Category: Statistics

BMC Pregnancy Childbirth. 2026 Mar 3. doi: 10.1186/s12884-026-08866-z. Online ahead of print.

ABSTRACT

BACKGROUND: Burnout in midwifery is widespread globally, influencing workforce attrition and undermining maternity service provision. Large-scale systematic and structural reforms are necessary but time-consuming. Meanwhile, midwives need immediate support for wellbeing to enable them to make sense of their workplace, workload and their practice. This research aimed to examine the impact of Group Clinical Supervision (GCS) on burnout among midwives.

METHODS: This superiority cluster randomised controlled trial studied registered midwives working at public maternity services in metropolitan New South Wales, Australia. Managers, agency staff and midwifery students were excluded. Sites were randomised electronically; midwives at intervention sites received monthly, hour-long, face-to-face GCS sessions. All participating midwives were surveyed six-monthly between June 2022 and November 2024. The primary outcome was burnout, measured with the Copenhagen Burnout Inventory, including sub-dimensions – personal, work-related and client-related burnout – and analysed using a mixed-effects linear regression model adjusted for covariates. Secondary outcomes were perceptions of workplace culture and the GCS sessions. Only the statistician analysing data was blinded to group allocation.

RESULTS: Twelve maternity services were enrolled, with 980 intervention participants and 1009 controls. Burnout rates were similar for both arms, but following adjustment for covariates, the intervention was associated with a small but statistically significant reduction in overall burnout scores: mean 47.3 for midwives at intervention sites (n = 882) and 50.0 for controls (n = 913), β=-2.7, 95% CI: -4.7 to -0.6] (p = 0.013). Specifically, work-related burnout was 3.0% points lower in the intervention group (p = 0.022), although reductions in client-related and personal burnout were not statistically significant. Most participants perceived their workplace culture positively, although the control group rated their overall workplace culture significantly more highly (p < 0.001). No unintended or harmful events occurred.

CONCLUSION: This study showed that regular GCS can lower overall and work-related burnout in midwives. The overall rate of 51.5% was similar to or lower than other studies, with similarly lower rates among older midwives. There is an urgent need for systemic changes in maternity services, encompassing institutional support strategies to mitigate burnout so that staff can better manage their professional demands.

TRIAL REGISTRATION: 10/05/2021 with Australian New Zealand Clinical Trials Registry – ACTRN12621000545864p.

PMID:41776497 | DOI:10.1186/s12884-026-08866-z

BMC Public Health. 2026 Mar 3. doi: 10.1186/s12889-026-26229-3. Online ahead of print.

ABSTRACT

BACKGROUND: The unmitigated spread of novel infectious pathogens, such as SARS-CoV-2, can result in significant disease burdens and widespread societal impacts. The magnitude, severity, and duration of these events are influenced by factors such as contact patterns and the application and effectiveness of public health control measures. Many non-pharmaceutical interventions (NPIs) were implemented to target these heterogeneous drivers and modifiers of wild-type SARS-CoV-2 transmission in Canada; however, determining and understanding their individual and joint effectiveness on different populations is challenging. In this retrospective study, we delineate the impacts of age-specific NPIs in three urban Canadian regions (Calgary, Greater Vancouver, and the Greater Toronto Area) prior to widespread vaccination availability (March 2020-February 2021) and identify relative age-specific NPI effectiveness on mitigating wild-type SARS-CoV-2 transmission.

METHODS: We developed an age-structured Susceptible-Exposed-Infectious-Recovered (SEIR) deterministic model and stratified our population into two age groups: children and youth (0-19 years) and adults (20+ years). The model incorporated contact mixing rates, wild-type SARS-CoV-2 age-specific susceptibility, and NPI strength. Detailed timelines for each region were compiled, capturing the time-dependent implementation of age-specific and population wide NPIs. Using maximum likelihood estimation, we determined regional baseline transmission probabilities in the absence of widespread NPIs, then estimated the subsequent time-dependent and age-specific NPI strength on transmission reduction. Finally, we considered counterfactual NPI scenarios and compared simulated regional age-specific epidemic trajectories with reported SARS-CoV-2 case data.

RESULTS: The age-specific and sequential time-dependent NPI strength on wild-type SARS-CoV-2 transmission reduction was estimated for each region during March 2020-February 2021. We observed that adult-specific contacts play a large role in transmission, and moderately-strengthened adult-specific NPIs were more effective in reducing transmission across all regions compared to a drastic strengthening of NPIs in children and youth (i.e., closing schools). These results held when varying temporal applications of singular and joint counterfactual NPI scenarios; however, regional contexts and data uncertainties caused varied levels of effectiveness.

CONCLUSIONS: By considering population heterogeneity, our retrospective study provides insight into age-specific NPI effectiveness on wild-type SARS-CoV-2 transmission. These findings and associated model can inform decision-making related to targeted NPI implementation and aid in resource planning and preparedness for future emerging disease outbreaks.

PMID:41776444 | DOI:10.1186/s12889-026-26229-3

BMC Nephrol. 2026 Mar 3. doi: 10.1186/s12882-026-04826-z. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic Kidney Disease (CKD) and epilepsy are common comorbidities in children; their clinical interaction in terms of seizure frequency and severity has been poorly explored. This study investigates the influence of CKD stage and kidney function markers on seizure outcomes in pediatric epilepsy patients.

METHODS: A cross-sectional study was conducted among 250 children aged 2-18 years with biopsy-confirmed CKD and a documented diagnosis of epilepsy. Clinical data were extracted from medical records, including seizure frequency, seizure severity (measured using the National Hospital Seizure Severity Scale, NHS3), serum creatinine, Blood Urea Nitrogen (BUN), and CKD stage. Statistical analyses were performed using SPSS version 26, employing Pearson correlation, one-way ANOVA, and independent samples t-tests to evaluate associations between kidney function, epilepsy etiology, seizure subtype, and seizure outcomes.

RESULTS: Significant positive correlations were observed between BUN and both seizure frequency (r = 0.45, p < 0.01) and seizure severity (r = 0.36, p < 0.01). Serum creatinine was similarly correlated with seizure frequency (r = 0.50, p < 0.01) and seizure severity (r = 0.48, p < 0.01). While seizure severity did not differ significantly across CKD stages, ANOVA revealed a significant effect of epilepsy etiology on seizure severity (F(2,247) = 39.45, p < 0.001), with higher severity in metabolic and genetic etiologies compared to structural ones. Additionally, generalized seizures were associated with greater severity than focal seizures (p < 0.001).

CONCLUSION: Although seizure severity remained relatively constant across CKD stages, impaired renal function-reflected by elevated BUN and serum creatinine-was strongly associated with increased seizure frequency and severity. These findings suggest that metabolic dysfunction plays a more prominent role than CKD stage in determining seizure burden. Regular monitoring of kidney function markers, consideration of epilepsy etiology, and individualized management strategies integrating nephrological and neurological care may improve outcomes for children with CKD and epilepsy.

PMID:41776419 | DOI:10.1186/s12882-026-04826-z

Biol Proced Online. 2026 Mar 3. doi: 10.1186/s12575-025-00267-4. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the regularities and clinical features of sintilimab-related autoimmune myocarditis, and to summarize the differential diagnosis key points between sintilimab-related autoimmune myocarditis and acute myocardial infarction.

METHODS: The case reports about sintilimab-related autoimmune myocarditis were searched on databases from the establishment of the database to April 1st 2024. The relevant medical records were searched on the hospital information system of Beijing Hospital of Traditional Chinese Medicine in the past 3 years. The case reports and medical records were collected for statistical analysis.

RESULT: Twenty three cases were collected including 22 case reports and 1 case record. Most of the sintilimab-related autoimmune myocarditis were in elderly men aged 60-75 years old and occurred between the end of the first dose of treatment to the beginning of the second dose. The symptom was nonspecific such as chest tightness and palpitation, sometimes with symptom of myasthenia as muscle weakness or myositisand as muscle soreness. Elevated cardiac biomarkers and changes in electrocardiogram were common, and decreased left ventricular ejection fraction was rarely seen in echocardiography. 9 cases underwent coronary angiography or computed coronary tomography angiography, and 3 cases underwent cardiovascular magnetic resonance.

CONCLUSION: The manifestations of sintilimab-related autoimmune myocarditis are not specific. The medication history and concomitant symptoms are of warning value. Coronary angiography or coronary computed coronary tomography angiography can be helpful when ruling out acute myocardial infarction. Cardiovascular magnetic resonance and myocardial biopsy can confirm the diagnosis. Cardiac biomarkers and the electrocardiogram can assist in diagnosis and prognosis assessment.

PMID:41776397 | DOI:10.1186/s12575-025-00267-4

Clin Trials. 2026 Mar 3:17407745261421842. doi: 10.1177/17407745261421842. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Bayesian designs for clinical trials using assurance to choose the sample size have been proposed in various trial contexts. Assurance allows for the incorporation of uncertainty on both the treatment effect and nuisance parameters into the sample size calculation. In the case of two-arm cluster randomised trials with continuous outcomes, assurance has been proposed with both a frequentist analysis (hybrid designs) and a Bayesian analysis (fully Bayesian designs). A Bayesian analysis in this context ensures a consistent treatment of probability throughout the design and analysis of the trial. In the fully Bayesian design, inference has been achieved via Markov chain Monte Carlo sampling, and since assurance itself is evaluated via simulation, the result is a computationally intensive and often slow-to-run approach. In the case of two-arm cluster randomised trials with binary outcomes, assurance has not yet been explored to specify sample sizes, either in the hybrid or fully Bayesian case.

METHODS: This article considers fully Bayesian designs for two-arm cluster randomised trials with continuous and binary outcomes. For the analysis of the trial, we use a (generalised) linear mixed-effects model. We summarise the inference for the treatment effect based on quantiles of the posterior distribution. We use assurance to choose the sample size. In the continuous case, we investigate Integrated Nested Laplace Approximations for inference to speed up calculation of the assurance and compare Integrated Nested Laplace Approximations in computation time and accuracy to Markov chain Monte Carlo. In the binary case, we develop the first fully Bayesian design for cluster randomised trials and conduct a similar comparison between Integrated Nested Laplace Approximations and Markov chain Monte Carlo. We demonstrate our novel approach using assurance to choose sample sizes for the SPEEDY cluster randomised trial, based on the results of a formal prior elicitation exercise with two clinical experts.

RESULTS: We report comparisons of Integrated Nested Laplace Approximations and Markov chain Monte Carlo for a range of different scenarios for cluster randomised controlled trials (RCTs), to determine when each inference scheme should be used, balancing the computational cost in terms of speed and accuracy. Overall Markov chain Monte Carlo with a very large number of samples produces very accurate inference but does not scale well in terms of computational speed compared to Integrated Nested Laplace Approximations. Based on our simulation study, we recommend that Integrated Nested Laplace Approximations is used for inference in cluster trials with binary outcomes and large (n> 500) cluster trials with continuous outcomes, and that Markov chain Monte Carlo is used in smaller (n≤500) cluster trials with continuous outcomes. Our case study demonstrated how to incorporate the uncertainty of trial clinicians into the sample size calculation to give an overall assessment of the likelihood of success of the trial.

CONCLUSION: A fully Bayesian design can be used for two-arm cluster trials with both continuous and binary outcomes. Integrated Nested Laplace Approximations can allow for more efficient assessment of the assurance for cluster trials with binary outcomes and large cluster trials with continuous outcomes, without loss of accuracy in inference. A fully Bayesian design of a cluster randomised trial provides a coherent design and analysis framework and incorporates uncertainty in model parameters when choosing the sample size.

PMID:41776384 | DOI:10.1177/17407745261421842

Eur J Hum Genet. 2026 Mar 3. doi: 10.1038/s41431-026-02064-3. Online ahead of print.

NO ABSTRACT

PMID:41776349 | DOI:10.1038/s41431-026-02064-3

Sci Rep. 2026 Mar 3. doi: 10.1038/s41598-026-41608-x. Online ahead of print.

ABSTRACT

Ambulatory surgery has become widely used in high-income countries because it is safe, cost-effective, and optimizes hospital resources, yet its development remains limited in many low- and middle-income settings, including Morocco. This study evaluated the feasibility and outcomes of ambulatory digestive surgery in a Moroccan tertiary care hospital and sought to identify factors associated with failure of same-day discharge. Over one year, all adult patients scheduled for elective ambulatory digestive procedures were prospectively included, and their perioperative outcomes were analyzed. Among 595 procedures performed in 2022, 266 were initially planned as ambulatory, but 64 ultimately required unplanned overnight hospitalization, resulting in an effective ambulatory rate of 33.9%. Complication and readmission rates were low, and no 90-day mortality was observed, supporting the overall safety of this approach. However, ambulatory failure was frequently associated with advanced age, comorbidities, prior abdominal surgery, and, importantly, social factors such as illiteracy, lack of caregiver support, and distance from the hospital. These findings indicate that while ambulatory digestive surgery is feasible and safe in this setting, its broader implementation is strongly influenced by non-medical barriers. Strengthening perioperative education, reinforcing family involvement, and adapting organizational infrastructure are essential to expand ambulatory surgery in similar healthcare contexts.

PMID:41776337 | DOI:10.1038/s41598-026-41608-x

Eur J Surg Oncol. 2026 Feb 27;52(4):111515. doi: 10.1016/j.ejso.2026.111515. Online ahead of print.

ABSTRACT

BACKGROUND: Pelvic exenteration (PE) performed for locally advanced or recurrent pelvic malignancies often required urinary reconstruction but associated with high postoperative morbidity (POM). The influence of urinary diversion type on outcomes remains uncertain.

METHODS: This retrospective cohort study included 90 patients who underwent PE with urinary reconstruction between 2016 and 2023. Urinary diversions were classified as ileal conduit and alternative reconstructions (vesico-urethral anastomosis, Mitrofanoff procedure, ureteral implantation and enterocystoplasty). POM, quality of life (QoL; EQ-5D-5L questionnaire), bowel dysfunction (LARS and Wexner scores), and overall (OS) and disease-free survival (DFS) were analyzed. Statistical analyses compared outcomes between groups.

RESULTS: Sixty-two patients (69%) underwent an ileal conduit and 28 (31%) an alternative urinary reconstruction.The POM rate occurred in 66% of cases, including 34% experiencing major complications with no difference between groups (p = 0.86). Urologic complications were observed in 13% of patients, mainly urinary tract infections (10%); urine leaks (5%) occurred only after ileal conduit. Severe bowel dysfunction (major LARS) affected 30% and significant fecal incontinence (Wexner >10) 35% of patients, with a trend toward worse outcomes in the alternative reconstruction group. QoL was similar across most domains, except for the “usual activities” category, which were more limited after alternative reconstructions(p = 0.046). OS and DFS were comparable while primary cancer had significantly better outcomes than recurrent cancers (p < 0.001).

CONCLUSION: Ileal conduit remains the predominant urinary diversion following PE. Alternative reconstructions do not significantly impact morbidity, survival or QoL, except for a modest limitation in “usual activities”. Shared decision-making is essential given the high morbidity and complex functional sequelae of PE.

PMID:41774974 | DOI:10.1016/j.ejso.2026.111515

J Psychiatr Res. 2026 Feb 12;197:107-117. doi: 10.1016/j.jpsychires.2026.02.025. Online ahead of print.

ABSTRACT

PURPOSE: Increased social demands during adolescence and early adulthood pose specific challenges for individuals with autism spectrum disorder (ASD) without accompanying intellectual impairment. Targeted group-based social competence trainings are effective interventions. This work evaluates the Zurich social competence training (KOMPASS), a manualized program for adolescents and young adults (12-25 years) with ASD.

METHODS: In this quasi-experimental longitudinal study with a naturalistic waiting period and follow-up, we assessed participants of the KOMPASS intervention (N = 108) at our clinic through parent-, teacher- and self-reports along with a computerized task. A subset of participants (N = 65) was additionally assessed during a waiting period prior to intervention, allowing within-subject comparison of change before and during treatment. One-year follow-up data for the KOMPASS intervention group were collected (N = 62). Furthermore, we analyzed pre- and post-data from 35 individuals who completed KOMPASS at external clinics using the KOMPASS- manual without prior introduction to the method. Critically, we used Bayesian statistics to show evidence for stability of effects and comparable outcomes across settings.

RESULTS: Compared to the waitlist period, the KOMPASS training period showed a significant decrease in social and behavioral difficulties associated with ASD and improvements in social competences, which were sustained one year after training. General psychiatric symptoms also improved post-intervention in the KOMPASS training period. Participants from external clinics demonstrated similar significant improvements, affirming the manual’s effectiveness in external settings. No significant gender or age moderation effects were observed for the primary outcomes. Participants and caregivers expressed satisfaction with the training.

CONCLUSION: KOMPASS demonstrates significant effects in improving social functioning and reducing ASD-related difficulties in adolescents and young adults. The study benefits from a large sample, a naturalistic waiting-period comparison, a one-year follow-up, multi-informant assessment, and external validation. Limitations include the quasi-experimental design, the lack of formal fidelity monitoring, and reliance on some older assessment measures.

PMID:41774970 | DOI:10.1016/j.jpsychires.2026.02.025

Waste Manag. 2026 Mar 2;215:115426. doi: 10.1016/j.wasman.2026.115426. Online ahead of print.

ABSTRACT

Food waste in schools presents significant environmental, economic, and social challenges. This large-scale study investigates the effectiveness of an awareness-raising campaign aimed at reducing food waste in schools. The intervention included printed materials, campaign videos, and an online food waste tracker to inform students about the consequences of food waste and encourage behaviour change. The study employed a three-phase methodology: initial food waste measurement, an awareness campaign combined with a questionnaire survey, and post-intervention food waste assessment. The survey was conducted across 10 schools, where data were collected on food waste generated from a total of 52,421 prepared lunch menus. Food waste was measured during two separate 10-day survey periods in consecutive years; in the second year, an awareness-raising campaign was implemented in the selected schools. In addition, students’ attitudes towards food waste were assessed through a questionnaire survey, yielding 1,480 responses. Data were analysed using statistical methods (Student’s t-test, Pearson’s correlation). On average, consumers left 103 g of food on their plates from each course, which accounted for 32% of the served meal. Although our hypothesis assumed that the campaign would reduce the amount of waste generated, the results did not support this expectation. The findings indicate that while students recognize the importance of reducing food waste, the campaign did not lead to a measurable reduction. This suggests that simply increasing awareness may not be sufficient to drive behavioural change, highlighting the need for alternative strategies.

PMID:41774966 | DOI:10.1016/j.wasman.2026.115426