DES. Artículos del Departamento de Estadística

The Effect of Rehabilitation Therapy in Children with Intervened Congenital Heart Disease: A Study Protocol of Randomized Controlled Trial Comparing Hospital and Home-Based Rehabilitation.

2026-03-21T01:00:41Z

[EN Children who suffer from congenital heart defects (CHDs) have a decreased ability to perform physical exercise and consequently have a decrease in their functional capacity. The main causes of this decrease in functional capacity have been related on the one hand to residual hemodynamic defects and, at the same time, to a situation of physical deconditioning due to inactivity, as well as problems in lung function, especially the presence of restrictive patterns that influence the amount of O2 insufflated (decreased maximum VO2), consequently generating a deficient maximum O2 consumption and maximum work rate. This represents an important prognostic value, since it constitutes an independent predictor of death and hospitalization. This study aims to determine the benefits obtained regarding respiratory function, exercise capacity, and quality of life after implementing a hospital-based cardio-respiratory rehabilitation program compared to a home-based Cardio-respiratory Physical Activity Program in patients with intervened CHDs. Methods: This is a randomized controlled trial on the effectiveness of two different rehabilitation programs on respiratory function, exercise capacity, and quality of life in patients with CHDs conducted at the Child Cardiology and Congenital Heart Disease Unit of the University Hospital Complex of A Coruña (CHUAC). There will be two groups: Cardio-respiratory rehabilitation group program conducted in a face-to-face format at the hospital (n = 26) and a study group that follows a home-based Cardio-respiratory Physical Activity Program (TELEA) (n = 26). The measurement variables will be respiratory function, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), maximum expiratory flow (PEF), the Tiffeneau index (FEV1 /FVC), forced expiratory flow (FEF25%, FEF50%, FEF75%, FEF25-75%), exercise capacity (peak VO2), and the quality of life of these children and their families. Conclusions: The implementation of cardiac and pulmonary rehabilitation programs in children with CHDs is essential to improve their quality of life, exercise tolerance, and socialization. These programs optimize life expectancy and promote integration, being crucial for their physical and emotional well-being.

Restless Legs Syndrome in Patients with Psoriatic Arthritis: Association with Inflammatory and Clinical Parameters and Other Comorbidities-A Cross-Sectional Observational Study.

2026-03-21T01:00:35Z

[EN]Introduction/Objectives: Restless legs syndrome (RLS), a chronic neurological disorder related to brain iron metabolism, has been linked to immune-mediated inflammatory conditions such as psoriatic arthritis (PsA). However, the role that inflammation plays in this association and the impact of RLS on PsA outcomes remain unclear. This study aims to investigate the association between RLS and inflammatory/clinical parameters in PsA patients. Materials and Methods: In this cross-sectional study, 230 PsA patients completed the International Restless Legs Syndrome Study Group (IRLSSG) screening questionnaire, with diagnoses confirmed by a neurologist. Data collected included clinical features, disease activity, and comorbidities (obesity, anxiety, depression, insomnia, and fibromyalgia). Results: In total, forty-six patients met the IRLSSG criteria (20%). Those with RLS more frequently had polyarthritis (27% vs. 6%; p < 0.001), more swollen joints (2.0 vs. 1.4; p = 0.04), greater psoriatic involvement (5.7 vs. 3.6; p < 0.001), greater fatigue (39.0 vs. 30.5; p < 0.001), and greater disease activity (14.5 vs. 10.5; p < 0.001). They also exhibited increased disease impact (4.7 vs. 2.9; p < 0.001), poorer functioning (0.7 vs. 0.5; p = 0.01), and higher levels of anxiety (8.0 vs. 5.5; p < 0.001), depression (6.5 vs. 3.9; p < 0.001), and sleep disturbance (13.9 vs. 8.7; p < 0.001). Skin lesions and polyarthritis explained nearly 40% of RLS cases (Odds Ratio (OR) 1.4; 95% Confidence Interval (CI) 1.03-2.0; p = 0.03 and OR 1.03; 95% CI 1.00-1.9; p = 0.04). Conclusions: Psoriatic activity and inflammation may contribute to RLS in PsA. The coexistence of RLS was associated with greater disease activity, greater disease impact, and more emotional and sleep-related comorbidities.

Effect of Physical Exercise on Telomere Length: Umbrella Review and Meta-Analysis.

2026-03-21T01:00:37Z

[EN]Telomere length (TL) is a marker of cellular health and aging. Physical exercise has been associated with longer telomeres and, therefore, healthier aging. However, results supporting such effects vary across studies. Our aim was to synthesize existing evidence on the effect of different modalities and durations of physical exercise on TL. The aim of this study was to explore the needs and expectations of individuals with physical disabilities and their interventionists for the use of a virtual reality physical activity platform in a community organization. We performed an umbrella review and meta-analysis. Data sources included PubMed, Embase, Web of Science, Cochrane Library, and Scopus. We selected systematic reviews and meta-analyses of randomized and nonrandomized controlled clinical trials evaluating the effect of physical exercise on TL. Our literature search retrieved 12 eligible systematic reviews, 5 of which included meta-analyses. We identified 22 distinct primary studies to estimate the overall effect size of physical exercise on TL. The overall effect size was 0.28 (95% CI 0.118-0.439), with a heterogeneity test value Q of 43.08 (P=.003) and I² coefficient of 51%. The number of weeks of intervention explained part of this heterogeneity (Q_B=8.25; P=.004), with higher effect sizes found in studies with an intervention of less than 30 weeks. Exercise modality explained additional heterogeneity within this subgroup (Q_B=10.28, P=.02). The effect sizes were small for aerobic exercise and endurance training, and moderate for high-intensity interval training. Our umbrella review and meta-analysis detected a small-moderate positive effect of physical exercise on TL, which seems to be influenced by the duration and type of physical exercise. High quality studies looking into the impact of standardized, evidence-based physical exercise programs on TL are still warranted.

Impact of physical exercise on memory and learning in healthy older women: a quasi-experimental study.

2026-03-21T01:00:36Z

[EN]The population of people over the age of 65 is currently growing thanks to social and health policies. It presents an increase in age-related diseases due to a series of morphological and physiological changes in these population groups. We aimed to study the effect of a physical exercise program on memory and learning. A quasi-experimental pilot study carried out with a sample of 73 healthy female subjects who were divided into two groups: an intervention group and a control group. Both groups underwent a neuropsychological evaluation before and after the intervention. Subjects in the intervention group performed physical exercise 3 times a week, 50 min each session. The subjects in the control group did not perform any type of physical exercise and completed their daily life activities. The intervention group improvement in cognitive functions after the intervention and obtained higher scores against the control group. Regular physical exercise improves global cognitive function, visoconstructive capacity, and memory functions. The online version contains supplementary material available at 10.1186/s12877-025-06614-0.

A non-parametric method to test the statistical significance in rolling window correlations, and applications to ecological time series

2026-02-25T01:01:33Z

[EN]We provide a non-parametric computing-intensive method to test the statistical significance of the rolling window correlation for bi-variate time series. This method (test) addresses the effects due to the multiple testing (inflation of the Type I error) when the statistical significance is estimated for the rolling window correlation coefficients. We follow Telford and Polanco-Martínez to carry out the proposed method. The method is based on Monte Carlo simulations by permuting one of the variables (dependent) under analysis and keeping fixed the other variable (independent). We improve the computational time of this method to reduce the computation time (speedup was up to practically five times faster than the sequential method using 11 cores) through parallel computing. We compare the results obtained through the proposed method with two p-value correction methods frequently used (Bonferroni and Benjamini and Hochberg –BH) after being applied to synthetic and to real-life ecological time series. Our results show that the proposed method works roughly similar to these two p-value correction methods, especially with the method of BH, but our test is a little more restrictive than BH and a little more permissive than Bonferroni. The test is programmed in R and is included in the package NonParRolCor that is available freely on CRAN.

RolWinMulCor: An R package for estimating rolling window multiple correlation in ecological time series

2026-02-25T01:01:31Z

[EN]RolWinMulCor estimates the rolling window correlation for bi- and multi-variate cases between regular time series, with particular emphasis on ecological data. It is based on the concept of rolling, running or sliding window correlation, being useful for evaluating the evolution and stability of correlation over time. RolWinMulCor contains six functions to estimate and to plot the correlation coefficients and their respective p-values. The first two focus on the bi-variate case: (1) rolwincor_1win and (2) rolwincor_heatmap, estimate the correlation coefficients and the p-values for only one window-length (time-scale) and considering all possible window-lengths or a band of window-lengths, respectively. The second two functions: (3) rolwinmulcor_1win and (4) rolwinmulcor_heatmap, are designed to analyze the multi-variate case, following the bi-variate case to visually display the results, but these two approaches are methodologically different (the multi-variate case estimate the adjusted coefficients of determination instead of the correlation coefficients). The last two functions: (5) plot_1win and (6) plot_heatmap, are used to represent graphically the outputs of the four aforementioned functions as simple plots or as heat maps. The functions contained in RolWinMulCor are highly flexible, containing several parameters for controlling the estimation of correlation and the features of the plot output. The RolWinMulCor package also provides examples with synthetic and real-life ecological time series for illustrating its use.

The Relationship between Healthy Vascular Aging with the Mediterranean Diet and Other Lifestyles in the Spanish Population: The EVA Study.

2026-02-11T01:01:56Z

[EN]The aim of this study was to analyze the relationship between healthy vascular aging (HVA) and the Mediterranean diet alongside other lifestyles in a Spanish population aged 35 to 75 years without previous cardiovascular diseases. In this cross-sectional descriptive study, 501 individuals aged 35 to 75 years were recruited from five health centers by random sampling stratified by age and sex (55.90 ± 14.24 years, 49.70% men). HVA was determined in two steps. Step 1: Subjects with vascular damage to the carotid arteries or peripheral arterial disease were classified as non-HVA. Step 2: The study population was classified by age and sex using the percentiles of the vascular aging index (VAI), with VAI ≤p25 considered HVA and >p25 considered non-HVA. The VAI was estimated using the following formula (VAI = (log (1.09) × 10 cIMT + log (1.14) cfPWV) × 39.1 + 4.76. Carotid-femoral pulse wave velocity (cfPWV) was measured with the SphygmoCor® device, and carotid intima-media thickness using Sonosite Micromax® ultrasound. Mediterranean diet (MD) adherence, alcohol and tobacco use were recorded through validated questionnaires. Physical activity was assessed with the ActiGraph-GT3X® accelerometer. The mean VAI value was 61.23 ± 12.86 (men-63.47 ± 13.75 and women-59.04 ± 11.54; p < 0.001). HVA was found in 18.9% (men-19.9% and women-17.8%). In the multiple regression analysis after adjusting for possible confounding factors, the mean VAI value showed a positive association with alcohol use (β = 0.020) and sedentary hours per week (β = 0.109) and a negative association with hours of activity per week (β = -0.102) and with the number of healthy lifestyles (β = -0.640). In the logistic regression analysis, after adjusting for possible confounding factors and compared to those classified as non-HVA, subjects classified as HVA were more likely to show MD adherence (OR = 0.571), do more than 26 h per week of physical activity (OR = 1.735), spend under 142 h per week being sedentary (OR = 1.696), and have more than two healthy lifestyles (OR = 1.877). The results of this study suggest that the more time spent doing physical activity and the less time spent in a sedentary state, the lower the vascular aging index and the greater the likelihood of being classified in the group of subjects with HVA.

Lenalidomide and dexamethasone with or without clarithromycin in patients with multiple myeloma ineligible for autologous transplant: a randomized trial

2026-02-10T01:02:15Z

[EN]Although case-control analyses have suggested an additive value with the association of clarithromycin to continuous lenalidomide and dexamethasone (Rd), there are not phase III trials confirming these results. In this phase III trial, 286 patients with MM ineligible for ASCT received Rd with or without clarithromycin until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS). With a median follow-up of 19 months (range, 0–54), no significant differences in the median PFS were observed between the two arms (C-Rd 23 months, Rd 29 months; HR 0.783, p = 0.14), despite a higher rate of complete response (CR) or better in the C-Rd group (22.6% vs 14.4%, p = 0.048). The most common G3–4 adverse events were neutropenia [12% vs 19%] and infections [30% vs 25%], similar between the two arms; however, the percentage of toxic deaths was higher in the C-Rd group (36/50 [72%] vs 22/40 [55%], p = 0.09). The addition of clarithromycin to Rd in untreated transplant ineligible MM patients does not improve PFS despite increasing the ≥CR rate due to the higher number of toxic deaths in the C-Rd arm. Side effects related to overexposure to steroids due to its delayed clearance induced by clarithromycin in this elderly population could explain these results. The trial was registered in clinicaltrials.gov with the name GEM-CLARIDEX: Ld vs BiRd and with the following identifier NCT02575144. The full trial protocol can be accessed from ClinicalTrials.gov. This study received financial support from BMS/Celgene.

Autologous stem-cell transplantation as consolidation of first-line chemotherapy in patients with peripheral T-cell lymphoma: a multicenter GELTAMO/FIL study

2026-02-10T01:02:12Z

[EN]Peripheral T-cell lymphomas (PTCL) are a heterogeneous group of rare lymphoid malignancies that mostly have poor prognoses with currently available treatments. Upfront consolidation with autologous stem cell transplantation (ASCT) is frequently carried out, but its efficacy has never been investigated in randomized trials. We designed a multicenter, international, retrospective study with the main objective of comparing progression-free survival and overall survival of patients with PTCL who underwent ASCT in complete remission (CR) after first-line chemotherapy with a control group who did not undergo ASCT. From the initial population of 286 registered patients, 174 patients with PTCL other than anaplastic large cell lymphoma, ALK-positive, deemed fit for ASCT at the time of diagnosis, and who were in CR or uncertain CR after induction therapy (CR1) were included in our analysis. one hundred and three patients underwent ASCT, whereas 71 did not, in most cases (n=53) because the physician decided against it. With a median follow-up of 65.5 months, progression-free survival was significantly better in the transplanted patients than in the non-transplanted group: 63% versus 48% at 5 years (P=0.042). Overall survival was significantly longer for ASCT patients in the subgroup with advanced stage at diagnosis (5-year overall survival: 70% vs. 50%, P=0.028). In the multivariate analysis, first-line ASCT was associated with significantly prolonged progression-free survival (HR=0.57, 95% CI: 0.35-0.93) and overall survival (HR=0.57, 95% CI: 0.33-0.99). In conclusion, our study supports the use of ASCT as a consolidation strategy for patients with PTCL in CR1. These results should be confirmed in a prospective randomized study.

Improvement in health‑related quality of life in patients with heavy menstrual bleeding after treatment and its association with hereditary bleeding disorders.

2026-02-10T01:02:18Z

[EN]The prevalence of hereditary bleeding disorders (HBDs) in heavy menstrual bleeding (HMB) and their impact on health-related quality of life (HRQoL) remain underexplored. We investigated the HRQoL of women with non-structural HMB and its association with HBDs. Method A prospective longitudinal study of 100 women with HMB without structural gynecological pathology. HMB was defined as ≥ 8 days of bleeding or a PBAC score > 100 points. Four HRQoL questionnaires —SF-12®v2, EQ-5D-3 L, MBQ, and SAMANTA— were administered at baseline and 6 months. HBD diagnosis included hypermobility spectrum disorders, von Willebrand disease, platelet disorders, congenital coagulation factor deficiencies, and hyperfibrinolysis. Result 88 women required treatment for HMB, anemia, or iron deficiency. Combined hormonal therapy (43%) and levonorgestrel intrauterine devices (14%) were the most frequently used treatments. Thirty-one women (31%) were diagnosed with HBD. After 6 months of treatment, SF-12®v2 results showed significant improvements in the mental and physical health components, particularly with respect to mobility, moderate activities, and pain perception. EQ-5D-3 L evaluations revealed significant improvements in anxiety and depression. MBQ and SAMANTA scores indicated significant reductions in menstrual bleeding and enhanced quality of life. However, at T6, HBD patients showed significantly lower improvements compared with non-HBD patients in physical health (SF-12 PCS, p = 0.035), EQ-5D index scores (p = 0.024), PBAC (p = 0.049), and MBQ (p = 0.028). Conclusion HBD is an important cause of HMB. Medical treatment improves mobility, moderate activities, pain perception, and anxiety/depression after 6 months, although HRQoL improvements are less pronounced in HBD patients.

Relationship between the Mediterranean Diet and Vascular Function in Subjects with and without Increased Insulin Resistance

2026-02-10T01:02:16Z

[EN]The main aim of this study was to analyze the relationship of the Mediterranean diet (MD) with vascular function in participants with and without increased insulin resistance (IR) in the Spanish population. A secondary aim was to study differences by gender. (2) Methods: Data were analyzed from 3401 subjects in the EVA, MARK, and EVIDENT studies (mean age = 60 years and 57% men). IR was evaluated with the triglyceride and glucose index (TyG index). TyG index = Ln [(fasting triglyceride mg/dL × fasting glucose mg/dL)/2]. The MD was measured against the MEDAS questionnaire, with the 14 items used in the PREDIMED study. Vascular stiffness was estimated with the brachial–ankle pulse wave velocity (baPWV) and the cardio ankle vascular index (CAVI) using the Vasera VS-1500®. (3) Results: The mean MEDAS value was 5.82 ± 2.03; (men: 5.66 ± 2.06; women: 6.04 ± 1.99; p < 0.001). MD adherence was 36.8% (men: 34.2%; women: 40.3%; p < 0.001). The mean baPWV value was 14.39 ± 2.78; (men: 14.50 ± 2.65; women: 14.25 ± 2.93; p = 0.005). A baPWV value ≥ 14.5 m/s was found in 43.4% (men: 43.6%; women: 40.0%; p = 0.727). The mean CAVI value was 8.59 ± 1.28; (men: 8.75 ± 1.28; women: 8.37 ± 1.26; p < 0.001). CAVI values ≥ 9 were present in 39.0% (men: 44.4%; women: 31.7%; p < 0.001). The mean value of the TGC/G index was 10.93 ± 1.39; (men: 11.08 ± 1.33; women: 10.73 ± 1.43; p < 0.001). IR was found in 49.9%. The average value of the MD score value was negatively associated with baPWV and CAVI in all groups analyzed (<0.05), except in the group of women with insulin resistance. (4) Conclusions: The results suggest that MD adherence is negatively associated with the vascular stiffness parameters analyzed in all the groups studied except the group of women with insulin resistance.

Characterization of Chronic Graft-versus-host Disease After Haploidentical Stem Cell Transplantation With Posttransplant Cyclophosphamide: A Study on Behalf of GETH-TC

2026-02-10T01:02:09Z

[EN]Chronic graft-versus-host disease (cGVHD) is a cause of late morbidity and nonrelapse mortality (NRM) after allogenic hematopoietic stem cell transplantation (allo-HSCT). Although studies evaluating haploidentical allo-HSCT (haplo-HSCT) using posttransplant cyclophosphamide (PTCy) demonstrate lower cGVHD rates, comprehensive data describing the clinical profile, risk factors, or outcomes of cGVHD within this platform are scarce. Methods. We conducted a retrospective multicenter analysis of 389 consecutive patients who underwent haplo-HSCT PTCy in 7 transplant centers of the Spanish Group Grupo Español de Trasplante Hematopoyético y Terapia Celular (GETH-TC) between 2008 and 2020 describing incidence, clinical profile, risk factors, and cGVHD outcomes. Results. Ninety-five patients of 389 developed cGVHD. Our data revealed that the incidence and severity of cGVHD are lower than those reported for HLA-identical transplantation with conventional prophylaxis and that the strongest predictor for cGVHD was previous acute GVHD (P = 0.031). Also, recipient age ≥60 y (P = 0.044) was protective against cGVHD. Moreover, patients with moderate cGVHD had longer event-free survival at 3 y than other patients (P = 0.016) and a lower relapse rate at 3 y (P = 0.036). Conclusions. Our results support the fact that the incidence and severity of cGVHD are lower than those reported for HLA-identical transplantation with conventional prophylaxis. In this series, patients who develop moderate cGVHD after haplo-HSCT PTCy had a higher overall survival and event-free survival, and lower relapse, suggesting higher graft-versus-leukemia effect. Although this is the largest series focused on characterizing cGVHD in haplo-HSCT PTCy, further prospective studies are needed to confirm the findings.

GvHD prophylaxis with tacrolimus, sirolimus, and mycophenolate mofetil after reduced intensity conditioning hematopoietic stem cell allogeneic transplantation

2026-02-06T01:01:07Z

[EN]We present the largest prospective real-world experience in 159 patients who received the triple combination of tacrolimus/ sirolimus/mycophenolate mofetil after reduced intensity conditioning allogeneic hematopoietic stem cell transplantation (RICalloHSCT) from matched-related (MRD), matched-unrelated (MUD) or mismatched-unrelated donors (MMURD). Despite the highrisk and elderly population, non-relapse mortality (NRM) at day +100 and 1 year was 5.1% and 8.6%. Grades 2-4 and 3-4 acute Graftversus-host disease (GvHD) at day +180 was 30.3% and 13%, respectively. Chronic GvHD at 1 and 3 years was 23.2% and 41% and for moderate/severe was 13.2% and 26.6%, respectively. With a median follow-up of 20 months, the 1- and 3-year progression-free survival was 60% and 49%, the GvHD-free relapse-free survival was 44% and 32%, and the overall survival was 70.3% and 61%, respectively, for the entire cohort. Patients receiving allo-HSCT from MMURD showed a higher incidence of aGvHD with impact on survival endpoints. GvHD prophylaxis with the triple-drug combination tacrolimus/sirolimus/mycophenolate mofetil showed excellent results in terms of NRM, GvHD and survival in a high-risk, frail and elderly population in the context of RIC-HSCT from MRD and MUD. The subgroup of patients receiving RIC-HSCT from MMURD might probably benefit from other prophylaxis strategies.

Health literacy and self-care in patients with heart failure: a cross-sectional study

2026-02-05T01:01:24Z

[EN]Background: Health literacy (HL) is recognized as a key determinant in the management of chronic diseases, including heart failure (HF). Adequate HL facilitates understanding and application of health information, promoting effective self-care and improved clinical outcomes. In contrast, low HL is associated with poorer disease control, higher hospitalization rates, and increased mortality. Despite its importance, the relationship between HL and self-care in HF patients remains underexplored in specific sociodemographic and clinical contexts. Objective: This study aimed to assess HL and self-care capacity in individuals with HF, identify associated sociodemographic and clinical variables, and explore the predictive value of HL on self-care behaviors. Methods: A cross-sectional, observational study was conducted among 195 HF patients attending a referral center in Burgos, Spain. HL was assessed using the European health literacy survey questionnaire (HLS-EU-Q16), while self-care was evaluated using the European heart failure self-care behavior scale (EHFScBS). Data were collected via telephone interviews. Descriptive and inferential statistics were applied, including correlation and multiple linear regression analyzes. Results: The mean age of participants was 69.26 (±9 years), with a predominance of males (83.1%). Most participants reported medium social class (87.7%) and basic education (64.6%). HL levels were significantly associated with educational attainment, social class, and gender; women and individuals with higher education levels demonstrated greater HL scores. Regression analysis revealed that HL negatively predicted self-care scores (p < 0.001), as higher EHFScB-9 scores indicate poorer self-care, and in our study higher HL was associated with lower EHFScB-9 scores (r = −0.320; β = −0.189), which is consistent with better self-care behaviors. Older age and lower educational attainment were linked to lower HL and poorer self-care. Notably, female sex and upper-middle social class were also significant predictors of self-care capacity. Conclusion: Health literacy is a significant predictor of self-care in HF patients, and its levels are influenced by key sociodemographic variables. These findings underscore the necessity of incorporating HL assessment into clinical practice and tailoring educational interventions to address disparities. Enhancing HL could promote more effective self-management and potentially reduce adverse outcomes in HF populations. Future research should focus on longitudinal analyzes and the development of targeted, equitable interventions based on HL profiles.

Logistic Biplots for Ordinal Variables Based on Alternating Gradient Descent on the Cumulative Probabilities, with an Application to Survey Data

2026-02-05T01:01:23Z

[EN]Biplot methods provide a framework for the simultaneous graphical representation of both rows and columns of a data matrix. Classical biplots were originally developed for continuous data in conjunction with principal component analysis (PCA). In recent years, several extensions have been proposed for binary and nominal data. These variants, referred to as logistic biplots (LBs), are based on logistic rather than linear response models. However, existing formulations remain insufficient for analyzing ordinal data, which are common in many social and behavioral research contexts. In this study, we extend the biplot methodology to ordinal data and introduce the ordinal logistic biplot (OLB). The proposed method estimates row scores that generate ordinal logistic responses along latent dimensions, whereas column parameters define logistic response surfaces. When these surfaces are projected onto the space defined by the row scores, they form a linear biplot representation. The model is based on a framework, leading to a multidimensional structure analogous to the graded response model used in Item Response Theory (IRT). We further examine the geometric properties of this representation and develop computational algorithms—based on an alternating gradient descent procedure—for parameter estimation and computation of prediction directions to facilitate visualization. The OLB method can be viewed as an extension of multidimensional IRT models, incorporating a graphical representation that enhances interpretability and exploratory power. Its primary goal is to reveal meaningful patterns and relationships within ordinal datasets. To illustrate its usefulness, we apply the methodology to the analysis of job satisfaction among PhD holders in Spain. The results reveal two dominant latent dimensions: one associated with intellectual satisfaction and another related to job-related aspects such as salary and benefits. Comparative analyses with alternative techniques indicate that the proposed approach achieves superior discriminatory power across variables.

Optimizing Lymphedema Management After Breast Cancer: Predictive Risk Models in Clinical Practice

2026-04-13T10:55:52Z

[EN]Background and Objectives: Lymphedema secondary to multimodal breast cancer treatment is a relatively common complication that significantly impacts patients' quality of life. Despite identifying several associated risk factors, accurately assessing individual risk remains challenging. This study aims to develop predictive tools integrating patient characteristics, tumor attributes, and treatment modalities to optimize clinical surveillance, enhance prevention, and enable earlier diagnosis. Methods: Data were analyzed from 309 patients referred to the Lymphedema Unit of Rehabilitation Service who underwent lymphadenectomy for breast cancer between January 2016 and December 2021. Collected variables included patient demographics, tumor clinicopathological features, and treatment details. A lymphedema incidence study was conducted, complemented by univariate and multivariate regression analyses to identify risk factors. A nomogram was developed to predict high‐risk patients, facilitating personalized prevention and management strategies. Results: The cumulative incidence of lymphedema was 18.4%. Independent risk factors included high body mass index, sedentary lifestyle, number of positive nodes (N stage), and radiotherapy, particularly targeting the breast, axilla, and supra‐infraclavicular regions. The logistic regression model demonstrated an area under the ROC curve (AUC) of 0.75, with acceptable calibration, validating the predictive model. Conclusions: The predictive tools developed provide healthcare professionals with a means to identify patients at elevated risk of lymphedema, supporting individualized prevention and management.