Tag: statistics

J Voice. 2026 Aug 25:S0892-1997(26)00402-9. doi: 10.1016/j.jvoice.2026.07.049. Online ahead of print.

ABSTRACT

OBJECTIVE: Online, crowdsourced sampling (OCS) platforms such as Amazon’s Mechanical Turk and CloudResearch Connect enable faster, cheaper, and larger-scale data collection than in-person sampling methods. However, OCS platforms are often criticized due to data quality concerns. This study examines a battery of screening tools to determine which best predicts data quality and to quantify the influence of low-quality data on the statistical properties of the samples. Finally, we issue recommendations to researchers interested in OCS-based clinical voice research that may reduce costly missteps when fielding their first OCS studies.

METHODS: To evaluate the suitability of OCS for clinical voice research, survey-based measures of vocal function, vocal fatigue, personality, communicative quality of life, and other factors were collected on Qualtrics from (1) a convenience sample of undergraduate students (n = 47), (2) Mechanical Turk users (n = 495), and (3) Connect users (n = 99) over 6 months. Low-quality responses were eliminated using six screening tools in four nested stages. Logistic regression was used to identify variables that strongly predicted data quality. Finally, patient-reported outcome measure (PROM) responses were compared between the high- and low-quality groups.

RESULTS: Depending on the stage, data quality screenings flagged between 5.00% (n = 32) and 13.6% (n = 87) of responses as low-quality. Hispanic/Latino ethnicity and long response times most strongly predicted low-quality responses, which uniformly exhibited more severe ratings of health- and voice-related disability than did high-quality responses.

CONCLUSIONS: Content-based screenings, particularly analysis of responses to open-ended questions, meaningfully augmented automated screenings. Low-quality respondents systematically over-reported health- and voice-related disability, a severity bias with plausible economic and behavioral explanations. The emergence of AI-generated responses represents an evolving and distinct challenge that content-based screening may be increasingly insufficient to address. We provide recommendations for collecting high-quality data on OCS platforms to minimize barriers to entry for future clinical voice research.

PMID:42642244 | DOI:10.1016/j.jvoice.2026.07.049

Int J Spine Surg. 2026 Aug 25:8939. doi: 10.14444/8939. Online ahead of print.

ABSTRACT

BACKGROUND: Cervical ossification of the posterior longitudinal ligament (OPLL) frequently progresses despite decompression surgery, leading to recurrent myelopathy. This meta-analysis aims to quantify risk factors for OPLL progression, compare surgical strategies, and determine the pooled reoperation rate due to symptomatic progression.

METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 26 high-quality studies comprising 1929 patients were included. Standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals were calculated to assess risk factors, and all of the analyses were done with a random-effects model. A network meta-analysis using a random-effects model was conducted to compare surgical approaches, utilizing laminoplasty (LP) as the reference node.

RESULTS: Significant demographic risk factors for OPLL progression included younger age (SMD: -0.68, P < 0.001) and higher body mass index (SMD: 0.43, P < 0.001). Radiographically, progression was strongly driven by longer preoperative OPLL (SMD: 0.42, P = 0.003), a lower preoperative cervical range of motion (SMD: -0.30, P = 0.039), and OPLL at the C3 level (OR: 7.04, P < 0.001). Mixed-type OPLL nearly tripled the progression risk (OR: 2.94, P < 0.001), whereas segmental-type was highly protective (OR: 0.13, P < 0.001).The network meta-analysis demonstrated that motion-preserving posterior surgeries were associated with higher rates of OPLL progression. Compared with LP, anterior surgery provided the greatest reduction in progression risk (OR 0.28, P < 0.001), followed by laminectomy with fusion (OR 0.42, P < 0.001). Direct pairwise comparisons similarly confirmed that laminectomy with fusion significantly reduced the likelihood of progression compared with LP (OR 0.44, P = 0.002). Nonsurgical management was also associated with lower odds of progression; however, this finding should be interpreted with caution due to potential confounding by indication. Additionally, the pooled long-term reoperation rate due to neurological deterioration from OPLL progression was 6.1% (95% confidence interval 2.9%-10.2%) over a mean follow-up of 72.6 ± 63.7 months.

CONCLUSIONS: OPLL progression is statistically predictable, driven by younger age, higher body mass index, reduced cervical range of motion, and mixed-type morphology. Because anterior and fusion procedures were associated with lower progression rates compared with LP, these approaches should be considered in high-risk patients; however, these findings should be interpreted with caution given the heterogeneity across included studies.

CLINICAL RELEVANCE: For patients with high-risk profiles (eg, mixed-type OPLL), fusion or anterior decompression should be strongly considered over LP. When laminoplasty is used in high-risk patients, they should be advised on the necessity of long-term surveillance.

PMID:42642207 | DOI:10.14444/8939

Ann Rehabil Med. 2026 Aug 26. doi: 10.5535/arm.260035. Online ahead of print.

ABSTRACT

OBJECTIVE: To clarify the influence of recording electrode placement on F-wave parameters, we investigated F-wave parameters recorded from the abductor pollicis brevis muscle using different recording electrode positions.

METHODS: Thirteen healthy volunteers participated. Recording electrodes were placed at four locations (20, 30, 40, and 50 mm from the reference electrode). The stimulating electrode was positioned over the median nerve at the wrist, and the reference electrode was placed on the distal tendon of the abductor pollicis brevis muscle. Stimulation intensity was set at 1.2 times that required to elicit the maximal M-wave amplitude. Thirty stimuli were delivered at 0.5 Hz. Outcome measures included M-wave latency and amplitude, F-wave mean latency and amplitude, F/M amplitude ratio, and F-wave persistence. Data were analyzed using one-way repeated-measures analysis of variance, and effect sizes were calculated using partial η².

RESULTS: M-wave amplitude varied substantially according to recording electrode position (partial η²=0.50). In contrast, effect sizes were small for most F-wave parameters. The F/M amplitude ratio did not reach statistical significance but demonstrated a moderate-to-large effect size (partial η²=0.24).

CONCLUSION: Recording electrode placement substantially affected M-wave amplitude and may also influence the F/M amplitude ratio. Therefore, consistent electrode placement should be maintained when interpreting these parameters in clinical or research settings. However, given the relatively small sample size, clinically meaningful effects on other F-wave parameters cannot be excluded and should be investigated in larger studies.

PMID:42642177 | DOI:10.5535/arm.260035

Taiwan J Obstet Gynecol. 2026 Sep;65(5):944-951. doi: 10.1016/j.tjog.2026.07.002.

ABSTRACT

OBJECTIVE: Anti-Müllerian hormone (AMH) is widely used as a marker of ovarian reserve, but its predictive value for pregnancy remains uncertain. We aimed to evaluate whether pre-pregnancy AMH predicts pregnancy with or without assisted reproductive technology (ART).

MATERIALS AND METHODS: This population-based register study included women aged 18-50 years from the Copenhagen Capital Region with a baseline AMH measurement between 2010 and 2022. Data were linked to national health registers via Statistics Denmark. The primary outcome was confirmed pregnancy, defined by the presence of a first-trimester biochemical screening (PAPP-A and free β-hCG). Women were stratified into subgroups based on ART (yes/no) and maternal age (<25, 25-30, 30-35, 35-40, >40 years). Associations were assessed using multivariable regression and ROC curve analysis.

RESULTS: Of 43,269 women, 27,395 women had a confirmed pregnancy, and 15,874 women did not within a 3-year follow-up period after measurement of AMH. We found an overall positive association between AMH and confirmed pregnancy, adjusted for age, fertility treatment and relevant comorbidities. ROC analyses showed modest predictive value (AUC 0.50-0.69), highest in women >40 years without ART.

CONCLUSION: AMH was positively associated with pregnancy but with a poor predictive value.

PMID:42642154 | DOI:10.1016/j.tjog.2026.07.002

Taiwan J Obstet Gynecol. 2026 Sep;65(5):932-937. doi: 10.1016/j.tjog.2026.04.001.

ABSTRACT

OBJECTIVE: To evaluate the long-term effects of HIFU ablation on quality of life, symptom severity, and psychological states (depression, anxiety, and stress) in women with uterine fibroids at least two years post-treatment.

MATERIALS AND METHODS: This retrospective cohort study investigated 38 patients who underwent HIFU ablation for uterine fibroids at Chung Shan Medical University Hospital from 2015 to December 2018. Participants completed validated questionnaires including the Depression, Anxiety, and Stress Scale-21 Items (DASS-21) and the Uterine Fibroid Symptom and Health-related Quality of Life (UFS-QOL) questionnaire. Statistical analyses included descriptive statistics, correlation analysis, ANOVA, and logistic regression.

RESULTS: The mean patient-rated symptom severity score (SSS) was 28.87, and the mean total health-related quality of life (HRQOL) score was 61.39. Over 60% of patients demonstrated normal scores in depression, anxiety, and stress domains. Significant negative correlations were found between HRQOL items and symptom severity scale (all p < 0.05). Positive correlations were observed between symptom severity and depression/anxiety/stress scores. For each one-point increase in disease severity, the likelihood of experiencing depression, anxiety, and stress increased by 1.041, 1.043, and 1.027 times, respectively.

CONCLUSION: HIFU ablation demonstrates favorable and sustained long-term efficacy in managing symptoms. Crucially, psychological well-being plays a central role in determining long-term quality of life, with psychological factors explaining a significant proportion of HRQOL variance. This interplay underscores the necessity of integrating routine psychological screening (such as DASS-21) and adopting a holistic, multidisciplinary approach to long-term follow-up care for uterine fibroid patients.

PMID:42642152 | DOI:10.1016/j.tjog.2026.04.001

BMJ Glob Health. 2026 Aug 25;11(8):e024479. doi: 10.1136/bmjgh-2026-024479.

ABSTRACT

INTRODUCTION: Pleasure is a key reason why people have sex. Yet many sexual and reproductive health (SRH) programmes do not consider the fundamental role of pleasure, focusing primarily on the prevention of pregnancy and sexually transmitted infections. Moreover, there is limited policy-ready evidence on pleasure-based sexual and reproductive healthcare (PBSRH), including implementation guidance, costs, impacts and return on investment at scale.

METHODS: We conducted semi-structured interviews with nine PBSRH providers to characterise the incremental activities required to implement PBSRH relative to conventional SRH. Using activity-based costing, we estimated the costs of integrating pleasure principles into existing SRH programmes for 15-24-year-olds in 99 low- and middle-income countries (LMICs) over 2026-2035. We focused on a narrow behavioural pathway – increased condom use – and projected its effects on (1) Unintended pregnancies, abortions, maternal and child mortality using methods consistent with Guttmacher’s Adding it Up approach and (2) HIV outcomes using the Goals-Spectrum application. We undertook a prospective, societal benefit-cost analysis to estimate global, regional and country-level return on investment.

RESULTS: Eighteen incremental activities are commonly undertaken when integrating pleasure into SRH programmes. The estimated incremental cost of these activities for 15-24 year olds in LMICs is $1.6 billion (95% CI $1.1 to $2.2) over 10 years. This is expected to lead to 30.7 million (95% CI 17.8 to 41.1) additional years of condom use, averting 4.3 million pregnancies (95% CI 2.1 to 6.7) and 2.1 million abortions (95% CI 1.1 to 3.4). PBSRH integration would avert 92 318 deaths by 2050 (95% CI 47 965 to 139 835), ~80% relating to women and children. The expected return on investment is $22.9 (95% CI $13.8 to $37.6) in benefits per $1 of incremental cost. The largest benefits and returns are in Sub-Saharan Africa and Latin America and the Caribbean.

CONCLUSION: PBSRH is a cost-effective and high-return intervention to support global SRHR and HIV/AIDS goals for young people in LMICs.

PMID:42642104 | DOI:10.1136/bmjgh-2026-024479

BMJ. 2026 Aug 25;394:e100526. doi: 10.1136/bmj-2026-100526.

NO ABSTRACT

PMID:42642089 | DOI:10.1136/bmj-2026-100526

BMJ Open. 2026 Aug 25;16(8):e121200. doi: 10.1136/bmjopen-2026-121200.

ABSTRACT

INTRODUCTION: Diabetic cardiomyopathy (DCM) is an important contributor to heart failure and death in patients with diabetes. Current management strategies mainly focus on glycaemic control and symptomatic treatment with limited disease-specific therapeutic options available. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated promising cardioprotective effects beyond glucose lowering; however, their efficacy and safety in DCM remain unclear. Therefore, this protocol describes the methods for a systematic review and meta-analysis to evaluate the efficacy and safety of GLP-1RAs in patients with DCM.

METHODS AND ANALYSIS: A systematic search will be conducted in PubMed (National Library of Medicine), Embase (Elsevier), the Cochrane Library (Wiley) and Web of Science (Clarivate Analytics), along with clinical trial registries and other relevant sources, up to 31 December 2026. All randomised controlled trials investigating GLP-1RAs for the treatment of DCM will be included. The primary outcomes will be cardiac function parameters, including left ventricular ejection fraction and left ventricular fractional shortening, while secondary outcomes will include metabolic indicators such as glycaemic and lipid profiles, biochemical markers such as oxidative stress-related indices and safety outcomes. Study selection and data extraction will be performed independently by two reviewers and risk of bias will be evaluated using version 2 of the Cochrane Risk of Bias tool. Statistical analyses will be performed using Stata V.16.0. Pooled effect sizes will be calculated using mean differences for continuous outcomes and risk ratios for dichotomous outcomes, with fixed-effect or random-effect models applied as appropriate. Meta-regression, subgroup and sensitivity analyses will be conducted to investigate the sources of heterogeneity. Publication bias will be assessed using funnel plots and Egger’s test, and the certainty of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

ETHICS AND DISSEMINATION: Ethical approval is not required because this protocol relies exclusively on secondary analysis of previously published randomised trial data. The review findings will be disseminated through peer-reviewed journal publication.

PROSPERO REGISTRATION NUMBER: CRD420261360886.

PMID:42642087 | DOI:10.1136/bmjopen-2026-121200

BMJ Open. 2026 Aug 25;16(8):e121099. doi: 10.1136/bmjopen-2026-121099.

ABSTRACT

INTRODUCTION: Perioperative monitoring requires clinicians to integrate multiple physiological data streams while managing interruptions and audible alarms. The Visual Patient Avatar (VPA) is an avatar-based monitor visualisation that integrates vital signs and sensor states into an animated virtual patient. This protocol evaluates whether VPA implementation is associated with objective changes in monitoring and alarm outcomes during routine perioperative care.

METHODS AND ANALYSIS: This investigator-initiated, dual-centre, quasi-experimental pre-post observational study uses routine perioperative monitoring and alarm data from NewYork-Presbyterian/Weill Cornell, USA and University Hospital Zurich, Switzerland. It includes approximately 58 000 anaesthesia cases (16 000 and 42 000, respectively); adult and paediatric cases will be analysed separately. Data span pre-implementation, adaptation and post implementation phases; technical deployment intervals are excluded. Each anaesthesia case is one unit of analysis. The primary outcome is the duration of vital-sign deviation per 60 min of valid measurement. Secondary outcomes are a time-based area under the curve metric and audible alarm burden (count, time and reaction time). Multivariable models will adjust for patient, procedure and care-context covariates. Analyses will be performed separately by centre.

ETHICS AND DISSEMINATION: The Weill Cornell Medicine Institutional Review Board approved the study and granted a waiver of informed consent (IRB No. 22-05024803). At University Hospital Zurich, only cases from patients with written general consent for research use of routinely collected health data were included. The Cantonal Ethics Committee Zurich issued a declaration of non-jurisdiction (BASEC Req-2021-00756; 6 July 2021), and the University Hospital Zurich Data Governance Board approved data export and anonymisation (DGR0000504; 31 January 2025). A data-sharing agreement was established on 11 April 2023. Data-collection windows are complete; extraction, linkage and quality control are ongoing, and no comparative outcome analyses have been performed. Findings will be disseminated through peer-reviewed publications and conferences.

PMID:42642085 | DOI:10.1136/bmjopen-2026-121099

BMJ Open. 2026 Aug 25;16(8):e120667. doi: 10.1136/bmjopen-2026-120667.

ABSTRACT

INTRODUCTION: The transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) represents a critical period of vulnerability, often marked by care discontinuities and adverse clinical outcomes. International studies have highlighted the risks associated with this transition, but local epidemiological data remain scarce in France. The Odyssée study aims to provide local data to inform the development of structured transition pathways.

METHODS AND ANALYSIS: This prospective monocentric cohort study will be conducted at Lenval University Children’s Hospital in Nice, the only paediatric hospital providing dedicated child psychiatry emergency services in the Alpes-Maritimes department. Recruitment started in April 2026 and is ongoing at the time of manuscript submission. Study completion is anticipated in September 2028. The primary objective is to determine the annual prevalence of 17-year-olds living in Nice who attend child and adolescent psychiatry services using administrative data combining census counts from the French National Institute of Statistics and Economy Studies and hospital discharge records (Programme de médicalisation des systèmes d’information (PMSI)).In parallel, a prospective cohort of 100 adolescents aged 17 years will be followed for 12 months to address secondary objectives, including clinical profiles, care trajectories, transition readiness, clinical outcomes and determinants of care continuity. Assessments will be conducted at baseline, 6 months and 12 months using validated instruments (Mini International Neuropsychiatric Interview-simplified (MINI-S), WHO Quality of Life-brief (WHOQOL-BREF), Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), Transition Readiness and Appropriateness Measure (TRAM), Transition Related Outcome Measure (TROM)). Descriptive and multivariable analyses will be performed to identify factors associated with continuity of care. This study is expected to provide one of the first city-level estimates of psychiatric transition needs in France and contribute to the international literature on continuity of care, youth mental health trajectories and transitional service organisation.

ETHICS AND DISSEMINATION: The study has been approved by the Comité de Protection des Personnes Sud-Ouest et Outre-Mer IV (approval number 2025-A01581-48). Written informed consent will be obtained from participants and one parent or legal guardian. Findings will be disseminated through peer-reviewed publications, scientific conferences and reports to regional health authorities.

TRIAL REGISTRATION NUMBER: NCT07068945.

PMID:42642081 | DOI:10.1136/bmjopen-2026-120667