Category: Statistics

Int J Gynaecol Obstet. 2026 Jan 2. doi: 10.1002/ijgo.70791. Online ahead of print.

ABSTRACT

OBJECTIVE: Obstetric anal sphincter injuries (OASIS) are among the most serious complications of vaginal delivery. While various prediction models have been proposed, most fail to stratify risk by parity and commonly rely on birth weight, a parameter unavailable during labor, rather than estimated fetal weight (EFW). The aim of the present study was to identify maternal and intrapartum risk factors for OASIS in term vaginal births and to explore parity-specific associations.

METHODS: This retrospective cohort study included all women who achieved or intended to achieve vaginal delivery of a live, singleton, cephalic fetus at term (≥37 weeks) at a single tertiary center. Maternal, obstetric, and intrapartum data were extracted from electronic medical records. EFW was usually obtained sonographically, or clinically when no recent ultrasound was available. Multivariable logistic regression analyses were performed for the whole cohort and stratified by parity.

RESULTS: The overall rate of OASIS was 0.46% (102/22220) for the entire cohort. Stratified by parity, the prevalence was higher in nulliparous women compared to multiparous women (67/7309; 0.92% for nulliparas vs. 35/14911; 0.23% for multiparas). Overall, nulliparity, vacuum-assisted delivery, and increased EFW increased the risk for OASIS. However, following stratification by parity and adjustment for confounders, the only statistically significant risk factor among nulliparous women was vacuum-assisted delivery (adjusted odds ratio [aOR]: 2.474, 95% confidence interval [CI]: 1.520-4.026, P < 0.001), while among multiparous women, previous cesarean delivery was associated with OASIS, (aOR: 2.018, 95% CI: 0.507-8.024, P = 0.013). Neither EFW nor second-stage duration remained significant in stratified models.

CONCLUSION: Traditional indicators such as second-stage duration and EFW did not reliably identify women at risk of OASIS in this cohort. The strongest associated factors were first-time vaginal birth and vacuum-assisted delivery, with previous cesarean delivery relevant among multiparous women. These findings highlight clear parity-related patterns that merit further investigation.

PMID:41482750 | DOI:10.1002/ijgo.70791

J Dent Educ. 2026 Jan 2. doi: 10.1002/jdd.70111. Online ahead of print.

ABSTRACT

PURPOSE: This mixed methods study, framed by Kolb’s Experiential Learning Theory, explored allied dental students’ perceptions of alginate versus digital impression techniques at a US dental assisting and dental hygiene program in 2024. The central research question was, “What are students’ perceptions of taking maxillary alginate impressions as compared to a digital scan of the maxillary arch?” and the sub-question was, “Do students have a preferred technique?”

METHODS: A mixed methods approach enabled a deeper understanding of student perception through qualitative analysis related to using both the alginate impression and digital scanning techniques, and quantitative analysis related to evaluations of the final impressions and scans. Using Kolb’s Experiential Learning Theory as a guide, this research study was centered around a concrete experience with hands-on learning and then student reflection related to the experience and their perceptions or abstract conceptualization. A convenience sample of 30 dental assisting and dental hygiene students currently enrolled in a dental materials course participated. Data collected via questionnaires, behavioral observation, and impression/scan analysis were analyzed qualitatively and quantitatively. Coding was used to identify key themes in students’ perceptions of alginate and digital impression techniques.

RESULTS: Five themes were derived from data collection for both maxillary alginate impressions and maxillary digital scans: emotions/feelings, technique/process, benefits, and drawbacks/obstacles. Overall, participants preferred using digital scanning over alginate impressions. Most students (79% n = 22) perceived alginate impressions as more time intensive despite objective time data suggesting otherwise. There was a statistically significant difference in the average time to complete an alginate impression compared to the digital impression. There was no difference in digital impression quality between dental assisting and dental hygiene students, and dental assisting students expressed more apprehension when using the alginate impression technique compared to dental hygiene students.

CONCLUSION: Echoing previous research, students recognized the advantages of digital scans, such as improved patient education, comfort, and ease of cleanup. Conversely, they shared concerns about the time constraints and rushed feeling associated with alginate impressions, also previously documented.

PMID:41482741 | DOI:10.1002/jdd.70111

Pediatr Allergy Immunol. 2026 Jan;37(1):e70274. doi: 10.1111/pai.70274.

ABSTRACT

BACKGROUND: The frequency of false negatives in exercise provocation tests (EPTs) when evaluating exercise-induced allergic reactions on desensitization (EIARD) remains unclear. This study aimed to determine the frequency of allergic symptom induction after a negative EPT result in patients at risk of EIARD and to identify its associated factors.

METHODS: This retrospective cohort study analyzed 109 patients aged 5-18 years who underwent EPTs between February 2012 and March 2023 to assess EIARD after wheat oral immunotherapy (OIT). EPT was performed in all cases after rush OIT and in high-risk cases after slow OIT. Patients with a negative/indeterminate EPT result were monitored for 1 year. Individuals who developed allergic reactions during exercise after wheat ingestion were categorized as “Event+” and were regarded as having false-negative EPT results. Patients without events were categorized as “Event-“. Candidate factors between the Event+ and Event- groups were compared using nonparametric statistical tests.

RESULTS: Among 53 patients with negative/indeterminate EPT results, 14 (26.4%) experienced allergic symptoms during follow-up (Event+ group). Higher ω5-gliadin-specific IgE levels at the time of EPT were significantly associated with Event+. No other factors (i.e., age, sex, allergy severity, or exercise intensity) showed any association. All Event+ cases occurred outdoors, suggesting a possible influence of environmental factors.

CONCLUSION: False negatives occurred in 26.4% of pediatric wheat-desensitized patients with EPTs. Our findings highlight the need to periodically monitor EIARD after negative EPT results. Future studies should explore methods to improve the accuracy of EPTs and identify predictive markers of EIARD risk.

PMID:41482726 | DOI:10.1111/pai.70274

Int J Adolesc Med Health. 2026 Jan 5. doi: 10.1515/ijamh-2025-0174. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to investigate the early effects of cigarette smoke exposure on endothelial function in healthy adolescents by analyzing blood endocan levels and urinary cotinine concentrations. A novel endocan/cotinine ratio was proposed to enhance the assessment of endothelial response to tobacco exposure.

METHODS: In this cross-sectional case-control study, 88 adolescents aged 13-18 years were recruited from Istanbul University between January and August 2021. Participants were divided into two groups: exposed (n=44) and non-exposed (n=44) to cigarette smoke. Blood endocan and urine cotinine levels were measured using ELISA. Statistical analysis included the Mann-Whitney U test and Spearman’s correlation.

RESULTS: Among the exposed participants, 11.4 % (n=5) were active smokers and 88.6 % (n=39) were passive smokers. Systolic blood pressure was significantly higher in the exposed group (p=0.03). Although endocan levels did not differ significantly between groups (p=0.74), median values were higher in the exposed group (1847.5 pg/mL, range: 14.79-3,121.63) compared to controls (1806.2 pg/mL, range: 116.83-4,618.90). Urinary cotinine levels were markedly elevated in the exposed group (p<0.001).Significant positive correlations were found between exposure duration (pack-years) and both endocan levels (r=0.318, p=0.01) and cotinine levels (r=0.524, p<0.001). A significant negative correlation was identified between cotinine and endocan levels specifically in the exposed group (r=-0.435, p=0.003), with regression analysis showing that each 1 ng/mL increase in urinary cotinine was associated with a 3.23 pg/mL reduction in serum endocan (R²=0.189, p=0.003), suggesting that cotinine levels accounted for 18.9 % of the variability in endocan concentrations. No such correlation was observed in the control group (r=-0.015, p=0.925).The endocan/cotinine ratio showed a decreasing trend in the exposed group (median: 25.69, mean: 28.76 ± 21.45) compared to non-exposed participants (median: 34.24, mean: 47.31 ± 53.89), though this difference did not reach statistical significance (U=1,149.0, p=0.132). A negative correlation was found between BMI and endocan levels (r=-0.337, p=0.001), while a weak positive correlation was observed between age and cotinine concentration (r=0.222, p=0.038).

CONCLUSIONS: Cigarette smoke exposure in adolescents leads to elevated cotinine levels and increased blood pressure (p=0.03), indicating early vascular changes. The observed negative correlation between cotinine and endocan levels (r=-0.435, p=0.003) may reflect a compensatory endothelial response. The endocan/cotinine ratio could serve as a novel, early biomarker for endothelial dysfunction in youth exposed to cigarette smoke.

PMID:41482722 | DOI:10.1515/ijamh-2025-0174

J Oral Pathol Med. 2026 Jan 2. doi: 10.1111/jop.70112. Online ahead of print.

ABSTRACT

INTRODUCTION: Odontogenic keratocyst (OKC) is a developmental odontogenic cyst characterized by a fragile epithelial lining attachment to the capsula and high recurrence rates. Matrix metalloproteinases (MMPs) and adhesion-related proteins (TLN1, FBLN1) may contribute to epithelial detachment, which could facilitate lesion recurrence. This study investigated the mRNA expression of MMP2, MMP9, TLN1, and FBLN1 in OKCs and their association with epithelial detachment, including the impact of marsupialization.

METHODS: Gene expression was analyzed by RT-qPCR in samples from OKCs (n = 10), marsupialized OKCs (n = 5), and oral mucosa controls (n = 4). Gelatinase activity was assessed by gelatin zymography in fresh samples (OKCs n = 7; oral mucosa n = 4). Histological sections were digitally measured to quantify areas of epithelial detachment. Correlation analyses were performed between mRNA expression levels and epithelial separation.

RESULTS: MMP2 and MMP9 mRNA levels were significantly higher in OKCs compared to oral mucosa (p < 0.05), with decreased mRNA levels after marsupialization. Gelatin zymography confirmed elevated gelatinase activity, particularly for MMP9, in OKC tissues. TLN1 and FBLN1 mRNA expressions were also elevated in OKCs, consistent with previous proteomic data, though not statistically significant. A significant correlation was observed between MMP9 mRNA expression and the total area of detached epithelium.

CONCLUSION: MMP9 may play a critical role in epithelial detachment in OKCs and could serve as a therapeutic target or prognostic marker. Marsupialization appears to modulate matrix metalloproteinases expression, suggesting a molecular mechanism for its clinical benefits.

PMID:41482718 | DOI:10.1111/jop.70112

J Clin Ultrasound. 2026 Jan 2. doi: 10.1002/jcu.70167. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the variations in junctional zone (JZ) ultrasonographic parameters using three-dimensional transvaginal ultrasound (3D-TVS) across different age groups and evaluate their diagnostic potential for adenomyosis.

METHODS: We conducted a retrospective analysis of 120 patients who underwent 3D-TVS examinations. Participants were categorized into adenomyosis and healthy control groups, with the control group further stratified into three age-based subgroups (20+, 30+, and 40+ years). Quantitative JZ parameters were meticulously measured, including maximum thickness (JZmax), minimum thickness (JZmin), thickness difference (JZdif, calculated as JZmax – JZmin), myometrial thickness adjacent to JZmax, and the ratio of JZmax to adjacent myometrial thickness. Statistical comparisons were performed among groups, and receiver operating characteristic (ROC) curves were constructed to determine the area under the curve (AUC) müllerian values for adenomyosis diagnosis.

RESULTS: Age-stratified analysis revealed no statistically significant differences in JZ parameters among control subgroups (p > 0.05), indicating minimal age-related variations in JZ characteristics. Compared to healthy controls, adenomyosis patients demonstrated significantly elevated values in JZmax, JZmin, JZdif, and the myometrial thickness adjacent to JZmax (p < 0.05). ROC analysis yielded AUC values of 0.85 for JZmax, 0.84 for myometrial thickness adjacent to JZmax, 0.79 for JZdif, and 0.76 for JZmin. Optimal diagnostic performance was achieved at JZmax ≥ 0.45 cm, demonstrating 77% sensitivity and 89% specificity.

CONCLUSION: 3D-TVS with 3D reconstruction technology enables clear visualization of uterine coronal section and accurate quantification of JZ parameters. These findings support the clinical utility of 3D-TVS in the diagnostic evaluation of adenomyosis.

PMID:41482716 | DOI:10.1002/jcu.70167

Rev Med Virol. 2026 Jan;36(1):e70102. doi: 10.1002/rmv.70102.

ABSTRACT

Persistent high-risk Human Papillomavirus (HPV) infection causes anogenital and oropharyngeal cancers across all genders. The primary cancer associated with HPV is cervical cancer and the HPV vaccination before sexual exposure is recommended for cervical cancer elimination globally. This scoping review aims to map the preliminary evidence regarding the determinants of adolescent HPV vaccine acceptance and hesitancy during the COVID-19 pandemic in high income countries. A scoping review was conducted as per the updated Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Using the PCC (Population, Concept, and Context) framework, search keywords and search strategies were developed. Electronic databases were searched using specific search terms and the last search date noted as February 8, 2025. A thematic content analysis was carried out to identify the themes and subthemes by a deductive approach. Fourteen studies were included as the potential sources of evidence in this review. The study population included 493,819 adolescents from Australia, Hong Kong, Italy, Poland, Saudi Arabia, and the USA. The themes identified were inequity, attitude and behaviour, knowledge and communication, and engagement and influence. The COVID-19 pandemic generated a negative parental attitude towards HPV vaccines for a brief period. The adolescent HPV vaccine acceptance mainly depended on strong parental support and appropriate access to healthcare professionals and vaccination services. Travel restrictions, lockdowns, school closures, and social distancing contributed to significant HPV vaccine hesitancy in high income countries.

PMID:41482705 | DOI:10.1002/rmv.70102

Med Sci Monit. 2026 Jan 3;32:e950481. doi: 10.12659/MSM.950481.

ABSTRACT

BACKGROUND With the global rise in geriatric populations, femoral fractures in elderly individuals have become a major health burden. This study aimed to evaluate the prognostic value of 3 readily available laboratory-based indices – HALP (hemoglobin, albumin, lymphocyte, platelet), Prognostic Nutritional Index (PNI), and Systemic Immune-Inflammation Index (SII) – in predicting 1-year mortality among elderly patients with femoral fractures. MATERIAL AND METHODS This retrospective cohort study included 309 patients aged ≥65 years who presented to the emergency department of a tertiary university hospital between 2018 and 2023 with low-energy femoral fractures and who underwent surgery. Demographic, clinical, and laboratory data were collected. HALP, PNI, and SII were calculated preoperatively. In-hospital, 30-day, and 1-year mortality were recorded. ROC analysis was used to assess the predictive accuracy of each index. RESULTS One-year mortality was 32.4%, while in-hospital and 30-day mortality were 5.5% and 11%, respectively. Lower albumin and PNI scores were significantly associated with higher mortality at all time points (P<0.001). PNI demonstrated moderate predictive accuracy (AUC=0.659), while HALP had limited but statistically significant predictive value (AUC=0.577, P=0.030). SII did not show statistically significant prognostic value (AUC=0.549, P=0.166). Multivariate analysis showed PNI and HALP are independent predictors of long-term mortality. CONCLUSIONS PNI and HALP are practical, cost-effective tools with prognostic utility in elderly patients with femoral fractures. Early identification of high-risk individuals using these biomarkers may facilitate targeted interventions and improved outcomes. Future multicenter prospective studies are warranted for external validation.

PMID:41482700 | DOI:10.12659/MSM.950481

Aging Cell. 2026 Jan;25(1):e70362. doi: 10.1111/acel.70362.

ABSTRACT

Age-varying DNA methylation sites reflect increasing interindividual epigenetic divergence during aging, offering insights into health heterogeneity and potential for personalized interventions. Leveraging longitudinal DNA methylation data (3 waves over 5 years) from 135 relatively healthy Chinese older adults in the Rugao Longitudinal Ageing Study, we systematically characterized dynamic DNA methylation changes with age via mixed-effects modeling, identifying 125,353 age-associated (i.e., sites showing significant shifts in average methylation levels with age) and 3145 age-varying CpG sites (i.e., sites showing significant interindividual variability in methylation trajectories with age). Functional analysis revealed distinct enrichment profiles: age-associated CpG sites were enriched in nervous system development, cell signaling, and disease-related pathways, whereas age-varying CpG sites were enriched in cell adhesion, synaptic organization, and organ morphogenesis pathways. Notably, both categories showed significant enrichment in nervous system-related pathways, such as regulation of nervous system development and neuronal cell body. Established epigenetic clocks (e.g., HannumAge) were significantly enriched for age-associated CpG sites but not for age-varying sites. Furthermore, we quantified the pace of aging across eight major organ systems and identified 925 significant associations between organ-specific pace of aging and longitudinal methylation change rates at age-varying CpG sites. Pathway enrichment analysis revealed organ system-relevant biological functions-CpG sites associated with a given organ system were often enriched in pathways relevant to that system’s function-with additional evidence of cross-system enrichment. Together, our findings elucidate the role of methylation variability in multi-organ systems aging and its potential for revealing mechanisms of aging heterogeneity and guiding precision monitoring and interventions.

PMID:41482678 | DOI:10.1111/acel.70362

Nurs Health Sci. 2026 Mar;28(1):e70283. doi: 10.1111/nhs.70283.

ABSTRACT

This study aimed to evaluate the validity and reliability of the Turkish version of the Health Protection Behavior Scale (HPBS). The study was conducted using a two-stage cross-cultural research design in accordance with STROBE guidelines. Data were analyzed using descriptive statistics and exploratory factor analysis (EFA), without performing confirmatory factor analysis (CFA) to avoid the use of the same dataset for model derivation and validation. The overall Cronbach’s alpha for the scale was 0.851, indicating high internal consistency. In terms of construct validity, the Healthy Lifestyle Behaviors Scale II and the WHOQOL-BREF showed strong and moderate positive correlations, respectively (p < 0.05). The psychometric properties of the Turkish version of the HPBS are generally good and acceptable.

PMID:41482673 | DOI:10.1111/nhs.70283