Category: Statistics

BMC Womens Health. 2026 May 5. doi: 10.1186/s12905-026-04506-y. Online ahead of print.

ABSTRACT

BACKGROUND: Depressive symptoms during pregnancy and the postpartum period have been extensively studied; however, evidence regarding mental health in the preconception period remains limited. Women preparing for pregnancy undergo physiological changes, lifestyle adjustments, and psychosocial transitions, and emotional vulnerability may be heightened by reproductive stressors, including infertility. Nevertheless, population-based studies examining depressive symptoms and their associated lifestyle and reproductive factors during the preconception period remain scarce.

METHODS: This cross-sectional study included 14,004 women aged 20-45 years who participated in the Seoul Metropolitan Preconception Health Management Program between 2019 and 2021. Depressive symptoms were assessed using the Korean-validated Hospital Anxiety and Depression Scale-Depression subscale (HADS-D), with scores ≥ 11 indicating elevated risk. Sociodemographic, lifestyle, nutritional, menstrual, and reproductive factors were assessed. A multivariable logistic regression model was used to identify factors independently associated with depressive symptoms.

RESULTS: Among the participants, 1,102 women (8.5%) exhibited elevated depressive symptoms. In a multivariable logistic regression model, depressive symptoms were independently associated with current smoking, passive smoking exposure, insomnia, binge eating, irregular menstruation, severe dysmenorrhea, infertility history, and previous pregnancy. Insomnia, binge eating, current smoking, and severe dysmenorrhea were each associated with more than twofold higher odds of depressive symptoms. In contrast, regular physical activity showed a clear dose-response association, with increasing physical activity level associated with progressively lower odds of depressive symptoms, whereas greater dysmenorrhea severity was associated with progressively higher proportions screening positive for depressive symptoms. Folic acid supplementation was also independently associated with reduced odds of depressive symptoms.

CONCLUSIONS: Depressive symptoms were relatively common among women preparing for pregnancy and were closely associated with modifiable lifestyle factors, including smoking, sleep problems, and eating behaviors, as well as reproductive-related factors such as dysmenorrhea and infertility. These findings underscore the need to integrate systematic mental health screening and targeted lifestyle and reproductive health interventions into routine preconception and infertility care to improve women’s psychological well-being and support healthier future pregnancies.

PMID:42087119 | DOI:10.1186/s12905-026-04506-y

Clin Neurol Neurosurg. 2026 Apr 30;267:109445. doi: 10.1016/j.clineuro.2026.109445. Online ahead of print.

ABSTRACT

INTRODUCTION: Antiseizure Medications (ASMs) can be beneficial for many patients with epilepsy; however, some individuals with medication-resistant epilepsy (MRE) may not experience effective seizure control. Although effective alternative diets and non-pharmacological interventions have received much attention, there are limited studies in this regard. Therefore, this study was conducted to investigate the efficacy of probiotic intervention on children with MRE.

METHODS: This prospective, triple-blind, randomized clinical trial study was conducted on 62 pediatric patients with MRE who were referred to the Children’s Medical Center (the main referral center for children with epilepsy) and diagnosed by an epileptologist. Patients were randomly divided into two equally distributed groups: intervention (31 patients) with daily probiotic intake and control (31 Patients) with placebo intake. Patients were followed up at intervals of 45 days, 3 months, and 6 months regarding the number of seizures as the primary outcome, and the times and dose of anticonvulsants taken by the patient as secondary outcomes.

RESULTS: In the probiotic group, 20 patients (64.5%) experienced a decrease in seizure frequency following the intervention, while 11 patients (35.5%) showed no change in their seizure frequency. This outcome was statistically significant when compared to the placebo intervention group (P = 0.007). A statistically significant relationship was found between probiotic consumption and the patient’s seizure frequency after starting probiotics in patients with normal neuroimaging results (P = 0.007). Probiotic administration had a statistically significant effect only on reducing the dose of Phenobarbital. This study found that probiotic use was associated with a reduction in the number of seizures in patients with MRE. Because antiseizure medication (ASM) adjustments were not protocolized and certain confounders were not fully controlled, the causative nature of the association between probiotic use and seizure reduction cannot be ascertained.

PMID:42085751 | DOI:10.1016/j.clineuro.2026.109445

Epidemics. 2026 Apr 22;55:100911. doi: 10.1016/j.epidem.2026.100911. Online ahead of print.

ABSTRACT

Susceptible-Exposed-Infectious-Recovered (SEIR) models with inter-individual variation in susceptibility or exposure to infection were proposed early in the COVID-19 pandemic as a potential element of the mathematical/statistical toolset available to policy development. In comparison with other models employed at the time, those designed to fully estimate the effects of such heterogeneity tended to predict small epidemic waves and hence require less containment to achieve the same outcomes. However, these models never made it to mainstream COVID-19 policy making due to lack of prior validation of their inference capabilities. Here we report the results of the first systematic investigation of this matter in idealized scenarios created with synthetic data. We simulate datasets using the model with strategically chosen parameter values, and then conduct maximum likelihood estimation to assess how well we can retrieve the assumed parameter values. Parameter uncertainties were found to markedly reduce when concurrently fitting multiple epidemics with shared parameters, suggesting a general methodological approach that can be further developed to tackle real-world questions.

PMID:42085746 | DOI:10.1016/j.epidem.2026.100911

Atherosclerosis. 2026 May 1;417:120773. doi: 10.1016/j.atherosclerosis.2026.120773. Online ahead of print.

ABSTRACT

AIMS: This study aims to explore the relationship between aortic aneurysm and dissection (AAD) and cognitive impairment, with an emphasis on uncovering the potential biological mechanisms.

METHODS: Utilizing the UK Biobank database, a matched cohort study was performed to assess the association between AAD and the risk of Alzheimer’s disease. Cognitive function was evaluated in a β-aminopropionitrile (BAPN)-induced AAD mouse model through a series of behavioral assays. Drug-target Mendelian randomization analysis was conducted to identify candidate genes implicated in this association. Expression levels of PRDX6 were examined in brain tissues from Alzheimer’s disease patients using datasets from the Gene Expression Omnibus (GEO), as well as in aortic tissues and blood samples obtained from both AAD patients and AAD model mice. Correlative analyses between PRDX6 and pro-inflammatory cytokines (IL-1β and TNF-α) were performed in mouse hippocampal tissues of the mouse model. Additionally, in vitro experiments employing SH-SY5Y cells were carried out to investigate the functional role of PRDX6 in modulating synaptic protein expression and inflammatory responses.

RESULTS: Competing risk regression analysis indicated that AAD is significantly associated with an increased incidence of cognitive impairment. Behavioral testing revealed that AAD model mice exhibited deficits in cognitive performance. Mendelian randomization prioritized PRDX6 was prioritized as a candidate gene of interest. Elevated PRDX6 expression was observed in brain tissues from Alzheimer’s disease patients. Both AAD patients and AAD model mice demonstrated markedly increased PRDX6 levels in aortic tissues and circulating blood; notably, PRDX6 expression was also upregulated in the hippocampus of AAD mice. In the hippocampus, PRDX6 expression positively correlated with levels of IL-1β and TNF-α expression in AAD mice. In SH-SY5Y cells, silencing of PRDX6 resulted in increased expression of synaptic proteins, reduced pro-inflammatory cytokine production, and decreased apoptosis, whereas overexpression of PRDX6 elicited inverse effects.

CONCLUSIONS: The present findings establish a significant association between AAD and heightened risk of cognitive impairment. PRDX6 has been identified as a potential mediator in this relationship, and PRDX6-related neuroinflammation is proposed as a plausible mechanistic pathway linking AAD to cognitive dysfunction.

PMID:42085745 | DOI:10.1016/j.atherosclerosis.2026.120773

Neuroimage Clin. 2026 Apr 29;50:103999. doi: 10.1016/j.nicl.2026.103999. Online ahead of print.

ABSTRACT

Although the classical language cortex significantly contributes to post-stroke aphasia (PSA), non-language-specific cortex, such as the cerebellum, is increasingly implicated in language. However, the specific contributions of its subregions to PSA, particularly regarding distinct language dimensions, remain unclear. Given fluency as a core dimension, we investigated the functional and structural integrity of cerebellar language-related subregions to clarify their distinct roles in fluent (FA) versus non-fluent aphasia (nonFA). We enrolled a primary cohort of 81 PSA patients (46 nonFA, 35 FA), and 77 healthy controls (HCs), alongside an independent external validation cohort (Aphasia Recovery Cohort [ARC]; 23 nonFA, 22 FA). Using individualized functional connectivity (FC) and volumetric analyses based on the Multi-Domain Task Battery (MDTB) atlas, we found that nonFA patients exhibited significantly decreased FC between the classical language network (LN) and language-related cerebellar subregions (right MDTB 8 and 9; R_MDTB8/9-LN FC), alongside reduced right Crus II volume. Correlation analysis revealed that these neuroimaging indicators were positively associated with language scores in nonFA, while no such relationships were observed in FA. Furthermore, mediation analysis indicated that right Crus II volume statistically accounted for the observed association between R_MDTB8/9-LN FC and overall Aphasia Quotient (AQ). As the key findings were replicated in the ARC, our results provide compelling evidence that the functional connectivity strength and structural integrity of specific cerebellar subregions contribute to language fluency. Our findings support expanding models of PSA beyond cortical regions and suggest that cerebellar-targeted strategies may improve language rehabilitation outcomes.

PMID:42085725 | DOI:10.1016/j.nicl.2026.103999

J Infect Public Health. 2026 Apr 29;19(6):103238. doi: 10.1016/j.jiph.2026.103238. Online ahead of print.

ABSTRACT

BACKGROUND: Despite global elimination goals, measles remains a persistent regional health challenge in the Association of Southeast Asian Nations (ASEAN). This systematic review and meta-analysis characterized the distribution of cases and deaths during ASEAN measles outbreaks (2015-2025) and computed pooled proportions of cases stratified by age, vaccination history, migration status, and indigenous group membership.

METHODS: In this systematic review and meta-analysis (PROSPERO CRD420251149627), we searched Scopus, Medline, Embase, and Google Scholar through January 15, 2026, for studies on measles outbreaks in ASEAN (2015-2025) that stratified cases by age, vaccination history, or marginalized groups. A modified Joanna Briggs Institute/ROBINS-E tool was used to assess the risk of bias. Pooled proportions were calculated using random-effects generalized linear mixed models (GLMM). Heterogeneity and small-study effects were evaluated using I² statistics and Luis Furuya-Kanamori (LFK) indices, respectively.

FINDINGS: Across 11 studies (15,679 cases), measles disproportionately affected children under five (n = 10,867). Vaccination history reporting was near-complete in children but negligible in adults (0·22%, 95% CI: 0·00-73·41%). Among cases with known history, 73·20% (95% CI: 59·37-83·61%) were unvaccinated. Age-ineligible infants (<9 months) comprised half the unvaccinated burden (49·98%, 95% CI: 24·85-75·13%). Among vaccinated cases, 74·84% (95% CI: 44·48-91·70%) were not fully vaccinated. Significant heterogeneity was observed throughout (I² ≥ 89·0%). Risk of bias was generally low. Transmission was also documented among migrant and indigenous subpopulations.

INTERPRETATION: ASEAN measles outbreaks are driven by immunity gaps in unvaccinated children, partially vaccinated individuals, and age-ineligible infants. Achieving and sustaining regional measles elimination requires closing coverage gaps and addressing systemic drop-outs between doses. Future strategies must prioritize lifecycle immunity, including enforcement of the 2nd dose of measles containing vaccine (MCV2) and potential adult boosters, digitized vaccine registries, and cross-border collaboration.

PMID:42085724 | DOI:10.1016/j.jiph.2026.103238

Traffic Inj Prev. 2026 May 5:1-11. doi: 10.1080/15389588.2026.2653672. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to systematically investigate how key geometric parameters of spiral tunnels, specifically tunnel length and radius and travel direction, influence drivers saccadic eye movements and visual load.

METHODS: A field experiment was conducted using a wearable eye tracker to record saccadic behavior from 30 licensed drivers. Participants drove through 3spiral tunnels with varying lengths and radii under both uphill and downhill traversal conditions. Four saccade metrics (amplitude, duration, frequency, and velocity) were analyzed using descriptive statistics and ANOVA to evaluate visual workload. These metrics have been selected because they collectively reflect distinct aspects of visual scanning behavior: amplitude indicates the breadth of visual search, duration reflects the time required for processing fixated information, frequency represents the rate of gaze shifting, and velocity denotes the efficiency of oculomotor movement.

RESULTS: The findings indicate that tunnel geometry and travel direction significantly affect saccadic dynamics. Longer tunnels and smaller radii resulted in increased saccade amplitude, prolonged duration elevated frequency, and reduced velocity, suggesting heightened visual processing demand. Furthermore uphill traversal consistently produced larger amplitudes, longer durations higher frequencies, and slower velocities than downhill traversal across all tunnels, revealing a directional asymmetry in visual load.

CONCLUSIONS: This study demonstrates that spiral tunnel design, especially extended length and reduced radius, elevates drivers’ visual cognitive load with uphill travel imposing greater demands. The results provide empirical evidence to inform geometry-based design guidelines for optimizing visual ergonomics and improving operational safety in spiral tunnels.

PMID:42085709 | DOI:10.1080/15389588.2026.2653672

JMIR Med Educ. 2026 May 5;12:e84935. doi: 10.2196/84935.

ABSTRACT

BACKGROUND: Assessment is a critical component of teaching and learning and serves as the foundation for how learners demonstrate success in achieving learning objectives. Formative assessments (FAs) and timely feedback play a crucial role in integrated curricula, whereas basic and clinical sciences are taught in a coordinated manner. Feedback-based FA supports student learning, and teachers can determine learning gaps to monitor progress in learning. Based on existing evidence, limited literature compared the effect of online versus onsite FA on summative performance in a fully integrated curriculum.

OBJECTIVE: This study aimed to examine the effectiveness of online versus on-site FAs and feedback on summative assessment in the integrated medical curriculum.

METHODS: This study used an exploratory mixed methods approach to delving into students’ experiences with face-to-face versus online FA and feedback, and its effect on their summative performance in the integrated Bachelor of Medicine, Bachelor of Surgery program. This study was conducted at Fakeeh College for Medical Sciences in Jeddah, Saudi Arabia. A total of 143 consenting students were recruited into the study. The students in the study were distributed voluntarily into 2 groups regardless of age, sex, or academic performance. Group 1 (n=92) was assigned to receive online FAs and immediate online feedback throughout the module using the Speedwell system. However, Group 2 (n=51) was assigned to receive onsite FAs and face-to-face feedback throughout the module in the examination hall in the college. The quantitative part of the study involved analyzing student scores of summative assessments in 2 groups exposed to online and onsite FA and feedback. The qualitative part aimed to explore students’ perceptions of FA and feedback.

RESULTS: The passing rate in summative examinations (quiz, midmodule, and final) was higher in the onsite group (61.2%, 51%, and 62.7%, respectively) compared with the online group (53.3%, 48.3%, and 45.7%, respectively). However, the difference was statistically significant only in the quiz examination. Four key themes were identified from the qualitative analyses regarding participants’ different experiences of FA and feedback: the accessibility of the examination format facilitates flexibility in learning; FA is a means of recognizing learning opportunities; FAs help shift student attitudes toward learning; and the last theme is opportunities for discussion and personalized feedback.

CONCLUSIONS: This research sheds light on the intricate interplay between assessment modalities and student learning outcomes by demonstrating that onsite FA followed by onsite feedback is more effective than online FA and feedback in fostering student engagement and promoting deep understanding and improving students’ performance in summative examinations. Thereafter, this study contributes to the ongoing discourse surrounding effective assessment practices in contemporary educational settings.

PMID:42085703 | DOI:10.2196/84935

JMIR Res Protoc. 2026 May 5;15:e91726. doi: 10.2196/91726.

ABSTRACT

BACKGROUND: Tuberous sclerosis complex (TSC) is a rare genetic disorder caused by pathogenic variants in the TSC1 or TSC2 genes. Apart from multisystem physical manifestations, most individuals with TSC experience TSC-associated neuropsychiatric disorders (TAND). Little is known about how TAND severity changes over time and what factors may predict these changes. Preliminary data suggest the presence of differential TAND severity trajectories. Caregiver well-being may act as a mediator of TAND severity, and a well-being intervention designed for caregivers of children with developmental disabilities may improve caregiver well-being.

OBJECTIVE: The study aims are to (1) examine longitudinal trajectories of TAND severity in a large sample of individuals with TSC and to examine potential predictors of differential trajectories, (2) evaluate the association between caregiver well-being characteristics, TAND severity, and severity trajectories, and (3) adapt and evaluate the feasibility, acceptability, and potential efficacy of a brief, online group-based well-being intervention for family caregivers.

METHODS: For the first 2 aims, 500 individuals with TSC or their caregivers will be recruited in an accelerated longitudinal design to document TAND severity at 5 time points over 12 months via a web-based app. At each time point, participants will complete demographic, TSC characteristics, intervention, and well-being questionnaires. Data will be analyzed using latent class mixed and multinomial regression modeling (aim 1) and structural equation and mediation modeling (aim 2). Participatory methods will be used to adapt an existing caregiver well-being intervention for the TSC community (aim 3). Thirty caregivers will be invited to participate in the adapted group-based online well-being intervention.

RESULTS: This study was funded from July 2024 (HT94252410790 and HT94252410791), and ethics approvals were obtained from the University of Cape Town (July 2024), Vrije Universiteit Brussel (November 2024), and the Department of Defense Office of Human Research Oversight (December 2024). The TAND Toolkit app was adapted for longitudinal data collection (aims 1 and 2). Recruitment started in December 2025 and will continue until 500 participants are enrolled (anticipated December 2026). Primary outputs are expected by July 2028. For aim 3, experiential and adaptation workshops were completed in June 2025, the pilot intervention was delivered in November 2025, and data collection will continue till May 2026. Outputs are expected by December 2026.

CONCLUSIONS: Identification of differential longitudinal TAND trajectories and their correlates will stimulate research in TSC and generate evidence for the self-report quantified TAND checklist as a clinical outcome measure. Understanding the association between caregiver well-being and TAND severity will provide support for targeted well-being interventions. A successful pilot trial will provide preliminary data for larger-scale clinical trials, with the potential to support caregivers and improve TAND outcomes. Together, the findings from the study will help close the gap in interventions for TAND.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06879665; https://clinicaltrials.gov/study/NCT06879665.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/91726.

PMID:42085697 | DOI:10.2196/91726

J Public Health Manag Pract. 2026 May 5. doi: 10.1097/PHH.0000000000002355. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the associations between sensitivity and specificity with prevalence in data matching.

METHODS: Using publicly available data, a synthetic dataset of names (“source population”; 8 million records) was created with records randomly assigned as positive or negative for a health outcome, as well as sex and birth date. All positives were included in file 1 (“disease registry”), and a random sample of positives and negatives were selected and merged to create file 2 (“study population”). The prevalence in the source population was defined as the proportion of individuals in the synthetic dataset who were randomly assigned as positive, and the prevalence in the study population as the proportion of individuals in the study population who were positive. Multiple disease registry and study population file pairs were created and matched with various prevalence in the source and study populations. Link Plus 3.0, a probabilistic record linkage program, was used for the data matching.

RESULTS: As the prevalence in the source population increases from 0.1% to 10%, the sensitivity increases from 80.0% to 94.6% and the specificity decreases slightly; as the prevalence in the study population increases from 10% to 99%, the sensitivity remains stable around 95.0% and the specificity stays at about 100.0%.

CONCLUSIONS: In data matching, the sensitivity is positively and the specificity is negatively associated with the prevalence in the source population, but not associated with the prevalence in the study population.

PMID:42085690 | DOI:10.1097/PHH.0000000000002355