Category: Statistics

Circ Popul Health Outcomes. 2026 Feb 16:e012216. doi: 10.1161/CIRCOUTCOMES.125.012216. Online ahead of print.

ABSTRACT

BACKGROUND: It remains unclear whether social determinants contribute to major ECG abnormalities (MEA), an early marker of cardiovascular disease, which predicts adverse cardiovascular events and mortality. We investigated the of MEA incidence and its associations with race and life-course socioeconomic position, as well as gender differences.

METHODS: This prospective cohort study included 11 761 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil [Estudo Longitudinal de Saúde do Adulto-Brasil]) free of MEA and cardiovascular disease at baseline (2008-2010). Incident MEA cases were identified by ECG at the second (2012-2014) and third (2017-2019) cohort visits. Explanatory variables included life-course socioeconomic position (childhood, youth, and adulthood); intergenerational social mobility; and race, and racial discrimination. Parametric survival models with interval censoring and Weibull distribution stratified by gender were used.

RESULTS: The mean age was 51 years (SD±8), and 55.5% of participants were women. The cumulative incidence of MEA was 15.8% in 8 years follow-up. Low childhood socioeconomic position (versus high socioeconomic position) was associated with a 48% higher incidence of MEA (95% CI, 1.17-1.87), only among women. In adulthood, low income and educational level were associated with a higher incidence of MEA in both genders, whereas occupational variables were associated only among women. Social immobility at the base of the educational and socio-occupational hierarchy was associated with an increase of 25% (95% CI, 1.04-1.49) and 31% (95% CI, 1.08-1.61) in the MEA incidence, respectively, only among women. MEA incidence was 35% higher (95% CI, 1.13-1.61) among Black women (versus White women). Furthermore, lifetime exposure to racial discrimination was associated with a higher incidence of MEA among both Black women (hazard ratio, 1.37 [95% CI, 1.04-1.82]) and Brown women (hazard ratio, 1.70 [95% CI, 1.07-2.70]). These associations were not observed among men.

CONCLUSIONS: Life-course social and racial inequalities are associated with MEA incidence, particularly among women, underscoring the importance of social determinants in cardiovascular health.

PMID:41693557 | DOI:10.1161/CIRCOUTCOMES.125.012216

Endocr Connect. 2026 Feb 16:EC-25-0541. doi: 10.1530/EC-25-0541. Online ahead of print.

ABSTRACT

OBJECTIVE: To establish sex- and age-specific reference intervals for plasma concentrations of adrenocorticotropic hormone (ACTH) and direct renin in healthy youth.

DESIGN: 529 healthy subjects (5.8 to 20.4 years) were recruited as part of the third Copenhagen Puberty Study, an ongoing cross-sectional study of healthy Danish participants attending compulsory school and high school.

METHOD: Using GAMLSS statistics, sex- and age-specific reference intervals and standard deviation (SD) scores for plasma ACTH and direct plasma renin concentrations were established. Concentrations were evaluated according to pubertal stage and oral contraceptive (OC) use.

RESULTS: ACTH concentrations did not differ between sexes. ACTH concentrations were higher in pubertal males than in prepubertal males (P = 0.015); however, this difference was not statistically significant when analyses were restricted to samples collected before 10:00 AM. In females, ACTH concentrations did not seem to differ according to pubertal status. In both sexes, renin concentrations were lower in pubertal than in prepubertal subjects (females: P < 0.001, males: P = 0.016). Renin SD scores were lower in OC-users than in non-OC users (P = 0.007), while ACTH SD scores did not differ between these groups.

CONCLUSION: Sex- and age-specific reference intervals for plasma concentrations of ACTH and direct renin in young, healthy subjects were provided, reflecting changed levels through puberty and significantly lower renin SDS in OC-users. Application of these biomarkers’ SD scores may enhance the management of patients with adrenal disorders.

SIGNIFICANCE STATEMENT: Reliable reference data for plasma adrenocorticotropic hormone (ACTH) and direct plasma renin in healthy children are limited. This large population-based cohort study of healthy participants attending compulsory school and high school provides comprehensive sex- and age-specific reference intervals for plasma ACTH and renin. Furthermore, absolute concentrations were converted to relative standard deviation (SD) scores, thereby providing a more unified and standardized tool for clinical assessment. Reporting ACTH and renin concentrations by pubertal stage represents a novel aspect. These new reference intervals enhance the clinical utility of biomarker-based monitoring and treatment of pediatric endocrine disorders like congenital adrenal hyperplasia (CAH), addressing a critical gap in current clinical pediatric practice.

PMID:41693548 | DOI:10.1530/EC-25-0541

Cancer Rep (Hoboken). 2026 Feb;9(2):e70498. doi: 10.1002/cnr2.70498.

ABSTRACT

BACKGROUND: Africa and sub-Saharan Africa reported higher cervical cancer cases globally. Cervical cancer is the second most leading cause of cancer in Ethiopia. Yet, the evidence was low for cervical cancer screening practices in Ethiopia.

AIM: In this study, we assessed the cervical cancer screening and associated factors among reproductive-age women in Sidama Region, Bensa, Ethiopia.

METHODS: A facility-based cross-sectional study design was conducted from January 1, 2023 to March 30, 2023 in Bensa district. Data were collected using a pre-tested and structured questionnaire. Multivariable logistic regression was used to identify the associated factors with knowledge, attitude, and practice of cervical cancer screening.

RESULTS: One hundred forty-seven 147 (36.7%) had good knowledge, 218 (54.4%) had a favorable attitude towards cervical cancer screening and only 60 (15%) respondents were screened for cervical cancer. Women having better educational status was 1.6 (AOR: 95% CI: 1.0, 2.5) times more likely to have knowledge of cervical cancer screening. Women being the protestant religion followers (AOR: 1.9; 95% CI; 1.0-3.4), Sidama ethnic group (AOR: 4.5; 95% CI: 2.1-9.7), having no formal education (AOR: 1.7; 95% CI: 1.1-2.7), and having good knowledge of cervical cancer (AOR: 2.2; 95% CI: 1.4-3.4) were associated with a positive attitude towards screening for cervical cancer. The odds of cervical cancer screening were low among Amhara’s ethnic categories (AOR: 0.2; 95% CI: 0.1-0.5), while higher in women with single marital statuses (AOR: 2.4; 95% CI: 1.2-4.8), and those who have information about cancer screening (AOR: 2.0; 95% CI: 1.1-3.8).

CONCLUSION: The results of this study showed that cervical cancer screening practice was low. The respondents’ knowledge and education status were positively associated with screening for cervical cancer.

PMID:41693541 | DOI:10.1002/cnr2.70498

Int Rev Psychiatry. 2026 Feb 16:1-9. doi: 10.1080/09540261.2026.2631758. Online ahead of print.

ABSTRACT

The increasing prevalence of common mental disorders such as depression and anxiety found in Hong Kong, coupled with substantial public healthcare service gaps, necessitates accessible and immediate therapeutic interventions. This pilot implementation study investigated the feasibility, safety and acceptability of a culturally and linguistically adapted Virtual Reality (VR)-based psychotherapy intervention for Cantonese-speaking adults experiencing mild-to-moderate depression and anxiety in Hong Kong. Employing a sequential explanatory mixed-methods design, the study utilized four culturally specific VR scenarios, namely “Crying Girl” (targeting depression/self-compassion), “MTR” (enabling social anxiety exposure), “Emigration” (addressing separation-related anxiety), and “Rock-paper-scissors” (enhancing prosocial functioning). Quantitative pre-post assessments were combined with qualitative semi-structured interviews and focus groups to explore user experience, immersion, and perceived therapeutic mechanisms. Preliminary quantitative findings indicated statistically significant reductions in depressive symptoms and increases in self-compassion in the “Crying Girl” scenario, alongside reductions in stress in the “MTR” scenario. Focus groups and interviews revealed that participants highly valued immersion, ecological validity, and culturally resonant scenarios in therapeutic practice. Barriers such as technical imperfections, device complexity, and interface demands were identified, particularly for users with limited digital experience. This pilot study highlights the premise of culturally adapted VR psychotherapy as a safe and engaging intervention, emphasizing the need for user-centred design iterations to improve accessibility and subsequent larger controlled trials to rigorously evaluate efficacy and inform real-world implementation.

PMID:41693503 | DOI:10.1080/09540261.2026.2631758

J Pediatr Gastroenterol Nutr. 2026 Feb 16. doi: 10.1002/jpn3.70380. Online ahead of print.

ABSTRACT

OBJECTIVES: There is a lack of research describing changes in vibration-controlled transient elastography (VCTE) parameters in pediatric metabolic dysfunction-associated steatotic liver disease (MASLD). We hypothesized that VCTE measurements would be positively associated with changes in anthropomorphic and biochemical parameters in pediatric MASLD over time, making VCTE a useful tool to monitor MASLD in children.

METHODS: This was a retrospective chart review of children under 18 with MASLD evaluated at Boston Children’s Hospital from 2015 to 2023. Demographic, biochemical, and anthropometric data were collected.

RESULTS: The cohort consisted of 336 children (72.8% male), 192 of which were less than 18 and had two or more VCTE exams, with median age 12.0 (interquartile range [IQR] 10.0-14.0) years. The mean time between VCTE exams was 16.8 months (standard deviation [SD] 11.1). Based on a linear mixed effects model, a unit increase in body mass index (BMI) z-score was associated with a 1.02 kPa increase in liver stiffness measurement (LSM) (p = 0.012). Follow-up time was statistically significantly associated with increasing liver stiffness (p = 0.015) after controlling for baseline age and BMI z-score. For controlled attenuation parameter (CAP), the linear mixed effects model demonstrated a unit increase in BMI z-score was associated with an 88.22 dB/m increase (p < 0.001).

CONCLUSIONS: This is the first study to describe changes in VCTE parameters over time in children with MASLD. Changes in BMI were positively associated with changes in LSM and CAP. VCTE can be an effective tool to monitor changes in disease status over time in pediatric MASLD.

PMID:41693480 | DOI:10.1002/jpn3.70380

Cell J. 2026 Jan 31;27(1):1-14. doi: 10.22074/cellj.2025.2050534.1775.

ABSTRACT

OBJECTIVE: This study intends to determine whether exercise-based interventions improve haemoglobin A1c (HbA1c) levels in adults with type 1 diabetes (T1D) and examines how different types of exercise influence this association.

MATERIALS AND METHODS: A search of the appropriate electronic databases revealed 18 eligible studies from initial 685 records. The effect of exercise training on HbA1c was examined in two parts: i. Exercise training intervention compared to a T1D control group (between-group analysis) and ii. Pre/post comparison of exercise training intervention on T1D patients (within-group analysis).

RESULTS: The between-group results showed that exercise training had a statistically significant reduction in HbA1c [mean difference (MD), confidence interval (CI)]: -0.39 (-0.64, -0.15), P=0.002, I²=0%). Subgroup analysis based on the types of exercise training showed a statistically significant effect of high-intensity interval training (HIIT) on HbA1c levels in both the within-group analyses [MD: -0.24 (-0.45, -0.02), P=0.03, I²=0%] and between-group analyses [MD: -0.39 (-0.64, -0.15), P=0.002, I²=0%].

CONCLUSION: The meta-analysis and meta-regression results suggest that HIIT may be a supportive intervention in T1D patients; however, there was insufficient evidence to confirm these findings. Data from more randomised controlled trials (RCTs) are needed to compare the effect of different types of exercise on HbA1c levels in T1D patients [registration: PROSPERO (CRD42023414580)].

PMID:41693438 | DOI:10.22074/cellj.2025.2050534.1775

Disabil Rehabil. 2026 Feb 16:1-12. doi: 10.1080/09638288.2026.2629823. Online ahead of print.

ABSTRACT

PURPOSE: Decision-making capacity (DMC) is the ability to make informed, autonomous choices. In healthcare settings, a range of providers typically evaluate DMC using a semi-structured interview approach. The presence of aphasia introduces a significant challenge to DMC assessments because a patient’s communication challenges can mask their underlying capacity. This quality improvement project aimed to (1) train providers to integrate evidence-based communication accommodations with support from a speech-language pathologist (SLP) to reduce the risk of underestimating capacity during a DMC assessment; and (2) assess the effectiveness of the training intervention.

MATERIALS AND METHODS: A team of SLPs and bioethicists in a research and rehabilitation hospital developed and evaluated an online training module for DMC assessors and SLPs to support the delivery of accessible DMC evaluations for patients with aphasia. Trainees completed pre- and post-training surveys to indicate self-reported change in knowledge and confidence and provide feedback on their learning experience.

RESULTS: The training resulted in positive learning experiences and statistically significant increases in self-reported knowledge and confidence for DMC evaluators and SLPs in providing accessible DMC evaluations for individuals with aphasia.

CONCLUSION: The online training module was viewed as effective in promoting communication accessible DMC evaluations by interdisciplinary provider trainees.

PMID:41693432 | DOI:10.1080/09638288.2026.2629823

J Endourol. 2026 Feb 16:8927790261422977. doi: 10.1177/08927790261422977. Online ahead of print.

ABSTRACT

OBJECTIVE: To critically appraise the Radius, Exophytic/endophytic, Nearness of tumor to collecting system or sinus, Anterior/posterior, Location relative to polar lines (R.E.N.A.L.), Preoperative Aspects and Dimensions Used for an Anatomical classification (PADUA), and Radius, Position, iNvasion of sinus (RPN) nephrometry systems with respect to their classification of tumor complexity for surgical planning in robot-assisted partial nephrectomy (RAPN) and to compare their statistical validity, methodological rigor, and predictive performance.

MATERIALS AND METHODS: A structured synthesis of published evidence identified large multicenter series, prospective cohorts, and meta-analyses from 2009 to 2025 that evaluated the predictive accuracy, methodological design, and clinical relevance of these systems. Key evaluation domains included statistical validation, anatomical parameter selection, and correlation with surgeon-perceived difficulty in RAPN.

RESULTS: Both the R.E.N.A.L. and PADUA scores were developed using empirically selected parameters and have historically been validated based on their correlation with perioperative outcomes. However, evidence in the literature now shows that such correlations are inconsistent and often clinically irrelevant in RAPN. In contrast, the RPN score was developed using a statistically modeled approach, reflecting the real-world surgical difficulty of RAPN as perceived by experienced robotic surgeons.

CONCLUSION: Current evidence does not support the continued use of R.E.N.A.L. and PADUA scores as validated tools in RAPN. The RPN score, with its statistically validated, anatomy-based methodology and alignment with surgical difficulty, represents a scientifically superior and clinically practical alternative for standardizing tumor complexity in RAPN.

PMID:41693428 | DOI:10.1177/08927790261422977

Assessment. 2026 Feb 16:10731911251412219. doi: 10.1177/10731911251412219. Online ahead of print.

ABSTRACT

The Wechsler Adult Intelligence Scale-Fifth Edition (WAIS-5) latent factor structure was assessed using complementary hierarchical exploratory factor analyses (EFA) with the Schmid and Leiman procedure and confirmatory factor analyses (CFA) using the standardization sample (N = 2,020) correlation matrix and descriptive statistics of the 20 primary and secondary WAIS-5 subtests. The WAIS-5 Technical and Interpretive Manual did not include EFA, CFA with fewer than five first-order (group) factors, CFA with rival bifactor models, or model-based reliability and dimensionality estimates; thus, the present independent structural validity assessment corrects this evidential lacuna to help guide ethical and evidence-based interpretation. EFA results did not support five latent factors with separate Visual Spatial and Fluid Reasoning factors. Instead, a four-factor model with Visual Spatial and Fluid Reasoning factors merged into the former Perceptual Reasoning factor and measurement dominated by a general intelligence (g) factor-similar to the WAIS-IV structure-was supported. CFA results indicated that a bifactor model with four group factors provided the best fit, consistent with the EFA findings. Overall, the EFA and CFA results did not support the purported WAIS-5 structure and instead replicated findings from independent assessments of the WISC-V with standardization and clinical samples, that indicated primary, if not exclusive, interpretation of the FSIQ as an estimate of psychometric g.

PMID:41693426 | DOI:10.1177/10731911251412219

Subst Use Misuse. 2026 Feb 16:1-19. doi: 10.1080/10826084.2026.2628149. Online ahead of print.

ABSTRACT

Background: Sport and physical activity are increasingly used in adolescent substance use prevention, but interventions differ substantially in how sport is integrated. This systematic review examined preventive effects according to physical activity implementation paradigm. Methods: Five databases and prior reviews were searched. Interventions were classified into three paradigms: Preventive Sport (PS), where sport alone is expected to prevent use; Prevention Combined with Sport (PCS), where sport and prevention are delivered in parallel; and Prevention Through Sport (PTS), where preventive strategies are embedded within the sport context. A structured narrative synthesis was conducted of substance use, intentions, and risk and protective factors. Results: Nineteen interventions (25 studies) met inclusion criteria. PS interventions showed little evidence of preventive effects. PCS and PTS interventions reported preventive effects across several outcomes, particularly for alcohol and tobacco. PCS effects appeared more consistent in the short term, whereas PTS showed more sustained effects across substances and follow-up periods. Effect sizes were generally small and heterogeneity across formats, mechanisms, and outcomes was substantial. Conclusions: The paradigms differ in sport use, the preventive mechanisms they activate, and outcomes. Sport alone (PS) shows insufficient evidence for recommendation, whereas combined (PCS) and through-sport (PTS) approaches show more promising patterns. This research contributes to a better understanding of the role of sport in prevention, helping professionals and decision-makers to design more effective interventions and make better decisions.

PMID:41693421 | DOI:10.1080/10826084.2026.2628149