Category: Statistics

World J Clin Oncol. 2026 Feb 24;17(2):115245. doi: 10.5306/wjco.v17.i2.115245.

ABSTRACT

BACKGROUND: Despite widespread mammographic screening, a substantial proportion of breast cancers are still diagnosed as palpable lesions, frequently self-detected by the patient. Prior studies have investigated palpability as a prognostic factor, but few have incorporated contemporary staging systems or focused on clinically homogeneous, screening-eligible populations. In high-resource settings with equal access to screening, it remains unclear whether palpability reflects intrinsic tumor aggressiveness rather than delayed detection. This study evaluates whether palpable tumors exhibit distinct clinicopathological characteristics and worse outcomes in a screening-eligible population, hypothesizing that palpability may reflect aggressive tumor biology and potentially influence prognosis even when screening programs are accessible.

AIM: To compare clinicopathological features and survival outcomes of palpable vs non-palpable breast cancers in a screened population.

METHODS: We retrospectively analyzed 2110 women with clinically node-negative, localized breast cancer treated surgically between 2004 and 2024. Palpability at diagnosis was used to classify tumors as palpable (n = 1234) or non-palpable (n = 876). Endpoints included tumor size, grade, subtype, Ki-67 index, nodal status, overall survival, and breast cancer-specific survival. Statistical analyses included χ ² and t-tests and Kaplan-Meier estimates, with significance set at P < 0.05.

RESULTS: Palpable tumors were significantly larger (17.5 mm ± 8.6 vs 11.0 ± 6.7 mm, P < 0.001), more often high-grade (G3: 33% vs 16.3%, P < 0.001), and more frequently of luminal B or triple-negative subtype (37.1% vs 20.6%, P < 0.001). Ki-67 proliferation index was markedly higher in palpable tumors (24.7% ± 11.9% vs 15.1% ± 9.4%, P < 0.001). Sentinel lymph node positivity was increased (27.6% vs 16.7%, P < 0.001). While 10-year overall survival was similar (92% palpable vs 95% non-palpable, P = 0.56), breast cancer-specific survival showed a trend toward worse survival in palpable cases (96% vs 99%, P = 0.1).

CONCLUSION: Palpable tumors display faster growth kinetics and aggressive features, potentially shortening the preclinical window. Palpability may indicate biologically aggressive disease, warranting individualized management despite access to routine screening.

PMID:41810341 | PMC:PMC12968550 | DOI:10.5306/wjco.v17.i2.115245

Res Pract Thromb Haemost. 2026 Feb 13;10(2):103397. doi: 10.1016/j.rpth.2026.103397. eCollection 2026 Feb.

ABSTRACT

BACKGROUND: Sickle cell disease (SCD) is associated with an increased risk of thrombosis and often leads to mortality.

OBJECTIVES: This study aimed to compare the clinical outcomes of direct oral anticoagulants (DOACs) with warfarin in the management of patients with SCD and first venous thrombosis.

METHODS: This retrospective study included adult patients aged ≥ 18 years with SCD who developed their first episode of venous thrombotic event. Recurrent thrombosis and bleeding were compared between patients treated with DOACs and warfarin. Data were analyzed using IBM Statistical Package for the Social Sciences version 21.

RESULTS: We included 99 patients, of whom 67 (67.7%) were treated with DOACs and 32 (32.3%) with warfarin. The median follow-up time was 44 (1-130) months. Pulmonary embolism was the most common type of thrombosis observed in 64 patients (64.6 %). Three patients developed recurrent venous thromboembolism within 6 months of the first episode, whereas 6 patients developed recurrent thrombosis after 1 year. No significant difference was noted among patients on either type of anticoagulation in terms of major bleeding episodes (OR = 1.1; 95% CI: 1.1-1.8; P: 1.00), recurrence of thrombosis (OR = 0.68; 95% CI: 0.03-11.2; P: .68), or mortality (OR = 0.46; 95% CI: 0.06-3.4; P: .59). Clinically relevant nonmajor bleeding was significantly lower in patients on DOACs than those on warfarin (OR = 0.06; 95% CI: 0.01-0.52; P: .01).

CONCLUSION: DOACs are associated with similar clinical outcomes and fewer bleeding complications as compared to warfarin in the management of patients with SCD and thrombosis. Randomized controlled trials are required to further confirm our findings.

PMID:41810336 | PMC:PMC12969728 | DOI:10.1016/j.rpth.2026.103397

J Public Health Dent. 2026 Mar 10. doi: 10.1111/jphd.70052. Online ahead of print.

ABSTRACT

OBJECTIVES: This study examined the effects of dental sealant insurance coverage on trends in pit and fissure sealant (PFS) use, decayed, missing, and filled teeth (DMFT) rates, and filled teeth (FT) rates among Korean adolescents, using data from the Korean Youth Risk Behavior Survey (2005-2024) and the Korean National Health and Nutrition Examination Survey (2007-2015).

METHODS: Data from participants aged 12-18 years were analyzed. The proportion of PFS use referred to the proportion of respondents who answered “yes” to the question “Have you received PFS in the past 12 months?” in the survey. DMFT and FT were classified based on oral examination criteria from 2007 to 2015. Statistical analyses were conducted using Joinpoint regression (version 4.8.0.1) and PROC SURVEYLOGISTIC in SAS 9.4 to estimate the annual percent change (APC), odds ratios, and 95% confidence intervals.

RESULTS: PFS use increased until 2018 (APC = +1.5%) and declined slightly thereafter until 2024, whereas DMFT and FT rates decreased from 2007 to 2015. Dental sealant insurance coverage was significantly associated with higher PFS use and lower DMFT and FT rates (p < 0.05).

CONCLUSIONS: Dental sealant insurance coverage effectively improved oral health and reduced dental caries among Korean adolescents.

PMID:41807286 | DOI:10.1111/jphd.70052

Pharmacoepidemiol Drug Saf. 2026 Mar;35(3):e70344. doi: 10.1002/pds.70344.

ABSTRACT

PURPOSE: Adverse drug reactions (ADRs) present significant obstacles for healthcare systems, impacting both patient safety and the effectiveness of treatments. Despite this, there is a scarcity of research on ADR reports in Sierra Leone, especially over long periods. This study aims to investigate the characteristics and reporting patterns found in the Sierra Leone pharmacovigilance database managed through VigiFlow.

METHOD: This study analyzes reports of ADRs from Sierra Leone’s national pharmacovigilance database, VigiFlow, spanning from January 2008 to December 2022. Data collected included patient demographics (age, sex), reporter characteristics (type of reporter, year of reporting), and ADR-specific information (suspected medication, indication, ADR types (MedDRA), seriousness, outcome, actions taken, and time to onset), and completeness score. Descriptive statistics, chi-square tests, and the Kruskal-Wallis test with Bonferroni-adjusted post hoc tests were applied to identify patterns and associations within the dataset.

RESULTS: A total of 3381 individual case safety reports (ICSRs) were analysed. The majority of reports involved females (54.7%) and adults aged 18 to 44 years (51.4%). Reporting rates increased after 2015, peaking in 2021. The most frequently implicated medications were anti-infective drugs (40.7%) and antiparasitic medicines (34.1%), particularly ivermectin, albendazole, and vaccines for cholera and yellow fever. The most commonly reported ADRs were headache (13.2%), fever (12.2%), and diarrhoea (7.6%), primarily affecting the nervous system and general disorder classes. Pharmacists were responsible for 39.0% of reports and achieved the highest completeness score, with a mean of 0.78. Age was significantly associated with the seriousness, outcome, and onset time of ADRs (p < 0.001), while gender was significantly associated with onset time (p = 0.007).

CONCLUSION: ADR reporting in Sierra Leone has improved, with antiparasitic medicines and vaccines most frequently linked to reactions. Sustaining progress requires enhanced training, public engagement, and strengthened active pharmacovigilance to ensure completeness and patient safety.

PMID:41807284 | DOI:10.1002/pds.70344

Proc Inst Mech Eng H. 2026 Mar 10:9544119261422821. doi: 10.1177/09544119261422821. Online ahead of print.

ABSTRACT

Schizophrenia is a severe neuropsychiatric disorder with a significant impact on individual’s real-life functioning. It is characterized by abnormal asymmetry in the neural activities of the brain reflecting functional and cognitive impairment. The irregularities in the neural dynamics are well captured by Electroencephalogram (EEG) based complexity measures. In this work, automated detection of schizophrenia is attempted using EEG based asymmetric entropy analysis and convolutional neural networks (CNN) integrated with Long Short Term Memory (LSTM) classification model. The asymmetric entropy feature maps are extracted from EEG frequency bands across all channel pairs using approximate, differential, sample, Shannon and spectral co-occurrence matrix entropies and are subjected to classification using pre-trained Inception-V3 CNN-LSTM model and the performance measures are evaluated. It is found that the magnitude values of approximate and sample entropies are found to be high when compared to other entropies and exhibit significant discrimination between normal and schizophrenic subjects. It is also found that statistically significant inception features derived from the inter-channel asymmetric feature maps yield high values of accuracy, precision, and F1 score across various frequency bands. It is further observed that high classification accuracy of 94.11% and precision of 100% are obtained for delta band. The classification model utilizing inter-channel asymmetries could capture the functional alterations due to the pathological condition and helps in accurate detection of schizophrenia.

PMID:41807278 | DOI:10.1177/09544119261422821

Public Health Rep. 2026 Mar 10:333549261427670. doi: 10.1177/00333549261427670. Online ahead of print.

ABSTRACT

OBJECTIVES: In 2024, the Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists suggested approaches, including upskilling and recruitment/hiring, to strengthen the workforce capacity in public health data science. We estimated the number of recently graduated data scientists who might be eligible for and potentially hirable into government public health jobs as a step toward filling data gaps in workforce planning.

METHODS: We used data from the National Center for Education Statistics to calculate the number of data science graduates in 2023. As a proxy for interest in government public health among graduates, we used data from the Association of Schools and Programs of Public Health (graduation years 2015-2022). We multiplied the number of data science graduates from US academic institutions (from National Center for Education Statistics data) by the percentage of public health graduates who entered government public health employment (from Association of Schools and Programs of Public Health data) to estimate the number of data science graduates who might be eligible for and interested in government public health employment.

RESULTS: In 2023, 467 435 graduates were awarded a data science degree from a US institution. Depending on the government employment criteria, 8.3% to 15.7% of 96 578 public health graduates reported first-destination employment in government public health. The total number of data science graduates who might be eligible for and interested in government public health employment ranged from nearly 29 000 to >57 000.

CONCLUSIONS: These data contribute to the evidence base for public health workforce planning but are likely to be overestimates of supply. If the estimated supply of data scientists falls short of demand projections, staff data science upskilling and changes to academic curricula could be emphasized.

PMID:41807275 | DOI:10.1177/00333549261427670

J Oral Pathol Med. 2026 Mar 10. doi: 10.1111/jop.70131. Online ahead of print.

ABSTRACT

BACKGROUND: Oral leukoplakia (OL) is the most common oral potentially malignant disorder, defined as a white patch or plaque not attributable to other causes. While OL carries an inherent risk of malignant transformation, the underlying immunological changes remain poorly characterized. This study aimed to profile a broad panel of cytokines in saliva and plasma of OL patients in comparison to healthy controls, in order to elucidate local and systemic immunoinflammatory alterations associated with OL.

METHODS: Thirty patients with clinically and histopathologically confirmed OL and 30 age- and gender-matched healthy controls were enrolled. Detailed clinical examinations were performed, including lesion characterization and psychosocial assessments. Unstimulated whole saliva and peripheral blood samples were collected, and concentrations of 13 cytokines/chemokines (IL-1β, IL-6, IL-8/CXCL8, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-33, TNF-α, IFN-γ, IFN-α2, and MCP-1/CCL2) were measured using a multiplex bead-based immunoassay. Group comparisons were performed using appropriate statistical tests (χ²/Fisher’s exact test for categorical variables and t-test or Mann-Whitney U test for continuous variables), with statistical significance set at p < 0.05.

RESULTS: OL patients (mean age 52.4 ± 10.7 years) and controls (59.9 ± 12.8 years) showed no significant differences in gender, socioeconomic status, or psychological scores. Salivary levels of IL-1β, TNF-α, MCP-1, IL-8, and IL-18 were significantly lower in OL patients compared to controls (p < 0.01 for all), whereas other salivary cytokines (IFN-α2, IFN-γ, IL-6, IL-10, IL-12p70, IL-17A, IL-23, IL-33) showed no significant differences. In contrast, plasma levels of IFN-α2, IL-6, IL-12p70, IL-17A, IL-18, and IL-33 were significantly higher in OL patients than in controls (p < 0.05), indicating systemic inflammation, while plasma IL-1β, IFN-γ, TNF-α, MCP-1, IL-8, IL-10, and IL-23 did not differ. No significant differences in salivary cortisol, liver enzymes, or hepatitis viral markers were observed between groups. Across histopathological subgroups, cytokine concentrations did not significantly differ between lesions graded as hyperkeratosis, OIN1, OIN2, or OIN3, although a trend toward higher plasma IL-6, IL-17A, and IL-18 levels was observed in cases with higher OIN grades.

CONCLUSION: These findings shed light on the inflammatory profile of OL. The decrease in salivary IL-1β, IL-8, TNF-α, and MCP-1 may indicate a more suppressed local immune response, whereas the higher plasma levels of IL-6, IL-17A, IL-18, and IL-33 tend to be seen in lesions showing greater degrees of dysplasia. In particular, patients with higher OIN grades often display this systemic inflammatory shift, which may signal an increased risk of progression.

PMID:41807270 | DOI:10.1111/jop.70131

Mult Scler. 2026 Mar 10:13524585261423063. doi: 10.1177/13524585261423063. Online ahead of print.

ABSTRACT

BACKGROUND: Observational studies suggest an association between immune responses to Epstein-Barr virus nuclear antigen 1 (EBNA1) and multiple sclerosis (MS) risk. Nevertheless, a causal effect cannot be established, as confounding and reverse causation cannot be excluded.

METHODS: We performed a bidirectional two-sample Mendelian randomization (MR) to test whether higher anti-EBNA1 IgG levels causally influence MS risk, or vice versa. Genetic associations for anti-EBNA1 IgG were obtained from 7972 UK Biobank participants, and for MS from 115,803 individuals in the International MS Genetics Consortium. Given that most anti-EBNA1 IgG instruments lie in the pleiotropic major histocompatibility complex, we applied a robust cis-MR framework, sensitivity analyses, and external validation using genetic association from anti-EBNA1 IgG levels obtained from 914 French individuals.

RESULTS: A one standard deviation increase in genetically predicted anti-EBNA1 IgG levels was causally associated with a 69% higher MS risk (OR = 1.69 [95% CI: 1.28; 2.23], p < 0.001). Results were consistent across sensitivity analyses and showed no directional pleiotropy. External validation supported these findings. Reverse MR provided no evidence that MS influences anti-EBNA1 IgG levels (p > 0.05).

CONCLUSION: These results support a unidirectional causal effect of elevated anti-EBNA1 IgG levels on MS risk, reinforcing the role of EBV-related immune responses in MS pathogenesis.

PMID:41807267 | DOI:10.1177/13524585261423063

Int J Oral Maxillofac Surg. 2026 Mar 9:S0901-5027(26)00080-9. doi: 10.1016/j.ijom.2026.02.021. Online ahead of print.

ABSTRACT

The fibula free flap (FFF) is commonly used in mandible reconstruction due to its good bone length and volume, and availability of a long vascular pedicle – the fibular artery (FA). In this study, digital subtraction angiography (DSA) was utilized to evaluate the lower leg arteries in 130 patients (48 female, 82 male). The mean distance from the fibula head to the fibular artery (FA) origin was 72.8 mm, with significant differences between sexes (P=0.019) and sides in males (P=0.033). FA diameters were significantly larger in males (P=0.042); in females, right-side FA diameters were larger than left (P=0.002). While stenosis grades varied significantly by side for popliteal and tibial arteries, the FA remained consistent. However, females showed higher popliteal stenosis (P=0.028). Notably, the FA was the primary foot supply in 20% of cases (24.0% females, 17.7% males). DSA provides valuable information for preoperative planning and for safe and effective FFF transfer. This study adds to our understanding of the lower leg vessel anatomy, supporting surgeons in selecting the most suitable flap.

PMID:41807239 | DOI:10.1016/j.ijom.2026.02.021

J Natl Med Assoc. 2026 Feb 13:S0027-9684(26)00027-1. doi: 10.1016/j.jnma.2026.02.002. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) is increasingly integrated into healthcare, offering opportunities to enhance clinical decision-making, efficiency, and patient outcomes.Despite rapid adoption, variability in AI use, confidence, and formal education acrosslevels of medical training and specialties remains poorly understood.

OBJECTIVE: To evaluate patterns of AI usage, confidence, educational exposure, and perceptions of AI training across the medical hierarchy, with particular attention to differences between gastroenterology (GI) and internal medicine (IM) providers.

METHODS: A descriptive, cross-sectional survey was conducted at an academic tertiary care medical center. A 25-item REDCap-based questionnaire assessed AI use, frequency, confidence, formal education, regulatory awareness, and attitudes toward AI curriculum integration among medical students, residents, fellows, and attending physicians. Descriptive statistics and chi-square tests were used for analysis, with significance defined as p < 0.05.

RESULTS: Among 120 respondents, 83.5% reported AI use in clinical or educational activities, with 42.6% indicating daily use. Residents (92.3%) and medical students (87.8%) reported significantly higher AI use compared with attending physicians (61.5%). Overall, 73.7% of GI providers used AI; however, 47.3% reported low confidence, and none reported formal AI education. In contrast, 25% of IM providers had received structured AI training, and 56.1% were aware of HIPAA-compliant AI tools, compared with 15.8% of GI providers. All GI respondents (100%) supported the incorporation of formal AI education into medical curricula.

CONCLUSIONS: AI use is widespread across medical training levels, yet formal education, confidence, and regulatory awareness lag behind adoption, particularly among subspecialty providers such as gastroenterologists. These findings underscore the need for structured, specialty-specific AI education integrated throughout medical training to ensure safe, effective, and equitable use of AI in clinical practice.

PMID:41807208 | DOI:10.1016/j.jnma.2026.02.002