Tag: statistics

Clin Teach. 2026 Aug;23(4):e70476. doi: 10.1111/tct.70476.

ABSTRACT

BACKGROUND: Spiritual care has been shown to be an important component of holistic patient care. However, students have reported it missing from current Australian medical school curricula. The aim of this study was to evaluate the impact of a three-hour spiritual care workshop designed to enable final year medical students to take a spiritual history from their patients.

METHODS: We used a prospective pilot study design to evaluate a novel half-day workshop designed to equip final year medical students to assess the spiritual wellbeing of their patients. The impact of the spiritual care workshop was evaluated using video analysis of a formative objective structured clinical examination (OSCE) of a spiritual consultation using a standardised patient prior to and after the teaching episode. Students self-assessed confidence scales pre- and post-workshop. Student characteristics that might facilitate learning in this domain were assessed.

RESULTS: Thirty-two final year medical students from four universities participated at two training sites. Video analysis by four independent assessors showed satisfactory inter-rater reliability and demonstrated a statistically significant increase (p < 0.001) in the use of spirituality questions. The students’ self-assessed confidence scales pre- and post-workshop demonstrated statistically significant increases in assessing all domains except empathic responsiveness; the greatest improvement was in the spiritual domain.

CONCLUSION: Whilst this study was confined to medical students, we believe that the objective and subjective effectiveness demonstrated in this spiritual care workshop will be readily translatable into multidisciplinary holistic communication skills training.

PMID:42417069 | DOI:10.1111/tct.70476

Stroke. 2026 Jul 8. doi: 10.1161/STROKEAHA.125.054810. Online ahead of print.

ABSTRACT

BACKGROUND: Changes in ischemic white matter hyperintensity (WMH) volume on magnetic resonance imaging over time are associated with cognitive decline. We investigated whether changes in WMH volume over time exhibit threshold effects of normalized WMH volume on declining cognitive performance and whether these effects on cognition differ between deep WMHs (DWMHs) and periventricular WMHs (PVWMHs).

METHODS: We followed 339 participants longitudinally from GeneSTAR (Genetic Study of Atherosclerosis Risk) with brain magnetic resonance imaging and neuropsychological testing at baseline (2009-2013) and at 13-year follow-up (2023 to present; 62% female, and 33% Black; mean baseline age, 49.7±9.6 years). WMHs were classified as PVWMH (within 2 mm of ventricles) or DWMH. Two-segment linear spline regression models using adjusted mixed linear regression identified test-specific thresholds longitudinally beyond which cognitive decline accelerated. Cognitive scores from both timepoints were treated as repeated measures, with WMH included as a time-varying predictor.

RESULTS: Declines in motor function and processing speed accelerated beyond thresholds of changing PVWMH and DWMH volumes. For Grooved Pegboard tests, changes in volume were associated with minimal effects below a threshold of changing volume (log-transformed ratio of lesion volume to intracranial volume for PVWMH from -9.42 to -9.29 and DWMH from -11.8 to -11.7). Substantial declines in cognitive performance were observed above thresholds of increases in volume (slope differences: PVWMH: 14.5-15.1 seconds per log-unit; P<0.001; and DWMH: 9.54-10.9; P<0.001). The digit symbol substitution test demonstrated paradoxical positive associations below changing volume thresholds (PVWMH: β=6.68; P=0.001; and DWMH: β=6.98; P<0.001), reversing to decline above thresholds of increase in volume for PVWMH (Δβ=-11.2; P<0.001) and DWMH (Δβ=-9.77; P<0.001).

CONCLUSIONS: Changes in WMH volume exhibit nonlinear threshold effects on changes in cognitive performance over time and differ by anatomic region. Minimal cognitive impact occurred below thresholds, with accelerated declines above. PVWMHs demonstrate larger effects on declining cognitive function than DWMH, particularly for motor and processing speed functions, and progress at a faster rate.

PMID:42417040 | DOI:10.1161/STROKEAHA.125.054810

J Womens Health (Larchmt). 2026 Jul 8:15409996261467343. doi: 10.1177/15409996261467343. Online ahead of print.

ABSTRACT

RESEARCH QUESTION: What is the current lifetime prevalence of infertility in the U.S., and how do U.S. adults view access to in vitro fertilization (IVF) and state-mandated insurance coverage?

DESIGN: Cross-sectional data were analyzed from a nationally weighted online survey of 1,000 U.S. adults in November 2024. Survey-weighted descriptive statistics estimated lifetime infertility prevalence and support for the right to access IVF and for state-mandated IVF insurance coverage. Survey-adjusted chi-square tests assessed differences in support across sociodemographic groups.

RESULTS: The sample included adults aged 18-87 years (median age 51 years). Lifetime infertility prevalence was 8.9% (95% CI: 7.2-11.0). Most respondents supported IVF access for infertility patients (74.2%; 95% CI: 70.9-77.2), and approximately two-thirds supported state-mandated IVF insurance coverage (64.6%; 95% CI: 61.2-67.7). Support for IVF access varied significantly by age (p = 0.04), education (p < 0.01), income (p < 0.01), race/ethnicity (p = 0.01), political leaning (p < 0.01), and infertility experience (p < 0.01). Lower support was observed among adults ages 18-29 and 30-49, those with lower income or educational attainment, Black respondents, Independents/Independent-leaning respondents, and individuals without personal or secondhand infertility experience. Support for state-mandated IVF insurance coverage varied by education (p < 0.01), income (p < 0.01), political leaning (p < 0.01), and infertility experience (p < 0.01), with the lowest support among respondents with lower income or education, Republican/Republican-leaning respondents, and those without infertility experience.

CONCLUSIONS: Approximately 1 in 11 U.S. adults has experienced infertility. Although support varied across demographic and political groups, most Americans support IVF access and insurance mandates.

PMID:42417028 | DOI:10.1177/15409996261467343

Womens Health (Lond). 2026 Jan-Dec;22:17455057261467280. doi: 10.1177/17455057261467280. Epub 2026 Jul 8.

ABSTRACT

BackgroundDepression is a widespread mental health disorder that disproportionately affects women of reproductive age due to a combination of biological, social, and environmental factors. It significantly impacts productivity, increases morbidity and disability, and poses challenges to the global economy. In Bangladesh, there have been few studies addressing this issue using modern analytical methods, despite its importance for public health.ObjectivesThe study aims to develop the best predictive model for depression risk factor analysis and to assess the PHQ-9 scale.DesignThis study extracted data from the cross-sectional survey.MethodsWe utilized data from the BDHS 2022, which gathered information on depression using the Patient Health Questionnaire (PHQ-9). The study included 13,113 ever-married women aged 15-49 years. To develop the predictive model, several machine learning algorithms were used. The performance of each model was assessed using metrics such as accuracy, precision, recall, and specificity. SHapley Additive exPlanations (SHAP) analysis was conducted to interpret and rank each feature’s contribution to the model’s output.ResultsApproximately 4.54% of women experienced moderate to severe depression. The Boruta algorithm identified 21 significant risk factors from a total of 25 variables, spanning demographic, socioeconomic, household, and reproductive domains, for predicting depressive symptoms. The Random Forest (RF) and Decision Tree models showed good performance across different performance metrics, achieving sensitivity of (0.068, 95% CI:0.064-0.072) and (0.409, 95% CI:0.395-0.423), specificity of (0.946, 95% CI:0.945-0.948) and (0.640, 95% CI: 0.629-0.651), and accuracy of (0.906, 95% CI:0.905-0.907), and (0.630, 95% CI:0.620-0.641). Whereas, boosting models also showed comparable performance. SHAP analysis revealed that household size, number of children under 5 in the household, and number of women in the household were the most influential predictors.ConclusionThe study demonstrated the effectiveness of the RF and decision tree model in detecting depression among Bangladeshi women, proving to be a valuable tool for identifying and predicting risk factors related to women’s mental health. The findings indicate that combining machine learning with the PHQ-9 would help screen for depressive symptoms in large-scale public health settings while accounting for different covariate effects.

PMID:42417027 | DOI:10.1177/17455057261467280

NeuroRehabilitation. 2026 Jul 8:10538135261426535. doi: 10.1177/10538135261426535. Online ahead of print.

ABSTRACT

ObjectivesTraumatic brain injury (TBI) is a leading cause of long-term disability. This study aimed to evaluate the effectiveness of a Post-Acute Care (PAC) program for patients with TBI in Taiwan and to identify the independent predictors associated with the magnitude of their functional recovery.MethodsThis retrospective cohort study included 168 patients with TBI admitted to a PAC program from a tertiary medical center. The primary outcome was the change score in the Barthel Index (BI)(ADL). The Wilcoxon Signed-Rank Test was used to assess changes in functional scores (BI(ADL), IADL, and EQ-5D) from admission to discharge.ResultsPatients demonstrated statistically significant improvements across all functional measures after the PAC intervention, including the BI(ADL), IADL, and EQ-5D (all p < .001). After adjusting for all covariates, length of stay was the sole significant independent predictor of the BI(ADL) change score (B = 0.309, p < .001), indicating that for each additional day of PAC, a patient’s BI score was expected to improve by 0.309 points.ConclusionPost-Acute Care is a highly effective intervention for improving functional outcomes in patients with TBI. These findings provide a strong evidence base for clinicians to advocate for sufficient rehabilitation time and for policymakers.

PMID:42417023 | DOI:10.1177/10538135261426535

NeuroRehabilitation. 2026 Jul 8:10538135261465902. doi: 10.1177/10538135261465902. Online ahead of print.

ABSTRACT

BackgroundEvidence on the feasibility of integrating music therapy into routine post-stroke aphasia rehabilitation in real-world settings remains limited.ObjectiveTo examine the feasibility of integrating a structured music therapy protocol into conventional speech-language therapy for post-stroke aphasia and explore preliminary outcomes.MethodsThis quasi-experimental study was conducted in an outpatient speech-language clinic in Thailand. Participants received standard speech-language therapy or therapy combined with a manualised music therapy protocol. The intervention represents a dose-augmented feasibility design, as the experimental group received increased overall therapeutic contact time. Language performance was assessed using the Thai Adaptation of the Western Aphasia Battery, and anxiety using the State-Trait Anxiety Inventory, Form Y-2. Pre-post changes were examined using descriptive statistics and exploratory analyses, including paired tests for within-group comparisons and independent tests for between-group differences.ResultsThe intervention was feasible, with complete delivery and assessment. Within-group improvements in language performance were observed in both groups, with greater gains in the music therapy-augmented group; however, between-group differences were not statistically significant. Anxiety scores decreased in both groups, with no significant differences. Interpretation of anxiety outcomes is limited by the use of a trait-based measure, which may reflect the limited sensitivity of trait-based measure to short-term changes.ConclusionsIntegrating music therapy into routine speech-language rehabilitation for post-stroke aphasia is feasible in a real-world outpatient setting. Findings should be interpreted as exploratory and reflective of increased therapeutic exposure rather than modality-specific effectiveness. These results inform the design of future dose-matched and methodologically rigorous trials.

PMID:42417018 | DOI:10.1177/10538135261465902

J Diabetes Res. 2026;2026(1):e4228661. doi: 10.1155/jdr/4228661.

ABSTRACT

BACKGROUND: To evaluate the prognostic performance of the single-sample confirmatory definition of undiagnosed diabetes on outcomes, including hypertension, chronic kidney disease (CKD), cardiovascular disease (CVD), and mortality, in the Tehran Lipid and Glucose Study cohort.

METHODS: Among 6712 participants (3682 women) aged ≥ 30 years not on glucose-lowering medication, unconfirmed undiagnosed diabetes was defined as either fasting plasma glucose (FPG) ≥ 7 mmol/L or 2-h postload glucose (2-h PG) ≥ 11.1 mmol/L, whereas confirmed undiagnosed diabetes required both. Multivariable Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for each outcome.

RESULTS: At baseline, 3.6% and 3.3% of participants had confirmed or unconfirmed undiagnosed diabetes, respectively. During a median follow-up of over 10 years, both unconfirmed and confirmed undiagnosed diabetes were associated with a higher risk of developing treated diabetes, with HRs (95% CI) of 7.73 (6.35-9.44) and 17.30 (14.32-20.83), respectively. Confirmed undiagnosed diabetes was further associated with incident CKD (1.33 [1.02-1.73]), hypertension (1.26 [1.00-1.60]), first CVD (1.40 [1.01-1.93]), and hard CVD (1.65 [1.04-2.61]), whereas the association with all-cause mortality did not reach statistical significance (1.50 [0.96-2.33], p = 0.07). Unconfirmed undiagnosed diabetes was only associated with treated diabetes and first CVD (1.53 [1.11-2.12]). Isolated FPG and 2-h PG elevations showed similar risks for treated diabetes (9.00 [6.26-13.00] and 7.40 [5.92-9.24], respectively), but only isolated FPG was significantly associated with first CVD (2.55 [1.50-4.31]) and hard CVD (2.43 [1.06-6.00]), comparable with confirmed undiagnosed diabetes.

CONCLUSIONS: Confirmed undiagnosed diabetes was associated with a higher risk of cardiovascular and renal outcomes. The unconfirmed undiagnosed phenotype shared a similar CVD risk with confirmed diabetes but had a 50% lower risk of treated diabetes, with a stronger association observed for isolated FPG elevation than for isolated 2-h PG.

PMID:42417014 | DOI:10.1155/jdr/4228661

Onderstepoort J Vet Res. 2026 Jun 18;93(1):e1-e4. doi: 10.4102/ojvr.v93i1.2262.

ABSTRACT

Pestivirus infection in camels has been insufficiently studied, particularly in Saudi Arabia. In the current work, the seroprevalence of pestivirus infection in camels’ sera (n = 180) in Rafha in northern Saudi Arabia was screened using Enzyme Linked Immuno-Sorbent Assay (ELISA). Data on age, sex and breed were analysed statistically. Pestivirus seroprevalence was 11.1. It was higher in adults (22.2%) than in young animals (10.5%), higher in females (33.3%) than in males (10.7%) and higher in the Mjahim breed (23.8%) compared to the Magater breed (9.4%). Chi-square analysis revealed a significant correlation between pestivirus infection and breed (p = 0.015), whereas no significant associations were noted with age (p = 0.123) or sex (p = 0.432). Wald statistics indicated that breed (p = 0.005) and sex (p = 0.048) were significant predictors of pestivirus infection.Contribution: To our knowledge, this is the first study to report the risk factors associated with pestivirus infection in camels in northern Saudi Arabia. The results can help explore epidemiological parameters and aid in control, while future research should include larger samples and molecular techniques to verify active infection.

PMID:42417001 | DOI:10.4102/ojvr.v93i1.2262

Breast J. 2026;2026(1):e1469203. doi: 10.1155/tbj/1469203.

ABSTRACT

BACKGROUND: Survivorship considerations have gained increasing importance in patients with early breast cancer. Every surgical procedure poses a risk of complications and a potential negative impact on patient-reported outcomes (PROs), thereby driving growing interest in de-escalation strategies in breast cancer surgery. In this context, we aimed to assess complication rates, the potential role of physiatric rehabilitation in managing these complications, and the impact of axillary surgery on PROs.

METHODS: This retrospective single-center cohort study included breast cancer patients who underwent surgery between January 2022 and March 2023 at the Breast Unit of Policlinico Umberto I, Rome. Among 164 patients operated on during the study period, 71 who underwent axillary surgery and received postoperative physiatric evaluation according to the institutional care pathway (PDTA) were included. The Disability of the Arm, Shoulder and Hand (DASH) questionnaire was administered to evaluate PROs.

RESULTS: Among the included patients (n = 71), SLNB was performed in 71.83% and ALND in 21.13%. A total of 34/71 patients (47.89%) developed complications requiring rehabilitative treatment and were classified as cases, while the remaining patients constituted the control group. Overall, shoulder painful mobility limitation (56.34%) (SPML), motor deficit (54.93%) (MD), and sensory deficit (46.48%) (SD) were the most frequent complications, whereas lymphedema (LE) and scapular winging (SW) occurred in 4.23% each. More extensive axillary procedures were associated with a higher number of lymph nodes removed (p < 0.0001). Cases had significantly more lymph nodes removed than controls (p = 0.0003). Patients requiring rehabilitation were younger on average than controls. Recovery time differed significantly between cases and controls (p < 0.0001), with most patients recovering within 3 months from the first physiatric visit. DASH scores were significantly worse in patients requiring rehabilitative treatment than in controls (p < 0.0001). The mean DASH score was 14%. Higher DASH values were associated with postoperative complications requiring rehabilitation and delayed or absent recovery, particularly SPML, DM, DS, and SW.

CONCLUSIONS: Functional impairment of the upper limb remained frequent and may affect patients’ daily activities. These findings support the importance of integrating surgical management with early physiatric evaluation and rehabilitation to optimize functional recovery. Systematic assessment using patient-reported outcome measures (PROMs), such as the DASH questionnaire, may help identify disability early and support patient follow-up.

PMID:42416988 | DOI:10.1155/tbj/1469203

Neurophotonics. 2026 Jul;13(3):035003. doi: 10.1117/1.NPh.13.3.035003. Epub 2026 Jul 7.

ABSTRACT

SIGNIFICANCE: Intraoperative cerebral ischemia is a critical complication that can arise during cerebral aneurysm clipping surgery. Although intraoperative neuromonitoring (IONM) can detect resulting functional deficits, these alerts may occur minutes after the initial ischemic event.

AIM: We aimed to demonstrate the clinical utility of laser speckle contrast imaging (LSCI) for continuous, real-time monitoring of cerebral blood flow (CBF) during aneurysm surgery.

APPROACH: In this case study, a 67-year-old female underwent a craniotomy for a left-sided cerebral aneurysm. A microscope-integrated LSCI system was used to continuously monitor cortical perfusion. After surgery, LSCI data were correlated with IONM alerts, indocyanine green angiography (ICGA), and surgical events, including an ischemic period following clip placement. A paired t-test, mixed effects model, and changepoint analysis were used to compare mean perfusion between the pre-ischemic and ischemic periods across seven regions of interest (ROIs) on the cortical surface.

RESULTS: LSCI detected a widespread drop in cortical perfusion immediately following the application of an aneurysm clip. This perfusion deficit was detected by LSCI $\sim 8\min$ before the corresponding IONM alert. During the ischemic period, blood flow decreased across six of the seven ROIs, with reductions ranging from 7.9% to 28.0%. The overall decrease in perfusion from the pre-ischemic to the ischemic period was statistically significant ( $p<0.0001$ ).

CONCLUSIONS: LSCI can provide continuous imaging of tissue perfusion during surgery, enabling the detection of developing ischemia before functional deficits may be evident on IONM. The ability of LSCI to track tissue perfusion changes highlights its potential as a valuable complementary tool for enhancing surgical safety alongside IONM and ICGA.

PMID:42416970 | PMC:PMC13340444 | DOI:10.1117/1.NPh.13.3.035003