Tag: statistics

JAMA Netw Open. 2026 Jun 1;9(6):e2620128. doi: 10.1001/jamanetworkopen.2026.20128.

ABSTRACT

IMPORTANCE: Females with atrial fibrillation (AF) experience a higher risk of stroke, myocardial infarction, and mortality than males with AF. Theories suggest that sex-based differences in hormonal, structural, and electrophysiologic factors are associated with this imbalance; we hypothesized that sex-based differences in health care access and utilization (HCAU) are also underlying factors.

OBJECTIVE: To determine whether sex-based disparities in HCAU barriers exist among individuals with AF.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data on patients with AF in the All of Us Research Program Registered Tier dataset (version 8), which contains integrated data from the electronic health record and various health surveys between August 8, 2016, and October 1, 2023. Inclusion criteria were age 18 years or older, a SNOMED (Systematized Nomenclature of Medicine) diagnosis of AF, and completion of the Health Care Access and Utilization Survey. Exclusion criteria included lack of binary sex information. Data were extracted and analyzed between November 2025 and April 2026.

MAIN OUTCOMES AND MEASURES: Association between sex at birth and participant responses to 20 HCAU outcomes. Multivariable logistic regression and marginal standardization were used to calculate unadjusted and adjusted odds ratios, adjusted predicted probabilities (APPs), and adjusted risk differences (ARDs). Multiplicity was addressed using the Holm-Bonferroni method.

RESULTS: The 12 428 eligible participants had a median (IQR) age of 70 (63-75) years and included 6877 males (55.3%). Compared with males with AF, females with AF had significantly higher APPs of reporting HCAU barriers to 14 of 20 outcomes after adjusting for baseline differences in sociodemographic and clinical characteristics. The largest differences were observed in cost-related medication access and adherence behaviors and nervousness about seeing a health care practitioner. Females compared with males were more likely to report asking for a lower-cost medication (APP, 25.12% [95% CI, 23.92%-26.32%] vs 20.84% [95% CI, 19.82%-21.86%]; ARD, 4.28 [95% CI, 2.65-5.90] percentage points), being unable to afford prescription medications (APP, 12.77% [95% CI, 11.93%-13.61%] vs 9.20% [95% CI, 8.47%-9.93%]; ARD, 3.57 [95% CI, 2.42-4.72] percentage points), delaying prescription fills (APP, 11.20% [95% CI, 10.38%-12.01%] vs 7.81% [95% CI, 7.12%-8.50%]; ARD, 3.39 [95% CI, 2.29-4.48] percentage points), and being nervous about seeing a health care practitioner (APP, 9.35% [95% CI, 8.57%-10.14%] vs 6.18% [95% CI, 5.56%-6.80%]; ARD, 3.17 [95% CI, 2.14-4.21] percentage points).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, females with AF reported a greater burden of HCAU barriers than males with AF. This finding may explain some of the observed differences in AF outcomes between sexes.

PMID:42348210 | DOI:10.1001/jamanetworkopen.2026.20128

JAMA Netw Open. 2026 Jun 1;9(6):e2620192. doi: 10.1001/jamanetworkopen.2026.20192.

ABSTRACT

IMPORTANCE: Individuals with chronic kidney disease (CKD) are disproportionately admitted to the intensive care unit (ICU); however, the association between CKD severity and outcomes after ICU admission remains uncertain.

OBJECTIVE: To evaluate the association between CKD severity and health outcomes after ICU admission.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study was conducted from November 1, 2008, to February 28, 2021. Participants included 531 090 consecutive adult (≥18 years) residents of Ontario, Canada, admitted to an ICU during the study period who had a baseline outpatient serum creatinine measurement within 7 to 365 days prior to admission. Statistical analyses were conducted from July 23, 2025, to April 16, 2026.

EXPOSURE: CKD severity was classified according to the baseline outpatient estimated glomerular filtration rate (eGFR) Kidney Disease Improving Global Outcomes criteria.

MAIN OUTCOMES AND MEASURES: Mortality (ICU, hospital, and 90-day mortality) and kidney replacement therapy (KRT) requirement in the ICU and dependence at 90 days.

RESULTS: The study included 531 090 adults (mean [SD] age, 67 [15] years; 57% men) admitted to the ICU. One in 4 individuals had preexisting CKD: stage 3a CKD, eGFR 45 to 59 mL/min/1.73 m2 (12% of adults); stage 3b CKD, eGFR 30 to 44 mL/min/1.73 m2 (7% of adults); stage 4 CKD, eGFR 15 to 29 mL/min/1.73 m2 (3% of adults); non-dialysis-dependent stage 5 CKD, eGFR less than 15 mL/min/1.73 m2 (1% of adults); and undergoing maintenance dialysis (2% of adults). Compared with individuals without CKD, the severity of the disease among individuals with CKD was progressively associated with increased mortality risk up to non-dialysis-dependent stage 5 CKD. However, the risk of mortality was lower for individuals receiving maintenance dialysis (odds ratio [OR], 1.92 [95% CI, 1.82-2.04]) compared with those with non-dialysis-dependent stage 5 CKD (OR, 2.32 [95% CI, 2.14-2.52]). Risk for KRT initiation in the ICU increased with CKD severity relative to individuals without CKD: stage 3a (adjusted OR [AOR], 1.79 [95% CI, 1.68-1.90]), stage 3b (AOR, 3.02 [95% CI, 2.83-3.22]), stage 4 (AOR, 6.71 [95% CI, 6.23-7.22]), and non-dialysis-dependent stage 5 (AOR, 32.00 [95% CI, 29.07-35.22]). Among those who initiated KRT in the ICU and survived to 90 days, KRT dependence at day 90 increased progressively by CKD stage: no CKD, 7.2%; stage 3a, 14.2%; stage 3b, 22.5%; stage 4, 50.3%; and previously non-dialysis-dependent stage 5, 83.8%.

CONCLUSIONS AND RELEVANCE: In this cohort study of consecutive adults admitted to the ICU, the presence and severity of CKD were associated with adverse health outcomes. These findings can inform risk prognostication, discussions about goals of care, resource allocation, and health policy initiatives for this large portion of the ICU population.

PMID:42348209 | DOI:10.1001/jamanetworkopen.2026.20192

Ir Med J. 2026 Jun 18;119(6):108.

ABSTRACT

AIMS: Mayo University Hospital performs approximately 350 joint arthroplasty surgeries per annum. We revised our analgesia protocol in 2024 based on best current practice.

METHODS: We conducted this evaluation from January to July 2025. All patients presenting for joint arthroplasty surgeries were invited to be included.

RESULTS: Our evaluation included 147 patients; 94 patients had a total hip arthroplasty and 53 had a total knee arthroplasty. The average age was 69 years, and 142 (96.5%) of patients were living at home independently before surgery. 53 (36%) were on prescribed analgesics pre-operatively. The average pain score on day 1 (day after surgery) was 4.8 for the hip arthroplasty patients and 5.5 for the knee arthroplasty patients. The total oral morphine equivalent requirements for the first 2 days were 48 mgs for the hip surgery patients and 65 mgs for the knee surgery patients. The median length of stay for all patients was 4 days. On follow up at 6 weeks, 135 (91%) of patients were mobilising independently. Overall satisfaction of the patient’s experience (0-10) was 8.7 for the knee arthroplasty patients and 8.8 for the hip arthroplasty patients.

DISCUSSION: Overall, we were satisfied with our analgesic protocol, but we want to improve the day 1 and 2 pain scores particularly in the knee arthroplasty patients. We are discussing the introduction of adductor canal blocks pre-operatively.

PMID:42348181

Infect Dis Ther. 2026 Jun 25. doi: 10.1007/s40121-026-01384-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Data on the influenza burden in Germany during and after the global COVID-19 pandemic are limited. This study presents nationwide trends in the clinical and economic inpatient burden of influenza and influenza-like illness (ILI) in the German population from 2019 to 2025.

METHODS: We conducted a descriptive, retrospective analysis of nationwide hospital data from the German Institute for Hospital Reimbursement covering six consecutive influenza seasons (2019-2020 to 2024-2025). Influenza/ILI hospitalizations were identified using the International Classification of Diseases version 10 (ICD-10) codes J09-J11 recorded as primary diagnosis. Outcomes included hospitalization counts, incidence rates, mean length of stay, ICU admissions, in-hospital mortality, and estimated costs, and were reported for three age groups (0-17 years, 18-59 years, ≥ 60 years). Regional variation across federal states was assessed using directly age-standardized rates.

RESULTS: We identified 240,646 influenza/ILI hospitalizations, with the highest burden observed in the 2024-2025 season (87,745 cases; incidence: 105.0/100,000 population). Less than 5000 cases were observed in both the 2020-2021 and 2021-2022 seasons. Across all seasons, adults aged ≥ 60 years accounted for 48% of hospitalizations and 92% of 10,054 in-hospital deaths. In this age group, in-hospital mortality ranged between 5.8% and 12.3% per season. Mean hospitalization costs per case increased during the study period and were highest in older adults, reaching €5430 in 2023-2024 and €5421 in 2024-2025. Total inpatient costs of influenza/ILI were highest in 2024-2025 and estimated at €390 million. Regional hospitalization rates varied considerably, but patterns were inconsistent across seasons.

CONCLUSIONS: Influenza/ILI causes a substantial and re-emergent inpatient burden in Germany, disproportionately affecting older adults. These findings highlight the need for sustained prevention efforts to reduce the burden of influenza/ILI in Germany. Further research is needed to understand the substantial regional disparities between federal states.

PMID:42348163 | DOI:10.1007/s40121-026-01384-7

J Clin Hypertens (Greenwich). 2026 Jun;28(6):e70321. doi: 10.1111/jch.70321.

ABSTRACT

Carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV) are widely used indicators of arterial stiffness, with cfPWV considered the gold standard and baPWV increasingly applied in Asian populations. In this community-based cohort from Beijing, we compared the associations of cfPWV and baPWV with the risk of new-onset cardiovascular events. A total of 5723 residents from the Shougang community with available cfPWV and baPWV measurements from the 2018 follow-up survey were included. CfPWV was measured using Pulsepen and baPWV using the Omron BP-203RPE III device. Cardiovascular events, defined as a composite outcome of cardiovascular death, first-ever myocardial infarction, or stroke, were identified from national and municipal registries through December 31, 2021. Over a median follow-up of 3.15 years, 173 cardiovascular events occurred. Both cfPWV and baPWV were associated with incident cardiovascular events in Kaplan-Meier analyses. However, in multivariable Cox regression models adjusting for traditional cardiovascular risk factors, cfPWV showed a nonsignificant trend (p = 0.072), while baPWV remained significantly associated with new-onset events (p < 0.001). These findings indicate that in this community-based population, baPWV, but not cfPWV, demonstrates a robust association with cardiovascular risk, suggesting that baPWV may serve as a more practical and effective tool for routine cardiovascular risk assessment in Asian populations.

PMID:42348156 | DOI:10.1111/jch.70321

3D Print Med. 2026 Jun 25. doi: 10.1186/s41205-026-00329-7. Online ahead of print.

ABSTRACT

BACKGROUND: The Latarjet procedure is effective for treating recurrent anterior shoulder instability, but graft-related complications may occur. Accurate preoperative planning is essential to minimize these complications. Three-dimensional (3D) printed models may support surgical planning; however, their role in Latarjet surgery remains unclear. This study aimed to evaluate whether coracoid dimensions measured on 3D-printed models differ from intraoperative measurements and whether their use influences surgical decision-making.

METHODS: In this cross-sectional study, 25 patients underwent computed tomography based 3D printing of the scapula. Coracoid length, width, and thickness were measured on the 3D-printed models and compared with intraoperative pre- and post-osteotomy measurements using precision calipers. Surgeons also subjectively rated the usefulness of the 3D models for surgical planning.

RESULTS: No significant differences were observed in coracoid thickness among the three measurement time points (p = 0.6956). Significant differences were found for coracoid length (p = 0.0005) and width (p = 0.02) between the 3D model and pre-osteotomy measurements, while no differences were observed between pre- and post-osteotomy measurements. The models were rated as “very helpful” in 28% of cases, “somewhat helpful” in 52%, and “not helpful” in 20%. In three cases, preoperative planning with the 3D model resulted in a change in fixation strategy.

CONCLUSION: Three-dimensional printed coracoid models provide reliable estimation of coracoid thickness and may assist in preoperative planning in selected Latarjet procedures, particularly when graft adequacy or fixation strategy is uncertain. Although statistically significant differences in length and width were observed, the models were considered helpful in most cases.

LEVEL OF EVIDENCE: IV.

PMID:42348155 | DOI:10.1186/s41205-026-00329-7

EJNMMI Res. 2026 Jun 25. doi: 10.1186/s13550-026-01474-0. Online ahead of print.

ABSTRACT

BACKGROUND: Fibroblast activation protein (FAP)-targeted radionuclide therapy is a promising approach for patients with advanced or metastatic medullary thyroid carcinoma (MTC). This study evaluates efficacy, safety, and survival outcomes of [¹⁷⁷Lu]/[²²⁵Ac]-DOTAGA.Glu.(FAPi)₂ therapy in this population.

RESULTS: Nineteen patients with progressive MTC were treated with either [¹⁷⁷Lu]Lu-DOTAGA.Glu.(FAPi)₂ or [²²⁵Ac]Ac-DOTAGA.Glu.(FAPi)₂, receiving a median of 5 cycles. The median cumulative activity administered was 20.3 GBq (Lu) and 6.66 MBq (Ac) and the median follow-up was 21 months. Of the 17 evaluable patients, radiological response was assessed in 15 patients using the Response Evaluation Criteria in Solid Tumors (RECIST 1.1). The analysis demonstrated a partial response (PR) in 33% of patients, stable disease (SD) in 47%, and progressive disease (PD) in 20%, resulting in a disease control rate (DCR) of 80%. Positron emission tomography response criteria in solid tumors (PERCIST) evaluation (n = 15) showed 47% PR, 40% SD, and 13% PD. Biochemical response was evaluable in 14 patients: 64.2% showed stable or decreasing tumor markers. Median calcitonin doubling time was 6.7 months. Clinical progression occurred in 2 patients. Median PFS was 26 months; median OS was 42 months. No statistically significant difference in OS was observed between progression and non-progression groups (log-rank p-0.758). No Grade 4 or life-threatening toxicities were observed. Only two patients experienced Grade 3 adverse events-one with elevated alkaline phosphatase and one with worsening anemia. All other hematologic and biochemical toxicities were limited to Grade 1-2.

CONCLUSION: [¹⁷⁷Lu]/[²²⁵Ac]-DOTAGA.Glu.(FAPi)₂ therapy shows encouraging disease control, acceptable safety, and preliminary efficacy signals such as increased survival in the treated patients of advanced MTC.

PMID:42348144 | DOI:10.1186/s13550-026-01474-0

Drugs Real World Outcomes. 2026 Jun 25. doi: 10.1007/s40801-026-00563-9. Online ahead of print.

ABSTRACT

BACKGROUND: Potential Drug-drug interactions (pDDIs) are a significant cause of adverse drug events and can compromise treatment outcomes, especially in hospitalized patients who are prescribed multiple medications. Pulmonary patients are especially vulnerable due to polypharmacy and the presence of multiple co-morbid conditions. This study aimed to determine the prevalence of pDDIs and identify associated risk factors among hospitalized pulmonary patients.

METHODS: A cross-sectional study was conducted among pulmonary patients admitted to a tertiary care hospital in Nepal between July 2024 and December 2025. Patients with a hospital stay of ≥ 24 h and receiving two or more medications were included. Data on socio-demographics, clinical conditions, and medications were collected using a structured form. pDDIs were identified using Lexicomp and IBM Micromedex. Descriptive statistics, bivariate analysis, and binary logistic regression were performed using SPSS V16, with p < 0.05 considered statistically significant.

RESULTS: Out of 377 patients who met the inclusion criteria, Lexicomp and Micromedex identified 36.1% and 19.9% pDDIs, respectively. A moderate agreement was observed between Lexicomp and Micromedex in identifying pDDIs (Cohen’s Kappa = 0.547). Micromedex classified most interactions as major (53.33%), while Lexicomp classified 66.18% as major severity; however, these classifications were based on screening databases and not confirmed clinical adverse events. Polypharmacy, longer hospital stays, presence of co-morbidities, alcohol consumption, and advanced age were significantly associated with an increased risk of pDDIs.

CONCLUSION: pDDIs are prevalent among hospitalized pulmonary patients and are closely linked to polypharmacy and complex clinical profiles. Routine medication review and the use of drug interaction screening tools are essential to minimize the risk of harmful interactions.

PMID:42348143 | DOI:10.1007/s40801-026-00563-9

Discov Ment Health. 2026 Jun 25. doi: 10.1007/s44192-025-00238-x. Online ahead of print.

ABSTRACT

BACKGROUND: Providing care to a family member who has been diagnosed with cancer can be quite tiresome both physically as well as psychologically; therefore, emotional preparedness within the family will contribute significantly in offering effective care. This study investigated the effects of acceptance and commitment therapy (ACT) on communication avoidance, emotional distress and hyper arousal among caregivers of patients with advanced breast cancer.

METHODS: This study was a randomized controlled trial with pretest-posttest follow-up design. The study sample were 80 caregivers of advanced breast cancer patients from Mashhad City, Khorasan Province, Iran, in 2023, who were selected by the convenience sampling method. The research instruments included a demographic, communication avoidance, positive and negative affect, and hyperarousal questionnaire. Eight weeks of intervention was conducted following the pre-test. The post-test and follow-up were conducted one week and three month post intervention. The data were analyzed using repeated measures MANOVA.

RESULTS: A statistically significant difference was observed between the intervention and control groups in the mean scores of communication avoidance, positive and negative affect, and hyperarousal questionnaire one week and three month after intervention. The intervention group demonstrated higher scores than the control in positive affect but lower in communication avoidance, negative affect, and hyperarousal. The intervention had a positive effect on the intervention group over time, with no significant differences observed between the post-test and follow-up stages (p < .001).

CONCLUSION: According to these results, ACT was effective in reducing communication avoidance and negative emotions and decreasing hyperarousal among caregivers. Thus, results point to the potential of ACT to contribute not only to emotional regulation but also to healthier coping with the burden associated with providing cancer caregiving.

PMID:42348142 | DOI:10.1007/s44192-025-00238-x

Aging Clin Exp Res. 2026 Jun 25. doi: 10.1007/s40520-026-03441-0. Online ahead of print.

ABSTRACT

BACKGROUND: The objective of this cross-sectional observational study was to validate a scale that highlights the personal and environmental barriers that hinder adherence to regular physical exercise in older adults.

METHODS: Individuals aged 60 years or over, sedentary and/or ex-practitioners, regular practitioners of physical exercise, with Brazilian Portuguese as their mother tongue. In addition to the Regular Physical Exercise Adherence Scale (REPEAS), the following instruments were applied: sociodemographic data sheet and Baecke Habitual Physical Activity Questionnaire. The measurement properties tested were: structural validity, construct validity, reliability, consistency internal and ceiling and floor effects.

RESULTS: This research involved 200 older adults’ participants, predominantly women. The confirmatory factor analysis supported the two-domain, 12-item structure of the REPEAS, demonstrating good model fit with the following indices: chi-square/degrees of freedom = 1.60, comparative fit index = 0.965, Tucker-Lewis index = 0.957, root mean square error of approximation = 0.078, and standardized root mean square residual = 0.078. Construct validity was evidenced by a statistically significant difference (p < 0.05) in the personal factors domain between groups. Additionally, the domains of the REPEAS showed appropriate correlations with the items in the factor analysis. Reliability was acceptable, with composite reliability ≥ 0.84 and intraclass correlation coefficient ≥ 0.89.

CONCLUSION: This scale presented adequate measurement properties when tested on Brazilian older adults to assess environmental and personal barriers to regular physical exercise. However, as this was a study conducted with a convenience sample, generalization of the findings should be made with caution. Despite this, the REPEAS can serve as a practical tool for health professionals and researchers to identify modifiable barriers and guide strategies to promote physical activity among older adults.

TRIAL REGISTRATION: Not applicable.

PMID:42348141 | DOI:10.1007/s40520-026-03441-0