Category: Statistics

Twin Res Hum Genet. 2026 May 21:1-11. doi: 10.1017/thg.2026.10063. Online ahead of print.

ABSTRACT

Hyperuricemia is a common metabolic disorder and has become a global health concern. This study investigated the association between DNA methylation (DNAm) and serum uric acid (SUA) by conducting an epigenomewide association study (EWAS) in Chinese monozygotic (MZ) twins. Genomewide DNAm of 50 MZ twin pairs was profiled using the Infinium MethylationEPIC v2.0 BeadChip (935K). Generalized estimating equations (GEE) were used to examine the association between DNAm and SUA. Causal relationships between DNAm and SUA were assessed using ICE FALCON approach. Associations between mRNA expression and SUA were further assessed. Finally, candidate genes identified through epigenomewide association study (EWAS), causal inference, and gene expression analyses were validated in a longitudinal twin study. We identified 70 CpGs, mapping to genes such as DOK6 and NGLY1, significantly associated with SUA (Bonferroni correction p < 5.8 × 10^-8). Causal analyses revealed one CpG with a causal effect of DNAm on SUA, 22 CpGs with causal effects of SUA on DNAm, and 33 CpGs showing bidirectional causality. Eleven genes displayed expression levels associated with SUA. DOK6, NGLY1, PKM, and SLC44A1 were selected as candidate genes, all of which showed unidirectional causal effect of SUA on DNAm. In the longitudinal analysis, baseline SUA levels (2012-13) were associated with subsequent DNAm levels in DOK6 and NGLY1 genes (2023-24). In conclusion, we found that SUA levels may influence DNAm variations, particularly at CpG loci within the DOK6 and NGLY1 genes. These findings provide key clues for future investigations into the mechanisms linking SUA with its epigenetic regulatory pathways.

PMID:42165100 | DOI:10.1017/thg.2026.10063

Psychol Med. 2026 May 21;56:e160. doi: 10.1017/S0033291726104541.

ABSTRACT

Prolonged grief disorder (PGD), recently classified in ICD-11 and DSM-5-TR, is characterized by persistent and functionally impairing grief lasting beyond 6-12 months. The COVID-19 pandemic was accompanied by widespread mortality, social isolation, disrupted mourning rituals, and social disconnection, raising concerns about a potentially high burden of PGD during the pandemic period. We conducted a systematic review and meta-analysis, following PRISMA guidelines and PROSPERO registration (CRD42023463720), to estimate PGD prevalence under standardized ICD-11 and DSM-5-TR diagnostic frameworks and to examine potential moderators during the COVID-19 pandemic. PubMed, EMBASE, and the Cochrane Library were searched from inception to October 2024. Eligible studies included adults who experienced bereavement during the pandemic and were assessed using validated PGD instruments (PG-13-R, ICG, BGQ). Random-effects models were applied to pool prevalence estimates, with subgroup and meta-regression analyses. Thirteen studies comprising 5,766 participants were included. The pooled prevalence of PGD during the pandemic period was 24% (95% CI: 13%-36%), with the highest estimates observed in China (43%, 95% CI: 33%-54%). In the overall pooled analysis, studies applying DSM-5-TR criteria yielded lower prevalence estimates than those using ICD-11 criteria (18% vs.26%, p = 0.41). Digital interventions showed no statistically significant pooled effects (Hedges’ g = -0.38, 95% CI: -0.90 to 0.14). The high and geographically heterogeneous prevalence of PGD observed during the COVID-19 pandemic underscores the need to strengthen mental health surveillance, standardized assessment, and service accessibility in large-scale public health emergencies, and provides important evidence to inform population-level interventions and resource allocation strategies.

PMID:42165098 | DOI:10.1017/S0033291726104541

Pediatr Obes. 2026 May;21(5):e70114. doi: 10.1111/ijpo.70114.

ABSTRACT

BACKGROUND: Antihypertensive class medications are prescribed long-term for adolescents, including for conditions other than hypertension. Evidence on weight effects is limited.

OBJECTIVE: To assess the weight effects of commonly prescribed antihypertensive class medications among adolescents, regardless of clinical indication for use.

METHODS: This retrospective study was conducted using electronic health record (EHR) data from a multi-site US research network. The study cohort included adolescents aged 13.0-19.5 years with ≥ 1 antihypertensive class medication order during 2010-2019. Weight and height documented in the EHR were used to calculate BMI z-scores. Inverse probability weighting with marginal structural models was used to account for selection factors and covariates.

RESULTS: Overall, 23 853 adolescents were prescribed an antihypertensive class medication, including clonidine (prescribed to n = 7491), guanfacine (n = 6411), lisinopril (n = 3584), propranolol (n = 3015), spironolactone (n = 1926), and atenolol (n = 1426). At baseline, 13% had a hypertension diagnosis. At 12 months after medication initiation, the estimated population-level BMI z-score was significantly increased for propranolol (BMI z-score 0.19 [95% CI 0.09, 0.29]) and significantly decreased for lisinopril (-0.06 [95% CI -0.10, -0.01]); clonidine, guanfacine, spironolactone, and atenolol were not associated with a significant change in BMI z-score.

CONCLUSIONS: Most antihypertensive class medications were not associated with statistically significant weight gain when prescribed to adolescents.

PMID:42165095 | DOI:10.1111/ijpo.70114

Pediatr Pulmonol. 2026 May;61(5):e71673. doi: 10.1002/ppul.71673.

ABSTRACT

BACKGROUND: Despite asthma being one of the most common chronic conditions among children in the United States, real-world evidence on medication adherence and healthcare utilization in underserved pediatric populations remains limited. Therefore, we aim to evaluate adherence, persistence, and asthma-related healthcare utilization among Medicaid-enrolled children receiving inhaled corticosteroids (ICS) versus ICS-long-acting beta-agonist (ICS-LABA) inhalers.

METHODS: We conducted a retrospective cohort study using Texas Children’s Health Plan claims data from 2016 to 2019. Children aged 4-17 years with asthma diagnoses and ≥1 prescription for an ICS or ICS-LABA were included. Adherence was determined as the proportion of days covered (PDC) of ≥ 50%, and persistence was defined as continuous therapy without a 60-day gap. The PDC ≥ 80% was evaluated in sensitivity analysis. Multivariable logistic regression was used to estimate adherence, asthma-related emergency department (ED) visits, and hospitalizations.

RESULTS: Among 8622 eligible children, 82.4% received ICS and 17.6% received ICS-LABA. In inverse probability of treatment weighting (IPTW) adjusted analyses, compared with ICS, ICS-LABA users had higher adherence rate i.e., 21.08% versus 16.56% achieved PDC ≥ 50% (aOR = 1.35; 95%CI: 1.25-1.45), and 10.82% versus 6.74% achieved PDC ≥ 80% (aOR = 1.61; 95%CI: 1.31-1.97). Refill persistence was also higher with ICS-LABA (36.16% vs. 23.35%, aOR: 1.86, 95%CI: 1.74-1.99). However, despite better adherence, we found ICS-LABA users exhibited greater asthma-related healthcare utilization, i.e., ED visits occurred in 18.69% versus 11.25% (aOR = 1.81; 95%CI: 1.56-2.11) and hospitalizations in 2.53% versus 1.00% (aOR= 2.55; 95%CI: 1.68-3.89), which persisted even after adjusting for adherence.

CONCLUSIONS: We found that adherence was greater in children with asthma who were dispensed an ICS-LABA as compared to those dispensed an ICS-only inhaler; however, adherence rates were low in both groups. Higher hospitalization and ED visit rates among those prescribed ICS-LABA therapy likely reflect higher disease severity in this group. Our findings should be interpreted in light of claims-based adherence measures and potential residual confounding due to unmeasured asthma severity and control.

PMID:42165090 | DOI:10.1002/ppul.71673

Nat Sci Sleep. 2026 May 15;18:591315. doi: 10.2147/NSS.S591315. eCollection 2026.

ABSTRACT

BACKGROUND: The sleep quality of Han Chinese and Tibetan firefighters at high altitude remains poorly understood. This study investigates the prevalence of sleep disturbances in these groups and whether ethnicity affects sleep quality in these two populations.

METHODS: Male firefighters were recruited from China Fire and Rescue stations at high altitude of 500 m, 2570 m, and 4509 m in Southwest China. The Pittsburgh Sleep Quality Index (PSQI) assessed sleep quality, considering scores >5 as poor sleep quality. Symptoms of anxiety and depression were evaluated using the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) and the 9-item Patient Health Questionnaire (PHQ-9).

RESULTS: As altitude increased, the total PSQI scores of Han Chinese firefighters showed a non-statistically significant rise: 4 (2-5) at 500 m, 4 (3-6.75) at 2570 m, and 5 (2.75-6) at 4509 m. Poor sleep quality prevalence also rose: 23%, 31%, and 44%, respectively. In contrast, the sleep quality of Tibetan firefighters remained relatively stable and was better than that of their Han Chinese counterparts. Furthermore, the GAD-7 and PHQ-9 scores were higher in Han Chinese firefighters compared to Tibetan firefighters. The PSQI score was positively correlated with GAD-7 scores (ρ = 0.454, p < 0.001) and PHQ-9 scores (ρ = 0.380, p < 0.001) but negatively correlated with Tibetan ethnicity (ρ = -0.228, p < 0.001). Logistic regression analysis indicated that, compared to Tibetans, being Han Chinese (odds ratio [OR] = 3.050, 95% confidence interval [CI]: 1.214-7.665) and having higher GAD-7 scores (OR = 1.816, 95% CI: 1.332-2.477) were independently associated factors for poor sleep quality.

CONCLUSION: This study suggests that Han Chinese firefighters in this field sample across these stations are at greater risk of poor sleep quality than Tibetan firefighters, with elevated GAD-7 scores being a potential contributing factor for poor sleep quality.

PMID:42165074 | PMC:PMC13185950 | DOI:10.2147/NSS.S591315

MedEdPORTAL. 2026 May 19;22:11601. doi: 10.15766/mep_2374-8265.11601. eCollection 2026.

ABSTRACT

INTRODUCTION: Biochemistry is often regarded as conceptually dense yet emotionally disconnected, limiting its relevance to patient care. To bridge this gap, an art-based learning intervention was developed to connect biochemistry of diseases with empathy, perspective-taking, and ethical awareness through visual thinking strategies, structured peer role-play, and guided reflection.

METHODS: This small-group activity was conducted for 150 first-year medical students over a total duration of 180 minutes. Students were divided into 30 groups and each group received a curated artwork and a biochemical role-play case scenario. Evaluation followed Kirkpatrick’s model with a 20-item perception survey and semistructured interviews for level 1 (reaction), postsession assessment, “I used to think, now I think, now I will” reflection, and a 7-item confidence questionnaire for level 2 (learning).

RESULTS: Students reported high levels of engagement across all components, particularly appreciating visual thinking strategies and structured peer role-play. The postsession assessment score was 24.1 (SD = 3.0) out of 30 [P < .001]. Thematic analysis of documented reflections yielded 16 distinct themes representing the shift in learners’ perspectives and their growing commitment to empathic patient care.

DISCUSSION: The integration of art and role-play into early biochemistry teaching effectively supported students in linking molecular mechanism of diseases with human experiences of illness. It also encouraged thoughtful participation and facilitated emotional and ethical awareness. While the approach proved feasible and impactful within this setting, its broader implementation may depend on institutional support and faculty readiness for arts-integrated pedagogy.

PMID:42165068 | PMC:PMC13183865 | DOI:10.15766/mep_2374-8265.11601

Front Psychiatry. 2026 May 5;17:1788310. doi: 10.3389/fpsyt.2026.1788310. eCollection 2026.

ABSTRACT

OBJECTIVE: This meta-analysis evaluated the associations between noise exposure, air pollutants, and attention-deficit/hyperactivity disorder (ADHD) in children, aiming to inform future prevention strategies.

METHODS: Studies were systematically retrieved from CNKI, Wanfang, PubMed, Web of Science, Embase, and the Cochrane Library, covering publications from inception to November 2025. Heterogeneity was assessed using Cochran’s Q test and the I² statistic. Subgroup analyses, meta-regression, and sensitivity analyses were performed to evaluate the robustness of the findings.

RESULTS: Noise exposure was associated with a small increase in ADHD risk (odds ratio [OR] = 1.03, 95% confidence interval [CI]: 1.01-1.05), with stronger associations for childhood exposure, whereas prenatal exposure showed no significant effect. Given the modest effect size, this finding should be interpreted cautiously. Particulate matter (PM_2.5 and PM₁₀) was significantly associated with ADHD in continuous-exposure models-PM_2.5 (OR = 1.32, 95% CI: 1.16-1.50) and PM₁₀ (OR = 1.47, 95% CI: 1.15-1.87). In dichotomous models, PM_2.5 was not significant, while PM₁₀ remained positively associated (OR = 1.58, 95% CI: 1.11-2.26). Elevated nitrogen dioxide (NO₂) exposure was also associated with a modest increase in ADHD risk (OR = 1.11, 95% CI: 1.02-1.20), whereas nitrogen oxides (NO_x), ozone (O₃), and sulfur dioxide (SO₂) did not show significant associations.

CONCLUSIONS: Noise and several air pollutants (PM_2.5, PM₁₀, and NO₂) were significantly associated with increased ADHD risk, particularly during childhood exposure. Other pollutants, including O₃ and SO₂, did not demonstrate significant effects. These findings suggest that environmental noise and several air pollutants may be associated with ADHD; however, some observed associations, particularly for noise and NO₂, were modest in magnitude and should be interpreted cautiously. These results reflect observational associations rather than evidence of a strong or causal effect, while the evidence for some pollutants remains limited or inconclusive. Further research is needed to clarify pollutant-specific associations and the role of exposure timing.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024593274, identifier CRD42024593274; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025632899, identifier CRD42025632899.

PMID:42165060 | PMC:PMC13185364 | DOI:10.3389/fpsyt.2026.1788310

Front Psychiatry. 2026 May 5;17:1813238. doi: 10.3389/fpsyt.2026.1813238. eCollection 2026.

ABSTRACT

PURPOSE: The COVID-19 pandemic disrupted essential services, posing unique challenges for individuals with Autism Spectrum Disorder (ASD) who depend on consistent, specialized support. Service providers faced unique challenges in adapting to remote delivery methods, highlighting the fragility of existing systems during crises. This study explored the experiences of ASD service providers in Qatar during the COVID-19 pandemic.

METHODS: An online survey of 66 ASD service providers in Qatar was conducted. Data were analyzed using descriptive statistics, chi-square, and likelihood ratio tests, with qualitative responses assessed through thematic analysis.

RESULTS: Most service providers (90.9%) worked remotely during the pandemic, with 81.8% engaging in online services. Providers reported significant skill regression in individuals with ASD. Stress levels were notably high (42.4%) and significantly associated with emotional tolls [p = 0.017, LR = 4.887], financial strains [p = 0.008, LR = 4.337], and personal challenges [p = 0.008, LR = 3.203]. Thematic analysis revealed decreased therapy effectiveness and difficulties in balancing work with family responsibilities.

CONCLUSION: These findings suggest the importance of adaptive service delivery systems that maintain continuity of care during crises. Strengthening autism service infrastructure and developing resilient models are essential to safeguard autism support for future emergencies.

PMID:42165059 | PMC:PMC13183810 | DOI:10.3389/fpsyt.2026.1813238

Integr Pharm Res Pract. 2026 May 15;15:583805. doi: 10.2147/IPRP.S583805. eCollection 2026.

ABSTRACT

BACKGROUND: Effective pharmacist-patient communication is essential for modern pharmaceutical services, relying heavily on optimized communication strategies that are essential for ensuring treatment adherence and overcoming the unique challenges of patient care in multilingual regions.

PURPOSE: This study investigates the perceptions, experiences, and strategies used by community pharmacists in Romania to overcome common communication barriers.

METHODS: The research employed an observational, descriptive, cross-sectional study design, utilizing a self-administered online questionnaire. The data was collected through an anonymous online questionnaire (N=150) administered to patients in eastern Romania. Explicit digital informed consent was obtained. Data analysis involved descriptive statistics, t-tests for independent samples, and Spearman correlation coefficient.

RESULTS: Results indicate the perception of significant barriers, notably differences in educational levels, the use of medical terminology, and time constraints. A negative and significant Spearman correlation (ρ = -0.207, p < 0.001) was found between the perceived effectiveness of communication and the need for service improvement, confirming the detrimental impact of these difficulties on the quality of pharmaceutical services. Furthermore, the average self-assessment score of 2.59 for communication training suggests a predominantly negative perception of both university and continuing education in this area.

CONCLUSION: The conclusions highlight an urgent need to integrate culturally and linguistically adapted communication training into the education of community pharmacists. Future research should focus on developing and evaluating pilot educational programs and interventions specifically tailored for bilingual communities.

PMID:42165040 | PMC:PMC13185963 | DOI:10.2147/IPRP.S583805

Front Endocrinol (Lausanne). 2026 May 5;17:1757107. doi: 10.3389/fendo.2026.1757107. eCollection 2026.

ABSTRACT

This study aimed to investigate how levels of serum follicle-stimulating hormone (FSH) on Day 7 of ovarian stimulation are related to the number of oocytes retrieved, and identify any cutoff or threshold point in protocols using gonadotropin-releasing hormone (GnRH) antagonists. We examined data from January 2017 to June 2024, covering 9,969 cycles from 7,981 patients using GnRH antagonists as part of in vitro fertilization processes. We found a complex link between serum FSH and oocyte collection. Lower serum FSH on Day 7 was associated with collection of fewer oocytes (β = -0.531, p < 0.0001), and different levels were associated with changes in the number of oocytes collected. The key point was 9.13mIU/mL. If serum FSH exceeded 9.13 mIU/mL on Day 7, each 1mIU/mL increase reduced the number of oocytes collected by 0.07 (effect β = -0.07, 95% confidence interval [CI] -0.10 to -0.05, P < 0.0001). When serum FSH was below 9.13 mIU/mL, each 1 mIU/mL rise increased the number of oocytes collected by 1.18 (effect β = 1.18, 95% CI 0.95 to 1.41, P < 0.0001). This association suggests that it may be possible to improve ovarian reaction by raising the FSH dose if serum FSH is under 9.13 mIU/mL. However, if serum FSH is already over 10 mIU/mL, it seems likely that other steps may be needed to increase ovarian reaction, although these hypotheses will need to be tested in future studies.

PMID:42165020 | PMC:PMC13183537 | DOI:10.3389/fendo.2026.1757107