Tag: statistics

JMIR Cancer. 2026 Feb 9;12:e73058. doi: 10.2196/73058.

ABSTRACT

BACKGROUND: Reliance on telehealth increased dramatically during the COVID-19 pandemic, introducing new opportunities to consider the use of telehealth across the cancer control continuum. However, patient, clinician, and staff perspectives about the types of cancer care appointments that are considered appropriate and the clinical care needs to support expanded remote care services are limited. Understanding older adults’ diverse technology needs and perspectives is especially important given that they comprise a large and growing proportion of patients with cancer.

OBJECTIVE: This study aimed to describe the perceptions and experiences of older patients with cancer and their clinical care team members regarding the expansion of telehealth use across the cancer control continuum and to solicit suggestions about how to support telehealth use for cancer care delivery.

METHODS: Using a convergent mixed methods design, we surveyed and interviewed patients aged ≥60 years, clinicians, and staff at a comprehensive cancer center in the southern United States between December 2020 and November 2021. Interview questions were rooted in the sociotechnical model, which proposes 8 interrelated dimensions representing factors influencing the design, use, and outcomes associated with health information technologies. Patient survey domains included telehealth experience and satisfaction and factors affecting telehealth perceptions and use; clinician survey domains included contexts of telehealth appropriateness, training, and barriers and facilitators to telehealth service provision. Survey data were analyzed using descriptive statistics. Qualitative data were thematically analyzed using a combined deductive and inductive approach.

RESULTS: We received completed surveys from 128 patients (567 invited) and 106 clinicians and staff (146 invited). We completed 14 patient (29 invited) and 20 clinician and staff (22 invited) interviews. Across all participants, most agreed or strongly agreed that multiple cancer care appointment types should be offered via telehealth, including discussing treatment side effects (75/102, 73.5% of patients and 66/94, 70.2% of clinicians and staff), results communication (71/102, 69.6% of patients and 65/94, 69.1% of clinicians and staff), and treatment follow-up (67/102, 65.7% of patients and 52/93, 55.9% of clinicians and staff). In interviews, participants elaborated on factors influencing the appropriateness of telehealth versus in-person appointments, including symptom severity, type of cancer, and purpose of the appointment. Many patient and staff suggestions focused on ways to address digital literacy gaps, while clinicians recommended improving clinic workflows, infrastructure, and training.

CONCLUSIONS: Overall, clinicians, staff, and older patients with cancer all responded positively toward expanding telehealth use across multiple cancer and appointment types across the cancer control continuum. Older adults with cancer are generally interested in telehealth for cancer care, especially if strategies to address digital literacy gaps are incorporated. Clinicians and staff members expressed specialized training and infrastructure needs to optimize telehealth uptake and service delivery.

PMID:41662673 | DOI:10.2196/73058

Int J Group Psychother. 2026 Feb 9:1-38. doi: 10.1080/00207284.2025.2600103. Online ahead of print.

ABSTRACT

Experienced and internalized weight stigma (IWS) are associated with a plethora of health and psychosocial consequences. In this study, we tested the outcomes of a 10-12 week, online, counselor-facilitated support group (We Deserve Space; WDS) for individuals who had experienced weight stigma. Twenty-five large-bodied individuals participated in three iterations of the WDS group. Participants average age was 43.68 years (SD = 13.84, range = 28-78). Revisions to WDS curricula were made iteratively in response to feedback. Paired samples t-tests yielded statistically significant improvements on all variables (IWS, antifat attitudes, depressive symptoms, loneliness, eating-disorder functional impairment, belongingness) from baseline to end-of-group, with effect sizes in the medium to large range. This study provides preliminary evidence that WDS may improve IWS, disordered-eating functional impairment, and psychosocial well-being in large-bodied individuals.

PMID:41662670 | DOI:10.1080/00207284.2025.2600103

Ann Plast Surg. 2026 Feb 9. doi: 10.1097/SAP.0000000000004661. Online ahead of print.

ABSTRACT

BACKGROUND: Nipple-sparing mastectomy (NSM) improves aesthetic outcomes but carries a higher risk of ischemic complications, particularly in patients with large, ptotic breasts. This study evaluates whether reduction mammaplasty prior to NSM with deep inferior epigastric perforator (DIEP) flap reconstruction can help mitigate these risks.

METHODS: All patients who underwent NSM with immediate DIEP flap reconstruction between 2016 and 2024 were identified. Only those with native breast cup size D or larger were included. Patients were divided into 2 cohorts: those who underwent reduction mammaplasty prior to NSM (reduction cohort) and those without prior breast surgery (control cohort).

RESULTS: The reduction group included 21 patients (39 breasts), and the control group included 29 patients (51 breasts). Both groups had an average preoperative breast cup size of DD. Within the reduction group, 41.0% underwent planned staged reductions (average interval, 4.63 months), whereas 59.0% had prior elective reductions (average interval, 13.35 years). Postoperatively, the reduction group experienced significantly lower rates of skin necrosis (5.1% vs 37.3%, P < 0.001) and nipple-areolar complex (NAC) necrosis (2.6% vs 21.6%, P = 0.011). Infection rates were also lower, approaching statistical significance (5.1% vs 19.6%, P = 0.061). On multivariate regression, reduction mammaplasty was a significant protective factor against both skin (β = -2.774, P = 0.002) and NAC necrosis (β = -2.385, P = 0.030), reducing the odds by 93.8% and 90.8%, respectively.

CONCLUSION: Our findings suggest that prior reduction mammaplasty is associated with decreased ischemic complications in large-breasted patients undergoing NSM and DIEP flap reconstruction.

PMID:41662666 | DOI:10.1097/SAP.0000000000004661

JMIR Form Res. 2026 Feb 9;10:e71541. doi: 10.2196/71541.

ABSTRACT

BACKGROUND: Effective diabetes management requires individualized treatment strategies tailored to patients’ clinical characteristics. With recent advances in artificial intelligence, large language models (LLMs) offer new opportunities to enhance clinical decision support, particularly in generating personalized recommendations.

OBJECTIVE: This study aimed to develop and evaluate an LLM-based outpatient treatment support system for diabetes and examine its potential value in routine clinical decision-making.

METHODS: Three compact LLMs (Llama 3.1-8B, Qwen3-8B, and GLM4-9B) were fine-tuned on deidentified outpatient electronic health records using a parameter-efficient low-rank adaptation approach. The optimized models were embedded into a prototype hospital information system via a retrieval-augmented generation framework to generate individualized treatment recommendations, laboratory test suggestions, and medication prompts based on demographic and clinical data.

RESULTS: Among the models evaluated, the fine-tuned GLM4-9B demonstrated the strongest performance, producing clinically reasonable treatment plans and appropriate laboratory test recommendations and medication suggestions. It achieved a mean Bilingual Evaluation Understudy for 4-grams score of 67.93 (SD 2.74) and mean scores of 44.30 (SD 3.91) for Recall-Oriented Understudy for Gisting Evaluation for overlap of unigrams, 27.34 (SD 1.85) for Recall-Oriented Understudy for Gisting Evaluation for overlap of bigrams, and 37.67 (SD 2.88) for Recall-Oriented Understudy for Gisting Evaluation for Longest Common Subsequence.

CONCLUSIONS: The fine-tuned GLM4-9B shows strong potential as a clinical decision support tool for personalized diabetes care. It can provide reference recommendations that may improve clinician efficiency and support decision quality. Future work should focus on enhancing medication guidance, expanding data sources, and improving adaptability in cases involving complex comorbidities.

PMID:41662664 | DOI:10.2196/71541

J Long Term Eff Med Implants. 2026;36(1):1-7. doi: 10.1615/JLongTermEffMedImplants.2025059687.

ABSTRACT

The purpose of this study was to compare outcomes following open reduction and internal fixation (ORIF) of proximal humerus fractures with Zimmer Biomet and DePuy Synthes plating systems. This was a retrospective review of patients who underwent proximal humerus fracture fixation utilizing Zimmer Biomet or DePuy Synthes plating systems between June 2016 and February 2023. Patients without postoperative follow-up were excluded. Complication rates were compared between the two cohorts using chi-square and two-tailed t-tests for categorical and continuous variables, respectively. A total of 86 patients were identified for inclusion and eight were excluded for inadequate follow up. Statistical analysis comprised a total of 78 patients, 41 who underwent ORIF with a Zimmer Biomet implant, and 37 who underwent ORIF with a DePuy Synthes implant. The overall complication rate was 4.88% (n = 2) in the Zimmer Biomet cohort and 13.5% (n = 5) in the DePuy Synthes cohort (P > 0.05). Both Zimmer Biomet patients required revision surgery, compared with two out of five patients in the DePuy-Synthes group. There were no statistically significant differences in rates of avascular necrosis, impingement, malunion, or fixation failure between the two cohorts. Overall complication rate and need for revision surgery were similar between patients who underwent fixation with the Zimmer Biomet or DePuy Synthes plating systems. Our findings support selection of either plating system based on surgeon preference and equipment availability as neither demonstrated clinical superiority.

PMID:41662644 | DOI:10.1615/JLongTermEffMedImplants.2025059687

Am J Clin Oncol. 2026 Feb 5. doi: 10.1097/COC.0000000000001300. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the hepatotoxicity and clinical outcomes following external beam radiation therapy (EBRT) in patients with hepatocellular carcinoma (HCC) previously treated with Yttrium-90 radioembolization (Y-90), a setting in which cumulative liver radiation exposure raises concern for increased toxicity risk.

METHODS: We performed a retrospective review of 94 HCC patients treated with EBRT from 2016 to 2024, including 15 treated with Y-90. Hepatotoxicity was assessed using Albumin-Bilirubin (ALBI) score changes at 3 and 6 months post-EBRT. Secondary outcomes included CTCAE toxicity, local control, and survival. Treatment details, prior locoregional therapies, and dosimetric parameters were collected. Fisher exact tests and Kaplan-Meier analyses were used for statistical comparisons.

RESULTS: Baseline demographics and liver function were similar between groups. Over half the Y-90 cohort (53%) received fractionated proton therapy. At 6 months, grade 1 and 2 ALBI deterioration occurred in 2 (13%) and 4 patients (27%) with prior Y-90, compared with 17 (22%) and 21 patients (27%) without prior Y-90 (P=0.77). Grade ≥2 CTCAE toxicity occurred in 2 patients (13%) with prior Y-90 and in 5 patients (6%) without. Local control was 92% with no local failures in patients treated after Y-90. Median OS was 39 months without prior Y-90 and 34 months with prior Y-90 (P=0.89).

CONCLUSIONS: EBRT following Y-90 was not associated with increased hepatotoxicity or inferior oncologic outcomes compared with EBRT alone. When delivered with individualized planning, including fractionation, EBRT represents a safe and effective salvage modality for patients with residual or recurrent HCC after Y-90.

PMID:41662643 | DOI:10.1097/COC.0000000000001300

J Breast Imaging. 2026 Feb 9:wbaf044. doi: 10.1093/jbi/wbaf044. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the contrast-enhanced mammography-guided biopsy (CEM-Bx) success rate for MRI-suspicious lesions lacking known tomosynthetic or sonographic correlate along with factors associated with biopsy success.

METHODS: From June 2022 to August 2023, this prospective IRB-approved study enrolled women with breast MRI lesions rated BI-RADS ≥4A for CEM-Bx. Ipsilateral contrast-enhanced mammography (CEM) was performed in the biopsy suite and correlated with MRI. For visible lesions, CEM-Bx was performed immediately after prebiopsy CEM. Success criteria included enhancing correlate visualization and biopsy completion with accurate lesion sampling. An MRI-guided biopsy was recommended for failures. The success rate was evaluated with the Wilson score interval. MRI lesion and patient characteristics (size, type [mass, focus, or nonmass enhancement], kinetics, breast density, body mass index, background parenchymal enhancement [BPE], radiologist CEM experience, radiologist MRI experience, and histopathology) were collected. Multivariable logistic regression was performed with backward feature selection.

RESULTS: Analysis included 152 women (mean age 53 ± 11 years) with 184 lesions. CEM-Bx was successful for 106/184 (57.6%; [95% CI, 50.0-65.0]) lesions with 24/106 (22.6%) malignant. Of 78 failures, 60 (76.9%) lacked enhancement on prebiopsy CEM, 14 (17.9%) were not visualized with the biopsy grid, and 4 (5.1%) were not accurately sampled; 14/78 (17.9%) failures proved malignant. Increasing lesion size (odds ratio [OR] = 1.03; [95% CI, 1.01-1.06]), more years of radiologist CEM experience (OR = 1.24; [95% CI, 1.01-1.49]), and lower BPE (OR = 0.68 [95% CI, 0.46-0.98]) were associated with success.

CONCLUSION: Contrast-enhanced mammography biopsy can be a successful alternative to MRI-guided biopsy for MRI-detected lesions. MRI-guided biopsy should be pursued if CEM-Bx fails.

PMID:41661663 | DOI:10.1093/jbi/wbaf044

J Med Internet Res. 2026 Feb 9;28:e78233. doi: 10.2196/78233.

ABSTRACT

BACKGROUND: The rapid proliferation of electronic devices has increased screen time, raising concerns about its potential health effects, including chronic pain. However, existing studies have limitations in scope and causal inference, with inconsistent findings and a lack of exploration of potential biological mechanisms.

OBJECTIVE: The objective of our study was to investigate the causal associations and potential shared biological mechanisms between different forms of screen time and various chronic pain phenotypes.

METHODS: Leveraging genome-wide association study data, we investigated the association and potential shared biological mechanisms between screen time (time spent watching television, time spent using computer, and length of mobile phone use) and chronic pain phenotypes (including multisite chronic pain [MCP], back, knee, neck or shoulder, hip pain, and headaches). Two-sample Mendelian randomization (MR), reverse MR and multivariable Mendelian randomization (MVMR) analysis were performed to examine associations between screen time and chronic pain. Summary data-based Mendelian randomization (SMR), transcriptome-wide association study (TWAS), and colocalization analysis were used to identify the shared genes and potential biological mechanism.

RESULTS: MR analysis revealed that time spent watching television and length of mobile phone use were positively associated with several types of chronic pain, while time spent using computer showed a negative association. Specifically, time spent watching television was positively associated with the risk of MCP (P=1.05×10^-31; odds ratio [OR] 1.61, 95% CI 1.49-1.74), back pain (P=2.41×10^-8; OR 1.14, 95% CI 1.09-1.19), knee pain (P=7.10×10^-6; OR 1.09, 95% CI 1.05-1.13), neck or shoulder pain, and hip pain. Length of mobile phone use was positively associated with the risk of MCP (P=2.15×10^-5; OR 1.22, 95% CI 1.11-1.34), headaches, and neck or shoulder pain. However, time spent using computer was negatively associated with the risk of MCP (P<.001; OR 0.83, 95% CI 0.75-0.92), back pain, and knee pain. The reverse MR results showed that MCP was positively associated with time spent watching television (P=4.8×10^-7; OR 1.27, 95% CI 1.16-1.4) and length of mobile phone use (P=3.38×10^-5; OR 1.29, 95% CI 1.14-1.45), while the association with time spent using computer (P=.61; OR 0.97, 95% CI 0.87-1.09) was not statistically significant. The MVMR results failed to meet the criterion that all conditional F-statistics exceed 10. Integrative 3 analysis methods identified overlapping genes, with CEP170 emerging as a key gene consistently supported by SMR, TWAS, and colocalization analysis in the relationship between time spent using computer and MCP.

CONCLUSIONS: Our findings demonstrate an association between screen time and various aspects of chronic pain. The CEP170 gene might contribute to the shared biological mechanism between time spent using computer and MCP risk. However, due to the absence of robust MVMR results, the potential influence of confounding factors cannot be ruled out.

PMID:41661662 | DOI:10.2196/78233

JAMA Pediatr. 2026 Feb 9. doi: 10.1001/jamapediatrics.2025.6120. Online ahead of print.

ABSTRACT

IMPORTANCE: Autism spectrum disorder (ASD), intellectual disability (ID), and cerebral palsy (CP) are lifelong neurodevelopmental conditions accompanied by varying impairments. US mortality data for these groups are limited.

OBJECTIVE: To compare mortality and causes of death among a multisite cohort identified at age 8 years with ASD, ID, or CP with the general population through youth or young adulthood.

DESIGN, SETTING, AND PARTICIPANTS: Nine US sites identified 32 787 individuals who met case definitions for ASD, ID, and/or CP at age 8 years during active population-based cross-sectional surveillance conducted biennially from 2000 through 2016 by the US Centers for Disease Control and Prevention’s Autism and Developmental Disabilities Monitoring (ADDM) Network. Individuals were linked to death certificates through 2021. Cases with multiple conditions (18.9%) were included in each case group. General population data from the National Vital Statistics System were matched to ADDM Network sites and years of participation. Analyses were completed in 2024.

EXPOSURE(S): ASD, ID, or CP.

MAIN OUTCOMES AND MEASURES: Death and International Classification of Diseases, 10th revision (ICD-10) International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) causes from death certificate linkage.

RESULTS: There were 145 deaths among 23 393 people with ASD, 285 deaths among 14 031 people with ID, and 123 deaths among 1612 people with CP. Increased mortality compared with the general population was seen for ASD (hazard ratio [HR], 1.35; 95% CI, 1.15-1.59), ID (HR, 4.35; 95% CI, 3.87-4.88), and CP (HR, 9.62; 95% CI, 8.06-11.48). Further stratified by sex and co-occurring ID, mortality for ASD was higher only for females with co-occurring ID (HR, 5.04; 95% CI,3.21-7.91) compared with females in the general population. The distribution of causes of death varied across groups. The most common underlying cause of death ICD-10 chapters were external causes of morbidity and mortality (V01-Y98) for the general population and ASD case group, and diseases of the nervous system (G00-G99) for CP and ID case groups. The only ICD-10 chapter hazard of death that was not elevated for ID and CP compared with the general population was external causes as underlying cause of death. Mortality from external causes was also not elevated as underlying or any cause of death for ASD. There were also notable subchapter mortality differences with important clinical and public health implications. Only 11% of those with ASD, 1% of those with ID, and 49% of those with CP had an ICD-10 code for the respective disability on their death certificate.

CONCLUSIONS AND RELEVANCE: In this study, individuals with ASD, ID, or CP experienced higher mortality from a range of causes compared with the general population in youth and young adulthood. Mortality among these groups is difficult to ascertain using death certificates alone, since ICD-10 codes for these disabilities were rarely listed. These findings can inform public health and health care strategies to understand and prevent health disparities and excess mortality associated with developmental disabilities.

PMID:41661606 | DOI:10.1001/jamapediatrics.2025.6120

JAMA. 2026 Feb 9. doi: 10.1001/jama.2025.27259. Online ahead of print.

ABSTRACT

IMPORTANCE: Evidence linking coffee and tea to cognitive health remains inconclusive, and most studies fail to differentiate caffeinated from decaffeinated coffee.

OBJECTIVE: To investigate associations of coffee and tea intake with dementia risk and cognitive function.

DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study that included female participants from the Nurses’ Health Study (NHS; n = 86 606 with data from 1980-2023) and male participants from the Health Professionals Follow-up Study (HPFS; n = 45 215 with data from 1986-2023) who did not have cancer, Parkinson disease, or dementia at study entry (baseline) in the US.

EXPOSURES: The primary exposures were intakes of caffeinated coffee, decaffeinated coffee, and tea. Dietary intake was collected every 2 to 4 years using validated food frequency questionnaires.

MAIN OUTCOMES AND MEASURES: The primary outcome was dementia, which was identified via death records and physician diagnoses. The secondary outcomes included subjective cognitive decline assessed by a questionnaire-based score (range, 0-7; higher scores indicate greater perceived decline; cases defined as those with a score ≥3) and objective cognitive function assessed only in the NHS cohort using telephone-based neuropsychological tests such as the Telephone Interview for Cognitive Status (TICS) score (range, 0-41) and a measure of global cognition (a standardized mean z score for all 6 administered cognitive tests).

RESULTS: Among 131 821 participants (mean age at baseline, 46.2 [SD, 7.2] years in the NHS cohort and 53.8 [SD, 9.7] years in the HPFS cohort; 65.7% were female) during up to 43 years of follow-up (median, 36.8 years; IQR, 28-42 years), there were 11 033 cases of incident dementia. After adjusting for potential confounders and pooling results across cohorts, higher caffeinated coffee intake was significantly associated with lower dementia risk (141 vs 330 cases per 100 000 person-years comparing the fourth [highest] quartile of consumption with the first [lowest] quartile; hazard ratio, 0.82 [95% CI, 0.76 to 0.89]) and lower prevalence of subjective cognitive decline (7.8% vs 9.5%, respectively; prevalence ratio, 0.85 [95% CI, 0.78 to 0.93]). In the NHS cohort, higher caffeinated coffee intake was also associated with better objective cognitive performance. Compared with participants in the lowest quartile, those in the highest quartile had a higher mean TICS score (mean difference, 0.11 [95% CI, 0.01 to 0.21]) and a higher mean global cognition score (mean difference, 0.02 [95% CI, -0.01 to 0.04]); however, the association with global cognition was not statistically significant (P = .06). Higher intake of tea showed similar associations with these cognitive outcomes, whereas decaffeinated coffee intake was not associated with lower dementia risk or better cognitive performance. A dose-response analysis showed nonlinear inverse associations of caffeinated coffee and tea intake levels with dementia risk and subjective cognitive decline. The most pronounced associated differences were observed with intake of approximately 2 to 3 cups per day of caffeinated coffee or 1 to 2 cups per day of tea.

CONCLUSIONS AND RELEVANCE: Greater consumption of caffeinated coffee and tea was associated with lower risk of dementia and modestly better cognitive function, with the most pronounced association at moderate intake levels.

PMID:41661604 | DOI:10.1001/jama.2025.27259