Tag: statistics

BMC Public Health. 2026 Jan 26;26(1):311. doi: 10.1186/s12889-025-25657-x.

ABSTRACT

BACKGROUND: Antibiotics are among the most frequently prescribed medications for pediatric patients. Inappropriate use, particularly in the first years of life, can contribute to the development of antibiotic resistances and impact the maturation of the gut microbiome. Describing prescription patterns using nationally collected data is essential for identifying or monitoring existing strategies for reducing excessive use. This study aims to identify antibiotic prescription trajectories during the first four years of life and to investigate their association with sociodemographic factors.

METHODS: In this retrospective cohort study, we used data collected through the Pedianet registry, a monitoring system involving approximately 200 family pediatricians (FPs) in Italy. We considered children born between 2004 and 2018 with complete follow-up during their first four years of life, excluding those with a birth weight of < 2500 g, gestational age < 37 weeks or genetic disorders. Prescription trajectories over the 16 trimesters of observation were estimated using Group-Based Trajectory Modelling (GBTM), by classifying the included children into homogeneous groups based on their probabilities of membership. The association between trajectories and sociodemographic factors was examined with multinomial logistic regression with random intercepts for FPs.

RESULTS: A total of 143,098 children born between 01/01/2004 and 31/12/2018 were included. Between 0 and 4 years of age, these children received a total of 684,010 antibiotic prescriptions. GBTM identified four different trajectories, defined as: [1] “very low use” of antibiotics (34.9% of children) [2], “low-to-moderate use” (22.8%) [3], “moderate-to-low use” (28.0%) and [4] “high use” (14.3%). Compared to the “very low use” trajectory, male subjects residing in the center and south of Italy and born between 2004 and 2008 had a higher probability of belonging to trajectory groups with “moderate-to-low use” and “high use”.

CONCLUSIONS: From 2004 to 2022 in Italy, we observed heterogeneous antibiotic prescription patterns among children aged 0-4 years. Future strategies aimed at reducing the number of prescriptions in this age group should target the subgroups at higher risk.

PMID:41588382 | DOI:10.1186/s12889-025-25657-x

BMC Cancer. 2026 Jan 26. doi: 10.1186/s12885-026-15618-x. Online ahead of print.

ABSTRACT

BACKGROUND: Uterine sarcoma has an inferior prognosis and high recurrence rate among gynecological malignancies, even in early-stage cases with complete resection. However, the risk factors for recurrence remain poorly understood. This study aimed to identify risk factors associated with recurrence in early-stage uterine sarcoma.

METHODS: Among 97 patients with uterine sarcoma treated at our institution between January 2007 and June 2023, we retrospectively investigated 55 patients of the following five histological types: uterine leiomyosarcoma (ULMS), low- or high-grade endometrial stromal sarcoma (LG-ESS or HG-ESS), adenosarcoma, and smooth muscle tumor of uncertain malignant potential (STUMP). Risk factors were compared between the recurrence and non-recurrence groups using univariate analysis, and recurrence rates, time to recurrence, progression-free survival (PFS), and overall survival (OS) were examined.

RESULTS: The median age of 55 patients was 48 years, and the most common initial symptom was abdominal pain or abdominal mass awareness (29.4%), followed by abnormal bleeding in 25.5% of the patients. The median tumor size was 9.7 cm, and stage I cases were 64.8% of the total. Histological types were 28 ULMS, 13 LG-ESS, 8 STUMP, 5 HG-ESS, and one adenosarcoma. Among stage I cases, ULMS had a recurrence rate of 81.3% with a median time to recurrence of 12.4 months, while LG-ESS had a recurrence rate of 30% with a median time to recurrence of 41.1 months. A high mitotic count was significantly associated with recurrence in stage I ULMS (p = 0.044). Other surgical pathological findings, such as lymphovascular space invasion, MIB-1 positive rate, and necrosis, and surgical factors, such as myomectomy and ovarian preservation, showed no statistically significant differences but were higher in the recurrence cases. The 5-year PFS rates in stage I ULMS and LG-ESS groups were 31.3% and 75%, and the 5-year OS rates were 68.5% and 100%, respectively.

CONCLUSIONS: In stage I ULMS, a high mitotic count was associated with an increased risk of recurrence after complete surgical resection.

PMID:41588380 | DOI:10.1186/s12885-026-15618-x

J Colloid Interface Sci. 2026 Jan 21;709:139953. doi: 10.1016/j.jcis.2026.139953. Online ahead of print.

ABSTRACT

HYPOTHESIS: The phenomenon of underscreening, where the screening of the electrostatic potential in the bulk electrolyte is weaker than it should be according to the canonical Debye-Hückel theory, has significant implications for colloidal stability in highly concentrated electrolytes. Current experimental and computational investigations of this phenomenon have been limited to single mode analyses, despite statistical mechanics predicting that many modes are present simultaneously. We hypothesise that using a multi-modal approach will provide insights not yet observed.

COMPUTATIONAL APPROACH: Here we apply Fourier analysis to radial charge densities, derived from polarisable molecular dynamic simulations of aqueous alkali chloride electrolytes, to determine if multiple modes are present. Prony’s method is then applied to a multi-modal ansatz to estimate screening lengths associated with each mode.

FINDINGS: Fourier analysis revealed that there are many modes present in the radial charge density. For all electrolytes considered at low concentrations the dominant mode was a non-oscillatory Yukawa decay mode, while at higher concentrations modes with non-zero spatial frequencies dominated. Resulting screening modes with oscillatory wavelengths ∼5-15 Å from Prony’s method agree with the largest experimental screening lengths from surface force apparatus and fluorescence experiments. Concurrently, screening lengths with shorter oscillatory wavelengths, 3-5 Å, have smaller magnitudes and agree with other experiments such as atomic force microscopy and optical second harmonic scattering experiments.

PMID:41587504 | DOI:10.1016/j.jcis.2026.139953

JMIR Form Res. 2026 Jan 26;10:e74101. doi: 10.2196/74101.

ABSTRACT

BACKGROUND: The World Health Organization reported that noncommunicable diseases (NCDs) contribute to around 74% of deaths worldwide. A similar phenomenon can also be observed in Brunei Darussalam. One of the most cost-effective approaches to control the growing burden of NCDs is to reduce related modifiable risk factors.

OBJECTIVE: This study aims to propose a composite health score called Health Index, inspired by the 6 pillars of lifestyle medicine, which acts as a measure of health and can show how health changes over time at an individual and national level.

METHODS: Health Index is a series of questionnaires that captures users’ health status on several domains of health and, upon completion, the users are categorized as either healthy, at risk, or in poor health. Users will also be able to view health advice based on their answers to the questionnaires.

RESULTS: The field testing results show Health Index as a promising population health management tool. 13.8% (166/1200) of the targeted users completed Health Index within 1 month, with 85% (1019/1200) of them in the “At Risk” category. We also identified diet as the most prominent health issue.

CONCLUSIONS: In conclusion, the Health Index potentially enables early detection and management of NCD risk factors to mitigate the high cost of advanced disease and complications. In the future, we aim to retrospectively and prospectively validate the Health Index through several statistical analyses.

PMID:41587487 | DOI:10.2196/74101

Ann Intern Med. 2026 Jan 27. doi: 10.7326/ANNALS-25-01344. Online ahead of print.

ABSTRACT

BACKGROUND: In embarking on randomized clinical trials (RCTs), researchers can hypothesize that a more intensive treatment is better than a less intensive treatment (positive hypothesis) or that a less intensive treatment is similar or noninferior to a more intensive treatment (negative hypothesis). Researchers may design noninferiority RCTs (NI-RCTs) to support negative hypotheses and standard RCTs (S-RCTs) to support negative or positive hypotheses. Regardless of hypotheses, S-RCTs and NI-RCTs should produce consistent results when assessing similar participants, interventions, control, and outcomes.

OBJECTIVE: To compare effect estimates in S-RCTs with positive hypotheses versus NI-RCTs and in S-RCTs with negative hypotheses versus NI-RCTs.

DESIGN: Meta-research.

SETTING: 98 meta-analyses.

PARTICIPANTS: 468 RCTs, including 153 NI-RCTs and 315 S-RCTs (149 positive and 166 negative hypotheses).

INTERVENTION: S-RCTs as the exposure and NI-RCTs as the control.

MEASUREMENTS: The ratio of effect estimates between S-RCTs and NI-RCTs in each meta-analysis was combined across meta-analyses.

RESULTS: Standard RCTs with positive hypotheses produced effect estimates 1.47 (95% CI, 1.27 to 1.70) times larger than NI-RCTs; among RCTs rated as having low risk of bias for blinding, the ratio was 1.01 (CI, 0.70 to 1.45), whereas among those rated as having high or unclear risk of bias for blinding, the ratio was 1.81 (CI, 1.41 to 2.33). Standard RCTs with negative hypotheses did not produce statistically different effect estimates from NI-RCTs (ratio, 0.93 [CI, 0.84 to 1.03]).

LIMITATION: Findings may be limited by residual differences between S-RCTs and NI-RCTs in the same meta-analysis.

CONCLUSION: The researchers’ hypotheses may bias the results of published RCTs, especially those with high or unclear risk of bias for blinding. The effect of researchers’ hypotheses should be assessed in systematic reviews and clinical practice guidelines when RCTs addressing the same clinical question report conflicting hypotheses.

PRIMARY FUNDING SOURCE: The Shenzhen Municipal Government, Guangdong Province, China, and the Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences.

PMID:41587480 | DOI:10.7326/ANNALS-25-01344

JMIR Hum Factors. 2026 Jan 26;13:e80812. doi: 10.2196/80812.

ABSTRACT

BACKGROUND: Delivering therapy through video consultations can increase the reach and impact of mental health care services. However, adoption varies, and there is a lack of professional consensus about the usefulness of video consultations in therapy settings.

OBJECTIVE: This study aimed to explore mental health professionals’ experiences with and attitudes toward video consultations across different clinical environments in the private and public health care sectors in Norway to inform the design of future digitalized services.

METHODS: In this qualitative study, we recruited leaders and clinicians from public hospitals and private clinics. We conducted semistructured interviews that mapped individual experiences and attitudes concerning video consultations, as well as contextual aspects concerning the participants’ professional environments. We used reflexive thematic analysis with an inductive, essentialist, and experiential orientation to analyze the data.

RESULTS: A total of 24 mental health professionals (16 from public hospitals and 8 from private clinics) participated. Variations in their attitudes did not follow patterns reflecting the type of service or sector they worked in. Rather, attitudes seemed related to higher-level assumptions rooted in professional culture, societal values, and previous experiences. We generated six themes capturing and structuring the professional perspectives: (1) meta-perspectives on the digitalization of therapeutic rooms, (2) the “how” of service integration, (3) challenging therapist culture, (4) negotiating the limits of the digital therapy room, (5) creating clinical value from the digital format, and (6) adapting techniques and technology in digital therapy sessions.

CONCLUSIONS: To strengthen the adoption and impact of video consultations, we should direct attention toward higher-level societal and cultural aspects that shape attitudes and practices. We suggest incorporating digitalized therapy in education, facilitating personal experiences with video consultations, increasing the sharing of knowledge between clinical environments, and sparking innovation of both service models and technology.

PMID:41587466 | DOI:10.2196/80812

JMIR Mhealth Uhealth. 2026 Jan 26;14:e66267. doi: 10.2196/66267.

ABSTRACT

BACKGROUND: Psychological stress during pregnancy is common and has been associated with adverse maternal and neonatal outcomes. Digital health interventions (DHIs) have emerged as a scalable approach to support stress management during pregnancy, yet evidence remains fragmented, and prior reviews have largely focused on broad perinatal mental health outcomes or delivery platforms rather than stress-specific effects and targeted intervention components.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the effectiveness of DHIs specifically designed to reduce stress during pregnancy and to examine how intervention strategies and delivery methods are associated with stress outcomes.

METHODS: We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Randomized controlled trials and quasi-experimental studies involving pregnant women were eligible if they evaluated any digitally delivered intervention-such as mobile apps, web-based programs, or telemedicine-intended to reduce stress, and reported validated stress outcomes. We searched CINAHL, the Cochrane Library, Embase, and PubMed from database inception through November 2025. Risk of bias was assessed using the Cochrane risk of bias 2 tool for randomized trials and the risk of bias in nonrandomized studies of interventions tool for nonrandomized studies. Where appropriate, effect sizes were pooled using random-effects meta-analysis with the Hartung-Knapp-Sidik-Jonkman method and reported as standardized mean differences.

RESULTS: A total of 19 studies were included. Overall, DHIs were associated with a significant reduction in stress compared with control conditions (standardized mean difference -0.45, 95% CI -0.59 to -0.32; 95% prediction interval -0.78 to -0.13), with low to moderate heterogeneity. Strategy-based subgroup analyses indicated that mindfulness- and education-focused interventions showed favorable effects, but formal tests for between-subgroup differences were not statistically significant. Evidence certainty was rated as moderate, primarily due to risk-of-bias concerns in some trials.

CONCLUSIONS: This review provides stress-focused evidence that DHIs can support stress reduction during pregnancy and extends existing literature by systematically disaggregating interventions according to delivery methods, functional features, and content strategies. This study offers a component-oriented synthesis that informs the design and selection of digital stress-management interventions for pregnant women. In real-world antenatal care, these tools may complement clinician-delivered services by expanding access to low-intensity, scalable support, particularly when interventions integrate skills-based content with supportive digital functions. Future research should directly compare single versus combined strategies and evaluate implementation across diverse populations and care settings.

PMID:41587461 | DOI:10.2196/66267

JMIR Med Educ. 2026 Jan 26;12:e75021. doi: 10.2196/75021.

ABSTRACT

BACKGROUND: Virtual reality (VR) technology is increasingly used in health care professionals’ education as a novel tool for teaching, learning, and assessment.

OBJECTIVE: This study explored the experiences of clinical students and lecturers with VR for training and assessment at a Nigerian institution. It also explored students’ perceptions of the usefulness of VR in improving their clinical abilities, knowledge retention, engagement, and overall learning experience.

METHODS: A qualitative research study was conducted among 24 clinical students and 8 clinical lecturers. A developed Virtual reality model to TRain and Assess Clinical Students (VTRACS) was used to train and assess clinical students using clinical scenarios. Data were collected through 4 focus group discussions conducted among the clinical students and 8 in-depth interviews conducted among the clinical lecturers. Trustworthiness was maintained, and ethical approval for the study was obtained. The focus group discussions and in-depth interviews were audio-recorded, transcribed verbatim, and analyzed using NVivo (version 11; QSR International).

RESULTS: Many of the participants had no previous experience with VR in teaching and learning activities, but judging from their engagement with VTRACS, they defined VR as an alternative learning method (alternative to the traditional physical method). Major themes emerging from the study were expression of excitement, simple and useful innovation, proficiency enhancement, challenges with innovation, and uniformity. The clinical students adjudged VTRACS as an educational supplement with a feeling of unlimited learning access, enhancing clinical abilities while positively impacting their confidence and reducing clinical errors. The participants also described the objectivity and standardization of clinical scenarios as drivers of uniformity in training and assessment of clinical students. The participants were, however, concerned about the loss of empathy with the use of VTRACS, which may negatively impact the affective domain of learning.

CONCLUSIONS: The use of VR in the teaching and assessment of clinical students at a Nigerian university is perceived as a complementary method of learning that increases skill acquisition, provides unlimited access to training, and enhances proficiency. While VR is considered to be engaging and beneficial to health care professionals’ education, there is a need for its effective incorporation into clinical courses and mitigation of challenges such as cost and technology to ensure the realization of the full potential of VR in health care professionals’ education.

PMID:41587456 | DOI:10.2196/75021

JMIR Med Educ. 2026 Jan 26;12:e60452. doi: 10.2196/60452.

ABSTRACT

BACKGROUND: The Icarus Paradox in health care refers to the tension between the ambition to succeed as a specialist doctor and the limitations of the medical education system. Indonesia aspires to produce quality doctors, yet limited infrastructure and resources hinder the educational journey of prospective specialists.

OBJECTIVE: This study aimed to identify the Icarus Paradox in Indonesia’s specialist medical education by examining prospective specialist medical students and the quality of health services and by analyzing how this paradox is reflected in society’s perspectives.

METHODS: Using a convergent mixed methods design, this study integrated quantitative content analysis of 5047 online reviews across multiple platforms with qualitative thematic and cognitive analysis using NVivo 14, combining sentiment classification and topic coding.

RESULTS: Twitter contributed 573 (11.3%) of 5047 reviews, with 218 (38%) negative, 251 (43.8%) neutral, and 104 (18.2%) positive entries. TikTok generated 282 (5.6%) reviews, the majority being neutral (n=225, 79.5%). YouTube produced 96 (1.9%) reviews, with 89 (92.7%) neutral entries. News platforms exhibited the largest volume (n=3040, 60.2%) of reviews, with 2885 (94.9%) neutral, 105 (3.5%) positive, and 50 (1.6%) negative entries. Blogs and websites contributed 353 (7%) and 692 (11.3%) reviews, respectively, with neutral sentiment dominating (n=329, 93.2%, for blogs and n=599, 86.6%, for websites). Three cognitive perspectives demonstrated the Icarus Paradox in the Indonesian medical education system: education system, society’s views of students, and health care services. Although there are aspirations to improve education and health care quality, these ambitions often collide with structural challenges, such as resource shortages, heavy workloads, and limited accessibility, which link directly to cognitive themes of stress, resilience, and ethical dilemmas. We proposed a conceptual model to illustrate these dynamics.

CONCLUSIONS: Our findings offer insights into the Icarus Paradox in Indonesia’s medical education system, highlighting its complexity and reinforcing the need for systemic reform. Beyond academic relevance, the findings also emphasize the importance of strengthening student mental health support, ensuring equitable access to health care, and enhancing regulatory oversight of training. This was not a clinical trial. Although limited by reliance on online reviews, the results underscore the urgent need for targeted policy interventions in medical education and health care services.

TRIAL REGISTRATION: ClinicalTrials.gov registration: NCT123456.

PMID:41587450 | DOI:10.2196/60452

JMIR Mhealth Uhealth. 2026 Jan 26;14:e58930. doi: 10.2196/58930.

ABSTRACT

BACKGROUND: Intermittent fasting emerges as a promising dietary approach against obesity, offering a cost-effective strategy for implementation via web-based platforms. We developed a Brief Online Intermittent Fasting Program (OIF), featuring a self-administered, weekly 1-day fasting regimen with replacement meals delivery, online guidance, and app messaging to support adherence.

OBJECTIVE: This pilot study aimed to assess the preliminary effectiveness, feasibility, and safety of the OIF on weight loss in adults with overweight and obesity in Japan. Secondary objectives were to assess its effects on body composition and metabolic markers.

METHODS: This 12-week, 1:1 randomized controlled trial recruited adults with overweight and obesity (BMI from 23 to <35) in 1 university, 1 hospital, and 2 company offices. Participants were randomized into 2 groups stratified by sex and age (<40 or ≥40 years). The intervention group received very low-calorie (407 kcal) meal replacements for weekly intermittent fasting, online guidance via Zoom (Zoom Video Communications, Inc), and app messages encouraging fasting and healthy lifestyles. The control group received app messages promoting healthy lifestyles only. Interventions were administered by a nonblinded researcher. The primary outcome was the change in body weight after 12 weeks, analyzed using intention-to-treat principles and adjusted for sex, age, and baseline weight. Secondary outcomes encompassed body composition, blood pressure, biomarkers (eg, hemoglobin A_1c, triglycerides, and cholesterol), quality of life, physical activity, intervention adherence, and adverse events.

RESULTS: A total of 57 individuals were enrolled (28 in the intervention group and 29 in the control group). At 12 weeks, 25 participants in the intervention group and 27 participants in the control group completed follow-up. The baseline median weight was 75.8 (IQR 68.3-80.6) kg for the intervention group and 74.8 (IQR 69.8-81.8) kg for the control group. The mean weight change was -0.9 (SD 1.9) kg in the intervention group and +0.6 (SD 1.4) kg in the control group. The adjusted between-group difference in weight change was statistically significant at -1.6 (95% CI -2.5 to -0.8) kg. Fat mass change was not statistically significant (-0.1, 95% CI -1.3 to 1.4 kg), but muscle mass reduction was implied (-1.3, 95% CI -2.5 to -0.2 kg). Intervention adherence was 79% (22/28) in the intervention group. No serious adverse events were reported, and there were no significant changes in key biomarkers, such as hemoglobin A_1c or quality of life.

CONCLUSIONS: The OIF demonstrated effectiveness in promoting modest weight loss among adults with overweight and obesity over 12 weeks, with high feasibility and safety indicated by low dropout rates and absence of serious adverse events. However, the observed reduction in muscle mass indicates a need for program refinement, such as incorporating exercise guidance, to optimize health outcomes.

TRIAL REGISTRATION: UMIN-CTR UMIN000050437; https://tinyurl.com/4x5h2t2x.

PMID:41587446 | DOI:10.2196/58930