Tag: statistics

BMJ Open. 2026 Aug 28;16(8):e115438. doi: 10.1136/bmjopen-2025-115438.

ABSTRACT

OBJECTIVES: To characterise demographics, comorbidities, co-medications and healthcare resource utilisation (HCRU) in patients newly diagnosed with Alzheimer’s disease (AD) in England using published and validated AD algorithms.

DESIGN: Observational cohort study.

SETTING: Real-world data in England from the Clinical Practice Research Datalink Aurum primary care database linked to the Hospital Episode Statistics secondary care database.

PARTICIPANTS: Two disease-based algorithms (Imfeld et al and Douros et al) and one medication-based algorithm (Schroeder et al) were selected from the literature to identify patients with AD. The index period for patient selection was from 1 January to 31 December 2019. Patients were grouped into three non-mutually exclusive cohorts reflecting these algorithms (cohorts A-C), then patients aged ≥60 years were further grouped into three subcohorts (subcohorts 1-3). Subcohort 1 included 9826 patients, subcohort 2 included 10 265 patients and subcohort 3 included 7355 patients.

PRIMARY OUTCOME MEASURES: Demographics, comorbidities, co-medications and HCRU present up to and including the date of cohort qualification were described.

RESULTS: Across subcohorts 1-3, mean age at index ranged from 81 to 83 years, and most patients were female (59%-63%) and White (93%). Common comorbidities were hypertension (67%-71%), asthma and chronic obstructive pulmonary disease (60%-63%) and arthritis and osteoarthritis (51%-53%). Common co-medications were analgesics (87%-89%), systemic corticosteroids (83%-84%) and anti-inflammatory and anti-rheumatic agents (81%-82%). Up to 34% of patients had a specialist referral or visit, with up to 18% involving a neurologist. In the 12 months prior to and including the index date, up to 46% of patients had an emergency department visit or inpatient visit for any cause.

CONCLUSIONS: In England, most newly diagnosed patients with AD were White females in their early 80s with common comorbidities including hypertension, asthma, chronic obstructive pulmonary disease, arthritis and osteoarthritis. This study addresses a critical evidence gap by quantifying the England-specific burden of comorbidity, polypharmacy, and HCRU among patients with AD using multiple validated and published AD algorithms. Findings were broadly consistent across the three subcohorts identified using disease-based and medication-based algorithms, strengthening internal validity of the study and demonstrating that the findings are robust to the method of AD case definition. This study provides a novel insight into the real-world AD population in England, and findings may help healthcare professionals to identify patients living with AD, understand patients’ needs and tailor treatment strategies.

PMID:42665355 | DOI:10.1136/bmjopen-2025-115438

BMJ Open. 2026 Aug 28;16(8):e121243. doi: 10.1136/bmjopen-2026-121243.

ABSTRACT

OBJECTIVE: To identify the main drivers of low-value medical imaging in Iran and explore potential strategies to reduce its use.

DESIGN: Qualitative study using semistructured interviews.

SETTING: Public and private healthcare settings in Iran.

PARTICIPANTS: 34 physicians, including general practitioners, radiologists and non-radiology specialists, selected using purposive and snowball sampling.

METHODS: Semistructured interviews were conducted between October 2023 and February 2024 through face-to-face, telephone and video calls. Data were analysed using thematic content analysis with a hybrid inductive-deductive approach and organised using the five control knobs framework.

RESULTS: Participants identified multiple drivers of low-value medical imaging across five domains: organisation, financing, payment, behaviour and regulation. Key drivers included weaknesses in the referral system, limited oversight, financial incentives, defensive medical practice, patient demand and misconceptions about diagnostic value. Suggested mitigation strategies included public education, physician training, stronger referral pathways, improved insurance oversight, use of evidence-based guidelines and better regulatory monitoring.

CONCLUSIONS: Low-value medical imaging in Iran is sustained by interacting weaknesses in referral pathways, financial incentives, professional practice and oversight. Efforts to reduce overuse should therefore combine physician and public education with stronger referral systems, insurer monitoring and regulatory action.

PMID:42665351 | DOI:10.1136/bmjopen-2026-121243

BMJ Open. 2026 Aug 28;16(8):e118421. doi: 10.1136/bmjopen-2026-118421.

ABSTRACT

BACKGROUND: The transition from chronic homelessness to being housed is a period of increased mortality risk. Examining the post-housing period is important for improving our understanding of this increased risk.

OBJECTIVES: To investigate, in a retrospective cohort study, the mortality rate of people who had been chronically homeless and who moved into supported housing and to identify risk factors associated with mortality.

DESIGN: Retrospective cohort study with eligible records reviewed from 1 October 2017 until 14 June 2024.

SETTING: Three supported housing units in Ottawa, Ontario, Canada.

PARTICIPANTS: Participants were any individual, alive or deceased, who moved into one of the eligible supported housing units within 6 months of their opening date. 123 participants were included in the study. The mean age was 41.3 (SD 11.9) years, and 76 (62%) were male.

OUTCOMES: The primary outcome was all-cause and cause-specific mortality following transition to supported housing. Differences in demographics and morbidity were also compared between people who were alive as of 14 June 2024 and those who were deceased as of 14 June 2024.

RESULTS: During a mean follow-up of 2.6 years, there were 27 deaths recorded (22% of those who moved into supported housing). Most, 11 (40%), died from ‘other causes’, where the cause of death was unclear or unknown and where they were found dead in their room, seven (26%) died of ‘natural causes’ usually in hospital after a medical event, seven (26%) of an opioid overdose and two (8%) where we have suppressed cause of death for privacy. There were no statistically significant differences in psychiatric diagnoses, substance use, medical diagnoses or opioid agonist therapy between those who died and those still alive at the end of the study period. Survival differed significantly across age groups (log-rank χ²=11.05, p=0.011), with residents aged 31-45 years demonstrating better survival than older age groups. No significant differences in survival were observed by sex.

CONCLUSIONS: There is a high mortality rate in people who are chronically homeless who move into supported housing. As our findings do not identify any clear baseline risk factor, it supports the idea that the transition into housing must be complemented with comprehensive health and well-being services that can meet this population’s complex needs to reduce the mortality risk.

PMID:42665348 | DOI:10.1136/bmjopen-2026-118421

Womens Health (Lond). 2026 Jan-Dec;22:17455057261481009. doi: 10.1177/17455057261481009. Epub 2026 Aug 28.

ABSTRACT

BackgroundThe prevalence of obesity has increased alarmingly over the last decades in the United Arab Emirates (UAE). Bariatric surgery (BS) is a more effective approach to losing weight than dieting in morbidly obese women. Perinatal depression is a well-known risk to maternal and neonatal health across the globe.ObjectivesTo determine whether bariatric surgery predicts depression among pregnant women in this descriptive cross-sectional study.DesignA descriptive cross-sectional survey study conducted in a major pediatric and maternity hospital in Abu Dhabi, UAE.MethodsForty-one pregnant women with a history of BS who attended a major pediatric and maternity hospital in Abu Dhabi, UAE, between July 2021 and November 2022 were recruited for the study. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen the participants for depression symptoms. An analysis of sociodemographic variables and depression scores was performed. Categorical variables were compared using chi-square tests. Continuous variables were compared using independent t-tests, and skewed data using the Mann-Whitney test. The ethical approval of the study was obtained from the Research and Ethics Committee of the hospital (No. RP DAE/2021/102) on 15 June 2021. Written informed consent was obtained from all participants prior to their enrollment in the study.ResultsDepression was present in 46.3% of the participants, among whom 2.7% were experiencing severe depression. The analysis of the EPDS scores between the Roux-en-Y bypass (RYGB) and sleeve gastrectomy (SG) groups indicates a higher EPDS score in the SG group compared to the RYGB group (U = 220.000; p = 0.015). There were no significant differences in the proportions of participants across the different sociodemographic characteristics based on depression score classification.ConclusionsThe prevalence of depression was high among pregnant women with a history of bariatric surgery. Although the results were based on a small sample, the results of this study indicate the risk of depression is higher in pregnant women who had had sleeve gastrectomy bariatric surgery.

PMID:42664494 | DOI:10.1177/17455057261481009

Neurology. 2026 Sep 22;107(6):e218475. doi: 10.1212/WNL.0000000000218475. Epub 2026 Aug 28.

ABSTRACT

BACKGROUND AND OBJECTIVES: Former American football players exposed to repetitive head impacts (RHI) are at a risk of chronic traumatic encephalopathy (CTE), but chronic pain, polypharmacy, and extensive orthopedic surgeries may also contribute to cognitive and behavioral symptoms. This study evaluated associations between chronic pain, centrally acting medications (CAMs), and orthopedic surgeries with cognitive and behavioral symptoms among former American football players.

METHODS: The sample included former professional (PRO) and collegiate (COL) football players and unexposed, asymptomatic men (UE) from DIAGNOSE CTE. Number of CAMs, orthopedic surgeries, and average pain scores were compared between the groups. Among former football players, logistic regression tested associations between CAMs, average pain score, and orthopedic surgeries with diagnoses of cognitive impairment and neurobehavioral dysregulation (NBD) using traumatic encephalopathy syndrome (TES) research criteria. Linear regression tested associations between CAMs, average pain score, and orthopedic surgeries with the Montreal Cognitive Assessment (MoCA) and behavioral and mood symptom scales. Covariates included age, education, race, and total years of football.

RESULTS: The study included 236 men (120 PRO, 60 COL, 56 UE). The mean ages were 59.1 (PRO), 53.5 (COL) and 59.6 (UE) years. PRO and COL used more CAMs (mean PRO = 0.76, COL = 1.14, UE = 0.14), had higher average pain scores (PRO = 4.22, COL = 3.21, UE = 1.05), and more orthopedic surgeries than the UE (mean PRO = 2.76, COL = 1.22, UE = 0.34). CAMs and average pain scores were associated with increased odds of consensus diagnosed NBD (CAMs OR = 2.15, 95% CI 1.53 to 3.26; average pain score OR = 1.55, 95% CI 1.32 to 1.85). CAMs and average pain scores were associated with increased measures of impulsivity, depression, anxiety, behavioral regulation, and aggression. CAMs and average pain scores were not associated with consensus diagnosed cognitive impairment, but CAMs were negatively associated with MoCA score (estimate = -0.47, 95% CI -0.81 to -0.13). There was no association between number of orthopedic surgeries and cognition or NBD.

DISCUSSION: CAMs and chronic pain are associated with NBD and CAMs are associated with reduced MoCA scores in former American football players.

PMID:42664488 | DOI:10.1212/WNL.0000000000218475

JCO Clin Cancer Inform. 2026 Jul-Sep;10(3):e2600105. doi: 10.1200/CCI-26-00105. Epub 2026 Aug 28.

ABSTRACT

PURPOSE: Machine learning models that predict survival time for patients are increasingly used for clinical decision support. Validating model performance in deployment is important but challenging because the only timely source of follow-up/death data is the electronic medical record (EMR), which is known to undercapture deaths, resulting in informative censoring. We examined whether model performance evaluation using EMR data alone can distinguish between low- and high-quality models using high-quality cancer registry data combined with EMR data as a comparison to calculate model performance.

MATERIALS AND METHODS: This was a retrospective study of 3,330 patients with metastatic cancer diagnosed from 2008 to 2018. We used regularized Cox proportional hazards regression trained on features from the EMR to predict length of survival after diagnosis. We trained models by varying the number of features to span a range of baseline discrimination performance and validated performance first using higher-quality EMR and cancer registry outcome data as a reference standard, followed by EMR data alone to simulate the scenario when real-time validation is performed and only EMR data are available.

RESULTS: The model with all features had a C-index of 0.66 (95% CI, 0.65 to 0.68) and an integrated Brier score (IBS) of 0.17 (95% CI, 0.16 to 0.18) when validating with reference standard data, compared with a C-index of 0.67 (95% CI, 0.65 to 0.69) and an IBS of 0.16 (95% CI, 0.15 to 0.17) with EMR data only. When using fewer features, performance estimates dropped similarly in both scenarios. When using reference standard data, the model was found to be reasonably calibrated, but with EMR data, the model was incorrectly found to systematically underpredict survival.

CONCLUSION: EMR data were useful for validation of model discrimination, but not calibration.

PMID:42664478 | DOI:10.1200/CCI-26-00105

Med Probl Perform Art. 2026 Aug 28;41(3):89-97. doi: 10.21091/mppa.2026.03009.

ABSTRACT

BACKGROUND: Temporomandibular disorders (TMDs) comprise a heterogeneous group of conditions affecting the temporomandibular joints, masticatory muscles, and related structures, and may influence both quality of life and professional performance. Professional musicians represent an occupational group exposed to combined physical and psychosocial demands that may increase vulnerability to temporomandibular symptoms.

OBJECTIVE: To determine the prevalence of temporomandibular symptom reporting and its association with socio-demographic and occupational factors, as well as health-related quality of life, among Portuguese professional orchestral musicians.

METHODS: A cross-sectional study was conducted involving 271 professional musicians from Portuguese orchestras. Data were collected using a self-administered questionnaire incorporating the Fonseca Anamnestic Index (FAI) and the SF-12v2 Health Survey, alongside sociodemographic and occupational variables. Descriptive statistics, chi-square tests, Student’s t-tests, Mann-Whitney U tests, and multiple logistic regression analyses were performed with a significance level of p < 0.05.

RESULTS: Temporomandibular symptoms were identified in 61.6% of participants. Female musicians showed a significantly higher prevalence than males (77.4% vs 48.3%, p < 0.001). Younger musicians (18-29 years) presented the highest prevalence, whereas those aged over 50 years showed the lowest frequency. Part-time employment was associated with increased odds of symptom reporting (OR = 2.15, 95% CI: 1.07-4.31). No significant associations were observed with education level, instrument category, or weekly practice time. Musicians reporting temporomandibular symptoms demonstrated significantly lower physical and mental health scores on the SF-12v2 (p < 0.01).

CONCLUSION: Temporomandibular symptoms are highly prevalent among professional orchestral musicians and are associated with demographic and occupational factors, as well as reduced health-related quality of life. These findings highlight the importance of preventive and multidisciplinary approaches addressing the occupational demands of orchestral performance.

PMID:42664464 | DOI:10.21091/mppa.2026.03009

Eur J Gastroenterol Hepatol. 2026 Oct 1;38(10):1213-1223. doi: 10.1097/MEG.0000000000003263. Epub 2026 Jul 27.

ABSTRACT

OBJECTIVE: To compare lenvatinib (LEN) and atezolizumab plus bevacizumab (Atezo + Bev) as first-line therapy in super-older adults (≥80 years) with hepatocellular carcinoma (HCC) and evaluate whether early relative dose intensity (RDI) is associated with outcomes.

METHODS: This retrospective cohort study included super-older adults initiating LEN or Atezo + Bev between May 2018 and August 2025. The primary endpoint was overall survival (OS); secondary endpoints included progression-free survival (PFS) and adverse events. Inverse probability of treatment weighting and multivariable Cox regression were performed. Within the LEN cohort, a day 56 landmark analysis evaluated the prognostic significance of 8-week RDI (RDI8 ≥ 75% vs. <75%).

RESULTS: Median OS was 15.6 and 10.7 months with LEN and Atezo + Bev [hazard ratio: 0.77, 95% confidence interval (CI): 0.42-1.41], whereas median PFS was 6.73 and 9.73 months, respectively (hazard ratio: 1.18, 95% CI: 0.65-2.17). IPTW and multivariable analyses yielded similar results. Within the LEN cohort, RDI8 greater than or equal to 75% was independently associated with improved OS (30.8 vs. 14.7 months; adjusted hazard ratio: 0.23, 95% CI: 0.07-0.73, P = 0.013). Grade greater than or equal to 3 adverse events occurred in 37 and 50% of the LEN and Atezo + Bev cohorts, respectively.

CONCLUSION: Although LEN and Atezo + Bev showed no statistically significant difference in real-world survival in this exploratory cohort, these findings require validation in larger studies. Higher early LEN dose intensity was consistently associated with improved survival and may represent an important therapeutic consideration in super-older adults with HCC.

PMID:42664455 | DOI:10.1097/MEG.0000000000003263

Eur J Gastroenterol Hepatol. 2026 Oct 1;38(10):1205-1212. doi: 10.1097/MEG.0000000000003255. Epub 2026 Jul 24.

ABSTRACT

BACKGROUND: Cirrhosis produces a rebalanced hemostatic state that predisposes patients to bleeding and thrombosis. We evaluated hepatic outcomes associated with deep vein thrombosis (DVT), pulmonary embolism, and portal vein thrombosis (PVT) in patients with cirrhosis.

METHODS: We conducted a retrospective cohort study using the Nationwide Readmissions Database from 2016 to 2022. Adults with cirrhosis identified during January index hospitalizations were followed through the end of the same calendar year and classified as having no thromboembolism, DVT, pulmonary embolism, or PVT. The primary outcome was liver transplantation. Secondary outcomes included in-hospital mortality, ascites, esophageal or gastric varices, variceal hemorrhage, acute liver failure, and hepatic decompensation. Survey-weighted logistic regression estimated adjusted odds ratios (aORs).

RESULTS: The weighted cohort included 365 467 patients: 363 007 without thromboembolism, 730 with DVT, 1036 with pulmonary embolism, and 694 with PVT. DVT was associated with lower odds of liver transplantation [aOR, 0.19; 95% confidence interval (CI), 0.05-0.83] and mortality (aOR, 0.54; 95% CI, 0.37-0.77). Pulmonary embolism was associated with lower odds of varices, ascites, acute liver failure, and hepatic decompensation. PVT was associated with higher odds of varices (aOR, 2.47; 95% CI, 1.95-3.13) and variceal hemorrhage (aOR, 2.83; 95% CI, 1.59-5.02).

CONCLUSION: Thrombotic phenotypes in cirrhosis have distinct prognostic associations. PVT was associated with portal hypertensive complications, whereas apparently favorable associations with DVT and pulmonary embolism should be interpreted cautiously.

PMID:42664454 | DOI:10.1097/MEG.0000000000003255

J Occup Environ Med. 2026 Aug 28. doi: 10.1097/JOM.0000000000003873. Online ahead of print.

ABSTRACT

OBJECTIVE: This study examined Thai wildland firefighters’ cardiopulmonary fitness, comparing previous and updated NFPA criteria.

METHODS: Chiang Mai wildland firefighters’ health was cross-sectionally examined. Chester Step cardiopulmonary fitness was assessed using the fixed 12-MET threshold and age- and sex-adjusted 50th percentile criterion. McNemar test indicated standard concordance, and multivariable linear regression found MET values. Statistical significance was assigned by p-values < 0.05.

RESULTS: Significant differences in fitness classifications between two methods (p < 0.05). Two previously passed participants failed, while 13 previously failed participants passed. Age (B=-0.07; 95% CI: -0.13, -0.01; p=0.016) and resting heart rate (B=-0.11; 95% CI: -0.16, -0.07; p<0.001) strongly correlated with METs.

CONCLUSION: The age- and sex-adjusted 50th percentile criteria requirements allow for better cardiovascular fitness and practical work duties. Updates in standards are beneficial for firefighters’ safety and health monitoring.

PMID:42664435 | DOI:10.1097/JOM.0000000000003873