Category: Statistics

Laryngoscope. 2026 May 24. doi: 10.1002/lary.70634. Online ahead of print.

ABSTRACT

OBJECTIVE: This systematic review explores the natural history of residual and recurrent juvenile nasopharyngeal angiofibromas (JNAs) to inform clinical decision-making.

DATA SOURCES: PubMed, Embase, Scopus, and Web of Science.

REVIEW METHODS: A systematic literature review was conducted according to PRISMA guidelines across PubMed, Embase, Scopus, and Web of Science from inception to February 20, 2025 and was re-run on September 21, 2025. Studies included patients with advanced JNA and documented follow-up of residual or recurrent disease. Descriptive statistics, chi-squared analysis, and analysis of variance were used to evaluate treatment outcomes across different modalities including surgery, radiotherapy, gamma knife surgery, and medical therapies.

RESULTS: Twenty-one studies encompassing 131 male patients (mean age 16.3 years) were included. Residual or recurrent disease demonstrated complete involution in 41%, stable disease in 29%, and reduction in size in 25% of cases. Only 2% of patients had progressive disease. A statistically significant association was observed between treatment modality and outcome (p = 0.015), with radiotherapy, either alone, or as part of a multimodal approach, showing the highest rates of spontaneous involution.

CONCLUSION: Residual and recurrent JNAs often remain stable or regress without further intervention. Close surveillance with imaging is a safe and effective strategy for asymptomatic patients, minimizing the risks of additional treatment in a young patient population with disease near critical anatomical structures.

PMID:42178599 | DOI:10.1002/lary.70634

Virol J. 2026 May 24. doi: 10.1186/s12985-026-03201-6. Online ahead of print.

ABSTRACT

Viruses strongly depend on the host cell for efficient replication and influenza A virus (IAV) amongst others also lead to remarkable changes of the host cell metabolism. The restriction of virus replication through suppression of glucose metabolism has already been described. In addition to glycolysis and glutaminolysis, viral replication also relies on the tricarboxylic acid (TCA) cycle. So far, the metabolic key intermediate of the TCA cycle, oxaloacetate (OAA), is described to enhance glycolysis and respiration flux rates under metabolic stress conditions. However, the mode of action of the metabolic fuel intermediate OAA in direct relation to influenza viral growth under strong glycolysis inhibition remains unclear. As the TCA cycle acts as a central metabolic hub linking all major metabolic pathways, the effects of OAA under glycolysis inhibition were examined in greater detail in this study. We aimed to get a better understanding of metabolic host-virus interactions and to analyze the effects of metabolic fueling intermediates on IAV replication under glycolysis inhibition. We inhibited glycolysis and supplemented IAV infected cells with the metabolic fueling intermediate OAA. Inhibition of glycolysis led to a statistically significant reduction of viral titers while OAA addition reversed the antiviral effects such as reduced viral protein accumulation, viral titers, and vRNA expression. In line with previous studies, we showed that mannose, which is closely connected to glycolysis, circumvents the virus restricting effects of glycolysis inhibition. Moreover, we demonstrated that supplementation of mannose or OAA led to a roughly comparable replication recovery under strong inhibition of glycolysis. Furthermore, mass spectrometry-based metabolomics data revealed a strong accumulation of pyruvate in OAA supplemented samples. Finally, comparing OAA and pyruvate rescuing capacities of IAV growth under glycolysis inhibition tended to show similar activities for both metabolites arguing that OAA mediated IAV rescue is achieved through its conversion to pyruvate. Summarizing, our data indicate that the TCA cycle intermediate OAA has virus supporting effects as it reversed the antiviral effects of glycolysis inhibition.

PMID:42178590 | DOI:10.1186/s12985-026-03201-6

BMC Psychol. 2026 May 25. doi: 10.1186/s40359-026-04836-4. Online ahead of print.

ABSTRACT

BACKGROUND: Workplace violence (WPV) represents a growing global health and occupational safety concern, with significant implications for employees’ well-being and job satisfaction as well as organizational performance. This study explores the prevalence of non-physical WPV, specifically perceived sexual harassment (PSH) and perceived gender discrimination (PGD), and examines their potential adverse outcomes such as job stress and intention to leave employment across the public and private sectors in Saudi Arabia.

METHODS: A cross-sectional online survey using non-probability purposive sampling was conducted from November 2023 to March 2025, involving 558 employees from 20 public and private sector organizations in Saudi Arabia. Descriptive statistics and multivariable generalized linear models with gamma regression were used for the analysis.

RESULTS: The mean PSH score was 18.5 (SD = 5.98) and the mean PGD score was 19.6 (SD = 7.97). The multivariable generalized linear models indicated that PGD was associated with higher PSH (adjusted rate ratio = 1.009, 95% CI [1.007, 1.012]) and that elevated job stress was associated with increased PSH (adjusted rate ratio = 1.005, 95% CI [1.002, 1.009]) and PGD (adjusted rate ratio = 1.015, 95% CI [1.010, 1.021]).

CONCLUSIONS: Non-physical forms of WPV, including PSH and PGD, are prevalent across workplace settings in Saudi Arabia and are associated with adverse psychological and occupational outcomes. The results underscore the necessity for organizational policies and psychologically informed workplace interventions to mitigate harassment and discrimination, enhance employee well-being, and foster safer workplace environments.

PMID:42178581 | DOI:10.1186/s40359-026-04836-4

Inj Epidemiol. 2026 May 24. doi: 10.1186/s40621-026-00690-5. Online ahead of print.

ABSTRACT

BACKGROUND: Mass public shootings represent a significant source of fatal and nonfatal injury in the United States. This study examines patterns of strain among individuals who carried out these events, with attention to the prevalence, co-occurrence, and cumulative burden of stressors.

METHODS: Data were drawn from a database of mass public shootings in the United States from 1999 to 2024, comprising 171 incidents and 175 perpetrators. Information was collected using a structured, multi-source approach including official records, secondary reports, and triangulated media sources. Eighteen dichotomous indicators of strain were coded. Descriptive statistics assessed prevalence and cumulative strain, and phi coefficients examined pairwise associations.

RESULTS: Perpetrators experienced multiple, overlapping forms of strain (mean = 4.78; SD = 2.78). Psychiatric concerns, job-related difficulties, and interpersonal stressors were most common. Strains frequently co-occurred, with strong associations among interpersonal and psychological factors and between structural stressors and ideological motivations. Most perpetrators experienced multiple concurrent stressors, indicating that these events rarely are preceded by a single, isolated grievance.

CONCLUSIONS: Mass public shootings may be better understood as the result of cumulative and co-occurring strains rather than isolated risk factors. Injury and violence prevention efforts may be strengthened by emphasizing patterns of stressors, early identification, and coordinated, systems-level responses, including threat assessment.

PMID:42178574 | DOI:10.1186/s40621-026-00690-5

BMC Nutr. 2026 May 25. doi: 10.1186/s40795-026-01371-8. Online ahead of print.

ABSTRACT

BACKGROUND: Vitamin D deficiency remains a major public health concern in the Middle East and North Africa despite abundant sunlight. The public’s understanding of vitamin D sources, risk factors, and preventive practices may influence recognition and prevention of deficiency, yet data from Palestine remain limited. This study assessed awareness and knowledge of vitamin D deficiency among Palestinian adults recruited online and examined whether knowledge differed according to sociodemographic characteristics and vitamin D-related experiences.

METHODS: An analytical online cross-sectional study was conducted among Palestinian adults using an adapted Arabic self-administered questionnaire distributed through social media between November and December 2025. The instrument assessed sociodemographic characteristics, vitamin D-related experiences, and knowledge across benefits, sources/determinants, and toxicity domains. Knowledge scores ranged from 0 to 14, and scores greater than 7 were classified as adequate knowledge, consistent with the source instrument. Descriptive statistics, bivariate analyses, and multivariable logistic regression were performed using SPSS version 25.

RESULTS: A total of 756 respondents were included (mean age 27.5 ± 9.9 years; 79.1% female). The mean knowledge score was 10.21 ± 2.25, and 88.8% of participants were classified as having adequate knowledge. Correct responses were highest for skeletal benefits and the role of sun exposure in vitamin D production. Lower correct response rates were observed for items related to vitamin D toxicity, vegetarian-related risk, and the effect of darker skin pigmentation on deficiency risk. Higher mean knowledge scores were observed among males, single participants, participants without children, and those who had undergone vitamin D testing or had taken supplements. However, no independent predictors of adequate knowledge were identified in the adjusted logistic regression model.

CONCLUSIONS: Palestinian adults in this online non-probability sample demonstrated a generally high level of vitamin D knowledge, particularly regarding bone health and sun exposure. However, important gaps persisted in specific domains, especially toxicity and less commonly recognized risk factors. Because the sample was recruited online and was disproportionately female and highly educated, the findings should be interpreted as descriptive of this sampled group rather than representative of all Palestinian adults.

PMID:42178572 | DOI:10.1186/s40795-026-01371-8

Int J Ment Health Syst. 2026 May 24. doi: 10.1186/s13033-026-00713-0. Online ahead of print.

ABSTRACT

BACKGROUND: The practice of electroconvulsive therapy (ECT) is constrained by limited resources. Anticipating recurrent peaks in demand is therefore essential for optimizing resource planning within public healthcare systems. This study examined seasonal patterns of ECT utilization in France over an extended period.

METHOD: We analyzed data from the French national administrative and medical database. Seasonal patterns in monthly ECT utilization time series from 2017 to 2023 were investigated using robust statistical methods.

RESULTS: We observed a clear seasonal pattern with a 12-month periodicity in monthly ECT utilization, accounting for 16% of the variance in use, with a major peak in December and a mean relative amplitude of 13.1%. Seasonal variation was observed across sex, age and diagnostic subgroups, although it was less pronounced among patients aged 24 years or younger and those with schizophrenia. Across all subgroups, ECT activity consistently peaked at the onset of winter, between November and December.

CONCLUSION: These findings emphasize the need for ECT providers in France to anticipate recurrent winter peaks in activity. Proactive healthcare policies should ensure that medical staffing and equipements ressources are adjusted to accommodate predictable winter peaks in ECT demand.

PMID:42178564 | DOI:10.1186/s13033-026-00713-0

Popul Health Metr. 2026 May 25. doi: 10.1186/s12963-026-00487-0. Online ahead of print.

ABSTRACT

BACKGROUND: Gastric cancer has historically been driven by long‑standing Helicobacter pylori infection. The nationwide expansion of H. pylori eradication therapy beginning in 2013 created a unique opportunity to evaluate its population‑level impact on gastric cancer mortality. However, short‑term mortality trends following eradication are difficult to interpret because they reflect overlapping influences of ageing, cohort replacement, and cumulative infection history. This study aimed to provide a model‑based, population‑level assessment of the early impact of eradication during the first decade of nationwide implementation.

METHODS: We applied a two‑layer analytic framework consisting of a counterfactual analysis comparing observed mortality during 2013-2021 with expected mortality had eradication uptake remained at pre‑2013 levels, combined with a structured state‑transition (Markov) model with time‑dependent parameters. To estimate annual gastric cancer deaths prevented and the proportion of mortality reduction attributable to eradication, the model integrated age‑specific biological hazard, cumulative infection history, cohort‑specific H. pylori prevalence, and annual changes in eradication uptake.

RESULTS: Observed gastric cancer deaths declined from 48,632 in 2013 to 41,624 in 2021, whereas counterfactual gastric cancer deaths declined more modestly, from 49,779 to 49,453. The divergence between observed and counterfactual deaths steadily widened from 1,147 in 2013 to 7,829 in 2021. Model‑based estimates indicated that eradication prevented 6,461 gastric cancer deaths during 2013-2021, with annual deaths prevented increasing from 165 in 2015 to 1,604 in 2021, particularly among adults aged 60-79, who showed the most pronounced early benefit reflecting cumulative infection history and real-world uptake patterns.

CONCLUSIONS: The early population‑level impact of H. pylori eradication is consistent with a 16% reduction in gastric cancer deaths by 2021. These findings provide real‑world insight into how primary prevention can shape short‑term national cancer trends. This approach offers a quantitative framework to inform future prevention strategies in high‑prevalence settings seeking to evaluate early implementation effects.

PMID:42178557 | DOI:10.1186/s12963-026-00487-0

BMC Oral Health. 2026 May 25. doi: 10.1186/s12903-026-08639-2. Online ahead of print.

ABSTRACT

BACKGROUND: Additive manufacturing of cobalt-chromium (Co-Cr) and titanium (Ti-6Al-4 V) alloys is increasingly used in prosthetic dentistry. Acidic oral environments associated with gastroesophageal reflux disease (GERD) may negatively influence the surface integrity and corrosion resistance of dental materials. This in vitro study assessed the effects of simulated gastric acid on the corrosion resistance, surface morphology, and topographical changes of selective laser melting (SLM) Co-Cr and Ti-6Al-4 V alloys.

METHODS: Thirty-two additively manufactured specimens (n = 16 per alloy) were randomly distributed into acidic (pH 1.2) and neutral control (pH 6.7 distilled water) subgroups (n = 8). A cyclic static immersion protocol was used to simulate GERD-related acid exposure. Specimens in the acidic group were immersed for 2 min in acidic solution, rinsed without scrubbing to preserve the delicate surface topography, and stored in distilled water at 37 °C, repeated six times daily over nine days with a 24-hour interval maintained between each daily cycle. Control specimens were stored continuously in distilled water at 37 °C. Surface morphology, elemental composition, and topography were evaluated using scanning electron microscopy (SEM) and Abbott-Firestone curve analysis.

RESULTS: In the Co-Cr alloy, immersion in an acidic solution resulted in a decrease in the percentage of all elements, except O, which increased to 6.37 ± 1.77%, with the change being statistically significant (P ≤ 0.05). In contrast, Ti-6Al-4 V also showed a decrease in all elements after immersion, with O rising to 2.26 ± 1.22%, although no changes were statistically significant (P ≥ 0.05). SEM images indicated more oxide deposits on Co-Cr in an acidic solution, which also showed a notable increase in surface roughness, whereas Ti-6Al-4 V exhibited greater stability. The Abbott-Firestone analysis further confirmed that Co-Cr underwent more significant changes in peak formation and exploitation zones than Ti-6Al-4 V did in acidic environments.

CONCLUSIONS: Under simulated gastric acid exposure, Ti-6Al-4 V alloys exhibited superior corrosion resistance and surface stability compared with Co-Cr alloys. These findings support the clinical preference for Ti-6Al-4 V in dental restorations for patients experiencing frequent acidic challenges, such as those with severe GERD.

PMID:42178550 | DOI:10.1186/s12903-026-08639-2

BMC Public Health. 2026 May 25. doi: 10.1186/s12889-026-27841-z. Online ahead of print.

ABSTRACT

BACKGROUND: Female genital mutilation (FGM) and child marriage (CM) remain pervasive in Ethiopia, driven by entrenched social norms, gender inequalities, and economic factors. Despite legal prohibition, national prevalence stands at 65% for FGM and 40% for CM. In response, Population Media Center (PMC) collaborated with the United Nations Population Fund (UNFPA) to implement a multimedia social and behavior change (SBC) intervention to raise awareness, shift attitudes and norms, and reduce the practice of FGM and CM in 4 targeted woredas of southern Ethiopia. This mixed-method study evaluates if and how the intervention was associated with changes in knowledge, attitudes, social norms, and practices related to FGM and CM.

METHODS: A mixed-methods evaluation was conducted in May 2025 using a comparative cross-sectional survey and qualitative interviews. A total of 403(205 exposed and 198 unexposed) survey participants were selected through systematic random sampling. For the qualitative components, 70 participants were purposively selected: 62 participants across 8 focus group discussions and 8 individual in-depth interviews. Respondents were categorized by exposure to the PMC multimedia intervention. Differences in knowledge, attitudes, behavioral intentions, social norms, and practices related to FGM and CM were analyzed. Chi-square tests determined statistical significance (p < 0.05), and quantitative insights were triangulated with qualitative insights.

RESULTS: Of 403 survey participants (205 exposed; 198 non-exposed; 73.7% female), the exposed group demonstrated significantly higher awareness about FGM and CM (93.2% vs. 84.6%, p < 0.001), stronger anti-FGM attitudes (90.2% vs. 81.4%, p = 0.014), and stronger anti-CM attitudes (83.4% vs. 78.1%, p < 0.001) compared to non-exposed participants. Total prevalence was 32.7% for FGM and 4.9% for CM. Qualitative data revealed that FGM persists covertly; families bypass legal restrictions by temporarily relocating girls to other villages for secret procedures. Despite high levels of awareness, deeply rooted sociocultural norms, marriageability myths, economic factors, social acceptability, and religious beliefs continue to perpetuate both practices.

CONCLUSION: Exposure to PMC multimedia SBC engagement was associated with significant differences in awareness and attitudes. However, the continued practice of FGM through covert means underscores the power of interlinked sociocultural and religious norms. Accelerating the abandonment of FGM and CM requires scaling community dialogues, empowering girls and young people, fostering intergenerational dialogue, coordinating stakeholder efforts, and strengthening legal enforcement to move beyond individual attitude shifts toward collective social norm change.

PMID:42178547 | DOI:10.1186/s12889-026-27841-z

BMC Surg. 2026 May 25. doi: 10.1186/s12893-026-03861-9. Online ahead of print.

ABSTRACT

The present study aimed to investigate the efficacy of indocyanine green (ICG) fluorescence-guided laparoscopic hepatectomy for the treatment of liver metastases. Therefore, data from patients with liver metastases who underwent laparoscopic hepatectomy were retrospectively collected. A total of 69 patients were divided into the ICG group (fluorescence-guided) and conventional group, with 24 well-matched pairs analyzed after propensity score matching. Laparoscopic hepatectomy was successfully performed in all patients.The ICG group had significantly wider surgical margins than the conventional group (1.73 ± 0.57 cm vs. 1.04 ± 0.44 cm; P < 0.001). Pre-matching R0 resection rates were 91.9% (ICG) and 90.6% (conventional), with 100% R0 resection achieved in both groups post-matching. Operative time, intraoperative blood loss and postoperative ALT levels were numerically lower in the ICG group without statistical significance. The rates of overall/severe (Clavien-Dindo ≥IIIa) complications and 6-month recurrence were comparable between the two groups (all P > 0.05). In conclusion, ICG fluorescence-guided laparoscopic hepatectomy is safe and feasible for liver metastases, yielding significantly wider surgical margins. Although perioperative outcomes and 6-month recurrence rates were comparable between groups after matching, the ICG-guided approach achieved significantly wider surgical margins-a finding with potential implications for long-term oncological outcomes that warrant further investigation.

PMID:42178544 | DOI:10.1186/s12893-026-03861-9