Category: Statistics

Malar J. 2026 Mar 4. doi: 10.1186/s12936-026-05847-7. Online ahead of print.

ABSTRACT

BACKGROUND: After substantial progress in malaria control, Ethiopia’s Amhara Region experienced a marked resurgence since 2018. The relative contributions of climate variability, environmental context, intervention coverage, and unmeasured factors to this resurgence remain inadequately quantified. This study used a Bayesian spatiotemporal framework to estimate factor associations with malaria incidence, decompose spatial versus temporal climate effects, and identify persistent hotspots.

METHODS: We conducted an ecological district-level panel analysis of 13,944 district-month observations from 166 districts (January 2018-December 2024). Monthly confirmed malaria counts (total, Plasmodium falciparum, P. vivax) were modelled using Bayesian hierarchical negative binomial regression with BYM2 spatial and AR(1) temporal random effects, fitted with integrated nested Laplace approximation. Covariates included lagged rainfall, temperature, NDVI, elevation, and programmatic indicators (ITN ownership, IRS protection, and larval source management [LSM] intensity). Climate covariates were decomposed into between-district (spatial) means and within-district (temporal) deviations. Sensitivity analyses included alternative IRS protection windows and district fixed-effects models.

RESULTS: A total of 5,746,571 confirmed cases were reported (64.3% P. falciparum, 35.7% P. vivax). Mean monthly incidence increased 5.5-fold from 1.19 per 1,000 (2018) to 6.53 per 1,000 (2024), while regional mean maximum temperature showed a small declining trend over the period. In fully adjusted models, higher lagged maximum temperature and rainfall were associated with higher incidence, and elevation was protective. IRS protection, higher ITN ownership, and higher LSM intensity were each associated with lower incidence; effect directions were consistent in within-district sensitivity analyses, although residual confounding and measurement error cannot be excluded. Climate-incidence associations were predominantly spatial (between-district) rather than temporal (within-district), suggesting that geographic ecological suitability explains much of the spatial patterning, rather than temporal warming trends explaining the resurgence. Districts with persistently elevated residual spatial risk (exceedance probability of residual RR > 1.25) clustered in low-elevation western border areas.

CONCLUSIONS: Malaria resurgence in Amhara (2018-2024) occurred alongside strong spatial climatic and elevational gradients and was not consistent with a temporal warming-driven explanation at the regional scale. Remaining unexplained spatiotemporal variation highlights the likely importance of unmeasured drivers (e.g., conflict-related service disruption, vector/insecticide resistance dynamics, and population mobility). Climate-informed, spatially targeted intervention packages prioritizing districts with persistently high residual risk are warranted.

PMID:41782025 | DOI:10.1186/s12936-026-05847-7

Mov Ecol. 2026 Mar 4. doi: 10.1186/s40462-026-00642-0. Online ahead of print.

ABSTRACT

Extreme weather events, such as tropical storms, can pose profound disruption to nearshore marine environments. Although coastal ecosystems are particularly vulnerable to storm impacts, research describing the response of marine taxa to extreme weather remains limited, especially for highly mobile marine predators. In this study, we use acoustic telemetry to investigate the behavioral responses of juvenile white sharks (Carcharodon carcharias) at a Southern California nursery aggregation site to Tropical Storm Hilary in 2023. To aid in these efforts, we developed a novel occupancy modeling approach to statistically account and correct for temporal variations in acoustic receiver performance during disruptive storm conditions. Using detection data from synchronization transmitters, we first estimated the effects of key environmental factors on transmitter detection efficiency, with ambient noise, receiver tilt, and the density of animal transmitters present inside the receiver array emerging as particularly influential predictors. We then leveraged these estimated effects to inform a Bayesian state space model designed to investigate nursery occupancy dynamics, including environmental drivers of nursery emigration. Our results provide evidence of partial nursery evacuation, with over half of tagged sharks temporarily leaving monitored nearshore habitats in response to peak storm conditions. However, most emigrations were short-lived, with all but one shark returning to the aggregation site within three weeks of the storm. Evacuations from nursery habitats were best predicted by falling sea surface temperatures, although increased wave height, declining barometric pressure, and drops in salinity may have served as important secondary flight cues. Our efforts provide a rare opportunity to document the storm response behaviors of a recovering top predator, while also presenting tangible analytical solutions to commonly encountered technical challenges in the field of acoustic telemetry.

PMID:41782015 | DOI:10.1186/s40462-026-00642-0

Malar J. 2026 Mar 4. doi: 10.1186/s12936-025-05752-5. Online ahead of print.

ABSTRACT

BACKGROUND: Maternal malaria and its sequelae, including maternal mortality and neonatal infection, represent a growing public health crisis in Sub-Saharan Africa, often exacerbated by underlying socioeconomic factors. The study seeks to assess the associations between maternal socioeconomic indicators, maternal malaria, and neonatal peripheral parasitaemia in a Nigerian hospital.

METHODS: A cross-sectional analysis of 85 mother-infant pairs was conducted at a hospital in Osogbo, Osun state, Nigeria. Well-structured questionnaires were used to collect maternal demographics, socioeconomic indicators, and preventive practices. Mother, cord blood, and neonatal peripheral blood samples were collected for parasitemia through microscopy. Descriptive statistics, Fisher exact and chi-square tests were used for categorical variables, and univariate logistic regression for continuous predictors.

RESULTS: The prevalence of neonatal peripheral parasitemia was 8.2% (7/85). Maternal parasitemia strongly predicted neonatal infection. All positive neonates were born to mothers with positive microscopy (7/19), whereas no neonates from parasitemia negative mothers were infected (p < 0.001). No statistically significant associations were found between neonatal parasitemia and maternal education (p = 0.912), occupation (p = 0.183), insecticide treated net use (p = 0.413), or intermittent preventive therapy uptake (p = 1.000).

CONCLUSIONS: The present study revealed maternal parasitemia as a primary risk factor for neonatal malaria. While socioeconomic factors showed no significant association in this small cohort, these preliminary findings highlighted the need for larger studies with refined socioeconomic measures to fully elucidate these relationships. This highlights the critical need for strengthening antenatal malaria screening, ensuring timely treatment of maternal infection, and enhancing community-based malaria education to reduce vertical transmission in high-burden regions like Osun State, Nigeria.

PMID:41781969 | DOI:10.1186/s12936-025-05752-5

Malar J. 2026 Mar 4. doi: 10.1186/s12936-026-05839-7. Online ahead of print.

ABSTRACT

BACKGROUND: Malaria is a major public health problem in Ethiopia, and long-lasting insecticide-treated nets (LLINs) are one of the primary preventive strategies used to control it. Gondar Zuria District, Central Gondar Zone’s highest malaria-reporting district, reached 100% LLIN coverage in 2023. However, malaria cases remain high, suggesting gaps in LLIN utilization. Therefore, this study aimed to assess LLIN usage and determinants in Gondar Zuria District.

METHODS: Community-based mixed-methods study was conducted from February 1 to 28, 2025 among 700 participants selected through multistage sampling. Quantitative data was collected via interviewer-administered questionnaires and entered into EpiData version 4.6.0.2 and exported to SPSS version 25 for analysis. A binary logistic regression model was fitted, and statistical significance was determined using 95% confidence intervals (CI) and a p-value ≤ 0.05. Qualitative data were collected through purposively sampled interviews (n = 7) and key informant interviews (n = 3) and analyzed thematically.

RESULTS: The prevalence of ITN utilization was 55.6% (95% CI: 51.9%-59.3%) and was significantly associated with perceived severity (AOR = 1.74; 95% CI: 1.27-2.39), LLINs-to-family size ratio (AOR = 2.09; 95% CI: 1.51-2.91), and occupation specifically, being a government employee (AOR = 3.45; 95% CI: 1.57-7.58). The mixed methods design therefore provided a more comprehensive understanding by revealing behavioral and contextual factors that were not captured through quantitative data alone. Qualitative findings complemented the quantitative results by explaining why LLIN utilization remained low, highlighting misconceptions about net safety, doubts about effectiveness, discomfort due to heat, and structural barriers such as lack of space for hanging nets.

CONCLUSION: LLIN utilization in Gondar Zuria District fell below the national target (100%). Misconceptions and misinformation contribute to irregular use and reduced trust. Beyond distribution and health education, community-based behavior changes strategies such as household follow-ups by health workers and integrating LLIN promotion into local forums alongside routine net condition monitoring are essential to improve consistent use and advance malaria elimination efforts.

PMID:41781949 | DOI:10.1186/s12936-026-05839-7

BMC Med Educ. 2026 Mar 4. doi: 10.1186/s12909-026-08915-3. Online ahead of print.

ABSTRACT

BACKGROUND: Emergency medicine residents perform invasive procedures under time pressure, clinical uncertainty, and medico-legal risk, which can generate substantial anxiety among residents themselves. In this study, anxiety refers specifically to the practitioners’ own emotional and cognitive responses while performing invasive procedures, rather than to patient-related anxiety. Although fear of malpractice and general anxiety have been studied, their relationship with procedure-specific anxiety and perceived clinical competence has not been examined in an integrated manner among emergency medicine residents.

METHODS: This two-phase cross-sectional study included 168 emergency medicine residents from emergency departments across Türkiye. An online survey assessed procedure-related anxiety, perceived procedural difficulty, procedural self-efficacy, fear of malpractice, and trait anxiety across nine invasive procedures. Descriptive statistics were calculated, gender differences were examined using independent samples t-tests, and associations among variables were analyzed using Pearson correlation coefficients.

RESULTS: Higher perceived procedural difficulty was strongly associated with higher procedure-related anxiety, while higher self-efficacy was strongly associated with lower anxiety. Greater training duration was linked to lower perceived difficulty and anxiety and to higher self-efficacy. Trait anxiety showed moderate positive associations with perceived difficulty and procedure-related anxiety and a negative association with self-efficacy. Fear of malpractice was only weakly associated with procedure-related anxiety and was unrelated to training duration or self-efficacy. Female residents reported higher general and procedure-specific anxiety than male residents. Lack of experience and fear of complications were the most frequently reported sources of anxiety, and supervision by more experienced physicians was the most commonly used and valued coping strategy.

CONCLUSIONS: Procedure-related anxiety among emergency medicine residents is closely related to perceived difficulty, self-efficacy, and clinical experience, whereas fear of malpractice appears to be a relatively stable background concern. These findings suggest that procedural anxiety is a modifiable educational outcome that can be addressed through structured supervision, simulation-based training, and supportive learning environments.

TRIAL REGISTRATION: Not applicable. This study is an observational cross-sectional survey and was not registered.

PMID:41781925 | DOI:10.1186/s12909-026-08915-3

BMC Gastroenterol. 2026 Mar 4. doi: 10.1186/s12876-026-04714-8. Online ahead of print.

ABSTRACT

BACKGROUND: Biliary tract cancers (BTCs) in East Asia have traditionally been linked to inflammation-related etiologies. However, metabolic risk factors are increasingly contributing to BTC development. Temporal trends in BTC epidemiology remain underexplored in the Korean population. This study aimed to review 13-year trends in BTCs, focusing on metabolic and inflammatory comorbidities, in a southeastern Korean cancer center historically characterized by a high incidence of inflammation-related BTCs.

METHODS: This retrospective observational study analyzed 2,001 patients diagnosed with BTC at a southeastern Korean cancer center between 2009 and 2021. Data on general demographics (age, sex, smoking, alcohol), metabolic factors (hypertension, body mass index (BMI) ≥ 25 kg/m², diabetes mellitus, hyperlipidemia), and inflammatory conditions (viral hepatitis, liver cirrhosis, bile duct stone, liver fluke infection) were collected from electronic medical records. Annual trends in clinical and demographic variables were evaluated using the Cochran-Armitage trend test.

RESULTS: The cohort comprised 680 patients with gallbladder cancers and 586 patients with intrahepatic, 367 patients with perihilar, and 368 patients with distal cholangiocarcinomas. Gallbladder cancer was more common in females, whereas intrahepatic and distal cholangiocarcinomas were more prevalent in males. Over 13 years, the prevalence of hypertension and BMI ≥ 25 kg/m² significantly increased (both p < 0.001). The prevalence of diabetes mellitus remained stable at approximately 26%. Although the proportion of patients with inflammatory factors increased from 38.9% to 49.7%, this trend was not statistically significant (p = 0.646).

CONCLUSIONS: These findings indicate an ongoing epidemiological transition in BTC risk profiles in Korea, with metabolic factors, such as hypertension and obesity, playing an increasingly prominent role.

PMID:41781899 | DOI:10.1186/s12876-026-04714-8

BMC Infect Dis. 2026 Mar 4. doi: 10.1186/s12879-026-13000-7. Online ahead of print.

NO ABSTRACT

PMID:41781891 | DOI:10.1186/s12879-026-13000-7

J Radiol Prot. 2026 Mar 4. doi: 10.1088/1361-6498/ae4d57. Online ahead of print.

ABSTRACT

BACKGROUND: The Rocky Flats (RF) Plant operated from 1951-1989 as part of the U.S. Department of Energy (DOE) nuclear complex. Its primary mission was weapons component fabrication, whereby workers were potentially exposed to radioactive and non-radioactive hazards. RF worker mortality was compared to the general population, and dose-response relationships between mortality and radiation organ doses were examined.

METHODS: RF workers first employed between 1951 through 1979 for ≥30 days were identified (n=9,397). Vital status was determined using national and state death records through 2017. Organ doses from external photons and neutrons irridation and internalized plutonium, americium, and uranium were modeled as cumulative lagged total dose per year. Beryllium exposure was evaluated as an effect modifier using data from the DOE Nationwide Beryllium Medical Program. Statistical analyses included standardized mortality ratios (SMRs), Cox proportional hazard models, and excess relative risk (ERR) models.

RESULTS: Approximately 53.2% were deceased by the end of study. Nearly 90% were monitored for radiation exposure, with mean weighted absorbed dose of 59.0 mGy for lung. Nearly 45% of workers had intakes of alpha-particle emitting radionuclides, and 46.7% were monitored for neutrons. Leading causes of death included ischemic heart disease (n=999) and lung cancer (n=361). The highest SMRs were observed for berylliosis (SMR: 176.9; 95% CI: 76.2, 348.7; n<10) and asbestosis (SMR: 4.65; 95% CI: 2.23, 8.55;n=10). Dose-response analyses showed no statistical increase in risk from low-dose radiation including lung cancer (ERR per 100 mGy: -0.02; 95% CI: -0.11, 0.08; n=361) and Parkinson’s disease (ERR per 100 mGy: 0.13; 95% CI: -0.26, 0.31; n=57). Approximately 45% of workers were monitored for beryllium, with a weak non-significant indication of effect modification for lung cancer risk.

CONCLUSION: The RF cohort showed no evidence of statistically significant increase in mortality from occupational radiation exposure. However, this study was limited by low statistical power, which inhibits the ability to detect effects. Future pooling of MPS cohorts will provide further insights, particularly regarding plutonium as a carcinogen.

PMID:41780076 | DOI:10.1088/1361-6498/ae4d57

Plast Reconstr Surg. 2026 Mar 4. doi: 10.1097/PRS.0000000000012984. Online ahead of print.

ABSTRACT

In surgical research, statistical sophistication is too often mistaken for scientific rigor. Across a growing body of plastic surgery literature, adjusted odds ratios, hazard ratios, and regression coef- ficients are frequently presented without the crude event rates or absolute measures of effect that give findings clinical meaning. We describe this phenomenon as “runic statistics”: results that are statistically valid yet clinically opaque. Through examples drawn from contemporary plastic surgery studies, we highlight three recurrent interpretive flaws: reliance on statistical significance without consideration of clinical relevance, reporting of relative measures without baseline risks or absolute differences, and conflation of association with causation. We further demonstrate how case-mix imbalances can create apparent contradictions in results (Simpson’s paradox), and how identical odds ratios can translate into very different clinical implications depending on the base- line risk. To address these challenges, we propose a thirteen-step reporting framework designed to promote transparency, interpretability, and clinical applicability. Key elements include explicit definition of the estimand, presentation of both crude and adjusted data, translation of relative effects into absolute risks and patient-facing numbers, assessment of minimal clinically important differences, careful handling of confounding, and restraint in the use of causal language. By an- choring statistical reporting in clinical realities, surgical research can remain both methodologically rigorous and directly relevant to patient care. Our goal is not to simplify science, but to ensure that its communication is clear, transparent, and ultimately useful at the bedside.

PMID:41780063 | DOI:10.1097/PRS.0000000000012984

N Engl J Med. 2026 Mar 5;394(10):947-957. doi: 10.1056/NEJMoa2512854.

ABSTRACT

BACKGROUND: The nonsteroidal mineralocorticoid receptor antagonist finerenone has been reported to improve kidney and cardiovascular outcomes in persons with type 2 diabetes and chronic kidney disease (CKD). The efficacy and safety of finerenone in persons with type 1 diabetes and CKD are unknown.

METHODS: We conducted a phase 3 trial involving adults who had type 1 diabetes, CKD (estimated glomerular filtration rate [eGFR], 25 to <90 ml per minute per 1.73 m² of body-surface area), and albuminuria (urinary albumin-to-creatinine ratio [with albumin measured in milligrams and creatinine measured in grams], 200 to <5000) and were receiving an angiotensin-converting-enzyme (ACE) inhibitor or an angiotensin-receptor blocker. Participants were randomly assigned to receive finerenone (10 or 20 mg per day, depending on the eGFR) or matching placebo. The primary outcome was the relative change in the urinary albumin-to-creatinine ratio over a period of 6 months.

RESULTS: A total of 242 participants underwent randomization. The median urinary albumin-to-creatinine ratio decreased from 574.6 at baseline to 373.5 at 6 months among all the participants assigned to receive finerenone and from 506.4 to 475.6 among those assigned to receive placebo. Over a period of 6 months, the urinary albumin-to-creatinine ratio decreased by 34% with finerenone (geometric mean ratio to baseline, 0.66; 95% confidence interval [CI], 0.60 to 0.73) and 12% with placebo (geometric mean ratio to baseline, 0.88; 95% CI, 0.79 to 0.98), which corresponded to a 25% greater reduction with finerenone than with placebo (geometric mean ratio for finerenone vs. placebo, 0.75; 95% CI, 0.65 to 0.87; P<0.001). The most common adverse event was hyperkalemia (in 12 participants [10.1%] with finerenone and in 4 [3.3%] with placebo); 2 participants (1.7%) discontinued finerenone because of hyperkalemia. At 6 months, the change in the eGFR was -5.6 ml per minute per 1.73 m² with finerenone and -2.7 ml per minute per 1.73 m² with placebo (difference, -2.9 ml per minute per 1.73 m²; 95% CI, -5.1 to -0.7); eGFR values approached baseline levels during the washout period.

CONCLUSIONS: In adults with type 1 diabetes and CKD, finerenone resulted in a significantly greater decrease in the urinary albumin-to-creatinine ratio than placebo. (Funded by Bayer; FINE-ONE ClinicalTrials.gov number, NCT05901831.).

PMID:41780000 | DOI:10.1056/NEJMoa2512854