Category: Statistics

BMC Sports Sci Med Rehabil. 2026 May 19. doi: 10.1186/s13102-026-01759-w. Online ahead of print.

ABSTRACT

PURPOSE: Chronic ankle instability (CAI) is a prevalent consequence of ankle sprains among athletes and is often linked to compromised dynamic balance. This meta-analysis aims to evaluate the effects of balance training (BT) on dynamic balance in athletes with CAI, while also exploring whether the pooled effects differ based on participant characteristics, types of comparators, intervention modalities, and assessment tools.

METHODS: A systematic search was conducted in PubMed, Web of Science, PsycINFO, and the Cochrane Library until April 7, 2025. Thirteen randomized controlled trials (RCTs) involving 468 athletes diagnosed with CAI were included in this review. A multilevel (three-level) random-effects meta-analysis was performed to synthesize both composite and direction-specific dynamic balance outcomes. Additionally, exploratory subgroup analyses, Egger’s regression test, trim-and-fill analysis, CR2-adjusted cluster-robust sensitivity analyses, and GRADE certainty assessments were conducted to evaluate the robustness of the findings.

RESULTS: BT statistically significantly improved dynamic balance across all pooled outcomes, including the composite score (SMD = 1.32, 95% CI: 0.08 to 2.55), anterior direction (SMD = 0.67, 95% CI: 0.29 to 1.06), posteromedial direction (SMD = 0.59, 95% CI: 0.16 to 1.02), and posterolateral direction (SMD = 0.74, 95% CI: 0.12 to 1.36). Substantial between-study heterogeneity was observed (I² = 76.6%-94.1%), and the approximate prediction intervals for all four outcomes crossed the null value, indicating uncertainty in the robustness of the findings. Exploratory subgroup analyses suggested possible variation across regions, participant types, comparator types, intervention modalities, and assessment tools, although these findings were inconsistent and based on small subgroup sample sizes. CR2-adjusted sensitivity analyses showed that the anterior, posteromedial, and posterolateral effects remained statistically significant, whereas the composite effect was attenuated and no longer statistically significant.

CONCLUSION: BT may improve direction-specific dynamic balance outcomes in athletes with CAI, particularly in the anterior, posteromedial, and posterolateral directions. Although the composite outcome was statistically significant in the primary three-level meta-analysis, it exhibited less robustness in the CR2-adjusted sensitivity analysis. Given the substantial heterogeneity, wide prediction intervals, and limited evidence base, the pooled effects should be interpreted with caution, and subgroup findings should be considered exploratory.

PMID:42157072 | DOI:10.1186/s13102-026-01759-w

BMC Psychol. 2026 May 19. doi: 10.1186/s40359-026-04776-z. Online ahead of print.

ABSTRACT

BACKGROUND: The relationship between teacher support and students’ mathematics achievement has been extensively studied. However, its underlying mechanism remains unclear.

METHODS: This study aimed to examine the associations between teacher support and mathematics achievement among high school students, and to test the potential mediating roles of mathematics anxiety and learning engagement in these associations. Participants included 1,340 high school students (M_age = 16.71 years), and all participants completed questionnaires measuring teacher support, math anxiety and learning engagement, as well as three standardized mathematics achievement tests. The data analysis in this study was performed using the structural equation model (SEM) in SPSS 25.0 and Mplus 8.3.

RESULTS: The results revealed that: (1)teacher support was positively correlated with mathematics achievement; (2)mathematics anxiety mediated the relationship between teacher support and mathematics achievement; (3)learning engagement mediated the relationship between teacher support and mathematics achievement; (4)mathematics anxiety and learning engagement jointly played a chain mediating role in the relationship between teacher support and mathematics achievement.

CONCLUSION: These findings highlight the significant associations between perceived teacher support and mathematics achievement among high school students, mediated through cognitive and behavioral mechanisms, thus providing preliminary correlational evidence that may inform future longitudinal and experimental research on educational practices.

PMID:42157062 | DOI:10.1186/s40359-026-04776-z

BMC Pregnancy Childbirth. 2026 May 19. doi: 10.1186/s12884-026-09268-x. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to identify the most diagnostically valuable features among the 11 MRI features of Placenta accreta spectrum (PAS) described in the joint consensus statement by the Society of Abdominal Radiology (SAR) and the European Society of Urogenital Radiology (ESUR), and to evaluate the diagnostic efficacy of MRI, risk factors, and ultrasound (US) used alone or in combination for prenatal PAS diagnosis.

METHODS: This retrospective study included 199 pregnant women who delivered at Zhengzhou Central Hospital from November 2018 to December 2022. Standardized evaluations of Risk Factors, US, and MRI features were conducted, and subjects were divided into PAS (89 cases) and non-PAS groups (110 cases). Chi-square tests, logistic regression, and the Bootstrap method were used to identify MRI features with intergroup differences. Diagnostic scheme efficacy was compared using the area under the curve (AUC), and improvements were assessed using the net reclassification improvement index (NRI) and integrated discrimination improvement index (IDI). The final diagnosis of PAS was based on surgical and/or pathological findings according to the International Federation of Gynecology and Obstetrics (FIGO) criteria.

RESULTS: Three Risk Factors (caesarean delivery (CD) history, placenta previa, advanced maternal age) and three MRI features (T2-dark intraplacental bands, Loss of retroplacental T2-hypointense line, and Asymmetric shape/thickening of the placenta) showed statistical differences. The AUC for Risk Factors, US, and MRI alone was > 0.8. Combined schemes (MRI + US and MRI + US + Risk Factors) had higher efficacy, with MRI + US + Risk Factors demonstrating the highest efficacy.

CONCLUSION: This study identifies three key standardized MRI features and three key risk factors to simplify clinical application. For high-risk pregnant women, a multimodal approach combining risk assessment, ultrasound, and standardized MRI features produced the highest diagnostic performance, but prospective external validation is required before broader clinical implementation.

PMID:42157046 | DOI:10.1186/s12884-026-09268-x

Diabetol Metab Syndr. 2026 May 19. doi: 10.1186/s13098-026-02182-4. Online ahead of print.

ABSTRACT

BACKGROUND: Insulin resistance (IR) is linked to overactive bladder (OAB), with chronic inflammation serving as a common pathophysiological mechanism in both conditions. As a robust marker of IR, estimated glucose disposal rate (eGDR) was selected as the exposure variable to examine its relationship with OAB, with a specific focus on the mediating role of inflammation.

METHODS: We conducted a cross-sectional study using data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). We utilized weighted logistic regression to assess the association of eGDR with OAB, while restricted cubic splines (RCS) helped characterize potential nonlinear patterns in this relationship. Subgroup analyses and interaction tests were performed to assess heterogeneity in the eGDR-OAB association across different subgroups. Mediation analysis was used to explore whether systemic inflammatory biomarkers statistically explain part of the eGDR-OAB association, while acknowledging that causal inference is limited by the cross-sectional design.

RESULTS: 31,351 participants were included in this study, of whom 6,356 (20.27%) were diagnosed with OAB. In the fully adjusted Model, each one-unit increment in eGDR was associated with a 11% reduction in OAB risk (OR = 0.89; 95% CI: 0.87-0.91; P < 0.001) and a 48% decreased risk of OAB for the highest eGDR quartile (Q4) compared to the lowest quartile (Q1) (OR = 0.52; 95% CI: 0.42-0.64; P < 0.001). RCS analysis showed a significant nonlinear inverse association between eGDR and OAB, and this association was consistently observed across nearly all subgroups. Mediation analyses revealed that systemic inflammatory biomarkers statistically mediated the relationship between eGDR and OAB, explaining approximately 0.64-3.15% of the total effect, suggesting that inflammation accounts for only a small fraction of the eGDR-OAB association, while other mechanisms (e.g., autonomic dysfunction, microvascular damage, urothelial changes) likely contribute more substantially.

CONCLUSIONS: Our research confirmed the correlation between eGDR, inflammation and OAB. The potential mediating effect of inflammation between eGDR and OAB provides a meaningful direction for future research and targeted interventions.

PMID:42157045 | DOI:10.1186/s13098-026-02182-4

BMC Oral Health. 2026 May 20. doi: 10.1186/s12903-026-08464-7. Online ahead of print.

ABSTRACT

BACKGROUND: Orthodontic malocclusion may affect both functional and psychosocial aspects of health; however, its relationship with global self-esteem in young adults remains unclear. This study aimed to compare self-esteem levels according to orthodontic treatment need as assessed by the Index of Complexity, Outcome, and Need (ICON) and Angle classification among university students.

METHODS: A cross-sectional study was conducted between April and December 2024 among university students. A total of 290 participants were initially recruited, and 269 were included in the final analysis (198 females, 92 males; mean age: 21.8 ± 2.3 years). Participants were recruited from different faculties through voluntary participation. Self-esteem was assessed using the validated Turkish version of the Rosenberg Self-Esteem Scale (RSES; 10 items, 4-point Likert scale). Orthodontic status was evaluated through intraoral examination by a single calibrated orthodontist using the ICON (treatment-need cutoff ≥ 43) and Angle classification (Class I, II/1, II/2, III). Intra-examiner reliability was high for both ICON and Angle assessments (κ = 0.91 and 0.89, respectively). Data were anonymized and analyzed using non-parametric statistical tests (Mann-Whitney U and Kruskal-Wallis H tests).

RESULTS: A total of 269 valid responses were analyzed, yielding a mean ± SD RSES score of 32.04 ± 5.13. No statistically significant difference in self-esteem was observed between ICON-defined treatment-need groups (U = 7168.00, r = 0.048, p = 0.446). However, a small but statistically significant difference was observed among Angle classifications (H = 13.10, η² = 0.038, p = 0.004). The RSES demonstrated high internal consistency (Cronbach’s α = 0.869).

CONCLUSIONS: Self-esteem was not significantly associated with orthodontic treatment need as defined by ICON, while only minimal differences were observed across Angle classifications. These findings suggest that objective measures of malocclusion may have a limited influence on global self-esteem among university students. Future studies incorporating broader sociodemographic variables may provide a more comprehensive understanding of the psychosocial impact of malocclusion.

PMID:42157033 | DOI:10.1186/s12903-026-08464-7

BMC Oral Health. 2026 May 19. doi: 10.1186/s12903-026-08622-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Transitioning from a treatment-oriented model to a prevention-focused approach is essential for improving oral health outcomes. This study aimed to assess the feasibility and implementation outcomes of Integrated Oral Health Care Pathways (IOHCPs) for pediatric and adult patients referred to a dental school setting.

METHODS: A four-month mixed-methods feasibility study was conducted at the School of Dentistry, Tehran University of Medical Sciences. IOHCPs were implemented for pediatric and adult patients using risk-based preventive care, oral health education, and structured follow-up. Participants were allocated into three groups (control, routine care, and IOHCP intervention). The study followed the Donabedian framework (structure, process, and outcomes). Clinical outcomes (OHI-S, DMFT, and bleeding on probing [BOP]) and behavioral indicators were assessed. Process indicators were evaluated between routine care and IOHCP groups. Semi-structured interviews were conducted to assess structural feasibility. Statistical analyses included trend tests, chi-square tests, and independent t-tests, with a significance level of 0.05.

RESULTS: A total of 780 patients (420 adults and 360 children) were included. OHI-S showed a significant improvement across groups in both adults (2.75 to 1.88) and children (2.29 to 1.25; p < 0.001). Behavioral indicators demonstrated favorable trends in the IOHCP group, including increased tooth brushing frequency and higher preventive care uptake (p < 0.001). Process indicators showed marked improvement in the delivery of preventive services in the IOHCP group compared to routine care (p < 0.001). DMFT increased in adults over time, reflecting cumulative disease experience, while no significant change was observed in children. Differences in BOP between routine care and IOHCP groups were not statistically significant.

CONCLUSION: The implementation of Integrated Oral Health Care Pathways in a dental educational setting was feasible and acceptable. The pathways improved preventive care delivery processes and were associated with favorable oral hygiene behaviors. However, changes in clinical disease indicators were limited within the short study period. Further long-term studies are needed to evaluate sustainability and clinical impact.

PMID:42157031 | DOI:10.1186/s12903-026-08622-x

Australas Psychiatry. 2026 May 19:10398562261447698. doi: 10.1177/10398562261447698. Online ahead of print.

ABSTRACT

BackgroundThe Dynamic Appraisal of Situational Aggression – Inpatient Version (DASA-IV) is a brief violence risk assessment tool to evaluate imminent risk of aggression. There have been no previous studies to investigate its utility in an acute adult non-forensic psychiatric setting in Australia.ObjectiveTo examine the feasibility of DASA-IV implementation in an acute adult inpatient non-forensic psychiatric setting.MethodsThis study utilised a quasi-experimental design with pre- and post-testing. Subjective data from questionnaires administered to psychiatric staff on utility of DASA-IV and objective data on frequency of aggression incidents were collected.ResultsStaff reported higher confidence in deciding when medications, seclusion, and security and medical staff were required to manage aggression. DASA-IV was reported as valuable and easy to use. Lack of time and lack of DASA-IV training for non-regular nurses were barriers to implementation. Only the control unit had a statistically higher number of aggression incidents post-intervention.Conclusions DASA-IV is a feasible tool that improves staff confidence in managing aggression and reduces aggression incidents in an acute adult non-forensic inpatient psychiatric setting in a metropolitan tertiary public hospital. Its implementation may assist in aggression management in the acute adult non-forensic inpatient psychiatric setting.

PMID:42157028 | DOI:10.1177/10398562261447698

Pharm Stat. 2026 Jul-Aug;25(4):e70074. doi: 10.1002/pst.70074.

ABSTRACT

Adaptive clinical dose-finding trials aim to identify an optimal drug dose for use in subsequent phase II and III trials. In adaptive dose-finding trials, dose levels for newly included patients are informed by outcomes of patients that received the drug earlier in the trial. The body of methodological research on adaptive dose-finding trials is extensive, but a clear overview is lacking. The goal of this paper is to provide a knowledge base of designs and statistical methods for adaptive clinical dose-finding trials by means of a literature review. We identified 315 adaptive dose-finding trial methodology articles of which the majority was inspired by oncology. Recent methods focused on identification of an optimal dose considering both toxicity and efficacy endpoints, and addressing challenges related to subgroup-specific dose-finding, dose-finding for combination therapies, and incorporation of delayed outcomes in dose-finding. These developments are driven by the emergence of newer classes of cancer drugs, such as targeted therapies and immunotherapies, and by initiatives like Project Optimus. Most articles focused on model-based designs, like the Continual Reassessment Method (CRM), but recent years have seen a strong increase in model-assisted or interval-based designs, including Toxicity Probability Interval (TPI) and Bayesian Optimal Interval (BOIN) designs and expansions thereof. Considering the increasing availability and large variety of adaptive dose-finding trial designs, it is challenging for researchers to find relevant designs tailored to their needs. Therefore, we provide an interactive map summarizing the classification of our results to facilitate the identification of relevant designs/methods, which we will update regularly.

PMID:42157027 | DOI:10.1002/pst.70074

Clin Neuropsychol. 2026 May 19:1-22. doi: 10.1080/13854046.2026.2670535. Online ahead of print.

ABSTRACT

Objective: To reevaluate the psychometric properties and contemporary relevance of the 1969 Lawton and Brody Instrumental Activities of Daily Living (iADL) Scale in older adults. Methods: Data from 3552 participants and co-participants in the Texas Alzheimer’s Research and Care Consortium cohort were analyzed. Lawton and Brody iADL Scale items were analyzed in a sample with no cognitive disorder, mild cognitive impairment, and dementia. Graded response models assessed item discrimination and difficulty, with differential item functioning (DIF) analyses examining demographic effects. Expert reviewers evaluated item content for cultural and technological relevance. Results: Items assessing shopping, food preparation, and transportation were most sensitive to mild functional impairment, while the total scale had limited detection of subtle functional decline. Statistical DIF emerged on 75% of items, whereas clinically meaningful DIF for several demographic groupings emerged on the transportation item. Expert reviewers identified outdated content, particularly for telephone and financial items, reflecting technological shifts. Broader changes in normative behaviors and sample demographics may further challenge scale applicability. Conclusions: The Lawton and Brody iADL Scale remains foundational but shows limited sensitivity for early functional decline. Outdated items and evolving socioeconomic and technological contexts underscore the need for refinement to enhance unbiased early detection and maintain longitudinal comparability. Updating the instrument to reflect modern demands could strengthen functional assessment in Alzheimer’s disease and related disorders research and clinical trials.

PMID:42157020 | DOI:10.1080/13854046.2026.2670535

Commun Med (Lond). 2026 May 19;6(1):290. doi: 10.1038/s43856-026-01658-8.

ABSTRACT

BACKGROUND: Primary amoebic meningoencephalitis (PAM) caused by Naegleria fowleri carries historical case fatality rates (CFR) exceeding 97%. The 2025 Kerala outbreak, the largest documented globally, provided an unprecedented opportunity to identify host factors and inflammatory correlates influencing survival under standardised management.

METHODS: We conducted a prospective observational study of 200 laboratory-confirmed PAM cases across six districts of Kerala, India (January-November 2025). All patients received protocolised amphotericin B ± miltefosine. Demographic, clinical, and laboratory data were collected, including inflammatory biomarkers (IL-6, TNF-α, IL-1β, neutrophil-to-lymphocyte ratio), pathogen burden (qPCR), and treatment timing. Multivariable logistic regression identified mortality predictors; bootstrap resampling and E-value sensitivity analyses assessed robustness.

RESULTS: Here we show that among 200 patients (median age 41 years; 50% male), 134 with resolved outcomes yield a CFR of 45·5% (95% CI 37·3-54·5%; 61 deaths, 73 recoveries). Diabetes mellitus is the only statistically significant predictor of mortality in the adjusted model (adjusted OR 2·59; 95% CI 1·01-6·66; p = 0·048), though the proximity of the lower confidence bound to unity warrants cautious interpretation. This association remains consistent across sensitivity analyses (bootstrap 95% CI 1·06-8·74; E-value 4·62). Asthma demonstrates a protective association in univariable analysis (OR 0·37; p = 0·021), though this finding remains hypothesis-generating. Early treatment (≤2 days) shows a trend toward improved survival (p = 0·084). Inflammatory biomarkers show no association with outcome, though CSF pathogen burden correlates significantly with admission neurological severity.

CONCLUSIONS: Under standardised treatment, diabetes mellitus emerges as a key host determinant of PAM mortality. The dissociation between inflammatory markers and outcomes suggests neurological fate may be determined early in infection, with immediate clinical implications as climate change expands the geographic range of N. fowleri.

PMID:42156999 | DOI:10.1038/s43856-026-01658-8