Category: Statistics

Am J Trop Med Hyg. 2026 Feb 10:tpmd250329. doi: 10.4269/ajtmh.25-0329. Online ahead of print.

ABSTRACT

The Mandoto District in the central highlands of Madagascar experiences year-round transmission of Plasmodium vivax (P. vivax) and Plasmodium falciparum (P. falciparum). Monthly malaria case data from 27 health centers across Mandoto between 2019 and 2024 were analyzed alongside meteorological data to understand transmission dynamics and forecast potential influences of climate change using descriptive, cross-correlation, and seasonal autoregressive integrated moving average forecast models. Over a period of 6 years, 276,318 rapid diagnostic tests (RDTs) were performed, yielding a 39.6% positivity rate, totaling 109,428 malaria cases. After 2021, when multispecies RDTs became available, 71.5% of cases were attributed to P. falciparum, and 28.5% were attributed to P. vivax. Both species were co-endemic across all health centers, with the western region experiencing a higher transmission risk. Malaria cases peaked in January, with a second peak from April to June after the rainy season, and declined between July and September. Precipitation and temperature effectively revealed the seasonality of malaria dynamics, thereby improving model accuracy. Plasmodium falciparum exhibited stronger associations with precipitation and temperature variability. The present study highlights that combining time-series modeling with precipitation and temperature data can help predict malaria cases and support timely planning and resource allocation.

PMID:41666420 | DOI:10.4269/ajtmh.25-0329

Am J Trop Med Hyg. 2026 Jan 15:tpmd250372. doi: 10.4269/ajtmh.25-0372. Online ahead of print.

ABSTRACT

Soil-transmitted helminths (STHs) predominantly affect resource-poor communities with poor access to water, sanitation, and hygiene (WASH) infrastructure. Understanding the risk factors for STH infections can help inform public health control strategies, including WASH interventions and preventive chemotherapy. In this school-based cross-sectional study, mixed-effects logistic regression was used to examine the associations between WASH and socioeconomic factors and STH infections in Timor-Leste. Two statistical analyses were conducted: the first included individual-level sanitation and hygiene factors, whereas the second also included household-level WASH and socioeconomic factors. In the sanitation and hygiene analysis, “always use household latrine” was associated with lower odds of undifferentiated STH infection (adjusted odds ratio [aOR]: 0.59; 95% CI: 0.37-0.96). “Always wash hands before eating” was associated with lower odds of Trichuris trichiura (T. trichiura) infection (aOR: 0.35; 95% CI: 0.13-0.97), whereas “always have soap to wash hands at home” was associated with higher odds of T. trichiura infection (aOR: 4.22; 95% CI: 1.56-11.43). In the WASH and socioeconomic factors analysis, “usually defecate at household/neighbor’s latrine” was associated with lower odds of undifferentiated STH (aOR: 0.13; 95% CI: 0.04-0.43) and Ascaris lumbricoides infections (aOR: 0.19; 95% CI: 0.06-0.64). Additionally, the availability of school handwashing stations was associated with lower odds of T. trichiura infection (aOR: 0.21; 95% CI: 0.05-0.86). The present study indicates that sanitation and hygiene are important risk factors for STH infections, and therefore, efforts to reduce STH infections should also promote sanitation and hygiene infrastructure and practices.

PMID:41666419 | DOI:10.4269/ajtmh.25-0372

Brief Bioinform. 2026 Jan 7;27(1):bbag053. doi: 10.1093/bib/bbag053.

ABSTRACT

To understand how the tumor immune microenvironment (TIME) impacts clinical outcomes and treatment response, researchers have been leveraging single-cell protein multiplex imaging techniques. These technologies measure multiple protein markers simultaneously within a tissue sample, providing a more complete assessment of the TIME. However, statistical challenges arise from the over-dispersed and zero-inflated nature of the data and from relationships among different immune cell populations. To address these challenges, we developed a Bayesian hierarchical method using a beta-binomial (BB) distribution to model the abundance of multiple immune cell types simultaneously while incorporating relationships and immune cell differentiation paths. We applied the model to data from three large studies of high-grade serous ovarian tumors (Nurses’ Health Study I/II: N = 321, African American Cancer Epidemiology Study: N = 92, University of Colorado Ovarian Cancer Study: N = 103). We examined associations between cancer stage, age at diagnosis, and debulking status and the abundance of immune cell populations. We compared the multi-cell type model to individual cell type analyses using a Bayesian BB model. The multi-cell type model detected more associations, when present, with narrower credible intervals. To support broader application, we developed an R package, BTIME, with a detailed tutorial. In conclusion, the Bayesian multi-cell type model is flexible in how relationships between cell types are incorporated and can be used for cancer studies that interrogate the TIME.

PMID:41666406 | DOI:10.1093/bib/bbag053

Anesth Analg. 2026 Feb 10. doi: 10.1213/ANE.0000000000007982. Online ahead of print.

ABSTRACT

BACKGROUND: Post-dural-puncture headache (PDPH) is a common complication of neuraxial procedures used during labor and delivery, affecting about 1% of patients. Epidural blood patch (EBP) is the most effective treatment for PDPH, but few studies assess the success of an EBP based on the volume of injected blood, especially >20 mL. Our practice is injection until the patient feels persistent back pressure. We aimed to determine whether the volume of injected blood was associated with an improved outcome after an EBP in the obstetric population.

METHODS: We reviewed records for patients receiving EBP after an obstetric epidural procedure over a 10-year period (May 2014-February 2024) at a single tertiary academic medical center. The primary outcome was failure of the first EBP, defined by the patient receiving a second EBP for treatment. Secondary outcome included the complete resolution of symptoms after the primary EBP. We used a binomial generalized model to identify factors associated with the success of the primary EBP. A value of P ≤.05 was considered statistically significant.

RESULTS: Records from 317 patients were available, and we excluded 32 patients who received only single-shot spinal anesthesia from the primary analysis. Repeat EBP was performed in 65 (22.8%, 95% confidence interval [CI], 18.1%-28.1%) patients. In univariable analyses, the injected volume during EBP (median 28.0 mL, interquartile range [IQR] (22.0-32.0)), days from procedure to PDPH diagnosis, and from PDPH to EBP were associated with a successful EBP. In multivariable analyses, injected volume (odds ratio [OR] 0.96 per 1 mL, P =.028, 95% CI, 0.92-0.999) and days from PDPH diagnosis to EBP (OR 0.61 per day, P =.002, 95% CI, 0.43-0.81) were significantly associated with successful EBP. An analysis of the relationship between injected volume and repeated EBP suggested a dose-response relationship (P =.030). Complete symptomatic follow-up data documented for at least 3 days were available for 226 patients, and headache was completely resolved in 118 (52.2%, 95% CI, 45.5%-58.9%). In a multivariable analysis, a dichotomous division of the population revealed a significant association with headache resolution in the group receiving an injected volume of ≥30 mL compared with patients receiving <30 mL (OR 1.85, P =.049, 95% CI, 1.01-3.47).

CONCLUSION: We found that a larger injected volume of blood during an EBP was associated with a reduced likelihood of receiving a second EBP. Injection of 30 mL or more was significantly associated with complete resolution of headache symptoms after the first EBP. A prospective trial to determine the etiology of this relationship is warranted.

PMID:41666403 | DOI:10.1213/ANE.0000000000007982

J Trauma Nurs. 2026 Jan 30. doi: 10.1097/JTN.0000000000000913. Online ahead of print.

ABSTRACT

BACKGROUND: Imaging interpretations for pediatric trauma patients transferred from general emergency departments to pediatric hospitals differ in up to 40% of cases, with more than half affecting patient care. Delays in radiology image interpretation lead to extended emergency department stays, unnecessary reimaging, and delayed injury recognition. Currently, no streamlined imaging protocol exists to ensure timely image interpretation for severely injured pediatric patients.

OBJECTIVE: To assess improvements in timeliness and consistency of imaging interpretation before and after implementation of a streamlined protocol for severely injured pediatric trauma patients.

METHODS: A quality improvement pre- and post-intervention study was conducted at Level I and Level II Pediatric Trauma Centers located in the western United States from April 2023 to December 2024. Pediatric patients aged 18 and younger who met the institutional trauma activation criteria and came from a referring facility with images were included in the study. Outcomes included image interpretation timeliness and consistency (measured by variability in interpretation times and sustained process change via statistical process control charts).

RESULTS: There were 86 patients meeting criteria during the study. After implementation, the median time to image interpretation decreased from 145 to 51 min, and variability in interpretation times decreased (standard deviation decreased from 680 to 170 min). No missed injuries that changed patient care were observed before or after the intervention.

CONCLUSION: Implementation of a streamlined imaging protocol for pediatric trauma patients led to faster and more consistent image interpretation without compromising care quality.

PMID:41666384 | DOI:10.1097/JTN.0000000000000913

Retina. 2026 Jan 30. doi: 10.1097/IAE.0000000000004799. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the long-term functional and anatomical outcomes of pars plana vitrectomy (PPV) combined with subretinal recombinant tissue plasminogen activator (tPA) injection and gas tamponade in patients with subretinal hemorrhage secondary to retinal arterial macroaneurysm (RAM) rupture.

METHODS: This retrospective multicenter study included 18 eyes of 18 patients who underwent PPV with subretinal tPA injection and gas tamponade for subfoveal hemorrhage due to RAM rupture. Baseline demographic and clinical features, pre- and postoperative best-corrected visual acuity (BCVA), central macular thickness (CMT), postoperative complications, and the relationship between symptom-to-surgery interval and visual outcomes were evaluated over a minimum follow-up period of 12 months.

RESULTS: The mean preoperative BCVA was approximately 20/3300 (2.22 ± 0.73 logMAR), improving to about 20/140 (0.85 ± 0.57 logMAR) at the 12-month visit (p < 0.001). Earlier surgical intervention (≤14 days) was associated with greater improvement in BCVA. Subfoveal retinal pigment epithelium (RPE) atrophy developed in 38.9% of patients and was significantly associated with worse visual outcomes compared to extrafoveal atrophy (p = 0.02). ILM peeling was performed in 44.4% of cases; although those patients tended to have greater BCVA gains, the difference was not statistically significant. RPE atrophy was observed in 77.8% of patients postoperatively, with varying progression patterns.

CONCLUSIONS: PPV with subretinal tPA injection and gas tamponade appears to be an effective treatment for RAM-related subretinal hemorrhage, with significant improvements in visual acuity, particularly when performed within two weeks of symptom onset. The location of postoperative RPE atrophy is a critical prognostic factor for visual outcomes.

PMID:41666381 | DOI:10.1097/IAE.0000000000004799

JMIR Mhealth Uhealth. 2026 Feb 10;14:e64323. doi: 10.2196/64323.

ABSTRACT

BACKGROUND: Previous research has attempted to determine the minimum number of days of accelerometry required to reliably reflect an individual’s physical activity. However, human behaviors on a day-to-day basis can be highly variable. As a consequence, the number of days required to reliably predict habitual physical activity is dependent on the variability that exists within an individual. There is a concern that adopting generic recommendations from previous research could provide unreliable estimates by failing to represent individuals with specific physical activity patterns.

OBJECTIVE: The main aim of this study was to identify clusters of individuals with distinct physical activity patterns and to determine if the number of days of accelerometry data required to reliably estimate short- (7 days) and medium-term (28 days) physical activity differed between each unique cluster.

METHODS: Accelerometry data were retrieved from 2 independent research studies. Participants during each study had their physical activity recorded using a Withings Scanwatch (Withings Health Solutions). Following a data eligibility process, agglomerative hierarchical clustering was used to identify clusters of individuals based on their physical activity. The clusters were determined using 4 dimensions; mean, SD, skewness, and kurtosis of the step count data. Intraclass correlation coefficients (ICCs) of step count were then calculated within each physical activity cluster. A series of ICCs were computed by separately comparing the average step count across the full periods (7 and 28, for the short- and medium-term analysis, respectively) to a series of averaged subsamples (ranging from 1-6 days and 1-27 days, for the short- and medium-term analysis, respectively). For each subsample, 500 random combinations were generated and compared, providing a distribution of ICCs for each subsample. An ICC of ≥0.80 identified when the subsample of days was sufficient to achieve appropriate reliability.

RESULTS: Of 258 participant datasets, 149 were eligible for the short-term analysis and 64 were eligible for the medium-term analysis. Following agglomerative hierarchical clustering, 4 and 3 clusters of sufficient size (n≥12) were identified in the short-term and medium-term analyses, respectively. When considering the short-term analysis, to achieve a mean ICC score greater than or equal to 0.80, using all randomized combinations, the number of days ranged from 2 to 6 days depending on the physical activity cluster. For the medium-term analysis, the number of days required to achieve a mean ICC score greater than or equal to 0.80 ranged from 6 to 11 days. The short-term analysis clusters displayed more diversity in physical activity patterns than the medium-term analysis.

CONCLUSIONS: Physical activity patterns influence the number of days required to estimate habitual physical activity. Thus, to avoid unreliable estimates of physical activity, which could significantly impact the interpretation of results, researchers should be mindful of the physical activity patterns of their sample before adopting generic recommendations.

PMID:41666367 | DOI:10.2196/64323

JMIR Med Inform. 2026 Feb 10;14:e64860. doi: 10.2196/64860.

ABSTRACT

BACKGROUND: Exploring user satisfaction is crucial for enhancing and ensuring the sustainable development of mobile health (mHealth) apps, particularly in the fitness and weight management sectors. Analyzing user types and developing user profiles are valuable for understanding differences in satisfaction. However, prior research lacks a classification of user types based on self-management characteristics and an analysis of satisfaction disparities among these types.

OBJECTIVE: This study analyzes user heterogeneity from a self-management perspective among fitness and weight management app users by identifying user types and constructing profiles. It further explores differences in satisfaction with the functional design of these mHealth apps across user types.

METHODS: First, 8 feature indicators were selected based on the Health Belief Model and the Behavior Change Wheel to evaluate users’ levels of health knowledge and beliefs, as well as self-regulation related to self-management. Existing research was integrated to categorize mHealth app functional design into 5 categories: health guidance, health education, health monitoring, social features, and gamification. Second, a questionnaire survey was used to collect data on users’ 8 health management characteristics and their satisfaction with the 5 functional design categories. A total of 2518 responses were collected, of which 1025 were included in the analysis. Cluster analysis was conducted to classify users into distinct types based on the 8 health management characteristics, and user profiles were constructed according to the distribution of these characteristics within each type. Finally, the Kruskal-Wallis test was used to analyze differences in satisfaction across user types with respect to the 5 functional design categories of mHealth apps.

RESULTS: Cluster analysis revealed that users could be categorized into 6 types based on the 8 self-management characteristics: positively proactive energizers, proactive intenders, negatively proactive energizers, low health management demanders, potential health management demanders, and passive attitude holders. Significant differences were observed across all 8 health management characteristics among the 6 user types (all P<.001). The Kruskal-Wallis test indicated significant variations in user satisfaction with the 5 functional designs of mHealth apps: H(4)=445.388, (P<.001). Overall, users reported the highest satisfaction with health guidance and health monitoring (median 4.00, IQR 1.00) and the lowest satisfaction with gamification (median 3.00, IQR 1.00). Positively proactive energizers, proactive intenders, and negatively proactive energizers demonstrated the highest satisfaction with health education and health guidance (median 4.00). Potential health management demanders, proactive intenders, positively proactive energizers, and negatively proactive energizers reported the highest satisfaction with health monitoring (median 4.00). Proactive intenders reported the highest satisfaction with social features and gamification (median 4.00).

CONCLUSIONS: Users of mHealth apps exhibit diverse types, with significant differences in health management characteristics and satisfaction with the 5 functional designs of fitness and weight management apps. This study clarifies individual-level differences in user satisfaction with mHealth apps.

PMID:41666365 | DOI:10.2196/64860

AIDS. 2026 Feb 9. doi: 10.1097/QAD.0000000000004457. Online ahead of print.

ABSTRACT

BACKGROUND: People with HIV (PWH) are more susceptible to drug reactions than the general population. This study aimed to investigate the prevalence of, and demographic characteristics associated with a history of penicillin and sulfonamide allergy and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), and to assess whether HLA-B∗57:01 is associated with these drug reactions among PWH followed in a large French multicenter cohort.

METHODS: All PWH followed from January 2000 to December 2023 with available results for HLA-B∗57:01 were included. Logistic regression models were used to identify associations between each drug allergy (outcome variable) and explanatory variables.

RESULTS: Among 35,924 PWH, the prevalence of penicillin and sulfonamide allergy and SJS/TEN were 1.05% (95%CI 0.94-1.16), 1.01% (95%CI 0.91-1.11) and 0.15% (95%CI 0.11-0.19), respectively. AIDS status was significantly associated with a higher risk of penicillin and sulfonamide allergy and SJS/TEN; while female sex was associated with sulfonamide allergy and SJS/TEN. Being born in mainland France, other European countries, and North Africa was associated with a higher risk of penicillin allergy (OR 1.88 [95%CI, 1.13-3.42], p = 0.02), while being born in Sub-Saharan Africa was associated with a lower risk of penicillin allergy (OR 0.39 [95% CI, 0.19-0.81], p = 0.009) and sulfonamide allergy (OR 0.57 [95%CI, 0.34-0.95], p = 0.03). The association between HLA-B∗57:01 and penicillin allergy was positive but statistically non-significant (OR 1.34 [95%CI, 0.87-1.97], p = 0.16).

CONCLUSION: In the combined antiretroviral therapy era, the prevalence of both penicillin and sulfonamide allergy is low. Our study confirms ethnic differences in penicillin and sulfonamide allergy.

PMID:41666357 | DOI:10.1097/QAD.0000000000004457

J Nurs Educ. 2026 Feb 11:1-10. doi: 10.3928/01484834-20251119-01. Online ahead of print.

ABSTRACT

BACKGROUND: Critical thinking and self-confidence are important concepts for nursing students. This study aimed to investigate the effects of mindfulness-based art therapy (MBAT) on the critical thinking dispositions and self-confidence levels of nursing students.

METHOD: A randomized controlled trial was conducted using a parallel-group design with pretest and posttest measurements. A total of 53 nursing students completed the study. The intervention group participated in an 8-week MBAT program, whereas the control group received no intervention during this period.

RESULTS: During the pretest phase, the intervention and control groups showed no statistically significant differences in their mean scores on the Critical Thinking Disposition and Self-Confidence scales (p > .05). However, following the MBAT program, the intervention group showed notably higher mean scores than the control group in both the posttest and follow-up assessments (p < .001).

CONCLUSION: The findings indicate that MBAT effectively enhances critical thinking disposition and self-confidence levels in nursing students.

PMID:41666347 | DOI:10.3928/01484834-20251119-01