Category: Statistics

Arq Bras Cardiol. 2026 Aug 10;123(7):e20260069. doi: 10.36660/abc.20260069. eCollection 2026.

ABSTRACT

BACKGROUND: Sacubitril/valsartan reduced mortality and hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF) compared to enalapril in pivotal clinical trials. However, real-world data under optimized dosing remain limited.

OBJECTIVE: To compare the outcomes of HFrEF patients treated with sacubitril/valsartan versus either enalapril or losartan at guideline-recommended maximum dosages.

METHODS: We analyzed data from an observational heart failure cohort (n = 2,314) including patients receiving care between August 2010 and September 2024 at six public hospitals in a large metropolitan area. The primary analysis included 254 HFrEF patients receiving the guideline-recommended maximum dosages of the investigated drugs. A sensitivity analysis included 452 patients receiving any submaximal dosages. The primary outcome was combined hospitalization or death. Baseline differences were adjusted using propensity score matching. A p-value < 0.05 was considered significant.

RESULTS: Among 254 HFrEF patients (mean age 63.6 ± 12.3 years, 61.4% male), 115 received sacubitril/valsartan 97/103mg twice daily, 33 enalapril 20 mg twice daily, and 106 losartan 100 mg daily. Over the median follow-up of 23.9 months (interquartile range 11.9-41.1), there were 70 primary endpoint events (56 first hospitalizations, 32 deaths). Compared to equivalent dosages of enalapril or losartan, sacubitril/valsartan was not associated with significant reductions in combined hospitalization or death (odds ratio 0.650, 95% confidence interval 0.354-1.195, p = 0.165), but it was associated with functional status improvement (odds ratio 3.902, 95% confidence interval 1.745-8.726, p = 0.001).

CONCLUSION: This real-world study did not demonstrate significant reductions in hospitalization or mortality for sacubitril/valsartan compared with enalapril or losartan at guideline-recommended maximum dosages; however, sacubitril/valsartan was associated with improved functional status.

PMID:42585517 | DOI:10.36660/abc.20260069

Rev Bras Epidemiol. 2026 Jul 31;29(suppl 1):e260029supl1. doi: 10.1590/1980-549720260029.supl.1. eCollection 2026.

ABSTRACT

OBJECTIVE: To analyze the evolution of inequalities in the distribution of complete denture use and need among older adults in Brazil, considering socioeconomic factors in 2010 and 2023.

METHODS: An analytical study was conducted using data from the Brazilian National Oral Health Surveys SB Brasil 2010 and 2023, with representative samples of individuals aged 65 to 74 years. The outcome integrated information on complete denture use and need, distinguishing need due to edentulism or replacement. Independent variables included sociodemographic and socioeconomic characteristics, with emphasis on the intersectional analysis of gender, race/skin color, and education. Descriptive analyses and the Concentration Index (CI) were performed to measure inequalities, accounting for the complex sampling design.

RESULTS: A slight increase was observed in the proportion of individuals who do not use and do not need dentures, particularly in the South (from 3.8%; 95% confidence interval – 95%CI 2.1-6.8 to 9.1%; 95%CI 5.7-14.3) and Southeast (from 2.3%; 95%CI 1.2-4.2 to 13.9%; 95%CI 9.1-20.7) regions. Nevertheless, around 90% of older adults still required complete dentures, either due to edentulism or replacement needs. Black men with low education concentrated the highest frequencies of need due to edentulism and showed the smallest reduction over the period. Concentration curves revealed the persistence of inequalities according to gender, race/skin color, education, and income.

CONCLUSION: Despite advances in public oral health policies, improvements in denture use and need occurred unevenly, favoring socially advantaged groups and maintaining gaps in oral health care among older adults in situations of greater vulnerability.

PMID:42585515 | DOI:10.1590/1980-549720260029.supl.1

Rev Bras Epidemiol. 2026 Jul 31;29(suppl 1):e260024supl1. doi: 10.1590/1980-549720260024.supl.1. eCollection 2026.

ABSTRACT

OBJECTIVE: To identify factors associated with the use of dental implants in Brazilian adults and older adults.

METHODS: This cross-sectional analytical study utilized population-based data from the 2023 National Oral Health Survey. The sample comprised adults (35-44 years) and older adults (65-74 years). Two dichotomous outcomes were modeled: self-reported implant use (yes/no) and clinically observed presence of implants (none/one or more). Adjusted odds ratios (ORs) were estimated using multiple logistic regression for complex samples, with demographic and socioeconomic factors, type of dental service used, and number of missing teeth as independent variables.

RESULTS: The prevalence of dental implants ranged from approximately one-tenth to one-fifth of the sample, depending on the method of identification. In the adjusted analysis for self-reported use, older adults, individuals with higher income, those who used private dental services, and those who sought care for treatment or rehabilitation had significantly higher odds of reporting implant use. Conversely, when analyzing clinically observed implants, only the number of permanent teeth lost showed a significant association.

CONCLUSION: The use of dental implants in the Brazilian population reflects both the accessibility of dental services and the clinical need for rehabilitation. Using different identification methods provides a more comprehensive understanding of the distribution of implants across the country. These findings can allow the refinement of clinical and organizational criteria for the provision of implant-supported oral rehabilitation within the public system, thereby promoting greater equity and sustainability.

PMID:42585513 | DOI:10.1590/1980-549720260024.supl.1

Rev Bras Epidemiol. 2026 Jul 31;29(suppl 1):e260017supl1. doi: 10.1590/1980-549720260017.supl.1. eCollection 2026.

ABSTRACT

OBJECTIVE: Analyze trends in socioeconomic inequalities in the distribution of dental caries among adolescents in the years 2003, 2010, and 2023.

METHODS: Longitudinal observational study using data from national oral health surveys. The Decayed, Missing and Filled Teeth (DMFT) index and the number of decayed teeth were analyzed, stratified by income and education. The analyses accounted for the complex sampling design and included measures of absolute inequality (Slope Index of Inequality – SII) and relative inequality (Relative Index of Inequality – RII). Statistical significance was assessed at the 95% confidence level (p < 0.05).

RESULTS: A global reduction in DMFT (Decayed, Missing, and Filled Teeth) and the number of decayed teeth was observed across all socioeconomic strata throughout the period, indicating a general improvement in oral health conditions. However, marked inequalities persisted between groups, maintaining the social gradient, in which adolescents with lower income and education levels presented worse indicators. The SII (Social Income Index) indicated stability in the absolute differences between the social extremes, while the RII (Inequality Index) showed variations over time, suggesting proportional changes in inequalities. For DMFT, an increase in inequalities was observed according to education level and a slight reduction in relation to income; for missing teeth, there was a reduction in inequalities in the most recent years.

CONCLUSION: Despite the overall improvement in caries indicators, socioeconomic inequalities in oral health among adolescents persist, reflecting structural social determinants. The findings reinforce the need for public policies aimed at reducing inequities and promoting equity in oral health.

PMID:42585512 | DOI:10.1590/1980-549720260017.supl.1

Rev Bras Epidemiol. 2026 Jul 31;29(suppl 1):e260015supl1. doi: 10.1590/1980-549720260015.supl.1. eCollection 2026.

ABSTRACT

OBJECTIVE: To analyze the evolution of population-based epidemiological surveys in oral health (saúde bucal) in Brazil, and implications for the 2030 edition of the SB Brasil project, of the Ministry of Health.

METHODS: This is an essay problematizing methodological and management aspects, and their implications for fieldwork, of population epidemiological surveys in oral health carried out in Brazil in different years, from 1986 to 2023.

RESULTS: Methodological and management decisions of the editions of the SB Brasil project, including 2023, are analyzed, focusing on the inclusion and exclusion of variables, such as dental fluorosis and the PUFA index, which registers the presence of seriously damaged teeth and which have visibly compromised pulp (P), ulcers caused by fragments of loose teeth (U), fistula (F) and abscess (A). The list of variables and the sampling plans of the nationwide oral health surveys carried out in 1986, 1996, 2003, 2010, and 2023 are problematized. The consequences of considering only clinical interest as a criterion for inclusion and exclusion of variables from epidemiological survey protocols are discussed, and the difficulties for the calibration of examiners are addressed, even when standardized methods are used.

CONCLUSION: The next editions of the SB Brasil institutional project, of the Ministry of Health, will start from a relevant accumulation of knowledge and practices resulting from the Brazilian experience with oral health epidemiology, within the scope of SUS, developed in the second half of the 20th century and the first decades of the 21st century.

PMID:42585511 | DOI:10.1590/1980-549720260015.supl.1

Med J Malaysia. 2026 Jul;81(4):586-592.

ABSTRACT

INTRODUCTION: Laryngeal squamous cell carcinoma (LSCC) is a common head and neck malignancy often diagnosed at advanced stages, resulting in poor prognosis and high recurrence rates. Circulating microRNAs (miRNAs), particularly miR-21 and miR-223, have emerged as promising non-invasive biomarkers because of their stability in body fluids and involvement in tumour biology. This study systematically reviewed the diagnostic and prognostic significance of circulating miR-21 and miR-223 in LSCC and performed an exploratory diagnostic metaanalysis of miR-21 when sufficient quantitative data were available.

MATERIALS AND METHODS: A systematic search was conducted in PubMed, Google Scholar, and SciSpace. Eligible studies evaluated circulating miR-21 and/or miR-223 in serum or plasma samples from LSCC patients and assessed their association with diagnostic or prognostic outcomes. Data regarding expression levels, diagnostic performance, and survival outcomes were synthesized qualitatively. Exploratory diagnostic meta-analysis was performed by pooling Area Under the Curve (AUC) values using the inverse variance method. Heterogeneity was assessed using the I² statistic, and a random-effects model was applied.

RESULTS: Five studies were included in the qualitative synthesis. Elevated miR-21 expression was consistently associated with advanced tumour stage, nodal involvement, recurrence, and poorer survival outcomes. miR-223 demonstrated dynamic changes following treatment and recurrence, suggesting potential utility for disease monitoring. Only two studies were eligible for exploratory diagnostic meta-analysis, yielding an exploratory pooled AUC of 0.77 (95% CI: 0.50-1.04) with substantial heterogeneity (I² = 83%).

CONCLUSION: Circulating miR-21 and miR-223 show potential clinical utility in LSCC, particularly for prognosis and recurrence monitoring. However, current evidence remains limited and heterogeneous, and the quantitative findings should be interpreted cautiously.

PMID:42584450

Med J Malaysia. 2026 Jul;81(4):577-585.

ABSTRACT

INTRODUCTION: Self-care behaviour, motivation, and selfefficacy represent related but distinct dimensions of hypertension self-management. Previous Indonesian studies have generally examined self-care behaviour as the primary outcome or treated motivation and self-efficacy as its explanatory factors. Evidence describing the outcomespecific associations of sociodemographic and clinical characteristics with these three domains remains limited. This study examined the associations of selected sociodemographic and clinical characteristics with self-care behaviour, motivation, and self-efficacy among adults with hypertension.

MATERIALS AND METHODS: This analytical cross-sectional study included 120 adults with hypertension attending the Gianyar 1 Community Health Centre, Bali, Indonesia, between August and September 2024. Participants were selected from an eligible patient registry using simple random sampling. Self-care behaviour, motivation, and selfefficacy were measured using the validated Indonesian version of the High Blood Pressure Self-Care Profile. Bivariate comparisons were followed by three separate multiple linear regression models.

RESULTS: The mean scores were 44.09 (95% confidence interval [CI] 42.44-45.74) for self-care behaviour, 44.64 (95% CI 42.56-46.72) for motivation, and 42.99 (95% CI 41.21- 44.78) for self-efficacy. The self-care behaviour model was statistically significant (R²=0.375; adjusted R²=0.304; p<0.001). Higher self-care behaviour scores were observed among participants aged 41-50 years and private-sector employees, whereas lower scores were observed among participants with no formal schooling, junior high school education, and a hypertension duration of 1-5 years. The motivation model was also statistically significant but had lower explanatory value (R²=0.186; adjusted R²=0.094; p=0.028). Participants aged 41-50 years had higher motivation scores, whereas those with junior high school education had lower scores. The overall self-efficacy model was not statistically significant.

CONCLUSION: Associations were observed mainly for selfcare behaviour and motivation, whereas the examined characteristics did not collectively explain self-efficacy. These findings support individualised assessment of behavioural, motivational, and confidence-related needs in primary care. Causal relationships cannot be inferred from this cross-sectional study.

PMID:42584449

Med J Malaysia. 2026 Jul;81(4):548-553.

ABSTRACT

INTRODUCTION: Chest drainage remains an important intervention for pneumothorax when conservative or ambulatory management is not suitable. Although chest drain techniques have been widely studied, contemporary real-world data from Southeast Asia remain limited, particularly in populations with a high burden of secondary pneumothorax related to infectious lung disease.

MATERIALS AND METHODS: We conducted a retrospective cohort study of adult pneumothorax patients who underwent intercostal chest drain insertion at Sibu Hospital, Sarawak, Malaysia, between January 2021 and February 2024. Patients were managed with either conventional trocar chest tubes or Seldinger wire-guided drains. The primary outcome was chest drain-related complications. Secondary outcomes included chest drain duration, hospital length of stay, persistent air leak (PAL >5 days) and mortality. Continuous variables were analysed using independent ttests and categorical variables using chi-square or Fisher’s exact tests. Multivariate logistic regression was performed to identify predictors of subcutaneous emphysema, and multiple linear regression was used to evaluate factors associated with chest drain duration.

RESULTS: A total of 123 patients were included (86 conventional and 37 Seldinger). Subcutaneous emphysema occurred significantly less frequently in the Seldinger group (5.4% vs 55.8%, p<0.001). Mean chest drain duration was shorter in the Seldinger group (8.86 ± 7.10 vs 10.34 ± 11.96 days, p=0.032). Differences in insertion failure (0% vs 8.1%, p=0.074), tube dislodgement (2.7% vs 11.6%, p=0.112), persistent air leak >5 days (67.6% vs 54.7%, p=0.182) and mortality (10.8% vs 15.1%, p=0.518) were not statistically significant. Multivariate logistic regression identified conventional chest drainage as an independent predictor of subcutaneous emphysema (OR 27.6, 95% CI 5.24-145.94; p<0.001). Multiple linear regression demonstrated that conventional drainage, non-tension pneumothorax, smoking and persistent air leak were independently associated with longer chest drain duration.

CONCLUSION: In this retrospective cohort, the Seldinger technique was associated with lower complication rates and shorter drainage duration compared with conventional chest drainage. Prospective multicentre studies are required to confirm these findings.

PMID:42584445

Med J Malaysia. 2026 Jul;81(4):540-547.

ABSTRACT

INTRODUCTION: Young adulthood is a critical period for establishing lifelong health behaviours, yet oral health is often neglected. This study investigated factors associated with oral health-related quality of life (OHRQoL) among Malaysian university students.

MATERIALS AND METHODS: A cross-sectional survey was conducted among 395 undergraduate students aged 18 to 25 years. Data were collected using a structured questionnaire assessing sociodemographic characteristics, perceived oral health status, oral healthcare seeking behaviour, and OHRQoL via the short Malay version of the Oral Health Impact Profile (S-OHIP(M)). Multiple linear regression was used to identify predictors of OHRQoL.

RESULTS: The prevalence of OHRQoL impact was 41.0%, with a mean S-OHIP(M) score of 9.15 (SD=6.39). Significant predictors of poorer OHRQoL included having at least one oral health problem, dissatisfaction with oral health status, and visiting the dentist due to an oral health issue. Dental and medical students reported significantly better OHRQoL compared to health sciences students. Oral health care seeking behaviour, although generally favourable, was not significantly associated with OHRQoL.

CONCLUSION: OHRQoL among young adults is influenced by both subjective perceptions and behavioural patterns. Promoting routine dental visits and enhancing oral health awareness may improve quality of life outcomes. These findings inform strategies for preventive care and service delivery targeting young adult populations.

PMID:42584444

Med J Malaysia. 2026 Jul;81(4):513-520.

ABSTRACT

INTRODUCTION: Endometrial cancer is the most common gynecologic malignancy in developed countries, with rising incidence worldwide. While early stage disease generally carries a favorable prognosis, recurrence remains a significant clinical concern. Among the histopathological features, lymphovascular space invasion (LVSI) has emerged as a critical prognostic factor, reflecting tumor aggressiveness and potential for metastatic spread. LVSI is associated with increased risk of recurrence, distant metastasis, and reduced survival, even in patients with otherwise low risk disease. Understanding the role of LVSI in endometrial cancer is essential for refining risk stratification, guiding adjuvant therapy decisions, and improving patient outcomes. Our study to evaluate the impact of lymphovascular space invasion (LVSI) on treatment outcomes, recurrence, and survival in patients with stage I endometrioid endometrial cancer.

MATERIALS AND METHODS: A retrospective cohort study was conducted at the Hospital Canselor Tuanku Muhriz (HCTM) Gynecologic Oncology Clinic, with ethical approval from Universiti Kebangsaan Malaysia. Patients with stage I endometrial carcinoma, classified according to the International Federation of Gynecology and Obstetrics (FIGO) 2018, and confirmed on hysterectomy specimens were included. Demographic clinicopathological, and treatment data were collected. LVSI was defined as the presence of tumor cells within endothelial lined spaces. Overall survival (OS) was the primary endpoint. Statistical analyses were performed using SPSS version 26, employing chi square, t tests, and Kaplan-Meier estimates, with significance set at p < 0.05.

RESULTS: Of 180 patients, 163 had endometrioid carcinoma; 114 were included in the final analysis (mean age 58 years; 79.8% postmenopausal). LVSI was present in 14.2% of cases and was associated with higher grade and deeper myometrial invasion. Recurrence occurred in 8.5% overall, with 18.8% in LVSI positive and 4.1% in LVSI negative patients. The 2 year disease free survival (DFS) rate was 93.4% (80.8% LVSI positive vs 99% LVSI negative). The 5 year DFS rate was 91.1% (73.4% LVSI positive vs 94% LVSI negative). The OS rate was 97.3% (87.5% LVSI positive vs 99% LVSI negative). Distant metastasis predicted 2 year DFS, whereas LVSI positivity independently predicted reduced 5 year OS. At 5 years, the DFS rate was 91.1% (SE = 0.031), while the OS rate was 97.3% (SE = 0.013). The similarity between DFS and OS reflects the low number of recurrence and death events, indicating favorable prognosis and effective disease control. Median survival was not reached.

CONCLUSION: LVSI was associated with higher recurrence and poorer survival in patients with Stage I endometrioid endometrial carcinoma, independently predicting 5-year survival, supporting its role in risk stratification and treatment planning.

PMID:42584440