Category: Statistics

Int Dent J. 2026 Jul 20;76(5):109760. doi: 10.1016/j.identj.2026.109760. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to estimate the relative contributions of genetic and environmental factors on acquired tooth loss among middle-aged and older twins in Qingdao, China.

METHODS: A total of 377 complete twin pairs (240 monozygotic, 137 dizygotic) were recruited from the Qingdao Twin Registry in China, and acquired tooth loss was recorded through structured interviews. Heritability of acquired tooth loss was estimated using correlation analysis and structural equation model, adjusting for age and sex.

RESULTS: The median age of the twins was 50 years (IQR: 46-57). The polychoric correlations for monozygotic twins (0.67; 95% CI: 0.55-0.78) were more than twice as high as that for dizygotic twins (0.25; 95% CI: 0.03-0.48). Therefore, we fitted an additive, dominant, and unique environmental factors model and its nested submodels. Based on the Akaike information criterion, the additive and unique environmental factors model was selected as the preferred model. After adjusting for age and sex, the model indicated that 56.51% (95% CI: 43.21%-69.81%) of the variance in acquired tooth loss was attributable to additive genetic factors, and 43.49% (95% CI: 30.20%-56.79%) to unique environmental influences.

CONCLUSION: This study demonstrated that variation in acquired tooth loss is influenced by both additive genetic and unique environmental factors. These findings may assist in developing strategies for tooth loss prevention and oral health maintenance.

PMID:42475771 | DOI:10.1016/j.identj.2026.109760

Placenta. 2026 Jul 14;182:348-353. doi: 10.1016/j.placenta.2026.07.005. Online ahead of print.

ABSTRACT

BACKGROUND: Maternal obesity is a well-established risk factor for preeclampsia; however, whether increased maternal BMI is associated with biologically distinct subtypes of this disorder remains unknown.

OBJECTIVE: To investigate whether maternal BMI is associated with differences in placental gene expression patterns observed in preeclampsia and to identify transcriptomic signatures with potential relevance for future biomarker research.

STUDY DESIGN: This exploratory analysis used placental transcriptomic data obtained from the Gene Expression Omnibus. Differential expression within prespecified contrasts encoding preeclampsia status and maternal BMI was analyzed using a multivariable linear modeling framework with adjustment for relevant confounders. In a secondary analysis, maternal BMI was modeled continuously with an interaction term between BMI and preeclampsia status.

RESULTS: Placental transcriptomic data from 132 placentas representing a range of maternal hypertensive and normotensive states were analyzed. Genes commonly associated with preeclampsia, including FLT1, LEP, HTRA4, and FSTL3, were differentially expressed across all BMI categories. SERPINA3 demonstrated the strongest differential expression in the obese contrast, with an estimated eight-fold increase (95% CI: 3.9-16.6) in preeclamptic pregnancies complicated by obesity, whereas expression differences were smaller and not statistically significant in healthy-weight and overweight contrasts. Gene set enrichment analysis suggested heterogeneity in the underlying biology of preeclampsia across BMI strata.

CONCLUSION: Placental transcriptional patterns associated with preeclampsia differed across maternal BMI strata. These findings are consistent with previously proposed molecular subtypes of preeclampsia and highlight SERPINA3 as a candidate transcriptomic marker warranting further investigation, specifically in pregnancies complicated by obesity.

PMID:42475769 | DOI:10.1016/j.placenta.2026.07.005

J Healthc Qual Res. 2026 Jul 20;41(4):101223. doi: 10.1016/j.jhqr.2026.101223. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Inappropriate use of antimicrobial agents accelerates the emergence and spread of resistance. Antimicrobial treatment guidelines (ATG) stand between evidence and clinical practice as they are designed to guide policy decision framework for all stakeholders promoting the prudent use of antimicrobials in bedside care. The trustworthiness of these decision-making instruments relies on their methodological quality and reporting. The aim of this systematic review is to critically appraise the methodological quality and reporting of antimicrobial treatment guidelines using the AGREE II, AGREE-REX tools and the RIGHT checklist respectively.

MATERIALS AND METHODS: A systematic review was conducted. ATGs from public institutions and hospitals with over 500 beds were identified through a systematic search using the Google search engine and by consulting members of the AFinf workgroup (https://gruposdetrabajo.sefh.es/afinf/en/). Screening and data extraction were performed in duplicate. Quality and reporting were assessed using the validated checklists AGREE II, AGREE REX and RIGHT. Central tendency, dispersion, and correlations were calculated and compared using Student’s t-test. Results are de-identified. Prospective protocol: https://osf.io/cey2v RESULTS: N=22. The mean scores for AGREE II, AGREE-REX, and RIGHT were generally low: 31.0% (95% CI: 23.7%-38.3%), 20.4% (95% CI: 15.6%-25.1%), and 28.7% (95% CI: 23.4%-34.0%) respectively. Low rates were observed for development rigour (10.2%); reference existing reviews (4.6%); quality assurance (4.6%); conflict of interests disclosure (4.6%); values and preferences (1.9%) while clarity (94.8%) and implementability (37.7%) rated the highest. Strong correlations among AGREE II and AGREE-REX (corr=0.9092) and RIGHT (corr=0.9203).

CONCLUSION: There is room for improvement in the quality and reporting of current ATGs in Spain, especially at hospital level, where they have greater potential to optimize antibiotic prescribing practices.

PMID:42475767 | DOI:10.1016/j.jhqr.2026.101223

Med Image Anal. 2026 Jun 16;113:104159. doi: 10.1016/j.media.2026.104159. Online ahead of print.

ABSTRACT

Despite high performance of deep learning in medical imaging applications, the critical lack of validated computational metrics for explainable AI (XAI) impedes clinical integration. To address this gap, our study introduces a multi-level validation framework to rigorously assess seven computational evaluation metrics applied to eight widely-used post-hoc attribution methods – spanning gradient-based, input attribution, and decomposition-based families – on large-scale structural MRI datasets (UK Biobank and ADNI) with two different benchmark tasks across several deep learning architectures. At the first level, we benchmark metrics against three scales of clinical relevance: voxel-based morphometry, regional volumetric associations, and expert radiologist assessments, revealing that many widely used conventional metrics exhibit negligible correlation with clinical evidence. At the second level, we show that metrics in addition are often significantly confounded by model architecture rather than reflecting explanation quality. At the third level, we conduct a computational efficiency and stability analysis focused on practical dimensions of the metrics. Across all levels, our statistical analyses show that only one of the metrics has consistent high performance: the Robustness score – defined as the stability of explanations across random training initializations – demonstrates strong alignment with morphometry, volumetric associations, and human expert judgments, effectively isolates the quality of the XAI method from architectural bias, and possesses good computational efficiency. Our novel, multi-level framework therefore establishes Robustness as a superior, scalable proxy for clinical validity and trustworthy AI in medical imaging.

PMID:42475759 | DOI:10.1016/j.media.2026.104159

J Bras Nefrol. 2026 Oct-Dec;48(4):e20260025. doi: 10.1590/2175-8239-JBN-2026-0025en.

ABSTRACT

INTRODUCTION: Pediatric rapidly progressive glomerulonephritis (RPGN) encompasses heterogeneous serology-based subtypes, including anti-glomerular basement membrane (anti-GBM), immune-complex-associated, and ANCA-associated (pauci-immune) RPGN. Although these subtypes differ in their underlying immune mechanisms, their ability to predict early renal recovery in children remains uncertain. This study aimed to evaluate the association between serology-based RPGN subtypes and early changes in renal function and tubular injury markers.

METHODS: This prospective cohort study included 30 children with newly diagnosed RPGN treated at Dr. Soetomo General Hospital. Patients were classified into anti-GBM, immune-complex-associated, or ANCA-associated RPGN based exclusively on serologic criteria. Estimated glomerular filtration rate (eGFR) and serum kidney injury molecule-1 (KIM-1) were measured at baseline and at 3 months after induction therapy. Primary outcomes were changes in eGFR (ΔeGFR) and serum KIM-1 (ΔKIM-1). Differences among subtypes were assessed using multivariate analysis of variance.

RESULTS: Of the 30 patients, 67% had immune-complex-associated RPGN, 20% had ANCA-associated RPGN, and 13% exhibited anti-GBM disease. The median age was 15 years. No statistically significant differences in ΔeGFR or ΔKIM-1 were observed among subtypes (MANOVA, p = 0.506), although numerical improvements varied across groups.

CONCLUSION: Serology-based RPGN subtype was not associated with early improvement in glomerular filtration or reduction in tubular injury markers in pediatric RPGN. Early renal recovery may be influenced more by baseline disease severity and therapeutic responsiveness than by serologic subtype classification alone.

PMID:42475735 | DOI:10.1590/2175-8239-JBN-2026-0025en

Genet Mol Biol. 2026 Jul 20;49Suppl 1(Suppl 1):e20250248. doi: 10.1590/1678-4685-GMB-2025-0248. eCollection 2026.

ABSTRACT

Ancient DNA research has expanded dramatically in recent years, transforming reconstructions of how and when humans settled the American continent. In this review, we synthesize evidence for genetic temporal continuity and discontinuity in Native American population history using mitochondrial DNA (mtDNA) from ancient and contemporary individuals. We systematically surveyed studies indexed in PubMed, ResearchGate, and Google Scholar, extending earlier compilations with publications through October 2025. For each population, we compiled sample sizes, mtDNA haplogroup frequencies, geographic coordinates, and associated archaeological and chronological information. These data were used to map the spatial distribution of founding mtDNA lineages, examine regional trajectories of haplogroup frequencies, and characterize patterns of mitochondrial population structure. Geographic distance showed a statistically detectable but limited association with mtDNA differentiation. Time-ordered haplogroup frequency series revealed region-specific dynamics, including long-term persistence of maternal lineages as well as marked episodes of turnover, some coincident with major cultural transitions. Genetic data were obtained from 315 studies. The dataset for contemporary populations included 23,315 individuals from 322 populations, while ancient DNA data included 4,192 individuals associated with 211 archaeological populations. Together, these data provide a comprehensive synthesis of mtDNA-based temporal and spatial patterns relevant to the peopling of the American continent.

PMID:42475729 | DOI:10.1590/1678-4685-GMB-2025-0248

Commun Dis Intell (2018). 2026 Jul 21;50. doi: 10.33321/cdi.2026.50.049.

ABSTRACT

BACKGROUND: In October 2024, Pilbara treatment guidance for uncomplicated urogenital gonorrhoea shifted from routine ZAP pack (amoxicillin 3 g and probenecid 1 g and azithromycin 1 g oral as a single treatment) to ceftriaxone-based LAC pack (ceftriaxone 500 mg in 2 mL 1% lignocaine intramuscularly and azithromycin 1 g oral, as a single treatment) in response to rising penicillinase-producing N. gonorrhoeae (PPNG) and the threat of imported ciprofloxacin resistance.

DESIGN: A retrospective clinical audit to describe demographics, compare treatment and resistance data collected for N. gonorrhoeae notifications for Pilbara health region residents meeting the surveillance case definitions in the Western Australian Notifiable Infectious Diseases Database (WANIDD) against clinical guidelines.

SETTING: All Pilbara health region resident N. gonorrhoeae notifications in the Western Australian Notifiable Infectious Diseases Database (WANIDD) from 1 July 2023 to 30 June 2024.

MAIN OUTCOME MEASURES: The proportion of notifications that reported treatment with a ZAP pack or LAC pack as per Western Australian and national clinical guidelines. Secondary outcomes included the proportion of notifications undertaken by the WA Country Health Service that reported test of cure at 1-2 weeks; the proportion that reported rescreening at 3 months post notification; and the proportion of notifications that reported PPNG and ciprofloxacin resistance.

RESULTS: A total of 188 N. gonorrhoeae notifications were received over the audit time frame. One hundred and twenty-seven notifications of a total of 156 N. gonorrhoeae notifications (81%) reported receiving treatment consistent with WA and National STI treatment guidelines, i.e. ZAP or LAC pack. Fifteen notifications of a total of 188 notifications (8%) reported detection of PPNG and 20 notifications of a total of 188 notifications (11%) reported ciprofloxacin resistance. For WA Country Health service notifications, 9 of 27 (33%) reported re-testing at 1-2 weeks or 3 months.

CONCLUSIONS: The majority of notifications (81%) reported N. gonorrhoeae treatment consistent with guidelines. A significant proportion of notifications (8%) indicated likely penicillin resistance due to the detection of PPNG. Reinforcing treatment consistent with the updated treatment guidelines of October 2024 for the Pilbara region will reduce the risk of ineffective treatment. Improving the rate of test of cure and test for reinfection (33%) would improve the likelihood of detecting treatment failure and detecting resistance.

PMID:42475726 | DOI:10.33321/cdi.2026.50.049

Commun Dis Intell (2018). 2026 Jul 21;50. doi: 10.33321/cdi.2026.50.045.

ABSTRACT

In 2020, the National Notifiable Diseases Surveillance System received 1,618 tuberculosis (TB) notifications, representing a notification rate of 6.3 per 100,0000 population. In 2019, there were 1,505 TB notifications, with a rate of 5.9 per 100,000 population. Australia has achieved and maintained good TB control since the mid-1980s, sustaining a low annual TB incidence rate of approximately five to six cases per 100,000 population. The number of multi-drug-resistant TB (MDR-TB) cases notified in Australia is lower than global rates, with approximately 2% of TB notifications per year classified as MDR-TB. In Australia, overseas-born people represent the majority of TB cases, accounting for 92% and 90% of TB notifications in 2020 and 2019, respectively. In 2020 and 2019, Aboriginal and Torres Strait Islander people recorded TB rates approximately four times higher than the Australian-born non-Indigenous population. Whilst Australia has achieved and maintained excellent control of TB, sustained effort is required to reduce local rates further, especially among Aboriginal and Torres Strait Islander populations, and to contribute to the World Health Organization’s goal to end the global TB epidemic by 2035.

PMID:42475724 | DOI:10.33321/cdi.2026.50.045

J Ultrasound Med. 2026 Jul 20. doi: 10.1002/jum.70372. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine the incidence of complete and partial levator ani muscle (LAM) lesions using 3-dimensional endovaginal ultrasound (3D-EVUS) at 3-months postpartum in low-risk primiparous women and evaluate associations with perineal outcomes and early urogynecological parameters.

METHODS: Prospective interventional study of primiparous women with spontaneous vaginal delivery (March 2021-May 2023) at a tertiary urogynecology center in Rome, Italy (LATA protocol, IRB: 4202).

INCLUSION CRITERIA: >37 weeks, age 18-45 years, body mass index (BMI) ≥20, physiologic pregnancy.

EXCLUSION CRITERIA: age >45, BMI <20, fetal macrosomia >4500 g, forceps delivery. Perineal outcomes were recorded at delivery. Participants underwent 3D-EVUS and urogynecological assessment evaluating pelvic floor muscle function, command inversion, recruitment of auxiliary muscles, and hypertonicity at 3-months postpartum. LAM lesions were classified as partial (asymmetry, irregularity, ballooning) or complete/avulsion (detachment from pubic bone). Statistical analysis included logistic regression.

RESULTS: Of 350 eligible patients, 202 completed follow-up. At 3D-EVUS, 52% had no LAM lesions, 45% had partial lesions, 3% had avulsions. Intact perineum was observed in 16.2% without LAM lesions, 4.4% with partial lesions, 0% with avulsion (p = .018). Lacerations were more frequent with partial LAM lesions (73.6%) versus no lesion (59.0%) and avulsion (33.3%) (p = .027). Command inversion was associated with LAM lesions (p = .004). Urogenital hiatal area under Valsalva independently predicted LAM lesions (p < .001), with area >20.8 cm² demonstrating 82% specificity and 45% sensitivity.

CONCLUSIONS: 3D-EVUS enables the detection of subtle lesions frequently missed by conventional approaches. Partial LAM lesions are common in primiparous women after low-risk delivery, while avulsions remain rare. Command inversion and enlarged urogenital area provide valuable markers for early detection and intervention.

PMID:42475720 | DOI:10.1002/jum.70372

Omega (Westport). 2026 Jul 20:302228261470280. doi: 10.1177/00302228261470280. Online ahead of print.

ABSTRACT

Patient death may constitute an emotionally significant but often unrecognized source of occupational grief among healthcare professionals. This study examined disenfranchised grief after patient death and tested whether maladaptive coping strategies mediated its association with psychological well-being. In this cross-sectional pilot survey, 56 healthcare professionals with direct patient contact and professional experience with patient death completed an anonymous online questionnaire assessing disenfranchised grief after patient death, maladaptive coping strategies, and psychological well-being. Disenfranchised grief was negatively associated with psychological well-being and positively associated with maladaptive coping, while maladaptive coping was negatively associated with well-being. Mediation analysis indicated a statistically significant indirect association between disenfranchised grief and well-being through maladaptive coping. These findings suggest that the psychological consequences of patient death may be related not only to exposure to death itself, but also to whether grief is recognized and how professionals cope with it. The results point to the need for organizational support that acknowledges occupational grief and promotes adaptive coping after patient death.

PMID:42475713 | DOI:10.1177/00302228261470280