Tag: statistics

J Cardiovasc Nurs. 2026 Aug 12. doi: 10.1097/JCN.0000000000001380. Online ahead of print.

ABSTRACT

BACKGROUND: Poor diabetes self-management is prevalent in individuals with diabetes and can result in macro- and micro-cardiovascular diabetes complications. Diabetes knowledge may impact diabetes self-management directly and indirectly via the impact on diabetes self-efficacy. However, these relationships have rarely been examined among individuals with diabetes, controlling for potential psychosocial, demographic, and clinical covariates.

OBJECTIVE: To investigate whether diabetes knowledge was associated with diabetes self-management directly and indirectly via diabetes self-efficacy, controlling for depressive symptoms, diabetes distress, self-esteem, self-compassion, resilience, social support, body mass index, and age.

METHODS: Baseline data from 2 studies were used in this cross-sectional, correlational study. Data on all study and demographic variables were collected from 228 adults with diabetes (mean age: 56.5 years) in 2023 and 2025. PROCESS Macro for the Statistical Package for Social Sciences (Model 4; 5000 bootstraps; 95% confidence intervals [CIs]) was used to examine the suggested relationships.

RESULTS: The mean diabetes knowledge score was 10.7 out of 13 (standard deviation [SD] = 1.9); the mean diabetes self-efficacy score was 28.0 (SD = 6.1); and the mean diabetes self-management score was 18.0 (SD = 6.3). Stronger diabetes knowledge showed a direct relationship with better diabetes self-management (effect(B) = 0.779, 95% bootstrap CI = 0.401, 1.157) and an indirect relationship through higher levels of diabetes self-efficacy (effect(B) = 0.193, 95% bootstrap CI = 0.078, 0.333).

CONCLUSIONS: Diabetes knowledge was associated with diabetes self-management directly and indirectly via diabetes self-efficacy. Clinicians and researchers may modify diabetes knowledge to improve diabetes self-efficacy, and, in turn, diabetes self-management.

PMID:42585591 | DOI:10.1097/JCN.0000000000001380

JMIR Form Res. 2026 Aug 12;10:e100764. doi: 10.2196/100764.

ABSTRACT

BACKGROUND: Consumer wearable activity monitors are increasingly being used as end points in exercise-oncology trials and in clinical decision-making, yet their accuracy is unvalidated in lung cancer, where slow, fragmented gait may challenge step-counting algorithms.

OBJECTIVE: This study assessed the criterion validity of the Fitbit Charge 6 device against video-recorded direct observation in adults with lung cancer under controlled laboratory conditions. We aimed to describe step-count agreement across walking bout durations and gait speeds, and to compare its accuracy in classifying active vs sedentary minutes and detecting spurious steps across nonwalking activities.

METHODS: Fourteen adults diagnosed with stage I-IV lung cancer completed a cross-sectional, in-laboratory validation study at The Ohio State Wexner Medical Center. Participants wore the Fitbit Charge 6 device on their nondominant wrist while completing variable-duration walking trials (5, 15, and 30 seconds); self-selected gait speed trials across 8 progressively faster speeds; and standing, sitting, lying, and fidgeting tasks. All activities were video recorded and coded at a 1-second resolution. Step count agreement was evaluated using repeated-measures Bland-Altman analysis (mean bias and 95% limits of agreement), supported by mean absolute percentage error (MAPE) and intraclass correlation coefficients (ICCs). Minute-level activity intensity classification was assessed via a pooled confusion matrix using a majority-rule active-minute threshold of ≥30 seconds. Spurious step detection was descriptively analyzed across nonwalking minutes, stratified by fidgeting status.

RESULTS: Across 126 walking trials, the Fitbit device undercounted steps by only a small absolute margin, which was consistent across bout durations (bias of 1-3 steps), but relative agreement was poor and strongly duration dependent (MAPE 50.6% at 5 seconds vs 16.3%-18.7% at 15-30 seconds). The ICC was low (overall ICC[A,1]=0.21). Across 111 gait speed trials, undercounting was the greatest at gait speeds below 0.6 m/s (bias of approximately 13 steps; MAPE 56.6%) and was minimized near 1.0-1.2 m/s, with a quadratic mixed-effects model confirming a nonlinear speed-error relationship (P<.001). For activity intensity classification, sensitivity was high (0.91), but specificity was modest (0.63), and the positive predictive value was low (0.31), reflecting frequent misclassification of sedentary minutes as active. Among 267 nonwalking minutes, 33 (12.4%) contained at least one spurious step, with higher false-positive rates during fidgeting (24/167, 14.4%) than nonfidgeting (9/100, 9.0%) periods.

CONCLUSIONS: The Fitbit Charge 6 device provides improved step counts during sustained, moderate-speed walking but introduces a clinically meaningful error during short bouts and at slower gait speeds, which are frequently noted in adults with lung cancer. High sensitivity but low specificity for activity intensity classification suggests systematic overestimation of active minutes. These findings have implications for the design and interpretation of exercise-oncology interventions relying on consumer wearable-derived end points in this population.

PMID:42585577 | DOI:10.2196/100764

Brief Bioinform. 2026 Jul 3;27(4):bbag434. doi: 10.1093/bib/bbag434.

ABSTRACT

Single-cell DNA methylation (scDNAm) profiling is revolutionizing our understanding of epigenetic control of gene expression, but its accurate analysis is severely hindered by extreme data sparsity. While imputation methods have undergone remarkable development in recent years, a rigorous benchmark to guide method selection remains absent. We established the first systematic benchmarking framework for scDNAm imputation, subjecting five state-of-the-art methods to a comprehensive evaluation across 13 published experimental scDNAm datasets. Performance was systematically assessed across seven critical dimensions: accuracy, sensitivity to data characteristics, scalability, robustness to data splitting strategies, inter-dataset generalizability, convergence behavior, and computational efficiency. Through rigorous statistical analysis, we dissected the influence of intrinsic data attributes and model architectures on the fidelity of scDNAm imputation to provide guidance for selecting appropriate methods for given scenarios. Furthermore, based on the benchmark-identified limitations, we proposed a dual-view strategy to address the performance bottlenecks of existing methods: at the model view, we developed BridgeCpG, an ensemble strategy to integrate complementary modeling strengths to overcome single-model limitations; at the data view, we introduced an adaptive divide-and-conquer strategy to partition highly heterogeneous datasets into several homogeneous subsets amenable to accurate imputation, followed by aggregating the sub-results. This integrated framework, spanning both model and data views, delivers quantitative analyses, scenario-aware selection guidelines, and targeted innovative strategies, establishing a rigorous, enabling foundation for accurate, high-throughput, and scalable next-generation single-cell epigenomic analysis.

PMID:42585575 | DOI:10.1093/bib/bbag434

Work. 2026 Aug 12:10519815261469529. doi: 10.1177/10519815261469529. Online ahead of print.

ABSTRACT

BackgroundRapid AI integration into healthcare necessitates proactive action to leverage benefits and reduce risks to clients and occupational therapy. Research on AI integration in occupational therapy shows promising outcomes.ObjectiveThis study assessed knowledge, use, and attitudes regarding AI in occupational therapy worldwide to inform development of guidance documents and resources for future policy, professional development, and practice in occupational therapy.MethodsThis cross-sectional descriptive study was conducted using a 28-item electronic survey. A global panel convened by the World Federation of Occupational Therapists (WFOT) reviewed the survey and translated it from English into French, German, and Spanish. WFOT distributed the survey via online communications and social media between September and November 2025. Analysis included descriptive statistics, nonparametric tests, and thematic analysis.ResultsResponses from 884 surveys representing 81 countries were analyzed. Most respondents were occupational therapists (87.8%), and one-third had over 20 years of experience. Two-thirds (68.4%) expressed positive views toward AI integration in occupational therapy. Over half (56.3%) reported using AI at work, most often for documentation, administrative tasks, education, research, intervention planning, and communication. Respondents learned about AI through online resources, peer networks, and continuing education. Qualitative analysis revealed three themes related to equity, implementation conditions, and ethical responsibilities.ConclusionsThe findings reveal high interest and increasing AI use for workflow support. Although attitudes were generally positive, respondents also raised important concerns. Professional organizations have an essential role in developing guidelines related to AI in occupational therapy, supporting education, ensuring ethical use, and advocating for research.

PMID:42585570 | DOI:10.1177/10519815261469529

Sex Med Rev. 2026 Jun 30;14(3):qeag057. doi: 10.1093/sxmrev/qeag057.

ABSTRACT

INTRODUCTION: Sexual dysfunction (SD) is an important complication in dialysis patients that affects quality of life but remains under-recognized in clinical practice. Previous reviews have mainly focused on prevalence, whereas systematic quantification of associated factors, sex-stratified comparisons, and evidence certainty evaluations remain limited.

OBJECTIVES: This meta-analysis aimed to identify factors associated with SD in dialysis patients and explore sex-specific differences.

METHODS: This systematic review and meta-analysis included observational studies of adult dialysis patients identified from database inception to April 20, 2025. Extracted data included adjusted odds ratios and 95% confidence intervals. Study quality was assessed using the Agency for Healthcare Research and Quality checklist or the Newcastle-Ottawa Scale. Sensitivity analyses, subgroup analyses, publication bias assessment, and GRADE evaluations were conducted to assess the robustness and certainty of the evidence.

RESULTS: A total of 19 studies involving 4989 patients were included. The primary analysis showed that factors associated with SD in males included age, diabetes mellitus, smoking history, dialysis vintage, depression, diabetic nephropathy, alcohol consumption, and inadequate dialysis. In females, factors associated with SD included age, depression, beta-blockers, low educational attainment, menopausal status, chronic diseases, and diabetic nephropathy, whereas recombinant human erythropoietin was associated with lower odds of SD. After REML+HKSJ adjustment, age, diabetes mellitus, smoking history, dialysis vintage, depression, and diabetic nephropathy in males, and depression, lower educational attainment, and diabetic nephropathy in females remained statistically significant.

CONCLUSIONS: Factors associated with SD in dialysis patients differed by sex. However, evidence certainty was limited by observational designs, heterogeneity, potential publication bias, and variations in measurement tools, diagnostic thresholds, and exposure definitions. Therefore, these findings reflect statistical associations rather than causal conclusions.

PMID:42585569 | DOI:10.1093/sxmrev/qeag057

Age Ageing. 2026 Aug 3;55(8):afag231. doi: 10.1093/ageing/afag231.

ABSTRACT

BACKGROUND: Falls are a major cause of morbidity and mortality in older adults. The World Falls Guidelines (WFG) propose a risk stratification algorithm using fall history, three key questions (3KQ), mobility tests and clinical criteria, but it has yet to be systematically evaluated.

OBJECTIVE: To assess whether the WFG algorithm, in original or modified form, effectively stratifies community-dwelling older adults into low, intermediate or high risk of future falls; whether it has been prospectively validated; and whether it has been adequately operationalised.

METHODS: We conducted a systematic review (PROSPERO CRD420251151506) by searching MEDLINE, Embase and Google Scholar. Two reviewers independently screened studies and extracted data on cohort characteristics, algorithm adaptations, baseline risk distribution and prospective falls outcomes over ≥6 months. Given the heterogeneity of the studies included, quantitative meta-analysis was not conducted.

RESULTS: Eight cohort studies (n = 25 027; mean age range 61-82 years) met the inclusion criteria. No study implemented the WFG algorithm as published; two used minor modifications and six had major adaptations due to dataset limitations. Common modifications included rephrasing the 3KQ, replacing ‘subjective unsteadiness’ question with objective measures, applying mobility test universally, adjusting mobility tests thresholds and omitting fall severity definition components. Across studies, 7.9%-82.6% of participants were classified as low risk, 0.4%-18.3% as intermediate risk and 10.5%-88.7% as high risk. High-risk classification showed modest sensitivity (26.5%-52.3%) and moderate-to-high specificity (34.2%-88.9%) for future falls (1-2 years), with an overall accuracy of 61.2%-74.2%. High-risk groups consistently had a two- to three-fold higher incidence of falls than low-risk groups, while intermediate-risk groups only showed a slightly elevated risk. Use of 3KQ alongside fall history and universal mobility testing improved discrimination and increased the proportion in the intermediate-risk category.

CONCLUSION: The operationalised versions of the WFG algorithm identify older adults at high falls risk with high specificity but limited sensitivity. Proposed pragmatic modifications improve stratification accuracy for intermediate risk group but require prospective validation.

PMID:42585559 | DOI:10.1093/ageing/afag231

Drug Dev Ind Pharm. 2026 Aug 12:1-20. doi: 10.1080/03639045.2026.2708900. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to design and evaluate pH-sensitive pellets loaded with 5-aminosalicylic acid (5-ASA) for targeted colon delivery in ulcerative colitis (UC) therapy.

SIGNIFICANCE: The proposed formulation leverages glyceryl monooleate (GMO) and linoleic acid (LA) as liquid crystal precursors to achieve site-specific drug release.

METHODS: Liquid crystal nanoparticles (LCNPs) were prepared from a GMO bulk phase using a top-down method, with LA added for pH sensitivity. The formulations were then evaluated for drug loading, encapsulation efficiency, and structure by polarised light microscopy, with drug release tested at pH 1.2 and 6.8. The LCNPs dispersions were then used to make pellets using the extrusion-spheronisation technique. Drug-excipient interactions were examined by FTIR and DSC. The pellet formulations were finally tested in a rat ulcerative colitis (UC) model by comparing colon damage scores across treatment groups.

RESULTS: The pH-sensitive pellets containing LCNPs exhibited a uniform morphology, desirable aspect ratio, and sufficient mechanical strength. The in vitro release profile demonstrated a 5.7-fold higher drug release at pH 6.8 compared to pH 1.2. This targeted release was ascribed to a pH-triggered phase transition of the LA and electrostatic repulsion between the ionised drug and the carrier. The in vivo results confirmed that the pH-sensitive pellets elicited the most pronounced and statistically significant (p < 0.05) reduction in colon damage scores.

CONCLUSION: The developed pellet system, which encapsulates 5-ASA within GMO/LA-based liquid crystal nanoparticles, presents a highly promising platform for targeted drug delivery in the treatment of ulcerative colitis.

PMID:42585548 | DOI:10.1080/03639045.2026.2708900

JMIR Form Res. 2026 Aug 12;10:e92230. doi: 10.2196/92230.

ABSTRACT

BACKGROUND: Breast cancer is a leading cause of mortality among Thai women. Breast self-examination (BSE) is a low-cost practice that promotes breast health awareness and familiarity with breast changes; however, adherence and correct technique remain suboptimal, partly due to limited guidance and reminder systems. Mobile health (mHealth) interventions could support BSE practice.

OBJECTIVE: This study aimed to develop VCheck, a culturally tailored mHealth app for Thai women, and conduct a formative evaluation of its usability and feasibility.

METHODS: A user-centered design framework guided the development of VCheck using the Thunkable cross-platform environment. The app included educational multimedia content, step-by-step BSE guidance, and a smart reminder system. A formative pilot usability study was conducted among 55 female volunteers aged 20 to 50 years over a 2-month period. Usability was assessed using the System Usability Scale. Feasibility and interface design were evaluated using a multidimensional satisfaction questionnaire, and qualitative feedback was collected.

RESULTS: The mean System Usability Scale score was 85.4 (SD 6.8), indicating excellent usability. Participants reported high overall satisfaction (mean 4.46, SD 0.68), including with feasibility (mean 4.48, SD 0.64) and interface design (mean 4.44, SD 0.72). Qualitative feedback suggested that the app was easy to navigate and culturally appropriate.

CONCLUSIONS: In this formative evaluation, VCheck demonstrated high usability and user acceptance as a culturally tailored mHealth tool for breast health education and BSE awareness among Thai women. The findings support further refinement and larger-scale evaluation of behavioral and implementation outcomes.

PMID:42585541 | DOI:10.2196/92230

J Intensive Care Med. 2026 Aug 12:8850666261475636. doi: 10.1177/08850666261475636. Online ahead of print.

ABSTRACT

ObjectiveTo evaluate the prevalence, clinical trajectory, and biologic phenotype of patients with rapidly improving acute hypoxemic respiratory failure (riAHRF), a subgroup of mechanically ventilated patients hypothesized to share features with the low-mortality, hypo-inflammatory phenotype previously described in rapidly improving ARDS.DesignSingle-center retrospective cohort study with nested biomarker analysis.SettingAcademic quaternary care medical intensive care unit (ICU) in California.PatientsTwo cohorts of mechanically ventilated ICU patients with AHRF were included: (1) 631 patients identified through the electronic health record (EHR) between March 1, 2022 and February 1, 2024, and (2) 164 patients in the Stanford ICU Biobank who had banked plasma samples collected within 24 h of intubation. Patients with cardiogenic or traumatic etiologies were excluded in both cohorts. AHRF was defined by PaO²/FiO² < 300 or SpO²/FiO² < 315 on the day of intubation. Resolution of hypoxemia was defined by achievement of minimal ventilator settings (FiO² ≤ 0.4 and PEEP ≤ 5 cmH²O for ≥ 6 h). riAHRF was defined as reaching minimal ventilator settings within 24 h of intubation.InterventionsNone.Measurements and Main ResultsIn the EHR cohort, 61% of patients experienced riAHRF. These patients had significantly lower 90-day mortality (22% vs 49%, P < .001) and more ventilator-free days (median 25 vs 23, P < .001) compared to non-riAHRF patients. Differences in clinical variables related to respiratory status, including S:F, respiratory rate, and blood gas data were subtle but statistically significant. In the BioBank cohort, riAHRF patients had lower levels of IL-8, IL-6, and sTNFR.ConclusionsRapidly improving AHRF (riAHRF) is common in patients intubated for AHRF and is associated with lower mortality and a hypo-inflammatory biomarker profile.

PMID:42585534 | DOI:10.1177/08850666261475636

Rev Bras Epidemiol. 2026 Aug 7;29:e260035. doi: 10.1590/1980-549720260035. eCollection 2026.

ABSTRACT

OBJECTIVE: To analyze the classification of the risk of transmission of vaccine-preventable diseases among children under 2 years of age in a large Brazilian municipality in 2022 and 2023.

METHOD: Ecological epidemiological study using secondary data on vaccination coverage (VC) for nine immunobiologicals recommended in the vaccination schedule for children under 2 years of age. Immunobiological dose data were obtained from the National Immunization Program Information System (Sistema de Informações do Programa Nacional de Imunizações – SI-PNI), while data were collected from the Ministry of Health website and filtered by place of residence. Data were analyzed using the R software package.

RESULTS: In 2022, 100% of the Health Surveillance Units (Unidades de Vigilância em Saúde – UVIS) showed low VC for the second dose of the measles-mumps-rubella (MMR) vaccine. In the same year, 61% and 54% of the UVIS achieved adequate VC for the hepatitis A and human rotavirus vaccines, respectively. In 2023, improvements in VC were observed for most vaccines, except for the meningococcal C and varicella vaccines, which showed a reduction in the number of UVIS achieving adequate VC. Regarding the classification of the risk of reintroduction of vaccine-preventable diseases, the proportion classified as “low and very low” increased from 0% in 2022 to 10.7% in 2023.

CONCLUSION: VC improved in 2023 for most vaccines analyzed across the UVIS. However, variations in VC were observed according to vaccine type and year. These findings reinforce the need to maintain regional actions aimed at achieving vaccination targets, given the indications of a recovery in VC.

PMID:42585533 | DOI:10.1590/1980-549720260035