Category: Statistics

An Acad Bras Cienc. 2026 Aug 3;98(3):e20251036. doi: 10.1590/0001-3765202420251036. eCollection 2026.

ABSTRACT

The Atlantic Forest Biome, historically marked by intense human occupation, hosts the majority of Brazil’s population despite covering only a fraction of the national territory. However, available population estimates lack methodological transparency, undermining their application in public policies and conservation strategies. This study aims to rigorously estimate the number of inhabitants living within the limits of the Atlantic Forest Biome, considering two official territorial boundaries: the area defined by the Atlantic Forest Law, 2006 and the domain defined by Brazilian Institute of Geography and Statistics, 2019. Using data from the 2022 Demographic Census and a standardized criterion for municipal inclusion, results indicate that approximately 57% of the Brazilian population resides within the Atlantic Forest Biome. This figure is lower than those reported in the literature but still represents a significant number, considering the biome covers approximately 15% of Brazil’s continental territory. These findings underscore the need for demographic studies based on replicable methods to support planning of policies aimed at conservation, restoration, and sustainable use of the Atlantic Forest.

PMID:42561357 | DOI:10.1590/0001-3765202420251036

Codas. 2026 Aug 3;38(5):e20250244. doi: 10.1590/2317-1782/e20250244pt. eCollection 2026.

ABSTRACT

PURPOSE: To analyze the neural response of the subcortical pathway through click and speech stimuli in infants and young children with congenital cytomegalovirus (CMVc).

METHODS: Cross-sectional and prospective study. The sample consisted of infants and young children with a median age of 6.43 months (Q1-Q3: 2.62-11.25) in the CMV group (G1; n=10) and 6.23 months (Q1-Q3: 1.60-12.06) in the control group (G2; n=10). All participants underwent Transient Evoked Otoacoustic Emissions (TEOAE) and bilateral peak positive pressure tympanometry. The procedures included anamnesis, Auditory Brainstem Response with click stimulus (ABR-click), and Frequency Following Response (FFR). Click ABR was performed at intensities of 80 and 30 dB nHL in both ears. FFR was recorded in the right ear with a speech stimulus /da/ of 170 ms. FFR responses were analyzed in the temporal and spectral domains, regarding neural synchrony, spectral representation, and stability of the speech response. The Mann-Whitney test or Student’s t-test was applied for intergroup analysis. The Wilcoxon test was applied for intragroup analysis.

RESULTS: In the analysis of click ABR latencies and amplitudes, as well as in FFR measurements related to subcortical neural coding of speech, no statistically significant differences were observed between groups or between ears in the intergroup analysis.

CONCLUSION: Preliminary results indicate a similar pattern of subcortical neural coding of speech and neural synchrony in infants and young children with and without CMVc.

PMID:42561348 | DOI:10.1590/2317-1782/e20250244pt

Codas. 2026 Aug 3;38(5):e20250202. doi: 10.1590/2317-1782/e20250202pt. eCollection 2026.

ABSTRACT

PURPOSE: To evaluate the clinical impact of the DHACA® method on the development of social skills in children with Autism Spectrum Disorder (ASD).

METHODS: This longitudinal quantitative intervention study conducted with 23 children with ASD, aged 3 to 6 years, who were nonverbal or minimally verbal. Individual intervention sessions using the DHACA® method were held weekly for 20 weeks. Social skills were assessed before and after the intervention using the ACOTEA-R protocol. Data were statistically analyzed using the Wilcoxon test.

RESULTS: There was a significant improvement (p < 0.05) in ten of the sixteen skills assessed, including “responds to name,” “eye contact,” “shared attention,” and “symbolic play.” Other skills, such as “responds to ‘no'” and “takes turns,” showed a tendency toward clinical improvement, although not statistically significant. Only three skills did not show relevant progress.

CONCLUSION: The DHACA® method proved effective in promoting social skills in children with ASD, contributing to greater autonomy and social participation. The results reinforce its clinical potential as a therapeutic resource in both educational and healthcare settings.

PMID:42561347 | DOI:10.1590/2317-1782/e20250202pt

Codas. 2026 Aug 3;38(5):e20250194. doi: 10.1590/2317-1782/e20250194pt. eCollection 2026.

ABSTRACT

PURPOSE: To evaluate the performance of the PETIT application (automated tablet-based screening) compared with conventional sweep screening in identifying the risk of hearing impairment in school-aged children, using headphones with passive noise cancellation.

METHODS: Cross-sectional observational study including 122 children (aged 5 to 8 years) from the public school of Santana de Parnaíba. The following procedures were performed: otoscopy; automated hearing screening via tablet (with Sennheiser HD-280 headphones); and conventional sweep screening. Part of the sample also underwent pure-tone audiometry. Statistical analysis used binomial and binary logistic regression tests, along with the calculation of sensitivity, specificity, and accuracy.

RESULTS: There was significant association between the results of the sweep screening and PETIT, as well as the coefficient of the predictor variable (conventional audiometry) was significant to the performance in the sweep screening. For PETIT, a sensitivity of 85.7%, specificity of 100%, and accuracy of 99.18% were observed.

CONCLUSION: The results suggest that this tool has promising applicability in schools for identifying children at risk of hearing impairments.

PMID:42561346 | DOI:10.1590/2317-1782/e20250194pt

Arq Bras Cardiol. 2026 Aug 3;123(6):e20250862. doi: 10.36660/abc.20250862. eCollection 2026.

ABSTRACT

BACKGROUND: Cardiovascular magnetic resonance (CMR) is the reference standard for morphofunctional cardiac assessment. In Brazil, the application of international normal reference values faces challenges related to population admixture, technical heterogeneity among centers, and the absence of national standardization, all of which may affect diagnostic accuracy.

OBJECTIVES: To compare normal reference values for morphofunctional parameters obtained by CMR between a multicenter international review and a Brazilian publication, discussing concordance, methodological differences, and implications for Brazilian clinical practice.

METHODS: An analytical-comparative review was performed using summarized data from an international reference-value review and a Brazilian study. Means and standard deviations of key ventricular variables were compared, with assessment of 95% CI overlap, Welch’s t-test, and effect size (Hedges’ g). Standard-deviation-based cut-off points were proposed for grading abnormality.

RESULTS: Overall concordance between means was observed for most variables. Statistically significant differences occurred in a few parameters, mainly ventricular diameters and left ventricular mass, with small to moderate effect sizes. Discrepancies were largely attributed to methodological differences in measurement and indexation.

CONCLUSIONS: International normal reference values may be used in Brazilian clinical practice, provided they are adjusted for body surface area and interpreted in light of local particularities. Standardization of protocols and national multicenter studies are needed to strengthen regional validation. Keywords: Normal Values, Cardiac Magnetic Resonance, Reference Interval.

PMID:42561341 | DOI:10.36660/abc.20250862

Lang Speech Hear Serv Sch. 2026 Aug 6:1-25. doi: 10.1044/2026_LSHSS-25-00264. Online ahead of print.

ABSTRACT

PURPOSE: This study examines the impact of diglossia on the phonological awareness of dyslexic Jordanian Arabic-speaking children, focusing on deletion, segmentation, and reading tasks in both Modern Standard Arabic (MSA) and Colloquial Arabic (CA).

METHOD: Forty dyslexic and 40 typically developing (TD) children from special education resource rooms in four private schools in Amman, Jordan, participated.

RESULTS: Statistical analysis revealed that both groups performed better in MSA than in CA across all tasks, with TD children outperforming dyslexic children and task difficulty decreasing with grade level. Dyslexic children found segmentation easier than deletion, whereas TD children found both tasks equally challenging. A significant relationship was observed between reading and deletion tasks in CA for second-grade TD children and in MSA for second-grade dyslexic children.

CONCLUSIONS: MSA-CA performance gap should inform instructional strategies, suggesting that phonological awareness interventions need to target the weaker variety (CA) while maintaining support in MSA. Strengthening phonological processing in CA may reduce the phonological load associated with dialectal mismatch and facilitate bidirectional transfer of phonological skills between CA and MSA. The findings may reflect exposure to multiple dialects, individual learning styles, and the complexities of the Arabic writing system. Overall, the study provides empirically grounded guidance for designing differentiated, dialect-sensitive interventions to support dyslexic learners in diglossic Arabic contexts.

PMID:42560735 | DOI:10.1044/2026_LSHSS-25-00264

J Magn Reson Imaging. 2026 Aug 6. doi: 10.1002/jmri.70479. Online ahead of print.

ABSTRACT

BACKGROUND: Conventional renal function markers, such as estimated glomerular filtration rate (eGFR), often fail to reflect occult renal parenchymal injury in early-stage chronic kidney disease (CKD). Renal biopsy is invasive, limiting longitudinal monitoring. Reliable noninvasive methods for early CKD detection and chronicity assessment are lacking.

PURPOSE: To evaluate 3D MR elastography (3D-MRE), arterial spin labeling (ASL), and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for detecting early CKD and grading its chronic changes.

STUDY TYPE: Prospective.

SUBJECTS: 96 CKD patients with renal biopsy (44 ± 13 years, 55 men) and 30 healthy controls (43 ± 15 years, 18 men).

FIELD STRENGTH/SEQUENCE: 3.0 T; multifrequency (60, 90, and 120 Hz) 3D vector MRE, pseudo-continuous arterial spin labeling (pCASL), and multi-b-value (0-2000 s/mm²) IVIM-DWI.

ASSESSMENT: MRE-derived renal stiffness (RS), ASL-derived renal blood flow (RBF), and IVIM-derived true diffusion coefficient (D), pseudodiffusion coefficient (D*), perfusion fraction (f), and apparent diffusion coefficient (ADC) were measured. CKD was staged from 1 to 5 according to eGFR, with Stages 1-2 defined as early CKD. Chronic changes were graded by chronicity score (CS), with CS > 4 indicating moderate-to-severe chronic changes.

STATISTICAL TESTS: Mann-Whitney U test, Kruskal-Wallis test with Bonferroni correction, intraclass correlation coefficients (ICC), Bland-Altman analysis, Spearman’s rank correlation, univariable and multivariable logistic regression, area under the receiver operating characteristic curve (AUC), and DeLong’s test. p < 0.05 was considered significant.

RESULTS: The combined entire RS at 90 Hz (ERS@90) and the entire D achieved the highest AUC for distinguishing healthy controls from early CKD, significantly outperforming eGFR (AUC = 0.87 vs. 0.59). In early CKD, ERS@90 was the only independent discriminatory variable of moderate-to-severe chronic changes, significantly outperforming eGFR (AUC = 0.86 vs. 0.62).

DATA CONCLUSION: 3D-MRE showed promise for noninvasive detection of early CKD and for identifying moderate-to-severe chronic changes.

EVIDENCE LEVEL: 1.

TECHNICAL EFFICACY: Stage 2.

PMID:42560709 | DOI:10.1002/jmri.70479

J Am Geriatr Soc. 2026 Aug 6. doi: 10.1111/jgs.70630. Online ahead of print.

ABSTRACT

BACKGROUND: People with Alzheimer’s disease and related dementias (ADRD) are at increased risk of motor vehicle crash (MVC) due to cognitive decline, which often begins years before diagnosis. MVC could serve as an indicator of ADRD-related cognitive impairment and facilitate earlier diagnosis.

METHODS: We conducted a matched cohort study of Medicare beneficiaries in New Jersey aged ≥ 69 years with incident ADRD diagnoses from 2010 to 2017 compared to individuals without ADRD and with four other medical conditions: acute myocardial infarction (AMI), asthma, chronic obstructive pulmonary disease (COPD), and diabetes. Comparison groups were sampled with replacement and matched on sex, age, and calendar quarter of diagnosis or claim (for the non-ADRD group). Crash prevalence at 6 months and 1, 2, and 3 years before diagnosis was compared using chi-square tests, and the monthly prevalence was plotted to examine longitudinal trends in crashes.

RESULTS: We identified 43,115 eligible individuals with incident ADRD diagnosis from 2010 to 2017. MVC crash prevalence was higher in the ADRD group than in non-ADRD and negative control groups at all measured pre-diagnosis time points: 6 months (2.99% vs. 2.31%-2.53%), 1 year (5.26% vs. 4.18%-4.65%), 2 years (9.52% vs. 7.88%-8.67%), and 3 years (13.64% vs. 11.29%-12.37%). The ADRD group was more likely to have multiple crashes in the pre-diagnosis period, but multiple events were rare overall (< 3%). Differences were statistically significant but represented small changes in prevalence. Crash prevalence did not reveal a clear signal of cognitive decline in the years leading up to the index diagnosis.

CONCLUSIONS: Older adults with ADRD had slightly higher prevalence of MVC in the 3 years before diagnosis than matched comparison groups, but absolute differences were small and recurrent crashes were rare. MVC alone is too rare to serve as a signal of incipient ADRD, highlighting the need for more sensitive measures.

PMID:42560687 | DOI:10.1111/jgs.70630

JAMA Oncol. 2026 Aug 6. doi: 10.1001/jamaoncol.2026.2781. Online ahead of print.

ABSTRACT

IMPORTANCE: Adaptive therapy is an evolution-based treatment paradigm that has been shown to delay resistance in prostate cancer through treatment breaks that control, rather than minimize, tumor burden. However, patient responses are highly heterogeneous, and there is a significant unmet clinical need for biomarkers to personalize treatment scheduling.

OBJECTIVE: To develop and retrospectively validate mathematical biomarkers that predict time to progression (TTP), mean daily dose, and overall survival (OS) under adaptive therapy from first-cycle prostate-specific antigen (PSA) dynamics.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective modeling and validation study used longitudinal, nonrandomized clinical trial data from 2 independent cohorts: 40 patients with castrate-sensitive prostate cancer (CSPC) (June 1996 to September 2006) and 13 patients with metastatic castrate-resistant prostate cancer (mCRPC) (April 2015 to January 2022). A 2-population differential equation model was used to describe the overall tumor growth through the competing dynamics of drug-sensitive and drug-resistant cells. The statistical analysis was conducted from January 2025 to May 2026.

EXPOSURES: Patients received either intermittent androgen deprivation therapy (for CSPC) or adaptive abiraterone acetate (for mCRPC). The initial treatment cycle served as the exposure period to extract longitudinal PSA kinetics.

MAIN OUTCOMES AND MEASURES: Mechanism-based mathematical biomarkers (adaptive therapy score, expected TTP, and expected mean daily dose) were derived from first-cycle PSA kinetics. Outcomes included in silico benchmarking experiments and retrospective validation against clinical TTP and OS. Performance was benchmarked against standard phenomenological PSA metrics (eg, PSA nadir, time to nadir, and doubling time).

RESULTS: Overall, data from 53 patients across 2 clinical trials were included. In the CSPC cohort of 40 patients, the adaptive therapy score derived from first-cycle data was highly prognostic for prolonged clinical TTP (univariable hazard ratio [HR], 0.49; 95% CI, 0.31-0.76; P = .002). In the mCRPC cohort of 13 patients, the adaptive therapy score exhibited a strong rank correlation with clinical TTP (Spearman ρ = 0.76; P = .002) and was associated with prolonged TTP (HR, 0.41; 95% CI, 0.16-1.07; P = .07). Analysis of long-term survival data in the mCRPC cohort demonstrated that both the adaptive therapy score and expected TTP were significantly associated with prolonged OS, whereas standard empirical PSA metrics displayed no association with OS.

CONCLUSIONS AND RELEVANCE: In this modeling and validation study, mechanism-based mathematical biomarkers derived from the initial-cycle PSA dynamics accurately predicted patient-specific outcomes and survival, outperforming traditional phenomenological PSA monitoring. These accessible metrics could act as a mathematically informed decision support framework to stratify patients into personalized treatment protocols.

PMID:42560686 | DOI:10.1001/jamaoncol.2026.2781

JAMA Netw Open. 2026 Aug 3;9(8):e2626959. doi: 10.1001/jamanetworkopen.2026.26959.

ABSTRACT

IMPORTANCE: Rural hospital-level surgical quality has been extensively evaluated. However, rural people in the US face growing inequities in care, and quality of surgical care experienced by rural patients nationally remains poorly defined.

OBJECTIVE: To evaluate surgical quality among rural vs nonrural Medicare beneficiaries undergoing common general surgery procedures.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used 100% Medicare inpatient claims linked with the American Hospital Association Annual Survey between 2016 and 2023. The cohort included beneficiaries aged 65 to 99 years who underwent admission for appendectomy, cholecystectomy, colectomy, or incisional hernia repair. This analysis was undertaken between August and October 2025.

EXPOSURE: Rural vs nonrural residence, defined using Rural-Urban Commuting Area codes based on patient home zip code (1-3: nonrural; 4-10: rural).

MAIN OUTCOMES AND MEASURES: Risk-adjusted 30-day mortality, in-hospital mortality, complications, 30-day readmission, discharge disposition, and hospital length of stay. Multivariable logistic regression models adjusted for patient factors, hospital factors, and year of surgery.

RESULTS: Among 2 317 497 beneficiaries (55.5% female; mean [SD] age, 75.2 [7.2] years), 462 358 (19.9%) were rural. Rural patients were more often male (46.4% vs 44.1%) and traveled longer for surgery (median, 45.0 [IQR, 22.0-77.0] minutes vs 20.0 [IQR, 13.0-31.0] minutes). Rural patients had higher adjusted 30-day mortality (6.78% [95% CI, 6.65%-6.90%] vs 5.84% [95% CI, 5.76%-5.93%]; odds ratio [OR], 1.21 [95% CI, 1.18-1.24]; P < .001), in-hospital mortality (3.65% [95% CI, 3.56%-3.74%] vs 3.20% [95% CI, 3.14%-3.25%]; OR, 1.17 [95% CI, 1.14-1.21]; P < .001), and 30-day readmission (14.31% [95% CI, 14.14%-14.48%] vs 13.57% [95% CI, 13.45%-13.69%]; OR, 1.07 [95% CI, 1.05-1.08]; P < .001). Complication rates were higher (29.31% [95% CI, 29.04%-29.57%] vs 28.58% [95% CI, 28.40%-28.76%]; OR, 1.05 [95% CI, 1.03-1.07]; P < .001). Rural patients were less likely to be discharged home (75.56% [95% CI, 75.24%-75.88%] vs 77.61% [95% CI, 77.36%-77.86%]; OR, 0.85 [95% CI, 0.83-0.88]; P < .001) and more likely to be transferred to another facility (1.40% [95% CI, 1.33%-1.47%] vs 0.70% [95% CI, 0.67%-0.73%]; OR, 2.04 [95% CI, 1.92-2.17]; P < .001).

CONCLUSIONS AND RELEVANCE: In this cohort study of Medicare beneficiaries undergoing common general surgery procedures, rural residence was independently associated with worse clinical outcomes across most measures. These findings identify significant opportunities for quality improvement focused on common rural surgical needs.

PMID:42560677 | DOI:10.1001/jamanetworkopen.2026.26959