dimensional speckle-tracking echocardiography. Comparisons between groups and correlation analyses between ICEBc, LVMD, and body mass index (BMI) were performed using appropriate statistical methods, with p < 0.05 considered statistically significant.

RESULTS: Obese individuals had higher systolic and diastolic blood pressures. LVMD was significantly higher and global longitudinal strain was significantly lower in obese participants. QTc and ICEBc were significantly higher in obesity. Among obese subgroups, LVMD and ICEBc increased with obesity severity. LVMD showed a good positive correlation with ICEBc (r = 0.675, p < 0.001). BMI correlated moderately with LVMD (r = 0.543, p < 0.001) and weakly with ICEBc (r = 0.257, p = 0.021).

CONCLUSION: Obesity was associated with higher LVMD and ICEBc values, suggesting increased electrical and mechanical myocardial heterogeneity. LVMD and ICEBc may serve as complementary, non-invasive surrogate markers of obesity-related electromechanical remodeling. Larger longitudinal studies with rhythm monitoring are required to determine whether these parameters predict clinical arrhythmic events.

PMID:42262739 | DOI:10.1111/echo.70529

Health Soc Work. 2026 Jun 9:hlag025. doi: 10.1093/hsw/hlag025. Online ahead of print.

ABSTRACT

Emergency departments are vital safety-net resources for adults seeking mental health treatment. Frequent mental health emergency department use has been associated with homelessness and alcohol use. However, little of this research has been conducted in rural settings, particularly in Northern Appalachia. Therefore, this program-level study aimed to describe the relationship between recent mental health emergency department use, homelessness, and alcohol use in intake survey data from one outpatient mental health clinic. Participants were 1,293 adults seeking treatment between June 2020 and August 2022. On average, participants reported using an emergency room for a psychiatric or emotional problem less than one time in the past 30 days. Nights spent homeless were statistically significantly positively associated with recent mental health emergency department use. Additionally, those who used alcohol daily or almost daily demonstrated a statistically significant greater frequency of mental health emergency department use compared with adults who did not use alcohol within the past 30 days. Future social work research should replicate this study with a larger, multisite, random sample of mental health treatment-seeking adults in rural Northern Appalachian settings.

PMID:42262733 | DOI:10.1093/hsw/hlag025