Category: Statistics

J Gastrointestin Liver Dis. 2026 Jun 27;35(2):229-236. doi: 10.15403/jgld-6786.

ABSTRACT

BACKGROUND AND AIMS: Publications influence selection into competitive gastroenterology fellowships, yet drivers of research productivity among current trainees are not well characterized. We evaluated whether training stage, institutional pedigree, and degree pathway are associated with research output among United States of America gastroenterology fellows.

METHODS: We performed a cross-sectional study of fellows listed on publicly available rosters from Accreditation Council for Graduate Medical Education (ACGME)-accredited adult gastroenterology fellowship programs (October-November 2025). PubMed-indexed publications were identified and categorized by training stage (medical school, residency, fellowship) and gastroenterology (GI)-specificity. Group comparisons used Mann-Whitney U tests. Poisson generalized estimating equation models clustered by program estimated adjusted incidence rate ratios (IRRs) for total publication counts.

RESULTS: Among 776 fellows from 125 programs, PGY6 fellows had more GI-specific publications than PGY4 fellows (median 3 vs 2) and greater fellowship-period output. Training in top-ranked environments was associated with higher total and GI-specific publication counts, with the largest differences observed for top 20 fellowship environments. In adjusted analyses, top-ranked training affiliations remained independently associated with higher total publication output. Women had approximately 15% lower total publication output than men (adjusted IRR ≈0.85). International medical graduates had higher publication counts than non-IMGs, whereas U.S. DO graduates had lower counts.

CONCLUSIONS: Research productivity among United States of America gastroenterology fellows varies by training stage, training environment, and degree pathway, likely reflecting opportunity and infrastructure as well as individual aptitude.

PMID:42365644 | DOI:10.15403/jgld-6786

J Gastrointestin Liver Dis. 2026 Jun 27;35(2):222-228. doi: 10.15403/jgld-6794.

ABSTRACT

BACKGROUND AND AIMS: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) may have favorable hepatic effects, but long-term outcomes in cirrhosis are uncertain. We investigated the relationship between SGLT2i exposure and 5-year outcomes among adults with cirrhosis.

METHODS: We performed a retrospective cohort study in the TriNetX US Collaborative Network (March 2013- January 2025). Adults (≥18 years) with cirrhosis were classified as SGLT2i users (first exposure on/after cirrhosis diagnosis) or non-users (no SGLT2i exposure) and propensity score matched 1:1. Outcomes were assessed over 5 years beginning 1 day after index. Primary outcomes were all-cause mortality and hospitalization burden (inpatient encounters per patient). Secondary outcomes included hepatic decompensation complications and prespecified adverse events; tertiary outcomes were the most recent liver- and kidney-related laboratory values during follow-up.

RESULTS: After matching, 24,559 patients were included per cohort. SGLT2i use was associated with lower all-cause mortality (11.8% vs 26.0%; OR=0.381, 95%CI: 0.363-0.399; p<0.001) and fewer hospitalizations (mean 3.6±10.7 vs 5.4±13.4; p<0.001). Composite hepatic decompensation was less frequent (OR=0.617, 95%CI: 0.580-0.656; p<0.001), including lower odds of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome; hepatic encephalopathy did not differ. Acute kidney failure and urinary tract infection were less frequent, while diabetic ketoacidosis did not differ. Laboratory profiles favored SGLT2i use (lower aspartate aminotransferase and bilirubin, higher albumin, lower international normalized ratio, and improved renal indices).

CONCLUSIONS: In this matched real-world cohort, SGLT2i exposure after cirrhosis diagnosis was associated with an improved 5-year survival, fewer hospitalizations, and fewer decompensation events.

PMID:42365643 | DOI:10.15403/jgld-6794

J Gastrointestin Liver Dis. 2026 Jun 27;35(2):173-180. doi: 10.15403/jgld-7121.

ABSTRACT

BACKGROUND AND AIMS: Inflammatory bowel diseases (IBD), including Crohn’s disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U), are increasingly recognized across Eastern Europe, including Romania, where historical data indicated low incidence. Contemporary real-time epidemiological data for our country are scarce. This study evaluated the short-term frequency and epidemiological characteristics of IBD patients presenting to major Romanian gastroenterology centers.

METHODS: We conducted a prospective, cross-sectional observational study over a 14-day period in November 2024 across 18 university-affiliated tertiary gastroenterology clinical sites in Romania. All consecutive adult patients with confirmed IBD were enrolled using a centralized online platform. Demographics, disease type and phenotype, severity, and treatment were recorded and analyzed descriptively.

RESULTS: A total of 1,045 patients were registered: 52.4% CD, 46.9% UC, and 0.7% IBD-U. Geographical distribution revealed a statistically significant variation, with Crohn’s disease being more frequent in Southern Romania, while UC predominated in the Eastern and Central-western regions (p=0.0009). Most patients resided in urban areas, and the majority were in clinical remission at presentation. Phenotypic analysis revealed ileocolonic CD (L3) and left-sided/pancolitis UC (E2/E3) as most frequent. Severe disease history was more common in CD, and prior surgery was significantly higher in CD than UC. Smoking and appendectomy were more frequently associated with CD as previously reported. Therapeutic patterns reflected disease type: anti-TNF use predominated in CD, while other biologics and small molecules were more common in UC. Regional differences in therapy were observed, with southern centers showing higher use of novel therapies, likely reflecting a more mature IBD population, with a higher CD prevalence. Notably, the number of IBD diagnoses increased over time, correlating with Romania’s GDP growth (R² = 0.89, p < 0.001), suggesting that socioeconomic factors may influence disease recognition and diagnosis.

CONCLUSIONS: This study offers the most recent snapshot of IBD epidemiology in Romania, highlighting a transition toward medium-incidence patterns and growing clinical complexity. These findings provide evidence for the need to establish nationwide population-based surveillance systems and healthcare planning initiatives aimed at mitigating the rising burden of IBD.

PMID:42365638 | DOI:10.15403/jgld-7121

Clin Exp Dent Res. 2026 Jun;12(3):e70396. doi: 10.1002/cre2.70396.

ABSTRACT

OBJECTIVES: To investigate the effect of different bonding heights on force-moment generation in orthodontic fixed lingual retainers under loading in a biomechanical setup.

MATERIALS AND METHODS: Three commercially available lingual retainers were evaluated: two conventionally fabricated stainless-steel retainers (R1, R2) and one CAD/CAM-manufactured nickel-titanium retainer (R3). Using a biomechanical test setup, vertical forces and labiolingual moments were recorded and applied in three dimensions in response to a standardized vertical displacement of 0.3 mm. The effect of three standardized bonding heights (incisal, middle, and gingival thirds of the clinical crown) was assessed.

RESULTS: Both forces and moments increased with vertical loading. Statistically significant differences were observed among retainer materials, whereas bonding height did not significantly affect the outcomes. At 0.3 mm vertical displacement, the lowest force and moment were recorded for R1 bonded incisally (0.59 ± 0.37 N; 3.48 ± 0.37 Nmm), and the highest for R3 at mid-crown bonding height (1.40 ± 0.13 N; 8.70 ± 1.19 Nmm).

CONCLUSIONS: Retainer type was found to have a greater influence on force and moment development than bonding height. Multistranded stainless-steel retainers may be more susceptible to deformation under occlusal loading. Further studies are required to determine the clinical relevance of bonding height in fixed lingual retainers.

PMID:42365618 | DOI:10.1002/cre2.70396

J Trop Pediatr. 2026 Jun 11;72(4):fmag046. doi: 10.1093/tropej/fmag046.

ABSTRACT

To evaluate the association of superior mesenteric artery (SMA) Doppler parameters after the first feed with feed intolerance and necrotizing enterocolitis (NEC) in very low birth weight (VLBW) neonates. This prospective cohort study was conducted in a tertiary neonatal intensive care unit from July 2024 to January 2025. VLBW neonates underwent SMA Doppler assessment before and 60 min after the first feed using standardized protocols. The primary outcome was time to full enteral feeds; secondary outcomes included feed intolerance, NEC, and sepsis. Fifty neonates were included. Post-feed resistive index (RI) decreased significantly (0.76-0.68; P = .01). On adjusted analysis, SMA Doppler parameters were not independently associated with time to full feeds, while respiratory distress syndrome (RDS) and hemodynamically significant patent ductus arteriosus (hsPDA) were significantly associated. Median time to full feeds was 9 days on Kaplan-Meier analysis. Neonates with feed intolerance had lower post-feed pulsatility index (PI) and RI, and a greater fall in RI. ROC analysis showed modest discrimination (AUC 0.69, 95% CI 0.53-0.84). Doppler differences in neonates with NEC were not statistically significant; an exploratory model showed modest discrimination (AUC 0.72, 95% CI 0.50-0.87). SMA Doppler parameters show possible association with feed intolerance and NEC but have limited predictive value as standalone markers. Feeding progression appeared to be more strongly influenced by systemic illnesses such as RDS, hsPDA, and by clinical management factors including feed withholding and individualized advancement decisions.

PMID:42365608 | DOI:10.1093/tropej/fmag046

Int J Neuropsychopharmacol. 2026 Jun 28:pyag035. doi: 10.1093/ijnp/pyag035. Online ahead of print.

ABSTRACT

BACKGROUND: Early detection of treatment-resistant schizophrenia (TRS) is of substantial clinical importance. While TRS is heritable, the associated genetic variants have been difficult to identify. Cigarette smoking is associated with non-response to antipsychotics, and smoking behavior and schizophrenia have a shared genetic basis. Thus, TRS may also have a shared genetic basis with smoking behavior.

OBJECTIVE: Here we aim to identify genetic variants associated with TRS, by leveraging overlapping genetic variants with smoking initiation to increase statistical power.

METHODS: We analyzed genome-wide data for TRS and smoking initiation with the conditional/conjunctional false discovery rate (cond/conjFDR) to identify shared loci, and LD score regression to determine genetic correlations. To investigate potential causal effects of shared loci, we performed Mendelian randomization (MR) analyses. Shared loci were mapped to genes, which were further investigated for enrichment of drug target genes.

RESULTS: We observed a significant positive genetic correlation between TRS and smoking initiation (rg = 0.47 p = 0.0002). Leveraging the genetic overlap between TRS and smoking initiation, we identified four novel loci jointly associated with TRS and smoking initiation. The condFDR results improved polygenic prediction of TRS. MR indicates putative evidence for a causal effect of genetic liability to TRS on smoking initiation. The functional genetic analyses suggest that alpha-1-adrenergic receptors may be involved in the pathophysiology of TRS and possibly related to the efficacy of clozapine versus other antipsychotic drugs.

CONCLUSION: In conclusion, our results show that shared genetic mechanisms influence both TRS and smoking behavior, which provide new insights into the biological underpinnings of TRS.

PMID:42365605 | DOI:10.1093/ijnp/pyag035

World J Surg. 2026 Jun 28. doi: 10.1002/wjs.70476. Online ahead of print.

ABSTRACT

BACKGROUND: Access to safe, timely, and affordable surgical care remains a challenge in low- and middle-income countries (LMICs), where deficits in infrastructure and workforce are most acute at the district hospital level. From 2018 to 2024, Rwanda implemented its first National Surgical, Obstetric, and Anesthesia Plan (NSOAP) and prioritized decentralized surgical care. We aimed to conduct a post-implementation national assessment of surgical infrastructure, workforce, and service delivery at Rwanda’s district and level 2 teaching (L2TH) hospitals.

METHODS: We conducted a nationwide cross-sectional survey of 43 hospitals, comprising all 34 district hospitals, and 9 L2TH in Rwanda from May-June 2025, using the WHO Situational Analysis Tool for Emergency and Essential Surgical Care (SAT-EESC). Five domain-specific informants per facility provided infrastructure, workforce, and service delivery data, complemented by facility walk-throughs and a review of operating room registers. In addition to descriptive data analysis, we compared rural and urban hospitals and mapped workforce distribution.

RESULTS: All facilities had at least one functional operating room. Most facilities reported continuous electricity and running water, and oxygen cylinders were available at all times in 90.7% of facilities. Blood banks and oxygen concentrators were the least consistently available, reported as available at all times in 32.6% and 58.1% of facilities, respectively. The median facility-level surgeon, anesthesiologist, and obstetrician density was 0.71 per 100,000 population, and 14 hospitals had no specialist SAO cadre. Non-specialist cadres were widely available, with a median non-specialist surgical workforce density of 6.76 per 100,000 population. No statistically significant urban-rural workforce differences were observed, although rural facilities were significantly farther from next-level referral facilities.

CONCLUSION: Rwanda’s district and level 2 teaching hospitals demonstrate high infrastructure readiness. However, gaps persist in the distribution of the specialist workforce, diagnostics, and advanced surgical care capacity. The findings also highlight the importance of non-specialist cadres in sustaining district-level surgical service delivery.

PMID:42365604 | DOI:10.1002/wjs.70476

Orv Hetil. 2026 Jun 28;167(26):1034-1040. doi: 10.1556/650.2026.33595. Print 2026 Jun 28.

ABSTRACT

INTRODUCTION: One of the most serious potential complications of thyroid surgery is temporary or permanent dysfunction of the recurrent laryngeal nerve. According to the literature, the development of nerve injury is influenced by several predictive factors, including demographic, surgical and pathological factors.

OBJECTIVE: The aim of our research was to determine the prevalence of temporary and permanent vocal cord paralysis following thyroid surgery in our patient population, and to identify preoperative factors that may be associated with the development of paralysis.

METHOD: We retrospectively analyzed the data of patients who underwent thyroid surgery between January 1, 2022 and March 31, 2024. In addition to demographic data, we examined the surgical indication, interventional procedure and postoperative histological results. Fisher’s exact test and multivariate regression analysis were used to analyze whether age 65 years or older, malignant indication, and total thyroidectomy had prognostic significance for recurrent laryngeal nerve injury.

RESULTS: During the study period, a total of 155 operations were performed on 153 patients (125 women, 30 men; mean age: 53.7 years) (nerve at risk: 227). Of these, 143 were primary operations, 11 were completion thyroidectomies and 1 was reoperation; 83 cases were lobectomy, 72 cases were total thyroidectomy. The surgical indication was benign in 123 cases (category II-IV according to The Bethesda System for Reporting Thyroid Cytopathology [2023], drug-resistant hyperthyroidism, compression symptoms), and malignant in 32 cases (category V-VI, contralateral malignancy, cold nodule). Histological examination confirmed 128 benign and 27 malignant lesions. Immediate postoperative laryngeal dysmotility occurred in 18 cases (nerve at risk: 19; 8.4%). 4 patients were lost to follow-up, so 11 cases (5.0% of 220 nerve at risk) proved to be temporary and 3 cases (1.4% of 220 nerve at risk) proved to be permanent paralysis. Statistical analysis did not confirm any of the examined factors as independent predictors.

CONCLUSION: The incidence of postoperative laryngeal paralysis was in line with international data, and none of the examined potential risk factors were able to prove their prognostic significance, so the personalized risk assessment still relies primarily on literature data in our practice. Orv Hetil. 2026; 167(26): 1034-1040.

PMID:42365591 | DOI:10.1556/650.2026.33595

Sports Med Open. 2026 Jun 28;12(1):81. doi: 10.1186/s40798-026-01042-9.

ABSTRACT

OBJECTIVE: Police force recruits have a high musculoskeletal injury burden, which results in a substantial economic burden and can lead to attrition. The objective of this study was to identify and prioritise the strategies perceived as important and feasible to reduce the prevalence, incidence, and burden of injury in police force recruits.

DESIGN: Mixed-methods concept mapping study.

METHODS: Forty-eight participants were recruited from four broad groups: police force recruits/officers; police force staff; health professionals; and research experts. Participants brainstormed statements in response to a prompt (“To prevent injury and/or reduce the impact of injury on law enforcement recruit training, I think it’s important to….”) before sorting and rating the statements/strategies for importance and feasibility. Descriptive statistics, multi-dimensional scaling, hierarchical cluster analysis, pattern matching and Welch’s t-tests were applied.

RESULTS: Ninety-six unique prevention strategies were identified (42 were above the grand mean for both importance and feasibility). Eight clusters appropriately represented all statements. From highest to lowest mean cluster importance these were: i) clearly communicate physical training program expectations and requirements; ii) prepare for, monitor and manage physical training load; iii) provide best practice injury identification, prevention and management; iv) educate recruits, staff and other stakeholders involved in academy training delivery; v) provide a supportive training environment that promotes health, wellbeing and injury reporting; vi) have experienced staff deliver training and use appropriate equipment; vii) deliver a comprehensive and holistic physical training program; and viii) have appropriate physical entry standards and requirements.

CONCLUSION: We identified 42 strategies above the grand means for both importance and feasibility to reduce the burden of injury in police force recruits. These strategies can be implemented by recruits, staff delivering the training program, and/ or staff managing or governing the training program. Future research should refine how these strategies can be implemented in practice and policy.

PMID:42365570 | DOI:10.1186/s40798-026-01042-9

CJEM. 2026 Jun 28. doi: 10.1007/s43678-026-01186-3. Online ahead of print.

ABSTRACT

OBJECTIVES: To describe public awareness of the Centre antipoison du Québec (CAPQ), expectations regarding acute poisoning management and service delivery, and satisfaction among prior users.

METHODS: We conducted a cross-sectional, bilingual online survey of Quebec residents aged ≥ 14 years between April 13, 2024, and June 27, 2025. The questionnaire collected demographic data, assessed awareness and prior use of the CAPQ, explored past poisoning events and expectations for acute poisoning management, and measured satisfaction among previous users using a 5-point Likert scale, with open-ended questions for qualitative input. Participants were recruited through convenience and snowball sampling via public settings, social media, and CIUSSS newsletters. Descriptive statistics summarized responses and explored trends.

RESULTS: A total of 611 respondents were included; 541 (88.5%) were aware of the CAPQ, including 152 prior users, while 70 (11.5%) were unaware. Unawareness was more common among females (60.0%), non-healthcare workers (91.4%), respondents with a non-North American ethnic background (34.2% vs. 10.1%), and those not primarily French-speaking (12.9% vs. 3.0%). Regional variation was observed, with Capitale-Nationale contributing the largest number of unaware respondents (35/70) and Laurentides showing the highest proportion (26.7%). Among respondents without prior CAPQ use who reported a poisoning event, most contacted emergency services or presented to the emergency department. Expectations were similar among aware and unaware respondents, particularly for acute poisoning management, with nurses expected to respond within five minutes. Among prior users, overall satisfaction was high across all domains, though communication and outreach were identified as areas for improvement. Key service expectations included rapid 24/7 access (76.9%), responder expertise (69.9%), and clear, adapted recommendations (56.1%). Most respondents preferred French (84.9%), telephone communication (94.1%), and follow-up calls (81.7%).

CONCLUSIONS: User satisfaction with the CAPQ was high, but gaps in public awareness and service expectations remain. These findings highlight opportunities to improve accessibility, communication and outreach strategies.

PMID:42365556 | DOI:10.1007/s43678-026-01186-3