Category: Statistics

JAMA Netw Open. 2026 Feb 2;9(2):e2556951. doi: 10.1001/jamanetworkopen.2025.56951.

ABSTRACT

IMPORTANCE: With advancements in imaging technology and more frequent health evaluations, the incidence and prevalence of pancreatic cysts have gradually increased. Certain types of pancreatic cystic neoplasms are precancerous lesions associated with an increased risk of pancreatic cancer. Hence, identifying risk factors and preventing their occurrence are crucial. Nonetheless, population-based research on modifiable risk factors remains lacking.

OBJECTIVE: To investigate the association of diabetes and related factors with risk of developing pancreatic cysts.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included adults (aged ≥20 years) who underwent health examinations in 2009 through medical institutions designated by the Korean National Health Insurance Service. Participants were followed up until December 31, 2020. Data were analyzed from March 23, 2023, to February 8, 2024.

EXPOSURE: All participants were categorized according to diabetes status as having normoglycemia, impaired fasting glucose, shorter diabetes duration (<5 years), or longer diabetes duration (≥5 years). Demographic characteristics, lifestyle factors, and comorbidities at the time of health examinations were investigated.

MAIN OUTCOMES AND MEASURES: Adjusted hazard ratios (AHRs) for pancreatic cyst occurrence for each diabetes status group were estimated using Cox proportional hazards regression models, adjusting for potential confounders.

RESULTS: Among the entire study population of 3 856 676 adults (mean [SD] age, 47.1 [14.0] years; 54.5% male), 330 138 (8.6%) had diabetes. The median observation period was 10.3 (IQR, 10.1-10.6) years. A total of 31 877 patients (0.8%) developed pancreatic cysts during the observation period. Compared with individuals with normoglycemia, AHRs for the development of pancreatic cysts were 1.06 (95% CI, 1.03-1.08) for those with impaired fasting glucose, 1.23 (1.18-1.28) for those with a shorter diabetes duration, and 1.37 (1.31-1.44) for those with a longer diabetes duration. Subgroup analyses showed higher AHRs for pancreatic cyst occurrence associated with diabetes among individuals younger than 60 years (AHR, 1.34 [95% CI, 1.27-1.40]), males (AHR, 1.32 [95% CI, 1.26-1.38]), and current smokers (AHR, 1.40 [95% CI, 1.30-1.51]) with diabetes compared with patients 60 years or older (AHR, 1.21 [95% CI, 1.16-1.27]), females (AHR, 1.20 [95% CI, 1.15-1.26]), never smokers (AHR, 1.22 [95% CI, 1.18-1.28]), and former smokers (AHR, 1.25 [95% CI, 1.16-1.35]) with diabetes.

CONCLUSIONS AND RELEVANCE: In this cohort study of 3 856 676 Korean adults, longer diabetes duration was associated with an increased risk of pancreatic cysts. The risk of pancreatic cyst occurrence was higher among younger male individuals with diabetes compared with their counterparts. Smoking cessation was associated with a lower risk of pancreatic cysts. Further studies incorporating imaging and longitudinal data are needed to clarify the clinical significance of pancreatic cysts in individuals with diabetes.

PMID:41686439 | DOI:10.1001/jamanetworkopen.2025.56951

JAMA Netw Open. 2026 Feb 2;9(2):e2559471. doi: 10.1001/jamanetworkopen.2025.59471.

ABSTRACT

IMPORTANCE: The impact of late onset in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is still controversial.

OBJECTIVE: To investigate the association of late onset MOGAD with moderate disability and relapse in Korean patients.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide, multicenter, retrospective cohort study included adult patients with a diagnosis of MOGAD according to the 2023 international diagnostic criteria between August 2018 and September 2024 across 28 hospitals in South Korea.

EXPOSURE: Age at onset of MOGAD, categorized into adult-onset MOGAD (AO-MOGAD; 18-49 years) and late-onset MOGAD (LO-MOGAD; ≥50 years).

MAIN OUTCOMES AND MEASURES: The primary outcomes were time to first relapse in patients with a disease duration of 12 or more months and moderate disability, defined as Expanded Disability Status Scale (EDSS) score of 3 or greater at last follow-up.

RESULTS: A total of 350 patients (mean [SD] age at onset, 43.2 [15.0] years; 189 female [54.0%]) with a median (IQR) baseline EDSS of 3.0 (2.0-4.0) were included, with 124 patients (35.4%) with LO-MOGAD and 226 patients (64.6%) with AO-MOGAD. The LO-MOGAD group had less frequent brain involvement than the AO-MOGAD group at onset (26 patients [21.0%] vs 75 patients [33.2%]; P = .02) and during the disease course (28 patients [22.6%] vs 95 patients [42.0%]; P < .001), while optic neuritis or myelitis was comparable between the 2 groups. The LO-MOGAD group showed more frequent monophasic course (55 of 95 patients [57.9%] vs 75 of 188 patients [39.9%]; P = .004), but higher EDSS score at last follow-up (median [IQR], 2.0 [1.0-2.0] vs 1.0 [0.0-2.0]; P < .001) compared with those in the AO-MOGAD group. However, late onset was not significantly associated with the time to first relapse in multivariable analysis (adjusted hazard ratio, 0.72; 95% CI, 0.48-1.08; P = .11), which was consistent after propensity score matching. By contrast, late onset was associated with a significantly higher risk of moderate disability at the last follow-up (adjusted odds ratio, 2.84; 95% CI, 1.39-5.80; P = .004).

CONCLUSIONS AND RELEVANCE: In this cohort study of MOGAD, late onset was not associated with a risk of relapse but with a higher risk of moderate disability at follow-up. Prospective studies with longer follow-up periods are warranted to better understand and manage patients with late-onset disease.

PMID:41686435 | DOI:10.1001/jamanetworkopen.2025.59471

Adv Ther. 2026 Feb 13. doi: 10.1007/s12325-025-03485-0. Online ahead of print.

ABSTRACT

INTRODUCTION: X-linked retinitis pigmentosa (XLRP) is one of the most severe forms of retinitis pigmentosa, representing 5-15% of all cases. There is a notable gap in understanding the health-related quality of life (HRQoL) impact on carers of people with XLRP, essential for holistic health economic evaluations. The objective of the study is to estimate health state utilities of informal carers for a person with XLRP which can be used in economic modelling.

METHOD: Four carer descriptions or “vignettes” were developed for mild, moderate, severe, and completely blind XLRP patient care. The vignettes were based on studies identified in a targeted literature review and validated through qualitative interviews with informal carers and an ophthalmologist. The vignettes were valued using the time trade-off (TTO) method by the general population of Great Britain. Descriptive statistics of the data were analysed.

RESULTS: A total of 220 respondents completed the survey. The mean utility value for providing care to someone with mild XLRP was 0.85, decreasing to 0.76 when caring for someone with moderate XLRP and further decreasing to 0.54 when caring for someone with severe XLRP. The mean carer utility declined to 0.42 for complete blindness.

CONCLUSION: Mean carer utility declined with increased severity of patient XLRP with the most substantial decline calculated when moving from moderate to severe XLRP. This is the first study to generate utility values reflecting HRQoL of carers of patients with XLRP, by different levels of disease severity, and finds that carer utility decreases with increased XLRP severity in patients.

PMID:41686418 | DOI:10.1007/s12325-025-03485-0

Psychiatr Q. 2026 Feb 13. doi: 10.1007/s11126-026-10261-y. Online ahead of print.

NO ABSTRACT

PMID:41686403 | DOI:10.1007/s11126-026-10261-y

J Ultrasound. 2026 Feb 13. doi: 10.1007/s40477-026-01120-4. Online ahead of print.

ABSTRACT

BACKGROUND: Hepatic elastography is a reliable, non-invasive imaging technique for assessing liver stiffness, aiding in the diagnosis of liver fibrosis and cirrhosis. Chronic hepatitis B (CHB) and chronic hepatitis C (CHC) contribute significantly to progressive liver disease and hepatocellular carcinoma (HCC) worldwide. Early detection and continuous monitoring of liver stiffness are crucial for effective disease management. However, data on hepatic elastography findings in Rwanda remain limited. This study aimed to describe hepatic elastography findings in patients with CHB and CHC at King Faisal Hospital; describe elastography findings difference in hepatitis B and C and Assess the correlation between demographic and clinical factors and fibrosis severity.

METHODS: A cross-sectional study was conducted among 149 patients with CHB and CHC. Liver stiffness was assessed using point shear wave elastography (pSWE) on the Siemens Acuson Sequoia ultrasound system. Demographic data, liver function tests, viral loads, and fibrosis staging were collected and analyzed using R and R Studio (v.4.3.3). Descriptive statistics were computed, Fisher’s exact test was used to assess associations, and multinomial logistic regression was applied to identify key contributors to fibrosis severity. Model accuracy, sensitivity, and specificity were also evaluated.

RESULTS: Of the 149 participants, 77 (52%) had CHB and 72 (48%) had CHC. Severe fibrosis (F3-F4) was significantly more prevalent in CHC patients (72%) than in CHB patients (28%) (p = 0.011). Age was a strong predictor of fibrosis severity; patients over 40 years were 10.3 times more likely to have advanced fibrosis (p = 0.002). Other significant predictors included patient with longer infection duration (7-12 years), hepatic steatosis, abnormal viral load, and without on antiviral therapy (p < 0.001). Elevated AST, ALT, and GGT were strongly associated with advanced fibrosis (p < 0.001). Sex was not significantly associated with fibrosis severity. Elastography findings correlated well with biopsy results, with 84% of patients classified as F3-F4 by elastography confirmed to have advanced fibrosis by biopsy.

CONCLUSION: This study confirms that hepatic elastography is a powerful, non-invasive diagnostic tool for assessing liver fibrosis in patients with chronic hepatitis B and C. Advanced fibrosis and cirrhosis were significantly more prevalent among hepatitis C patients. Several clinical and demographic factors including older age, longer infection duration, hepatic steatosis observed on routine abdominal ultrasound, abnormal viral load, and lack of antiviral therapy were strongly associated with increased liver stiffness. Elevated liver enzymes (AST, ALT, GGT) also showed a significant correlation with fibrosis severity. Sex was not found to be a statistically significant predictor of fibrosis stage. These findings reaffirm the clinical reliability of elastography as a practical alternative to biopsy, particularly in resource-limited settings.

PMID:41686400 | DOI:10.1007/s40477-026-01120-4

J Patient Rep Outcomes. 2026 Feb 13. doi: 10.1186/s41687-026-01018-z. Online ahead of print.

ABSTRACT

BACKGROUND: The QUAlity of Life Assessment in Spina bifida (QUALAS) is a self-administered questionnaire that measures health-related quality of life. The Japanese versions of QUALAS for children and teenagers with spina bifida (SB) have been validated. This study aimed to develop and validate the reliability and validity of the Japanese version of QUALAS-A (QUALAS-A-J), the adult version of the instrument.

METHODOLOGY: The participants were adults with SB aged ≥ 18 years. The results of cognitive interviews and a preliminary survey conducted on 16 participants were analyzed to confirm the face and content validity of the responses, and the item wording was modified. The revised questionnaire was administered from April to December 2022. The survey requested responses regarding demographics, QUALAS-A-J, and the World Health Organization Quality of Life Scale (WHOQOL-26). We then calculated descriptive statistics and correlation coefficients, and conducted exploratory factor analysis and Student’s t-test. Cronbach’s α and retests were used to determine reliability and intraclass correlation coefficients (ICCs), respectively.

RESULTS: Valid responses were received from 133 participants (52% female; mean age, 31.3 ± 10.5 years). Factor analysis indicated a 12-item, three-factor structure. Three items related to sexual activity that had low variance estimates were eliminated. Two factors converged on the same items as the original version; the correlation coefficients for QUALAS-A-J and WHOQOL-26 domains were 0.36 ≤ r ≤ 0.72, which confirmed discriminability for two domains. In all three domains, health-related quality of life was higher for those without than for those with urinary incontinence, validating known-groups validity. Cronbach’s α was 0.66-0.88 and the ICCs were > 0.8, thereby confirming reliability.

CONCLUSIONS: The present study evaluated the reliability of QUALAS-A-J, which has three domains, 12 items, and two original and one new structure.

PMID:41686393 | DOI:10.1186/s41687-026-01018-z

Ann Biomed Eng. 2026 Feb 13. doi: 10.1007/s10439-026-04011-1. Online ahead of print.

ABSTRACT

BACKGROUND: For decades, researchers have used Detrended Fluctuation Analysis (DFA) as a method to assess the temporal structure of gait variability through the Hurst exponent (H). However, DFA’s reliance on long time series limits reliability and reduces statistical power when applied to short walking trials, restricting its applicability. The Hurst-Kolmogorov process (HKp), an increasingly common algorithm, may offer more reliable and efficient estimates of the H in short walking trials. This study evaluated the reliability and statistical power of HKp versus DFA in estimating H from gait kinematics using short time series.

METHODS: 119 healthy adults (34 young, 57 middle-aged, and 38 older) were sampled from the NONAN GaitPrint dataset. Each participant walked 9 four-minute trials per day over the course of two days, which were a week apart. H was estimated for stride interval, stride length, and the lower limb joint range of motion using DFA and HKp. Kinematic variables were calculated for time series ranging from 50 to 175 strides. Intraclass correlation coefficients (ICCs) were calculated between days using the average of 1 to 9 trials per day. Power estimations using simulated time series were performed to assess the ability of each method to detect group differences under varying effect sizes, sample sizes, trial numbers, and time series lengths.

RESULTS: HKp achieved excellent reliability (ICC > 0.90) in short trials (<100 strides), whereas DFA rarely exceeded moderate reliability. Statistical power simulations demonstrated that HKp yielded higher power than DFA, particularly when fewer trials and subjects were available. A summary table is provided to guide sample size selection under different design conditions.

CONCLUSION: HKp offers a more reliable and statistically powerful alternative to DFA for estimating H in short walking trials. These findings support HKp as a practical tool for assessing the temporal structure of gait variability, improving feasibility in experimental and research settings.

PMID:41686388 | DOI:10.1007/s10439-026-04011-1

J Neurooncol. 2026 Feb 13;176(3):210. doi: 10.1007/s11060-025-05366-6.

ABSTRACT

PURPOSE: Brain tumors, characterized by the uncontrolled proliferation of abnormal cells within cerebral tissue, remain clinically challenging entities. Radiotherapy and chemotherapy constitute fundamental therapeutic modalities; however, their effects on healthy brain structures are not fully understood. This study aimed to evaluate the impact of these treatments on volumetric changes in brain structures and tumor size in patients with primary or metastatic brain tumors.

METHODS: A retrospective cohort of 47 patients aged 18-90 years treated at Inonu University Turgut Özal Medical Center between 2012 and 2023 was analyzed. Brain MRI scans were evaluated at three time points: pre-treatment, post-radiotherapy, and post-chemotherapy. Radiotherapy was delivered at a median dose of 60 Gy in 30-33 fractions, and temozolomide was used as the chemotherapy agent. Volumetric measurements of the telencephalon, diencephalon, ventricles, white matter, brainstem, cerebellum, and cerebral cortex were performed using MRICloud, while tumor volumes were quantified using the VolBrain platform. All volumetric differences were statistically tested using repeated-measures ANOVA with corresponding p-values reported.

RESULTS: A statistically significant increase in telencephalon volume was observed after radiotherapy, followed by a return toward baseline measurements after chemotherapy. The diencephalon demonstrated a significant and persistent volume reduction following radiotherapy (p < 0.05). No statistically significant volumetric changes were identified in the ventricles, white matter, brainstem, cerebellum, or cerebral cortex (p > 0.05). Tumor volume changes were also statistically evaluated and showed no significant differences across the three time points (p = 0.456), indicating stable disease during the treatment course.

CONCLUSION: Radiotherapy and chemotherapy lead to region-specific volumetric alterations in the brain. The transient telencephalon enlargement is more likely attributable to treatment-related edema or inflammatory processes rather than functional improvement. The persistent diencephalon volume decline may reflect early treatment-related tissue vulnerability. Incorporating automated volumetric assessment into routine follow-up may support early detection of therapy-related structural changes and facilitate more personalized treatment planning.

PMID:41686371 | DOI:10.1007/s11060-025-05366-6

Drug Saf. 2026 Feb 13. doi: 10.1007/s40264-026-01652-y. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Herpes zoster (HZ) infection and long-term non-steroidal anti-inflammatory drugs (NSAIDs) use are established risk factors for stroke and other cardiovascular diseases. Given the paucity of evidence regarding an association between NSAIDs use and HZ on stroke risk, this case-crossover study, utilizing a nationwide, population-based cohort, aimed to investigate the effect of HZ infection and concurrent NSAIDs use on the incidence of stroke.

METHODS: Using Taiwan’s National Health Insurance database (2014-2020), we identified 336,075 patients with incident stroke. A case-crossover design comparing exposure to HZ and NSAIDs between the focal period (1-30 days before stroke) and referent period (366-395 days before stroke) was employed. Conditional logistic regression estimated adjusted odds ratios (aORs) for stroke risk associated with NSAIDs use during HZ episodes. Pre-planned subgroup analyses further examined such effects on stroke subtypes (ischemic stroke, hemorrhagic stroke, and transient ischemic attack [TIA]), across age groups (< 50, 50-64, ≥ 65 years) and in patients with various comorbidities, including immunocompromised and autoimmune diseases, cardiometabolic risk factors, and renal and liver diseases.

RESULTS: Combined HZ infection and NSAIDs use was associated with doubled stroke risk (aOR 2.05, 95% confidence interval [CI] 1.80-2.33) compared with periods without either exposure. For specific stroke types, the aORs were 1.94 (95% CI 1.65-2.29) for ischemic stroke, 1.81 (95% CI 1.34-2.43) for hemorrhagic stroke, and 2.81 (95% CI 2.06-3.85) for TIA. HZ episodes without NSAIDs (aOR 1.70, 95% CI 1.45-2.00) and NSAIDs use alone (aOR 1.42, 95% CI 1.40-1.44) showed lower but significant risk increment. In age-stratified analyses, individuals aged 65 years and older exhibited a significantly elevated stroke risk while concurrently utilizing NSAIDs during HZ episodes (aOR 2.19, 95% CI 1.92-2.62). Subgroup analyses demonstrated consistent elevated risks in patients with pre-existing comorbidities, particularly immunocompromised conditions (aOR 3.07, 95% CI 1.95-4.81) and renal disease (aOR 4.30, 95% CI 2.20-8.41).

CONCLUSIONS: Our findings demonstrate a significant association between HZ infection and NSAIDs use on stroke risk, particularly among individuals aged 65 years and older or those with pre-existing immunocompromised, cardiometabolic, and chronic conditions. The optimization of pain management strategies during HZ episodes is paramount to mitigate the risk of stroke while ensuring effective management of HZ-associated pain.

PMID:41686364 | DOI:10.1007/s40264-026-01652-y

Arch Osteoporos. 2026 Feb 13;21(1):34. doi: 10.1007/s11657-026-01663-3.

ABSTRACT

In our real-world study of women with postmenopausal osteoporosis (PMO), general practitioners (GPs) adhered to French guidelines on stopping, changing, or continuing oral bisphosphonates in 60% of cases and adhered to guidelines on initiating oral BPs in only 39%. These findings highlight the need to educate GPs on PMO treatment recommendations.

PURPOSE: French guidelines for postmenopausal osteoporosis (PMO) recommend dual energy X-ray absorptiometry (DXA) assessment of bone mineral density (BMD) to guide treatment decisions. However, data reporting implementation of these guidelines in general practice is lacking. Our study assessed general practitioners’ (GPs’) use of DXA results to guide decisions regarding first-line oral bisphosphonate (oBP) treatment in women with PMO.

METHODS: In this multicenter cohort study, participating GPs enrolled women with PMO who had been receiving the first-line bisphosphonates for 2-5 years, had a reference (baseline) DXA in the 2 years pre-enrolment or ≤ 2 years prior to BP initiation, and agreed to a follow-up DXA. GPs prescribed a follow-up DXA to guide their decision to stop, continue, or change BPs. We checked the GPs’ decision for concordance with national treatment guidelines.

RESULTS: From January 2018 to November 2019, 23 GPs enrolled 99 women meeting the inclusion criteria. Based on follow-up DXA, the decision to stop, change, or continue oBPs aligned with guidelines in 60% of cases. Agreement was higher in women receiving oBPs for < 3 vs ≥ 3 years (70.2% vs 54.3%). Based on baseline DXA, the decision to initiate treatment was aligned in only 39% of cases, with the follow-up treatment decision aligned with guidelines in 72% of these cases. The consistency of treatment decision between GPs and the scientific committee was weak (kappa coefficient of 0.295).

CONCLUSION: Our study suggests insufficient awareness of national recommendations for PMO treatment in French general practice, highlighting the need for stronger GP education.

PMID:41686362 | DOI:10.1007/s11657-026-01663-3