Category: Statistics

BMC Psychol. 2026 May 7. doi: 10.1186/s40359-026-04691-3. Online ahead of print.

ABSTRACT

This study aimed to investigate the associations linking nature connection and pro-environmental behavior (PEB) in adolescents by constructing a chain mediation model, with a focus on the mediating effects of empathy with nature and moral identity. A cross-sectional questionnaire survey was administered to 379 adolescents aged 12-16 from three cities in Yunnan Province, China. The findings revealed that: (1) significant positive correlations were observed among adolescents’ nature connection, empathy with nature, moral identity, and pro-environmental behaviors; (2) moral identity and empathy with nature are consistent with a chain mediating role between adolescents’ nature connections and pro-environmental behaviors. This study suggests cognitive-emotional pathways that are statistically consistent with a link from nature connection to pro-environmental behavior among adolescents, providing a potential theoretical basis and practical guidance for fostering such behavior.

PMID:42098880 | DOI:10.1186/s40359-026-04691-3

J Cardiothorac Surg. 2026 May 7. doi: 10.1186/s13019-026-04251-1. Online ahead of print.

ABSTRACT

BACKGROUND: Large language models (LLMs) are increasingly being explored in surgical training and clinical knowledge assessment. Although these models have demonstrated promising performance in standardized examinations, their performance in highly specialized fields such as cardiovascular surgery remains insufficiently investigated. This study aimed to evaluate the performance of current large language models in answering and generating board-level cardiovascular surgery questions reflecting guideline-based clinical reasoning.

METHODS: In this cross-sectional evaluation study, three large language models (ChatGPT-5.1, Gemini 3, and DeepSeek v3.2) were evaluated in two stages. In the first stage, the models answered 150 multiple-choice questions developed and validated by five cardiovascular surgery specialists using a Delphi process, designed to reflect the content scope and difficulty level of the American Board of Thoracic Surgery certification examination. Accuracy rates and pairwise comparisons were analyzed using the McNemar test. In the second stage, model-generated questions were evaluated by expert cardiovascular surgeons in terms of medical accuracy, clinical relevance, exam-level appropriateness, error type, and difficulty level. Statistical analyses included Spearman correlation, Wilcoxon signed-rank test, and chi-square analysis.

RESULTS: The models demonstrated comparable accuracy rates (ChatGPT 80.7%; Gemini 78.7%; DeepSeek 82.0%), with no statistically significant differences between them. Question difficulty level was not associated with model accuracy. Error distribution differed significantly between models (χ² = 8.1; p = 0.02), with Gemini demonstrating the highest rate of valid question generation and DeepSeek showing a higher rate of major errors. A significant positive correlation was observed between model- and expert-assigned difficulty levels.

CONCLUSIONS: Current large language models demonstrate strong performance in board-level cardiovascular surgery knowledge assessment. However, the presence of major errors and variability in difficulty calibration, together with known limitations in clinical reasoning, indicate that these systems should be used cautiously as supportive tools in surgical training and knowledge assessment rather than as substitutes for clinical decision-making.

PMID:42098878 | DOI:10.1186/s13019-026-04251-1

Genome Med. 2026 May 7. doi: 10.1186/s13073-026-01665-3. Online ahead of print.

ABSTRACT

BACKGROUND: Compared to European American women, African American women are more likely to be diagnosed with triple-negative breast cancer (TNBC). This difference may be partially due to genetic factors. This study aims to investigate associations of African ancestry and risk variants with TNBC among African American women.

METHODS: We used data from 2,335 TNBC cases, 8,159 estrogen receptor (ER)-positive cases, and 9,814 controls included in the African-ancestry Breast Cancer Genetics (AABCG) Consortium. The proportion of African ancestry (%AFR) and local ancestry were estimated using samples from the 1000 Genomes Project as reference. Logistic regressions were performed for case-control (TNBC vs. control) and case-case (TNBC vs. ER-positive) comparisons, adjusted for age, study, genotype principal components 2-5, body mass index, and reproductive factors. Local ancestry-aware association analyses were conducted in 12 TNBC risk loci to identify ancestry-specific risk variants.

RESULTS: In case-control analyses, no statistically significant association was found between %AFR and TNBC risk after adjustment for potential confounders. However, TNBC cases had a significantly higher mean % AFR (mean = 0.811, standard deviation, SD = 0.104) compared to ER-positive cases (mean = 0.798, SD = 0.110, P < 0.001). Females with %AFR of ≥ 95% had 1.62 times higher odds (95% confidence interval, CI: 1.16-2.25) of having TNBC rather than ER-positive breast cancer, compared to those with %AFR of 55.0-64.9%. Local ancestry-aware association analyses identified seven subtype-informative variants in or near MDM4, RP11-19E11.1, TERT, MRPL36, TCF7L2, C11orf65, and ANKLE1. All of them were significantly associated with TNBC as compared with ER-positive cases, and six of them were also associated with TNBC risk in case-control analyses. Large allelic odds ratios of 1.25 or higher were found in association with TNBC risk or subtype classification. The risk allele frequency for five of them is substantially higher in haplotypes of African ancestry than those of European ancestry.

CONCLUSIONS: These findings support a significant role of African-ancestry specific genetic factors in determining breast cancer subtypes and highlight the need for future research to uncover possible pathways driving TNBC susceptibility.

PMID:42098873 | DOI:10.1186/s13073-026-01665-3

Subst Abuse Treat Prev Policy. 2026 May 7;21(1):33. doi: 10.1186/s13011-026-00705-w.

ABSTRACT

BACKGROUND: Cardiovascular multimorbidity (CVD MM), defined as two or more cardiovascular conditions, poses a significant public health challenge. Substance use disorders (SUDs) may elevate CVD MM risk, and health insurance disparities could exacerbate this relationship. We examined if insurance type moderates the association between SUDs and CVD MM.

METHODS: We analyzed cross-sectional data from 45,133 US adults in the 2023 National Survey on Drug Use and Health (NSDUH). CVD MM was defined as two or more specific cardiovascular conditions. SUDs included illicit drugs and cannabis, excluding nicotine dependence and alcohol use disorder. Logistic regression models examined the SUDs-CVD MM relationship and tested for an interaction between insurance type and SUDs, adjusting for covariates.

RESULTS: Individuals in the representative sample of US adults were 60.8% privately insured, 17.4% with Medicaid, 9.1% with Medicare, 8.7% uninsured, and 4.0% with other types of insurance. CVD MM (12.7% Uninsured to 47.7% Medicare; p < 0.0001) and SUDs (2.8% Medicare to 8.3% Medicaid; p < 0.0001) prevalence varied significantly by insurance type. In adjusted models, SUDs were not associated with CVD MM; however, Medicaid enrollees had higher odds of CVD MM than those privately insured. In interaction models, insurance type was a statistically significant moderator of the SUDs-CVD MM association (p = 0.0146). Stratified models showed uninsured adults with SUDs had higher odds of CVD MM (aOR:2.25, 95% CI:1.28,3.93) compared to uninsured counterparts without SUDs. No significant association was found among privately insured, Medicaid, or other insured individuals.

CONCLUSIONS: Uninsured individuals with SUDs face an elevated risk of CVD MM. Interventions improving access to care for this vulnerable population are crucial for reducing cardiovascular health disparities.

PMID:42098860 | DOI:10.1186/s13011-026-00705-w

Alzheimers Res Ther. 2026 May 7. doi: 10.1186/s13195-026-02043-2. Online ahead of print.

ABSTRACT

BACKGROUND: Brain endothelial dysfunction is an early pathological feature of Alzheimer disease (AD). We here investigate associations of the brain endothelial glycocalyx protein, syndecan-4 (SDC4), with amyloid and tau pathologies and cognitive impairment in a large longitudinal cohort of AD and controls.

METHODS: The study included n = 1,041 (n = 802 cognitively unimpaired and n = 239 cognitively impaired) participants who underwent biological classification using the NIA-AA “ATN” framework. Cognitive assessments included the Clinical Dementia Rating^®-sum of boxes and the Knight- Preclinical Alzheimer’s Cognitive Composite. Cerebrospinal fluid (CSF) measures of SDC4 and emerging AD biomarkers were obtained using Olink Proteomics. Amyloid-PET (n = 719) and tau-PET (n = 302) scans were performed in subsets of participants. Partial correlations and linear mixed models, respectively, examined cross-sectional and longitudinal associations of CSF SDC4 levels with amyloid-PET and tau-PET burden and cognition. Pseudo-time models estimated CSF biomarker trajectories across the course of AD progression.

RESULTS: CSF SDC4 levels were elevated in even the earliest preclinical stages of AD compared to controls and were closely associated with other CSF and imaging biomarkers of AD. Higher CSF SDC4 levels correlated with higher global and regional amyloid-PET and tau-PET burden and worse baseline cognition. Higher baseline CSF SDC4 levels predicted more rapid progression of brain amyloid and tau, and faster decline in global cognition, episodic memory, language, and executive functions over follow-up (mean, 8 years). CSF SDC4 associations with cognition were mainly mediated by global tau-PET burden. Importantly, our pseudo-time models estimate that SDC4 upregulation begins very early in AD pathogenesis near the point of amyloid-positivity and increases more robustly following the point of tau-positivity. SDC4 was among the top 10 most important proteins in predicting the pseudo-time models of AD progression and predicted these models to a potentially better extent than other emerging AD biomarkers.

CONCLUSION: Findings from this large longitudinal study suggest that CSF SDC4 levels are increased in the earliest preclinical stages of AD and are closely associated with the progression of amyloid and tau pathologies and future rates of cognitive decline. We propose that SDC4 upregulation is an important early event in AD pathogenesis which predicts cognitive and pathological disease trajectories.

PMID:42098850 | DOI:10.1186/s13195-026-02043-2

J Anesth Analg Crit Care. 2026 May 8. doi: 10.1186/s44158-026-00401-y. Online ahead of print.

ABSTRACT

BACKGROUND: Intensive care unit (ICU) professionals face high levels of stress, burnout, and work-related psychological strain. However, comprehensive multinational assessments of their well-being-particularly those exploring gender differences and work-life dynamics-are scarce.

METHODS: A cross-sectional survey was conducted by the International Women in Intensive and Critical Care Network (iWIN) between October 2023 and June 2024. The 113-item questionnaire assessed well-being using the WHO-5 Well-Being Index and other validated instruments across eight domains. ICU professionals were recruited via email, professional meetings, and the iWIN website. Descriptive statistics, T-tests, chi-square, and Mann-Whitney U tests were used for analysis.

RESULTS: One hundred fifty-eight ICU professionals from diverse roles responded (62% female, 37% male, 1% other). The median WHO-5 score was 68 (IQR 52-80); males reported significantly higher scores than females (72 vs. 60; p = 0.0051). Respondents reported high workload, moderate job autonomy, and frequent stress. Temporary employment was common, with 41.1% considering job transfers. Despite generally positive diversity ratings, gender disparities remained in perceptions of hiring, promotion, and career advancement fairness.

CONCLUSIONS: This exploratory survey found generally positive well-being among ICU professionals, with a gender difference observed in WHO-5 scores. Concerns related to workload, job insecurity, and career development were also reported. Findings should be interpreted with caution and warrant further investigation.

PMID:42098838 | DOI:10.1186/s44158-026-00401-y

BMC Nurs. 2026 May 7. doi: 10.1186/s12912-026-04705-w. Online ahead of print.

ABSTRACT

BACKGROUND: Self-regulatory fatigue is an emerging concern within nursing education, with implications for professional competence, emotional resilience, and long-term career development. To assess the level of self-regulatory fatigue among nursing interns and explore its related influencing factors.

METHODS: A total of 340 nursing interns participated in this survey. Data were collected from March to December 2024 using an online survey comprising a general information questionnaire, the Perceived Stress Scale (PSS), the Adolescent Mental Health Literacy Assessment Questionnaire (AMHLAQ), and the Psychological Detachment Scale. Descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficients, and multiple linear regression analyses were conducted.

RESULTS: Perceived stress (β = 0.47, p < 0.001), mental health literacy (β = -0.13, p = 0.008), psychological detachment (β = -0.10, p = 0.025), academic performance (β = 0.15, p < 0.001), length of clinical placement (β = -0.11, p = 0.016) and left-behind experience (β = -0.10, p = 0.032) were significant predictors of self-regulatory fatigue. The model explained 39.1% of the variance in self-regulatory fatigue.

CONCLUSIONS: Nursing interns showed a moderate level of self-regulatory fatigue. Three psychological factors, namely, perceived stress, mental health literacy, and psychological detachment, along with academic performance, clinical placement duration, and left-behind experience, were significantly associated factors of self-regulatory fatigue. These findings suggest that targeted strategies should be developed to mitigate interns’ fatigue and promote their holistic health.

PMID:42098828 | DOI:10.1186/s12912-026-04705-w

J Orthop Surg Res. 2026 May 7. doi: 10.1186/s13018-026-06902-4. Online ahead of print.

ABSTRACT

BACKGROUND: The standard metal working channel in percutaneous translaminar endoscopic discectomy (PTED) creates a significant visual “blind spot,” presenting a particular challenge during surgery for prolapsed lumbar disc herniation (PLDH). This obstruction can result in semi-blind surgical maneuvers, elevating the risk of neural injury and incomplete fragment removal. To overcome this fundamental limitation, we developed a novel transparent visual channel (TVC) and assessed its clinical performance.

METHODS: In a retrospective comparative study, we analyzed 65 patients with PLDH who underwent PTED, utilizing either the novel TVC (n = 29) or the conventional metal working channel (n = 36). Key metrics for comparison included surgical field of view (quantified using the structural similarity index measure [SSIM]), total operation time, frequency of intraoperative neurophysiological monitoring alerts, standard perioperative clinical indicators, complication rates, and patient-reported outcomes (Visual Analog Scale [VAS] for pain, Oswestry Disability Index [ODI], and MacNab criteria).

RESULTS: The TVC group demonstrated a significantly larger and more consistent surgical field of view, evidenced by a markedly higher SSIM (98.2% ± 1.1% vs. 54.6% ± 8.3%, P < 0.05). Operative efficiency was improved in the TVC group, with a significantly shorter mean operation time (83.2 ± 9.7 min vs. 97.5 ± 8.9 min, P < 0.05). Critically, the use of the TVC was associated with enhanced intraoperative safety, as indicated by a significant reduction in the number of intraoperative neurophysiological monitoring alerts during neural decompression (2 vs. 11, P < 0.05). Both groups exhibited significant and comparable improvements in VAS scores, ODI scores, and MacNab outcomes at follow-up, with no statistically significant differences between the groups (P > 0.05).

CONCLUSION: The novel transparent visual channel effectively converts the PTED procedure from a semi-blind technique to a fully visualized one. This material innovation delivers direct clinical advantages by improving intraoperative safety through reduced neural irritation and increasing procedural efficiency, all while maintaining the excellent clinical outcomes associated with standard PTED. This study substantiates the TVC as a significant advancement in endoscopic spine surgery instrumentation, directly addressing a core visual constraint of the established technique.

PMID:42098825 | DOI:10.1186/s13018-026-06902-4

Environ Health. 2026 May 7;25(1):44. doi: 10.1186/s12940-026-01290-y.

ABSTRACT

BACKGROUND: The health impacts of extreme temperatures have been extensively studied through epidemiological models. However, limited attention has been paid to the specification of these models, particularly regarding input structure and model selection. Although exposure metrics and statistical techniques have evolved over time, a comprehensive synthesis of the variables included in these models, and the rationale behind their inclusion, is still lacking. This gap limits the comparability of studies and may compromise the robustness of temperature-health evidence.

METHODS: We conducted a systematic review of peer-reviewed studies published between 2014 and 2024 that employed quantitative epidemiological models to estimate the association between extreme temperatures and health outcomes. Following PRISMA guidelines, we selected 119 studies through searches conducted in Scopus, PubMed, and Web of Science. Each study was analysed in terms of spatial coverage, modelling framework, and model inputs. Inputs were classified into six functional groups: thermal exposures; environmental covariates (including both non-thermal meteorological variables and air pollutants); temporal controls; socio-demographic factors; health system indicators; and built environment characteristics.

RESULTS: Substantial heterogeneity was observed in both input selection and model specification. Daily mean temperature was the dominant exposure metric, though rarely justified over alternatives. Environmental covariates were inconsistently included: while relative humidity was frequent, other meteorological modifiers and air pollutants were often omitted without clear rationale. Temporal adjustments were common but heterogeneous. Distributed lag non-linear models were the prevailing framework, varying greatly in lag structure, spline specification, and covariate integration. Socio-economic, health, and infrastructural indicators appeared in less than one third of studies, typically as effect modifiers in meta-regression analyses, highlighting uneven integration of contextual determinants. No consensus currently exists on what constitutes a minimum model specification necessary to ensure reliable and interpretable effect estimates.

CONCLUSIONS: Current temperature and health modelling remains fragmented, with notable variability in input specification and transparency. Strengthening methodological coherence through clearer guidance on input selection is essential. Greater integration of socio-economic and infrastructural variables would further enhance models’ capacity to capture contextual vulnerability. To ensure reliability and policy relevance, future research should develop shared guidelines for input specification, define minimum modelling standards, and promote transparent reporting of analytical decisions.

PMID:42098811 | DOI:10.1186/s12940-026-01290-y

Malar J. 2026 May 7. doi: 10.1186/s12936-026-05926-9. Online ahead of print.

ABSTRACT

BACKGROUND: Despite decades of control efforts. malaria burden in Tanzania remains high, with marked heterogeneity in transmission intensity across regions. Insecticide-treated bed nets (ITNs) are a core malaria intervention and are distributed through multiple channels in Tanzania to promote equitable access and use, yet disparities in ITNs ownership and use persist. This study evaluated socio-demographic predictors of ITNs ownership and use among rural communities from five regions with varying malaria endemicity.

METHODS: A community-based cross-sectional survey covering individuals aged ≥ 6 months was conducted from July to August 2023 in 15 villages across five districts from five regions of Mainland Tanzania (Kagera, Kigoma, Njombe, Ruvuma, and Tanga). Data on demographics, malaria prevention practices, anthropometrics and socio-economic status (SES) were collected using structured questionnaires installed in tablets, run with Open Data Kit (ODK) software. Socio-demographic predictors of ITNs ownership and use were assessed using logistic regression analysis. The results were reported as crude (cOR) and adjusted odds ratios (aOR) with 95% confidence intervals (CI) and a p-value < 0.05 was considered statistically significant.

RESULTS: Among the 10,228 enrolled participants, 7939 (77.6%) and 7899 (77.2%) reported owning and using ITNs, respectively. ITNs ownership and use varied significantly across districts (p < 0.001), with the highest rates observed in Nyasa (Ruvuma) and the lowest in Kyerwa (Kagera). Females had higher odds of both ITNs ownership and use than males (aOR = 1.27, 95% CI 1.12-1.45, p < 0.001 for both outcomes). Under-fives were more likely to own (aOR = 1.83, 95%CI 1.56-2.15, p < 0.001) and use ITNs (aOR = 2.26, 95%CI 1.62-3.15, p < 0.001) than adults. Participants from Nyasa (Ruvuma), Ludewa (Njombe), Muheza (Tanga) and Buhigwe (Kigoma) districts exhibited higher odds of ITNs ownership and use compared to those from Kyerwa (Kagera) (p < 0.001). Higher education attainment and household SES were independently associated with increased ITNs ownership and use (p < 0.001).

CONCLUSION: Although ITNs ownership and use were relatively higher across the surveyed communities, coverage remained below the national target of 80% (projected for 2023). Higher ITNs ownership and use were reported among females, under-fives, participants with higher education and those from households with high SES. Disparities by sex, age groups, household SES and education status persist and should be explicitly addressed through ITNs distribution strategies to enable equitable access and use of ITNs across all population groups to expedite progress toward malaria elimination in Tanzania.

PMID:42098806 | DOI:10.1186/s12936-026-05926-9