Tag: statistics

JMIR Mhealth Uhealth. 2026 May 18;14:e79642. doi: 10.2196/79642.

ABSTRACT

BACKGROUND: As digital health solutions gain traction, there is an urgent need for effective, person-centered stress management tools for employees. Advances in wearable stress monitoring and machine learning now enable the collection of high-resolution, real-time data and the delivery of personalized interventions with respect to both timing and content. Despite this technological progress, there remains a notable paucity of mobile health (mHealth) interventions that capitalize on these capabilities to implement just-in-time adaptive interventions (JITAIs).

OBJECTIVE: This pilot study aimed to examine the preliminary effects of the RELAX mHealth app, which uses a JITAI framework to reduce occupational stress, with a particular focus on initial indications of stress reduction, the influence of the app’s degree of personalization on these effects, and overall user experience.

METHODS: A 2-arm randomized trial was conducted with 46 employees across two phases of 3 weeks each. Participants used the RELAX mHealth app, which adapts intervention timing based on real-time stress data and tailors content according to users’ preferences. Stress was assessed via multiple heart rate variability (HRV) parameters measured with wearable sensors, alongside subjective questionnaires and ecological momentary assessment (EMA) questionnaires. Usability and user satisfaction were also evaluated. In the second phase, a group randomization was implemented, with two groups of different degrees of in-app personalization.

RESULTS: The findings were mixed. While selected subjective stress indicators decreased from baseline to the end of the study, one physiological measure increased. Retrospective chronic stress (P=.048) and arousal related to the most recent stress event prior to EMA entry (P=.02) were reduced; however, the low frequency (LF)-to-high frequency (HF) ratio of HRV increased (P=.03). Other stress variables, such as work-related stress, valence of daily experiences, and momentary arousal, showed no change over the course of the study. No between-group differences were observed with respect to the assigned degree of personalization. Additionally, usability increased (P<.001), whereas satisfaction decreased at a trend level (P=.05).

CONCLUSIONS: Although the results provide selective preliminary indications of stress reduction with app use, the variability of outcomes raises concerns about its current practical utility. The effects are also discussed with regard to the specific design of the prototype and the study setup. Technical issues and user discomfort were noted despite increasing usability over the study period, indicating areas for improvement in the developed prototype. Given the absence of a control group and the use of interventional arms only, no definitive conclusions about effects can be drawn. Nevertheless, this study highlights both the potential and the challenges of a personalized mHealth approach to occupational stress management. Further refinement of the app and more comprehensive evaluations are needed to fully understand the impact and functional usability of this JITAI-based approach in real-world settings.

PMID:42150167 | DOI:10.2196/79642

J Agric Saf Health. 2026 May 22;32(2):75-101. doi: 10.13031/jash.16385.

ABSTRACT

HIGHLIGHTS: Moderate handle lift angles (27°-56°) and handle lift heights (545-1111 mm) reduce hip/shoulder flexion. Lighter tools (<2.0 kg) lower MSD risk; heavier ones boost leverage for taller users. D-grip handles with natural curves enhance wrist alignment and comfort (64% preference). Adjustable designs can accommodate diverse anthropometrics to mitigate physical strain.

ABSTRACT: The design and characteristics of agricultural hand tools, including shovels and pitchforks, are essential for reducing physical strain and enhancing task efficiency among women farmers. This study investigates the ergonomic performance of conventional shovels and pitchforks in reducing physical strain among women farmers. A sample of seven female participants performed simulated farm tasks, scooping and throwing straw using 10 shovels and 8 pitchforks selected from an initial pool of 24 and 19, respectively. Tool mechanical parameters (weight, handle lift height, handle length, and handle lift angle) were measured with digital instruments, while user posture and biomechanical strain were assessed via 3D pose estimation using commercial AI-based ergonomic software (TuMeke). The software provided peak joint angles and calculated RULA and REBA scores as approximate indicators of musculoskeletal risk, and mechanical advantage was calculated using measured effort and resistance arm lengths. Two-way ANOVA analyses revealed statistically significant differences (p < 0.05) in hip and shoulder angles and mechanical advantage between tool types (shovels versus pitchforks) and handle grip designs (D-grip with natural inward curve versus straight handles). Results indicate that tools featuring moderate handle angles (27°-56°), handle lift heights aligning with typical standing elbow heights (545-1,111 mm), and lighter weights (<1.5-2.0 kg) effectively reduced awkward postures, as evidenced by lower peak hip and shoulder flexion angles and improved RULA/REBA scores. Conversely, heavier tools, while offering a higher mechanical advantage, imposed greater strain on the upper body. Additionally, approximately 64% of participants preferred D-grip handles with natural inward curves, which enhanced wrist alignment and overall comfort. This study highlights the importance of tool designs tailored to anthropometric variability. Tools with adjustable handle lift heights and moderate handle lift angles might improve health, reduce physical strain, and enhance productivity. Future research should explore broader anthropometric diversity, advanced analytical methods, and additional tool configurations to refine ergonomic recommendations.

PMID:42150159 | DOI:10.13031/jash.16385

JMIR Res Protoc. 2026 May 18;15:e86168. doi: 10.2196/86168.

ABSTRACT

BACKGROUND: Neck pain poses a significant and growing public health challenge, with rising prevalence among younger populations and negative impacts on both quality of life and socioeconomic costs. Clinical manifestations are diverse, including restricted movement, muscle spasms, headaches, and upper limb numbness. Although drug therapy is widely used, its long-term use is limited by adverse effects. Traditional Chinese medicine (TCM) exercises offer a promising alternative, but high-quality evidence directly comparing their efficacy and safety to oral medications is currently lacking.

OBJECTIVE: This study aims to compare the efficacy and safety of TCM exercises and oral medication in treating neck pain.

METHODS: We will identify relevant randomized controlled trials (RCTs) through a systematic search of multiple databases (including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure [CNKI], Chinese Biomedical Literature Database [CBM], VIP, and Wanfang) from inception through September 2025. Only RCTs directly comparing TCM exercise to oral medication will be included. Study quality will be assessed using the Cochrane RoB2 tool, and the overall evidence will be graded via the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. For heterogeneity, the I² statistic and Cochran Q test will be applied. A fixed-effect model will be adopted if I²<50% and P≥.10; otherwise, subgroup analysis will be performed. Should heterogeneity persist, sensitivity analysis or a random-effects model will be employed, leading to a reduction in the GRADE rating.

RESULTS: This is a study protocol; therefore, no results are available at this stage. The systematic review is scheduled to commence in August 2025, with the literature search from August to September 2025, study screening from September to December 2025, data extraction and analysis from January to May 2026, and manuscript submission by June 2026.

CONCLUSIONS: This protocol outlines a systematic review and meta-analysis designed to compare the efficacy and safety of TCM exercises versus oral medications for neck pain. The completed review aims to synthesize the available evidence and clarify whether TCM exercises offer a comparable or superior alternative to pharmacotherapy. By systematically evaluating direct head-to-head RCTs, this study seeks to provide evidence-based insights to inform clinical decision-making. Potential limitations of the forthcoming review may include heterogeneity in exercise protocols, challenges in blinding, and a possible limited number or geographic concentration of available trials, which could affect the generalizability of the findings. These limitations will be considered when interpreting the results.

PMID:42150155 | DOI:10.2196/86168

Am J Respir Crit Care Med. 2026 May 18:aamag251. doi: 10.1093/ajrccm/aamag251. Online ahead of print.

NO ABSTRACT

PMID:42150113 | DOI:10.1093/ajrccm/aamag251

J Bras Nefrol. 2026 Jul-Sep;48(3):e20250294. doi: 10.1590/2175-8239-JBN-2025-0294en.

ABSTRACT

INTRODUCTION: Kidney transplantation remains the most cost-effective treatment for end-stage renal disease (ESRD); however, persistent organ scarcity and immunological barriers contribute to prolonged waiting times and inequitable access. Human leukocyte antigen (HLA) sensitization and homozygosity represent major challenges inadequately addressed by previous allocation models.

OBJECTIVES: This study aimed to assess the impact of HLA sensitization and HLA homozygosity on access to kidney transplantation in the regional sector of Minas Gerais.

METHODS: We conducted a cross-sectional analysis of deceased-donor kidney transplant recipients and active candidates listed in the Brazilian National Transplant System (SNT) from January 2010 to August 2024 in a regional allocation sector of Minas Gerais. We assessed the impact of HLA sensitization and HLA-DRB1 homozygosity on access to transplantation, contextualizing the findings within recent national regulatory updates.

RESULTS: Of 2,907 patients analyzed, 1,794 (61.7%) underwent transplantation and 1,113 (38.3%) remained active on the waiting list. Diabetes mellitus (HR 1.177; p = 0.030) and blood groups A (HR 1.206; p < 0.001) and AB (HR 1.419; p = 0.002) were associated with increased access to transplantation. Higher levels of sensitization and HLA-DRB1 homozygosity were the strongest predictors of prolonged waiting time. These findings are consistent with inequities targeted by the Brazilian SNT regulatory revisions implemented in September 2025.

CONCLUSION: Our results support recent Brazilian allocation reforms aimed at prioritizing hypersensitized and immunogenetically disadvantaged patients. Incorporating both the degree of sensitization and HLA-DR homozygosity into allocation algorithms represents a critical step toward improving equity in deceased-donor kidney transplantation.

PMID:42150098 | DOI:10.1590/2175-8239-JBN-2025-0294en

Proc Natl Acad Sci U S A. 2026 May 26;123(21):e2602686123. doi: 10.1073/pnas.2602686123. Epub 2026 May 18.

ABSTRACT

Immigrants play a critical role in the US childcare workforce, yet little is known about how immigration enforcement shapes employment in this essential sector. We study how the sharp escalation in community-based Immigration and Customs Enforcement (ICE) activity following President Trump’s inauguration in early 2025 affected childcare employment in the United States. Monthly data from the Current Population Survey are linked to compiled state-level ICE arrest records from September 2023 through September 2025, to ask how changes in enforcement intensity influence employment across childcare settings that differ in regulation and visibility. We find that increased ICE activity led to significant declines in employment among foreign-born women, with effects concentrated in center-based settings that are highly regulated and publicly visible. At the same time, employment in private household childcare increased, consistent with a reallocation toward less visible and less formal arrangements rather than a complete exit from the sector. These effects strengthened markedly after early 2025, a period characterized both by a sharp rise in nonprison ICE arrests and heightened public attention to immigration enforcement. Among native-born women, employment responses are limited in magnitude and confined to a limited number of specific care settings, providing little evidence of broad substitution for foreign-born workers. Overall, the results show that immigration enforcement reshapes not only the size but also the structure of the childcare workforce, with important potential implications for childcare access, labor markets, and families.

PMID:42150063 | DOI:10.1073/pnas.2602686123

JMIR Res Protoc. 2026 May 18;15:e92115. doi: 10.2196/92115.

ABSTRACT

BACKGROUND: Negative symptoms (NS) such as anhedonia (reduced pleasure), avolition (reduced motivation), asociality (social withdrawal), blunted affect (diminished emotional expression), and alogia (poverty of speech) are associated with poor functional outcomes in psychiatric and neurological disorders and are an unmet treatment need. Current medication primarily targets positive or affective symptoms, leaving NS neurobiology unaddressed. A critical research gap exists in understanding whether these symptoms share a common biological architecture across different diagnoses or whether they emerge from distinct pathological pathways.

OBJECTIVE: This observational, single-center study aims to characterize NS across a transdiagnostic sample of individuals with mental disorders and related conditions, with a particular focus on avolition, its biological correlates, and associated neurocognitive and electrophysiological profiles and the aim of determining whether particular NS consistently occupy central positions across disorders or centrality patterns differ by diagnosis. By linking these symptom profiles to underlying neurocognitive, electrophysiological, and genetic markers, the study seeks to disentangle shared versus disorder-specific mechanisms.

METHODS: In total, 300 participants with a primary diagnosis of schizophrenia, bipolar disorder, unipolar depressive disorder, autism, or dementia will be recruited, with a target of at least 50 individuals in each diagnostic group. Over a 4-day schedule, participants will undergo clinical (Brief Negative Symptom Scale, Positive and Negative Syndrome Scale, Hamilton Depression Rating Scale, Personal and Social Performance Scale, Udvalg for Kliniske Undersøgelser Side Effect Rating Scale, and Barnes Akathisia Rating Scale), neurocognitive (Brief Assessment of Cognition in Schizophrenia, and Temporal Experience of Pleasure Scale), and biological (resting-state electroencephalography and blood sampling for polygenic risk score) assessments. Network analysis will compute symptom centrality to determine if avolition acts as a transdiagnostic hub. Structural equation modeling will link network profiles to neurophysiological and genetic data. This methodology is designed to identify convergent biological markers, clarify avolition’s role in symptom heterogeneity, and refine understanding of NS as multidimensional phenomena beyond traditional diagnostic boundaries.

RESULTS: The initial version of the study protocol was developed in February 2024. The finalized protocol was completed on May 8, 2024, and updated on January 11, 2025, to incorporate minor methodological clarifications. Participant recruitment and data collection commenced on July 1, 2024, and are ongoing at the time of manuscript submission. By March 2026, the study had enrolled 286 participants. Data quality control and preliminary analyses are performed concurrently with data collection. Final statistical analyses and dissemination of results are planned following completion of the recruitment phase.

CONCLUSIONS: This study will provide critical insights into the characterization and underlying mechanisms of NS across psychiatric disorders. By focusing on avolition, reward processing, and their interaction with neurocognitive and social cognitive deficits, it will help identify potential biological and electrophysiological markers of NS. The findings may guide the development of more precise assessment tools and inform novel therapeutic strategies, with broad translational impact for improving outcomes in individuals with serious mental illnesses and related conditions.

PMID:42150051 | DOI:10.2196/92115

Drug Alcohol Rev. 2026 May;45(4):e70167. doi: 10.1111/dar.70167.

ABSTRACT

INTRODUCTION: Illicit alcohol sales account for 90% of the alcohol-related lost tax revenue in Australia (unrecorded alcohol); however, there is a paucity of research on this segment of the alcohol market. It is currently unclear if illicit alcohol is widely available in Australia and whether it is safe for human consumption.

METHODS: In this preliminary investigation, to establish immediate availability, we visited four licensed alcohol retailers in high socio-economic areas of Melbourne, Victoria, during June, July and September 2025. We found and purchased three suspected illicit alcohol products and one control product and submitted all four products for chemical testing.

RESULTS: Three out of the four retailers we visited stocked suspected illicit alcohol products. These products were the cheapest products available in their category. Two of the products we tested contained both plasticizers and methanol at levels that far exceed food safety standards.

DISCUSSION AND CONCLUSIONS: Our study confirms that illicit alcohol products are in circulation in Australia, and stocked alongside licit alcohol products by licensed retailers, in contravention of food safety, liquor and tax regulations. Regulations such as those in place in the European Union that routinise sampling and testing of food products could potentially reduce the likelihood of products such as these being stocked in stores; however, it is unclear how widely spread this practice is. There is an urgent need for trans-disciplinary research into the prevalence, nature and magnitude of illicit alcohol in Australia, to inform and justify a proactive policy approach that could curtail this market.

PMID:42150049 | DOI:10.1111/dar.70167

Adv Gerontol. 2026;39(1):154-159. doi: 10.34922/AE.2026.39.1.018.

ABSTRACT

The analysis of demographic trends reveals a sustained pattern of population aging. This process is associated with both declining fertility rates and increasing life expectancy. Despite these well-documented global demographic shifts, the health status of centenarians remains understudied. The aim of this research is to assess the medical and social status of centenarians in the Chelyabinsk Region. To investigate the health of centenarians, data extraction was performed for patients aged 100 years and older. The final database comprises 72 records detailing the health status and parameters of hundred-year centenarians in the Chelyabinsk Region. Each entry includes age, sex, diagnosis upon presentation, anthropometric measurements (height, weight, BMI), and a range of laboratory indicators from complete blood count and biochemical panels. The most prevalent conditions among the centenarian population of the Chelyabinsk Region belong to the following nosological groups: «I.67 Other cerebrovascular diseases» – recorded as either a primary or concomitant diagnosis in 65,27% of patients; «I.11 Hypertensive heart disease» – 51,39%; and «I.20 Angina pectoris» – 22,22%. These conditions were found in both the group of centenarians with disability and the group without this social status. In the group of patients without disability, the diagnosis «I.11 Hypertensive heart disease» as a primary diagnosis (46,5%) upon presentation to a healthcare facility is established statistically significantly more often than in the group of centenarians with the aforementioned social status (disability) (17,24%), p<0,05. A statistically significant difference exists in the number of clinical diagnoses between individuals with disability – 5 (4-6) and those without this status – 3 (2-3,5). This supports the assertion of a link between permanent loss of working capacity and polymorbidity (p<0,001). Venous blood glucose levels are statistically significantly higher in the group of hundred-year centenarians without disability (p<0,05).

PMID:42150037 | DOI:10.34922/AE.2026.39.1.018

Adv Gerontol. 2026;39(1):135-143. doi: 10.34922/AE.2026.39.1.016.

ABSTRACT

Motor and cognitive impairments in older adults living in long-term care facilities are characterized by high clinical heterogeneity and pose significant challenges for diagnosis and rehabilitation planning. The limited sensitivity of traditional clinical approaches to differentiating the leading component of functional decline limits the possibilities for informed personalization of rehabilitation interventions. The aim of this study was to identify resting-state functional connectivity patterns associated with clinical and rehabilitation profiles (motor, cognitive, and mixed). The cross-sectional study involved 60 residents of a nursing home (mean age 76±11,3 years), stratified into groups based on their predominant motor (n=21), cognitive (n=19), and mixed (n=20) profiles, using comprehensive clinical and functional testing. In total, the student provided most of the information in a state close to that of 164 people within the country; statistical analysis was conducted using power.

PMID:42150035 | DOI:10.34922/AE.2026.39.1.016