Category: Statistics

Am J Trop Med Hyg. 2025 Nov 25;114(2):247-252. doi: 10.4269/ajtmh.25-0021. Print 2026 Feb 4.

ABSTRACT

Latent tuberculosis infection (LTBI) and Schistosoma mansoni are common in Africa, and helminth-induced immunomodulation may affect LTBI detection. This study aimed to assess whether S. mansoni infection affects LTBI detection by the QuantiFERON-TB Gold Plus (QFT-Plus) assay and alters serum interferon-γ (IFN-γ) concentrations in response to Mycobacterium tuberculosis (Mtb) antigens at baseline and after 1 year, during which participants with S. mansoni infection received praziquantel treatment. At baseline, 65 individuals with schistosome infection had lower average IFN-γ concentrations in TB1-stimulated QFT-Plus supernatants compared with 83 uninfected individuals (10.4 versus 51.9 pg/mL, P = 0.038). Although not statistically significant, QFT-Plus test positivity rate was unexpectedly slightly higher among adults with schistosome infection at baseline (26.2% versus 18.1%, P = 0.24). The incidence over 12 months was higher posttreatment in participants initially infected with S. mansoni compared with those uninfected (13.9% [n = 5/36] versus 4.2% [n = 2/48], P = 0.13). By 12 months, IFN-γ concentrations were comparable between the two groups (53.8 versus 33.5 pg/mL, respectively, P = 0.56). Individuals who cleared S. mansoni infection experienced a nearly 12-fold increase in IFN-γ levels relative to those who remained uninfected, although this difference did not reach statistical significance (P = 0.17). In conclusion, baseline S. mansoni infection was associated with suppressed IFN-γ responses to Mtb antigens, suggesting helminth-induced immune dampening. Praziquantel treatment may partially restore TB-specific immune responses and facilitate LTBI detection. These findings highlight the potential role of S. mansoni as a critical cofactor affecting LTBI diagnosis in schistosomiasis-endemic regions.

PMID:41662761 | DOI:10.4269/ajtmh.25-0021

Am J Trop Med Hyg. 2025 Dec 9;114(2):375-383. doi: 10.4269/ajtmh.24-0454. Print 2026 Feb 4.

ABSTRACT

Twenty percent of French Guiana’s population lives in remote villages surrounded by tropical forests, accessible only by plane or boat. Some specialists, including pediatricians, regularly visit these villages for consultation purposes. The main objective for the present study was to provide an epidemiological description of childhood diseases that require follow-up or consultation with pediatricians in remote health centers. A descriptive, retrospective, multicenter study of pediatricians’ consultations in these health centers was conducted from January 1, 2011 to December 31, 2019. A total of 1,458 patients were included in the current study. In 2011, at the beginning of the pediatric missions, 91 patients had at least one consultation with a pediatrician, whereas in 2019, 319 patients were seen by a pediatrician in remote health centers. Sixty-two percent of pediatric consultations were single. Twenty-three deaths were recorded between 2011 and 2019, representing 1.4% of all children seen by the pediatricians. Forty-five percent of the children were under 2 years old at the time of their first consultation. The most common diseases were cardiac, infections, developmental delays, prematurity, and genetic diseases, including sickle cell disease. The current study revealed that the rate of children being followed up by pediatricians in the field is high. Children with chronic conditions can be followed up regularly, and additional investigations or support can be provided as needed. However, this comprehensive study highlights the difficulties pediatricians face in providing care, often due to external factors, such as a lack of healthcare infrastructure, cultural and linguistic differences, and educational and social difficulties, and emphasizes the need to reduce these barriers.

PMID:41662759 | DOI:10.4269/ajtmh.24-0454

Am J Trop Med Hyg. 2025 Dec 9;114(2):384-391. doi: 10.4269/ajtmh.24-0705. Print 2026 Feb 4.

ABSTRACT

French Guiana has developed a health organization to respond to its geographical situation. Remote health centers provide primary and emergency care in isolated areas. The limited technical facilities at the remote health centers result in a significant number of patient transfers to the Cayenne emergency department (ED). The objective of this study was to describe the epidemiology and management of patients transferred to Cayenne ED. A retrospective observational study was conducted from January 1 to December 31, 2019, and it included all patients transferred from remote health centers to Cayenne ED. All sociodemographic, prehospital, hospital, and referral data were collected; 842 patients were transferred by remote health centers to the Cayenne ED. The male/female ratio was 1.27, with an age of 36 (±23) years old. The two main modes of transportation used were helicopter (36%) and plane (22%). The most frequent reasons for transfer were trauma (28%), digestive (9%), respiratory (9%), and infectious (8%) conditions. Patients were hospitalized in 71% of cases. Among patients who were not hospitalized, 7% did not require further examination or specialist advice in the ED. Our work underlines the important use of airborne resources, particularly medical ones; they were initially intended for the management of vital emergencies, but they are also used for nonurgent situations. The geography and road access in French Guiana make alternative means of transport difficult. Our work identifies a number of areas for optimizing care to decrease the number of transfers: improving biomedical equipment, improving imaging equipment, and use of telemedicine.

PMID:41662756 | DOI:10.4269/ajtmh.24-0705

Am J Trop Med Hyg. 2025 Dec 4;114(2):338-347. doi: 10.4269/ajtmh.24-0837. Print 2026 Feb 4.

ABSTRACT

The alarming growth of dengue worldwide, as well as its social and economic impact, has necessitated effective responses for its control. Brazil, the second country to use Dengvaxia® (Sanofi Pasteur, Paris, France) after the Philippines, has offered the vaccine to ∼500,000 residents in 30 municipalities, with ∼300,000 being vaccinated. In this population-based cohort study, the vaccine’s effectiveness (VE) is reported after a 6-year follow-up for a vaccination campaign. The primary outcome was probable dengue case (PDC). Laboratory-confirmed dengue, serotype, warning signs, and hospitalization were considered secondary endpoints. Approximately 60% of participants received at least one vaccine dose. A total of 50,658 PDCs were identified, of which 15,131 were laboratory-confirmed dengue cases. Overall, the VE was 34% (95% CI: 33% to 35%) for PDCs and 20% (95% CI: 17% to 23%) for laboratory-confirmed cases. Greater VE was observed in older individuals. Vaccination was effective in reducing dengue virus (DENV)-1 and DENV-4 cases but not DENV-2 cases. No DENV-3 cases were registered. Among the 1,129 hospitalizations, 619 (54.8%) occurred within the vaccinated population, including 16 severe cases, whereas 510 (45.2%) hospitalizations occurred within the non-vaccinated population, with 18 severe cases. The VE for PDC hospitalizations was 16.5% (95% CI: 5.5% to 26.3%). Five and nine dengue-related deaths occurred within the vaccinated and non-vaccinated populations, respectively. The low incidence of severe cases and warning signs compromised accuracy. Vaccination with at least one dose was associated with approximately a one-third reduction in PDC incidence and a significant reduction in DENV-1 and DENV-4 cases. Despite the VE falling below 50%, vaccination may be justifiable in regions with high disease burden.

PMID:41662753 | DOI:10.4269/ajtmh.24-0837

Am J Trop Med Hyg. 2025 Dec 2;114(2):216-223. doi: 10.4269/ajtmh.25-0440. Print 2026 Feb 4.

ABSTRACT

Antimicrobial resistance poses a growing threat to pediatric care, yet data on its clinical and economic burden in low-resource settings remain limited. The impact of antibiotic-resistant infections on mortality, hospital stay, and treatment costs was assessed among children admitted to a national referral hospital in Kenya in the present study. A retrospective review of medical records for pediatric patients (0-12 years) hospitalized with bacterial infections between January 2017 and December 2021 was conducted. Diagnoses included gastroenteritis, pneumonia, sepsis, urinary tract infections, meningitis, and others. Data on treatment, laboratory testing, outcomes, hospital stays, and costs were abstracted. Statistical analyses included Kaplan-Meier survival curves, Cox regression, and mixed-effects negative binomial and generalized linear models. Among 1,608 patients, 63% were infants, and 38% were referrals. Gastroenteritis (46%) and pneumonia (28%) were the most common diagnoses. Antibiotic-resistant infections occurred in 27% of participants and were associated with higher mortality (26% versus 9% in susceptible participants) and an attributable risk of 17%; the population attributable fraction was 65%. After adjustment, resistance was associated with increased mortality (HR 1.44), longer hospital stays (60% increase), and higher treatment costs (33% increase). Antimicrobial resistance significantly increases mortality, hospital stays, and healthcare costs in pediatric patients. Strengthening diagnostics, antimicrobial stewardship, and policy interventions is critical to address this threat.

PMID:41662743 | DOI:10.4269/ajtmh.25-0440

JMIR Hum Factors. 2026 Feb 9;13:e54431. doi: 10.2196/54431.

ABSTRACT

BACKGROUND: Over 1 million Dutch people have diabetes, of whom 90% have type 2 diabetes. Studies show that lifestyle plays an important role in the course of type 2 diabetes. MiGuide (MiGuide Ltd) is an online platform that helps people adopt and sustain lifestyle changes. The platform is integrated into existing diabetes care within primary care. Previous research has shown that implementing new (eHealth) interventions is challenging and may reduce effectiveness. Mapping out the barriers and success factors in the implementation process is essential so that eHealth interventions such as MiGuide can be used effectively in regular health care.

OBJECTIVE: This study aimed to evaluate the implementation of MiGuide within Dutch primary care.

METHODS: A qualitative study design was used, supplemented by quantitative data from patients. Five general practices participated. Three focus groups (FGs; at baseline, after 6 months, and after 12 months) were conducted with 3 general practitioners, 3 FGs with 8 specialized practice nurses (divided into 2 separate groups with 4 participants per group), 2 FGs (at 6 months and after 12 months) with 5 patients, and 2 FGs (at baseline and after 12 months) with 4 stakeholders from the management of the care group. The implementation process was discussed with health care professionals and management, and usage and user-friendliness were discussed with patients. The framework method was used to analyze the data. The following quantitative data were collected: patient characteristics, user data, and questionnaires at baseline and 6 months, assessing quality of life, usability, and diabetes self-care. The quantitative data were examined using exploratory analyses.

RESULTS: Four themes were found in the qualitative data: “innovation,” “capability, motivation, and opportunity,” “processes,” and “setting.” Different factors within these themes played an essential role throughout the implementation process, such as facilities, technical difficulties, motivation, COVID-19, and the work processes. Areas for improvement were also identified. The supplemented quantitative data showed that usability scored below average at 6 months (mean 53.8; SD 9.3; n=8). Participants had a mean score of 0.84 (SD 0.13) on the EuroQoL-5 dimension and 81.9 (SD 13.4) on the EuroQoL visual analogue scale at baseline. Moreover, the average number of days someone exercised was 4.2 (SD 1.7), and the number of days someone ate a generally healthy diet was 5.1 (SD 1.3). Insufficient data on quality of life and diabetes self-care were collected at 6 months and therefore not presented in this study.

CONCLUSIONS: Implementation is a complex process with multiple barriers and facilitators. It is essential to explore the use of context-specific strategies that are aligned with the implementation process phase. Further research is needed to evaluate the next version of the MiGuide platform, which is being implemented in another setting with lifestyle coaches.

PMID:41662702 | DOI:10.2196/54431

JMIR Hum Factors. 2026 Feb 9;13:e78483. doi: 10.2196/78483.

ABSTRACT

BACKGROUND: Patient autonomy through informed consent is a foundational ethical principle for health care practitioners. Online consent processes risk producing “consent in name only,” using manipulative or confusing user interfaces to extract consent artificially. This presents a significant danger for safe and ethical remote consultations for primary care providers, which often extract significant amounts of sensitive personal data.

OBJECTIVE: This study aims to examine the quality of consent obtained through both currently used and novel consent acquisition interfaces for remote e-consultations between a patient and a primary care provider.

METHODS: A total of 55 adult participants in the United Kingdom completed an interaction with a mock-up e-consultation system’s consent interface for data processing, with 54 completing the full study protocol. The participants were then asked questions regarding what they had provided consent for and the usability of the interface. These responses led to the calculation of an industry-standard System Usability Scale (SUS) score and a novel Quality of Informed Consent Collected Digitally (QuICCDig) score.

RESULTS: Users perceiving interfaces to be more usable (with a greater SUS score) were statistically significantly (n=54; P=.004) correlated with an increase in the quality of consent collected from those users (with a higher QuICCDig score). Nonetheless, both existing and novel user interfaces for collecting e-consultation consent were rated poorly, achieving a maximum SUS letter grade of “F.” In total, 45% (25/55) of all the participants reported not recalling making a privacy-related decision at all during their consultation, and 87% (48/55) did not recall being offered any alternatives to e-consultation.

CONCLUSIONS: The findings demonstrate that current methods for collecting consent in telemedical applications may not be fit for purpose and potentially fail to collect valid informed consent. However, increased usability scores from users do appear to drive improvements in the quality of consent collected. Therefore, decision-makers should place importance on high-quality interface design when building or procuring these systems. We have also provided the QuICCDig score for further use.

PMID:41662699 | DOI:10.2196/78483

JMIR AI. 2026 Jan 30. doi: 10.2196/76928. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) models are increasingly being used in medical education. Although models like ChatGPT have previously demonstrated strong performance on USMLE-style questions, newer AI tools with enhanced capabilities are now available, necessitating comparative evaluations of their accuracy and reliability across different medical domains and question formats.

OBJECTIVE: To evaluate and compare the performance of five publicly available AI models: Grok, ChatGPT-4, Copilot, Gemini, and DeepSeek, on the USMLE Step 1 Free 120-question set, checking their accuracy and consistency across question types and medical subjects.

METHODS: This cross-sectional observational study was conducted between February 10 and March 5, 2025. Each of the 119 USMLE-style questions (excluding one audio-based item) was presented to each AI model using a standardized prompt cycle. Models answered each question three times to assess confidence and consistency. Questions were categorized as text-based or image-based, and as case-based or information-based. Statistical analysis was done using Chi-square and Fisher’s exact tests, with Bonferroni adjustment for pairwise comparisons.

RESULTS: Grok got the highest score (91.6%), followed by Copilot (84.9%), Gemini (84.0%), ChatGPT-4 (79.8%), and DeepSeek (72.3%). DeepSeek’s lower grade was due to an inability to process visual media, resulting in 0% accuracy on image-based items. When limited to text-only questions (n = 96), DeepSeek’s accuracy increased to 89.6%, matching Copilot. Grok showed the highest accuracy on image-based (91.3%) and case-based questions (89.7%), with statistically significant differences observed between Grok and DeepSeek on case-based items (p = .011). The models performed best in Biostatistics & Epidemiology (96.7%) and worst in Musculoskeletal, Skin, & Connective Tissue (62.9%). Grok maintained 100% consistency in responses, while Copilot demonstrated the most self-correction (94.1% consistency), improving its accuracy to 89.9% on the third attempt.

CONCLUSIONS: AI models showed varying strengths across domains, with Grok demonstrating the highest accuracy and consistency in this dataset, particularly for image-based and reasoning-heavy questions. Although ChatGPT-4 remains widely used, newer models like Grok and Copilot also performed competitively. Continuous evaluation is essential as AI tools rapidly evolve.

PMID:41662695 | DOI:10.2196/76928

Ann Plast Surg. 2026 Feb 9. doi: 10.1097/SAP.0000000000004663. Online ahead of print.

ABSTRACT

BACKGROUND: Free tissue transfer (FTT) can be used to achieve functional limb salvage in patients undergoing transmetatarsal amputation (TMA). However, the added bulk of the FTT can limit footwear options and hinder ambulation. Dysfunctional gait mechanics may lead to uneven pressure distribution and an increased risk of ulceration. In this proof-of-concept study, wearable sensor data were utilized to compare gait patterns between TMA patients closed with free tissue transfer (FTT) versus those closed with native plantar flaps to assess the biomechanical impact of FTT closure in patients undergoing TMA.

METHODS: Nineteen patients who underwent TMA (n = 14 [73.7% with native plantar flap] and n = 5 [26.3% with FTT]) completed a 120-second gait test with wearable sensors. Gait parameters included cadence (steps per minute), speed (meters per second), stride length (meters), stride duration (seconds), single- and double-limb support (%), elevation at midswing (centimeters), and root mean square (RMS) sway (centimeters), a marker of postural instability. Demographics, comorbidities, and operative details were collected. Groups were compared using univariate and multivariate analyses.

RESULTS: There were no significant differences observed between cohorts with respect to gait speed (0.85 vs 0.85 m/s, P = 0.997), cadence (97.8 vs 98.5 steps/min, P = 0.883), stride duration (P = 0.797), or elevation at midswing (1.64 vs 2.73 cm, P = 0.131). RMS sway was statistically significantly higher in the FTT group (0.35 vs 0.20 cm, P = 0.041), suggesting greater postural instability. On multivariate analysis, flap type was not independently associated with RMS sway (P = 0.839), although higher BMI trended toward significance (P = 0.116). The FTT group had significantly higher BMI (35.5 vs 28.1 kg/m2, P = 0.018) and greater prevalence of peripheral vascular disease (PVD) (80.0% vs 21.4%, P = 0.038).

CONCLUSION: Most spatiotemporal gait parameters were similar between TMA patients reconstructed with FTT and those with a native plantar flap. Although FTT patients had significantly higher RMS sway on univariate analysis, this was not independently associated with flap type after adjusting for confounders. This proof-of-concept analysis suggests that FTT, despite its bulk, may not significantly impair postamputation ambulation and remains a valuable limb salvage option when native plantar flap coverage may not be feasible.

PMID:41662694 | DOI:10.1097/SAP.0000000000004663

Ann Plast Surg. 2026 Feb 9. doi: 10.1097/SAP.0000000000004645. Online ahead of print.

ABSTRACT

BACKGROUND: Social media influences adolescent self-image and confidence, yet its impact on psychosocial outcomes in adolescents with cleft lip and/or palate remains poorly defined. This population may be particularly vulnerable given the importance of craniofacial features to self-perception during adolescence. Negative self-perceptions have been linked to psychosocial distress and interest in revisional surgery, whereas social media may also provide peer support and cleft-related information. This study examined social media use patterns and their association with psychosocial functioning in adolescents with cleft lip and/or palate.

METHODS: A cross-sectional online survey adapted from the CLEFT-Q and Pediatric Quality of Life Inventory (PedsQL) was distributed via REDCap to adolescents aged 10-18 years with cleft lip and/or palate. A parallel survey assessed parental perceptions of their child’s psychosocial functioning. Recruitment occurred at the Lancaster Cleft Palate Clinic between 2023 and 2025. The approximately 10-minute survey assessed demographics, social media use, and psychosocial outcomes across well-being, social functioning, school functioning, and self-perception domains using 5-point Likert scales.

RESULTS: Thirty-one adolescents completed the teen survey (mean [SD] age, 15.2 [2.1] years). Daily social media use was reported as <1 hour by 5/31 (16.1%), 1-3 hours by 14/31 (45.2%), 3-5 hours by 9/31 (29.0%), and ≥5 hours by 3/31 (9.7%). The most commonly used platforms were YouTube 24/31 (77.4%), TikTok 21/31 (67.7%), Snapchat 21/31 (67.7%), and Instagram 16/31 (51.6%). Palate surgery was reported by 29/31 (93.5%), and 17/31 (54.8%) had undergone combined lip, palate, and nasal surgery. Adolescents reporting ≥5 h/d of use demonstrated lower psychosocial functioning scores across domains, including teasing, appearance concerns, and happiness, although differences were not statistically significant. No significant differences were observed between adolescents reporting 1-3 versus 3-5 h/d of use. Surgical history and platform choice were not associated with psychosocial outcomes.

CONCLUSIONS: This pilot study provides preliminary descriptive insight into social media use and psychosocial functioning among adolescents with cleft lip and/or palate. Although no statistically significant associations were identified, consistent directional trends suggested lower psychosocial scores among adolescents reporting heavy social media use. These findings support cautious consideration of social media-based interventions and highlight the need for larger, adequately powered studies.

PMID:41662684 | DOI:10.1097/SAP.0000000000004645