Category: Statistics

Am J Public Health. 2026 Aug 27:e1-e7. doi: 10.2105/AJPH.2026.308640. Online ahead of print.

ABSTRACT

Politicians and advocates across the political spectrum have called for health policy to follow the data. But the political implications of this claim depend on the data that are collected, the analysis methods used, and the standards for evidence that are applied or ignored. As the political nature of public health has come to the forefront of public policy, so has the political aspect of the statistics that underpin public health research and practice. Power and political economy have always shaped data, even when data are portrayed as technocratic and apolitical. Statistical methods are built on assumptions about the world, as they have been since their inception. And the demand for a specific type of causal or cost‒benefit evidence for some policies, or what counts as evidence, is a political, not technical, claim. Rather than attempting to claim legitimacy by retreating from the political aspects of public health, biostatisticians need to confront this role head-on, acknowledge the political and social structures that shape our work, and engage fully at the intersection of the political and the statistical. (Am J Public Health. Published online ahead of print August 27, 2026:e1-e7. https://doi.org/10.2105/AJPH.2026.308640).

PMID:42659582 | DOI:10.2105/AJPH.2026.308640

J Clin Oncol. 2026 Aug 27:JCO2600161. doi: 10.1200/JCO-26-00161. Online ahead of print.

ABSTRACT

PURPOSE: Measurable residual disease (MRD) status after limited-duration treatment for chronic lymphocytic leukemia (CLL) strongly predicts survival times and is considered a surrogate end point. However, most prognostic indices, including the International Prognostic Index (CLL-IPI), rely solely on pretreatment features. To incorporate dynamic MRD data in prognostic models, the continuous individualized risk index (CIRI) was proposed in 2019. Since developed in the context of chemoimmunotherapy, we here propose a refined version of CIRI, in the context of fixed-duration targeted therapy, which includes MRD status at interim, end-of-treatment (EoT) and, in addition, 12-month post-EoT (CIRI2-CLL).

METHODS: After developing model parameters from the CLL8/10/11 and MURANO trials, we applied CIRI2-CLL to independent validation sets from the CLL14 (venetoclax-obinutuzumab v chlorambucil-obinutuzumab) and CLL13 (venetoclax-obinutuzumab with or without ibrutinib v chemoimmunotherapy) trials and assessed model calibration, stratification, and performance.

RESULTS: We compared CIRI2-CLL with individual indices and found good calibration with an approximately 5% difference between observed and predicted event probabilities for progression-free survival (PFS). CIRI2-CLL demonstrated superior performance compared with individual indices as measured by C-statistics between 0.82 and 0.98 at all time points, including MRD and CLL-IPI, improving PFS prediction by 14%-37% from 2 to 5 years. When stratifying patients by CIRI2-CLL into low-, intermediate-, and high-risk groups, the corresponding 3-year PFS rates were 100.0%, 70.2%, and 10.8%. Performance was maintained for overall survival.

CONCLUSION: These results validate CIRI2-CLL in the context of limited-duration CLL therapy. Our approach suggests the models’ adaptability to emerging additional longitudinal MRD and/or outcome data. By introducing CIRI2-CLL, we offer a dynamic tool for investigators to reliably identify patients with increased risk of disease relapse after limited-duration therapy with venetoclax and obinutuzumab, freely accessible at CIRI2 (Stanford University), with important implications for informed decision making and for future risk-adapted CLL trial design.

PMID:42659576 | DOI:10.1200/JCO-26-00161

Knee Surg Sports Traumatol Arthrosc. 2026 Aug 27. doi: 10.1002/ksa.70573. Online ahead of print.

ABSTRACT

PURPOSE: This study assessed the association between (1) annual and (2) cumulative surgeon volume and patient-reported outcome measures (PROMS) after hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) using data from the UK Nonarthroplasty hip registry (NAHR).

METHODS: All hip arthroscopies (HAs) recorded in the UK NAHR between January 2012 and May 2023 were identified. Annual and cumulative consultant HA volume were derived for each case. International Hip Outcome Tool (iHOT)-12 and EuroQol-5 Dimensions (EQ-5D) index scores were captured preoperatively and at 6 and 12 months postoperatively. Multivariable linear regression models with restricted cubic splines were used to define associations between consultant annual and cumulative volume and outcome. The null hypothesis was that neither annual nor cumulative volume would be significantly associated with postoperative iHOT-12 or EQ-5D score change.

RESULTS: A total of 3531 HAs were identified (median age 36 years [IQR: 28-44], 62.4% female) from 76 contributing consultant surgeons. Median annual consultant HA volume was 51 (IQR: 22-102), and median cumulative volume was 163 (IQR: 57-404). Cumulative consultant volume of 170 HA cases demonstrated the lowest 12-month postoperative iHOT-12 score gain (29.6 [95%CI: 27.0-32.1]) compared to a cumulative consultant HA volume of 972 cases (35.2 [95%CI 32.1-38.3]), where the score difference became significant but remained below the minimal clinically important difference (MCID). No statistically significant relationship between consultant volume and EQ-5D Index were observed. Cases where the consultant had the highest cumulative volumes were younger (35.7 vs. 37.0 years, p = 0.03) and a greater proportion underwent excision of isolated cam impingement lesions (62.2% vs. 49.3% p = 0.001), compared to cases performed by the lowest volume consultants.

CONCLUSION: This study found a small but statistically significant association (below the MCID) between higher cumulative case volume and improved early functional outcome following HA. Highest-volume surgeons consistently treated younger patients with less-severe chondral damage.

LEVEL OF EVIDENCE: Level III.

PMID:42659574 | DOI:10.1002/ksa.70573

Medicina (B Aires). 2026 Aug;86 Suppl 3:104-109.

ABSTRACT

This study aimed to establish the linguistic validity of content on a scale based on DSM-5 criteria to evaluate symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents, aimed at parents and teachers. It is a psychometric instrumental research, which included the participation of nine experts in ADHD and a pilot test with fifteen parents and teachers, in order to adapt the instrument to the sociocultural characteristics of the Spanish-speaking population. The methodology used is rigorous and appropriate for the proposed objective. The V-Aiken coefficient was used to estimate the validity of content, considering values ≥ 0.80 as acceptable, and was complemented with a qualitative analysis of the expert comments and a pilot test with parents and teachers in order to evaluate the understanding and contextual adequacy of the items. Most of the items (72.2%) showed high inter-evaluative concordance, some required semantic and contextual adjustments. The conclusions support the validity of the scale content and its potential usefulness in future psychometric evaluations.

PMID:42659559

Medicina (B Aires). 2026 Aug;86 Suppl 3:97-103.

ABSTRACT

INTRODUCTION: Sturge-Weber syndrome is a rare neurocutaneous disorder. The extent of leptomeningeal angioma has been associated with greater neurological severity.

OBJECTIVE: To analyze the correlation between clinical phenotype severity and neuroradiological findings in a cohort of patients with Sturge-Weber syndrome.

METHODS: We conducted a retrospective, descriptive, longitudinal study of patients diagnosed between 2009 and 2024 who underwent contrast-enhanced brain MRI. Clinical variables included epilepsy, stroke-like episodes, status epilepticus, headache, hemiparesis, and academic difficulties. MRI findings (unilateral vs. bilateral angioma; supratentorial vs. supra- and infratentorial involvement) were correlated with clinical features. Statistical analysis was performed using Fisher’s exact test.

RESULTS: Twenty-two patients (3-16 years) were included. Epilepsy occurred in 91%, with a mean onset age of 6.6 months; 64% developed status epilepticus and 27% drug-resistant epilepsy. Among patients with bilateral leptomeningeal angioma, 67% developed drug-resistant epilepsy, with a median onset of 2 months. Stroke-like episodes were observed in 64% and migraine-like headache in 36%. MRI showed unilateral angioma in 86% and bilateral involvement in 13%; 23% had infratentorial extension.

CONCLUSIONS: In our cohort, early-onset epilepsy was highly prevalent. Bilateral leptomeningeal angioma and calcifications were associated with a more severe clinical phenotype, characterized by earlier seizure onset, higher rates of drug resistance, and cognitive impairment. Infratentorial involvement was also associated with increased intellectual disability.

PMID:42659558

Am Surg. 2026 Aug 27:31348261484510. doi: 10.1177/00031348261484510. Online ahead of print.

ABSTRACT

BackgroundThe Brain Trauma Foundation’s guidelines specifically highlight the need to determine optimal triage destination for moderate traumatic brain injury (modTBI) patients, particularly in rural settings where Level I trauma centers may be geographically distant.MethodsRetrospective cohort analysis utilizing sequential adult patients (≥18 years) with modTBI, defined by a field Glasgow Coma Scale (GCS) score of 9-13, admitted to two Level-1 trauma centers (2017-2024). Patients were divided into two groups based on initial triage: initial assessment at regional centers with subsequent transfer (n = 60) vs direct admission to Level I trauma centers (n = 148). Outcomes included hospital discharge disposition, hospital interventions, complications, and functional outcomes as measured by the Glasgow Outcome Scale-Extended (GOSE) at six months. Statistical analysis involved chi-square and Mann-Whitney U tests, with sensitivity analyses to address missing six-month follow-up data.ResultsBaseline injury severity and imaging findings were comparable between groups. The Transfer group had fewer surgical interventions (26.7% vs 52.7%, P < .002). There were no significant differences in hospital mortality (21.7% vs 14.2%, P = 0.27), home discharge (28.3% vs 34.5%, P = 0.49), or hospital complications (23.3% vs 29.7%, P = 0.40). At six months, Favorable outcomes (GOSE 5-8) were comparable between groups (65.9% vs 74.8%, P = 0.38), as were six-month mortality rates (16.7.% vs 8.8%, P = 0.16). Sensitivity analyses remained robust under most missing data assumptions.DiscussionInitial triage location did not significantly affect discharge disposition, complication rates, or six-month functional outcomes in modTBI patients. Hub-and-spoke triage appears safe for hemodynamically stable modTBI in rural trauma systems with established transfer networks.

PMID:42659542 | DOI:10.1177/00031348261484510

An Acad Bras Cienc. 2026 Aug 24;98(3):e20241458. doi: 10.1590/0001-3765202620241458. eCollection 2026.

ABSTRACT

Proper management of natural resources is essential to improve agricultural productivity and reduce potential losses. The PROJETA platform provides global climate models regionalized by the ETA model, enabling more accurate climate projections for specific regions. This study aimed to evaluate the influence of climate change on irrigation water demand using three global climate models (CANESM2, HADGEM2-ES, and MIROC5) regionalized by the ETA model for the baseline period (1961-2005) and two future scenarios (RCP 4.5 and RCP 8.5). The scenarios were subdivided into three future periods and analyzed for 27 municipalities located in the Southern and Steppe regions of Rio Grande do Sul using the SWAP (Soil, Water, Atmosphere and Plant) model. The results indicate variations in irrigation water demand among models and scenarios. Some projections suggest an increase in irrigation requirements in certain municipalities, while others indicate a reduction when compared to the baseline period. The projected increase in water demand is mainly associated with rising temperatures, which may intensify crop transpiration and soil water evaporation. These findings highlight the importance of climate adaptation strategies and improved water resource management to support sustainable agricultural production under future climate conditions.

PMID:42659533 | DOI:10.1590/0001-3765202620241458

An Acad Bras Cienc. 2026 Aug 24;98(suppl 1):e20250485. doi: 10.1590/0001-3765202620250485. eCollection 2026.

ABSTRACT

Floods are among the most destructive natural disasters, necessitating accurate and timely prediction systems to mitigate their impact. This study evaluates the performance of two machine learning models, – K-Nearest Neighbors (KNN) and Long Short-Term Memory (LSTM) networks – in predicting daily water levels based on hydrological and meteorological data from the Wupper River in Wuppertal, Germany. The KNN model yielded the best accuracy (R2 = 0.97; MAE = 1.65; RMSE = 2.84). Owing to its lazy-learning nature, KNN incurs negligible training cost but requires full dataset storage and high computational effort during inference due to repeated distance evaluations. In contrast, the LSTM model (optimal window t = 1 day) reached R2 = 0.84, MAE = 4.19, and RMSE = 6.84. Unlike KNN, the LSTM forms an explicit parametric model during training – an expensive step – but produces fast predictions once deployed.

PMID:42659525 | DOI:10.1590/0001-3765202620250485

Braz Oral Res. 2026 Aug 21;40:e068. doi: 10.1590/1807-3107bor-2026.vol40.068. eCollection 2026.

ABSTRACT

This prospective cohort study assessed the influence of contextual variables of the residential neighborhood on the pattern of preventive use of dental services among young adults from southern Brazil. The study was linked to a population-based cross-sectional survey carried out in 2018 that evaluated the oral health conditions of adolescents aged 15-19 years from Santa Maria, southern Brazil (n = 1,197). After a mean (± SD) period of 5 (± 0.5) years, 570 individuals were reassessed (response rate: 47.6%). Questionnaires collected sociodemographic characteristics, dental service use (including the reason for the last visit), and participants’ addresses. The outcome was the last dental visit for prevention, defined as positive responses at both baseline and follow-up. The main predictor variables were contextual neighborhood variables (mean income, percentage of literate inhabitants, percentage of residences with tap water, paved streets, sewerage system, and public lighting). Unadjusted and adjusted multilevel Poisson regression models were used to estimate relative risk (RR) and 95% confidence intervals (CI). Approximately one-quarter of participants reported that their last dental visit was for prevention (n = 151, 26.5%). After controlling for individual-level variables, participants living in neighborhoods with above-median income (RR=1.27; 95%CI: 1.04-1.55; p = 0.02), higher literacy levels (RR = 1.31; 95%CI:1.02-1.68; p = 0.03), greater proportion of paved streets (RR =1.28; 95%CI: 1.01-1.63; p = 0.04), or greater sewerage coverage (RR = 1.40; 95%CI: 1.05-1.85; p = 0.02) were more likely to report their last dental visit for prevention. In conclusion, this cohort study demonstrated that neighborhood-level variables influenced the pattern of preventive dental visits among young adults in southern Brazil.

PMID:42659520 | DOI:10.1590/1807-3107bor-2026.vol40.068

Braz Oral Res. 2026 Aug 21;40:e052. doi: 10.1590/1807-3107bor-2026.vol40.052. eCollection 2026.

ABSTRACT

This study aimed to evaluate the survival outcomes of pediatric patients with head and neck (HN) rhabdomyosarcoma (RMS) treated at a reference center in Brazil, comparing them with those of patients with non-head and neck (NHN) RMS. Additionally, it sought to identify the clinical-pathological variables, histological subtypes, and antineoplastic therapy regimens that significantly influence patient prognosis. The study included RMS patients treated between 1990 and 2022. Statistical analyses comprised t-tests, chi-square tests, Kaplan-Meier survival analysis, and Cox regression for overall survival (OS), disease-free survival (DFS), and event-free survival (EFS). A total of 64 patients (60.9% male) were included, with head and neck tumors being the most common presentation. Prognostic factors associated with OS included age ≥ 10 years, intermediate-risk classification, tumor relapse, and surgery. DFS was significantly influenced by age ≥10 years and high-risk classification, while EFS was associated with lesion size, histological subtype, and radiotherapy. In conclusion, anatomical site was not a significant prognostic factor. Age and risk classification significantly influenced OS and DFS, while histological subtype emerged as an independent factor for EFS. This study, conducted at a reference center in Latin America with a 30-year history of care, provides clinically relevant insights by identifying specific prognostic factors for RMS in Brazilian pediatric patients. These findings enable comparisons with international data and contribute to planning health interventions.

PMID:42659518 | DOI:10.1590/1807-3107bor-2026.vol40.052