Category: Statistics

Environ Pollut. 2026 Aug 29:129060. doi: 10.1016/j.envpol.2026.129060. Online ahead of print.

ABSTRACT

Ambrosia artemisiifolia is a climate-sensitive invasive species whose airborne pollen constitutes a major allergenic burden across Central Europe. Operational forecasting is constrained by monitoring system design: conventional Hirst-type samplers involve processing delays that preclude real-time data availability, whereas automated systems provide near-instantaneous data. This study evaluates exceedance-based forecasting under these two paradigms across eight urban sites in Slovakia and the Czech Republic, spanning a gradient from high to minimal ragweed abundance. The real-time scenario was simulated by assuming immediate availability of Hirst-type data rather than using measurements from automated pollen monitors. Four elastic net-penalised logistic regression models incorporating seasonal, meteorological, and Ambrosia pollen history predictors were evaluated across forecast horizons of 1-7 days using an expanding window cross-validation. Exceedance thresholds were 20 pollen/m³ (Slovak sites) and 5 pollen/m³ (Czech sites). Forecast performance was strongly governed by exceedance prevalence. At Slovak sites (prevalence 8-17%), the best real-time models generally achieved higher F1 scores at a 1-day horizon (0.67-0.82) than the best delayed-reporting models (0.59-0.72). At Czech sites (prevalence below 3%), F1 scores rarely exceeded 0.30, and sensitivity was a more informative metric under severe class imbalance. The real-time advantage diminished progressively with forecast horizon, converging towards delayed-reporting performance at day 7. Sunshine duration and maximum temperature were the most consistently positive predictors, relative humidity was predominantly positive across most sites, whereas precipitation and wind speed showed weaker, less consistent associations. These findings provide a transferable framework for ragweed pollen early warning systems adaptable to heterogeneous monitoring infrastructure.

PMID:42668132 | DOI:10.1016/j.envpol.2026.129060

J Gynecol Obstet Hum Reprod. 2026 Aug 29:103262. doi: 10.1016/j.jogoh.2026.103262. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the association between air travel during early pregnancy and the risk of spontaneous miscarriage.

SETTING: This population-based retrospective cohort study included completed singleton pregnancies ending in either a first-trimester spontaneous miscarriage or a live birth between 2010 and 2019. Only pregnancies with a confirmed last menstrual period (LMP) date were included to ensure accurate temporal assessment of air travel in relation to pregnancy outcome.

METHODS: Singleton pregnancies resulting in live birth were compared with those ending in spontaneous miscarriage during the first trimester. Air travel between 4+0 and 13+6 weeks of gestation was defined as the primary exposure. Spontaneous miscarriage was identified using ICD-9 codes. Multivariable logistic regression was performed to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI).

RESULTS: A total of 439,990 pregnancies were analyzed, including 427,727 live births (97.2%) and 12,263 miscarriages (2.8%). Air travel during the first trimester was more common among women who experienced miscarriage compared to those with live births (0.01 % vs. 0.00014 %, P < 0.001). After adjustment for potential confounders, air travel was associated with more than fivefold higher odds of miscarriage (aOR 5.20, 95% CI 4.38-6.33).

CONCLUSION: Air travel during the first trimester was associated with an increased risk of spontaneous miscarriage. While causality cannot be established, these findings may have implications for counseling women considering air travel during early pregnancy.

PMID:42668118 | DOI:10.1016/j.jogoh.2026.103262

J Dent. 2026 Aug 29:107005. doi: 10.1016/j.jdent.2026.107005. Online ahead of print.

ABSTRACT

BACKGROUND: The association between sustained anterior head flexion during portable electronic device use and neuromuscular function remain poorly understood. This study aimed to investigate the relationship between TMD status, the HT operational classification, and the surface electromyographic activity of the masticatory muscles.

METHODS: This cross-sectional study included 100 adults (63 F, 37 M; mean age 32.4 ± 11.3 years), equally distributed into four groups according to TMD status and HT classification. HT operational classification was defined by portable electronic device-use duration and an illustrated postural scale. Surface electromyography was recorded during clenching in the neutral head position and during 40°-60° anterior head flexion. POC TA, POC MM, Asymmetry Index, Activity Index, Torque Index, and Impact were analyzed. Main effects and interactions were assessed using Scheirer-Ray-Hare tests, and within-group changes using paired Wilcoxon tests. Statistical significance was set at p < 0.05. Multiple related comparisons were adjusted using the Benjamini-Hochberg false discovery rate procedure (FDR).

RESULTS: TMD status was significantly associated with POC TA, POC MM, Asymmetry Index, and Torque Index in both positions (all pFDR ≤ 0.027). HT operational classification was significantly associated with Activity Index in both conditions (both pFDR < 0.001). Activity Index decreased during flexion in all groups (all pFDR ≤ 0.041), but the magnitude of change did not differ by TMD status, HT operational classification, or their interaction (all p ≥ 0.205).

CONCLUSIONS: TMD status and HT operational classification showed distinct associations with the investigated sEMG parameters. Participants with TMD exhibited lower muscular symmetry and greater imbalance, whereas HT operational classification was associated primarily with differences in temporalis-masseter recruitment. Activity Index emerged as a potentially posture-sensitive parameter. However, TMD-related findings should be interpreted cautiously because the analyses were not adjusted for demographic differences.

CLINICAL RELEVANCE: Activity Index may represent a potentially posture-sensitive sEMG parameter reflecting posture-associated differences in neuromuscular function; however, its clinical, diagnostic, and prognostic relevance remains to be established.

PMID:42668105 | DOI:10.1016/j.jdent.2026.107005

J Nutr. 2026 Aug 29:101813. doi: 10.1016/j.tjnut.2026.101813. Online ahead of print.

ABSTRACT

BACKGROUND: Adolescence is a period of rapid growth and rising nutrient needs, with girls facing additional iron requirements from menstrual losses, yet Food-Based Dietary Guidelines (FBDGs) in many low- and middle-income countries (LMICs) inadequately address these needs.

OBJECTIVE: This study assessed the adequacy and equity of national FBDGs and government-run adolescent nutrition programs in supporting adolescent nutrition and anemia prevention across eight LMICs in Africa and Asia.

METHODS: A structured desk review of national FBDGs and government-led adolescent nutrition programs was conducted across Ethiopia, Kenya, Nigeria, Tanzania, Bangladesh, India, Indonesia, and Pakistan, with specific focus on adolescents’ nutritional needs, particularly iron; cultural and economic relevance; behavioral communication strategies; and equity considerations. Documents were identified via the FAO FBDG repository, government websites, WHO/UNICEF/World Bank sources, and Nutrition International offices, with duplicate screening and extraction by two independent reviewers, discrepancies resolved by a third. Iron recommendations were cross-referenced against FAO/INFOODS food composition data, and iron-source food affordability, seasonality, and accessibility were rated by two independent reviewers on a 5-point scale, reconciled by a third. No statistical hypothesis testing was performed.

RESULTS: Thirty-one documents were identified (8 national FBDGs, 10 communication materials, 13 program documents). Most FBDGs lacked age- and gender-specific recommendations and gave only general iron guidance despite elevated anemia risk among adolescent girls; iron supplementation and fortification recommendations were inconsistent and poorly aligned with national anemia programs. Adolescent-friendly communication and equity considerations, particularly for out-of-school, rural, and marginalized adolescents, were largely absent.

CONCLUSIONS: Among the FBDGs and program documents reviewed across eight LMICs, adolescent-specific guidance on iron, communication, and equity remains substantially underdeveloped. Strengthening FBDGs through adolescent-specific recommendations and closer alignment with supplementation/fortification programs could improve the relevance of adolescent nutrition guidance; effects on dietary behavior or anemia reduction were not assessed and warrant prospective evaluation.

PMID:42668094 | DOI:10.1016/j.tjnut.2026.101813

J Acad Nutr Diet. 2026 Aug 29:156839. doi: 10.1016/j.jand.2026.156839. Online ahead of print.

ABSTRACT

BACKGROUND: Store checkouts are key retail locations that promote impulse purchases of unhealthy foods and beverages. Perris, California, became the second U.S. jurisdiction-following Berkeley, California-to adopt a healthy checkout policy to improve the nutritional quality of items displayed at checkout.

OBJECTIVES: To assess the healthfulness of food and beverage facings at retail store checkouts in Perris and three neighboring Southern California cities, prior to the implementation of the policy.

DESIGN: Cross-sectional observational study using in-store audits on all checkout product facings at sampled checkouts.

SETTING: Product-level data at checkouts were collected in June 2023 from 19 stores in Perris and 69 matched stores in Moreno Valley, Rialto, and Riverside, California. Stores included chain supermarkets, chain drugstores, chain convenience stores, chain dollar stores, chain mass merchandisers, and independent grocery stores. A total of 42,294 product facings were included in the analysis.

MAIN OUTCOME MEASURES: The main outcome was the proportion of food and beverage facings at checkout in Southern California that met the nutritional standards of Perris’ healthy checkout ordinance (HCO). For comparison, the analysis also examined this proportion using Berkeley’s HCO standards.

STATISTICAL ANALYSES PERFORMED: Descriptive analyses and log-binomial regression with robust standard errors clustered by store and checkout location were used to estimate the proportion of healthy food and beverage facings and compare differences by location, store type, and checkout staffing.

RESULTS: Only 33% of food and beverage checkout facings were considered healthy under Perris’ standards, and only 22% under Berkeley’s. The most common food and beverage categories at checkouts were candy (35%), gum (14%), salty snacks (13%), sugar-sweetened beverages (12%), and mints (6%). Water accounted for 2%, and fruits and vegetables for less than 1%. The percentage of checkout foods and beverages meeting Perris’ standards was lowest at checkout endcaps and independent grocery stores.

CONCLUSIONS: Most checkout foods and beverages were unhealthy before the implementation of a healthy checkout policy. To improve checkouts, healthy checkout policies should include the entire checkout (e.g., including endcaps where most SSBs are located) and cogent nutritional standards such as those in Berkeley’s HCO.

PMID:42668086 | DOI:10.1016/j.jand.2026.156839

J Acad Nutr Diet. 2026 Aug 29:156837. doi: 10.1016/j.jand.2026.156837. Online ahead of print.

ABSTRACT

BACKGROUND: The consumption of ultra-processed foods (UPF) has been associated with diseases in which inflammation plays a key role. The Dietary Inflammatory Index (DII) was developed as a tool to estimate the inflammatory potential of the diet; however, the association between UPF consumption and higher DII scores remains insufficiently explored.

OBJECTIVE: To investigate the association between UPF consumption and the DII.

DESIGN: This was a cross-sectional study.

PARTICIPANTS: /Setting: Data from 36,669 adults enrolled in the NutriNet-Brasil cohort between 2020 and 2025 were analyzed.

MAIN OUTCOME MEASURES: The outcome was the DII, calculated as proposed in previous studies, based on dietary components such as macronutrients, vitamins, minerals, and bioactive compounds STATISTICAL ANALYSES: UPF contribution to energy intake was estimated using the mean of 2-3 24-hour recalls (Nova24h). Associations between UPF consumption (percentage of energy, in quintiles and as a continuous variable) and the DII were analyzed using multiple linear regression models.

RESULTS: The mean DII was 1.31 (95% CI: 1.28-1.33) and mean UPF contribution was 22.7%, ranging from an average of 7.50% (Q1) to 41.14% (Q5). In adjusted models, the DII increased linearly across quintiles of UPF intake (p for linear trend < 0.001). The estimated DII score in the highest quintile (Q5: 2.57) was eleven times higher than in the lowest quintile (Q1: 0.22), demonstrating a strong positive association between UPF consumption and the pro-inflammatory potential of the diet. As a continuous variable, each 10% increase in UPF energy was associated with a 0.70-point higher DII (p <0.001).

CONCLUSIONS: Higher UPF consumption was associated with a more pro-inflammatory dietary pattern. These findings highlight the potential role of UPF consumption in shaping the inflammatory potential of the diet and support further research on its implications for diet-related health outcomes.

PMID:42668084 | DOI:10.1016/j.jand.2026.156837

Pharmacol Res. 2026 Aug 29:108420. doi: 10.1016/j.phrs.2026.108420. Online ahead of print.

ABSTRACT

BACKGROUND: This systematic review and meta-analysis aimed to comprehensively evaluate the prognostic impacts of seven classes of antidiabetic medications in patients with cancer, predominantly in the setting of concomitant type 2 diabetes mellitus (T2DM), and to elucidate their potential differential effects.

METHODS: A systematic search of PubMed, Embase, Cochrane Library, and the Web of Science was conducted from inception to May 2025, utilizing keywords including “antidiabetic drugs,” “cancer,” and “prognosis.” Based on predefined criteria, eligible English-language randomized controlled trials and cohort studies were included if they compared the prognostic impacts of metformin, insulin, sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and thiazolidinediones in patients with cancer. The primary outcome domain was all-cause survival, represented by all-cause mortality (ACM) or overall survival (OS) according to the terminology of the original studies. Secondary cancer-related outcomes included cancer-specific mortality (CSM), disease-free survival (DFS), progression-free survival (PFS), and recurrence-free survival (RFS). Multiple independent investigators performed data extraction and quality assessment. Statistical analyses were performed using OnlineMeta V1.1. DerSimonian-Laird random-effects models were used for all primary meta-analyses to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), while fixed-effects estimates were examined as complementary sensitivity analyses. Study quality was assessed using the Newcastle-Ottawa Scale and the Cochrane risk-of-bias tool for randomized trials.

RESULTS: A total of 61 studies comprising 1,106,966 patients with cancer were included. Metformin use was associated with lower ACM (HR=0.82, 95% CI: 0.74-0.91, P=0.0001) and CSM (HR=0.77, 95% CI: 0.69-0.87, P<0.0001), whereas insulin use was associated with higher ACM (HR=2.03, 95% CI: 1.63-2.51, P<0.0001). Among the drug classes analyzed, SGLT2 inhibitor use showed a nonsignificant inverse trend with ACM (HR=0.44, 95% CI: 0.11-1.71, P=0.24) and was associated with lower CSM (HR=0.21, 95% CI: 0.20-0.22, P<0.0001), although these estimates were based on few observational studies with study-specific comparator groups and do not establish superiority over other drug classes. In adjusted-HR-only sensitivity analyses, the direction of association was generally consistent for the major metformin outcomes and insulin-related ACM, whereas several other comparisons were attenuated or could not be pooled because too few studies reported adjusted estimates.

CONCLUSION: This meta-analysis identified heterogeneous associations between antidiabetic drug use and cancer-related survival outcomes, with variation across drug classes, cancer types, and study-level mean age groups. Because the evidence was derived predominantly from observational studies with study-specific comparator groups, substantial between-study heterogeneity, and limited data for newer agents, the pooled estimates should not be interpreted as evidence of treatment superiority or used to rank drug classes. These findings are hypothesis-generating and warrant confirmation in prospective studies using clinically comparable treatment groups, standardized outcome definitions, and rigorous control of confounding.

PMID:42668074 | DOI:10.1016/j.phrs.2026.108420

J ISAKOS. 2026 Aug 29:101211. doi: 10.1016/j.jisako.2026.101211. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to objectively identify and describe intraoperative patellar tracking patterns in osteoarthritic knees and examine their relationship with coronal alignment according to the Coronal Plane Alignment of the Knee (CPAK) classification.

METHODS: A retrospective analysis was performed on 252 knees that underwent robotic-assisted primary total knee arthroplasty (TKA). Intraoperative patellar tracking was assessed prior to any bone cuts. Patellar tracking was recorded using a previously described technique with the CORI robotic system. Preoperative full-length standing radiographs were used to assess coronal alignment parameters. Knees were classified according to the CPAK classification. Associations between patellar tracking patterns and radiographic parameters were analyzed.

RESULTS: The mean age of the cohort was 71.4 ± 7.1 years. Pre-implantation patellar tracking was classified into three patterns: central tracking in 58% (n = 147), lateral tracking in 35% (n = 89), and medial tracking in 7% (n = 16). A statistically significant association was observed between coronal alignment category (varus, neutral, valgus) and coronal patellar tracking pattern (p = 0.006). Central tracking was more frequently observed in varus knees, whereas lateral tracking showed a relative predominance in neutral-to-valgus alignment. Consistently, lateral patellar tracking was associated with more valgus limb alignment.

CONCLUSION: Three distinct native coronal patellar tracking patterns were identified using robotic intraoperative assessment prior to implantation. Patellar tracking pattern was associated with coronal limb alignment, with lateral tracking relatively more frequent in neutral-to-valgus knees. The clinical significance of these passive intraoperative tracking patterns requires further investigation.

LEVEL OF EVIDENCE: Level III, Retrospective Comparative Cohort Study.

PMID:42668065 | DOI:10.1016/j.jisako.2026.101211

Rev Esp Med Nucl Imagen Mol (Engl Ed). 2026 Aug 29:500348. doi: 10.1016/j.remnie.2026.500348. Online ahead of print.

ABSTRACT

PURPOSE: Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is characterized by persistent symptoms. Fibroblast activation protein (FAP), expressed on activated fibroblasts during tissue remodeling, can be visualized with [⁶⁸Ga]Ga-FAPI PET/CT. This study investigated lung and muscle fibroblastic activity in patients with post-acute sequelae of COVID-19 (PASC) following moderate-to-severe COVID-19 pneumonia more than two years after the acute infection, using [⁶⁸Ga]Ga-FAPI PET/CT.

METHODS: In this pilot prospective observational study, we enrolled patients with PASC following severe acute COVID-19 requiring high-flow nasal cannula or mechanical ventilation and age- and sex-matched controls without pulmonary pathology between September 2023 and February 2024. PASC patients underwent high-resolution CT (HRCT), pulmonary function tests (PFTs), and [⁶⁸Ga]Ga-FAPI PET/CT. SUVmax and SUVmean were measured for each lung lobe. HRCT abnormalities were scored using a semi-quantitative scale (0-20) and categorized as ground-glass opacities, reticulations, parenchymal bands, traction bronchiectasis, or subpleural cysts. These findings were statistically compared and correlated with PET parameters, PFTs, and clinical symptoms. In addition, [⁶⁸Ga]Ga-FAPI uptake in the paravertebral muscles was assessed at the level of the L3 vertebra.

RESULTS: Twenty patients with PASC and 10 control subjects were included (median ages: 64 and 58.5 years, respectively). The mean interval between hospitalization for acute COVID-19 and study imaging was 25 ± 4.5 months. PASC patients exhibited significantly increased [⁶⁸Ga]Ga-FAPI uptake in the lungs compared with controls. Lung [⁶⁸Ga]Ga-FAPI uptake was markedly increased in patients with traction bronchiectasis. No correlations were observed between lung [⁶⁸Ga]Ga-FAPI SUVmax and PFTs or symptom burden. However, lung [⁶⁸Ga]Ga-FAPI SUVmean demonstrated moderate inverse correlation with DLCO (r = -0.455, p = 0.044). In addition, [⁶⁸Ga]Ga-FAPI SUVmax in muscle was significantly higher in PASC patients than in controls, with particularly elevated uptake observed in patients with a history of mechanical ventilation.

CONCLUSIONS: [⁶⁸Ga]Ga-FAPI PET/CT demonstrated increased lung tracer uptake in patients with PASC more than two years after moderate to severe COVID-19, supporting persistent fibroblast-related tissue activity. Limited associations between lung SUVmean and DLCO suggest a potential link between tracer uptake and functional impairment. Increased muscle [⁶⁸Ga]Ga-FAPI uptake was also observed as an exploratory finding requiring further functional and histopathological validation.

PMID:42668009 | DOI:10.1016/j.remnie.2026.500348

Am J Med Sci. 2026 Aug 29:S0002-9629(26)00357-5. doi: 10.1016/j.amjms.2026.08.025. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiorenal syndrome (CRS), characterized by cardiac-renal interplay, imposes a substantial clinical burden. Biological aging (BA), a comprehensive indicator for evaluating the overall aging status of an organism, is linked to individual cardiac or renal diseases, while its association with mortality in the CRS population remains unclear.

METHODS: We utilized data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. CRS was defined as chronic cardiorenal comorbidities, specifically the coexistence of self-reported cardiovascular disease and calculated chronic kidney disease. BA was calculated using 12 clinical biomarkers, including the Klemera-Doubal method BA (KDM-BA) and Phenotypic Age (PhenoAge). BA acceleration (BAA), quantified as residuals from linear regression of BA on chronological age, includes KDM-BAA and PhenoAge acceleration (PhenoAgeAccel). Cox proportional hazards model and restricted cubic spline were performed to investigate these associations. Results were presented as hazard ratios (HRs) with 95% confidence intervals (CIs).

RESULTS: 1,100 CRS participants were included in the final analysis. A 10-year increase in KDM-BA and PhenoAge in CRS participants was associated with 1.14-fold and 1.63-fold higher all-cause mortality risk, respectively. CRS participants with KDM-BAA (HR: 1.40, 95% CI: 1.13-1.73) or PhenoAgeAccel (HR: 1.54, 95% CI: 1.20-1.96) had elevated all-cause mortality risk. Meanwhile, these positive associations were more pronounced in males. Moreover, KDM-BA was associated with mortality from heart disease and cerebrovascular disease in the CRS population, with a non-linear relationship observed in cerebrovascular disease.

CONCLUSIONS: As composite indicators for aging, KDM-BA, PhenoAge, KDM-BAA, and PhenoAgeAccel are significantly associated with all-cause mortality among the CRS population. These measures may serve as potential prognostic biomarkers in this population.

PMID:42667983 | DOI:10.1016/j.amjms.2026.08.025