Category: Statistics

Int J Rheum Dis. 2026 May;29(5):e70683. doi: 10.1111/1756-185x.70683.

ABSTRACT

OBJECTIVES: Tofacitinib, the first approved oral small-molecule Janus kinase inhibitor (JAKi), is widely used for treating rheumatoid arthritis (RA). This study aims to compare the drug retention rates of tofacitinib between elderly (≥ 65 years) and nonelderly (< 65 years) RA patients in a real-world clinical setting in Taiwan and to identify clinical factors associated with treatment discontinuation.

METHODS: We conducted a retrospective cohort study of RA patients receiving tofacitinib between 2015 and 2020, with follow-up until December 31, 2021. Patients were categorized into an elderly group (≥ 65 years, n = 82) and a nonelderly group (< 65 years, n = 224). Drug discontinuation was defined as the cessation of tofacitinib during follow-up. Primary outcomes included retention rates, reasons for discontinuation, and the incidence of adverse events. Kaplan-Meier analysis and multivariate Cox proportional hazards models were used to identify independent factors for discontinuation.

RESULTS: A total of 306 RA patients were included (mean age: 56.97 ± 12.44 years). The elderly group had a significantly higher prevalence of comorbidities, including hypertension, diabetes, hyperlipidemia, and osteoporosis. There was no significant difference in mean treatment duration (2.70 ± 1.73 vs. 2.61 ± 1.69 years, p = 0.7049). Kaplan-Meier analysis showed no statistically significant difference in retention rates (Log-rank test, p = 0.425). Multivariate analysis revealed that age was not an independent risk factor for discontinuation (adjusted HR = 1.086, 95% CI: 0.729-1.618, p = 0.685). Among 40 patients who discontinued due to adverse events, serious infection was the leading cause (35.0%), comprising 10 non-fatal serious infection events and 4 infection-related deaths. Major adverse cardiovascular events (MACE) occurred only in the elderly group (15.8%).

CONCLUSIONS: In real-world practice, the drug retention of tofacitinib in elderly RA patients is comparable to that in nonelderly patients. Despite a higher comorbidity burden, age itself is not an independent risk factor for treatment discontinuation. However, the risk of MACE is higher in elderly patients, necessitating careful cardiovascular assessment and monitoring before tofacitinib treatment. These findings suggest that tofacitinib is a viable option for elderly RA patients, provided individualized risk assessment is performed. Notably, discontinuation due to adverse events was substantially less frequent than discontinuation due to lack of efficacy, supporting the overall favorable tolerability of tofacitinib in this population.

PMID:42177625 | DOI:10.1111/1756-185x.70683

J Cardiothorac Surg. 2026 May 23. doi: 10.1186/s13019-026-04255-x. Online ahead of print.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is a common complication following cardiac surgery. The RCR (ratio of RDW to total serum calcium (TSC)), which exhibits high predictive value for various perioperative diseases, may also be associated with kidney injury. Therefore, we tested the hypothesis that the postoperative RCR index is associated with kidney injury following major cardiac surgery.

METHODS: This was a retrospective observational cohort study. We included 7,872 patients who underwent cardiac surgery from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The exposure was the first postoperative measurements of red blood cell distribution width (RDW) and Total serum calcium (TSC). The primary outcome was severe AKI, defined as stage 3 AKI or new-onset dialysis. Secondary outcomes included AKI of any stage, length of hospital stay, and length of intensive care unit (ICU) stay.

RESULTS: A total of 5,992 patients (76.1%) developed postoperative AKI, among whom 3,348 (42.5%) had stage 2 AKI, 654 (8.3%) had stage 3 AKI, and 160 (2.0%) required new-onset dialysis. In the multivariate regression model, the RCR index (categorical variable) was significantly associated with severe AKI (adjusted odds ratio [OR], 2.02 [95% CI, 1.54-2.68]) and AKI of any stage (OR, 1.26 [95% CI, 1.05-1.50]). When the RCR index was treated as a continuous variable, this association remained statistically significant.

CONCLUSIONS: Elevated postoperative RCR index is associated with postoperative AKI in patients who undergo cardiac surgery.

PMID:42177596 | DOI:10.1186/s13019-026-04255-x

J Transl Med. 2026 May 23. doi: 10.1186/s12967-026-08266-z. Online ahead of print.

ABSTRACT

BACKGROUND: Gliomas constitute 80% of malignant brain tumors, with glioblastoma (GBM) being the most aggressive subtype. The single-cell-level mechanisms underlying gliomagenesis are poorly understood, hindering therapeutic development. We combine genome-wide association studies (GWAS) with bulk tissue and single-cell multi-omics to prioritize genetically supported candidate genes and to explore potential cell-type-specific mechanisms relevant to gliomagenesis.

METHODS: We integrated the largest glioma GWAS with brain-specific multi-omics to prioritize genetically supported candidate genes using two broad categories of prioritized methods. Biological enrichment, differential gene expression, and CRISPR/miRNA were used to assess target enrichment and druggability. By integrating single-cell multi-omics data (genomics, transcriptomics, epigenomics), we investigated GBM-relevant cells, tumor microenvironment (TME) interactions, and cell-type-specific mechanisms in glioblastomagenesis. Additionally, phenome-wide association studies (PheWAS) and drug repurposing analyses were conducted to annotate genetic pleiotropy and enhance drug repositioning.

RESULTS: We prioritized 11 high-confidence and 47 putatively causal genes, most of which are druggable. Astrocytes and oligodendrocyte precursor cells (OPCs) were implicated as GBM-relevant cell populations, with significantly increased TME cell communication between these populations and neurons. We further identified 14 putative cell-type-specific effects related to glioblastomagenesis, including three high-confidence genes (EGFR in astrocytes, CDKN2A in OPCs, and JAK1 in excitatory neurons). Most effects (85.7%, 12/14) were associated with non-GBM-relevant cell cells, encompassing both glial and neural cells.

CONCLUSIONS: This study systematically identifies genetically supported candidate genes in gliomagenesis and their cell-type-specific effects. These findings provide a resource for future mechanistic investigation and may help inform the development of more precise therapeutic hypotheses.

PMID:42177594 | DOI:10.1186/s12967-026-08266-z

J Health Popul Nutr. 2026 May 23. doi: 10.1186/s41043-026-01347-1. Online ahead of print.

ABSTRACT

BACKGROUND: Child malnutrition remains a major global public health concern, with a disproportionately higher burden in developing countries such as Bangladesh. It is a leading contributor to childhood morbidity and mortality and has long-term consequences for physical growth, cognitive development, educational attainment, and adult productivity. Multiple socioeconomic and demographic factors are responsible for this condition. Therefore, this study aims to identify the factors associated with child malnutrition in Bangladesh using multivariate analytical approaches.

METHODS: In this study, malnutrition-related data from the Bangladesh Demographic and Health Survey (BDHS) 2022 were used. Multivariate analysis of variance (MANOVA) and multivariate linear regression models were performed to identify significant factors of child malnutrition in Bangladesh (p[Formula: see text]).

RESULTS: Multivariate linear regression analysis showed that the Z-scores for height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WAH) among children aged 12-23 months were significantly lower compared to those aged < 12 months, with reductions of 32.63, 24.01, and 16.40 units, respectively (p < 0.001). Maternal underweight was negatively associated with all three anthropometric outcomes, whereas higher maternal education and better household wealth status were positively associated with improved nutritional outcomes.

CONCLUSION: The findings of this study suggest that both governmental and non-governmental organizations should prioritize improving maternal education and nutritional status, enhancing household income-generating activities among disadvantaged populations, and promoting adequate birth spacing.

PMID:42177590 | DOI:10.1186/s41043-026-01347-1

Arch Public Health. 2026 May 23. doi: 10.1186/s13690-026-01959-3. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic underscored the importance of integrating human behaviour in infectious disease modelling approaches, yet an in-depth assessment of how behavioural components are incorporated remains limited. We conducted a scoping review of COVID-19 models applied to Belgian data to examine how behavioural dynamics, both voluntary and policy-driven, were represented within model structures. Our aim was to identify current practices, highlight methodological gaps, and provide recommendations for the development of behaviourally integrated epidemiological models.

METHODS: Using Scopus and PubMed, we identified 98 studies published between March 2020 and October 2024, describing 105 models in total. Models were classified by model class (mathematical, statistical, or ensemble), objectives, approaches used to incorporate behavioural factors, and types of behaviour data employed.

RESULTS: Behavioural integration was confined to specific modelling contexts, with only half of the 105 models incorporating behavioural components. Mechanistic models, particularly compartmental models, were the most likely to include behavioural features, especially in studies assessing non-pharmaceutical interventions or conducting long-term forecasts and scenario analyses. Behavioural change was most commonly represented through modifications to transmission parameters or contact matrices. These adjustments were frequently informed by social contact surveys or mobility data derived from various sources.

CONCLUSIONS: In contrast to previous reviews that focused exclusively on behavioural models, this study evaluates the full landscape of Belgian COVID-19 models, offering a comprehensive perspective on how behavioural representation varies across modelling approaches. Our findings recommend that effective behavioural integration relies on timely, routine, and disaggregated surveillance and behaviour data, alongside the use of flexible mechanistic models.

PMID:42177562 | DOI:10.1186/s13690-026-01959-3

Reprod Health. 2026 May 23. doi: 10.1186/s12978-026-02371-4. Online ahead of print.

ABSTRACT

INTRODUCTION: The immediate postpartum period represents a critical yet underutilized opportunity to prevent unintended and closely spaced pregnancies, particularly in low- and middle-income countries. In Rwanda, despite high rates of facility-based delivery, initiation of contraception before hospital discharge remains suboptimal. Evidence on how sociodemographic characteristics, childbirth-related factors, male partner presence during childbirth, and health provider practices jointly determine immediate postpartum family planning (IPPFP) uptake is limited. This study assessed IPPFP uptake, examined male partner involvement, and identified associated factors.

METHODS: The study was conducted in the maternity units of Muhima District Hospital and King Faisal Hospital in Kigali, Rwanda. Quantitative data were collected from 480 women aged ≥ 18 years within 96 h postpartum. Qualitative in-depth interviews were conducted with five male partners to explore perspectives on postpartum contraceptive decision-making. Immediate postpartum family planning was defined as self-reported initiation of a modern contraceptive method before discharge. Quantitative data were analyzed using descriptive statistics, chi-square tests, and regression analysis, and qualitative data were analyzed thematically to complement quantitative findings.

RESULTS: Overall, 60.6% (291/480) of women initiated a contraceptive method before discharge, with intrauterine devices being the most commonly chosen method (33.7%). Male partners were present during childbirth for 48.3% of women; however, partner presence was not significantly associated with IPPFP uptake (χ² = 1.409, p = 0.262). Qualitative findings from a small exploratory sample suggest that contraceptive decisions were largely made during pregnancy, driven by considerations such as maternal health, parity, and household economic capacity, rather than male partners’ physical presence at childbirth.

CONCLUSIONS: IPPFP uptake in these two urban Rwandan hospitals was moderate. Initiation of contraception before discharge was associated with selected sociodemographic and obstetric characteristics, although these associations were based on unadjusted analyses. Male partner presence during childbirth was not statistically associated with IPPFP uptake, and qualitative findings suggest that contraceptive decisions are often made earlier in pregnancy. Strengthening postpartum counseling and clinical assessment may improve informed decision-making. However, findings should be interpreted in light of the study’s limited scope and design.

PMID:42177551 | DOI:10.1186/s12978-026-02371-4

Trials. 2026 May 23. doi: 10.1186/s13063-026-09812-2. Online ahead of print.

ABSTRACT

BACKGROUND: To facilitate equitable access to novel treatments, cancer trial participants should represent as far as possible those that will receive the treatment in practice. We can identify groups who rarely participate in cancer trials by collecting demographic data from participants. In the UK, there is no standardised practice around demographic data capture, leading to inconsistent collection across trials. A lack of systematically collected and published quantitative data from participants in UK cancer trials may limit our ability to identify underrepresented groups.

METHODS: We reviewed availability and completeness of demographic data recorded from 2235 participants in six bladder and six head and neck cancer trials conducted by the Clinical Trials and Statistics Unit at the Institute of Cancer Research (ICR-CTSU) between 2001 and 2023. To assess the representativeness of trial populations, demographic data from trial participants were compared with published data (NHS Digital) from 260,350 people who were treated for these cancers between 2013 and 2022 in England, using chi-squared goodness-of-fit tests and one-sample tests of proportion. A survey was distributed to 12 clinical trials units conducting similar trials to establish which demographic data are routinely collected across the UK.

RESULTS: Data on ethnicity, postcode, smoking status, and co-morbidity burden were inconsistently captured across ICR-CTSU trials, with missing data. Amongst the overall trial population, people older than 80 (n = 486/2235, 22%), females (n = 466/2235, 21%), people living in the most deprived areas (n = 390/1447, 27%), and ethnic minority groups (n = 5/275, 2%) were underrepresented, with some differences by treatment modality. Responses from UK trial teams showed that aside from age and sex (routinely captured), smoking status was the most consistently captured (13/17 trials).

CONCLUSIONS: This study provides quantitative data on cancer trial participants examining several demographic factors and indicates potentially underrepresented groups in trials of the disease subtypes investigated. Missing data were likely observed as a result of data cleaning being focused on items directly addressing the research question. Collecting and analysing a broad range of demographic data with a focus on inclusivity can inform researchers of groups who may benefit from tailored interventions to increase accessibility to cancer trials in the future.

PMID:42177546 | DOI:10.1186/s13063-026-09812-2

J Ovarian Res. 2026 May 23. doi: 10.1186/s13048-026-02140-8. Online ahead of print.

ABSTRACT

CONTEXT: Luteinizing hormone (LH) plays an integral role in follicular development. In gonadotropin-releasing hormone (GnRH) antagonist protocols, LH levels have been demonstrated to affect assisted reproductive technology (ART) outcomes. However, the exact nature of this relationship remains unclear, and LH measurements at a single time point may not be sufficient to capture it fully.

METHODS: We conducted a retrospective cohort study on 4,953 infertile women who underwent their first ART cycle with the GnRH antagonist protocol. Four LH measurements (basal status, antagonist administration day and 24 h later, and ovulation trigger day) were obtain for all participants. We used group-based trajectory modeling (GBTM) to characterize the trajectories of LH level changes during antagonist protocol implementation. Factors influencing the different LH trajectories were explored. Associations between LH levels at different time points and their trajectories with the number of obtained oocytes and ART outcomes in embryo transfer (ET) cycles were analyzed.

RESULTS: Based on the statistical criteria, the model with 4 trajectories were selected as the best-fitting model, and the LH change trajectories during antagonist protocol can be grouped into stable (77.0%), rising (11.0%), decreasing (6.2%) and fluctuating (5.8%) types. Different trajectory groups exhibited significant differences in the number of retrieved oocytes. Compared with that in the stable trajectory group, the oocyte yield in the rising trajectory group decreased and that in the fluctuating trajectory group increased. Of these participants, 884 underwent fresh ET cycles, with no significant differences in pregnancy outcomes between the different trajectory groups. On ovulation trigger day, high LH levels predicted better pregnancy outcomes, indicating significant positive associations with the odds of biochemical pregnancy, clinical pregnancy and live birth.

CONCLUSION: Oocyte yield differed significantly among the LH trajectory groups, suggesting that LH dynamics during antagonist controlled ovarian stimulation may be relevant to treatment outcomes. For individuals with risk factors for a rising trajectory (e.g., advanced age, higher body mass index), closer monitoring of LH profiles may be warranted. For fresh ET cycles, trigger-day LH levels may merit heightened clinical attention.

PMID:42177529 | DOI:10.1186/s13048-026-02140-8

BMC Med Educ. 2026 May 23. doi: 10.1186/s12909-026-09494-z. Online ahead of print.

ABSTRACT

BACKGROUND: Ethical climate is an important component of professional development in medical education, yet little is known about how medical students’ perceptions of ethical climate evolve during training or whether these perceptions are associated with career intentions. This study aimed to examine longitudinal changes in perceived and desired ethical climate among medical students and to explore potential associations with intended residency choice.

METHODS: We conducted a follow-up study of a student cohort among medical students enrolled in the Croatian-language medical program at the University of Split School of Medicine. Ethical climate was assessed using the Ethical Climate Questionnaire (ECQ), which evaluates nine ethical climate domains. Data were collected during the third and the sixth year of study. Students completed both perceived and desired versions of the ECQ. Paired analyses were performed for students who participated at both time points, while independent-sample analyses compared third and sixth-year cohorts. Ethical climate domains were also examined in relation to students’ desired residency choice.

RESULTS: A total of 70 third year and 77 sixth-year students participated, with 57 students included in paired analyses. The two dominant climates were Company profit and Laws and professional codes. Perceived ethical climate scores decreased significantly from the third to the sixth year in the Company rules and procedures (p < 0.001), while other domains remained stable. No statistically significant differences were observed in desired ethical climate domains between the third and sixth study years after Bonferroni correction. No associations were found between ethical climate domains and intended residency choice.

CONCLUSIONS: Medical students’ perceptions of institutional ethical climate change during undergraduate training, particularly regarding organizational structure, while ethical ideals remain largely stable. Ethical climate perceptions do not appear associated with residency choice, suggesting that ethical development and career decision-making may follow distinct trajectories. These findings highlight the importance of addressing the hidden curriculum and supporting structured reflection on ethical tensions encountered during clinical training.

PMID:42177514 | DOI:10.1186/s12909-026-09494-z

BMC Med Educ. 2026 May 23. doi: 10.1186/s12909-026-09520-0. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to explore the effects of the Simroid dental training robot on the training of undergraduate dental students in patient interviews and clinical examinations.

METHODS: Undergraduate students who participated in internship rotations in the Department of Endodontics at Tianjin Stomatological Hospital from July 2023 to June 2025 were enrolled as the research participants. This study adopted a non-randomized controlled design, dividing students from different academic years into two groups: the control group received conventional training, while the experimental group utilized the Simroid patient robot for patient interview and clinical examination training. The effectiveness of the training was evaluated using the Mini Clinical Exercise Evaluation (Mini-CEX) and a learning satisfaction questionnaire. Statistical analyses were conducted through independent samples t-test and repeated measures ANOVA.

RESULTS: The experimental group achieved significantly higher assessment scores in both clinical examination and doctor-patient communication compared to the control group (P < 0.05). Additionally, the experimental group reported higher levels of learning satisfaction.

CONCLUSION: This study demonstrated that incorporating the Simroid dental training robot into patient interview and clinical examination training significantly enhanced undergraduate students’ clinical examination skills and doctor-patient communication abilities. By enabling students to proficiently master patient interview process and experience realistic doctor-patient communication scenarios during preclinical training, this approach effectively prepared them for subsequent clinical internships.

PMID:42177505 | DOI:10.1186/s12909-026-09520-0