Category: Statistics

JAMA Netw Open. 2026 May 1;9(5):e2614345. doi: 10.1001/jamanetworkopen.2026.14345.

ABSTRACT

IMPORTANCE: Pandemic-related disruptions in cirrhosis care resulted in major gaps and delays in surveillance for hepatocellular carcinoma (HCC). Whether these initial declines improved and rebounded to prepandemic levels remains unclear.

OBJECTIVE: To evaluate contemporary clinical practice data on HCC surveillance utilization from before the COVID-19 pandemic to 4 years after the onset of the pandemic among safety-net populations with cirrhosis.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted at 5 safety-net health systems in the US. Adults with cirrhosis were evaluated longitudinally across 3 time periods: March 1, 2018, to February 29, 2020 (pre-COVID-19 period), March 1, 2020, to February 28, 2022 (COVID-19 era), and March 1, 2022, to February 29, 2024 (post-COVID-19 period).

MAIN OUTCOMES AND MEASURES: The primary outcome was undergoing HCC surveillance identified using Current Procedural Terminology codes for ultrasonography, computed tomography, and magnetic resonance imaging, and corresponding International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for indication. Comparisons of HCC surveillance across time periods used paired t tests, and comparisons of HCC surveillance between subgroups within the same time period used χ2 tests.

RESULTS: Among 6940 patients with cirrhosis, 4001 (57.7%) were men (median [IQR] age, 58 [52-64] years), 206 (3.0%) were Asian, 1720 (24.8%) were Hispanic, 1672 (24.1%) were non-Hispanic Black or African American, and 3081 (44.4%) were non-Hispanic White. The proportion who underwent HCC surveillance within 6 months after diagnosis was 30.8% (1940 patients) in the pre-COVID-19 era, which declined to 21.1% (1468 patients) in the COVID-19 era, and remained at 22.3% (1405 patients) in the post-COVID-19 era. Consistent trends were observed among men and women and among all age and race groups, except for Asian individuals, for whom there was an observed increase in the post-COVID-19 era. Similar trends of low HCC surveillance post-COVID-19 were observed across insurance types but was particularly concerning among uninsured or indigent care covered patients, among whom only 116 of 997 (11.9%) underwent surveillance in the most recent period.

CONCLUSIONS AND RELEVANCE: In this observational study of US safety-net populations with cirrhosis, rates of HCC surveillance following pandemic-related declines remained persistently low even up to 4 years after the onset of the COVID-19 pandemic, with fewer than 1 in 4 patients having undergone guideline-concordant HCC surveillance.

PMID:42172025 | DOI:10.1001/jamanetworkopen.2026.14345

Nutr Health. 2026 May 22:2601060261454264. doi: 10.1177/02601060261454264. Online ahead of print.

ABSTRACT

Background: Orthorexic tendencies involve rigid, rule-governed “healthy eating” and are associated with perfectionism, yet their developmental correlates are less understood. Aim: This study examined whether retrospectively reported childhood picky eating is associated with orthorexic tendencies in adulthood, whether maladaptive perfectionism dimensions mediate these associations, and whether associations vary by gender. Methods: Adults (N = 209) completed validated self-report measures of childhood picky eating, orthorexic tendencies (Eating Habits Questionnaire), and multidimensional perfectionism. Correlations, bootstrapped mediation models (2000 resamples), and gender-moderation analyses were conducted, controlling for age and gender. Results: Childhood picky eating was modestly associated with orthorexic tendencies (r = .18, p = .009). Indirect effects were statistically significant via doubts about actions (β = .06, 95% CI [.02, .10]) and parental expectations/criticism (β = .05, 95% CI [.01, .10]). The association was significant among men but not women. Conclusion: Retrospectively reported childhood picky eating may function as a developmental correlate, rather than a deterministic risk factor, for orthorexic tendencies.

PMID:42172017 | DOI:10.1177/02601060261454264

JAMA Health Forum. 2026 May 1;7(5):e261187. doi: 10.1001/jamahealthforum.2026.1187.

ABSTRACT

IMPORTANCE: State Medicaid prescription cap policies (ie, limiting the monthly number of covered prescriptions) may impede access to medications for opioid use disorder (OUD) and other chronic conditions. Yet, these policies remain understudied among those who become subject to caps at age 21 years.

OBJECTIVE: To evaluate the association of prescription cap policies with medication and acute care use among young adults with OUD.

DESIGN, SETTING, AND PARTICIPANTS: This study identified a cohort of young adults diagnosed with OUD using T-MSIS Analytic Files from January 1, 2016, to December 31, 2021. Data analysis was conducted from July 2025 to December 2025. The study compared outcomes between prescription cap and noncap states using a difference-in-differences analysis where a 2-month policy phase-in window was applied before and after age 21 years and effects estimated across the full follow-up period and the early (months 3-6), mid (months 7-9), and late (months 10-12) periods since the 21st birthday.

EXPOSURES: Becoming exposed to prescription caps at age 21 years.

MAIN OUTCOMES AND MEASURES: Monthly use (any and count) of buprenorphine, overall prescriptions, inpatient hospitalizations, and emergency department (ED) visits 12 months before vs after participant reached the age of 21.

RESULTS: This study analyzed 15 526 individuals from 26 non-prescription cap states and 1769 from 8 states with prescription cap policies. Most individuals were female (noncap states, 8156 [52.5%]; cap states, 1033 [58.4%]) and White (noncap states, 9512 [61.3%]; cap states, 705 [39.9%]). The baseline monthly prevalence for noncap and cap states was 39.3% vs 40.2% for any prescription receipt, 7.5% vs 3.1% for buprenorphine receipt, 3.2% vs 4.8% for hospitalizations, and 14.1% vs 18.7% for ED visits. After adjustment, cap policies were associated with a 4.7% (95% confidence limit [CL], -9.9% to -0.2%) lower prevalence of any prescription receipt and 12.7% (95% CL, -18.7%, -6.7%) fewer total monthly prescriptions 10 to 12 months after participants reached the age of 21. Cap states had more hospitalizations during postperiod months 10 to 12 (6.0%; 95% CL, 0.3%-10.0%) and more ED visits in postperiod months 3 to 6 (4.7%; 95% CL, 1.0%-10.0%) and months 7 to 9 (8.3%; 95% CL, 3.3%-13.3%). Buprenorphine use did not significantly change after cap implementation.

CONCLUSIONS AND RELEVANCE: In this cohort study, Medicaid prescription caps were associated with lower overall use of prescription medications and greater frequency of acute care use among young adults with OUD.

PMID:42172006 | DOI:10.1001/jamahealthforum.2026.1187

JAMA Health Forum. 2026 May 1;7(5):e261212. doi: 10.1001/jamahealthforum.2026.1212.

ABSTRACT

IMPORTANCE: Housing instability is associated with adverse mental health and increased health care use. Policies that reduce eviction risk may affect mental health-related health care utilization. Eviction moratoria enacted during the COVID-19 pandemic provide a natural experiment to examine these associations.

OBJECTIVE: To examine whether the lifting of eviction moratoria during the pandemic was associated with changes in mental health care utilization.

DESIGN, SETTING, AND PARTICIPANTS: A synthetic difference-in-differences approach was used, with state-week level, nationwide data of all-payer records of individuals with a mental health diagnosis or medication prescription in March to August 2020 and June to December 2021. The data were analyzed from November 2024 to November 2025. Two phases of eviction moratorium expirations were analyzed. Phase 1 included staggered expiration of state eviction moratoria from March to August 2020; phase 2 assessed the expiration of the federal eviction moratorium in August 2021, when some states maintained their own state-level eviction moratoria after the federal expiration.

EXPOSURES: State-level or federal-level eviction moratorium expirations.

MAIN OUTCOMES AND MEASURES: Weekly, state-level counts of unique patients who had (1) any outpatient mental health visit, (2) any psychotropic medication prescription, (3) outpatient visits associated with mood-related disorders, (4) outpatient visits associated with serious mental illness (SMI), and (5) suicide-related visits.

RESULTS: Of 8 963 310 individuals, 62% were female, and the mean (SD) age was 42.8 (21.5) years. Expiration of moratoria was associated with statistically significant increases in the weekly number of patients who were prescribed a psychotropic medication (0.57% in phase 1 and 1.17% in phase 2) and the number of patients who received outpatient care for SMI (3.42% in phase 1 and 3.13% in phase 2). By contrast, no measurable changes were observed in the overall patient count for mental health-related outpatient visits, outpatient visits associated with mood-related conditions, or suicide-related visits.

CONCLUSIONS AND RELEVANCE: The results of this differences-in-differences study suggest that the expiration of eviction moratoria was associated with increases in the mean number of patients with psychotropic medication prescriptions and outpatient visits for SMI. These findings underscore the importance of housing for psychiatric treatments and highlight the broader health care implications of housing policy decisions.

PMID:42172005 | DOI:10.1001/jamahealthforum.2026.1212

Med Educ Online. 2026 Dec 31;31(1):2675066. doi: 10.1080/10872981.2026.2675066. Epub 2026 May 22.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) is increasingly integrated into healthcare, making AI literacy an essential competency for medical students. Existing assessments are often generic, lack validation in medical education, and are not grounded in learning theory. This study developed and validated the AI Literacy Scale for Medical Students (ALSMS) within a self-determination theory (SDT) framework.

METHODS: We used a split-sample validation design (N = 518; exploratory factor analysis [EFA], n = 204; confirmatory factor analysis [CFA], n = 314). Candidate facets were derived from prior AI literacy instruments and a previously developed framework, then organized according to SDT. EFA refined the first-order structure, and CFA cross-validated the retained structure and compared prespecified first-order and SDT-aligned higher-order models.

RESULTS: EFA identified nine factors organized into the SDT domains of competence, relatedness, and autonomy. CFA supported the correlated nine-factor structure and demonstrated strong psychometric properties. Model comparisons identified two theory-consistent, well-fitting solutions: a correlated nine-factor model and an SDT-aligned second-order model with Ethics loading on Autonomy. Unidimensional and some hierarchical general-factor models showed poorer fit or identification problems, supporting the construct’s multidimensionality.

CONCLUSIONS: This study provides initial validity evidence for interpreting ALSMS scores as indicators of medical students’ AI literacy within an SDT-informed framework. The findings highlight the significance of integrating ethics into autonomy-supportive curricula and underscore the potential utility of ALSMS for curriculum design, advising, and the evaluation of AI literacy initiatives in medical education.

PMID:42171999 | DOI:10.1080/10872981.2026.2675066

Eur J Mass Spectrom (Chichester). 2026 May 22:14690667261454102. doi: 10.1177/14690667261454102. Online ahead of print.

ABSTRACT

The stability of key Orbitrap analyzer parameters-specifically, the absence of parasitic spectral signals and the maintenance of constant ultra-high vacuum (UHV) pressure-is critically dependent on the quality of its quartz insulators. However, results from testing over 500 production units in 2025 indicate that the occurrence of disqualifying anomalies (spectral spikes and UHV pressure jumps) is not merely a function of general quartz quality but is deterministically linked to specific, localized defects introduced during assembly. A clear differentiation of root causes was established: Spectral spikes showed a statistically significant correlation (p < .001) with defects (micro-cracks, chips) on the quartz insulators of the external injection (IE) and detection (DE) electrodes, as well as on the quartz spacer ring. In contrast, UHV pressure jumps were almost exclusively (97% of cases) caused by mechanical damage and contamination on the quartz insulators of the central electrode power contact (Buchse-ZE). Critical defects on the latter included contamination and scoring from the mounting bolt, indentation marks from the spring contact, and other manufacturing micro-damage. These defects act as potent local outgassing sources. The implementation of targeted 100% optical inspection of these critical zones, supported by photographic documentation, along with modified assembly procedures, led to the practical elimination of these anomalies in a subsequent validation batch of 100 units.

PMID:42171991 | DOI:10.1177/14690667261454102

Egypt Heart J. 2026 May 22;78(1):38. doi: 10.1186/s43044-026-00752-5.

ABSTRACT

INTRODUCTION: Cardiac rehabilitation is a multidisciplinary intervention designed to improve functional capacity and quality of life in patients with cardiovascular diseases. However, its impact on anthropometric and functional parameters remains an important area of study. This study evaluates the effects of a cardiac rehabilitation program on body mass index, abdominal circumference, blood pressure, heart rate, energy expenditure measured in METs, and NYHA functional classification.

METHODS: An observational pre-post study without a control group was conducted with 287 patients diagnosed with cardiovascular disease who completed a cardiac rehabilitation program. Anthropometric and functional variables were measured before and after the intervention. Statistical analysis included paired-sample t-tests and the Wilcoxon test for NYHA classification, with a significance level of p < 0.05.

RESULTS: Significant reductions were observed in BMI (pre: 27.79 ± 4.31 kg/m²; post: 27.11 ± 4.09 kg/m²; p < 0.001) and abdominal circumference (pre: 100.38 ± 11.16 cm; post: 97.33 ± 12.28 cm; p < 0.001). Systolic and diastolic blood pressure significantly decreased (p < 0.001). An increase in energy expenditure measured in METs was found (pre: 7.89 ± 2.68; post: 10.52 ± 2.63; p < 0.001), as well as in maximum heart rate. Additionally, NYHA functional classification improved (Z = -9.356, p < 0.001) with a reduction in the proportion of patients in classes III and II and an increase in class I.

CONCLUSION: The cardiac rehabilitation program resulted in significant improvements in body composition, blood pressure, functional capacity, and NYHA classification. These findings support the importance of cardiac rehabilitation as an effective strategy in managing patients with cardiovascular diseases. Further strategies should be implemented to improve adherence and assess the long-term impact of the intervention.

PMID:42171984 | DOI:10.1186/s43044-026-00752-5

Gastric Cancer. 2026 May 22. doi: 10.1007/s10120-026-01755-6. Online ahead of print.

ABSTRACT

BACKGROUND: Homologous recombination deficiency (HRD), a genomic instability phenotype resulting from impaired DNA repair, has been associated with increased tumor immunogenicity in several solid tumors. However, its clinical relevance in metastatic gastric cancer (mGC), particularly in the context of immunotherapy-containing regimens, remains unclear.

METHODS: This study included 139 GC patients with nivolumab plus chemotherapy as first line between May 2022 and May 2024 and underwent tissue-based NGS (n = 116); a smaller subset additionally underwent ctDNA-based NGS (n = 24). HRD was defined by the presence of pathogenic or likely pathogenic variants in predefined homologous recombination repair (HRR) genes. Treatment outcomes, and molecular characteristics were compared according to HRD status based on tissue- and/or circulating tumor DNA (ctDNA) NGS results.

RESULTS: Among 116 patients who underwent tissue-based NGS, HRD-positive tumors (14.7%) were significantly associated with longer progression-free survival (PFS; median 23.1 vs. 9.6 months; p = 0.032) to immune checkpoint inhibitor (ICI) plus chemotherapy and overall survival (OS; median not reached vs. 17.9 months; p = 0.027). HRD positivity remained an independent favorable prognostic factor for OS in multivariate analysis (HR: 0.247; 95% CI 0.071-0.859; p = 0.028). HRD-positive tumors showed higher frequencies of high tumor mutational burden (TMB) and microsatellite instability (MSI)-high tumors. However, exploratory analysis of ctDNA-based HRD in a small subset did not demonstrate a statistically significant association with survival outcomes.

CONCLUSION: Tissue-based HRD positivity was associated with favorable survival outcomes and may provide complementary prognostic information in mGC patients with nivolumab plus chemotherapy as first line.

PMID:42171983 | DOI:10.1007/s10120-026-01755-6

Clin Transl Oncol. 2026 May 22. doi: 10.1007/s12094-026-04376-8. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate contemporary practice patterns in prostate cancer radiotherapy (RT) in Turkiye, with a particular focus on the adoption of hypofractionated and ultrahypofractionated regimens, and to identify factors influencing fractionation preferences among radiation oncologists specialized in uro-oncology.

METHODS: A cross-sectional, web-based survey consisting of 14 items was distributed to registered members of the Turkish Society for Radiation Oncology (TROD) Uro-Oncology Working Group between September and December 2024. The questionnaire assessed physician demographics, institutional characteristics, technological infrastructure, prostate cancer patient volume, preferred RT fractionation across predefined clinical scenarios, and perceived rationales and barriers to hypofractionation. Descriptive statistics were used to summarize responses, and multivariable logistic regression analysis was performed to identify factors independently associated with hypofractionation use. Analyses were performed using SPSS version 23.0 (IBM Corp., Armonk, NY).

RESULTS: The survey achieved a response rate of 42.9% (n = 54). Most respondents had ≥ 11 years of clinical experience (96.2%), and 43.7% were employed in private institutions. Advanced RT technologies were widely available, including intensity-modulated radiotherapy (IMRT) (92.6%), volumetric modulated arc therapy (VMAT) (85.2%), stereotactic body radiotherapy (SBRT)-capable platforms (88.9%), and cone-beam computed tomography (CBCT)-based image guidance (85.2%). Hypofractionation was most frequently preferred in low- and intermediate-risk prostate cancer, whereas conventional fractionation predominated in high-risk disease, pelvic irradiation, and adjuvant or salvage settings. In palliative scenarios, hypofractionation was overwhelmingly favored. On multivariable analysis, treating more than 11 new prostate cancer patients per month was independently associated with increased use of hypofractionated RT (p = 0.04).

CONCLUSIONS: Despite high technological readiness and increasing adoption of hypofractionation among specialized uro-oncology practitioners, Turkish radiation oncologists exhibit caution in high-risk and postoperative settings. Higher clinical volume significantly drives the transition to shorter regimens, suggesting that clinical experience is a key catalyst for closing the evidence-practice gap.

PMID:42171982 | DOI:10.1007/s12094-026-04376-8

Clin Transl Oncol. 2026 May 22. doi: 10.1007/s12094-026-04306-8. Online ahead of print.

ABSTRACT

BACKGROUND: Myeloid-derived suppressor cells (MDSCs) constitute a heterogeneous population of immature bone marrow cells that have been demonstrated to exert immunosuppressive effects in various cancers. However, research on their role in breast cancer remains limited.

METHODS: We selected peripheral blood samples from 236 breast cancer patients with complete clinical and pathological data who met inclusion criteria, and from 33 healthy individuals undergoing routine health examinations, all enrolled at the Fourth Hospital of Hebei Medical University between 2021-2022. Flow cytometry was employed to detect peripheral blood MDSCs, promyelocytic bone marrow-derived suppressor cells (PMN-MDSCs), monocytic bone marrow derived inhibitory cells (M-MDSCs), and regulatory T cells (Tregs) in peripheral blood, while analyzing their association with clinical-pathological characteristics of breast cancer patients.

RESULTS: Results showed that compared with healthy individuals, breast cancer patients exhibited significantly higher levels of MDSCs and Treg cells in peripheral blood (P< 0.05). After multivariate adjustment for potential clinical confounders, these differences did not reach statistical significance (Adjusted P > 0.05). Among breast cancer patients, those with lymph node metastasis exhibited significantly higher levels of MDSCs cells compared to those without lymph node metastasis (P< 0.05). Receiver operator characteristic (ROC) curve analysis revealed that combined detection of MDSCs + Perineural invasion (PNI) demonstrated higher diagnostic value than either MDSCs alone, suggesting enhanced sensitivity for clinical management in breast cancer.

CONCLUSION: This study confirms that peripheral blood MDSCs have certain value in the identification of lymph node metastasis in early breast cancer and have the potential to serve as a predictive factor for lymph node metastasis. The predictive model constructed by integrating MDSCs levels with the key pathological feature of perineural invasion (PNI) has good predictive performance. Ultimately, the assessment of MDSC expression holds substantial promise as a reliable biomarker to guide clinical decision-making and monitor patient prognosis.

PMID:42171980 | DOI:10.1007/s12094-026-04306-8