Category: Statistics

Epidemics. 2026 Jan 21;54:100890. doi: 10.1016/j.epidem.2026.100890. Online ahead of print.

ABSTRACT

Early outbreak data analysis is critical for informing about their potential impact and interventions. However, data obtained early in outbreaks are often sensitive and subject to strict privacy restrictions. Thus, federated analysis, which implies decentralised collaborative analysis where no raw data sharing is required, emerged as an attractive paradigm to solve issues around data privacy and confidentiality. In the present study, we propose two approaches which require neither data sharing nor direct communication between devices/servers. The first approach approximates the joint posterior distributions via a multivariate normal distribution and uses this information to update prior distributions sequentially. The second approach uses summaries from parameters’ posteriors obtained locally at different locations (sites) to perform a meta-analysis via a hierarchical model. We test these models on simulated and on real outbreak data to estimate the incubation period of multiple infectious diseases. Results indicate that both approaches can recover incubation period parameters accurately, but they differ in terms of structure and complexity; which makes them suitable for different types of analyses or to be used in combination. We provide a framework for federated analysis of early outbreak data where the public health contexts are complex.

PMID:41689886 | DOI:10.1016/j.epidem.2026.100890

Int J Med Inform. 2026 Feb 3;211:106337. doi: 10.1016/j.ijmedinf.2026.106337. Online ahead of print.

ABSTRACT

BACKGROUND: Heterogeneity in the long-term progression of Alzheimer’s disease (AD) challenges the efficiency of clinical trials. Identifying long-term prognostic factors is critical for enhancing trial efficiency, although it has been limited by the lack of appropriate statistical approaches. We applied a recently developed statistical model-based AI method to identify the baseline prognostic factors for long-term cognitive decline in a clinical trial population.

METHODS: We analyzed pooled placebo arm data (N = 1,597) from four Phase III trials in patients with mild-to-moderate AD. Long-term trajectories for the Mini-Mental State Examination (MMSE), 11- and 14-item versions of the Alzheimer’s Disease Assessment Scale-Cognitive subscale (ADAS-Cog11, ADAS-Cog14), and Clinical Dementia Rating-Sum of Boxes (CDR-SB) were predicted from their short-term data (≤80 weeks). Trajectories were compared between subgroups defined by six baseline factors (age, sex, apolipoprotein E ε4 [APOE ε4] status, years of education, years from diagnosis, and years from disease onset) using the area under the curve (AUC).

RESULTS: Longer years of education (≥13 years) was the most robust predictor associated with faster progression across all four outcomes (e.g., for 20-year ADAS-Cog11, AUC ratio, 1.11, p < 0.001). Younger age (<74 years) was associated with a faster decline in MMSE and ADAS-Cog scores, but not in CDR-SB. APOE ε4 status, sex, years from diagnosis, and years from disease onset were not significantly associated with long-term progression.

CONCLUSIONS: Baseline educational level and age were significant prognostic factors of long-term cognitive decline. These findings will help optimize patient stratification in future clinical trials on AD.

PMID:41689882 | DOI:10.1016/j.ijmedinf.2026.106337

Urol Oncol. 2026 Feb 13;44(4):111006. doi: 10.1016/j.urolonc.2026.111006. Online ahead of print.

ABSTRACT

BACKGROUND: Adjuvant Intravesical BCG and chemotherapy are utilized viables options for intermediate-risk (IR) NMIBC. We are lacking well-designed evidence for superiority of any in terms of effectiveness, toxicity, and patient tolerability.

OBJECTIVES: We compared the oncological outcomes, treatment-related adverse events (AEs) and Health-related quality of life (HRQoL) in IR NMIBC patients who received intravesical BCG vs. intravesical Epirubicin.

MATERIALS AND METHODS: After institutional review board (IRB) approval, 134 patients were randomly allocated into two groups; adjuvant intravesical BCG and intravesical Epirubicin. Patients were followed every 3 to 6 months by cystourethroscopy and urine cytology. The primary end points were recurrence, progression, and disease-free survivals. The secondary end points comprised treatment-related AEs and quality of life using HRQoL-EORTC QLQ-30 questionnaire.

RESULTS: Of the 134 patients, 122 were followed for a mean of 19 months and included in the final analysis. There were no statistically significant differences between the two groups in terms of baseline demographic/tumor criteria. The tumor recurrence and progression rates were comparable between BCG vs. Epirubicin groups, (19.4% vs. 28.5%), (6.5% vs. 5%), respectively. Mean time to recurrence and RFS were significantly prolonged in BCG group (18 vs. 16.7 months, Log rank P = 0.02) While time to progression and PFS were statically comparable between the two groups (18.5 vs. 18.3 months, Log rank P = 0.76). Local treatment-related AEs as dysuria/urgency/frequency were significantly more reported in BCG group (19.5% vs. 10%, P = 0.03). BCG group experienced significantly worse HRQoL in terms of urinary symptoms and treatment-related future worries domains (P = 0.008, 0.001, respectively).

CONCLUSIONS: In patients with IR NMIBC, adjuvant intravesical therapy with BCG and Epirubicin are equivalent in terms of recurrence and progression rates. Nevertheless, RFS was significantly prolonged in patient receiving intravesical BCG. On the contrary, patients treated with BCG experienced significantly more local bladder symptoms and worse HRQoL in terms of bothering urinary symptoms and negative treatment-related future worries.

PMID:41689868 | DOI:10.1016/j.urolonc.2026.111006

Musculoskeletal Care. 2026 Mar;24(1):e70187. doi: 10.1002/msc.70187.

ABSTRACT

BACKGROUND: Lumbopelvic Flexion-Rotation Movement Impairment Syndrome is a common pattern observed in individuals with mechanical low back pain (MLBP) characterised by altered postural control and neuromuscular dysfunction. Isolated balance training may offer focused benefits in such cases.

OBJECTIVE: To compare the effectiveness of an isolated balance exercise regimen with conventional physiotherapy in managing Lumbopelvic flexion-rotation movement impairment syndrome in male patients with MLBP.

MATERIALS AND METHODS: A single-centre experimental study was conducted on 30 male patients (aged 18-26 years) diagnosed with Lumbopelvic flexion-rotation movement impairment syndrome. Participants were randomly assigned to Group A (Isolated Balance Exercise) or Group B (Conventional Physiotherapy). Outcomes were assessed pre- and post-intervention using standardised pain and disability scales.

RESULTS: Both groups showed statistically significant improvements. Group A showed reductions in pain (Mean = 1.86, SD = ± 0.639) and disability (Mean = 1.60, SD = ± 0.736). Group B also improved in pain (Mean = 1.66, SD = ± 0.899) and disability (Mean = 1.60, SD = ± 0.7368). The isolated balance regimen was comparably effective with conventional therapy.

CONCLUSION: Isolated balance training is an effective and viable standalone intervention for managing MLBP due to Lumbopelvic flexion-rotation movement impairment syndrome.

PMID:41689861 | DOI:10.1002/msc.70187

Cartilage. 2026 Feb 14:19476035261423333. doi: 10.1177/19476035261423333. Online ahead of print.

ABSTRACT

PurposeTo compare the clinical and biological outcomes of minced autologous cartilage transplantation versus hyaluronic acid-based scaffold with bone marrow aspirate concentrate (HA-BMAC) in the treatment of full-thickness cartilage lesions of the knee.MethodsA total of 41 patients treated with minced autologous cartilage transplantation were retrospectively analyzed. Using propensity score matching, a control group of 41 patients was selected from a large cohort treated with HA-BMAC-based cartilage repair. Minced cartilage was harvested from unloaded cartilage and fibrin-glued into the defect. Bone marrow aspirate concentrate (BMAC) was obtained from the iliac crest, centrifuge concentrated, and seeded onto a hyaluronic acid scaffold. Clinical outcomes were assessed using the Knee Injury Outcome Score (KOOS) score. Magnetic resonance imaging (MRI) evaluations were performed preoperatively with AMADEUS score and at 1-year follow-up using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART)-2 score.ResultsThe groups were comparable in terms of age, sex, lesion size, and location. Significant improvements were observed in all KOOS subscales in both cartilage repair groups, with no statistical difference between them at 1-year follow-up. MOCART-2 scores showed a trend toward superior biological healing in the minced cartilage group (mean score: 77) compared to the BMAC group (mean score: 73). Excellent healing (MOCART >80) was observed in 51% of minced cartilage cases versus 38% of BMAC cases.ConclusionBoth minced cartilage transplantation and HA-BMAC treatments resulted in comparable subjective clinical outcomes. However, minced cartilage transplantation demonstrated a tendency for enhanced biological healing based on MRI compared to HA-BMAC. This suggests potential advantages of minced cartilage transplantation over HA-BMAC cartilage repair.

PMID:41689853 | DOI:10.1177/19476035261423333

Hum Reprod. 2026 Feb 14:deag008. doi: 10.1093/humrep/deag008. Online ahead of print.

ABSTRACT

STUDY QUESTION: What are the prevalence, type, and stratified risks (reproductive failure subtype, sex, age, semen quality, and prior adverse pregnancy events) of chromosomal aberrations in couples seeking ART treatment in a large-scale cohort study?

SUMMARY ANSWER: The prevalence of chromosomal aberrations in couples with reproductive failure was 3.42%, with a higher prevalence in younger individuals, men with poorer semen quality, and those experiencing multiple adverse pregnancy outcomes.

WHAT IS KNOWN ALREADY: Reproductive failure is a global health issue, with chromosomal aberrations playing an important role. ART is widely used for the treatment of reproductive failure; however, large-scale, comprehensive studies characterizing the stratified risks of chromosomal aberrations in couples seeking ART remain scarce.

STUDY DESIGN, SIZE, DURATION: This retrospective study analysed chromosomal data from 227 818 couples seeking ART at our hospital between January 1993 and March 2024.

PARTICIPANTS/MATERIALS, SETTING, METHODS: This study included 227 818 couples with reproductive failure, including 130 213 couples with primary infertility, 58 161 with secondary infertility, and 39 444 with adverse pregnancy outcomes. All participants underwent routine cytogenetic analysis using GTG-banding prior to ART. Statistical analysis was performed using R software (v4.4.0), with significance set at P < 0.05.

MAIN RESULTS AND THE ROLE OF CHANCE: Chromosomal aberrations were detected in 7785 couples (3.42%), with the highest prevalence in those with adverse pregnancy outcomes (4.83%), followed by those with primary infertility (3.54%) or secondary infertility (2.18%) (all P < 0.001). Significant sex differences were observed in infertile couples (men: 1.91% vs women: 1.52%) and couples with adverse pregnancy outcomes (men: 2.04% vs women: 2.81%), (P < 0.001). The prevalence of chromosomal aberrations was inversely correlated with age (2.36% in <25 years to 1.29% in ≥35 years) and increased significantly with poorer semen quality (0.89% in normozoospermia to 12.54% in azoospermia) and more adverse pregnancy events (3.07% in 1 event to 9.38% in ≥3 events, P < 0.001). Common structural aberrations included reciprocal and Robertsonian translocations and inversions, with frequent breakpoints at 11q23, 22q11, and 7q22. The percentage of haploid length of each autosome and the corresponding percentage of breakpoints showed a strong Pearson’s correlation (R = 0.933, P < 0.001, two-tailed test). Robertsonian translocations and t(11;22)(q23;q11) were recurrent. The most frequent aneuploidies identified were 47,XXY (Klinefelter) and 45, X (Turner) syndromes, in both mosaic and non-mosaic forms.

LIMITATIONS, REASONS FOR CAUTION: The lack of detailed clinical characteristics limited patient stratification and hindered the in-depth analysis of karyotype-phenotype relationships. The absence of a large fertile control group restricted comparative analysis. Conventional GTG-banding resolution may miss some cryptic chromosomal abnormalities. Single-centre data may limit the generalizability of our findings to more diverse populations.

WIDER IMPLICATIONS OF THE FINDINGS: Stratified risk data (such as the higher prevalence of chromosomal aberrations in younger populations, individuals with poor semen quality, or those with a history of multiple adverse pregnancies) provide crucial evidence for clinicians to assess reproductive risks associated with chromosomal aberrations and make karyotyping decisions prior to ART treatment.

STUDY FUNDING/COMPETING INTEREST(S): This work was supported by the National Key Research and Development Program of China (2023YFC2705605). The authors declare that there are no competing interests.

TRIAL REGISTRATION NUMBER: N/A.

PMID:41689847 | DOI:10.1093/humrep/deag008

J Prim Care Community Health. 2026 Jan-Dec;17:21501319261420566. doi: 10.1177/21501319261420566. Epub 2026 Feb 14.

ABSTRACT

PURPOSE: To examine whether primary care visit frequency (PVF) is associated with non-urgent emergency department visits (NU-EDVs) at a large urban medical center, and to identify determinants of higher PVF among Emergency Department patients.

METHODS: We conducted a cross-sectional survey of adult ED patients (ESI ≥4 considered NU-EDV) at a Southern California Level I trauma center (September 2021-April 2024). Undergraduate research associates administered a 29-item instrument capturing demographics, utilization, barriers, trust in primary care, and comorbidities. Bivariate tests and multivariable logistic regression estimated adjusted odds ratios (aOR) for NU-EDV and for PVF ≥3 visits/year.

RESULTS: Among 964 patients with a primary care provider, 62.9% reported <3 PCP visits/year; 59.2% presented with NU-EDV. After adjustment, PVF ≥3/year was associated with lower odds of NU-EDV (aOR 0.64, 95% CI 0.48-0.87). Medicaid/Cal insurance was associated with higher odds of NU-EDV versus private insurance (aOR 1.53, 95% CI 1.12-2.08). Determinants of PVF ≥3/year included female sex (aOR 1.39, 95% CI 1.04-1.86), older age (aOR 1.01 per year, 95% CI 1.00-1.02), Black race (aOR 2.21, 95% CI 1.17-4.19), Medicaid/Cal coverage (aOR 1.70, 95% CI 1.22-2.37), more chronic conditions (aOR 1.53 per condition, 95% CI 1.35-1.71), and lower odds with PCP distrust (aOR 0.54, 95% CI 0.30-0.96).

CONCLUSIONS: Greater primary care engagement is independently associated with fewer NU-EDVs; however, Medicaid beneficiaries remain at elevated risk for non-urgent ED use. Improving after-hours access, care coordination, and Medicaid-eligible unscheduled primary care may further reduce avoidable ED utilization.

PMID:41689840 | DOI:10.1177/21501319261420566

J Prim Care Community Health. 2026 Jan-Dec;17:21501319251411430. doi: 10.1177/21501319251411430. Epub 2026 Feb 14.

ABSTRACT

BACKGROUND: Global Initiative for Asthma (GINA) has recommended inhaled corticosteroid (ICS)-Formoterol as Track-1 treatment for patients. Using ICS and SABA (Short-Acting Beta-Agonist) as a reliever is an alternative Track-2 option. Both modalities are tied to type of inhaler use, dry powder inhalers (DPI) and propellent-containing metered-dose inhalers (pMDI). Compared to propellent-free DPI, pMDI have much higher carbon footprint (CF) detrimental to the environment. Leveraging on dispensed inhaler data from the electronic medical records of patients managed in primary care, the study aimed to quantify their CF using Budesonide-Formoterol (BUD-FOR) DPI alone, compared to those who were treated with BUD-FOR DPI + pMDI as a reliever.

METHODS: Electronic medical records from 8 public primary care clinics were analysed, covering adult asthma patients (aged ≥21) between 2018 and 2023. Data on inhaler dispensing, asthma control test (ACT) scores and rescue therapy (RT) needs were assessed. CF was computed based on inhaler canisters dispensed. Associations between treatment modality, asthma control, RT and CF were analysed using Generalized Estimating Equations.

RESULTS: A total of 5634 patients using BUD-FOR DPI were included. Over the study period, Track-1 usage increased substantially from 466 to 2317 patients, while Track-2 rose modestly from 628 to 758. In 2023, 78.5% of patients achieved good asthma control compared to 68.7% in Track-2. The total CF per patient was substantially lower in Track-1 compared to Track-2 (3.3 vs 62.4 kgCO₂e). Patients in Track-1 had a significantly lower CF by 60 kgCO₂e (P < .001), had 1.5 times higher odds to achieve good asthma control based on ACT scores (P < .001) and had approximately 30% lower odds of receiving RT (P < .001). The average number of SABA-pMDI canisters dispensed per patient declined from 2.8 to 2.1 over the study period. BUD/FOR inhalers use per patient per year was consistently higher in Track 2 compared to Track 1, with an average difference of 1.2 canisters (5.3 vs 4.1).

CONCLUSION: Patients managed under Track-1 treatment approach demonstrated significantly better asthma outcomes and lower CF. These findings highlight potential of Track-1 treatment as the preferred strategy, enabling better clinical outcomes and reduced environmental impact.

PMID:41689839 | DOI:10.1177/21501319251411430

Psychol Health Med. 2026 Feb 14:1-20. doi: 10.1080/13548506.2026.2628984. Online ahead of print.

ABSTRACT

With the development of society and the transformation of education, the mental health of Chinese teachers, especially kindergarten teachers, is deteriorating. Although numerous theoretical frameworks and empirical studies have been devoted to exploring factors (e.g. social support, self-efficacy, job burnout, et al.) in relation to individual mental health, limited studies have jointly examined the mechanisms linking these factors to mental health outcomes. This study aimed to apply the social cognitive model of job and life satisfaction to understand Chinese kindergarten teachers’ mental health problems. A total of 1114 Chinese kindergarten teachers, whose mean age was 32.75 ± 8.36 and of whom 1073 (96.3%) were female, completed several measures concerning social support, emotional intelligence, emotional self-efficacy, job burnout, and mental health. The Harman single-factor test, descriptive statistics, correlation analysis, and structural equation modeling were used to identify key predictors and mediating pathways among these variables. The integrated social cognitive model of mental health demonstrated a strong fitness to the data across both the general sample and sub-samples categorized by teaching years and parenting experiences. Simultaneously, social support might serve as an indirect predictor of mental health problem, which was mediated primarily via job burnout, the chain links of emotional intelligence and job burnout, the chain links of emotional self-efficacy and job burnout, and the chain links of emotional intelligence, emotional self-efficacy, and job burnout. The mental health of kindergarten teachers fluctuates by a combination of social support, emotional intelligence, emotional self-efficacy, and job burnout. Therefore, constructing an emotional support system, improving teachers’ emotional literacy, and integrating teachers’ diverse learning experiences might more effectively promote their mental health.

PMID:41689831 | DOI:10.1080/13548506.2026.2628984

Infancy. 2026 Jan;31(1):e70073. doi: 10.1111/infa.70073.

ABSTRACT

As young children’s digital media use increases, more research on parents’ decisions, such as preferred digital content and mediation strategies, is necessary, particularly with underrepresented populations. The present study analyzed survey data on Arab parents’ decisions regarding digital media use of their children under 3 years in the United Arab Emirates. Most children did not use digital media, and those who did predominantly engaged in “watching” activities. Media content focused on early learning activities and Arabic-language videos. Most parents engaged in digital media together with their child, and joint engagement was linked to less digital media use. The results suggest Arab parents’ media decisions included consideration of content and an emphasis on co-using media with their children. Implications are suggested for policymakers, media developers, and parental guidelines.

PMID:41689822 | DOI:10.1111/infa.70073