Tag: statistics

J Vet Med Educ. 2026 Aug 11:e20260040. doi: 10.3138/jvme-2026-0040. Online ahead of print.

ABSTRACT

The study objective was to evaluate changes in senior veterinary students’ perceptions of companion animal primary care and career preferences following a primary care clinical rotation. A multi-institutional survey was administered to veterinary students at 10 US colleges of veterinary medicine before and after a companion animal primary care rotation between January 2024 and July 2025. Survey items were organized into six conceptually defined perception groupings. Changes in perception scores and agreement with a career goal were analyzed using linear mixed-effects models with random intercepts for student and school. Career preferences were assessed using ordinal rankings of eight career paths, and free-text responses were analyzed using structured, AI-assisted inductive thematic analysis. A total of 442 students completed the pre-rotation survey, and 83 had a paired post-rotation survey. Post-rotation, modest but statistically significant increases were observed in perceptions of clinical complexity and intellectual engagement (β = 0.13, 95% CI 0.01-0.26) and scope and holistic practice (β = 0.09, 95% CI 0.00-0.18). Agreement that companion animal primary care was a career goal also increased (β = 0.21, 95% CI 0.07-0.36). School-level clustering accounted for little variance, while student-level clustering was substantial. Companion animal practice was the only career path for which the median rank improved. Free-text responses reflected greater appreciation of the breadth, complexity, and intellectual demands of primary care following the rotation. Overall, primary care rotations were associated with small but consistent shifts toward more informed and favorable perceptions of companion animal primary care.

PMID:42579334 | DOI:10.3138/jvme-2026-0040

J Hum Nutr Diet. 2026 Aug;39(4):e70330. doi: 10.1111/jhn.70330.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the validity and reliability of the Turkish version of the Short Questionnaire for the Evaluation of Adherence to the Mediterranean Diet and Nutritional Sustainability (MedQ-Sus), which excludes alcohol consumption and simultaneously assesses adherence to the Mediterranean diet and a sustainable diet, in adults.

METHODS: The study included 138 adults, of whom 39.9% were male and 60.1% were female, with a mean age of 34.3 ± 12.7 years. The MedQ-Sus is a brief questionnaire that generates a Mediterranean Diet score and a Sustainable Diet score from the same eight food-group consumption data using different scoring criteria. Dietary intake was assessed using 3-day food records. Validity was evaluated by comparing the MedQ-Sus scores with corresponding food-group and nutrient intakes derived from the food records and by examining construct validity using a modified alternate Mediterranean Diet score (aMED) and the Planetary Health Diet Index (PHDI). Associations and agreement were assessed using Spearman correlation coefficients, Bland-Altman analysis, and intraclass correlation coefficients (ICCs) based on absolute agreement, as appropriate. Test-retest reliability was evaluated in 71 randomly selected participants 4 weeks after the initial administration.

RESULTS: Statistically significant and positive correlations were found between the consumption levels of all food groups associated with the Mediterranean Diet score components. The Sustainable Diet score showed positive correlations with all food groups except legumes and fresh fruits (p < 0.05). The strongest relationship for both the Mediterranean Diet score (r = 0.490) and the Sustainable Diet score (r = 0.488) was observed in the consumption of fish and fish products (p < 0.001). Bland-Altman analysis indicated an acceptable level of agreement between the MedQ-Sus scores and the corresponding estimates derived from the food records. As adherence levels measured by the MedQ-Sus increased, intakes of fish, olive oil, dietary fibre, magnesium, zinc, monounsaturated fatty acids, and omega-3 fatty acids increased, whereas polyunsaturated fatty acid intake decreased. In the test-retest analysis, strong positive correlations were observed for the Mediterranean Diet score (r = 0.782) and the Sustainable Diet score (r = 0.813) (both p < 0.001).

CONCLUSION: The MedQ-Sus demonstrated good validity and reliability as a practical screening tool for simultaneously assessing adherence to the Mediterranean diet and adherence to a sustainable diet among the adults included in this study, while its exclusion of alcohol consumption may support its use across different adult population groups.

PMID:42579329 | DOI:10.1111/jhn.70330

Eur J Prev Cardiol. 2026 Aug 11:zwag412. doi: 10.1093/eurjpc/zwag412. Online ahead of print.

ABSTRACT

AIMS: To investigate the effect of long-term beta-blocker therapy on physical activity (PA) level after myocardial infarction (MI) in patients without heart failure.

METHOD: The BETAMI trial, randomised patients hospitalised with a MI without heart failure (LVEF ≥40%) to beta-blocker or no beta-blocker. In this pre-planned sub-study PA level was assessed by guideline-recommended PA level (≥30 minutes moderate activity ≥5 days/week) or not and self-reported hours/week with light to moderate and vigorous PA. Between-group differences in PA from baseline before randomisation to 18-months were estimated by linear mixed models. Exploratory analysis assessed treatment effects on a composite of all-cause mortality and major adverse cardiovascular events using Cox proportional hazards model.

RESULTS: Of the 2867 randomised patients, 2185 (76%) responded to the PA questions and were included in this analysis. Mean age was 62.5 (SD 10.1) years, 20.6% were women. No differences in guideline-recommended PA level or mean hours of light to moderate and vigorous PA were reported between the beta-blocker and non-beta-blocker group at baseline or during 18-months follow-up. At 12-month follow-up, 37.0% in the beta-blocker group and 36.7% in the no beta-blocker group reported guideline-recommended PA level (OR 0.97, 95% CI 0.69-1.37). Exploratory, hypothesis-generating analyses did not demonstrate a statistically significant interaction (p for interaction = 0.06) between treatment assignment and baseline PA level for recurrent clinical events.

CONCLUSIONS: Beta-blocker therapy did not result in a change in PA level in post-MI patients without heart failure during the 18 months follow-up.

PMID:42579327 | DOI:10.1093/eurjpc/zwag412

Cranio. 2026 Aug 11:1-11. doi: 10.1080/08869634.2026.2715421. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate short-term clinical and ultrasonographic changes in the masseter muscle following botulinum toxin type A (BoNT-A) injection in participants clinically assessed as having bruxism.

METHODS: Seventeen participants received standardized bilateral BoNT-A injections. Masseter muscle thickness was measured by ultrasonography at baseline, 14 days, and 90 days. Pain intensity (VAS), histogram parameters, and fractal dimension were also assessed. Bilateral measurements were averaged for statistical analysis.

RESULTS: VAS scores and masseter muscle thickness decreased significantly at days 14 and 90 compared with baseline, with no significant difference between follow-up visits. Histogram and fractal dimension analyses showed no significant changes over time.

CONCLUSION: BoNT-A significantly reduced pain and masseter muscle thickness, whereas ultrasonographic texture parameters remained unchanged during the 90-day follow-up.Clinical trials number: NCT07545200.

PMID:42579291 | DOI:10.1080/08869634.2026.2715421

JASA Express Lett. 2026 Aug 1;6(8):081201. doi: 10.1121/10.0044581.

ABSTRACT

Monitoring the abundance and distribution of marine mammals is essential for evaluating human and environmental effects. Passive acoustic monitoring offers a non-visual alternative, but estimating animal numbers remains difficult. We introduce Spatial Counting of Animal Numbers (SCAN), a method that counts unique bearings of detected calls to estimate a conservative minimum number of animals present. SCAN is a complementary metric to traditional presence/absence results and calibrated density estimates. The method is demonstrated using sei whale calls recorded by a four-element array on an autonomous glider. SCAN increases the information on marine mammal populations derived from passive acoustic recordings.

PMID:42579286 | DOI:10.1121/10.0044581

JAMA Netw Open. 2026 Aug 3;9(8):e2627878. doi: 10.1001/jamanetworkopen.2026.27878.

ABSTRACT

IMPORTANCE: American Indian and Alaska Native individuals report higher rates of substance use disorders and psychological distress compared with individuals from other racial and ethnic groups. However, few evidence-based, culturally grounded programs address substance use and mental health for urban American Indian and Alaska Native emerging adults.

OBJECTIVE: To test 2 culturally grounded virtual interventions for substance use among urban American Indian and Alaska Native emerging adults.

DESIGN, SETTING, AND PARTICIPANTS: In this randomized clinical trial, participants were recruited across the US from December 1, 2020, to October 27, 2023. Participants completed an online screening questionnaire. Eligibility criteria included (1) age 18 to 25 years; (2) living in an urban area in the US (not a rancheria or a reservation); (3) self-identification as American Indian or Alaska Native; (4) no opioid use disorder; and (5) English speaking. The participants completed baseline surveys, were randomized to 1 of 2 culturally grounded virtual interventions, and completed 3-, 6-, and 12-month surveys. Follow-up was completed January 28, 2025. Analysis was based on intention to treat.

INTERVENTIONS: Participants received either 3 Traditions and Connections for Urban Native Americans (TACUNA) workshops and a wellness circle, or an opioid education health and wellness cultural (HWC) workshop (usual care).

MAIN OUTCOMES AND MEASURES: Surveys focused on opioid, alcohol, and cannabis use (primary outcome) and consequences of alcohol and other drug use, mental health, cultural connection, and peer influence (secondary outcomes).

RESULTS: Among the 541 randomized participants (451 [83.2%] female; mean [SD] age, 22.1 [2.2] years), the TACUNA and HWC groups both reported decreased frequency of cannabis use (B [SE], -0.44 [0.20] and -0.54 [0.21], respectively) and decreased rates of positive screens for alcohol (B [SE], -0.03 [0.01] and -0.02 [0.01], respectively) and cannabis (B [SE], -0.02 [0.01] and -0.03 [0.01], respectively) use disorders. Rates of time spent with peers who use alcohol and prescription opioids, clinical depression and anxiety, alcohol and cannabis consequences, and peer norms around alcohol, cannabis, prescription opioids, and heroin use improved in both groups. Only TACUNA participants reported decreases in frequency (B [SE], -0.51 [0.20]) and quantity (B [SE], -0.25 [0.09]) of alcohol use and quantity of cannabis use (B [SE], -0.07 [0.03]). In addition, TACUNA participants reported greater decreases in time spent around peers using cannabis and heroin and greater decreases of anxiety compared with HWC participants.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of 2 virtual culturally grounded interventions for substance use, virtual recruitment and intervention successfully reached urban American Indian or Alaska Native emerging adults with decreased access to resources. Both groups reduced consequences and cannabis use; however, only TACUNA participants reported decreases in quantity of alcohol and cannabis use and time spent around peers using cannabis and heroin and greater decreases in anxiety. These findings emphasize the role of bringing American Indian and Alaska Native emerging adults together to discuss ways to reduce alcohol and other drug use and socially connect with their tribal communities in the urban environment in a virtual setting.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04617938.

PMID:42579280 | DOI:10.1001/jamanetworkopen.2026.27878

JAMA Netw Open. 2026 Aug 3;9(8):e2627917. doi: 10.1001/jamanetworkopen.2026.27917.

ABSTRACT

IMPORTANCE: More than 70% of people experiencing homelessness report current smoking. Contingency management (CM) interventions that provide financial incentives for smoking cessation have shown short-term promise, but extended CM interventions have not been well studied in this population.

OBJECTIVE: To assess the feasibility and preliminary efficacy of an extended 6-month CM intervention for smoking cessation among adults experiencing homelessness.

DESIGN, SETTING, AND PARTICIPANTS: This pilot parallel 2-group randomized clinical trial was conducted in 3 safety-net clinics in San Francisco, California. Adults experiencing homelessness who smoked cigarettes and intended to quit within 6 months were enrolled from November 8, 2021, to June 27, 2023. Participants were followed up for 6 months, completed 24-week follow-up on January 9, 2024, and completed exploratory 52-week follow-up on May 21, 2024. Data were analyzed between June 1, 2024, and December 31, 2025.

INTERVENTIONS: Participants were randomized to extended CM or a control condition. The CM group received escalating gift card incentives for carbon monoxide (CO)-verified abstinence, starting at $13 and increasing by $0.50 for each negative test result for 6 months. Control participants received $5 per visit regardless of abstinence.

MAIN OUTCOMES AND MEASURES: The preliminary efficacy outcome was 7-day point prevalence abstinence (PPA; CO-verified self-report of abstinence). The secondary outcome was repeated 7-day PPA.

RESULTS: Of 83 participants, 42 were randomized to CM and 41 to a control. The mean (SD) age was 47.0 (10.8) years, and 53 participants (63.9%) were men. At 6 months, 7-day PPA was 31.0% in the CM group and 12.2% in the control group. After adjustment for covariates and with missing data treated as smoking, participants in the CM group had higher odds of achieving 7-day PPA at 6 months than those in the control group (adjusted odds ratio, 3.24 [95% CI, 1.03-10.19]; P = .04).

CONCLUSIONS AND RELEVANCE: In this pilot randomized clinical trial of adults experiencing homelessness, an extended CM intervention was feasible to implement and was associated with higher odds of 7-day PPA than the control condition. These findings suggest that extended CM may be a promising strategy for supporting smoking cessation in this population, but larger trials are needed to confirm efficacy.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04982952.

PMID:42579279 | DOI:10.1001/jamanetworkopen.2026.27917

JAMA Netw Open. 2026 Aug 3;9(8):e2628389. doi: 10.1001/jamanetworkopen.2026.28389.

ABSTRACT

IMPORTANCE: Maternal influenza vaccination effectively reduces risk of influenza among infants younger than 6 months, who are too young to receive influenza vaccination, in temperate countries with well-demarcated influenza seasons. However, evidence is limited supporting the clinical effectiveness of seasonal maternal influenza vaccination in tropical regions with year-round influenza transmission.

OBJECTIVE: To identify the clinical effectiveness of maternal influenza vaccination in reducing the risk of infant influenza hospitalization in a tropical setting.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted in Singapore, a tropical country with year-round influenza transmission. Participants included all infants (citizens or permanent residents of Singapore) born between May 1, 2017, and December 1, 2023, who had complete sociodemographic information for both children and their mothers derived from national administrative databases and survived at least 2 weeks after birth. Statistical analysis was performed from May 1, 2017, to April 30, 2024.

EXPOSURE: Receipt of influenza vaccination during pregnancy. Maternal vaccination status was classified using the National Immunization Registry and was linked to infant outcomes via the national birth registry.

MAIN OUTCOME AND MEASURES: The main outcome was infant influenza hospitalization from birth until 6 months of age, recorded in the national health care claims database. Hazard ratio (HR) of infant influenza hospitalizations was contrasted among infants with vaccinated mothers (received influenza vaccination during pregnancy) vs unvaccinated mothers (did not receive influenza vaccination during pregnancy), using overlap-weighted Cox proportional hazards regression model. Vaccine effectiveness (VE) was calculated as 1 – HR.

RESULTS: A total of 221 185 infants (113 625 males [51.4%]) were included. Overall, 25.9% of infants were born to vaccinated mothers. Infants were followed up from birth until an influenza hospitalization, 6 months of age, or death, whichever occurred first. The mean (SD) follow-up time was 181.9 (5.6) days for infants born to vaccinated mothers and 182.3 (5.0) days for infants born to unvaccinated mothers. Risk of influenza hospitalization was significantly lower in infants born to vaccinated mothers (adjusted HR [AHR], 0.59; 95% CI, 0.45-0.77). Maternal influenza vaccination was associated with significant VE estimates among infants (VE against hospitalization, 41%; 95% CI, 23%-55%). The VE estimate was statistically significant regardless of trimester timing (VE against hospitalization, first trimester: 52% [95% CI, 20%-71%]; second trimester: 37% [95% CI, 12%-56%]; third trimester: 41% [95% CI, 8%-64%). Maternal influenza vaccination remained protective regardless of season timing (VE against hospitalization, current season: 41% [95% CI, 12%-61%]; prior season: 41% [95% CI, 19%-58%]).

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study in a tropical region with year-round influenza transmission, a strategy of immunizing mothers at any point during their pregnancy was associated with reduced risk of infant influenza hospitalization.

PMID:42579278 | DOI:10.1001/jamanetworkopen.2026.28389

JAMA Netw Open. 2026 Aug 3;9(8):e2628395. doi: 10.1001/jamanetworkopen.2026.28395.

ABSTRACT

IMPORTANCE: Metabolic bariatric surgery (MBS) is the most effective treatment for severe obesity, yet patient selection and prioritization remain largely based on body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) thresholds rather than clinical conditions. The Lancet Diabetes and Endocrinology Commission recently proposed distinguishing clinical obesity (adiposity with obesity-related organ dysfunction) from preclinical obesity (excess adiposity with preserved function). The implications of this framework for MBS practice have not been evaluated.

OBJECTIVE: To assess the prevalence of clinical and preclinical obesity among MBS candidates and examine their demographic and clinical profiles, perioperative risk, and long-term prognosis.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, multicenter, cross-sectional study audited data of adults (aged ≥18 years) undergoing primary MBS (laparoscopic gastric bypass or sleeve gastrectomy) between January 1, 2014, and December 31, 2025, at 4 high-volume tertiary centers in the UK, Spain, France, and Brazil. Patients who underwent revisional procedures or multiple bariatric operations within the same year were excluded.

EXPOSURES: Classification of obesity as clinical or preclinical using a pragmatic operationalization.

MAIN OUTCOMES AND MEASURES: The primary outcome was the prevalence of clinical obesity. Secondary outcomes were patterns of organ dysfunction, BMI levels, baseline American Society of Anesthesiologists classification and Charlson Comorbidity Index, estimated 10-year cardiovascular risk (Framingham risk score), and 30-day major postoperative complications (Clavien-Dindo grade ≥3). Comparative analyses between patients with clinical obesity vs those with preclinical obesity were performed only within each individual cohort. No direct statistical comparisons were performed between centers as patient-level data were not shared across cohorts.

RESULTS: Among the 2316 patients included, 1709 (73.8%) had clinical obesity (mean [SD] age across cohorts, 45.6 [11.0] to 48.9 [11.7] years; 1149 women [67.2%]) and 607 (26.2%) had preclinical obesity (mean [SD] age across cohorts, 34.7 [10.4] to 40.0 [9.8] years; 486 women [80.1%]). Clinical obesity was the most prevalent category across all centers (from 62.7% in the Brazilian cohort to 79.3% in the UK cohort). Mean (SD) BMI ranged from 40.2 (4.9) (preclinical obesity in the Brazilian cohort) to 48.5 (9.0) (preclinical obesity in the UK cohort), and BMI levels and BMI category distributions (<40, 40-49, ≥50) were similar between clinical and preclinical obesity. Patients with clinical obesity were significantly older compared with those with preclinical obesity (UK cohort: mean [SD], 48.9 [11.7] vs 39.5 [9.7] years; French cohort: mean [SD], 45.6 [11.0] vs 34.7 [10.4] years; Spanish cohort: mean [SD], 47.1 [9.3] vs 40.0 [9.8] years; Brazilian cohort: mean [SD], 48.3 [11.7] vs 40.0 [9.4] years (all P < .001) and had a higher American Society of Anesthesiologists classification (UK cohort: median [IQR], 3 [2-3] vs 2 [2-3]; P < .001; French cohort: median [IQR], 3 [3-3] vs 2 [2-3]; P < .001; Spanish cohort: median [IQR], 2 [2-3] vs 2 [1-2]; P < .001; Brazilian cohort: median [IQR], 2 [2-2] vs 2 [2-2]; P = .02), as well as higher estimated cardiovascular Framingham risk score (Spanish cohort: median [IQR], 1.31 [0.20-4.34] vs 0.20 [0.20-1.68]; Brazilian cohort: median [IQR], 1.57 [0.20-5.28] vs 0.20 [0.20-0.20]; French cohort: median [IQR], 8.00 [3.00-13.00] vs 2.00 [1.00-4.00]) (all P < .001) and all-cause mortality risk (Charlson Comorbidity Index score) (UK cohort: median [IQR], 1 [0-2] vs 0 [0-0]; Spanish cohort: median [IQR], 1 [0-1] vs 0; Brazilian cohort: median [IQR], 1 [1-3] vs 1 [0-1]) (all P < .001). Clinical obesity was associated with increased 30-day major postoperative complications (Clavien-Dindo grade ≥3) compared with preclinical obesity in the French cohort (4.0% vs 1.1%; P = .04).

CONCLUSIONS AND RELEVANCE: This international, multicenter cross-sectional study found that the majority of MBS candidates met criteria for clinical obesity, while a substantial minority were classified as having preclinical obesity. Despite similar BMI distributions, patients with clinical obesity may have a greater disease burden, higher operative risk, and higher estimated cardiovascular risk, supporting its potential value as a clinically meaningful framework for surgical practice.

PMID:42579277 | DOI:10.1001/jamanetworkopen.2026.28395

J Robot Surg. 2026 Aug 11;20(1):814. doi: 10.1007/s11701-026-03811-w.

ABSTRACT

To compare short-term outcomes and resource use between ambulatory and conventional inpatient robot-assisted partial nephrectomy (RAPN). This single-center retrospective cohort included 143 consecutive adults with localized renal tumors who underwent RAPN from June 2021 to December 2024. The ambulatory group (n = 75) followed a standardized pathway with planned discharge within 48 h and structured post-discharge nursing follow-up; the conventional inpatient group comprised 68 patients. Perioperative recovery, hospital resource use, renal function, and 30-day safety outcomes were compared. Baseline, tumor, operative, and renal-function measures did not differ significantly between groups. The ambulatory group had shorter drainage-tube duration, earlier ambulation, oral intake, catheter removal, and return to normal activity, shorter hospital stay [29.0 (27.5-30.5) vs. 87.5 (80.8-99.0) h], and lower hospitalization cost [45,860 (44,876 – 46,806) vs. 62,096 (60,452 – 63,862) CNY] (all P < 0.001). Planned discharge was completed by 67 of 75 ambulatory patients (89.3%); 8 (10.7%) had delayed discharge. No statistically significant between-group differences were detected in transfusion, positive margins, readmission, reoperation, 30-day complications, wound infection, or eGFR through 3 months. The ambulatory group had more follow-up calls and messages within 7 days (both P < 0.001). In selected patients at an experienced center, ambulatory RAPN was associated with shorter hospitalization, lower in-hospital cost, and earlier recovery without a statistically detectable increase in short-term adverse outcomes. The retrospective single-center design and low event counts preclude causal or equivalence conclusions.

PMID:42579266 | DOI:10.1007/s11701-026-03811-w