Category: Statistics

Int Angiol. 2026 Mar 18. doi: 10.23736/S0392-9590.26.05521-5. Online ahead of print.

ABSTRACT

BACKGROUND: Evaluate mid-term outcomes, including amputations and mortality, in patients with critical limb-threatening ischemia (CLTI) deemed unsuitable for vein bypass surgery undergoing endovascular treatment in the femoropopliteal segment.

METHODS: A retrospective analysis was conducted including all patients undergoing endovascular treatment for CLTI at a university hospital between 2013-2017. Kaplan-Meier (KM) analyses estimated survival probabilities, and major amputation rates were compared between genders and diabetic versus non-diabetic patients.

RESULTS: One hundred thirty-four patients and 142 limbs were included. 49% of lesions classified as TASC-II D. Technical success was achieved in 95% of limbs. Median follow-up was 24 months (IQR: 13-36 months). 31% had died by study conclusion. KM-estimated freedom from all-cause mortality was 67% (95% CI: 59-77%) at 48 months. The major amputation rate was 25% (N.=35 limbs). KM-estimated freedom from major amputation was 64% (95% CI: 48-85%) at 46 months. There was no significant difference in major amputation-free survival between genders: females 76% (95% CI 63-91%) vs males 70% (95% CI 60-82%) at 36 months. The rate of major amputations was higher in patients with diabetes (19/55, 35% vs. 16/87, 18%, P=0.048), however, KM-estimates showed no statistically significant difference over time, P=0.570.

CONCLUSIONS: In this CLTI cohort unsuitable for vein bypass surgery, 25% underwent major amputation and 31% died following endovascular treatment during a median follow-up of 24 months. Larger comparative studies, including conservative treatment, are needed to define optimal management for complex femoropopliteal lesions.

PMID:41848486 | DOI:10.23736/S0392-9590.26.05521-5

J Nutr Educ Behav. 2026 Mar 17:S1499-4046(26)00040-0. doi: 10.1016/j.jneb.2026.02.004. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the relationship between adult intuitive eating and perceived food security during childhood.

METHODS: A survey was conducted consisting of the Intuitive Eating Scale-2 and the 6-item short form of the US Household Food Security Module modified to assess perceived food security status in participants aged 0-17 years. Student, faculty, and staff participants (n = 331) were primarily White, women, and aged 18-24 years. Analyses included descriptive statistics, Mann-Whitney U tests, and Kendall’s Tau-b correlations.

RESULTS: Overall, perceived childhood food insecurity was negatively correlated with adult intuitive eating (T_b = -0.1, P = 0.03) and body-food choice congruence (T_b = -0.1, P = 0.03). When stratified by gender, among women, perceived childhood food insecurity was negatively correlated with adult intuitive eating (T_b = -0.1, P = 0.04).

CONCLUSIONS AND IMPLICATIONS: Perceived childhood food insecurity and adult intuitive eating warrant further exploration to identify those who may benefit from intuitive eating education.

PMID:41848476 | DOI:10.1016/j.jneb.2026.02.004

J Foot Ankle Surg. 2026 Mar 17:S1067-2516(26)00045-1. doi: 10.1053/j.jfas.2026.02.009. Online ahead of print.

ABSTRACT

BACKGROUND: Comparative trials evaluating surgical outcomes are critical in guiding treatment for hallux valgus. However, the statistical stability of these outcomes is not well documented. Purpose The purpose of this study was to evaluate the statistical fragility of comparative studies analyzing minimally invasive surgery (MIS) versus open techniques for hallux valgus correction.

STUDY: Design A systematic review identified comparative studies assessing MIS versus open hallux valgus correction.

METHODS: Outcome data were extracted with Fragility Index (FI) and Continuous Fragility Index (CFI) calculated for significant outcomes, and reverse FI (rFI) and reverse CFI (rCFI) for nonsignificant outcomes. Fragility Quotient (FQ) was calculated for each and compared to the number of patients lost to follow-up (LTFU).

RESULTS: Of 628 studies screened, 18 met inclusion criteria, totaling 1,369 patients. Among 88 dichotomous outcomes, the median FI was 2, FQ was 0.021, rFI was 4, and rFQ was 0.072. For 236 continuous outcomes, the median CFI was 8, CFQ was 0.116, rCFI was 19, and rCFQ was 0.280.

CONCLUSION: This is the first study to evaluate fragility in comparative trials on MIS versus open hallux valgus correction and among the first to assess reverse fragility in continuous outcomes. Significant results were more fragile than nonsignificant data and dichotomous outcomes were more fragile than continuous ones with nearly a quarter having an FI lower than the number of patients LTFU. Both outcome types demonstrated considerable statistical fragility supporting the cautious interpretation of MIS vs open hallux valgus findings and the reporting of statistical fragility data alongside P-values to better contextualize the robustness of clinical research.

PMID:41848475 | DOI:10.1053/j.jfas.2026.02.009

J Am Coll Cardiol. 2026 Mar 10:S0735-1097(26)00328-1. doi: 10.1016/j.jacc.2026.01.076. Online ahead of print.

ABSTRACT

BACKGROUND: Coronary artery disease (CAD) polygenic risk score (PRS), low-density-lipoprotein cholesterol (LDL-C), lipoprotein(a) (Lp(a)), and high-sensitivity C-reactive protein (hsCRP) are biomarkers that predict CAD. It is unclear whether integrating genomics with lipid and inflammatory biomarkers could complement traditional risk scores in identifying people at risk of CAD.

OBJECTIVES: This study assesses the predictive value of CAD PRS, LDL-C, Lp(a), and hsCRP for incident CAD across different age and sex groups.

METHODS: Participants (n = 215,695) from the UK Biobank aged 40 to 69 years with baseline CAD PRS, LDL-C, Lp(a), and hsCRP values were followed for 12 years to assess the incidence of CAD. We evaluated a multivariable-adjusted Cox model that included all 4 biomarkers, net reclassification index, C-statistics, and population attributable risk across different age and sex groups.

RESULTS: Over a 12-year follow-up, 4,721 men and 2,425 women developed CAD. The HRs for incident CAD associated with each biomarker elevation were 1.79 (95% CI: 1.70-1.89) for CAD PRS, 1.60 (95% CI: 1.48-1.66) for LDL-C, 1.20 (95% CI: 1.12-1.29) for Lp(a), and 1.64 (95% CI: 1.57-1.72) for hsCRP. CAD PRS demonstrated a stronger association in men (HR per SD: 1.49; 95% CI: 1.45-1.54) than women (HR per SD: 1.37; 95% CI: 1.31-1.44; P-interaction ≤ 0.001). All biomarkers conferred greater HRs at younger ages (P < 0.0001). Individuals with all biomarkers elevated had a 4.65-fold increased risk of CAD compared with those with no elevated biomarkers. A combined 4-biomarker model had a higher C-statistic of 0.753 compared with the pooled cohort equations (C-statistic of 0.740). The C-statistic of the combined 4-biomarker model was also higher in younger individuals in both sexes and yielded a 32.0% continuous net reclassification index when compared with the pooled cohort equations.

CONCLUSIONS: CAD PRS, LDL-C, hsCRP, and Lp(a) show independent age- and sex-specific associations with CAD. Measuring all 4 biomarkers may improve midlife CAD risk prediction for both male and female patients.

PMID:41848465 | DOI:10.1016/j.jacc.2026.01.076

Stat Med. 2026 Mar;45(6-7):e70465. doi: 10.1002/sim.70465.

ABSTRACT

Publication bias (PB) poses a significant threat to meta-analysis of diagnostic studies, as studies yielding significant results are more likely to be published in scientific journals, leading to the synthesized diagnostic capacity possibly being overestimated. Sensitivity analysis provides a flexible method to address PB by assuming different proportions of unpublished studies. Most existing methods addressing PB in meta-analysis of diagnostic studies are based on the bivariate normal model using normal approximations. However, they are unsuitable for meta-analysis with sparse data, which is common in diagnostic studies with high sensitivities or specificities. Alternatively, the bivariate binomial model relies on the exact within-study model and has better finite sample properties. To address PB in the bivariate binomial model, we model the selective publication process of diagnostic studies by extending the Copas t-statistic model and propose the likelihood conditional on published and estimation strategies. Our proposal provides an interpretable way to address PB on the summary receiver operating characteristic curve, an essential tool for synthesizing diagnostic accuracy. We show the practicability of the proposed method on several real-world meta-analyses of diagnostic studies and evaluate the performance by simulation studies.

PMID:41847888 | DOI:10.1002/sim.70465

Emerg Med Australas. 2026 Apr;38(2):e70245. doi: 10.1111/1742-6723.70245.

ABSTRACT

OBJECTIVE: The National Blood Authority (NBA) provides a Major Haemorrhage Protocol (MHP) template for Australian hospitals to develop and modify an MHP algorithm for their needs. However, it is unclear whether the evidence-based guidance from NBA is utilised by individual facilities. The aims of this study were to: (1) establish the baseline composition of MHP from public hospitals across Queensland and (2) compare content using the NBA algorithm and evidence-based recommendations.

METHODS: An explanatory qualitative design was used. Individual health service MHP were assessed against the NBA algorithm by a minimum of two members of the research team.

RESULTS: Seventy-eight MHP algorithms were retrieved from 113 hospitals and health facilities within Queensland. 99% (n = 77) of algorithms provided recommendations for red blood cell delivery and fibrinogen replacement. Variations existed on the availability of fresh blood products between hospitals and geographical locations. 90% of algorithms (n = 70) contained activation criteria; 21% (n = 14) incorporated additional non-NBA specific criteria. Less than half of MHP algorithms (n = 30, 40%) contained information regarding the management of critically bleeding paediatric patients.

CONCLUSION: There is significant variability in the content of MHP algorithms across Queensland, Australia, despite the availability of evidence-based guidelines for patients who are severely bleeding. Whilst individual health facilities are encouraged to modify MHPs to suit local contexts, the evidence on how to safely accomplish this remains limited and could account for the variations identified in this study. Further guidance is required for hospitals with restricted access to blood products, limited pathology testing capabilities, and who manage critically bleeding paediatric patients.

PMID:41847872 | DOI:10.1111/1742-6723.70245

Eur J Public Health. 2026 Mar 14;36(2):ckag029. doi: 10.1093/eurpub/ckag029.

ABSTRACT

With increasing life expectancy, multimorbidity represents a growing global challenge, affecting quality of life. We analyzed electronic health records of individuals aged 45-74 from Catalonia, Spain (2007-2021), who were healthy at the end of 2007. We use sequence and cluster analysis to describe and categorize monthly disease accumulation patterns, from healthy to one or multiple conditions or death, involving four disease groups with the highest global morbidity and mortality burdens. We further investigate the association between identified clusters and sociodemographic factors and the association of cluster membership with healthcare utilization. Approximately 36% of individuals remained healthy throughout the study, while the remainder transitioned to single or multiple morbidity and/or died. A higher number of conditions in a given month increased transition probability, with metabolic and hypertensive conditions being the most common entry points. We identified nine disease accumulation trajectories linked to sociodemographic characteristics: Women were more likely to be in clusters involving neurodegenerative conditions and men in those involving cardiovascular and cancer conditions. Higher-income individuals were more likely to be in lower morbidity clusters, except the cancer multimorbidity cluster. Healthcare utilization was elevated in all clusters relative to the healthy group, with notably higher emergency use in cardiovascular clusters and more hospital admissions in cancer-related clusters. The study shows that disease accumulation follows identifiable patterns linked to sociodemographic factors and underscores the propagative nature of multimorbidity. Further, healthcare utilization is shaped more by condition type than by the number, highlighting the need for targeted health services.

PMID:41847870 | DOI:10.1093/eurpub/ckag029

Eur J Public Health. 2026 Mar 14;36(2):ckag028. doi: 10.1093/eurpub/ckag028.

ABSTRACT

Vaccination is a modifiable behaviour resulting from a complex decision-making process influenced by a wide range of factors, including the ‘7Cs’ model (confidence, complacency, constraints, calculation, collective responsibility, compliance, and conspiracy) and the ability to find, understand, evaluate and use vaccine information. This work aimed to analyse the intention to receive a booster dose of the COVID-19 vaccine in Spain in the subsequent rollout of the COVID-19 vaccination campaign and how it was influenced by COVID-19 vaccination health literacy and the ‘7Cs’ determinants of vaccine hesitancy. A descriptive cross-sectional study was conducted in February 2022 using an online survey. The sample comprised 1067 participants aged 18 or older, representative of the Spanish general population. Willingness to receive an additional booster dose of the COVID-19 vaccine was assessed using a single yes/no answer question. Determinants of vaccine readiness were evaluated through seven statements aligned with the 7Cs model, adapted to the COVID-19 context. A multivariable logistic regression showed that vaccination intention was influenced by Confidence (OR = 3.79; 95% CI = 2.58-5.58), Calculation (OR = 0.63; 95% CI = 0.45-0.90), Collective Responsibility (OR = 0.52; 95% CI = 0.32-0.86), Compliance (OR = 2.10; 95% CI = 1.42-3.09), Conspiracy (OR = 0.46; 95% CI = 0.29-0.74), and vaccine related HL (OR = 1.03; 95% CI = 1.02-1.06). Fostering vaccination health literacy, strengthening trust in science and health professionals, fighting misinformation and enhancing collective responsibility are relevant aspects for designing effective vaccination campaigns.

PMID:41847868 | DOI:10.1093/eurpub/ckag028

Toxicol Mech Methods. 2026 Mar 18:1-16. doi: 10.1080/15376516.2026.2645333. Online ahead of print.

ABSTRACT

Arsenic (As) and cadmium (Cd) frequently co-occur in groundwater and target renal proximal tubules. Although each metal can engage ferroptosis pathways, how co-exposure shapes the integrated transcript-protein-lipid ROS axis remains unclear. Human HK-2 cells were exposed for 24 h to commonly used experimental concentrations of As (10 µM), Cd (10 µM), or As + Cd (5 µM + 5 µM). We profiled (i) a focused ferroptosis/oxidative stress gene panel and visualized Z-score heatmaps; (ii) ferroptosis-related proteins (GPX4, SLC7A11, ACSL4, PTGS2, TFR1, ferritin heavy/light chains (FTH/FTL), LC3, Bax/Bcl-2, cleaved caspase-3) by Western blot with densitometric analysis; and (iii) lipid peroxidation using BODIPY 581/591 C11 imaging (oxidized green/reduced red). Statistical analyses were performed using one-way ANOVA followed by Tukey’s post hoc test. These readouts were interpreted alongside measurements of cell viability, ROS, MDA, and metabolomics profiling. Co-exposure produced the most coherent transcriptional shifts across modules regulating iron handling, glutathione-cysteine metabolism, lipid remodeling, CoQ/mitochondrial function, macroautophagy, and NRF2 signaling. Protein analyses corroborated pathway activation: GPX4 and SLC7A11 decreased, whereas ACSL4, PTGS2, and TFR1 increased. FTH/FTL exhibited a downward trend, and LC3-II levels increased, consistent with impaired peroxide detoxification, enhanced polyunsaturated fatty acid (PUFA)-phospholipid acylation, increased iron import, and autophagy engagement. BODIPY C11 imaging revealed the highest oxidized fraction in the As + Cd group, indicating a maximal lipid-peroxide burden. As and Cd act cooperatively to (1) weaken the GPX4-xCT (cystine/glutamate antiporter; SLC7A11) antioxidant axis, (2) increase iron availability and iron-handling stress, and (3) remodel membrane PUFA pools, collectively tipping renal epithelial cells toward ferroptosis. These multi-layer signatures nominate ferroptosis inhibition and iron handling as potential therapeutic targets for mixed-metal nephrotoxicity.

PMID:41847867 | DOI:10.1080/15376516.2026.2645333

Acta Odontol Scand. 2026 Mar 18;85:116-124. doi: 10.2340/aos.v85.45574.

ABSTRACT

OBJECTIVE: This study aimed to investigate the following: (1) the preferences of public dentists for procedures and materials in carious or non-carious pulp exposure of permanent teeth; (2) how factors such as clinical experience, scientific literature reading, and material availability affect their choices; (3) the self-assessed risk of root canal treatment after pulp capping.

MATERIALS AND METHODS: An online questionnaire consisting of 20 multiple choice and open-ended questions was e-mailed to Norwegian public dental clinics. It assessed dentists’ material preferences for direct pulp capping for carious or non-carious exposures, alongside factors such as years since graduation, scientific literature engagement, availability of materials, and clinical scenario choices. Respondents were also asked to estimate and reason long-term outcomes of their chosen materials. Standardized case descriptions ensured shared clinical understanding. Data were statistically analyzed and p-values ≤ 0.05 were considered statistically significant.

RESULTS: A total of 218 (23.9%) dentists responded. Direct pulp capping was preferred by 65% of respondents, with chemically curing materials – primarily calcium hydroxide – being most used. Chi-square analyses showed that dentists with fewer years of experience and those who had read scientific literature were more likely to prefer calcium silicate materials; however, these variables were not statistically significant predictors in the logistic regression models. Material availability was the strongest predictor of preference, with significantly increased odds of selecting calcium silicates or light-curing materials when available. ‘Satisfied with clinical results for the chosen material’ was the most frequently reported reason for material selection.

CONCLUSION: Most respondents in this study preferred calcium hydroxide for direct pulp capping in permanent teeth with closed apices, despite the superior clinical outcomes of hydraulic calcium silicates. Material availability in the clinic was the primary factor influencing dentists’ choices, surpassing clinical experience and scientific literature engagement.

PMID:41847838 | DOI:10.2340/aos.v85.45574