Tag: statistics

Emotion. 2026 Jun 8. doi: 10.1037/emo0001674. Online ahead of print.

ABSTRACT

Alexithymia is an important risk factor for psychopathology. However, it is not yet clear why. Here, we examine alexithymia’s relationship with both ill-being and well-being outcomes and test whether emotion regulation patterns are a key mechanism explaining these links. Based on contemporary affective science frameworks, we predicted that people high (vs. low) in alexithymia would more frequently use maladaptive emotion regulation strategies that involve disengaging from negative emotions and less frequently use adaptive strategies that involve engaging with negative emotions. We also predicted that emotion regulation strategy choice should, in turn, statistically mediate relationships between alexithymia and ill- and well-being. We conducted two cross-sectional survey studies with mediation modeling, one exploratory (N = 427) and one preregistered (N = 600). In both studies, results indicated that (a) alexithymia is associated with higher ill-being and lower well-being, (b) alexithymia is associated with greater use of maladaptive disengagement emotion regulation strategies and less use of adaptive engagement strategies, and (c) the relationships between alexithymia and ill- and well-being outcomes are statistically partially explained by this profile of emotion regulation. Conceptually, these findings are well aligned with the attention-appraisal model of alexithymia and process model of emotion regulation, empirically supporting the claim that interactions between alexithymia and emotion regulation have important implications for people’s ill-being and well-being. Clinically, these findings highlight the importance of targeting both alexithymia and emotion regulation patterns in treatment to help facilitate desirable affective outcomes. Our findings suggest that such work may help reduce ill-being and enhance well-being. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42258281 | DOI:10.1037/emo0001674

Am J Manag Care. 2026 Jun 1;32(Spec. No. 6):eSP12-eSP21. doi: 10.37765/ajmc.2026.89974.

ABSTRACT

OBJECTIVES: Guillain-Barré syndrome (GBS) is a rapidly progressive neuromuscular disorder that often requires intensive care and immunomodulatory therapy. Despite standardized treatment approaches, access to care and outcomes may be influenced by social determinants of health. We evaluated associations between socioeconomic and racial factors and inpatient interventions and outcomes in GBS in the US.

STUDY DESIGN: Retrospective cohort study.

METHODS: This retrospective cohort study used data from the National Inpatient Sample (2016-2021) to identify hospitalizations with a primary diagnosis of GBS ( International Statistical Classification of Diseases, Tenth Revision code G61.0). Multivariable logistic regression models assessed associations between demographic and socioeconomic variables and 5 prespecified outcomes: in-hospital mortality, nonroutine discharge, prolonged hospitalization, receipt of intravenous immunoglobulin (IVIG), and receipt of plasmapheresis.

RESULTS: We analyzed 45,515 GBS-related hospitalizations (patients’ mean age, 50.7 years; 46.0% female). After adjusting for covariates, higher zip code income was associated with reduced inpatient mortality (OR per quartile, 0.80; 95% CI, 0.66-0.98). Admission to private investor-owned hospitals was associated with lower IVIG or plasmapheresis use, an effect not seen when analyzing only privately insured patients. Black patients were less likely to receive plasmapheresis (OR, 0.75; 95% CI, 0.59-0.95). Black and Native American patients had higher odds of nonroutine discharge (Black: OR, 1.26; 95% CI, 1.06-1.51; Native American: OR, 2.16; 95% CI, 1.20-3.88). Medicare coverage was associated with higher odds of nonroutine discharge (OR, 1.90; 95% CI, 1.62-2.23), and Medicaid coverage was associated with prolonged hospitalization (OR, 1.73; 95% CI, 1.48-2.02). Self-pay was linked to reduced odds of nonroutine discharge but longer hospitalization (OR, 0.53; 95% CI, 0.43-0.66).

CONCLUSIONS: This study reveals socioeconomic, racial, and institutional disparities in GBS hospitalization outcomes despite standardized treatment guidelines. These findings highlight the need for equity-focused strategies to ensure timely and consistent care for patients with acute neurologic conditions.

PMID:42258266 | DOI:10.37765/ajmc.2026.89974

Psychol Aging. 2026 Jun 8. doi: 10.1037/pag0000999. Online ahead of print.

ABSTRACT

To date, few studies have explored the role of older adults’ self-perceptions of aging (SPA) in the context of volunteering and how SPA might shape or be shaped by volunteering. Using random-intercept cross-lagged panel models and data from the German Ageing Survey, this study examined the bidirectional associations between different gain- and loss-related facets of older adults’ SPA (i.e., perceptions of physical losses, social losses, and ongoing development) and their engagement in volunteering over a 9-year period. Gender differences in these associations were also examined. The study sample comprised 4,512 older adults (ages 65-93 years at baseline). At the between-person level, individuals with overall higher scores on SPA of social losses reported overall fewer hours of volunteering per week, whereas participants’ scores on the other two SPA scales were not significantly associated with volunteering at the between-person level. With regard to within-person cross-lagged associations, paths from prior volunteering to subsequent SPA were statistically nonsignificant. However, higher than one’s average SPA of physical losses was associated with less volunteering than one’s average at the subsequent measurement occasion, whereas scoring higher than one’s average SPA of ongoing development showed the opposite association with volunteering at subsequent occasions. Findings also revealed gender differences in the associations between SPA of social losses and volunteering. In summary, the findings of this study showed that different dimensions of older adults’ SPA are differentially associated with their volunteering over time and that it may be important to take a gender-specific perspective on volunteering. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42258264 | DOI:10.1037/pag0000999

Rehabil Psychol. 2026 Jun 8. doi: 10.1037/rep0000678. Online ahead of print.

ABSTRACT

PURPOSE/OBJECTIVE: Brain injuries often have lifelong consequences that include long-term impairments and disability. Policy-, community-, and society-level interventions are a critical path to survivor impact. A recent qualitative study highlighted the potential of a new tool, Brain Injury Identification Cards, for enhancing survivor safety, self-advocacy, and well-being. The primary purpose of our study was to conduct a quantitative assessment of perceived benefits and self-reported credibility, expectancy, and acceptability to inform future trials.

RESEARCH METHOD/DESIGN: In this cross-sectional study, we assessed the impressions of current owners (N = 99) of Brain Injury Identification Cards. We administered online self-report questionnaires and characterized perceived experiences, acceptability, and utility using descriptive statistics.

RESULTS: Most (>67%) had favorable impressions about their own use of the Brain Injury Identification Cards, although approximately 19% perceived the cards as stigmatizing or embarrassing, and 22% said the cards were not helpful for their stress and anxiety surrounding traumatic brain injury symptoms. Overall, participants rated treatment credibility and expectancy as high, and all respondents who completed survey items (n = 96) indicated that they would recommend cards to others with traumatic brain injury and other medical conditions.

CONCLUSIONS/IMPLICATIONS: Our findings highlight the perceived benefits of using a Brain Injury Identification Card among established Card owners. Future studies in representative samples of survivors assessing user experiences before and after the receipt of Brain Injury Identification Cards are needed to assess potential intervention effects. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42258251 | DOI:10.1037/rep0000678

J Exp Psychol Gen. 2026 Jun 8. doi: 10.1037/xge0001948. Online ahead of print.

ABSTRACT

Previous research provides abundant evidence that variability plays a key role in the process by which a newly encountered face becomes familiar. Theoretical models propose that exposure to variable images improves recognition because such variability is diagnostic (i.e., predicts idiosyncratic within-person variability in appearance). We sought disconfirmatory evidence for such models by examining whether noisy variability also benefits learning. The present study provides compelling evidence that two sources of noisy variability-contextual variability and augmentation (visual noise)-do not improve generalization of learning. Across five preregistered experiments and a total sample of over 1,000 participants, Bayesian statistics revealed no benefit of noisy variability, even when the study phase required active retrieval and even among child participants (i.e., participants with less expertise). These findings support current models of face learning and pave a path toward a deeper understanding of how variability operates. These findings also contribute to recent calls to identify core principles of variability across domains. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42258241 | DOI:10.1037/xge0001948

JAMA Netw Open. 2026 Jun 1;9(6):e2617213. doi: 10.1001/jamanetworkopen.2026.17213.

ABSTRACT

IMPORTANCE: Anticoagulation for stroke prevention in subclinical, device-detected atrial fibrillation (AF) remains an area of clinical equipoise, and its cost-effectiveness is unknown.

OBJECTIVE: To evaluate the cost-effectiveness of direct oral anticoagulant (DOAC) therapy in patients with device-detected AF.

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation was a cost-effectiveness analysis using a Markov model comparing initiation of DOAC therapy vs no anticoagulation over a 10-year time horizon. Base-case analyses modeled 10 000 patients per strategy with device-detected subclinical AF, with baseline characteristics and risks of stroke, bleeding, and mortality reflecting those observed in randomized clinical trials. The evaluation was conducted from the health system perspective, with treatment and event costs derived from Nordic health care data. The modeling was conducted on March 10, 2026.

EXPOSURE: The associations of DOAC therapy with the risk and severity of clinical events were incorporated into the analysis, based on a meta-analysis of trials evaluating DOAC therapy in subclinical AF. Probabilistic sensitivity analysis also considered the 95% CIs in the reported treatment effect sizes.

MAIN OUTCOMES AND MEASURES: Incremental quality-adjusted life-years (QALYs), costs, and the incremental cost-effectiveness ratio (ICER; cost difference per QALY gained) from a health system perspective, with 3% annual discounting of both costs and QALYs. Cost-effectiveness was assessed using a €50 000 per QALY willingness-to-pay threshold.

RESULTS: The mean age of the 20 000-person simulated cohort was 77 years. In the base case analysis, DOAC therapy was associated with an additional 0.016 QALYs and an incremental cost of €1676 per patient, resulting in an ICER of €105 293 per QALY. In probabilistic sensitivity analysis, DOAC therapy was cost-effective in 35% of simulations and dominated in 38%, with a mean QALY gain of 0.016 per patient, a mean incremental cost of €2883 per patient, and a mean ICER of €176 772. Probabilistic sensitivity analyses by CHA2DS2-VASc (congestive heart failure; hypertension; age ≥75 years; diabetes; prior stroke, transient ischemic attack, or thromboembolism; vascular disease; age 65-74 years; and sex category) score showed probabilities of cost-effectiveness of 31%, 41%, and 52% for patients with scores less than 4, of 4, and greater than 4, respectively.

CONCLUSIONS AND RELEVANCE: This economic evaluation found that routinely initiating DOAC therapy in all patients with device-detected subclinical AF is unlikely to be cost-effective. Whether treatment is cost-effective in patients with very high CHA2DS2-VASc scores is uncertain.

PMID:42258212 | DOI:10.1001/jamanetworkopen.2026.17213

JAMA Intern Med. 2026 Jun 8. doi: 10.1001/jamainternmed.2026.1910. Online ahead of print.

ABSTRACT

IMPORTANCE: Postoperative delirium is associated with long-term cognitive decline in older adults. This might be caused by the delirium itself or because delirium is more common in persons who are ill and frail, and these conditions are also associated with cognitive decline.

OBJECTIVE: To determine whether cognitive decline associated with postoperative delirium is mediated by illness and frailty, as measured by recurrent hospitalizations.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included community-dwelling older adults (age ≥70 years), enrolled from June 2010 to August 2013 with 5 years of follow-up data in the ongoing Successful Aging after Elective Surgery longitudinal study. Data were analyzed from November 2022 to May 2026.

EXPOSURES: Incident delirium following major elective surgery, with and without rehospitalizations, combined and by type (rehospitalization alone, rehospitalization with intensive care unit stay, rehospitalization with postacute care stay).

MAIN OUTCOMES AND MEASURES: The main outcome was long-term cognitive decline, measured as change in General Cognitive Performance (GCP) score, a composite measure of 11 neuropsychological tests, between preoperative baseline and 10 repeated assessments over 5 years.

RESULTS: In the cohort of 560 older adults (mean [SD] age, 76.7 [5.2] years; 326 female [58%]), the mean (SD) GCP score at baseline was 57.6 (7.3). Each rehospitalization was associated with a decline of -0.19 (95% CI, -0.31 to -0.09) GCP units per year. Delirium was associated with more marked cognitive decline of -0.33 (95% CI, -0.67 to -0.06) GCP units per year. Rehospitalizations were more common among patients who developed delirium (adjusted incidence rate ratio, 1.42 [95% CI, 1.17 to 1.72]). However, adjustment for combined rehospitalizations and for each type of rehospitalization resulted in only a minimal percentage change that was not statistically significant (-6% to -9%) in the association of delirium with cognitive decline.

CONCLUSIONS AND RELEVANCE: In this cohort study, contrary to expectations, rehospitalization did not mediate the association between delirium and long-term cognitive decline. Future work will be needed to elucidate the pathways by which delirium is associated with long-term cognitive decline.

PMID:42258189 | DOI:10.1001/jamainternmed.2026.1910

JAMA Pediatr. 2026 Jun 8. doi: 10.1001/jamapediatrics.2026.2118. Online ahead of print.

ABSTRACT

IMPORTANCE: Smartphone acquisition and use under age 13 years is common and has been linked to adverse health implications. Although delaying acquisition until after age 13 years is often recommended, evidence supporting this guideline remains limited.

OBJECTIVE: To quantify the associations of smartphone acquisition around age 13 years and smartphone use with depression, obesity, and insufficient sleep at age 14 years.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study of youth from the Adolescent Brain Cognitive Development Study, eligible participants were study participants who did not have a smartphone by the 13-year-old assessment. Mixed-effects regression models were applied to quantify associations of past-year smartphone acquisition and use with health outcomes adjusting for pre-exposure depression, obesity and sleep, multiple socioeconomic and parental confounders, and use of other devices. Analyses were conducted between November 2025 and April 2026.

EXPOSURES: Smartphone acquisition and self-reported smartphone use duration (smartphone time).

MAIN OUTCOMES: Odds ratios (ORs) for associations with depression diagnosis (based on a validated computerized diagnostic assessment), obesity (body mass index above 95th percentile), and insufficient sleep (less than 8 hours/night).

RESULTS: Participants included 1959 youth (803 girls [41.0%]; 292 Black [14.9%], 314 Hispanic [16.0%], 1661 White [84.8%]) followed up from the 3-year (mean [SD] age, 12.7 [0.6] years) to the 4-year (mean [SD] age, 14.0 [0.7] years) assessment. Between the 3- and 4-year assessments, 1230 participants acquired a smartphone and 729 did not. Smartphone acquisition was not significantly associated with depression (OR, 1.45; 95% CI, 0.98-2.14) or obesity (OR, 1.02; 95% CI, 0.71-1.46), but was associated with insufficient sleep (OR, 1.29; 95% CI, 1.03-1.62) at follow-up. Among those who had acquired a smartphone, total smartphone time (standardized z score) was associated with depression (OR, 1.22; 95% CI, 1.01-1.80), obesity (OR, 1.34; 95% CI, 1.09-1.65), and insufficient sleep (OR, 1.28; 95% CI, 1.12-1.47). Placing smartphones outside the bedroom at bedtime was associated with lower odds of insufficient sleep (OR, 0.64; 95% CI, 0.47-0.87).

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that simply smartphone acquisition at age 13 years was not associated with depression or with obesity, but was associated with insufficient sleep at age 14 years; however, the amount of smartphone use was associated with higher odds of all 3 outcomes. Behavioral interventions like limiting smartphone time and keeping smartphones out of bedrooms at night may protect adolescents from potential adverse health outcomes. Findings offer insights to guide caregivers on adolescent smartphone use and inform policies aimed at protecting youth, such as delaying smartphone acquisition until age 13 years.

PMID:42258187 | DOI:10.1001/jamapediatrics.2026.2118

Integr Comp Biol. 2026 Jun 8:icag063. doi: 10.1093/icb/icag063. Online ahead of print.

ABSTRACT

Since the first publication in 2014 reporting that progesterone is detectable in whale baleen, numerous studies have confirmed that patterns of hormones in baleen can provide a multi-year time series of continuous endocrine information from individual whales. The field is poised to expand substantially in the near future, and thus it is an opportune time to review findings and identify current knowledge gaps and pathways for future research. A search of baleen-hormone literature reveals 30 publications that, in total, investigate eight steroid hormones and two thyroid hormones in baleen of ten species of mysticete whale, with the pygmy right whale representing the only mysticete family not yet studied. An early phase of methodological validations optimized the technique, including reduction of sample mass requirement and improvements in hormone yield. Steroid hormones have consistently passed technical and physiological validations; thyroid hormones, however, are still in need of physiological validations. Later literature has entailed a series of descriptive studies, which typically combine endocrine and isotope analyses to elucidate typical hormone ranges and patterns across years in relation to species, sex, age class, and reproductive state. Most descriptive studies have been limited to a small n of individuals (a consequence of the high n of subsamples per whale), yet have been highly informative nonetheless, revealing many unexpected findings (e.g., evidence suggestive of extended gestation, timing and location of breeding, reproductive senescence, early sexual maturity, pregnancy loss, and effects of stressors). Such case-study reports remain of considerable value, but the field is increasingly expanding to include hypothesis-driven research on ecological questions of broad significance, such as influences of oceanographic factors and anthropogenic stressors, and the physiological and behavioral plasticity of individual responses to such environmental drivers. Addressing such questions will require robust statistical frameworks and larger sample sizes of individual whales, a daunting task given that a single baleen specimen can generate > 150 samples requiring months of labor and associated costs. Thus, increased collaborations could be both fruitful and necessary (e.g., a baleen-hormone research consortium wherein datasets can be pooled across research teams). In sum, baleen hormone research has provided unique and invaluable insights into patterns of physiology across time in the great whales and has great promise to continue advancing understanding of the biology of these vulnerable, long-lived, enigmatic species.

PMID:42258149 | DOI:10.1093/icb/icag063

J Clin Monit Comput. 2026 Jun 8. doi: 10.1007/s10877-026-01452-w. Online ahead of print.

ABSTRACT

This study aimed to achieve two primary objectives: (1) to evaluate the opioid-sparing effect of Surgical Pleth Index (SPI)-directed analgesia during surgery via a randomized controlled trial (RCT), and (2) to propose and preliminarily assess a novel dynamic metric, Threshold-based Time-Weighted SPI (Tb-TW-SPI), which integrates stimulus intensity and duration, for its predictive efficacy regarding postoperative moderate-to-severe pain. Employing an RCT combined with exploratory analysis, 61 patients undergoing elective laparoscopic gynecologic surgery were randomized into an SPI-directed analgesia group or a conventional analgesia group. The primary outcome was total intraoperative remifentanil consumption. Postoperatively, an exploratory analysis of the control group data evaluated the correlation between Tb-TW-SPI and Numeric Rating Scale (NRS) pain scores in the post-anesthesia care unit (PACU), calculating its predictive value for moderate-to-severe pain (NRS ≥ 4). Results: The SPI-directed group required significantly less intraoperative remifentanil than the conventional group [median (IQR): 5.84(5.02,6.62)vs. 6.96(5.81,8.19)µg/kg/h; P = 0.016]. Postoperative pain scores did not differ significantly between groups (P > 0.05). Exploratory analysis of the conventional analgesia group revealed that Tb-TW-SPI values were significantly higher in patients with moderate-to-severe postoperative pain (NRS ≥ 4) compared to those without (P = 0.0417).The area under the ROC curve for Tb-TW-SPI predicting this pain was 0.74 (95% CI: 0.52-0.96), with 67% sensitivity and 76% specificity at an optimal cutoff of 1210. This RCT suggests that SPI-directed analgesia can safely and moderately reduce intraoperative remifentanil consumption. Furthermore, the proposed Tb-TW-SPI metric, in this exploratory analysis, suggests potential for predicting postoperative pain, though this finding requires validation in larger cohorts with higher-frequency SPI sampling, offering a new direction for SPI interpretation. Large-scale, multicenter trials are warranted to validate the predictive utility of Tb-TW-SPI. Clinical Trial Registration, China Clinical Trial Registry: ChiCTR2400088444.

PMID:42258123 | DOI:10.1007/s10877-026-01452-w