Tag: statistics

J Med Internet Res. 2026 Apr 29;28:e80330. doi: 10.2196/80330.

ABSTRACT

BACKGROUND: Human milk feeding and breastfeeding are the recommended standards for infant feeding. Nevertheless, breastfeeding rates in the United States remain below target levels, with disparities across racial, ethnic, and income groups. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) plays a substantial role in reducing these disparities by providing lactation support to individuals with low income. With ongoing WIC modernization efforts, there is an opportunity to create and optimize technology solutions responsive to WIC participants’ and staff’s needs to increase access to the program and its services.

OBJECTIVE: This study aimed to describe the development and pilot testing of Daily Drop, a gamified, low-bandwidth mobile app to provide human milk feeding education and support for WIC participants.

METHODS: Guided by the 5-stage model for comprehensive research on telehealth, Daily Drop underwent 3 stages: concept development, service design, and preimplementation. Using a mixed methods approach, the project team sought feedback from WIC leadership and staff at the state and local levels, state IT staff, and WIC participants at each stage. Suggestions from stages 1 and 2 were incorporated into the testable app before field testing (stage 3). During field testing, participants and staff completed surveys across multiple time points and qualitative interviews to evaluate the app’s feasibility, usability, and acceptability. Quantitative data were analyzed using descriptive statistics, and qualitative data were thematically analyzed.

RESULTS: Key feedback from WIC participants and staff included providing flexibility for a variety of human milk feeding approaches (stage 1); and providing easily accessible educational information throughout gameplay, diversifying progress tracking to emphasize knowledge growth and expertise development, and including supportive or affirming messages for users (stage 2). During field testing (stage 3), >67% of WIC participants agreed with 7 out of 12 acceptability, satisfaction, and usability questions about the app, reiterated in interviews where they highlighted the simplicity of the app and how it increased their confidence to feed human milk. However, barriers to app use included a lack of reminders and repetitive information for parents with previous human milk feeding experience. Similarly, for WIC staff, mean scores for acceptability and feasibility were 3.8 (SD 1.0) and 4.4 (SD 0.6), respectively (max 5) at the early phase, but these scores declined over time. Staff recommendations included providing further, in-depth training to increase their familiarity with the app and reporting, and integrating the reports into WIC’s management information system.

CONCLUSIONS: The development of Daily Drop followed an agile development, co-design approach with the involvement of relevant key partners at all stages of development. Overall, Daily Drop was deemed acceptable, usable, and engaging by WIC participants and staff. Future research could focus on testing its effectiveness in improving human milk feeding behaviors and cost-effectiveness.

PMID:42054666 | DOI:10.2196/80330

Rambam Maimonides Med J. 2026 Apr 26;17(2). doi: 10.5041/RMMJ.10573.

ABSTRACT

BACKGROUND: Chronic hypoxemia in patients with COPD is associated with increased morbidity and mortality. Although arterial partial pressure of oxygen (PaO₂) is widely used, it does not adequately reflect systemic oxygen transport. Arterial oxygen content (CaO₂) may provide a more comprehensive assessment.

OBJECTIVE: This study aimed to evaluate whether or not CaO₂ is a better predictor of mortality than PaO₂ in patients with COPD.

METHODS: This retrospective observational cohort study included 147 COPD patients aged ≥45 years. Patients were categorized according to CaO₂ levels (low, normal, high). Mortality at 1, 3, and 5 years was analyzed. Statistical methods included ROC curves, Kaplan-Meier survival analysis, and Cox regression models.

RESULTS: A total of 66 deaths (45.2%) occurred in the study cohort. Mortality was highest in the low CaO₂ group. The CaO₂ demonstrated better predictive performance than PaO₂ (AUC 0.73 versus 0.53, respectively). Low CaO₂ was associated with a 2.5-fold increased risk of mortality. Despite improvements in PaO₂ after long-term oxygen therapy, CaO₂ did not significantly change.

CONCLUSIONS: The CaO₂ is a more informative marker of oxygen transport and mortality risk than PaO₂ in COPD patients. It should be considered a complementary parameter in clinical assessment.

PMID:42054663 | DOI:10.5041/RMMJ.10573

Rambam Maimonides Med J. 2026 Apr 26;17(2). doi: 10.5041/RMMJ.10572.

ABSTRACT

OBJECTIVES: This study explored the relationship between visual perceptual skills and participation performance in 4-6-year-old children diagnosed with autism spectrum disorder (ASD).

METHODS: A cross-sectional design was employed for children diagnosed with ASD. Visual perceptual abilities were assessed using the Motor-Free Visual Perception Test-Fourth Edition (MVPT-4), and participation levels were measured using the Children Participation Questionnaire (CPQ). Statistical analysis was done using SPSS version 26, employing one-sample t-tests and Pearson correlation analysis.

RESULTS: A total of 48 participants were included in the study: mean age, 4.98±0.82 years; 66.7% were male; 79.2% attended regular schools. One-sample t-tests indicated significant deficits across all CPQ dimensions (P<0.001). Visual perception was negatively correlated with autism severity (r=-0.429, P=0.002) and positively correlated with participation diversity (r=0.404, P=0.004). In the activities of daily living (ADL) and instrumental ADL (IADL) occupations, visual perception was significantly associated with all CPQ elements. Conversely, play and leisure occupations showed mostly negative correlations with the CPQ occupations, while social participation and education showed mixed results. Visual perception was positively correlated with most elements but negatively associated with enjoyment (r=-0.428; P=0.002).

CONCLUSIONS: Preschool children with ASD demonstrate significant participation restrictions. Visual perception emerged as a critical determinant of participation, particularly in ADL and educational contexts. Early interventions targeting visual perception skills may enhance independence and functional engagement, though interventions should also address the enjoyment and emotional experience occupations to ensure holistic participation outcomes.

PMID:42054662 | DOI:10.5041/RMMJ.10572

JMIR Hum Factors. 2026 Apr 29;13:e87522. doi: 10.2196/87522.

ABSTRACT

BACKGROUND: Computerized clinical decision support (CDS) has the potential to improve patient outcomes by offering evidence-based guidance at the point of care-enhancing guideline adherence and diagnostic accuracy-and supporting system-level outcomes by enabling predictive analytics for more efficient resource planning. Prior work has identified factors that affect adoption, such as clinicians’ expectations of usefulness, ease of use, alignment with workflows, and resources to support utilization. However, CDS adoption is not static and changes according to dynamic systems of behaviors and workflows, requiring a deeper understanding of how evolving conditions affect implementation and outcomes.

OBJECTIVE: To explore the dynamic factors influencing CDS adoption, we examined the implementation of the “Unplanned readmission model version 1,” developed by Epic Medical Records System, at Duke University Health System, using group model building and system dynamics modeling.

METHODS: We first conducted group model-building workshops with staff (case managers, physical and occupational therapists, hospitalist faculty physicians, and resident physicians) who participate in decisions about discharging patients. Study team members guided participants to identify and connect variables in causal loop diagrams. We coded workshop transcripts in software designed for system dynamics analysis to identify themes, aggregated them into a causal loop diagram, and reviewed them with participants to converge on a common model. A team member applied equations to the pathways and tested data to simulate conditions leading to full, limited, or no adoption of a tool.

RESULTS: We identified key balancing loops driven by external pressure (eg, Centers for Medicare & Medicaid Services penalties) that motivated initial adoption and reinforcing loops based on perceived internal benefits to sustain use. While institutional incentives led to early training and tool use, efforts declined due to staff turnover, competing priorities (eg, COVID-19), and workflow changes. Reinforcing loops emerged when staff described clinical utility, such as improved discharge planning and team communication. However, staff also suggested that these loops were often weak due to difficulty linking the use of the tool to outcomes in real time. Simulation modeling showed that while strong external pressure and rapid training led to initial success, interest in using the tool waned as workflows improved and readmission rates approached Centers for Medicare & Medicaid Services goals. When conflicting priorities were introduced, adoption stalled earlier, and fewer staff were trained. In contrast, when internal motivation was strengthened by reducing the amount of evidence needed to perceive success, individual interest remained high even as institutional attention declined, sustaining tool use and further reducing readmissions.

CONCLUSIONS: External pressure to improve can be a strong motivator for initial adoption, but in the face of conflicting demands for attention, it may fall short of sustained long-term tool use. Tools are more likely to have extensive and sustained use when those using the tools can perceive internal benefits.

PMID:42054653 | DOI:10.2196/87522

JMIR Med Inform. 2026 Apr 29;14:e84095. doi: 10.2196/84095.

ABSTRACT

BACKGROUND: Brain tumor is one of the most malignant diseases of the central nervous system, and early accurate detection is of great significance for improving patient survival rate. However, the heterogeneity of brain tumors in terms of morphology, size, and location on magnetic resonance imaging (MRI) image, as well as their similarity to surrounding normal brain tissue, poses significant challenges for tumor detection.

OBJECTIVE: This study aims to develop a high-performance brain tumor detection framework that integrates feature enhancement, channel attention, and progressive pruning, achieving an optimal balance between detection accuracy, model efficiency, and interpretability for slice-level MRI tumor localization tasks.

METHODS: This paper proposes a convolution Prewitt-and-pooling-based preprocessing (CSPP) approach, based on the “you only look once” version 11 (YOLOv11) framework, which highlights important structural detail more effectively than traditional statistics. A dynamic convolution-based C3k2 (DCC) module was integrated to more efficiently capture both local and global features. A channel prior convolutional attention (CPCA) module was introduced before the detection head, enabling the network to specifically focus on information-rich channels and key spatial regions. Through a progressive hybrid pruning strategy (PHPS), the model was optimized for efficient inference. Furthermore, Eigen-class activation mapping (Eigen-CAM) was used to interpret the prediction result, making them more transparent.

RESULTS: Extensive experiments on 3 brain tumor MRI datasets demonstrated the superior performance of CDCP-YOLO (CSPP-DCC-CPCA-PHPS-YOLO). On Br35H, the mean average precision (mAP) at an intersection-over-union (IoU) threshold of 0.5 (mAP0.5) increased by 2.6%, average mAP over several IoU thresholds (0.50-0.95; mAP0.5:0.95) increased by 5.9%, and number of floating-point operations (×10⁹; GFLOPs) decreased by 47.7%. On Roboflow, mAP0.5 increased by 19.5%, mAP0.5:0.95 increased by 7.7%, and GFLOPs decreased by 47.7%. On Capstone, mAP0.5 increased by 6.9%, mAP0.5:0.95 increased by 5.8%, and GFLOPs decreased by 47.7%.

CONCLUSIONS: The proposed CDCP-YOLO framework achieves an optimal balance between accuracy, efficiency, and interpretability, providing a lightweight and reliable solution for slice-level brain tumor detection in MRI images.

PMID:42054652 | DOI:10.2196/84095

JMIR Hum Factors. 2026 Apr 29;13:e89126. doi: 10.2196/89126.

ABSTRACT

BACKGROUND: Motivational interviewing (MI) is a patient-centered communication approach that supports health behavior change; yet, its integration into undergraduate medical curricula remains inconsistent. Combined learning models that comprise face-to-face instruction with structured web-based components may strengthen MI training, but evidence supporting their effectiveness among medical students, particularly in Asian contexts, is limited.

OBJECTIVE: This study evaluated the impact of a combined MI educational model on final-year medical students’ MI knowledge, confidence, and application in real patient encounters during clinical rotations.

METHODS: This study used a sequential explanatory mixed methods design. The quantitative component used a before-and-after study to evaluate changes in MI knowledge and confidence among final-year medical students enrolled in an Ambulatory Care course in 2024. All 130 students participated in a 2-hour interactive MI workshop, and 120 completed pre- and postintervention questionnaires assessing MI knowledge and self-reported confidence. Students were also provided access to a 3-hour web-based MI learning module, and learning-management system analytics were used to track engagement. The qualitative component consisted of semistructured interviews with 12 purposively selected students, conducted to explore their experiences applying MI during clinical encounters. Quantitative data were analyzed using paired-samples t tests, and qualitative data were analyzed using inductive conventional content analysis. Findings from both components were integrated during interpretation to provide a comprehensive understanding of the educational intervention.

RESULTS: Students demonstrated a significant improvement in MI knowledge following the educational intervention (pretest mean 8.87, SD 2.69; posttest mean 15.04, SD 2.99; t₁₁₉=-18.45; P<.001; η²=0.74). After the workshop, 96.9% (126/130) of students reported applying MI with patients, and 92.3% (n=120) agreed that the combined learning approach was adequate for supporting clinical use. Learning analytics data showed that 76.9% (n=100) of students enrolled in the web-based MI module, and 51% (n=51) completed all lessons. Students most frequently applied MI when counseling patients with diabetes, hypertension, and dyslipidemia, especially related to diet, physical activity, and medication adherence. Interview findings indicated that students mainly used brief MI, were most comfortable with engaging and focusing, and developed greater empathy, confidence, and patient-centered communication skills. Challenges included limited time during consultations, clinical workload, and difficulty applying all MI processes to complex cases.

CONCLUSIONS: A combined MI learning approach integrating a short workshop with a web-based course was associated with higher MI knowledge scores and greater self-reported confidence among students, as well as reported use of MI-informed communication strategies during clinical encounters. Students perceived MI as a practical and ethically grounded communication approach that can enhance patient engagement, particularly in the management of chronic diseases. Introducing MI training longitudinally through a spiral curriculum, with opportunities for repeated practice and reinforcement, may help strengthen behavior-change communication competencies in undergraduate medical education.

PMID:42054651 | DOI:10.2196/89126

JMIR Public Health Surveill. 2026 Apr 29;12:e88992. doi: 10.2196/88992.

ABSTRACT

BACKGROUND: It is important to understand the motives behind why people want to reduce their alcohol consumption to inform messaging for public health campaigns.

OBJECTIVE: This study aimed to identify the motives for reducing alcohol consumption among users of the Drink Less app in the United Kingdom.

METHODS: Content analysis of Drink Less app users’ responses to the prompt “I want to drink less because…” Users were aged 18 years or older, lived in the United Kingdom, and had downloaded the app between May 20, 2016, and June 24, 2024 (n=2520). Inductive content analysis was conducted to analyze users’ motives to drink less, and the frequencies were stratified by age, sex, and Alcohol Use Disorders Identification Test (AUDIT) score categories.

RESULTS: The most common motives to drink less were wanting to improve their physical health (1329/2520, 52.7%), feel better in their body (823/2520, 32.7%), improve their mental well-being (567/2520, 22.5%), regain agency (483/2520, 19.2%), live a different life (321/2520, 12.7%), and have better relationships (309/2520, 12.3%). The motives for drinking less,”improve physical health” and “feel better in their body,” had a lower prevalence among users in higher AUDIT risk zones compared with low-risk, while wanting to “improve their mental well-being,” “regain agency,” “live a different life,” and “have better relationships” had a higher prevalence among users in higher AUDIT risk zones.

CONCLUSIONS: Users of an alcohol reduction app in the United Kingdom most commonly reported wanting to improve their physical health, feel better in their bodies, and improve their mental well-being as their motives for drinking less alcohol. The pattern of prevalence of different motives varied by AUDIT risk zones, highlighting the importance of tailoring interventions based on what is most likely to be motivating for individuals.

PMID:42054642 | DOI:10.2196/88992

JMIR Public Health Surveill. 2026 Apr 29;12:e82792. doi: 10.2196/82792.

ABSTRACT

BACKGROUND: Although recovery is a central tenet of the US substance use disorder service delivery system, empirical research on youth recovery remains limited and underdeveloped. Notably, no population-based representative surveys, either in the United States or internationally, currently assess recovery status among secondary school-aged youth (aged 14-18 years). Consequently, little is known about how many youth identify as being in recovery or about their characteristics and needs.

OBJECTIVE: This study presents the first statewide representative estimate of adolescent self-reported recovery (ASR), derived from a large Midwestern state in the United States.

METHODS: We used data from the 2024 Illinois Youth Survey, a weighted, statewide representative survey of students from 8th, 10th, and 12th grades across Illinois. We examined the prevalence of ASR with a widely used single-item question, “Do you consider yourself to be in recovery?” The question was presented after an instruction directing students to consider only substance use when responding. We estimated the prevalence of ASR and conducted descriptive analyses to characterize this group.

RESULTS: Among the 6871 participating students from the 10th and 12th grades, the prevalence of ASR was 3.3% (95% CI 2.6%-4.1%). Among participants with ASR, 51.1% (118/231) were female, 39% (90/231) identified as Latino or Latina, 38.1% (88/231) identified as White, and 13% (30/231) identified as Black or African American. The average age of participants with ASR was 16.5 (SD 1.14) years. Participants with ASR were demographically diverse, and a little over half received free or reduced-price lunch.

CONCLUSIONS: Findings suggest that financial recovery capital may be particularly important for participants with ASR. This study provides the first population-based estimate of the prevalence of ASR and underscores the importance of including recovery status in large-scale surveys to inform and strengthen recovery support systems.

PMID:42054636 | DOI:10.2196/82792

J Med Internet Res. 2026 Apr 29;28:e81485. doi: 10.2196/81485.

ABSTRACT

BACKGROUND: Podcasts provide a platform for delivering patient information. They have the potential to enhance patient engagement in shared decision-making (SDM), reduce anxiety in relation to hospital visits, and improve patient satisfaction. However, their impact on these outcomes in the context of hospital visits remains underexplored.

OBJECTIVE: This study aimed to examine whether podcasts influence patients’ (1) engagement in SDM, (2) anxiety after the hospital visit, and (3) satisfaction with the hospital visit.

METHODS: A quasi-experimental design with a nonequivalent comparison group was used. The study was conducted in 3 specialized outpatient clinics at a Danish hospital. Patients were allocated to one of 2 groups: the intervention group, which received access to informational podcasts in addition to standard written information before their hospital visit, and the comparison group, which received only the standard written information. All patients received validated questionnaires to assess SDM (9-item Shared Decision-Making Questionnaire [SDM-Q-9]), anxiety (State-Trait Anxiety Inventory-State), and satisfaction after the consultation.

RESULTS: A total of 240 patients participated. Compared with the control group, the intervention group showed a 15% higher level of SDM (SDM-Q-9) scores (adjusted relative difference=1.15, 95% CI 1.05-1.26; P=.18). Subgroup analyses indicated a statistically significant effect among patients with low health literacy (adjusted relative difference=1.81, 95% CI 1.42-2.32; P=.002). Anxiety scores were 9% lower (adjusted relative difference=0.91, 95% CI 0.84-0.99; P=.23), and satisfaction with previsit information increased by 14% (adjusted relative difference=1.14, 95% CI 1.07-1.21; P=.003).

CONCLUSIONS: Informational podcasts, provided as a supplement to traditional written information, may offer modest support for patient engagement in SDM, particularly among patients with low health literacy. Podcasts also appear to improve satisfaction with previsit information more broadly. Effects on previsit anxiety were inconclusive.

PMID:42054634 | DOI:10.2196/81485

JCO Oncol Pract. 2026 Apr 29:OP2500963. doi: 10.1200/OP-25-00963. Online ahead of print.

ABSTRACT

PURPOSE: It has been theorized that antibiotic therapy (ABT) affects response to immune checkpoint inhibition (ICI) by inducing dysbiosis of the gut microbiome (GM). To investigate the association between ABT and real-world overall survival (rwOS)/progression-free survival (rwPFS) in patients with metastatic renal cell carcinoma (mRCC) receiving ICI versus tyrosine kinase inhibitors (TKIs).

METHODS: In total, 5,237 patients with mRCC from a nationwide electronic health record-derived deidentified database who received ICI or TKI first-line after diagnosis were included. ABT exposure was stratified by exposure (yes or no), timing (before v after treatment initiation v none), excretion modes (hepatic v renal excretion v none), and administration routes (oral v intravenous v none). Three-month landmark Kaplan-Meier estimation and log-rank tests were used to compare rwOS/rwPFS among ABT groups. Multivariable Cox proportional hazards models with time-varying coefficients investigated the association between rwPFS, rwOS, ABT, and treatment modality.

RESULTS: ABT exposure was negatively associated with rwOS/rwPFS in both ICI (rwOS [23.9 v 33.6 months, P = .029]; rwPFS [8.8 v 11.6 months, P < .001]) and TKI (rwOS [17.4 v 26.2 months, P < .001]; rwPFS [8.0 v 9.7 months, P < .001]) recipients. For ICI patients only, a negative correlation between ABT after treatment initiation (rwOS, P = .003, rwPFS <0.001) and oral administration route (rwOS P = .004, rwPFS P = .001) was identified. In time-varying Cox proportional models, the effect of ABT on rwPFS beyond 12 months was only statistically significant in ICI patients (ICI, hazard ratio [HR], 1.67, P = .013; TKI, HR, 0.95; P = .7).

CONCLUSION: In our observational study, we identified a potential unique and complex association between ABT and rwOS/rwPFS in patients with mRCC receiving ICI. We found a negative correlation between ABT use after treatment initiation or via the oral route on oncologic outcomes in ICI patients. Moreover, there appears to be an ICI-specific negative association of ABT on rwPFS beyond 1 year. Our findings are associative, but they emphasize the importance of antibiotic stewardship in this space.

PMID:42054627 | DOI:10.1200/OP-25-00963