Tag: statistics

Urol Oncol. 2026 May 19;44(7):243-247. doi: 10.1016/j.urolonc.2026.04.287. Online ahead of print.

ABSTRACT

Many patients who receive prostate magnetic resonance imaging are classified as Patient Imaging Reporting and Data Systems level 3 (PI-RADS 3), which is inconclusive for cancer. An important question is whether PI-RADS 3 patents should receive a biopsy. Prostate biopsy has a 4.6% chance of complications including a 1.3% chance of a hospital or emergency room visit. I critically examine the literature on the standard endpoint for PI-RADS 3 decision-making, namely clinically significant prostate cancer (csPCa) determined on biopsy. Some methods for estimating the probability of csPCa are statistically flawed. Importantly, even if there were no methodological flaws, these estimates have limited information for decision-making because the benefit of detecting csPCa on biopsy is not well established. Therefore, PI-RADS 3 patients should consider events after biopsy. The prostate testing for cancer and treatment trial of patients with localized prostate cancer found similar probabilities of prostate cancer death among patients randomized to active monitoring, prostatectomy, and radiotherapy. Adding perspective, based on calculations from the results of this trial, the probability of prostate cancer death is much smaller than the probability of death from other causes, particularly in older patients. Therefore, for PI-RADS 3 patients who would choose active monitoring if diagnosed with csPCa on biopsy, a reasonable decision is no biopsy with active monitoring.

PMID:42155163 | DOI:10.1016/j.urolonc.2026.04.287

J Clin Densitom. 2026 May 7;29(3):101714. doi: 10.1016/j.jocd.2026.101714. Online ahead of print.

ABSTRACT

BACKGROUND: Postmenopausal osteoporosis (PMO), a major cause of fractures and disability, places a burden on healthcare systems. Erxian Decoction (EXD), a traditional Chinese herbal formula, is commonly used to support bone health. However, its efficacy and safety in treating PMO remain uncertain. This study assessed the efficacy and safety of EXD combined with conventional treatments in PMO.

METHODOLOGY: Following PRISMA guidelines, we systematically searched MEDLINE, Embase, CENTRAL, CNKI, Wanfang, SinoMed, and Chongqing VIP database through July 2025 for randomized controlled trials (RCTs). Two reviewers independently conducted study selection, data extraction, and risk-of-bias assessment (RoB 2). Random-effects meta-analyses were performed using mean differences (MDs), odds ratios (ORs), relative risks (RRs), and 95 % confidence intervals (CIs).

RESULTS: Thirteen RCTs comprising 1,269 women were included. All studies were conducted in China and published between 2012 and 2025. EXD significantly improved lumbar spine bone mineral density (BMD) (MDs 0.05 g/cm² and 0.09 g/cm² in pharmacological and calcium-vitamin D settings), femoral neck BMD (MD 0.06 g/cm² in both settings), and pain intensity (VAS MDs -1.17 and -0.88). Biochemical outcomes showed improvements in CTX within pharmacological settings, and in serum calcium, BGP, and E2 within calcium-vitamin D settings. Clinical response showed consistent improvements (ORs 3.62 and 3.56). Adverse events were reported in five studies. Pooled analyses suggested fewer events with EXD (RR = 0.68), with statistical significance in one trial. Fracture incidence (reported in one study) favored EXD but was not statistically significant. Heterogeneity was substantial across outcomes but was partly reduced in sensitivity analyses after excluding studies at high risk-of-bias.

CONCLUSION: EXD combined with conventional therapy may improve BMD, reduce pain in patients with PMO, though the evidence regarding safety remains insufficient to draw firm conclusions. However, the current evidence is limited to small, single-country RCTs with methodological limitations. Confirmation requires larger, rigorously designed trials across diverse populations.

PMID:42155162 | DOI:10.1016/j.jocd.2026.101714

J Clin Virol. 2026 May 19;184:105952. doi: 10.1016/j.jcv.2026.105952. Online ahead of print.

ABSTRACT

BACKGROUND: Capillary blood self-collection devices offer a minimally invasive alternative to venipuncture, potentially expanding access to serologic studies in outpatient and remote settings. We aimed to evaluate the concordance of influenza HAI titers between capillary blood collected using a minimally invasive device and venous blood collected via standard venipuncture.

METHODS: We compared three paired samples collected from participants during a single visit: venipuncture, staff-assisted capillary device collection (clinic-collect), and participant self-collected capillary device with 72-hour delayed processing (self-collect) to simulate both on-site and at-home blood collection conditions. We compared HAI titers against influenza A(H1N1) antigen across collection methods using Pearson correlation coefficients, Bland-Altman plots, and paired t-tests. Sample volume adequacy and correlation thresholds for clinical interpretability were also assessed.

RESULTS: Among 27 participants, HAI titers correlated strongly between venipuncture and both minimally invasive device approaches (clinic-collect: r = 0.955; self-collect: r = 0.937). Venipuncture titers were modestly higher, with mean differences of + 0.26 log₂ units (clinic-collect) and + 0.35 log₂ units (self-collect); these differences were below the 1-dilution (2-fold) threshold and not clinically meaningful. Most device samples (89-96%) fell within ±1 log₂ unit of venipuncture. On first attempt, 78% of device collections met the ≥ 600 μL volume threshold, increasing to > 93% with use of a second device.

CONCLUSION: Minimally invasive devices yielded influenza HAI titers highly comparable to venipuncture, with clinically acceptable differences in adults. Self-collection with a minimally invasive device could serve as a practical, scalable alternative for serologic studies.

PMID:42155157 | DOI:10.1016/j.jcv.2026.105952

JMIR Form Res. 2026 May 19;10:e78563. doi: 10.2196/78563.

ABSTRACT

BACKGROUND: The COVID-19 pandemic was marked by rapidly evolving and inconsistent public health messaging, contributing to confusion regarding recommended preventive behaviors. Knowledge, attitudes, and practices (KAP) and perceived risk frameworks offer a structured approach to examine how education, personal beliefs, and contextual factors influence health behaviors during public health emergencies. Vulnerable populations, such as patients with multiple sclerosis (MS), experience heightened risk perception compared with the general population, which may further shape behavioral responses.

OBJECTIVE: This study aimed to examine COVID-19-related KAP and perceived risk among patients with MS, health care providers, and laypeople during the first 6 months of the pandemic. The aim of mixed methods was to explore quantitative factors associated with KAP and perceived risk and to qualitatively describe participants’ perceptions and emotional responses to the pandemic.

METHODS: A descriptive, cross-sectional, partially mixed methods explanatory sequential design was used. Participants were recruited using convenience sampling and completed an online demographic questionnaire and a COVID-19 KAP instrument that included perceived risk items. Quantitative data were analyzed using descriptive statistics and inferential analyses to examine group differences and associations between perceived risk and preventive behaviors. Chi-square testing was applied to compare perceived risk across groups, and correlational analyses were used to examine the relationships between perceived risk and behavioral practices. Qualitative comments provided by participants were analyzed using thematic analysis to further contextualize quantitative findings and to explore perceived risk experiences.

RESULTS: A total of 148 participants were included, comprising 43 (29%) individuals with MS, 50 (33.8%) health care providers, and 55 (37.2%) laypeople. Overall, 90% (n=133) of participants demonstrated basic knowledge of COVID-19 transmission and prevention. Attitudes toward public health guidance and self-reported preventive behaviors varied across groups. Lay participants most frequently reported a moderate perceived risk of COVID-19 infection, whereas participants with MS and health care providers more commonly reported high perceived risk (χ²6=12.65, P=.049). Neither immunosuppressive treatment status nor vaccine hesitancy significantly predicted perceived risk. However, higher perceived risk was significantly associated with greater avoidance of crowded and public places. Qualitative analysis yielded 5 interrelated themes describing participants’ perceived risk experiences: uncertainty related to evolving scientific information; anxiety regarding personal and family safety; fear of infection and long-term consequences; vulnerability, particularly among individuals with chronic illness and frontline exposure; and accountability toward protecting others through adherence to preventive measures. These themes provided contextual insight into the emotional and cognitive processes underlying reported attitudes and behaviors.

CONCLUSIONS: Knowledge of COVID-19 is associated with favorable attitudes and engagement in preventive practices across populations. Differences in perceived risk highlight the importance of tailoring risk communication and educational strategies to specific populations. KAP-focused educational interventions that explicitly address uncertainty, emotional responses, and behavioral translation may strengthen preparedness and promote sustained protective behaviors during future public health emergencies.

PMID:42155141 | DOI:10.2196/78563

JMIR Mhealth Uhealth. 2026 May 19;14:e66151. doi: 10.2196/66151.

ABSTRACT

BACKGROUND: Previous research suggests that 14.4% of the general population is affected by tinnitus. For some of those affected, the ear noise is bothersome or associated with severe distress. There are various treatment options such as cognitive behavioral therapy (CBT), sound therapy, or hearing aids. In addition to browser-based online interventions, mobile apps have been introduced as novel treatment approaches. Previous studies have identified several apps aimed at supporting users with tinnitus. Yet, knowledge about the content of tinnitus apps is limited.

OBJECTIVE: This study aimed to provide an overview of apps specifically developed for tinnitus by analyzing general app characteristics, as well as app content, focusing on intervention components and behavior change techniques (BCTs).

METHODS: A systematic search using 7 search terms (eg, tinnitus and ear noise) was conducted in the Google Play Store and the Apple App Store. Apps designed specifically for tinnitus and available in German or English met the inclusion criteria. Two independent trained raters assessed general app characteristics (eg, age group and costs) using the app description section of the German version of the Mobile App Rating Scale. In addition, raters analyzed app content using the BCT taxonomy (v1) and a list of typical intervention components in tinnitus treatment. Differences in ratings were discussed, and a third trained rater was consulted if no consensus was reached.

RESULTS: A total of 1198 apps were identified in the systematic search. Of those, 69 apps were included in the final analysis. Fifty-two apps were available for free, 23 of which offered in-app purchases. Among the 17 paid apps, costs ranged between €0.69 (US $0.81) and €450 (US $527) per 12 months. Fifty-eight of 69 apps provided sounds (eg, white noise and nature sounds). Many apps assessed tinnitus characteristics (n=38) and provided information about tinnitus (n=27). The most frequently used BCTs were “instruction on how to perform the behavior” (n=25; eg, audio instructions for relaxation techniques), “feedback on behavior” (n=11), “behavioral practice/rehearsal” (n=11), “information about health consequences” (n=11), “information about emotional consequences” (n=11), and “prompts/cues” (n=11). The number of BCTs implemented varied widely across apps (0-18 per app).

CONCLUSIONS: Most tinnitus apps offer sound-based interventions (eg, white noise and nature sounds). Notably, CBT elements (eg, cognitive restructuring, attention training, and relaxation training) are implemented less frequently, despite CBT being recommended in tinnitus treatment guidelines. Further research on the efficacy of tinnitus apps is needed. Transparent reporting of intervention techniques may help clarify mechanisms of action and support the replication of effective interventions. Given the large number of readily accessible apps, this study provides an overview relevant to both researchers and health care professionals.

PMID:42155139 | DOI:10.2196/66151

MSMR. 2026 May 15;33(4):10-14.

ABSTRACT

This study utilized de-identified surveillance data to estimate the incidence of head and neck cancer among active component service members (Army, Navy, Air Force, Marine Corps, Coast Guard) from 2010 through 2024. This report updates the June 2021 MSMR analysis of oral and pharyngeal cancers (2007-2019) by expanding the case definition to include all head and neck cancers and extending the surveillance period through 2024. There were 549 cases of head and neck cancer diagnosed in the active component military during the 15-year period of analysis. The Army had the highest 15-year incidence rate (3.3 per 100,000 person-years) compared to the Navy (2.6 per 100,000), Air Force (2.6 per 100,000), Coast Guard (2.0 per 100,000), and Marine Corps (1.3 per 100,000). Service members ages 40 years and older had the highest overall incidence rate (12.3 per 100,000), which was 3.3 times the next highest rate observed among those ages 35-39 years. The 15-year male incidence rate (2.9 per 100,000) was greater than that among females (1.7 per 100,000). The parotid gland was the most common site of diagnosis, comprising 14.8% of cases. This report provides the most current head and neck cancer incidence data for active component service members from 2010 through 2024; it establishes baseline rates for monitoring of future trends and highlights specific high-risk populations (e.g., men, Army personnel, service members ages 40 years and older). Although head and neck cancer is the seventh most prevalent cancer worldwide, its incidence among active component service members is seldom reported. Head and neck cancer is often not diagnosed until it has metastasized. Significant physical limitations (e.g., difficulty chewing, speaking, and swallowing) and psychosocial effects (e.g., anxiety, depression, social isolation), compromising service member readiness, can accompany this type of cancer.

PMID:42155135

MSMR. 2026 May 15;33(4):3-9.

ABSTRACT

Military service members remain a priority population for assessing the prevalence, patterns, and long-term consequences of tobacco and nicotine use. The limitations inherent to documenting use among military service members, however, complicate the design of exposure assessment. This study combined 2 data sources-by aggregating self-reported Periodic Health Assessment (PHA) survey data with International Classification of Diseases, 9th and 10th revisions, Clinical Modification (ICD-9-CM/ICD-10-CM) medical diagnostic codes-to classify nicotine and tobacco use as exposures delineated by recent use or history of any use. The study population included a total of 921,394 U.S. active component service members who completed a PHA in 2023. PHA classification for ‘recent use’ was defined by self-reported use of any tobacco or nicotine product within the past 30 days, whereas ‘history of any use’ included recent users in addition to those who reported cessation of use. The full roster of service members who completed the PHA in 2023 was matched to ambulatory and inpatient medical records within 30 days, before or after, the PHA sample period (December 1, 2022-January 31, 2024) to identify selected ICD-10-CM codes for recent use. Selected diagnostic codes for a ‘history of any use’ were queried for a period of 20 years preceding and 30 days following (January 1, 2004-January 31, 2024) the PHA sample period. Among PHA respondents, 22.0% (n=203,156) self-reported recent nicotine or tobacco use. When aggregating PHA data with recent exposure classified from diagnostic codes, the resulting assessment of recent nicotine or tobacco use increased to 28.7% (n=264,194). Critically, this aggregation identified 61,038 U.S. service members with no evidence of recent use on the PHA but with a concurrent clinical record during the specified matching period. Aggregating data sources for a history of any use only nominally improved the estimate, increasing it from 41.1% (PHA alone) to 43.1%. Agreement between sources was fair for both recent use (κ=0.28) and historical use (κ=0.36). The results of this study indicate that neither self-reported PHA data nor medical diagnostic codes alone provide a complete picture of tobacco and nicotine use among U.S. active component service members. The combination of medical diagnostic codes with self-reported PHA survey responses increases exposure estimates of recent tobacco or nicotine use among U.S. active component service members to 28.7%, in comparison to 22.0% if exclusively assessing recent use from the PHA. The integration of multiple data sources may provide a more comprehensive assessment of recent nicotine and tobacco exposure among service members, directly supporting enhanced public health surveillance.

PMID:42155134

Port J Card Thorac Vasc Surg. 2026 May 10;33(1):19-23. doi: 10.48729/pjctvs.607.

ABSTRACT

INTRODUCTION: The management of chest tubes after pulmonary resection remains non- standardized, and suction levels are often determined by the surgeon’s preference. This retrospective study aimed to compare the clinical outcomes of low suction -2cmH2O-2cmH2​O versus the conventional suction level used in our institution -15cmH2O-15cmH2​O using digital drainage devices after videoassisted thoracic surgery (VATS) lobectomy for suspected or confirmed lung cancer in a thoracic surgery centre.

METHODS: We analysed 120 patients who underwent pleural drainage after VATS lobectomy between January 2023 and September 2024. The primary outcome was drainage duration. Secondary outcomes included hospital stay, prolonged air leak, complications, and readmissions.

RESULTS: No significant differences were observed in drainage duration (2.0 vs. 4.0 days; p=0.125p=0.125) or hospital stay (3.0 vs. 4.0 days; p=0.104p=0.104 ). The incidence of prolonged air leak was similar between groups (20.3% vs. 24.6%; p=0.578p=0.578 ). However, subcutaneous emphysema occurred more frequently in the low suction group (22% vs. 8.2%; p=0.04p=0.04 ), with a higher need for intervention, despite comparable baseline forced expiratory volume in the first second (FEV1) values between suction level groups. Importantly, patients who developed subcutaneous emphysema had significantly lower baseline FEV1 values, regardless of suction level. COPD was identified as a significant predictor of longer drainage duration, longer hospital stay, and higher complication rates.

CONCLUSION: Although suction level did not significantly influence postoperative recovery, the higher incidence of subcutaneous emphysema in the low suction group warrants further investigation. The presence of COPD and impaired baseline lung function should be considered when selecting suction levels after VATS lobectomy.

PMID:42155129 | DOI:10.48729/pjctvs.607

JMIR Hum Factors. 2026 May 19;13:e73369. doi: 10.2196/73369.

ABSTRACT

BACKGROUND: Mental health problems are prevalent among young people aged 16 to 24 years. With the health care system prioritizing severe cases, most young people wait months before accessing professional support. One-to-one helplines offer alternative and accessible mental health services for young people with emotional support, psychoeducation, and signposting. Signposting empowers young people to access long-term support beyond a brief helpline session. However, young people often choose not to access the signposts. Despite its importance, there is a dearth of existing research examining signposting via digital mental health helplines for young people.

OBJECTIVE: Using cross-sectional survey data from The Mix, a UK charity supporting young people aged 25 years or younger, this study conducted a mixed methods analysis of their multichannel (webchat, email, telephone, and web-based contact form) helpline survey between February 2020 and October 2023.

METHODS: The analytic sample included 296 participants who collectively received 872 signposts (approximately 872/4500, 19% of signposts provided during the survey collection period), of which 822 with complete outcome data were included in the statistical models. Multinomial logistic regressions were conducted to examine whether young people’s use and perceived usefulness of the signposts they received differed across modes of delivery and their demographic characteristics (gender, ethnicity, and age). Qualitative thematic analysis of 106 open-ended responses from 97 participants was also examined to illuminate why young people found signposting helpful and how it could be improved.

RESULTS: In the overall model, which included all predictors, webchat users identifying as White, women, and aged 16-19 years were significantly more likely to use and find signposts helpful than to perceive them as unhelpful (odds ratios [OR] 0.28, 95% CI 0.17-0.46; P<.001), not intend to use them (OR 0.13, 95% CI 0.07-0.26; P<.001), or only plan to use them later (OR 0.29, 95% CI 0.18-0.46; P<.001). Thematic analysis of open-ended responses revealed that young people found the choice of signposts relevant and appreciated how signposting was integrated with emotional support. Young people also felt more hopeful after being signposted and gained both clarity and insight into the support available. However, they also noted challenges, such as feeling overwhelmed or encountering outdated signposts.

CONCLUSIONS: Given the increasing reliance on digital mental health services, ensuring that signposting remains accessible, relevant, and tailored to diverse user needs is essential. By optimizing signposting strategies, helplines can empower young people to seek appropriate long-term support, ultimately improving mental health outcomes.

PMID:42155126 | DOI:10.2196/73369

JMIR Form Res. 2026 May 19;10:e84249. doi: 10.2196/84249.

ABSTRACT

BACKGROUND: Despite the notable proliferation of smoking cessation mobile apps, to date, no validated, Spanish-language, culturally tailored mobile intervention exists for Spanish speakers in the United States.

OBJECTIVE: The aim of this study was to conduct formative research to inform the adaptation of an evidence-based smoking cessation intervention developed for Spanish-speaking Hispanic and Latino individuals from a printed format into a mobile app.

METHODS: Guided by a user-centered approach and in collaboration with product design industry experts, wireframes were developed to present the app’s layout and functionality. Focus groups were conducted over Zoom (Zoom Communications) with Spanish-speaking individuals who currently smoke to assess their previous mobile app experience, attitudes toward mobile apps, and feedback on app architecture and design. Two independent reviewers (RB in collaboration with another member from the qualitative core) trained in qualitative methods coded the focus group data using a thematic analysis approach and identified emerging themes.

RESULTS: The app wireframes included 4 navigation buttons on the home screen to organize and deliver evidence-based intervention content-Home (Inicio), Learn (Aprende), My Coach (Mi Couch), and Profile (Perfil). Different wireframe designs were generated in distinct color palettes. Data saturation was reached after three focus groups. Participants were 54% (7/13) women, had a mean age of 56 (SD 14.9) years, 39% (5/13) had an education ≤high school, and 31% (4/13) were married or cohabitating. All participants smoked daily, a mean of 14 (SD 7.8) cigarettes per day, for 32 (SD 16.9) years, and 54% (7/13) smoked ≤30 minutes of waking. Participants reported using social media, news, shopping, and gaming apps, but few used mobile health apps. Salient barriers for app use included worries regarding privacy breaches and fears about misinformation. Desired features included community-building elements, personalization, reward badges, knowledge checks, and audiovisual presentation of content within the app. Participants disliked having a countdown to quit date, preferring an “I quit” button to initiate monitoring progress. They also viewed sharing progress with support networks as a source of unwanted pressure, although a few saw it as motivational. Overall, participants liked the app design and indicated willingness to use it.

CONCLUSIONS: This formative research provides critical insights into preferences related to the development of culturally tailored mobile smoking cessation interventions for Spanish-speaking individuals. Key findings highlighted enthusiasm for a smoking cessation app and the importance of including features that foster social connection and allow for personalization.

PMID:42155124 | DOI:10.2196/84249