Tag: statistics

Eur J Oncol Nurs. 2026 Apr 9;82:103189. doi: 10.1016/j.ejon.2026.103189. Online ahead of print.

ABSTRACT

OBJECTIVE: This study investigates the associations between anticipatory grief and dyadic coping among advanced cancer patients and their spouses, aiming to provide empirical evidence for the development of family-centered dyadic interventions.

METHODS: A total of 230 dyads, consisting of advanced cancer patients and their spouses, were enrolled via convenience sampling from three hospitals in Guangdong Province between June and September 2025. Data acquisition was conducted utilizing a sociodemographic questionnaire, the Dyadic Coping Inventory (DCI), and the Anticipatory Grief Scale (AGS) tailored for patients and spouses. Subsequently, the Actor-Partner Interdependence Model (APIM) was constructed to analyze dyadic interactions, with all statistical estimations performed using Mplus software (version 8.3).

RESULTS: Based on the results of the Actor-Partner Interdependence Model (APIM), significant actor effects were identified, wherein higher levels of anticipatory grief were found to be negatively associated with individual dyadic coping for both patients and spouses (P < 0.001). Furthermore, significant partner effects were established; specifically, patients’ dyadic coping was negatively linked to spousal anticipatory grief, and spousal dyadic coping was similarly associated with patients’ anticipatory grief (P < 0.001).

CONCLUSION: An interdependent association is identified between the levels of anticipatory grief and dyadic coping patterns within advanced cancer patient-spouse dyads. Accordingly, the implementation of comprehensive assessments and the formulation of collaborative intervention strategies are advocated for the optimization of mental health and coping capacities for both members of the dyad.

PMID:41996769 | DOI:10.1016/j.ejon.2026.103189

J Med Internet Res. 2026 Apr 12. doi: 10.2196/78321. Online ahead of print.

ABSTRACT

BACKGROUND: Previous research has demonstrated that continuous glucose monitoring (CGM) use can improve glycemic control in people with type 2 diabetes when used regularly alongside an in-person digital diabetes self-management and education support (DSMES) program. However, to date there is limited evidence showing the benefits of a digitally-delivered DSMES program combined with real-time CGM for adults with type 2 diabetes.

OBJECTIVE: To evaluate the impact of a DSMES program coupled with CGM on hemoglobin A1c (HbA1c) and CGM-derived glycemic measures compared to usual care for adults with type 2 diabetes over 6 months.

METHODS: Participants with type 2 diabetes and HbA1c ≥8% (64 mmol/mol) not using mealtime bolus insulin (26-83 years old; mean HbA1c: 9.6% [81.2 mmol/mol]) were randomly assigned to a digital DSMES + CGM integrated solution (n=51) or usual care (n=49) for 6 months. The primary outcome was HbA1c. Secondary outcomes were CGM-derived glycemic measures, including glucose management indicator (GMI), percent time in range 70-180 mg/dL (TIR), above range (TAR; >180 mg/dL), and below range (TBR; <70 mg/dL), and mean glucose. Linear mixed effects models were used for intention-to-treat analyses.

RESULTS: HbA1c was lower among intervention versus usual care at 3 months (difference=-0.7% [-8.1 mmol/mol]; P=.03) and at 6 months (difference=-0.6% [-6.9 mmol/mol]; P=.12) but only reached statistical significance at 3 months. CGM-derived glycemic measures, including GMI (difference=-0.9%; P=.03), TIR (difference=14.6%; P=.04), and TAR (difference=-14.9%; P=.04), and mean glucose (difference=-36.4 mg/dL; P=.03) were also significantly improved for intervention vs usual care at 6 months.

CONCLUSIONS: The combination of digital DSMES + CGM is effective for supporting adults with type 2 diabetes in managing their condition and has potential to reduce the risk of long-term health complications.

CLINICALTRIAL: The trial was registered on ClinicalTrials.gov (NCT05368454).

PMID:41996671 | DOI:10.2196/78321

PLOS Glob Public Health. 2026 Apr 17;6(4):e0006316. doi: 10.1371/journal.pgph.0006316. eCollection 2026.

ABSTRACT

A proportion of global migration involves individuals migrating without parental or legal guardianship and those who face varied barriers to citizenship. Yet empirical evidence on their morbidity burdens and hospitalization particularly in Ghana and similar context remains scarce. This limits capacity for informed policy, planning, and response strategies aligned with global health targets. This study examined the burden of communicable and non-communicable diseases (NCDs), and predictors of hospitalization among these vulnerable groups. A cross-sectional survey was conducted from March 2024 to May 2024 among 481 purposively selected unaccompanied migrants and persons prone to statelessness in the Greater Kumasi Metropolitan Area and the Awutu Senya East Municipal Area. Data were analyzed using descriptive statistics (frequency, and percentages) and complementary log-log regression in Stata 14.2. Statistical significance was set at p ≤ 0.05. The analyses revealed a higher prevalence of communicable diseases (23.3%) than NCDs (8.1%). Malaria (90%), flu/cold (30%), typhoid (27%), diabetes (33%) and asthma (21%) emerged as common health conditions with limited and condition-specific subgroup differences. Overall, 8.7% of respondents reported ever being hospitalized. Across models, frequent illness (Model 1: OR = 4.097, 95% CI: 2.056-8.163; Model 2: OR = 3.724, 95% CI: 1.830-7.576; Model 3: OR = 4.224, 95% CI: 2.002-8.913; all p < 0.001) and diagnosis with an NCD (Model 1: OR = 3.336, 95% CI: 1.611-6.906; Model 2: OR = 3.600, 95% CI: 1.737-7.460; Model 3: OR = 3.873, 95% CI: 1.861-8.058; all p ≤ 0.001) were consistently associated with higher odds of hospitalization. These findings offer contextually bounded insights highlighting that health vulnerability among these populations is manifested less through differential disease prevalence but more through recurrent illness and NCD diagnosis necessitating hospitalization. This underscores the need for early detection, continuous care, and effective outpatient NCD management.

PMID:41996346 | DOI:10.1371/journal.pgph.0006316

J Nutr Educ Behav. 2026 Apr 17:S1499-4046(26)00070-9. doi: 10.1016/j.jneb.2026.03.006. Online ahead of print.

ABSTRACT

OBJECTIVE: Identify attributes of thriving school gardens and provide recommendations to improve school garden sustainability.

DESIGN: Cross-sectional survey administered nationally.

PARTICIPANTS: Three hundred and sixty-four school administrators, teachers, and garden coordinators.

MAIN OUTCOME: Characteristics that predict thriving school gardens measured by a sustainability survey.

ANALYSIS: Logistic regression analyses were used to identify which factors predicted the odds of having a thriving school garden. All models were adjusted for Title I status, school classification, and garden age with corrections for multiple comparisons. Statistical significance criterion: P ≤ 0.05.

RESULTS: Each additional subject and grade taught increased the odds to thrive by 21% and 22% (P < 0.001 and P < 0.01, respectively). Schools’ odds of having a thriving garden increased 4 times with ≥ 6 garden workdays (P = 0.05), 7 times with ≥ 26 annual volunteers (P = 0.02), 9 times with an annual budget > $1,000 (P < 0.001), and 42 times with higher administrative support (P < 0.001).

CONCLUSIONS AND IMPLICATIONS: Administrative support and budget remain integral to garden sustainability, along with volunteer support and garden workdays. School gardens will benefit from fostering administrative support, strategic use of volunteers, increasing classroom use, and developing a sustainable budget. More research is needed to support paid garden staff and garden training for teachers.

PMID:41995647 | DOI:10.1016/j.jneb.2026.03.006

Medicine (Baltimore). 2026 Apr 17;105(16):e48315. doi: 10.1097/MD.0000000000048315.

ABSTRACT

High fasting plasma glucose (HFPG) is the second dominant metabolic risk factor contributing to the global burden of pancreatic cancer (PC). However, detailed investigations into the spatiotemporal patterns of PC burden attributable to HFPG remain limited. This study aims to assess global, regional, and national trends in PC mortality and disability-adjusted life years (DALYs) attributable to HFPG from 1990 to 2021. This longitudinal observational study was based on data from the global burden of disease 2021 study, covering data from 204 countries and territories. We extracted mortality, DALYs, age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) for PC attributable to HFPG. These metrics were stratified by sex, age group, country, and socio-demographic index (SDI). Temporal trends were evaluated using the estimated annual percentage change (EAPC) for ASMR and ASDR between 1990 and 2021. In 2021, an estimated 132,753 (95% uncertainty interval [UI]: 15,077-252,345) deaths and 2,751,644 (95% UI: 315,351-5,201,444) DALYs were attributable to HFPG, accounting for 40.9% and 39.3% of total PC-related deaths and DALYs, respectively. From 1990 to 2021, the number of HFPG-attributable PC deaths and DALYs increased by 234.1% and 209.7%, respectively. Substantial regional and national disparities were observed in the burden of PC attributable to HFPG. The highest ASMR and ASDR were recorded in high-SDI regions. Among global regions, East Asia reported the largest number of HFPG-attributable PC deaths and DALYs. The burden was also disproportionately higher among males and older adults. Notably, both ASMR and ASDR were significantly inversely correlated with EAPC. The global burden of PC attributable to HFPG has risen substantially over the past 3 decades, with marked regional and demographic disparities. These findings underscore the urgent need for glycemic control strategies and nutrition-based public health interventions to reduce HFPG-related cancer burden, particularly among high-risk populations.

PMID:41995512 | DOI:10.1097/MD.0000000000048315

Medicine (Baltimore). 2026 Apr 17;105(16):e41364. doi: 10.1097/MD.0000000000041364.

ABSTRACT

The relationship between anion gap (AG) and long-term mortality in intensive care unit has been widely reported, but whether this association exists in critically ill patients with chronic obstructive pulmonary disease (COPD) is still unknown. The data of this study were collected from the Medical Information Mart for Intensive Care-IV. First of all, we used the Cox regression analysis and Kaplan-Meier curves to measure the relationship between AG and 365-day mortality for critically ill patients with COPD. Next, a restricted cubic spline was used to analyze the relationship between AG and mortality. Finally, age, sex, weight, hypertension, type 2 diabetes mellitus, heart failure, myocardial infarction, and chronic kidney disease were considered for subgroup analysis. A total of 2594 eligible subjects were sampled, of which 36.24% died within 365 days of intensive care unit admission. Cox regression analysis, after adjusting for confounders, demonstrated a significant association between AG and 365-day mortality in patients with COPD (hazard ratio = 1.03, 95% confidence interval: 1.01-1.05. P < .05). Stratifying AG into quartiles revealed higher levels of AG associated with an increased risk of death (Q1: 1.00, Q2: 1.34 [1.09-1.66], Q3: 1.44 [1.17-1.78], and Q4: 1.49 [1.19-1.87]). Additionally, restricted cubic spline analysis indicated a nonlinear relationship, with a critical value of AG at 14 mmol/L. Subgroup analysis highlighted AG as a significant predictor of long-term mortality in COPD patients across different subgroups, with an interaction effect observed in the subgroup with type 2 diabetes mellitus. In critically ill patients with COPD, there was a significant positive association between AG and 365-day mortality. In addition, there is a saturation effect at AG of 14 mmol/L.

PMID:41995484 | DOI:10.1097/MD.0000000000041364

J Am Acad Orthop Surg. 2026 May 1;34(9):e1228-e1236. doi: 10.5435/JAAOS-D-25-00483. Epub 2025 Oct 17.

ABSTRACT

INTRODUCTION: Existing literature supports weight-bearing and activity restriction following hip arthroscopy, as well as early participation in physical therapy. However, there is a knowledge gap surrounding how failure to adhere to these instructions affects long-term outcomes. This study aims to evaluate how noncompliance with postoperative protocol after hip arthroscopy affects patient-reported outcomes at 2 years after surgery.

METHODS: Seventy-nine patients who underwent hip arthroscopy for femoroacetabular impingement between January and December 2022 were identified, with 52 in the compliant group and 27 in the noncompliant group. Patient noncompliance was defined as loss to follow-up (n = 4), delayed or lack of physical therapy (n = 12), and nonadherence to weight-bearing and activity restrictions (n = 17) within 3 months following surgery. Symptom and functional status were assessed at 2 years with the international Hip Outcomes Tool (iHOT-12), the Physical Function Short Form of the Hip Disability and Osteoarthritis Outcome Score (HOOS-PS), and the single-item patient-acceptable symptom state.

RESULTS: The average iHOT and HOOS-PS scores were lower for noncompliant patients (iHOT, 50.67; SD, 28.9; HOOS-PS, 60.9; SD, 23.8) compared with compliant patients (iHOT, 71.95; SD, 26.8; P = 0.002; HOOS-PS, 79.0; SD, 23.0; P = 0.002). Noncompliant patients had lower rates of reaching Patient Acceptable Symptom State at 2 years (compliant: 69%, noncompliant: 37%; OR = 3.86; 95% CI [1.42, 10.0] 0.006). Multivariate analysis revealed independent predictors of lower iHOT scores were history of a mental health disorder (-12.0 points SD, 2.9; P = 0.001) and noncompliance (-8.6 points SD, 3.0; P = 0.01). No baseline demographic differences were identified between compliant and noncompliant patients.

CONCLUSION: Noncompliance with functional restrictions and postoperative physical therapy is a strong independent risk factor for poor patient-reported outcomes at 2 years after hip arthroscopy.

PMID:41995396 | DOI:10.5435/JAAOS-D-25-00483

Am J Epidemiol. 2026 Apr 17:kwag078. doi: 10.1093/aje/kwag078. Online ahead of print.

ABSTRACT

We examined the role of nSEP on 1-year and 5-year survival among children with critical congenital heart defects (CCHDs). Children with CCHDs in the National Birth Defects Prevention Study (1999-2011) were grouped into univentricular and biventricular defects and linked to vital records for 1-year and 5-year mortality. The Neighborhood Deprivation Index (NDI) classified census-tract nSEP (low [referent], moderate, high deprivation) using maternal periconceptional address. Kaplan-Meier survival curves and log-rank tests evaluated survival differences. Cox proportional hazards regression models estimated crude and adjusted hazard ratios (HRs) and 95% confidence intervals, adjusting for birth years, maternal sociodemographic factors, and residential mobility. Among 2459 children with CCHDs, 1-year survival curves differed by neighborhood deprivation. Survival was lowest among children of mothers living in high vs. low deprivation neighborhoods. In crude analyses, high deprivation was associated with higher 1-year mortality (all CCHDs: 1.58 [1.17, 2.13]; univentricular CCHDs: 1.50 [0.99, 2.26]; biventricular CCHDs: 1.64 [1.02, 2.64]). After adjustment, estimates were generally attenuated and less precise. Five-year survival showed similar trends. Further research could inform strategies to address the structural, environmental, and/or physiological factors associated with a potential reduced survival among children with CCHDs born to mothers in socioeconomically deprived areas.

PMID:41995389 | DOI:10.1093/aje/kwag078

Appl Environ Microbiol. 2026 Apr 17:e0234225. doi: 10.1128/aem.02342-25. Online ahead of print.

ABSTRACT

Fusarium graminearum is a major pathogen of wheat and barley, causing fusarium head blight (FHB) and contaminating grain with harmful mycotoxins. Azole fungicides (demethylation inhibitors) are among the key tools available for managing F. graminearum infections. In an attempt to characterize how resistance to azole fungicides arises, we performed an experimental evolution study that imposed selection by exposing F. graminearum to increasing concentrations of prothioconazole (PTZ), tebuconazole (TBF), a combination of both fungicides (CMB), or a no-drug control. All evolved lineages exceeded the ancestral minimum inhibitory concentration before strain extinction, retained normal in vitro colony growth in the absence of drugs, and were able to successfully infect a fusarium head blight-susceptible wheat cultivar. However, most lineages lost their apparent resistance improvements after being revived from preservation at -80°C. One lineage (TBF1), however, showed stable enhanced resistance to tebuconazole, which was accompanied by a phenotype of precocious germination of macroconidia. Genomic analyses indicated no change in the cyp51 genes in any lineage but identified a single base insertion resulting in a premature stop codon in the aos1 gene (involved in SUMOylation) in the TBF1 genome. We created aos1 gene deletion strains, which phenocopied TBF1 for both tebuconazole resistance and altered macroconidial germination. This work suggests that adjustments to spore germination processes may influence sensitivity toward fungicides and also highlights the role of SUMOylation in spore dormancy.IMPORTANCEFusarium graminearum is a major crop pathogen that can acquire mutations over time to common fungicides. Historically, studies have focused their attention on a single gene, cyp51, as the primary cause of resistance. However, there may be other pathways to enhanced resistance. For example, changes in macroconidium germination rates and transitions between cell types offer a route to fungicide resistance that has not been adequately appreciated to date. This study highlights a novel pathway to azole resistance, providing new insights into how F. graminearum may circumvent chemical controls. Through laboratory evolution, a single base insertion arose within the aos1 gene, which caused phenotypes of altered macroconidium dormancy and reduced fungicide sensitivity. This research highlights the importance of experimental approaches that remain open to surprising evolutionary innovations and unexpected resistance mechanisms.

PMID:41995307 | DOI:10.1128/aem.02342-25

Womens Health (Lond). 2026 Jan-Dec;22:17455057261442095. doi: 10.1177/17455057261442095. Epub 2026 Apr 17.

ABSTRACT

BACKGROUND: In the United States, Black women face racial stressors that significantly undermine their well-being and contribute to poor mental health outcomes.

OBJECTIVES: The current study examines how racial stressors (i.e., racial violence exposure through social media, vicarious racism, and interpersonal racism) are associated with racial trauma and dysphoria (i.e., depression, anxiety, and hostility) and the moderating role of emotion-focused coping self-efficacy (e.g., suppression of unpleasant thoughts and emotions) among Black women (M_age = 35, N = 283).

DESIGN: The study employed a quantitative, cross-sectional, analytical design.

METHODS: A cross-sectional online survey was administered to Black women aged 18 and over in the Northeast US between March and July 2024. Participants from diverse socioeconomic backgrounds were recruited. Data were collected via Qualtrics and analyzed using IBM SPSS version 29.0. A hierarchical regression analysis assessed the association between racial stressors (social media violence, interpersonal racism, and vicarious racism), racial trauma, and dysphoria, with emotion-focused coping self-efficacy as a moderator.

RESULTS: Greater exposure to racial stressors and the suppression of unpleasant thoughts and emotions were associated with higher dysphoria. Interpersonal racism was positively linked to racial trauma, while social media exposure to racial violence was associated with lower trauma. Interaction effects showed that Black women who reported high social media violence exposure and suppressed unpleasant thoughts experienced less trauma. Similarly, those who reported higher vicarious racism and felt confident in suppressing unpleasant thoughts also experienced less trauma. Conversely, those who felt less efficacious in suppressing unpleasant thoughts were more likely to endorse racial trauma symptoms.

CONCLUSION: Black women’s racial stressors, dysphoria, and racial trauma are linked. However, the psychological effects of racial violence exposure through social media depend on available coping resources. Suppressing unpleasant thoughts and emotions is a conditional coping strategy that may mitigate racial trauma when accompanied by high coping self-efficacy, especially in situations involving vicarious racism and social media-based racial violence exposure. Conversely, low confidence in suppressing distress is associated with heightened racial trauma, highlighting the importance of emotion-focused coping self-efficacy in shaping psychological vulnerability.

PMID:41995294 | DOI:10.1177/17455057261442095