Category: Statistics

Am J Occup Ther. 2026 Jul 1;80(4):8004205080. doi: 10.5014/ajot.2026.051493.

ABSTRACT

IMPORTANCE: Sleep health supports child development and family well-being. Toddlers with Down syndrome experience elevated sleep difficulties, yet few studies have examined their sleep within a multidimensional framework.

OBJECTIVE: To apply the Pediatric Sleep Health framework (Peds B-SATED) to characterize multidimensional sleep health and sleep-related practices of toddlers with Down syndrome (12-36 mo).

DESIGN: Secondary analysis of cross-sectional descriptive data.

SETTING: Clinics and organizations serving families of children with Down syndrome.

PARTICIPANTS: Twenty-four mothers of children with Down syndrome were recruited.

OUTCOMES AND MEASURES: Parent-reported Brief Infant Sleep Questionnaire items mapped onto the Peds B-SATED domains (Behavior, Satisfaction, Alertness, Timing, Efficiency, Duration). Descriptive statistics summarized sleep profiles and parental practices.

RESULTS: Fifty percent of the sample demonstrated multidomain sleep difficulties; 33% had difficulties in a single domain, and 17% had none. Behavior was the most problematic domain (63%), followed by satisfaction and efficiency (29% each), timing (25%), and duration (13%). Most children had structured sleep behaviors (consistent bedtimes/routines ≥80%; falling asleep independently, 70%; limited prebedtime screen exposure, 67%) and high parental satisfaction. Most children woke up happy and took one daytime nap (>90%). Sleep timing and efficiency were characterized by early bedtimes (median lights-out 8 p.m.; median wake 7 a.m.), no night awakenings (71%), and mean sleep latency of 13.5 min. Mean 24-hr sleep duration was 12.5 hr.

CONCLUSIONS AND RELEVANCE: A multidimensional approach to characterizing sleep health reveals heterogeneous sleep profiles across domains and offers clinicians and researchers an in-depth view of intervention targets for toddlers with Down syndrome. Plain-Language Summary: This study examined the sleep health of toddlers with Down syndrome ages 12-36 months by using the Pediatric Sleep Health framework, which looks at multiple aspects of sleep, including routines, quality, timing, and duration. Parents of 24 children completed a questionnaire about their child’s sleep, and then we mapped their responses to this sleep health framework. We found that most children went to bed and woke up early, slept about 12.5 hr per day, and were described as good sleepers. However, many children had at least one area of difficulty, most often related to bedtime behaviors (63%). In general, about 17% had no sleep-related concerns, whereas the remainder experienced challenges in one or more areas. These findings show that even when overall sleep appears good, specific sleep behaviors may still benefit from attention. Using a multidimensional sleep health framework can help identify these patterns and better describe sleep health of young children with Down syndrome.

PMID:42102306 | DOI:10.5014/ajot.2026.051493

JMIR Mhealth Uhealth. 2026 May 8;14:e72242. doi: 10.2196/72242.

ABSTRACT

BACKGROUND: In the management of gestational diabetes mellitus (GDM), the usual medical treatment requires frequent visits for glucose monitoring and insulin dose adjustment, and this imposes significant physical, psychological, and economic burdens on pregnant women. As mobile health platforms become increasingly integrated into diabetes care, telemedicine may help alleviate these burdens; however, evidence evaluating its effectiveness as a replacement for routine in-person GDM care remains limited.

OBJECTIVE: This study aims to evaluate the impact of telemedicine on the quality of life and costs for patients with GDM requiring insulin therapy.

METHODS: This single-center, 2-arm, randomized, open-label, parallel-group study included patients with GDM who started insulin injection therapy. Participants were randomized to either the telemedicine or standard face-to-face care groups for 10 (SD 2) weeks. The telemedicine intervention used a smartphone-linked platform that enabled the automatic transfer of glucose data from connected glucose meters and facilitated real-time video consultations. Primary end points included costs and patient satisfaction. Costs were assessed using claims data, transportation calculations, and wage-based productivity losses, while patient satisfaction was evaluated through changes in the Problem Areas in Diabetes Survey and Diabetes Therapy-Related Quality of Life questionnaire scores. Secondary outcomes included glycemic control and perinatal outcomes.

RESULTS: In total, 38 participants were included, with 18 assigned to the telemedicine group and 20 to the standard care group. Total costs (32,712, 95% CI 15,412-50,013 vs 59,202, 95% CI 42,603-75,800 Japanese yen; $284, 95% CI 134-435 vs $515, 95% CI 370-659, purchasing power parity [PPP]-adjusted; P=.01), direct non-health care costs (922, 95% CI -240 to 2084 vs 2561, 95% CI 1447-3676 yen; $8, 95% CI -2 to 18 vs $22, 95% CI 13 to 32 PPP-adjusted; P=.02), and indirect costs (8981, 95% CI -7119 to 25,082 vs 32,832, 95% CI 17,384-48,279 yen; $78, 95% CI -62 to 218 vs $285, 95% CI 151-420 PPP-adjusted; P=.01) reduced significantly in the telemedicine group compared with the standard care group. The improvements in the Problem Areas in Diabetes Survey (-7.6, 95% CI -13.7 to -1.4; P=.02) and Diabetes Therapy-Related Quality of Life domain 1 (10.5, 95% CI 0.9-20.1; P=.03) scores from the baseline were significantly greater in the telemedicine group than that in the standard care group. Nonetheless, glycemic control and frequency of perinatal complications were comparable between the 2 groups. Consultation time was similar across groups, suggesting no added workload for clinicians.

CONCLUSIONS: In this randomized trial, mobile health-enabled telemedicine safely replaced routine in-person visits for patients with GDM requiring insulin therapy. Telemedicine significantly reduced psychological and economic burdens without compromising glycemic or perinatal outcomes, demonstrating its value as a patient-centered and cost-efficient model of care. These findings support the broader implementation of mobile-based telemedicine approaches in GDM management.

PMID:42102285 | DOI:10.2196/72242

JMIR Form Res. 2026 May 8;10:e92644. doi: 10.2196/92644.

ABSTRACT

BACKGROUND: Childhood obesity constitutes a complex medical and psychosocial challenge that requires both nutritional knowledge and sensitive, relationship-oriented doctor-patient communication. The Planetary Health Diet links individual health promotion with environmental sustainability and represents a relevant framework for contemporary medical education.

OBJECTIVE: This proof-of-concept study investigated how different information sources influence medical students’ acquisition, structuring, and application of knowledge on childhood obesity and the Planetary Health Diet within a communication-based teaching setting, including the exploratory use of artificial intelligence-based tools.

METHODS: A total of 359 second-year medical students participated in a mandatory communication seminar during the 2023-2024 academic year. Following a precourse knowledge assessment and a brief theoretical introduction, students worked on a standardized counseling scenario addressing childhood obesity. In small groups, students used only 1 assigned information source (ChatGPT, Google Search, scientific papers, or instructional videos) to prepare a counseling approach. Group outcomes were assessed using a predefined scoring system based on a sample solution, complemented by thematic content analysis.

RESULTS: All information sources enabled students to acquire relevant knowledge on childhood obesity and the Planetary Health Diet. However, groups differed with regard to the depth, differentiation, and structuring of their responses. The ChatGPT group achieved the highest conformity scores with the sample solution and provided the most additional information, followed by the Google and video groups, while the paper group achieved the lowest scores. Prior to the course, students reported limited knowledge of the Planetary Health Diet and little practical experience in counseling children with obesity and their families.

CONCLUSIONS: Communication-based teaching formats provide an effective framework for introducing medical students to complex topics such as childhood obesity and sustainability-related nutrition early in their training. Easily accessible digital tools, including artificial intelligence-based systems, may facilitate knowledge acquisition and elaboration; however, their use requires explicit didactic framing, critical source evaluation, and reflection on the complexity of chronic conditions to support responsible and realistic learning outcomes in future physicians.

PMID:42102283 | DOI:10.2196/92644

JMIR Form Res. 2026 May 8;10:e79735. doi: 10.2196/79735.

ABSTRACT

BACKGROUND: Marijuana initiation among adults aged 50 years and older has increased substantially. Although acute tetrahydrocannabinol exposure can impair psychomotor function, less is known about how real-world medical marijuana initiation relates to functional tasks such as driving in mid-to-late life.

OBJECTIVE: The objective of our study was to evaluate the feasibility of recruiting and retaining adults aged 50 years and older, who are newly registered for medical marijuana, and matched non-marijuana-using controls, into a longitudinal high-fidelity driving simulator protocol, and to explore preliminary associations between medical marijuana initiation and simulated driving performance.

METHODS: This prospective, nonrandomized feasibility cohort study enrolled adults aged 50 years and older who are newly registered in the Florida Medical Marijuana Use Registry, along with age-, race-, and sex-matched controls. Assessments occurred at baseline (T1; preinitiation) and at 1 month (T2). Primary feasibility outcomes included recruitment, retention, simulator completion and tolerance, and exposure verification. Exploratory outcomes included reaction time and divided attention (DA) performance, which are measured using an immersive, high-fidelity driving simulator.

RESULTS: Recruitment and exposure verification procedures were feasible, but simulator sickness contributed to substantial missing data. Exploratory analyses suggested group differences in select DA outcomes at T2. At T2, reaction time to DA situation 3 (DA3) was significantly shorter in the medical marijuana group (n=14, mean 2.57, SD 1.63) than in the control group (n=7, mean 5.79, SD 4.32; t19=-2.50, P=.02, g=-1.11, 95% CI -2.04 to -0.16). These findings should be interpreted cautiously, given the small sample size, missing data, and multiple comparisons.

CONCLUSIONS: A prospective protocol examining medical marijuana initiation and simulated driving among mid-to-late-life adults is feasible, but future studies should incorporate design and analytic refinements to address simulator sickness and missing data and to better characterize exposure timing and patterns.

PMID:42102282 | DOI:10.2196/79735

JMIR Cancer. 2026 May 8;12:e86412. doi: 10.2196/86412.

ABSTRACT

BACKGROUND: Wearable devices are becoming more ubiquitous and are capable of capturing health-relevant information that patients may be interested in sharing with their providers. However, limited research has been conducted on oncology provider perspectives on how these data could be used to inform cancer care.

OBJECTIVE: The goal of this study was to understand oncology clinicians’ preferences about which data would be most clinically valuable and in what clinical scenarios, the benefits and barriers to integrating wearable device data into cancer care, and perspectives on how wearable device data could impact decision-making using 3 clinical vignettes.

METHODS: A total of 13 oncology care clinicians completed an online questionnaire to assess the perceived value of different types of wearable device data in different clinical scenarios and participated in semistructured interviews to gather preferences around integrating these data into clinical workflows. During the interviews, providers were also presented with 3 clinical vignettes and asked for clinical recommendations both before and after seeing the patient’s wearable device data. Descriptive statistics were calculated to summarize quantitative data from questionnaires and structured interview questions, and interviews were transcribed and coded using an iterative thematic analysis approach.

RESULTS: Survey responses indicated that providers were most interested in tracking vital sign metrics, followed by data related to falls and functioning, and then by data on sleep and activity. Clinicians thought that wearable device data might be especially useful for remotely monitoring patients at high-risk moments in their care trajectory, such as after an acute hospitalization or after starting a new outpatient treatment. Four main themes were discussed by providers in the interviews: (1) corroborating reports, (2) identifying new issues, (3) coordinating care, and (4) patient-provider communication. Although there were no statistically significant differences in clinical recommendations before and after viewing wearable device data for any vignette (all P>.25), all clinicians reported that the wearable device data impacted their decision-making confidence, and most rated the wearable device data as helpful.

CONCLUSIONS: Oncology providers highlighted the potential clinical value of vital sign and physical functioning data from wearable devices, particularly when outpatients might be at risk for readmissions or other acute deteriorations between clinic visits. Providers noted that the objective data captured by consumer wearable devices can be helpful complements to patient and caregiver subjective reports and that this information could improve patient-provider communication and care coordination. During the interviews, most providers found wearable device data to be helpful when making decisions. While there are challenges to address on how to integrate this information into the clinical workflow and communicate alerts with patients, there is cautious enthusiasm among clinicians about how these data could inform and improve cancer care.

PMID:42102279 | DOI:10.2196/86412

Lett Appl Microbiol. 2026 May 8:ovag046. doi: 10.1093/lambio/ovag046. Online ahead of print.

ABSTRACT

Lyme disease remains the most reported vector-borne disease in the United States, yet traditional surveillance methods rely heavily on clinical diagnosis and laboratory confirmation, both of which are subject to underreporting and diagnostic limitations. This study evaluated the feasibility of wastewater-based epidemiology (WBE) as a complementary surveillance tool for monitoring the lyme disease causing agent, Borrelia burgdorferi in a small urban community. It was conducted between 2023-2025 with 92 influent wastewater samples collected from two municipal treatment facilities in Bloomington, Indiana. Samples were concentrated using 0.45 µm pore size electronegative membrane filtration and analyzed via digital PCR for B. burgdorferi, with crAssphage quantified as a fecal normalization marker. B. burgdorferi was detected intermittently at low concentrations, with peak values reaching 3,649 gene copies/L. Detection exhibited pronounced seasonal variability, with the highest positivity occurring in fall (62.5%) and no detections observed in spring. No statistically significant differences were observed between treatment plants. Our findings indicate that B. burgdorferi can be detected in municipal wastewater and that detection patterns align with known seasonal trends in Lyme disease transmission. Despite low and intermittent detections, WBE may serve as a useful complementary population- level surveillance tool for B. burgdorferi in small urban systems.

PMID:42101881 | DOI:10.1093/lambio/ovag046

Oncologist. 2026 May 8;31(6):oyag127. doi: 10.1093/oncolo/oyag127.

ABSTRACT

BACKGROUND: Biologically based complementary and alternative medicine (BBCAM) includes special diets, dietary supplement and herbal remedies, not prescribed by a doctor or dietitian. The use of BBCAM is common among cancer survivors. BBCAM can interact with conventional treatments and unregulated products may cause harm. This study aimed to determine the prevalence, types, and motivations for BBCAM use among cancer survivors.

METHODS: A survey assessed clinical characteristics and BBCAM use in participants >18 yrs who had received cancer treatment in Ireland from 2018 to 2022.

RESULTS: Amongst 295 respondents (77% female, mean age 53 yrs), BBCAM use increased from 28% pre-diagnosis to 34% post-diagnosis (p < 0.001). For BBCAM users (n = 97, 33%), “daily-use” increased from 38% to 72% (p < 0.001) post-diagnosis. Common types included: mineral/vitamin supplements (84%), dietary supplements (e.g. turmeric, coenzyme-Q10) (78%), herbal remedies/botanicals (e.g. mistletoe, St. John’s Wort, echinacea, ginseng) (50%), cannabis (21%), and other natural products (laetrile, shark cartilage, apricot kernels) (19%). Biological medicines (GcMAF, immuno-augmentative therapy) were used by 12% of BBCAM users. Special diets including dairy free (32%), gluten-free (19%), intermittent fasting (17%), ketogenic diet (15%), juicing/detox (10%) were also common. Perceived benefits included: improved well-being (63%) and reduced psychological stress (59%).

CONCLUSION: BBCAM use increases after a cancer diagnosis. Patient perceived benefits highlight potential gaps in the current healthcare model, indicating a need for greater emphasis on safe survivorship care.

PMID:42101869 | DOI:10.1093/oncolo/oyag127

Am J Manag Care. 2026 May;32(6 Suppl):S95-S111. doi: 10.37765/ajmc.2026.89949.

ABSTRACT

BACKGROUND: Heart failure (HF) with mildly reduced ejection fraction (HFmrEF) or preserved EF (HFpEF) constitutes 74% of all HF cases in the US and is associated with significant clinical and economic burdens. Hospitalizations for HFmrEF/HFpEF are a leading contributor to the rising economic burden of HF. This literature review aims to identify key drivers of hospitalization costs for patients with HFmrEF/HFpEF in the US and to inform targeted interventions to reduce health care expenditures.

METHODS: A comprehensive search of MEDLINE and Embase was conducted to identify observational studies published between January 2022 and May 2025 that reported on hospitalization-related costs for US adults with HFmrEF/HFpEF (defined as left ventricular ejection fraction ≥ 40%). Eligible studies were those reporting direct costs of hospitalization, readmission rates, time to readmission, length of stay, and number of hospitalizations per person. Data were synthesized narratively, and costs were adjusted to 2025 US$.

RESULTS: Of 2624 records identified by the literature searches, 37 studies met inclusion criteria. Total annual costs for HFmrEF/HFpEF were $36,921 to $49,081 per person per year (PPPY), with inpatient hospitalizations accounting for nearly half ($18,844-$20,095 PPPY). Readmissions were a major cost driver, with median all-cause readmission costs ($21,371-$28,615) consistently higher than index admission costs ($13,763-$14,944). Approximately 20% of patients were readmitted within 30 days, with HF-specific readmissions accounting for one-third of 30-day readmissions. Comorbidities such as type 2 diabetes (T2D) and chronic kidney disease (CKD) significantly increased costs, with patients having multiple morbidities incurring nearly double the costs of individuals without comorbidities. Prolonged hospital stay was also linked to higher costs.

CONCLUSIONS: HFmrEF/HFpEF hospitalizations represent a significant economic burden that is driven by high inpatient costs, frequent readmissions, and coexisting conditions (eg, T2D, CKD). These findings highlight the need for improved adherence to guideline-directed medical therapy and better management of comorbidities. Policymakers and health care providers should prioritize strategies to reduce HF-related hospitalizations and readmissions to mitigate the growing economic impact of HF.

PMID:42101866 | DOI:10.37765/ajmc.2026.89949

JAMA Health Forum. 2026 May 1;7(5):e261045. doi: 10.1001/jamahealthforum.2026.1045.

ABSTRACT

IMPORTANCE: Private equity (PE) is one form of corporate investment that has rapidly expanded into primary care, with more than 2400 primary care physicians becoming PE-affiliated since 2019. There are concerns that profit incentives associated with PE investment might be detrimental to care quality and patient outcomes.

OBJECTIVE: To examine changes in patient outcomes for the traditional Medicare (TM) population after primary care practices are acquired by PE firms and to identify any changes in patient composition.

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation used a stacked difference-in-differences analysis with a 20% Medicare Part B sample from 2016 to 2022. Medicare beneficiaries with PE-acquired primary care physicians were matched to control patients based on age, risk score, sex, race and ethnicity, state of residence, and dual-eligibility status. Statistical analysis was performed from November 2024 to February 2026.

EXPOSURE: Primary care practice acquisition by a PE firm, identified using PitchBook data.

MAIN OUTCOMES AND MEASURES: Primary outcomes at the patient-quarter level include number of all-cause hospitalizations, number of potentially avoidable hospitalizations for ambulatory-sensitive conditions, and number of emergency department (ED) visits. Secondary outcomes include measures of patient composition, including patient age, sex, race and ethnicity, and hierarchical condition category score.

RESULTS: The analysis included 24 397 beneficiaries with PE-acquired primary care physicians, matched to 121 939 control patients. The mean (SD) age was 74 (10) years, and 56% of patients were female. After PE acquisition, the number of all-cause ED visits decreased by 1.36% (95% CI, -2.72% to -0.14%) per patient-quarter relative to baseline. Considering various sensitivity tests, there were no significant changes to the probability of or number of potentially preventable hospitalizations or all-cause hospitalizations. Patient composition remained unchanged.

CONCLUSIONS AND RELEVANCE: In this national study of traditional Medicare beneficiaries, PE acquisitions of primary care practices were not associated with meaningful short-term changes in acute care outcomes. Overall, findings contribute to policy discourse on understanding the role of PE investments in shaping care quality, suggesting heterogeneity in outcomes across health care settings.

PMID:42101854 | DOI:10.1001/jamahealthforum.2026.1045

JAMA Netw Open. 2026 May 1;9(5):e2616556. doi: 10.1001/jamanetworkopen.2026.16556.

ABSTRACT

IMPORTANCE: High-quality discharge summaries are essential for safe care transitions but contribute substantially to clinician documentation burden and burnout. While retrospective studies suggest that large language models (LLMs) can generate clinical summaries of comparable quality to those by physicians, prospective data on their safety, utility, and association with clinician well-being in clinical environments are lacking.

OBJECTIVE: To evaluate the safety, use, and association with clinician burden of MedAgentBrief, an LLM-based agentic workflow for generating hospital course summaries, during prospective clinical deployment.

DESIGN, SETTING, AND PARTICIPANTS: This single-arm prospective pilot quality improvement study encompassed hospital discharges at 1 academic inpatient medicine unit from August 1 to October 11, 2025, with baseline comparisons drawn from April 9 to July 31, 2025.

INTERVENTION: A custom agentic LLM workflow using Gemini 2.5 Pro generated draft hospital course summaries nightly using patient history and physical and daily progress notes. Drafts were securely emailed to physicians daily for review and optional use.

MAIN OUTCOMES AND MEASURES: The primary outcome was physician-reported potential for and severity of harm from unedited summaries (Agency for Healthcare Research and Quality Common Format Harm Scale). Secondary outcomes included use rate, error types (omissions, inaccuracies, and hallucinations), time spent in discharge summaries (electronic health record logs), and changes in cognitive burden (NASA Task Load Index; score range, 0-100, with higher scores indicating greater cognitive burden) and burnout (Stanford Professional Fulfillment Index Work Exhaustion Scale; score range, 0-4, with higher scores indicating greater burnout).

RESULTS: Among 384 hospital discharges, the system generated 1274 summaries. Physicians used artificial intelligence (AI) content in 219 cases (57.0%). Feedback on 100 summaries (88 of 219 used summaries [40.2%] and 12 of 165 unused summaries [7.3%]) noted omissions (25 summaries [25.0%]) and inaccuracies (20 summaries [20.0%]) but rare hallucinations (2 summaries [2.0%]). Physicians rated 88 unedited summaries (88.0%) as having no harm potential and 1 (1.0%) as likely to cause moderate harm; no severe harm was reported. Mean physician burnout scores decreased significantly from before to after the intervention (1.75; 95% CI, 1.16-2.34 vs 1.20; 95% CI, 0.71-1.69; P = .03). Time savings were heterogeneous, with 5 of 7 physicians with matched baseline data (71.4%) seeing reductions in median documentation time; changes from baseline to pilot were up to 2.9 minutes, which was a nonsignificant difference (10.7 minutes; 95% CI, 7.4-13.3 minutes vs 7.8 minutes; 95% CI, 5.1-11.7 minutes; P = .13).

CONCLUSIONS AND RELEVANCE: In this study, an LLM-based agentic workflow produced hospital course summaries that were frequently used with minimal risk of harm identified. The intervention was associated with a reduction in physician burnout, supporting the viability of AI summarization to mitigate documentation burden.

PMID:42101844 | DOI:10.1001/jamanetworkopen.2026.16556